HB 1629

1	A bill to be entitled
2	An act relating to affordable health care; providing a
3	popular name; providing purpose; amending s. 381.026,
4	F.S.; requiring certain licensed facilities to provide
5	public Internet access to certain financial information;
6	providing a definition; amending s. 381.734, F.S.;
7	including participation by health care providers, small
8	businesses, and health insurers in the Healthy
9	Communities, Healthy People Program; requiring the
10	Department of Health to provide public Internet access to
11	certain public health programs; requiring the department
12	to monitor and assess the effectiveness of such programs;
13	requiring a report; requiring the Office of Program Policy
14	and Government Accountability to evaluate the
15	effectiveness of such programs; requiring a report;
16	amending s. 395.1041, F.S.; authorizing hospitals to
17	develop certain emergency room diversion programs;
18	amending s. 395.1055, F.S.; requiring licensed facilities
19	to make certain patient charge and performance outcome
20	data available on Internet websites; amending s. 395.1065,
21	F.S.; authorizing the Agency for Health Care
22	Administration to charge a fine for failure to provide
23	such information; amending s. 395.301, F.S.; requiring
24	certain licensed facilities to provide prospective
25	patients certain estimates of charges for services;
26	requiring such facilities to provide patients with certain
27	bill verification information; providing for a fine for
28	failure to provide such information; providing charge
29	limitations; requiring such facilities to establish a
30	patient question review and response methodology;
31	providing requirements; requiring certain licensed
32	facilities to provide public Internet access to certain
33	financial information; requiring posting of a notice of
34	the availability of such information; amending s. 408.061,
35	F.S.; requiring the Agency for Health Care Administration
36	to require health care facilities, health care providers,
37	and health insurers to submit certain information;
38	providing requirements; requiring the agency to adopt
39	certain risk and severity adjustment methodologies;
40	requiring the agency to adopt certain rules; requiring
41	certain information to be certified; amending s. 408.062,
42	F.S.; requiring the agency to conduct certain health care
43	costs and access research, analyses, and studies;
44	expanding the scope of such studies to include collection
45	of pharmacy retail price data, use of emergency
46	departments, physician information, and Internet patient
47	charge information availability; requiring a report;
48	requiring the agency to conduct additional data-based
49	studies and make recommendations to the Legislature;
50	requiring the agency to develop and implement a strategy
51	to adopt and use electronic health records; authorizing
52	the agency to develop rules to protect electronic records
53	confidentiality; requiring a report to the Governor and
54	Legislature; amending s. 408.05, F.S.; requiring the
55	agency to develop a plan to make performance outcome and
56	financial data available to consumers for health care
57	services comparison purposes; requiring submittal of the
58	plan to the Governor and Legislature; requiring the agency
59	to update the plan; requiring the agency to make the plan
60	available electronically; providing plan requirements;
61	amending s. 409.9066, F.S.; requiring the agency to
62	provide certain information relating to the Medicare
63	prescription discount program; amending s. 408.7056, F.S.;
64	renaming the Statewide Provider and Subscriber Assistance
65	Program as the Subscriber Assistance Program; revising
66	provisions to conform; expanding certain records
67	availability provisions; revising membership provisions
68	relating to a subscriber grievance hearing panel; revising
69	a list of grievances the panel may consider; providing
70	hearing procedures; amending s. 641.3154, F.S., to conform
71	to the renaming of the Subscriber Assistance Program;
72	amending s. 641.511, F.S., to conform to the renaming of
73	the Subscriber Assistance Program; adopting and
74	incorporating by reference the Employee Retirement Income
75	Security Act of 1974, as implemented by federal
76	regulations; amending s. 641.58, F.S., to conform to the
77	renaming of the Subscriber Assistance Program; amending s.
78	408.909, F.S.; expanding a definition of "health flex plan
79	entity" to include public-private partnerships; making a
80	pilot health flex plan program apply permanently
81	statewide; providing additional program requirements;
82	creating s. 381.0271, F.S.; providing definitions;
83	creating the Florida Patient Safety Corporation;
84	authorizing the corporation to create additional not-for-
85	profit corporate subsidiaries for certain purposes;
86	specifying application of public records and public
87	meetings requirements; exempting the corporation and
88	subsidiaries from public procurement provisions; providing
89	purposes; providing for a board of directors; providing
90	for membership; authorizing the corporation to establish
91	certain advisory committees; providing for organization of
92	the corporation; providing for meetings; providing powers
93	and duties of the corporation; requiring the corporation
94	to collect, analyze, and evaluate patient safety data and
95	related information; requiring the corporation to
96	establish a reporting system to identify and report near
97	misses relating to patient safety; requiring the
98	corporation to work with state agencies to develop
99	electronic health records; providing for an active library
100	of evidence-based medicine and patient safety practices;
101	requiring the corporation to develop and recommend core
102	competencies in patient safety and public education
103	programs; requiring an annual report; providing report
104	requirements; authorizing the corporation to seek funding
105	and apply for grants; requiring the Office of Program
106	Policy Analysis and Government Accountability, the
107	Department of Health, and the Agency for Health Care
108	Administration to develop performance standards to
109	evaluate the corporation; amending s. 409.91255, F.S.;
110	expanding assistance to certain health centers to include
111	community emergency room diversion programs and urgent
112	care services; amending s. 627.410, F.S.; requiring
113	insurers to file certain rates with the Office of
114	Insurance Regulation; creating s. 627.64872, F.S.;
115	providing legislative intent; creating the Florida Health
116	Insurance Plan for certain purposes; providing
117	definitions; providing exclusions; providing requirements
118	for operation of the plan; providing for a board of
119	directors; providing for appointment of members; providing
120	for terms; specifying service without compensation;
121	providing for travel and per diem expenses; requiring a
122	plan of operation; providing requirements; providing for
123	powers of the plan; requiring reports to the Governor and
124	Legislature; providing for an actuarial study; providing
125	certain immunity from liability for plan obligations;
126	authorizing the board to provide for indemnification of
127	certain costs; requiring an annually audited financial
128	statement; providing for eligibility for coverage under
129	the plan; providing criteria, requirements, and
130	limitations; specifying certain activity as an unfair
131	trade practice; providing for a plan administrator;
132	providing criteria; providing requirements; providing term
133	limits for the plan administrator; providing duties;
134	providing for paying the administrator; providing for
135	premium rates for plan coverage; providing rate
136	limitations; providing for sources of additional revenue;
137	specifying benefits under the plan; providing criteria,
138	requirements, and limitations; providing for
139	nonduplication of benefits; providing for annual and
140	maximum lifetime benefits; providing for tax exempt
141	status; providing for abolition of the Florida
142	Comprehensive Health Association upon implementation of
143	the plan; providing for continued operation of the Florida
144	Comprehensive Health Association until adoption of a plan
145	of operation for the Florida Health Insurance Plan;
146	providing for enrollment in the plan of persons enrolled
147	in the association; requiring insurers to pay certain
148	assessments to the board for certain purposes; providing
149	criteria, requirements, and limitations for such
150	assessments; providing for repeal of ss. 627.6488,
151	627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
152	627.6498, F.S., relating to the Florida Comprehensive
153	Health Association, upon implementation of the plan;
154	amending s. 627.662, F.S.; providing for application of
155	certain claim payment methodologies to certain types of
156	insurance; providing for certain actions relating to
157	inappropriate utilization of emergency care; amending s.
158	627.6699, F.S.; revising provisions requiring small
159	employer carriers to offer certain health benefit plans;
160	preserving a right to open enrollment for certain small
161	groups; requiring small employer carriers to file and
162	provide coverage under certain high deductible plans;
163	including high deductible plans and health reimbursement
164	arrangements under certain required plan provisions;
165	creating the Small Employers Access Program; providing
166	legislative intent; providing definitions; providing
167	participation eligibility requirements and criteria;
168	requiring the Office of Insurance Regulation to administer
169	the program by selecting an insurer through competitive
170	bidding; providing requirements; specifying insurer
171	qualifications; providing duties of the insurer; providing
172	a contract term; providing insurer reporting requirements;
173	providing application requirements; providing for benefits
174	under the program; requiring the office to annually report
175	to the Governor and Legislature; creating ss. 627.6405 and
176	641.31097, F.S.; providing for decreasing inappropriate
177	use of emergency care; providing legislative findings and
178	intent; requiring health maintenance organizations and
179	providers to provide certain information electronically
180	and develop community emergency department diversion
181	programs; authorizing health maintenance organizations to
182	require higher copayments for certain uses of emergency
183	departments; amending s. 627.9175, F.S.; requiring certain
184	health insurers to annually report certain coverage
185	information to the office; providing requirements;
186	deleting certain reporting requirements; retitling ch.
187	636, F.S.; designating ss. 636.002-636.067, F.S., as pt. I
188	of ch. 636, F.S.; providing a part title; amending s.
189	636.003, F.S.; revising the definition of "prepaid limited
190	health service organization" to exclude discount medical
191	plan organizations; creating pt. II of ch. 636, F.S.,
192	consisting of ss. 636.202-636.244, F.S.; providing a part
193	title; providing definitions; providing for regulation and
194	operation of discount medical plan organizations;
195	requiring corporate licensure before doing business as a
196	discount medical plan; specifying application
197	requirements; requiring license fees; providing for
198	expiration and renewal of licenses; requiring such
199	organizations to establish an Internet website; requiring
200	publication of certain information on the website;
201	specifying collection and deposit of the licensing fee;
202	authorizing the office to examine or investigate the
203	business affairs of such organizations; requiring
204	examinations and investigations; authorizing the office to
205	order production of documents and take statements;
206	requiring organizations to pay certain expenses;
207	specifying grounds for denial or revocation under certain
208	circumstances; authorizing discount medical plan
209	organizations to charge certain fees under certain
210	circumstances; providing reimbursement requirements;
211	prohibiting certain activities; requiring certain
212	disclosures to prospective members; requiring provider
213	agreements to provide services under a medical discount
214	plan; providing agreement requirements; requiring forms
215	and rates to be filed with the office; requiring annual
216	reports to be filed with the office; providing
217	requirements; providing for fines and administrative
218	sanctions for failing to file annual reports; establishing
219	minimum capital requirements; providing for suspension or
220	revocation of licenses under certain circumstances;
221	providing for suspension of enrollment of new members
222	under certain circumstances; providing terms of
223	suspensions; requiring notice of any change of an
224	organization's name; requiring discount medical plan
225	organizations to maintain provider names listings;
226	specifying marketing requirements of discount medical
227	plans; providing limitations; specifying fee disclosure
228	requirements for bundling discount medical plans with
229	other insurance products; authorizing the commission to
230	adopt rules; applying insurer service of process
231	requirements on discount medical plan organizations;
232	requiring a security deposit; prohibiting levy on certain
233	deposit assets or securities under certain circumstances;
234	providing criminal penalties; authorizing the office to
235	seek certain injunctive relief under certain
236	circumstances; providing limitations; providing for civil
237	actions for damages for certain violations; providing for
238	awards of court costs and attorney fees; specifying
239	application of unauthorized insurer provisions of law to
240	unlicensed discount medical plan organizations; creating
241	ss. 627.65626 and 627.6402, F.S.; providing for insurance
242	rebates for healthy lifestyles; providing for rebate of
243	certain premiums for participation in health wellness,
244	maintenance, or improvement programs under certain
245	circumstances; providing requirements; amending s. 641.31,
246	F.S.; authorizing health maintenance organizations
247	offering certain point-of-service riders to offer such
248	riders to certain employers for certain employees;
249	providing requirements and limitations; providing for
250	application of certain claim payment methodologies to
251	certain types of insurance; providing for rebate of
252	certain premiums for participation in health wellness,
253	maintenance, or improvement programs under certain
254	circumstances; providing requirements; creating s.
255	626.593, F.S.; providing fee and commission limitations
256	for health insurance agents; requiring a written contract
257	for compensation; providing contract requirements;
258	requiring a rebate of commission under certain
259	circumstances; amending ss. 626.191 and 626.201, F.S.;
260	clarifying certain application requirements; preserving
261	certain rights to enrollment in certain health benefit
262	coverage programs for certain groups under certain
263	circumstances; creating s. 465.0244, F.S.; requiring each
264	pharmacy to make available on its Internet website a link
265	to certain performance outcome and financial data of the
266	Agency for Health Care Administration and a notice of the
267	availability of such information; amending s. 627.6499,
268	F.S.; requiring each health insurer to make available on
269	its Internet website a link to certain performance outcome
270	and financial data of the Agency for Health Care
271	Administration and a notice in policies of the
272	availability of such information; amending s. 641.54,
273	F.S.; requiring health maintenance organizations to make
274	certain insurance financial information available to
275	subscribers; requiring health maintenance organizations to
276	make available on its Internet website a link to certain
277	performance outcome and financial data of the Agency for
278	Health Care Administration and a notice in policies of the
279	availability of such information; repealing s. 408.02,
280	F.S., relating to the development, endorsement,
281	implementation, and evaluation of patient management
282	practice parameters by the Agency for Health Care
283	Administration; providing appropriations; providing
284	effective dates.
285
286	WHEREAS, according to the Kaiser Family Foundation, eight
287	out of ten uninsured Americans are workers or dependents of
288	workers and nearly eight out of ten uninsured Americans have
289	family incomes above the poverty level, and
290	WHEREAS, fifty-five percent of those who do not have
291	insurance state the reason they don't have insurance is lack of
292	affordability, and
293	WHEREAS, average health insurance premium increases for the
294	last two years have been in the range of ten to twenty percent
295	for Florida's employers, and
296	WHEREAS, an increasing number of employers are opting to
297	cease providing insurance coverage to their employees due to the
298	high cost, and
299	WHEREAS, an increasing number of employers who continue
300	providing coverage are forced to shift more premium cost to
301	their employees, thus diminishing the value of employee wage
302	increases, and
303	WHEREAS, according to studies, the rate of avoidable
304	hospitalization is fifty to seventy percent lower for the
305	insured versus the uninsured, and
306	WHEREAS, according to Florida Cancer Registry data, the
307	uninsured have a seventy percent greater chance of a late
308	diagnosis, thus decreasing the chances of a positive health
309	outcome, and
310	WHEREAS, according to the Agency for Health Care
311	Administration's 2002 financial data, uncompensated care in
312	Florida's hospitals is growing at the rate of twelve to thirteen
313	percent per year, and, at $4.3 billion in 2001, this cost, when
314	shifted to Floridians who remain insured, is not sustainable,
315	and
316	WHEREAS, the Florida Legislature, through the creation of
317	Health Flex, has already identified the need for lower cost
318	alternatives, and
319	WHEREAS, it is of vital importance and in the best
320	interests of the people of the State of Florida that the issue
321	of available, affordable health care insurance be addressed in a
322	cohesive and meaningful manner, and
323	WHEREAS, there is general recognition that the issues
324	surrounding the problem of access to affordable health insurance
325	are complicated and multifaceted, and
326	WHEREAS, on August 14, 2003, Speaker Johnnie Byrd created
327	the Select Committee on Affordable Health Care for Floridians in
328	an effort to address the issue of affordable and accessible
329	employment-based insurance, and
330	WHEREAS, the Select Committee on Affordable Health Care for
331	Floridians held public hearings with predetermined themes around
332	the state, specifically, in Orlando, Miami, Jacksonville, Tampa,
333	Pensacola, Boca Raton, and Tallahassee, from October through
334	November 2003 to effectively probe the operation of the private
335	insurance marketplace, to understand the health insurance market
336	trends, to learn from past policy initiatives, and to identify,
337	explore, and debate new ideas for change, and
338	WHEREAS, recommendations from the Select Committee on
339	Affordable Health Care were adopted on February 4, 2004, to
340	address the multifaceted issues attributed to the increase in
341	health care cost, and
342	WHEREAS, these recommendations were presented to the
343	Speaker of the House of Representatives in a final report from
344	the committee on February 18, 2004, and subsequent legislation
345	was drafted creating the "The 2004 Affordable Health Care for
346	Floridians Act," NOW, THEREFORE,
347
348	Be It Enacted by the Legislature of the State of Florida:
349
350	Section 1.  This act may be referred to by the popular name
351	"The 2004 Affordable Health Care for Floridians Act."
352	Section 2.  The purpose of this act is to address the
353	underlying cause of the double-digit increases in health
354	insurance premiums by mitigating the overall growth in health
355	care costs.
356	Section 3.  Paragraph (c) of subsection (4) of section
357	381.026, Florida Statutes, is amended to read:
358	381.026  Florida Patient's Bill of Rights and
359	Responsibilities.--
360	(4)  RIGHTS OF PATIENTS.--Each health care facility or
361	provider shall observe the following standards:
362	(c)  Financial information and disclosure.--
363	1.  A patient has the right to be given, upon request, by
364	the responsible provider, his or her designee, or a
365	representative of the health care facility full information and
366	necessary counseling on the availability of known financial
367	resources for the patient's health care.
368	2.  A health care provider or a health care facility shall,
369	upon request, disclose to each patient who is eligible for
370	Medicare, in advance of treatment, whether the health care
371	provider or the health care facility in which the patient is
372	receiving medical services accepts assignment under Medicare
373	reimbursement as payment in full for medical services and
374	treatment rendered in the health care provider's office or
375	health care facility.
376	3.  A health care provider or a health care facility shall,
377	upon request, furnish a person patient, prior to provision of
378	medical services, a reasonable estimate of charges for such
379	services. Such reasonable estimate shall not preclude the health
380	care provider or health care facility from exceeding the
381	estimate or making additional charges based on changes in the
382	patient's condition or treatment needs.
383	4.  Each licensed facility not operated by the state shall
384	make available to the public on its Internet website or by other
385	electronic means a description of and a link to the performance
386	outcome and financial data that is published by the agency
387	pursuant to s. 408.05(3)(l). The facility shall place a notice
388	in the reception area that such information is available
389	electronically and the website address. The licensed facility
390	may indicate that the pricing information is based on a
391	compilation of charges for the average patient and that each
392	patient's bill may vary from the average depending upon the
393	severity of illness and individual resources consumed. The
394	licensed facility may also indicate that the price of service is
395	negotiable for eligible patients based upon the patient's
396	ability to pay.
397	5.4.  A patient has the right to receive a copy of an
398	itemized bill upon request. A patient has a right to be given an
399	explanation of charges upon request.
400	Section 4.  Subsection (1) and paragraph (g) of subsection
401	(3) of section 381.734, Florida Statutes, are amended, and
402	subsections (4), (5), and (6) are added to said section, to
403	read:
404	381.734  Healthy Communities, Healthy People Program.--
405	(1)  The department shall develop and implement the Healthy
406	Communities, Healthy People Program, a comprehensive and
407	community-based health promotion and wellness program. The
408	program shall be designed to reduce major behavioral risk
409	factors associated with chronic diseases, including those
410	chronic diseases identified in chapter 385, by enhancing the
411	knowledge, skills, motivation, and opportunities for
412	individuals, organizations, health care providers, small
413	businesses, health insurers, and communities to develop and
414	maintain healthy lifestyles.
415	(3)  The program shall include:
416	(g)  The establishment of a comprehensive program to inform
417	the public, health care professionals, health insurers, and
418	communities about the prevalence of chronic diseases in the
419	state; known and potential risks, including social and
420	behavioral risks; and behavior changes that would reduce risks.
421	(4)  The department shall make available on its Internet
422	website, no later than October 1, 2004, and in a hard-copy
423	format upon request, a listing of age-specific, disease-
424	specific, and community-specific health promotion, preventive
425	care, and wellness programs offered and established under the
426	Healthy Communities, Healthy People Program. The website shall
427	also provide residents with information to identify behavior
428	risk factors that lead to diseases that are preventable by
429	maintaining a healthy lifestyle. The website shall allow
430	consumers to select by county or region disease-specific
431	statistical information.
432	(5)  The department shall monitor and assess the
433	effectiveness of such programs. The department shall submit a
434	status report based on this monitoring and assessment to the
435	Governor, the Speaker of the House of Representatives, the
436	President of the Senate, and the substantive committees of each
437	house of the Legislature, with the first annual report due
438	January 31, 2005.
439	(6)  The Office of Program Policy and Government
440	Accountability shall evaluate and report to the Governor, the
441	President of the Senate, and the Speaker of the House of
442	Representatives, by March 1, 2005, on the effectiveness of the
443	department's monitoring and assessment of the program's
444	effectiveness.
445	Section 5.  Subsection (7) is added to section 395.1041,
446	Florida Statutes, to read:
447	395.1041  Access to emergency services and care.--
448	(7)  EMERGENCY ROOM DIVERSION PROGRAMS.--Hospitals may
449	develop emergency room diversion programs, including, but not
450	limited to, an "Emergency Hotline" which allows patients to help
451	determine if emergency department services are appropriate or if
452	other health care settings may be more appropriate for care, and
453	a "Fast Track" program allowing nonemergency patients to be
454	treated at an alternative site. Alternative sites may include
455	health care programs funded with local tax revenue and federally
456	funded community health centers, county health departments, or
457	other nonhospital providers of health care services. The program
458	may include provisions for followup care and case management.
459	Section 6.  Paragraph (h) is added to subsection (1) of
460	section 395.1055, Florida Statutes, to read:
461	395.1055  Rules and enforcement.--
462	(1)  The agency shall adopt rules pursuant to ss.
463	120.536(1) and 120.54 to implement the provisions of this part,
464	which shall include reasonable and fair minimum standards for
465	ensuring that:
466	(h)  Licensed facilities make available on their Internet
467	websites, no later than October 1, 2004, and in a hard-copy
468	format upon request, a description of and a link to the patient
469	charge and performance outcome data collected from licensed
470	facilities pursuant to s. 408.061.
471	Section 7.  Subsection (7) is added to section 395.1065,
472	Florida Statutes, to read:
473	395.1065  Criminal and administrative penalties;
474	injunctions; emergency orders; moratorium.--
475	(7)  The agency shall impose a fine of $500 for each
476	instance of the facility's failure to provide the information
477	required by rules adopted pursuant to s. 395.1055(1)(h).
478	Section 8.  Subsections (1), (2), and (3) of section
479	395.301, Florida Statutes, are amended, and subsections (7),
480	(8), (9), and (10) are added to said section, to read:
481	395.301  Itemized patient bill; form and content prescribed
482	by the agency.--
483	(1)  A licensed facility not operated by the state shall
484	notify each patient during admission and at discharge of his or
485	her right to receive an itemized bill upon request. Within 7
486	days following the patient's discharge or release from a
487	licensed facility not operated by the state, or within 7 days
488	after the earliest date at which the loss or expense from the
489	service may be determined, the licensed facility providing the
490	service shall, upon request, submit to the patient, or to the
491	patient's survivor or legal guardian as may be appropriate, an
492	itemized statement detailing in language comprehensible to an
493	ordinary layperson the specific nature of charges or expenses
494	incurred by the patient, which in the initial billing shall
495	contain a statement of specific services received and expenses
496	incurred for such items of service, enumerating in detail the
497	constituent components of the services received within each
498	department of the licensed facility and including unit price
499	data on rates charged by the licensed facility, as prescribed by
500	the agency.
501	(2)(a)  Each such statement submitted pursuant to this
502	section:
503	1.(a)  May not include charges of hospital-based physicians
504	if billed separately.
505	2.(b)  May not include any generalized category of expenses
506	such as "other" or "miscellaneous" or similar categories.
507	3.(c)  Shall list drugs by brand or generic name and not
508	refer to drug code numbers when referring to drugs of any sort.
509	4.(d)  Shall specifically identify therapy treatment as to
510	the date, type, and length of treatment when therapy treatment
511	is a part of the statement.
512	(b)  Any person receiving a statement pursuant to this
513	section shall be fully and accurately informed as to each charge
514	and service provided by the institution preparing the statement.
515	(3)  On each such itemized statement submitted pursuant to
516	subsection (1) there shall appear the words "A FOR-PROFIT (or
517	NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
518	CENTER) LICENSED BY THE STATE OF FLORIDA" or substantially
519	similar words sufficient to identify clearly and plainly the
520	ownership status of the licensed facility. Each itemized
521	statement must prominently display the phone number of the
522	medical facility's patient liaison who is responsible for
523	expediting the resolution of any billing dispute between the
524	patient, or his or her representative, and the billing
525	department.
526	(7)  Each licensed facility not operated by the state shall
527	provide, prior to provision of any nonemergency medical
528	services, a written good-faith estimate of reasonably
529	anticipated charges for the facility to treat the patient's
530	condition upon written request of a prospective patient. The
531	estimate shall be provided to the prospective patient within 7
532	business days after the receipt of the request. The estimate may
533	be the average charges for that diagnosis related group or the
534	average charges for that procedure. Upon request, the facility
535	shall notify the patient of any revision to the good-faith
536	estimate. Such estimate shall not preclude the actual charges
537	from exceeding the estimate. The facility shall place a notice
538	in the reception area that such information is available.
539	Failure to provide the estimate within the provisions
540	established pursuant to this section shall result in a fine of
541	$500 for each instance of the facility's failure to provide the
542	requested information.
543	(8)  A licensed facility shall make available to a patient
544	all records necessary for verification of the accuracy of the
545	patient's bill within 30 business days after the request for
546	such records. The verification information must be made
547	available in the facility's offices. Such records shall be
548	available to the patient prior to and after payment of the bill
549	or claim. The facility may not charge the patient for making
550	such verification records available; however, the facility may
551	charge its usual fee for providing copies of records as
552	specified in s. 395.3025.
553	(9)  Each facility shall establish a method for reviewing
554	and responding to questions from patients concerning the
555	patient's itemized bill. Such response shall be provided within
556	30 days after the date a question is received. If the patient is
557	not satisfied with the response, the facility must provide the
558	patient with the address of the agency to which the issue may be
559	sent for review.
560	(10)  Each licensed facility shall make available on its
561	Internet website a link to the performance outcome and financial
562	data that is published by the Agency for Health Care
563	Administration pursuant to s. 408.05(3)(l). The facility shall
564	place a notice in the reception area that the information is
565	available electronically and the facility's Internet website
566	address.
567	Section 9.  Subsection (1) of section 408.061, Florida
568	Statutes, is amended to read:
569	408.061  Data collection; uniform systems of financial
570	reporting; information relating to physician charges;
571	confidential information; immunity.--
572	(1)  The agency shall may require the submission by health
573	care facilities, health care providers, and health insurers of
574	data necessary to carry out the agency's duties. Specifications
575	for data to be collected under this section shall be developed
576	by the agency with the assistance of technical advisory panels
577	including representatives of affected entities, consumers,
578	purchasers, and such other interested parties as may be
579	determined by the agency.
580	(a)  Data to be submitted by health care facilities,
581	including the facilities as defined in chapter 395, shall may
582	include, but are not limited to: case-mix data, patient
583	admission and or discharge data, hospital emergency department
584	data which shall include the number of patients treated in the
585	emergency department of a licensed hospital reported by patient
586	acuity level, data on hospital-acquired infections as specified
587	by rule, data on complications as specified by rule, data on
588	readmissions as specified by rule, with patient and provider-
589	specific identifiers included, actual charge data by diagnostic
590	groups, financial data, accounting data, operating expenses,
591	expenses incurred for rendering services to patients who cannot
592	or do not pay, interest charges, depreciation expenses based on
593	the expected useful life of the property and equipment involved,
594	and demographic data. The agency shall adopt nationally
595	recognized risk adjustment methodologies or software consistent
596	with the standards of the Agency for Healthcare Research and
597	Quality and as selected by the agency for all data submitted as
598	required by this section. Data may be obtained from documents
599	such as, but not limited to: leases, contracts, debt
600	instruments, itemized patient bills, medical record abstracts,
601	and related diagnostic information. Reported data elements shall
602	be reported electronically in accordance with Rule 59E-7.012,
603	Florida Administrative Code. Data submitted shall be certified
604	by the chief executive officer or an appropriate and duly
605	authorized representative or employee of the licensed facility
606	that the information submitted is true and accurate.
607	(b)  Data to be submitted by health care providers may
608	include, but are not limited to: Medicare and Medicaid
609	participation, types of services offered to patients, amount of
610	revenue and expenses of the health care provider, and such other
611	data which are reasonably necessary to study utilization
612	patterns. Data submitted shall be certified by the appropriate
613	duly authorized representative or employee of the health care
614	provider that the information submitted is true and accurate.
615	(c)  Data to be submitted by health insurers may include,
616	but are not limited to: claims, premium, administration, and
617	financial information. Data submitted shall be certified by the
618	chief financial officer, an appropriate and duly authorized
619	representative, or an employee of the insurer that the
620	information submitted is true and accurate.
621	(d)  Data required to be submitted by health care
622	facilities, health care providers, or health insurers shall not
623	include specific provider contract reimbursement information.
624	However, such specific provider reimbursement data shall be
625	reasonably available for onsite inspection by the agency as is
626	necessary to carry out the agency's regulatory duties. Any such
627	data obtained by the agency as a result of onsite inspections
628	may not be used by the state for purposes of direct provider
629	contracting and are confidential and exempt from the provisions
630	of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
631	(e)  A requirement to submit data shall be adopted by rule
632	if the submission of data is being required of all members of
633	any type of health care facility, health care provider, or
634	health insurer. Rules are not required, however, for the
635	submission of data for a special study mandated by the
636	Legislature or when information is being requested for a single
637	health care facility, health care provider, or health insurer.
638	Section 10.  Subsections (1) and (4) of section 408.062,
639	Florida Statutes, are amended, and subsection (5) is added to
640	said section, to read:
641	408.062  Research, analyses, studies, and reports.--
642	(1)  The agency shall have the authority to conduct
643	research, analyses, and studies relating to health care costs
644	and access to and quality of health care services as access and
645	quality are affected by changes in health care costs. Such
646	research, analyses, and studies shall include, but not be
647	limited to, research and analysis relating to:
648	(a)  The financial status of any health care facility or
649	facilities subject to the provisions of this chapter.
650	(b)  The impact of uncompensated charity care on health
651	care facilities and health care providers.
652	(c)  The state's role in assisting to fund indigent care.
653	(d)  In conjunction with the Office of Insurance
654	Regulation, the availability and affordability of health
655	insurance for small businesses.
656	(e)  Total health care expenditures in the state according
657	to the sources of payment and the type of expenditure.
658	(f)  The quality of health services, using techniques such
659	as small area analysis, severity adjustments, and risk-adjusted
660	mortality rates.
661	(g)  The development of physician information payment
662	systems which are capable of providing data for health care
663	consumers taking into account the amount of resources consumed,
664	including such information at licensed facilities as defined in
665	chapter 395, and the outcomes produced in the delivery of care.
666	(h)  The collection of a statistically valid sample of data
667	on the retail prices charged by pharmacies for the 50 most
668	frequently prescribed medicines from any pharmacy licensed by
669	this state as a special study authorized by the Legislature to
670	be performed by the agency quarterly. If the drug is available
671	generically, price data shall be reported for the generic drug
672	and price data of a brand-named drug for which the generic drug
673	is the equivalent shall be reported. The agency shall make
674	available on its Internet website for each pharmacy, no later
675	than October 1, 2005, drug prices for a 30-day supply at a
676	standard dose. The data collected shall be reported for each
677	drug by pharmacy and by metropolitan statistical area or region
678	and updated quarterly The impact of subacute admissions on
679	hospital revenues and expenses for purposes of calculating
680	adjusted admissions as defined in s. 408.07.
681	(i)  The use of emergency department services by patient
682	acuity level and the implication of increasing hospital cost by
683	providing nonurgent care in emergency departments. The agency
684	shall submit an annual report based on this monitoring and
685	assessment to the Governor, the Speaker of the House of
686	Representatives, the President of the Senate, and the
687	substantive legislative committees with the first report due
688	January 1, 2006.
689	(j)  The making available on its Internet website no later
690	than October 1, 2004, and in a hard-copy format upon request, of
691	patient charge, volumes, length of stay, and performance outcome
692	indicators collected from health care facilities pursuant to s.
693	408.061(1)(a) for specific medical conditions, surgeries, and
694	procedures provided in inpatient and outpatient facilities as
695	determined by the agency. In making the determination of
696	specific medical conditions, surgeries, and procedures to
697	include, the agency shall consider such factors as volume,
698	severity of the illness, urgency of admission, individual and
699	societal costs, and whether the condition is acute or chronic.
700	Performance outcome indicators shall be risk adjusted or
701	severity adjusted, as applicable, using nationally recognized
702	risk adjustment methodologies or software consistent with the
703	standards of the Agency for Healthcare Research and Quality and
704	as selected by the agency. The website shall also provide an
705	interactive search that allows consumers to view and compare the
706	information for specific facilities, a map that allows consumers
707	to select a county or region, definitions of all of the data,
708	descriptions of each procedure, and an explanation about why the
709	data may differ from facility to facility. Such public data
710	shall be updated quarterly. The agency shall submit an annual
711	status report on the collection of data and publication of
712	performance outcome indicators to the Governor, the Speaker of
713	the House of Representatives, the President of the Senate, and
714	the substantive legislative committees with the first status
715	report due January 1, 2005.
716	(4)(a)  The agency shall may conduct data-based studies and
717	evaluations and make recommendations to the Legislature and the
718	Governor concerning exemptions, the effectiveness of limitations
719	of referrals, restrictions on investment interests and
720	compensation arrangements, and the effectiveness of public
721	disclosure. Such analysis shall may include, but need not be
722	limited to, utilization of services, cost of care, quality of
723	care, and access to care. The agency may require the submission
724	of data necessary to carry out this duty, which may include, but
725	need not be limited to, data concerning ownership, Medicare and
726	Medicaid, charity care, types of services offered to patients,
727	revenues and expenses, patient-encounter data, and other data
728	reasonably necessary to study utilization patterns and the
729	impact of health care provider ownership interests in health-
730	care-related entities on the cost, quality, and accessibility of
731	health care.
732	(b)  The agency may collect such data from any health
733	facility or licensed health care provider as a special study.
734	(5)  The agency shall develop and implement a strategy for
735	the adoption and use of electronic health records. The agency
736	may develop rules to facilitate the functionality and protect
737	the confidentiality of electronic health records. The agency
738	shall report to the Governor, the Speaker of the House of
739	Representatives, and the President of the Senate on legislative
740	recommendations to protect the confidentiality of electronic
741	health records.
742	Section 11.  Paragraph (l) is added to subsection (3) of
743	section 408.05, Florida Statutes, to read:
744	408.05  State Center for Health Statistics.--
745	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
746	produce comparable and uniform health information and
747	statistics, the agency shall perform the following functions:
748	(l)  Develop, in conjunction with the State Comprehensive
749	Health Information System Advisory Council, and implement a
750	long-range plan for making available performance outcome and
751	financial data that will allow consumers to compare health care
752	services. The performance outcomes and financial data the agency
753	must make available shall include, but is not limited to,
754	pharmaceuticals, physicians, health care facilities, and health
755	plans and managed care entities. The agency shall submit the
756	initial plan to the Governor, the President of the Senate, and
757	the Speaker of the House of Representatives by March 1, 2005,
758	and shall update the plan and report on the status of its
759	implementation annually thereafter. The agency shall also make
760	the plan and status report available to the public on its
761	Internet website. As part of the plan, the agency shall identify
762	the process and timeframes for implementation, any barriers to
763	implementation, and recommendations of changes in the law that
764	may be enacted by the Legislature to eliminate the barriers. As
765	preliminary elements of the plan, the agency shall:
766	1.  Make available performance outcome and patient charge
767	data collected from health care facilities pursuant to s.
768	408.061(1)(a) and (2). The agency shall determine which
769	conditions and procedures, performance outcomes, and patient
770	charge data to disclose based upon input from the council. When
771	determining which conditions and procedures are to be disclosed,
772	the council and the agency shall consider variation in costs,
773	variation in outcomes, and magnitude of variations and other
774	relevant information. When determining which performance
775	outcomes to disclose, the agency:
776	a.  Shall consider such factors as volume of cases; average
777	patient charges; average length of stay; complication rates;
778	mortality rates; and infection rates, among others, which shall
779	be adjusted for case mix and severity, if applicable.
780	b.  May consider such additional measures that are adopted
781	by the Centers for Medicare and Medicaid Studies, National
782	Quality Forum, the Joint Commission on Accreditation of
783	Healthcare Organizations, the Agency for Healthcare Research and
784	Quality, or a similar national entity that establishes standards
785	to measure the performance of health care providers, or by other
786	states.
787
788	When determining which patient charge data to disclose, the
789	agency shall consider such measures as average charge, average
790	net revenue per adjusted patient day, average cost per adjusted
791	patient day, and average cost per admission, among others.
792	2.  Make available performance measures, benefit design,
793	and premium cost data from health plans licensed pursuant to
794	chapter 627 or chapter 641. The agency shall determine which
795	performance outcome and member and subscriber cost data to
796	disclose, based upon input from the council. When determining
797	which data to disclose, the agency shall consider information
798	that may be required by either individual or group purchasers to
799	assess the value of the product, which may include membership
800	satisfaction, quality of care, current enrollment or membership,
801	coverage areas, accreditation status, premium costs, plan costs,
802	premium increases, range of benefits, copayments and
803	deductibles, accuracy and speed of claims payment, credentials
804	of physicians, number of providers, names of network providers,
805	and hospitals in the network. Health plans shall make available
806	to the agency any such data or information that is not currently
807	reported to the agency or the office.
808	3.  Determine the method and format for public disclosure
809	of data reported pursuant to this paragraph. The agency shall
810	make its determination based upon input from the Comprehensive
811	Health Information System Advisory Council. At a minimum, the
812	data shall be made available on the agency's Internet website in
813	a manner that allows consumers to conduct an interactive search
814	that allows them to view and compare the information for
815	specific providers. The website must include such additional
816	information as is determined necessary to ensure that the
817	website enhances informed decision making among consumers and
818	health care purchasers, which shall include, at a minimum,
819	appropriate guidance on how to use the data and an explanation
820	of why the data may vary from provider to provider. The data
821	specified in subparagraph 1. shall be released no later than
822	March 1, 2005. The data specified in subparagraph 2. shall be
823	released no later than March 1, 2006.
824	Section 12.  Subsection (3) of section 409.9066, Florida
825	Statutes, is amended to read:
826	409.9066  Medicare prescription discount program.--
827	(3)  The Agency for Health Care Administration shall
828	publish, on a free website available to the public, the most
829	recent average wholesale prices for the 200 drugs most
830	frequently dispensed to the elderly and, to the extent possible,
831	shall provide a mechanism that consumers may use to calculate
832	the retail price and the price that should be paid after the
833	discount required in subsection (1) is applied. The agency shall
834	provide retail information by geographic area and retail
835	information by provider within geographical areas.
836	Section 13.  Section 408.7056, Florida Statutes, is amended
837	to read:
838	408.7056  Statewide Provider and Subscriber Assistance
839	Program.--
840	(1)  As used in this section, the term:
841	(a)  "Agency" means the Agency for Health Care
842	Administration.
843	(b)  "Department" means the Department of Financial
844	Services.
845	(c)  "Grievance procedure" means an established set of
846	rules that specify a process for appeal of an organizational
847	decision.
848	(d)  "Health care provider" or "provider" means a state-
849	licensed or state-authorized facility, a facility principally
850	supported by a local government or by funds from a charitable
851	organization that holds a current exemption from federal income
852	tax under s. 501(c)(3) of the Internal Revenue Code, a licensed
853	practitioner, a county health department established under part
854	I of chapter 154, a prescribed pediatric extended care center
855	defined in s. 400.902, a federally supported primary care
856	program such as a migrant health center or a community health
857	center authorized under s. 329 or s. 330 of the United States
858	Public Health Services Act that delivers health care services to
859	individuals, or a community facility that receives funds from
860	the state under the Community Alcohol, Drug Abuse, and Mental
861	Health Services Act and provides mental health services to
862	individuals.
863	(e)  "Managed care entity" means a health maintenance
864	organization or a prepaid health clinic certified under chapter
865	641, a prepaid health plan authorized under s. 409.912, or an
866	exclusive provider organization certified under s. 627.6472.
867	(f)  "Office" means the Office of Insurance Regulation of
868	the Financial Services Commission.
869	(g)  "Panel" means a statewide provider and subscriber
870	assistance panel selected as provided in subsection (11).
871	(2)  The agency shall adopt and implement a program to
872	provide assistance to subscribers and providers, including those
873	whose grievances are not resolved by the managed care entity to
874	the satisfaction of the subscriber or provider. The program
875	shall consist of one or more panels that meet as often as
876	necessary to timely review, consider, and hear grievances and
877	recommend to the agency or the office any actions that should be
878	taken concerning individual cases heard by the panel. The panel
879	shall hear every grievance filed by subscribers and providers on
880	behalf of subscribers, unless the grievance:
881	(a)  Relates to a managed care entity's refusal to accept a
882	provider into its network of providers;
883	(b)  Is part of an internal grievance in a Medicare managed
884	care entity or a reconsideration appeal through the Medicare
885	appeals process which does not involve a quality of care issue;
886	(c)  Is related to a health plan not regulated by the state
887	such as an administrative services organization, third-party
888	administrator, or federal employee health benefit program;
889	(d)  Is related to appeals by in-plan suppliers and
890	providers, unless related to quality of care provided by the
891	plan;
892	(e)  Is part of a Medicaid fair hearing pursued under 42
893	C.F.R. ss. 431.220 et seq.;
894	(f)  Is the basis for an action pending in state or federal
895	court;
896	(g)  Is related to an appeal by nonparticipating providers,
897	unless related to the quality of care provided to a subscriber
898	by the managed care entity and the provider is involved in the
899	care provided to the subscriber;
900	(h)  Was filed before the subscriber or provider completed
901	the entire internal grievance procedure of the managed care
902	entity, the managed care entity has complied with its timeframes
903	for completing the internal grievance procedure, and the
904	circumstances described in subsection (6) do not apply;
905	(i)  Has been resolved to the satisfaction of the
906	subscriber or provider who filed the grievance, unless the
907	managed care entity's initial action is egregious or may be
908	indicative of a pattern of inappropriate behavior;
909	(j)  Is limited to seeking damages for pain and suffering,
910	lost wages, or other incidental expenses, including accrued
911	interest on unpaid balances, court costs, and transportation
912	costs associated with a grievance procedure;
913	(k)  Is limited to issues involving conduct of a health
914	care provider or facility, staff member, or employee of a
915	managed care entity which constitute grounds for disciplinary
916	action by the appropriate professional licensing board and is
917	not indicative of a pattern of inappropriate behavior, and the
918	agency, office, or department has reported these grievances to
919	the appropriate professional licensing board or to the health
920	facility regulation section of the agency for possible
921	investigation; or
922	(l)  Is withdrawn by the subscriber or provider. Failure of
923	the subscriber or the provider to attend the hearing shall be
924	considered a withdrawal of the grievance; or
925	(3)  The agency shall review all grievances within 60 days
926	after receipt and make a determination whether the grievance
927	shall be heard. Once the agency notifies the panel, the
928	subscriber or provider, and the managed care entity that a
929	grievance will be heard by the panel, the panel shall hear the
930	grievance either in the network area or by teleconference no
931	later than 120 days after the date the grievance was filed. The
932	agency shall notify the parties, in writing, by facsimile
933	transmission, or by phone, of the time and place of the hearing.
934	The panel may take testimony under oath, request certified
935	copies of documents, and take similar actions to collect
936	information and documentation that will assist the panel in
937	making findings of fact and a recommendation. The panel shall
938	issue a written recommendation, supported by findings of fact,
939	to the provider or subscriber, to the managed care entity, and
940	to the agency or the office no later than 15 working days after
941	hearing the grievance. If at the hearing the panel requests
942	additional documentation or additional records, the time for
943	issuing a recommendation is tolled until the information or
944	documentation requested has been provided to the panel. The
945	proceedings of the panel are not subject to chapter 120.
946	(4)  If, upon receiving a proper patient authorization
947	along with a properly filed grievance, the agency requests
948	medical records from a health care provider or managed care
949	entity, the health care provider or managed care entity that has
950	custody of the records has 10 days to provide the records to the
951	agency. Records include medical records, communication logs
952	associated with the grievance both to and from the subscriber,
953	and contracts. Failure to provide requested medical records may
954	result in the imposition of a fine of up to $500. Each day that
955	records are not produced is considered a separate violation.
956	(5)  Grievances that the agency determines pose an
957	immediate and serious threat to a subscriber's health must be
958	given priority over other grievances. The panel may meet at the
959	call of the chair to hear the grievances as quickly as possible
960	but no later than 45 days after the date the grievance is filed,
961	unless the panel receives a waiver of the time requirement from
962	the subscriber. The panel shall issue a written recommendation,
963	supported by findings of fact, to the office or the agency
964	within 10 days after hearing the expedited grievance.
965	(6)  When the agency determines that the life of a
966	subscriber is in imminent and emergent jeopardy, the chair of
967	the panel may convene an emergency hearing, within 24 hours
968	after notification to the managed care entity and to the
969	subscriber, to hear the grievance. The grievance must be heard
970	notwithstanding that the subscriber has not completed the
971	internal grievance procedure of the managed care entity. The
972	panel shall, upon hearing the grievance, issue a written
973	emergency recommendation, supported by findings of fact, to the
974	managed care entity, to the subscriber, and to the agency or the
975	office for the purpose of deferring the imminent and emergent
976	jeopardy to the subscriber's life. Within 24 hours after receipt
977	of the panel's emergency recommendation, the agency or office
978	may issue an emergency order to the managed care entity. An
979	emergency order remains in force until:
980	(a)  The grievance has been resolved by the managed care
981	entity;
982	(b)  Medical intervention is no longer necessary; or
983	(c)  The panel has conducted a full hearing under
984	subsection (3) and issued a recommendation to the agency or the
985	office, and the agency or office has issued a final order.
986	(7)  After hearing a grievance, the panel shall make a
987	recommendation to the agency or the office which may include
988	specific actions the managed care entity must take to comply
989	with state laws or rules regulating managed care entities.
990	(8)  A managed care entity, subscriber, or provider that is
991	affected by a panel recommendation may within 10 days after
992	receipt of the panel's recommendation, or 72 hours after receipt
993	of a recommendation in an expedited grievance, furnish to the
994	agency or office written evidence in opposition to the
995	recommendation or findings of fact of the panel.
996	(9)  No later than 30 days after the issuance of the
997	panel's recommendation and, for an expedited grievance, no later
998	than 10 days after the issuance of the panel's recommendation,
999	the agency or the office may adopt the panel's recommendation or
1000	findings of fact in a proposed order or an emergency order, as
1001	provided in chapter 120, which it shall issue to the managed
1002	care entity. The agency or office may issue a proposed order or
1003	an emergency order, as provided in chapter 120, imposing fines
1004	or sanctions, including those contained in ss. 641.25 and
1005	641.52. The agency or the office may reject all or part of the
1006	panel's recommendation. All fines collected under this
1007	subsection must be deposited into the Health Care Trust Fund.
1008	(10)  In determining any fine or sanction to be imposed,
1009	the agency and the office may consider the following factors:
1010	(a)  The severity of the noncompliance, including the
1011	probability that death or serious harm to the health or safety
1012	of the subscriber will result or has resulted, the severity of
1013	the actual or potential harm, and the extent to which provisions
1014	of chapter 641 were violated.
1015	(b)  Actions taken by the managed care entity to resolve or
1016	remedy any quality-of-care grievance.
1017	(c)  Any previous incidents of noncompliance by the managed
1018	care entity.
1019	(d)  Any other relevant factors the agency or office
1020	considers appropriate in a particular grievance.
1021	(11)(a)  The panel shall consist of the Insurance Consumer
1022	Advocate, or designee thereof, established by s. 627.0613; at
1023	least two members employed by the agency and at least two
1024	members employed by the department, chosen by their respective
1025	agencies; a consumer appointed by the Governor; a physician
1026	appointed by the Governor, as a standing member; and, if
1027	necessary, physicians who have expertise relevant to the case to
1028	be heard, on a rotating basis. The agency may contract with a
1029	medical director, and a primary care physician, or both, who
1030	shall provide additional technical expertise to the panel but
1031	shall not be voting members of the panel. The medical director
1032	shall be selected from a health maintenance organization with a
1033	current certificate of authority to operate in Florida.
1034	(b)  A majority of those panel members required under
1035	paragraph (a) shall constitute a quorum for any meeting or
1036	hearing of the panel. A grievance may not be heard or voted upon
1037	at any panel meeting or hearing unless a quorum is present,
1038	except that a minority of the panel may adjourn a meeting or
1039	hearing until a quorum is present. A panel convened for the
1040	purpose of hearing a subscriber's grievance in accordance with
1041	subsections (2) and (3) shall not consist of more than 11
1042	members.
1043	(12)  Every managed care entity shall submit a quarterly
1044	report to the agency, the office, and the department listing the
1045	number and the nature of all subscribers' and providers'
1046	grievances which have not been resolved to the satisfaction of
1047	the subscriber or provider after the subscriber or provider
1048	follows the entire internal grievance procedure of the managed
1049	care entity. The agency shall notify all subscribers and
1050	providers included in the quarterly reports of their right to
1051	file an unresolved grievance with the panel.
1052	(13)  A proposed order issued by the agency or office which
1053	only requires the managed care entity to take a specific action
1054	under subsection (7) is subject to a summary hearing in
1055	accordance with s. 120.574, unless all of the parties agree
1056	otherwise. If the managed care entity does not prevail at the
1057	hearing, the managed care entity must pay reasonable costs and
1058	attorney's fees of the agency or the office incurred in that
1059	proceeding.
1060	(14)(a)  Any information that identifies a subscriber which
1061	is held by the panel, agency, or department pursuant to this
1062	section is confidential and exempt from the provisions of s.
1063	119.07(1) and s. 24(a), Art. I of the State Constitution.
1064	However, at the request of a subscriber or managed care entity
1065	involved in a grievance procedure, the panel, agency, or
1066	department shall release information identifying the subscriber
1067	involved in the grievance procedure to the requesting subscriber
1068	or managed care entity.
1069	(b)  Meetings of the panel shall be open to the public
1070	unless the provider or subscriber whose grievance will be heard
1071	requests a closed meeting or the agency or the department
1072	determines that information which discloses the subscriber's
1073	medical treatment or history or information relating to internal
1074	risk management programs as defined in s. 641.55(5)(c), (6), and
1075	(8) may be revealed at the panel meeting, in which case that
1076	portion of the meeting during which a subscriber's medical
1077	treatment or history or internal risk management program
1078	information is discussed shall be exempt from the provisions of
1079	s. 286.011 and s. 24(b), Art. I of the State Constitution. All
1080	closed meetings shall be recorded by a certified court reporter.
1081	Section 14.  Paragraph (c) of subsection (4) of section
1082	641.3154, Florida Statutes, is amended to read:
1083	641.3154  Organization liability; provider billing
1084	prohibited.--
1085	(4)  A provider or any representative of a provider,
1086	regardless of whether the provider is under contract with the
1087	health maintenance organization, may not collect or attempt to
1088	collect money from, maintain any action at law against, or
1089	report to a credit agency a subscriber of an organization for
1090	payment of services for which the organization is liable, if the
1091	provider in good faith knows or should know that the
1092	organization is liable. This prohibition applies during the
1093	pendency of any claim for payment made by the provider to the
1094	organization for payment of the services and any legal
1095	proceedings or dispute resolution process to determine whether
1096	the organization is liable for the services if the provider is
1097	informed that such proceedings are taking place. It is presumed
1098	that a provider does not know and should not know that an
1099	organization is liable unless:
1100	(c)  The office or agency makes a final determination that
1101	the organization is required to pay for such services subsequent
1102	to a recommendation made by the Statewide Provider and
1103	Subscriber Assistance Panel pursuant to s. 408.7056; or
1104	Section 15.  Subsection (1), paragraphs (b) and (e) of
1105	subsection (3), paragraph (d) of subsection (4), subsection (5),
1106	paragraph (g) of subsection (6), and subsections (9), (10), and
1107	(11) of section 641.511, Florida Statutes, are amended to read:
1108	641.511  Subscriber grievance reporting and resolution
1109	requirements.--
1110	(1)  Every organization must have a grievance procedure
1111	available to its subscribers for the purpose of addressing
1112	complaints and grievances. Every organization must notify its
1113	subscribers that a subscriber must submit a grievance within 1
1114	year after the date of occurrence of the action that initiated
1115	the grievance, and may submit the grievance for review to the
1116	Statewide Provider and Subscriber Assistance Program panel as
1117	provided in s. 408.7056 after receiving a final disposition of
1118	the grievance through the organization's grievance process. An
1119	organization shall maintain records of all grievances and shall
1120	report annually to the agency the total number of grievances
1121	handled, a categorization of the cases underlying the
1122	grievances, and the final disposition of the grievances.
1123	(3)  Each organization's grievance procedure, as required
1124	under subsection (1), must include, at a minimum:
1125	(b)  The names of the appropriate employees or a list of
1126	grievance departments that are responsible for implementing the
1127	organization's grievance procedure. The list must include the
1128	address and the toll-free telephone number of each grievance
1129	department, the address of the agency and its toll-free
1130	telephone hotline number, and the address of the Statewide
1131	Provider and Subscriber Assistance Program and its toll-free
1132	telephone number.
1133	(e)  A notice that a subscriber may voluntarily pursue
1134	binding arbitration in accordance with the terms of the contract
1135	if offered by the organization, after completing the
1136	organization's grievance procedure and as an alternative to the
1137	Statewide Provider and Subscriber Assistance Program. Such
1138	notice shall include an explanation that the subscriber may
1139	incur some costs if the subscriber pursues binding arbitration,
1140	depending upon the terms of the subscriber's contract.
1141	(4)
1142	(d)  In any case when the review process does not resolve a
1143	difference of opinion between the organization and the
1144	subscriber or the provider acting on behalf of the subscriber,
1145	the subscriber or the provider acting on behalf of the
1146	subscriber may submit a written grievance to the Statewide
1147	Provider and Subscriber Assistance Program.
1148	(5)  Except as provided in subsection (6), the organization
1149	shall resolve a grievance within 60 days after receipt of the
1150	grievance, or within a maximum of 90 days if the grievance
1151	involves the collection of information outside the service area.
1152	These time limitations are tolled if the organization has
1153	notified the subscriber, in writing, that additional information
1154	is required for proper review of the grievance and that such
1155	time limitations are tolled until such information is provided.
1156	After the organization receives the requested information, the
1157	time allowed for completion of the grievance process resumes.
1158	The Employee Retirement Income Security Act of 1974, as
1159	implemented by 29 C.F.R. 2560.503-1, is adopted and incorporated
1160	by reference as applicable to all organizations that administer
1161	small and large group health plans that are subject to 29 C.F.R.
1162	2560.503-1. The claims procedures of the regulations of the
1163	Employee Retirement Income Security Act of 1974 as implemented
1164	by 29 C.F.R. 2560.503-1 shall be the minimum standards for
1165	grievance processes for claims for benefits for small and large
1166	group health plans that are subject to 29 C.F.R. 2560.503-1.
1167	(6)
1168	(g)  In any case when the expedited review process does not
1169	resolve a difference of opinion between the organization and the
1170	subscriber or the provider acting on behalf of the subscriber,
1171	the subscriber or the provider acting on behalf of the
1172	subscriber may submit a written grievance to the Statewide
1173	Provider and Subscriber Assistance Program.
1174	(9)(a)  The agency shall advise subscribers with grievances
1175	to follow their organization's formal grievance process for
1176	resolution prior to review by the Statewide Provider and
1177	Subscriber Assistance Program. The subscriber may, however,
1178	submit a copy of the grievance to the agency at any time during
1179	the process.
1180	(b)  Requiring completion of the organization's grievance
1181	process before the Statewide Provider and Subscriber Assistance
1182	Program panel's review does not preclude the agency from
1183	investigating any complaint or grievance before the organization
1184	makes its final determination.
1185	(10)  Each organization must notify the subscriber in a
1186	final decision letter that the subscriber may request review of
1187	the organization's decision concerning the grievance by the
1188	Statewide Provider and Subscriber Assistance Program, as
1189	provided in s. 408.7056, if the grievance is not resolved to the
1190	satisfaction of the subscriber. The final decision letter must
1191	inform the subscriber that the request for review must be made
1192	within 365 days after receipt of the final decision letter, must
1193	explain how to initiate such a review, and must include the
1194	addresses and toll-free telephone numbers of the agency and the
1195	Statewide Provider and Subscriber Assistance Program.
1196	(11)  Each organization, as part of its contract with any
1197	provider, must require the provider to post a consumer
1198	assistance notice prominently displayed in the reception area of
1199	the provider and clearly noticeable by all patients. The
1200	consumer assistance notice must state the addresses and toll-
1201	free telephone numbers of the Agency for Health Care
1202	Administration, the Statewide Provider and Subscriber Assistance
1203	Program, and the Department of Financial Services. The consumer
1204	assistance notice must also clearly state that the address and
1205	toll-free telephone number of the organization's grievance
1206	department shall be provided upon request. The agency may adopt
1207	rules to implement this section.
1208	Section 16.  Subsection (4) of section 641.58, Florida
1209	Statutes, is amended to read:
1210	641.58  Regulatory assessment; levy and amount; use of
1211	funds; tax returns; penalty for failure to pay.--
1212	(4)  The moneys received and deposited into the Health Care
1213	Trust Fund shall be used to defray the expenses of the agency in
1214	the discharge of its administrative and regulatory powers and
1215	duties under this part, including conducting an annual survey of
1216	the satisfaction of members of health maintenance organizations;
1217	contracting with physician consultants for the Statewide
1218	Provider and Subscriber Assistance Panel; maintaining offices
1219	and necessary supplies, essential equipment, and other
1220	materials, salaries and expenses of required personnel; and
1221	discharging the administrative and regulatory powers and duties
1222	imposed under this part.
1223	Section 17.  Paragraph (f) of subsection (2) and
1224	subsections (3) and (9) of section 408.909, Florida Statutes,
1225	are amended to read:
1226	408.909  Health flex plans.--
1227	(2)  DEFINITIONS.--As used in this section, the term:
1228	(f)  "Health flex plan entity" means a health insurer,
1229	health maintenance organization, health-care-provider-sponsored
1230	organization, local government, health care district, or other
1231	public or private community-based organization, or public-
1232	private partnership that develops and implements an approved
1233	health flex plan and is responsible for administering the health
1234	flex plan and paying all claims for health flex plan coverage by
1235	enrollees of the health flex plan.
1236	(3)  PILOT PROGRAM.--The agency and the office shall each
1237	approve or disapprove health flex plans that provide health care
1238	coverage for eligible participants who reside in the three areas
1239	of the state that have the highest number of uninsured persons,
1240	as identified in the Florida Health Insurance Study conducted by
1241	the agency and in Indian River County. A health flex plan may
1242	limit or exclude benefits otherwise required by law for insurers
1243	offering coverage in this state, may cap the total amount of
1244	claims paid per year per enrollee, may limit the number of
1245	enrollees, or may take any combination of those actions. A
1246	health flex plan offering may include the option of a
1247	catastrophic plan supplementing the health flex plan.
1248	(a)  The agency shall develop guidelines for the review of
1249	applications for health flex plans and shall disapprove or
1250	withdraw approval of plans that do not meet or no longer meet
1251	minimum standards for quality of care and access to care. The
1252	agency shall ensure that the health flex plans follow
1253	standardized grievance procedures similar to those required of
1254	health maintenance organizations.
1255	(b)  The office shall develop guidelines for the review of
1256	health flex plan applications and provide regulatory oversight
1257	of health flex plan advertisement and marketing procedures. The
1258	office shall disapprove or shall withdraw approval of plans
1259	that:
1260	1.  Contain any ambiguous, inconsistent, or misleading
1261	provisions or any exceptions or conditions that deceptively
1262	affect or limit the benefits purported to be assumed in the
1263	general coverage provided by the health flex plan;
1264	2.  Provide benefits that are unreasonable in relation to
1265	the premium charged or contain provisions that are unfair or
1266	inequitable or contrary to the public policy of this state, that
1267	encourage misrepresentation, or that result in unfair
1268	discrimination in sales practices; or
1269	3.  Cannot demonstrate that the health flex plan is
1270	financially sound and that the applicant is able to underwrite
1271	or finance the health care coverage provided.
1272	(c)  The agency and the Financial Services Commission may
1273	adopt rules as needed to administer this section.
1274	(9)  PROGRAM EVALUATION.--The agency and the office shall
1275	evaluate the pilot program and its effect on the entities that
1276	seek approval as health flex plans, on the number of enrollees,
1277	and on the scope of the health care coverage offered under a
1278	health flex plan; shall provide an assessment of the health flex
1279	plans and their potential applicability in other settings; shall
1280	use health flex plans to gather more information to evaluate
1281	low-income consumer driven benefit packages; and shall, by
1282	January 1, 2005, and annually thereafter 2004, jointly submit a
1283	report to the Governor, the President of the Senate, and the
1284	Speaker of the House of Representatives.
1285	Section 18.  Section 381.0271, Florida Statutes, is created
1286	to read:
1287	381.0271  Florida Patient Safety Corporation.--
1288	(1)  DEFINITIONS.--As used in this section, the term:
1289	(a)  "Adverse incident" has the same meanings provided in
1290	ss. 395.0197, 458.351, and 459.026.
1291	(b)  "Corporation" means the Florida Patient Safety
1292	Corporation.
1293	(c)  "Patient safety data" has the same meaning provided in
1294	s. 766.1016.
1295	(2)  CREATION.--
1296	(a)  The Florida Patient Safety Corporation is created as a
1297	not-for-profit corporation and shall be registered,
1298	incorporated, organized, and operated in compliance with chapter
1299	617. The corporation may create not-for-profit corporate
1300	subsidiaries that are organized under the provisions of chapter
1301	617, upon the prior approval of the board of directors, as
1302	necessary, to fulfill its mission.
1303	(b)  The corporation and any authorized and approved
1304	subsidiary are not an agency as defined in s. 20.03(11).
1305	(c)  The corporation and any authorized and approved
1306	subsidiary are subject to the public meetings and records
1307	requirements of s. 24, Art. I of the State Constitution, chapter
1308	119, and s. 286.011.
1309	(d)  The corporation and any authorized and approved
1310	subsidiary are not subject to the provisions of chapter 287.
1311	(e)  The corporation is a patient safety organization as
1312	defined in s. 766.1016.
1313	(3)  PURPOSE.--
1314	(a)  The purpose of the corporation is to serve as a
1315	learning organization dedicated to assisting health care
1316	providers in this state to improve the quality and safety of
1317	health care rendered and to reduce harm to patients. The
1318	corporation shall promote the development of a culture of
1319	patient safety in the health care system in this state. The
1320	corporation shall not regulate health care providers in this
1321	state.
1322	(b)  In fulfilling its purpose, the corporation shall work
1323	with a consortium of patient safety centers and other patient
1324	safety programs.
1325	(4)  BOARD OF DIRECTORS; MEMBERSHIP.--The corporation shall
1326	be governed by a board of directors. The board of directors
1327	shall consist of:
1328	(a)  The chair of the Florida Council of Medical School
1329	Deans.
1330	(b)  Two representatives with expertise in patient safety
1331	issues for the authorized health insurer and authorized health
1332	maintenance organization with the largest market shares,
1333	respectively, as measured by premiums written in the state for
1334	the most recent calendar year, appointed by such insurer.
1335	(c)  A representative of an authorized medical malpractice
1336	insurer appointed by the Florida Insurance Council.
1337	(d)  The president of the Central Florida Health Care
1338	Coalition.
1339	(e)  Two representatives of a hospital in this state that
1340	is implementing innovative patient safety initiatives, appointed
1341	by the Florida Hospital Association.
1342	(f)  A physician with expertise in patient safety,
1343	appointed by the Florida Medical Association.
1344	(g)  A physician with expertise in patient safety,
1345	appointed by the Florida Osteopathic Medical Association.
1346	(h)  A physician with expertise in patient safety,
1347	appointed by the Florida Podiatric Medical Association.
1348	(i)  A physician with expertise in patient safety,
1349	appointed by the Florida Chiropractic Association.
1350	(j)  A dentist with expertise in patient safety, appointed
1351	by the Florida Dental Association.
1352	(k)  A nurse with expertise in patient safety, appointed by
1353	the Florida Nurses Association.
1354	(l)  An institutional pharmacist, appointed by the Florida
1355	Society of Health-System Pharmacists.
1356	(m)  A representative of Florida AARP, appointed by the
1357	state director of Florida AARP.
1358	(5)  ADVISORY COMMITTEES.--In addition to any committees
1359	that the corporation may establish, the corporation shall
1360	establish the following advisory committees:
1361	(a)  A scientific research advisory committee that
1362	includes, at a minimum, a representative from each patient
1363	safety center or other patient safety program in the
1364	universities of the state who are physicians licensed pursuant
1365	to chapter 458 or chapter 459, with experience in patient safety
1366	and evidenced-based medicine. The duties of the advisory
1367	committee shall include, but not be limited to, the analysis of
1368	existing data and research to improve patient safety and
1369	encourage evidence-based medicine.
1370	(b)  A technology advisory committee that includes, at a
1371	minimum, a representative of a hospital that has implemented a
1372	computerized physician order entry system and a health care
1373	provider that has implemented an electronic medical records
1374	system. The duties of the advisory committee shall include, but
1375	not be limited to, implementation of new technologies, including
1376	electronic medical records.
1377	(c)  A health care provider advisory committee that
1378	includes, at a minimum, representatives of hospitals, ambulatory
1379	surgical centers, physicians, nurses, and pharmacists licensed
1380	in this state and a representative of the Veterans Integrated
1381	Service Network 8, Virginia Patient Safety Center. The duties of
1382	the advisory committee shall include, but not be limited to,
1383	promotion of a culture of patient safety that reduces errors.
1384	(d)  A health care consumer advisory committee that
1385	includes, at a minimum, representatives of businesses that
1386	provide health insurance coverage to their employees, consumer
1387	advocacy groups, and representatives of patient safety
1388	organizations. The duties of the advisory committee shall
1389	include, but not be limited to, incentives to encourage patient
1390	safety and the efficiency and quality of care.
1391	(e)  A state agency advisory committee that includes, at a
1392	minimum, a representative from each state agency that has
1393	regulatory responsibilities related to patient safety. The
1394	duties of the advisory committee shall include, but not be
1395	limited to, interagency coordination of patient safety efforts.
1396	(f)  A litigation alternatives advisory committee that
1397	includes, at a minimum, representatives of medical malpractice
1398	attorneys for plaintiffs and defendants and a representative of
1399	each law school in the state. The duties of the advisory
1400	committee shall include, but not be limited to, alternatives
1401	systems to compensate for injuries.
1402	(g)  An education advisory committee that includes, at a
1403	minimum, the associate dean for education, or the equivalent
1404	position, as a representative from each medicine, nursing,
1405	public health, or allied health service to provide advice on the
1406	development, implementation, and measurement of core
1407	competencies for patient safety to be considered for
1408	incorporation in the educational programs of the universities
1409	and colleges of this state.
1410	(6)  ORGANIZATION; MEETINGS.--
1411	(a)  The Agency for Health Care Administration shall assist
1412	the corporation in its organizational activities required under
1413	chapter 617, including, but not limited to:
1414	1.  Eliciting appointments for the initial board of
1415	directors.
1416	2.  Convening the first meeting of the board of directors
1417	and assisting with other meetings of the board of directors,
1418	upon request of the board of directors, during the first year of
1419	operation of the corporation.
1420	3.  Drafting articles of incorporation for the board of
1421	directors and, upon request of the board of directors,
1422	delivering articles of incorporation to the Department of State
1423	for filing.
1424	4.  Drafting proposed bylaws for the corporation.
1425	5.  Paying fees related to incorporation.
1426	6.  Providing office space and administrative support, at
1427	the request of the board of directors, but not beyond July 1,
1428	2005.
1429	(b)  The board of directors must conduct its first meeting
1430	no later than August 1, 2004, and shall meet thereafter as
1431	frequently as necessary to carry out the duties of the
1432	corporation.
1433	(7)  POWERS AND DUTIES.--
1434	(a)  In addition to the powers and duties prescribed in
1435	chapter 617, and the articles and bylaws adopted under that
1436	chapter, the corporation shall, directly or through contract:
1437	1.  Secure staff necessary to properly administer the
1438	corporation.
1439	2.  Collect, analyze, and evaluate patient safety data and
1440	quality and patient safety indicators, medical malpractice
1441	closed claims, and adverse incidents reported to the Agency for
1442	Health Care Administration and the Department of Health for the
1443	purpose of recommending changes in practices and procedures that
1444	may be implemented by health care practitioners and health care
1445	facilities to improve health care quality and to prevent future
1446	adverse incidents. Notwithstanding any other provision of law,
1447	the Agency for Health Care Administration and the Department of
1448	Health shall make available to the corporation any adverse
1449	incident report submitted under ss. 395.0197, 458.351, and
1450	459.026. To the extent that adverse incident reports submitted
1451	under s. 395.0197 are confidential and exempt, the confidential
1452	and exempt status of such reports shall be maintained by the
1453	corporation.
1454	3.  Establish a "near-miss" patient safety reporting
1455	system. The purpose of the near-miss reporting system is to:
1456	identify potential systemic problems that could lead to adverse
1457	incidents; enable publication of systemwide alerts of potential
1458	harm; and facilitate development of both facility-specific and
1459	statewide options to avoid adverse incidents and improve patient
1460	safety. The reporting system shall record "near misses"
1461	submitted by hospitals, birthing centers, and ambulatory
1462	surgical centers and other providers. For the purpose of the
1463	reporting system:
1464	a.  The term "near miss" means any potentially harmful
1465	event that could have had an adverse result but, through chance
1466	or intervention in which, harm was prevented.
1467	b.  The near-miss reporting system shall be voluntary and
1468	anonymous and independent of mandatory reporting systems used
1469	for regulatory purposes.
1470	c.  Near-miss data submitted to the corporation is patient
1471	safety data as defined in s. 766.1016.
1472	d.  Reports of near-miss data shall be published on a
1473	regular basis and special alerts shall be published as needed
1474	regarding newly identified, significant risks.
1475	e.  Aggregated data shall be made available publicly.
1476	f.  The corporation shall report the performance and
1477	results of the near-miss project in its annual report.
1478	4.  Work collaboratively with the appropriate state
1479	agencies in the development of electronic health records.
1480	5.  Provide for access to an active library of evidence-
1481	based medicine and patient safety practices, together with the
1482	emerging evidence supporting their retention or modification,
1483	and make this information available to health care
1484	practitioners, health care facilities, and the public. Support
1485	for implementation of evidence-based medicine shall include:
1486	a.  A report to the Governor, the President of the Senate,
1487	the Speaker of the House of Representatives, and the Agency for
1488	Health Care Administration by January 1, 2005, on:
1489	(I)  The ability to join or support efforts for the use of
1490	evidence-based medicine already underway, such as those of the
1491	Leapfrog Group, the international group Bandolier, and the
1492	Healthy Florida Foundation.
1493	(II)  The means by which to promote research using Medicaid
1494	and other data collected by the Agency for Health Care
1495	Administration to identify and quantify the most cost-effective
1496	treatment and interventions, including disease management and
1497	prevention programs.
1498	(III)  The means by which to encourage development of
1499	systems to measure and reward providers who implement evidence-
1500	based medical practices.
1501	(IV)  The review of other state and private initiatives and
1502	published literature for promising approaches and the
1503	dissemination of information about them to providers.
1504	(V)  The encouragement of the Florida health care boards
1505	under the Department of Health to regularly publish findings
1506	related to the cost-effectiveness of disease-specific, evidence-
1507	based standards.
1508	(VI)  Public and private sector initiatives related to
1509	evidence-based medicine and communication systems for the
1510	sharing of clinical information among caregivers.
1511	(VII)  Regulatory barriers that interfere with the sharing
1512	of clinical information among caregivers.
1513	b.  An implementation plan reported to the Governor, the
1514	President of the Senate, the Speaker of the House of
1515	Representatives, and the Agency for Health Care Administration
1516	by September 1, 2005, that must include, but need not be limited
1517	to: estimated costs and savings, capital investment
1518	requirements, recommended investment incentives, initial
1519	committed provider participation by region, standards of
1520	functionality and features, a marketing plan, and implementation
1521	schedules for key components.
1522	6.  Develop and recommend core competencies in patient
1523	safety that can be incorporated into the undergraduate and
1524	graduate curricula in schools of medicine, nursing, and allied
1525	health in the state.
1526	7.  Develop and recommend programs to educate the public
1527	about the role of health care consumers in promoting patient
1528	safety.
1529	8.  Provide recommendations for interagency coordination of
1530	patient safety efforts in the state.
1531	(b)  In carrying out its powers and duties, the corporation
1532	may also:
1533	1.  Assess the patient safety culture at volunteering
1534	hospitals and recommend methods to improve the working
1535	environment related to patient safety at these hospitals.
1536	2.  Inventory the information technology capabilities
1537	related to patient safety of health care facilities and health
1538	care practitioners and recommend a plan for expediting the
1539	implementation of patient safety technologies statewide.
1540	3.  Recommend continuing medical education regarding
1541	patient safety to practicing health care practitioners.
1542	4.  Study and facilitate the testing of alternative systems
1543	of compensating injured patients as a means of reducing and
1544	preventing medical errors and promoting patient safety.
1545	5.  Conduct other activities identified by the board of
1546	directors to promote patient safety in this state.
1547	(8)  ANNUAL REPORT.--By December 1, 2004, the corporation
1548	shall prepare a report on the startup activities of the
1549	corporation and any proposals for legislative action that are
1550	needed for the corporation to fulfill its purposes under this
1551	section. By December 1 of each year thereafter, the corporation
1552	shall prepare a report for the preceding fiscal year. The
1553	report, at a minimum, must include:
1554	(a)  A description of the activities of the corporation
1555	under this section.
1556	(b)  Progress made in improving patient safety and reducing
1557	medical errors.
1558	(c)  Policies and programs that have been implemented and
1559	their outcomes.
1560	(d)  A compliance and financial audit of the accounts and
1561	records of the corporation at the end of the preceding fiscal
1562	year conducted by an independent certified public accountant.
1563	(e)  Recommendations for legislative action needed to
1564	improve patient safety in the state.
1565	(f)  An assessment of the ability of the corporation to
1566	fulfill the duties specified in this section and the
1567	appropriateness of those duties for the corporation.
1568
1569	The corporation shall submit the report to the Governor, the
1570	President of the Senate, and the Speaker of the House of
1571	Representatives.
1572	(9)  FUNDING.--The corporation is required to seek private
1573	sector funding and apply for grants to accomplish its goals and
1574	duties.
1575	(10)  PERFORMANCE EXPECTATIONS.--The Office of Program
1576	Policy Analysis and Government Accountability, the Agency for
1577	Health Care Administration, and the Department of Health shall
1578	develop performance standards by which to measure the success of
1579	the corporation in fulfilling the purposes established in this
1580	section. Using the performance standards, the Office of Program
1581	Policy Analysis and Government Accountability shall conduct a
1582	performance audit of the corporation during 2006 and shall
1583	submit a report to the Governor, the President of the Senate,
1584	and the Speaker of the House of Representatives by January 1,
1585	2007.
1586	Section 19.  Subsection (3) of section 409.91255, Florida
1587	Statutes, is amended to read:
1588	409.91255  Federally qualified health center access
1589	program.--
1590	(3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.--The
1591	Department of Health shall develop a program for the expansion
1592	of federally qualified health centers for the purpose of
1593	providing comprehensive primary and preventive health care and
1594	urgent care services, including services that may reduce the
1595	morbidity, mortality, and cost of care among the uninsured
1596	population of the state. The program shall provide for
1597	distribution of financial assistance to federally qualified
1598	health centers that apply and demonstrate a need for such
1599	assistance in order to sustain or expand the delivery of primary
1600	and preventive health care services. In selecting centers to
1601	receive this financial assistance, the program:
1602	(a)  Shall give preference to communities that have few or
1603	no community-based primary care services or in which the current
1604	services are unable to meet the community's needs.
1605	(b)  Shall require that primary care services be provided
1606	to the medically indigent using a sliding fee schedule based on
1607	income.
1608	(c)  Shall allow innovative and creative uses of federal,
1609	state, and local health care resources.
1610	(d)  Shall require that the funds provided be used to pay
1611	for operating costs of a projected expansion in patient
1612	caseloads or services or for capital improvement projects.
1613	Capital improvement projects may include renovations to existing
1614	facilities or construction of new facilities, provided that an
1615	expansion in patient caseloads or services to a new patient
1616	population will occur as a result of the capital expenditures.
1617	The department shall include in its standard contract document a
1618	requirement that any state funds provided for the purchase of or
1619	improvements to real property are contingent upon the contractor
1620	granting to the state a security interest in the property at
1621	least to the amount of the state funds provided for at least 5
1622	years from the date of purchase or the completion of the
1623	improvements or as further required by law. The contract must
1624	include a provision that, as a condition of receipt of state
1625	funding for this purpose, the contractor agrees that, if it
1626	disposes of the property before the department's interest is
1627	vacated, the contractor will refund the proportionate share of
1628	the state's initial investment, as adjusted by depreciation.
1629	(e)  May require in-kind support from other sources.
1630	(f)  May encourage coordination among federally qualified
1631	health centers, other private-sector providers, and publicly
1632	supported programs.
1633	(g)  Shall allow the development of community emergency
1634	room diversion programs in conjunction with local resources,
1635	providing extended hours of operation to urgent care patients.
1636	Diversion programs shall include case management for emergency
1637	room followup care.
1638	Section 20.  Paragraph (a) of subsection (6) of section
1639	627.410, Florida Statutes, is amended to read:
1640	627.410  Filing, approval of forms.--
1641	(6)(a)  An insurer shall not deliver or issue for delivery
1642	or renew in this state any health insurance policy form until it
1643	has filed with the office a copy of every applicable rating
1644	manual, rating schedule, change in rating manual, and change in
1645	rating schedule; if rating manuals and rating schedules are not
1646	applicable, the insurer must file with the office order
1647	applicable premium rates and any change in applicable premium
1648	rates. This paragraph does not apply to group health insurance
1649	policies, effectuated and delivered in this state, insuring
1650	groups of 51 or more persons, except for Medicare supplement
1651	insurance, long-term care insurance, and any coverage under
1652	which the increase in claim costs over the lifetime of the
1653	contract due to advancing age or duration is prefunded in the
1654	premium.
1655	Section 21.  Section 627.64872, Florida Statutes, is
1656	created to read:
1657	627.64872  Florida Health Insurance Plan.--
1658	(1)  LEGISLATIVE INTENT.--
1659	(a)  The Legislature recognizes that to secure a more
1660	stable and orderly health insurance market, the establishment of
1661	a plan to assume risks deemed uninsurable by the private
1662	marketplace is required.
1663	(b)  The Florida Health Insurance Plan is to make coverage
1664	available to individuals who have no other option for similar
1665	coverage, at a premium that is commensurate with the risk and
1666	benefits provided, and with benefit designs that are reasonable
1667	in relation to the general market. While plan operations may
1668	include supplementary funding, the plan shall fundamentally
1669	operate on sound actuarial principles, using basic insurance
1670	management techniques to ensure that the plan is run in an
1671	economical, cost-efficient, and sound manner, conserving plan
1672	resources to serve the maximum number of people possible in a
1673	sustainable fashion.
1674	(2)  DEFINITIONS.--As used in this section:
1675	(a)  "Board" means the board of directors of the plan.
1676	(b)  "Dependent" means a resident spouse or resident
1677	unmarried child under the age of 19 years, a child who is a
1678	student under the age of 25 years and who is financially
1679	dependent upon the parent, or a child of any age who is disabled
1680	and dependent upon the parent.
1681	(c)  "Director" means the director of the Office of
1682	Insurance Regulation.
1683	(d)  "Health insurance" means any hospital or medical
1684	expense incurred policy or health maintenance organization
1685	subscriber contract pursuant to chapter 641. The term does not
1686	include short-term, accident, dental-only, vision-only, fixed-
1687	indemnity, limited-benefit, or credit insurance; disability
1688	income insurance; coverage for onsite medical clinics; insurance
1689	coverage specified in federal regulations issued pursuant to
1690	Pub. L. No. 104-191, under which benefits for medical care are
1691	secondary or incidental to other insurance benefits; benefits
1692	for long-term care, nursing home care, home health care,
1693	community-based care, or any combination thereof, or other
1694	similar, limited benefits specified in federal regulations
1695	issued pursuant to Pub. L. No. 104-191; benefits provided under
1696	a separate policy, certificate, or contract of insurance, under
1697	which there is no coordination between the provision of the
1698	benefits and any exclusion of benefits under any group health
1699	plan maintained by the same plan sponsor and the benefits are
1700	paid with respect to an event without regard to whether benefits
1701	are provided with respect to such an event under any group
1702	health plan maintained by the same plan sponsor, such as for
1703	coverage only for a specified disease or illness; hospital
1704	indemnity or other fixed indemnity insurance; coverage offered
1705	as a separate policy, certificate, or contract of insurance,
1706	such as Medicare supplemental health insurance as defined under
1707	s. 1882(g)(1) of the Social Security Act; coverage supplemental
1708	to the coverage provided under chapter 55 of Title 10, United
1709	States Code, the Civilian Health and Medical Program of the
1710	Uniformed Services (CHAMPUS); similar supplemental coverage
1711	provided to coverage under a group health plan; coverage issued
1712	as a supplement to liability insurance; insurance arising out of
1713	a workers' compensation or similar law; automobile medical
1714	payment insurance; or insurance under which benefits are payable
1715	with or without regard to fault and which is statutorily
1716	required to be contained in any liability insurance policy or
1717	equivalent selfinsurance.
1718	(e)  "Implementation" means the effective date after the
1719	first meeting of the board when legal authority and
1720	administrative ability exists for the board to subsume the
1721	transfer of all statutory powers, duties, functions, assets,
1722	records, personnel, and property of the Florida Comprehensive
1723	Health Association as specified in s. 627.6488.
1724	(f)  "Insurer" means any entity that provides health
1725	insurance in this state. For purposes of this section, insurer
1726	includes an insurance company with a valid certificate in
1727	accordance with chapter 624, a health maintenance organization
1728	with a valid certificate of authority in accordance with part I
1729	or part III of chapter 641, a prepaid health clinic authorized
1730	to transact business in this state pursuant to part II of
1731	chapter 641, multiple employer welfare arrangements authorized
1732	to transact business in this state pursuant to ss. 624.436-
1733	624.45, or a fraternal benefit society providing health benefits
1734	to its members as authorized pursuant to chapter 632.
1735	(g)  "Medicare" means coverage under both Parts A and B of
1736	Title XVIII of the Social Security Act, 42 USC 1395 et seq., as
1737	amended.
1738	(h)  "Medicaid" means coverage under Title XIX of the
1739	Social Security Act.
1740	(i)  "Office" means the Office of Insurance Regulation of
1741	the Financial Services Commission.
1742	(j)  "Participating insurer" means any insurer providing
1743	health insurance to citizens of this state.
1744	(k)  "Provider" means any physician, hospital, or other
1745	institution, organization, or person that furnishes health care
1746	services and is licensed or otherwise authorized to practice in
1747	the state.
1748	(l)  "Plan" means the Florida Health Insurance Plan created
1749	in subsection (1).
1750	(m)  "Plan of operation" means the articles, bylaws, and
1751	operating rules and procedures adopted by the board pursuant to
1752	this section.
1753	(n)  "Resident" means an individual who has been legally
1754	domiciled in this state for a period of at least 6 months.
1755	(3)  BOARD OF DIRECTORS.--
1756	(a)  The plan shall operate subject to the supervision and
1757	control of the board. The board shall consist of the director or
1758	his or her designated representative, who shall serve as a
1759	member of the board and shall be its chair, and an additional
1760	eight members, five of whom shall be appointed by the Governor,
1761	at least two of whom shall be individuals not representative of
1762	insurers or health care providers, one of whom shall be
1763	appointed by the President of the Senate, one of whom shall be
1764	appointed by the Speaker of the House of Representatives, and
1765	one of whom shall be appointed by the Chief Financial Officer.
1766	(b)  The term to be served on the board by the director of
1767	the Office of Insurance Regulation shall be determined by
1768	continued employment in such position. The remaining initial
1769	board members shall serve for a period of time as follows: two
1770	members appointed by the Governor and the members appointed by
1771	the President of the Senate and the Speaker of the House of
1772	Representatives shall serve a term of 2 years; and three members
1773	appointed by the Governor and the Chief Financial Officer shall
1774	serve a term of 4 years. Subsequent board members shall serve
1775	for a term of 3 years. A board member's term shall continue
1776	until his or her successor is appointed.
1777	(c)  Vacancies on the board shall be filled by the
1778	appointing authority, such authority being the Governor, the
1779	President of the Senate, the Speaker of the House of
1780	Representatives, or the Chief Financial Officer. The appointing
1781	authority may remove board members for cause.
1782	(d)  The director, or his or her recognized representative,
1783	shall be responsible for any organizational requirements
1784	necessary for the initial meeting of the board which shall take
1785	place no later than September 1, 2004.
1786	(e)  Members shall not be compensated in their capacity as
1787	board members but shall be reimbursed for reasonable expenses
1788	incurred in the necessary performance of their duties in
1789	accordance with s. 112.061.
1790	(f)  The board shall submit to the Financial Services
1791	Commission a plan of operation for the plan and any amendments
1792	thereto necessary or suitable to ensure the fair, reasonable,
1793	and equitable administration of the plan. The plan of operation
1794	shall ensure that the plan qualifies to apply for any available
1795	funding from the Federal Government that adds to the financial
1796	viability of the plan. The plan of operation shall become
1797	effective upon approval in writing by the Financial Services
1798	Commission consistent with the date on which the coverage under
1799	this section must be made available. If the board fails to
1800	submit a suitable plan of operation within 1 year after the
1801	appointment of the board of directors, or at any time thereafter
1802	fails to submit suitable amendments to the plan of operation,
1803	the Financial Services Commission shall adopt such rules as are
1804	necessary or advisable to effectuate the provisions of this
1805	section. Such rules shall continue in force until modified by
1806	the office or superseded by a plan of operation submitted by the
1807	board and approved by the Financial Services Commission.
1808	(4)  PLAN OF OPERATION.--The plan of operation shall:
1809	(a)  Establish procedures for operation of the plan.
1810	(b)  Establish procedures for selecting an administrator in
1811	accordance with subsection (11).
1812	(c)  Establish procedures to create a fund, under
1813	management of the board, for administrative expenses.
1814	(d)  Establish procedures for the handling, accounting, and
1815	auditing of assets, moneys, and claims of the plan and the plan
1816	administrator.
1817	(e)  Develop and implement a program to publicize the
1818	existence of the plan, plan eligibility requirements, and
1819	procedures for enrollment and maintain public awareness of the
1820	plan.
1821	(f)  Establish procedures under which applicants and
1822	participants may have grievances reviewed by a grievance
1823	committee appointed by the board. The grievances shall be
1824	reported to the board after completion of the review, with the
1825	committee's recommendation for grievance resolution. The board
1826	shall retain all written grievances regarding the plan for at
1827	least 3 years.
1828	(g)  Provide for other matters as may be necessary and
1829	proper for the execution of the board's powers, duties, and
1830	obligations under this section.
1831	(5)  POWERS OF THE PLAN.--The plan shall have the general
1832	powers and authority granted under the laws of this state to
1833	health insurers and, in addition thereto, the specific authority
1834	to:
1835	(a)  Enter into such contracts as are necessary or proper
1836	to carry out the provisions and purposes of this section,
1837	including the authority, with the approval of the Chief
1838	Financial Officer, to enter into contracts with similar plans of
1839	other states for the joint performance of common administrative
1840	functions, or with persons or other organizations for the
1841	performance of administrative functions.
1842	(b)  Take any legal actions necessary or proper to recover
1843	or collect assessments due the plan.
1844	(c)  Take such legal action as is necessary to:
1845	1.  Avoid payment of improper claims against the plan or
1846	the coverage provided by or through the plan;
1847	2.  Recover any amounts erroneously or improperly paid by
1848	the plan;
1849	3.  Recover any amounts paid by the plan as a result of
1850	mistake of fact or law; or
1851	4.  Recover other amounts due the plan.
1852	(d)  Establish, and modify as appropriate, rates, rate
1853	schedules, rate adjustments, expense allowances, agents'
1854	commissions, claims reserve formulas, and any other actuarial
1855	functions appropriate to the operation of the plan. Rates and
1856	rate schedules may be adjusted for appropriate factors such as
1857	age, sex, and geographic variation in claim cost and shall take
1858	into consideration appropriate factors in accordance with
1859	established actuarial and underwriting practices. For purposes
1860	of this paragraph, usual and customary agent's commissions shall
1861	be paid for the initial placement of coverage with the plan and
1862	for one renewal only.
1863	(e)  Issue policies of insurance in accordance with the
1864	requirements of this section.
1865	(f)  Appoint appropriate legal, actuarial, investment, and
1866	other committees as necessary to provide technical assistance in
1867	the operation of the plan and develop and educate its
1868	policyholders regarding health savings accounts, policy and
1869	contract design, and any other function within the authority of
1870	the plan.
1871	(g)  Borrow money to effectuate the purposes of the plan.
1872	Any notes or other evidence of indebtedness of the plan not in
1873	default shall be legal investments for insurers and may be
1874	carried as admitted assets.
1875	(h)  Employ and fix the compensation of employees.
1876	(i)  Prepare and distribute certificate of eligibility
1877	forms and enrollment instruction forms to insurance producers
1878	and to the general public.
1879	(j)  Provide for reinsurance of risks incurred by the plan.
1880	(k)  Provide for and employ cost-containment measures and
1881	requirements, including, but not limited to, preadmission
1882	screening, second surgical opinion, concurrent utilization
1883	review, and individual case management for the purpose of making
1884	the plan more cost-effective.
1885	(l)  Design, use, contract, or otherwise arrange for the
1886	delivery of cost-effective health care services, including, but
1887	not limited to, establishing or contracting with preferred
1888	provider organizations, health maintenance organizations, and
1889	other limited network provider arrangements.
1890	(m)  Adopt such bylaws, policies, and procedures as may be
1891	necessary or convenient for the implementation of this section
1892	and the operation of the plan.
1893	(n)  Subsume the transfer of statutory powers, duties,
1894	functions, assets, records, personnel, and property of the
1895	Florida Comprehensive Health Association as specified in ss.
1896	627.6488, 627.6489, 627.649, 627.6492, 627.6496, 627.6498, and
1897	627.6499, unless otherwise specified by law.
1898	(6)  INTERIM REPORT; ANNUAL REPORT.--
1899	(a)  By no later than December 1, 2004, the board shall
1900	report to the Governor, the President of the Senate, and the
1901	Speaker of the House of Representatives the results of an
1902	actuarial study conducted by the board to determine, including,
1903	but not limited to:
1904	1.  The impact the creation of the plan will have on the
1905	small group insurance market and the individual market on
1906	premiums paid by insureds. This shall include an estimate of the
1907	total anticipated aggregate savings for all small employers in
1908	the state.
1909	2.  The number of individuals the pool could reasonably
1910	cover at various funding levels, specifically, the number of
1911	people the pool may cover at each of those funding levels.
1912	3.  A recommendation as to the best source of funding for
1913	the anticipated deficits of the pool.
1914	4.  The effect on the individual and small group market by
1915	including in the Florida Health Insurance Plan persons eligible
1916	for coverage under s. 627.6487, as well as the cost of including
1917	these individuals.
1918
1919	The board shall take no action to implement the Florida Health
1920	Insurance Plan, other than the completion of the actuarial study
1921	authorized in this paragraph, until funds are appropriated for
1922	startup cost and any projected deficits.
1923	(b)  No later than December 1, 2005, and annually
1924	thereafter, the board shall submit to the Governor, the
1925	President of the Senate, the Speaker of the House of
1926	Representatives, and the substantive legislative committees of
1927	the Legislature a report which includes an independent actuarial
1928	study to determine, including, but not be limited to:
1929	1.  The impact the creation of the plan has on the small
1930	group and individual insurance market, specifically on the
1931	premiums paid by insureds. This shall include an estimate of the
1932	total anticipated aggregate savings for all small employers in
1933	the state.
1934	2.  The actual number of individuals covered at the current
1935	funding and benefit level, the projected number of individuals
1936	that may seek coverage in the forthcoming fiscal year, and the
1937	projected funding needed to cover anticipated increase or
1938	decrease in plan participation.
1939	3.  A recommendation as to the best source of funding for
1940	the anticipated deficits of the pool.
1941	4.  A summarization of the activities of the plan in the
1942	preceding calendar year, including the net written and earned
1943	premiums, plan enrollment, the expense of administration, and
1944	the paid and incurred losses.
1945	5.  A review of the operation of the plan as to whether the
1946	plan has met the intent of this section.
1947	(7)  LIABILITY OF THE PLAN.--Neither the board nor its
1948	employees shall be liable for any obligations of the plan. No
1949	member or employee of the board shall be liable, and no cause of
1950	action of any nature may arise against a member or employee of
1951	the board, for any act or omission related to the performance of
1952	any powers and duties under this section, unless such act or
1953	omission constitutes willful or wanton misconduct. The board may
1954	provide in its bylaws or rules for indemnification of, and legal
1955	representation for, its members and employees.
1956	(8)  AUDITED FINANCIAL STATEMENT.--No later than June 1
1957	following the close of each calendar year, the plan shall submit
1958	to the Financial Services Commission an audited financial
1959	statement prepared in accordance with statutory accounting
1960	principles as adopted by the National Association of Insurance
1961	Commissioners.
1962	(9)  ELIGIBILITY.--
1963	(a)  Any individual person who is and continues to be a
1964	resident of this state shall be eligible for coverage under the
1965	plan if:
1966	1.  Evidence is provided that the person received notices
1967	of rejection or refusal to issue substantially similar coverage
1968	for health reasons from at least two health insurers or health
1969	maintenance organizations. A rejection or refusal by an insurer
1970	offering only stoploss, excess of loss, or reinsurance coverage
1971	with respect to the applicant shall not be sufficient evidence
1972	under this paragraph.
1973	2.  The person is enrolled in the Florida Comprehensive
1974	Health Association as of the date the plan is implemented.
1975	(b)  Each resident dependent of a person who is eligible
1976	for coverage under the plan shall also be eligible for such
1977	coverage.
1978	(c)  A person shall not be eligible for coverage under the
1979	plan if:
1980	1.  The person has or obtains health insurance coverage
1981	substantially similar to or more comprehensive than a plan
1982	policy, or would be eligible to obtain such coverage, unless a
1983	person may maintain other coverage for the period of time the
1984	person is satisfying any preexisting condition waiting period
1985	under a plan policy or may maintain plan coverage for the period
1986	of time the person is satisfying a preexisting condition waiting
1987	period under another health insurance policy intended to replace
1988	the plan policy.
1989	2.  The person is determined to be eligible for health care
1990	benefits under Medicaid, Medicare, the state's children's health
1991	insurance program, or any other federal, state, or local
1992	government program that provides health benefits;
1993	3.  The person voluntarily terminated plan coverage unless
1994	12 months have elapsed since such termination;
1995	4.  The person is an inmate or resident of a public
1996	institution; or
1997	5.  The person's premiums are paid for or reimbursed under
1998	any government-sponsored program or by any government agency or
1999	health care provider.
2000	(d)  Coverage shall cease:
2001	1.  On the date a person is no longer a resident of this
2002	state;
2003	2.  On the date a person requests coverage to end;
2004	3.  Upon the death of the covered person;
2005	4.  On the date state law requires cancellation or
2006	nonrenewal of the policy; or
2007	5.  At the option of the plan, 30 days after the plan makes
2008	any inquiry concerning the person's eligibility or place of
2009	residence to which the person does not reply.
2010	6.  Upon failure of the insured to pay for continued
2011	coverage.
2012	(e)  Except under the circumstances described in this
2013	subsection, coverage of a person who ceases to meet the
2014	eligibility requirements of this subsection shall be terminated
2015	at the end of the policy period for which the necessary premiums
2016	have been paid.
2017	(10)  UNFAIR REFERRAL TO PLAN.--It is an unfair trade
2018	practice for the purposes of part IX of chapter 626 or s.
2019	641.3901 for an insurer, health maintenance organization
2020	insurance agent, insurance broker, or third-party administrator
2021	to refer an individual employee to the plan, or arrange for an
2022	individual employee to apply to the plan, for the purpose of
2023	separating that employee from group health insurance coverage
2024	provided in connection with the employee's employment.
2025	(11)  PLAN ADMINISTRATOR.--The board shall select through a
2026	competitive bidding process a plan administrator to administer
2027	the plan. The board shall evaluate bids submitted based on
2028	criteria established by the board, which shall include:
2029	(a)  The plan administrator's proven ability to handle
2030	health insurance coverage to individuals.
2031	(b)  The efficiency and timeliness of the plan
2032	administrator's claim processing procedures.
2033	(c)  An estimate of total charges for administering the
2034	plan.
2035	(d)  The plan administrator's ability to apply effective
2036	cost-containment programs and procedures and to administer the
2037	plan in a cost-efficient manner.
2038	(e)  The financial condition and stability of the plan
2039	administrator.
2040
2041	The administrator shall be an insurer, a health maintenance
2042	organization, or a third-party administrator, or another
2043	organization duly authorized to provide insurance pursuant to
2044	the Florida Insurance Code.
2045	(12)  ADMINISTRATOR TERM LIMITS.--The plan administrator
2046	shall serve for a period specified in the contract between the
2047	plan and the plan administrator subject to removal for cause and
2048	subject to any terms, conditions, and limitations of the
2049	contract between the plan and the plan administrator. At least 1
2050	year prior to the expiration of each period of service by a plan
2051	administrator, the board shall invite eligible entities,
2052	including the current plan administrator, to submit bids to
2053	serve as the plan administrator. Selection of the plan
2054	administrator for each succeeding period shall be made at least
2055	6 months prior to the end of the current period.
2056	(13)  DUTIES OF THE PLAN ADMINISTRATOR.--
2057	(a)  The plan administrator shall perform such functions
2058	relating to the plan as may be assigned to it, including, but
2059	not limited to:
2060	1.  Determination of eligibility.
2061	2.  Payment of claims.
2062	3.  Establishment of a premium billing procedure for
2063	collection of premiums from persons covered under the plan.
2064	4.  Other necessary functions to ensure timely payment of
2065	benefits to covered persons under the plan.
2066	(b)  The plan administrator shall submit regular reports to
2067	the board regarding the operation of the plan. The frequency,
2068	content, and form of the reports shall be specified in the
2069	contract between the board and the plan administrator.
2070	(c)  On March 1 following the close of each calendar year,
2071	the plan administrator shall determine net written and earned
2072	premiums, the expense of administration, and the paid and
2073	incurred losses for the year and report this information to the
2074	board and the Governor on a form prescribed by the Governor.
2075	(14)  PAYMENT OF THE PLAN ADMINISTRATOR.--The plan
2076	administrator shall be paid as provided in the contract between
2077	the plan and the plan administrator.
2078	(15)  FUNDING OF THE PLAN.--
2079	(a)  Premiums.--
2080	1.  The plan shall establish premium rates for plan
2081	coverage as provided in this section. Separate schedules of
2082	premium rates based on age, sex, and geographical location may
2083	apply for individual risks. Premium rates and schedules shall be
2084	submitted to the office for approval prior to use.
2085	2.  Initial rates for plan coverage shall be limited to no
2086	more than 300 percent of rates established for individual
2087	standard risks as specified in s. 627.6675(3)(c). Subject to the
2088	limits provided in this paragraph, subsequent rates shall be
2089	established to provide fully for the expected costs of claims,
2090	including recovery of prior losses, expenses of operation,
2091	investment income of claim reserves, and any other cost factors
2092	subject to the limitations described herein, but in no event
2093	shall premiums exceed the 300-percent rate limitation provided
2094	in this section. Notwithstanding the 300-percent rate
2095	limitation, sliding scale premium surcharges based upon the
2096	insured's income may apply to all enrollees.
2097	(b)  Sources of additional revenue.--Any deficit incurred
2098	by the plan shall be primarily funded through amounts
2099	appropriated by the Legislature from general revenue sources,
2100	including, but not limited to, a portion of the annual growth in
2101	existing net insurance premium taxes. The board shall operate
2102	the plan in such a manner that the estimated cost of providing
2103	health insurance during any fiscal year will not exceed total
2104	income the plan expects to receive from policy premiums and
2105	funds appropriated by the Legislature, including any interest on
2106	investments. After determining the amount of funds appropriated
2107	to the board for a fiscal year, the board shall estimate the
2108	number of new policies it believes the plan has the financial
2109	capacity to insure during that year so that costs do not exceed
2110	income. The board shall take steps necessary to ensure that plan
2111	enrollment does not exceed the number of residents it has
2112	estimated it has the financial capacity to insure.
2113	(16)  BENEFITS.--
2114	(a)  The benefits provided shall be the same as the
2115	standard and basic plans for small employers as outlined in s.
2116	627.6699. The board shall also establish an option of
2117	alternative coverage such as catastrophic coverage that includes
2118	a minimum level of primary care coverage and a high deductible
2119	plan that meets the federal requirements of a health savings
2120	account.
2121	(b)  In establishing the plan coverage, the board shall
2122	take into consideration the levels of health insurance provided
2123	in the state and such medical economic factors as may be deemed
2124	appropriate and adopt benefit levels, deductibles, copayments,
2125	coinsurance factors, exclusions, and limitations determined to
2126	be generally reflective of and commensurate with health
2127	insurance provided through a representative number of large
2128	employers in the state.
2129	(c)  The board may adjust any deductibles and coinsurance
2130	factors annually according to the medical component of the
2131	Consumer Price Index.
2132	(d)1.  Plan coverage shall exclude charges or expenses
2133	incurred during the first 6 months following the effective date
2134	of coverage for any condition for which medical advice, care, or
2135	treatment was recommended or received for such condition during
2136	the 6-month period immediately preceding the effective date of
2137	coverage.
2138	2.  Such preexisting condition exclusions shall be waived
2139	to the extent that similar exclusions, if any, have been
2140	satisfied under any prior health insurance coverage which was
2141	involuntarily terminated, provided application for pool coverage
2142	is made not later than 63 days following such involuntary
2143	termination. In such case, coverage under the plan shall be
2144	effective from the date on which such prior coverage was
2145	terminated and the applicant is not eligible for continuation or
2146	conversion rights that would provide coverage substantially
2147	similar to plan coverage.
2148	(17)  NONDUPLICATION OF BENEFITS.--
2149	(a)  The plan shall be payor of last resort of benefits
2150	whenever any other benefit or source of third-party payment is
2151	available. Benefits otherwise payable under plan coverage shall
2152	be reduced by all amounts paid or payable through any other
2153	health insurance, by all hospital and medical expense benefits
2154	paid or payable under any workers' compensation coverage,
2155	automobile medical payment, or liability insurance, whether
2156	provided on the basis of fault or nonfault, and by any hospital
2157	or medical benefits paid or payable under or provided pursuant
2158	to any state or federal law or program.
2159	(b)  The plan shall have a cause of action against an
2160	eligible person for the recovery of the amount of benefits paid
2161	that are not for covered expenses. Benefits due from the plan
2162	may be reduced or refused as a setoff against any amount
2163	recoverable under this paragraph.
2164	(18)  ANNUAL AND MAXIMUM BENEFITS.--Maximum benefits under
2165	the plan shall be determined by the board.
2166	(19)  TAXATION.--The plan is exempt from any tax imposed by
2167	this state. The plan shall apply for federal tax exemption
2168	status.
2169	(20)  COMBINING MEMBERSHIP OF THE FLORIDA COMPREHENSIVE
2170	HEALTH ASSOCIATION; ASSESSMENT.--
2171	(a)1. Upon implementation of the Florida Health Insurance
2172	Plan, the Florida Comprehensive Health Association, as specified
2173	in s. 627.6488, is abolished as a separate nonprofit entity and
2174	shall be subsumed under the board of directors of the Florida
2175	Health Insurance Plan. All individuals actively enrolled in the
2176	Florida Comprehensive Health Association shall be enrolled in
2177	the plan subject to its rules and requirements, except as
2178	otherwise specified in this section. Maximum lifetime benefits
2179	paid to an individual in the plan shall not exceed the amount
2180	established under subsection (16), and benefits previously paid
2181	for any individual by the Florida Comprehensive Health
2182	Association shall be used in the determination of total lifetime
2183	benefits paid under the plan.
2184	2.  All persons enrolled in the Florida Comprehensive
2185	Health Association upon implementation of the Florida Health
2186	Insurance Plan are only eligible for the benefits authorized
2187	under subsection (16). Persons identified by this section shall
2188	convert to the benefits authorized under subsection (16) no
2189	later than January 1, 2005.
2190	3.  Except as otherwise provided in this section, the
2191	administration of the coverage of persons actively enrolled in
2192	the Florida Comprehensive Health Association shall operate under
2193	the existing plan of operation without modification until the
2194	adoption of the new plan of operation for the Florida Health
2195	Insurance Plan.
2196	(b)1.  As a condition of doing business in this state, an
2197	insurer shall pay an assessment to the board in the amount
2198	prescribed by this section. For operating losses incurred on or
2199	after July 1, 2004, by persons enrolled in the Florida
2200	Comprehensive Health Association, each insurer shall annually be
2201	assessed by the board in the following calendar year a portion
2202	of such incurred operating losses of the plan. Such portion
2203	shall be determined by multiplying such operating losses by a
2204	fraction, the numerator of which equals the insurer's earned
2205	premium pertaining to direct writings of health insurance in the
2206	state during the calendar year preceding that for which the
2207	assessment is levied, and the denominator of which equals the
2208	total of all such premiums earned by insurers in the state
2209	during such calendar year.
2210	2.  The total of all assessments under this paragraph upon
2211	an insurer shall not exceed 1 percent of such insurer's health
2212	insurance premium earned in this state during the calendar year
2213	preceding the year for which the assessments were levied.
2214	3.  All rights, title, and interest in the assessment funds
2215	collected under this paragraph shall vest in this state.
2216	However, all of such funds and interest earned shall be used by
2217	the plan to pay claims and administrative expenses.
2218	(c)  If assessments and other receipts by the plan, board,
2219	or plan administrator exceed the actual losses and
2220	administrative expenses of the plan, the excess shall be held in
2221	interest and used by the board to offset future losses. As used
2222	in this subsection, the term "future losses" includes reserves
2223	for claims incurred but not reported.
2224	(d)  Each insurer's assessment shall be determined annually
2225	by the board or plan administrator based on annual statements
2226	and other reports deemed necessary by the board or plan
2227	administrator and filed with the board or plan administrator by
2228	the insurer. Any deficit incurred under the plan by persons
2229	previously enrolled in the Florida Comprehensive Health
2230	Association shall be recouped by the assessments against
2231	insurers by the board or plan administrator in the manner
2232	provided in paragraph (b), and the insurers may recover the
2233	assessment in the normal course of their respective businesses
2234	without time limitation.
2235	(e)  If a person actively enrolled in the Florida
2236	Comprehensive Health Association after implementation of the
2237	plan loses eligibility for participation in the Florida
2238	Comprehensive Health Association, such person shall not be
2239	included in the calculation of the assessment if the person
2240	later regains eligibility for participation in the plan.
2241	(f)  When all persons actively enrolled in the Florida
2242	Comprehensive Health Association as of the date of
2243	implementation of the plan are no longer eligible for
2244	participation in the Florida Comprehensive Health Association,
2245	the board of directors and plan administrator shall no longer be
2246	allowed to assess insurers in this state for incurred losses in
2247	the Florida Comprehensive Health Association.
2248	Section 22.  Upon implementation, as defined in s.
2249	627.64872(2), Florida Statutes, and as provided in s.
2250	627.64872(20), Florida Statutes, of the Florida Health Insurance
2251	Plan created under s. 627.64872, Florida Statutes, sections
2252	627.6488, 627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
2253	627.6498, Florida Statutes, are repealed.
2254	Section 23.  Subsections (12) and (13) are added to section
2255	627.662, Florida Statutes, to read:
2256	627.662  Other provisions applicable.--The following
2257	provisions apply to group health insurance, blanket health
2258	insurance, and franchise health insurance:
2259	(12)  Section 627.6044, relating to the use of specific
2260	methodology for payment of claims.
2261	(13)  Section 627.6405, relating to the inappropriate
2262	utilization of emergency care.
2263	Section 24.  Paragraphs (c) and (d) of subsection (5),
2264	paragraph (b) of subsection (6), and subsection (12) of section
2265	627.6699, Florida Statutes, are amended, subsections (15) and
2266	(16) of said section are renumbered as subsections (16) and
2267	(17), respectively, present subsection (15) of said section is
2268	amended, and new subsections (15) and (18) are added to said
2269	section, to read:
2270	627.6699  Employee Health Care Access Act.--
2271	(5)  AVAILABILITY OF COVERAGE.--
2272	(c)  Every small employer carrier must, as a condition of
2273	transacting business in this state:
2274	1.  Offer and issue all small employer health benefit plans
2275	on a guaranteed-issue basis to every eligible small employer,
2276	with 2 to 50 eligible employees, that elects to be covered under
2277	such plan, agrees to make the required premium payments, and
2278	satisfies the other provisions of the plan. A rider for
2279	additional or increased benefits may be medically underwritten
2280	and may only be added to the standard health benefit plan. The
2281	increased rate charged for the additional or increased benefit
2282	must be rated in accordance with this section.
2283	2.  In the absence of enrollment availability in the
2284	Florida Health Insurance Plan, offer and issue basic and
2285	standard small employer health benefit plans on a guaranteed-
2286	issue basis, during a 31-day open enrollment period of August 1
2287	through August 31 of each year, to every eligible small
2288	employer, with fewer than two eligible employees, which small
2289	employer is not formed primarily for the purpose of buying
2290	health insurance and which elects to be covered under such plan,
2291	agrees to make the required premium payments, and satisfies the
2292	other provisions of the plan. Coverage provided under this
2293	subparagraph shall begin on October 1 of the same year as the
2294	date of enrollment, unless the small employer carrier and the
2295	small employer agree to a different date. A rider for additional
2296	or increased benefits may be medically underwritten and may only
2297	be added to the standard health benefit plan. The increased rate
2298	charged for the additional or increased benefit must be rated in
2299	accordance with this section. For purposes of this subparagraph,
2300	a person, his or her spouse, and his or her dependent children
2301	constitute a single eligible employee if that person and spouse
2302	are employed by the same small employer and either that person
2303	or his or her spouse has a normal work week of less than 25
2304	hours. Any right to an open enrollment of health benefit
2305	coverage for groups of fewer than two employees, pursuant to
2306	this section, shall remain in full force and effect in the
2307	absence of the availability of new enrollment into the Florida
2308	Health Insurance Plan.
2309	3.  This paragraph does not limit a carrier's ability to
2310	offer other health benefit plans to small employers if the
2311	standard and basic health benefit plans are offered and
2312	rejected.
2313	(d)  A small employer carrier must file with the office, in
2314	a format and manner prescribed by the committee, a standard
2315	health care plan, a high deductible plan that meets the federal
2316	requirements of a health savings account plan or a health
2317	reimbursement arrangement, and a basic health care plan to be
2318	used by the carrier. The provisions of this section requiring
2319	the filing of a high deductible plan are effective September 1,
2320	2004.
2321	(6)  RESTRICTIONS RELATING TO PREMIUM RATES.--
2322	(b)  For all small employer health benefit plans that are
2323	subject to this section and are issued by small employer
2324	carriers on or after January 1, 1994, premium rates for health
2325	benefit plans subject to this section are subject to the
2326	following:
2327	1.  Small employer carriers must use a modified community
2328	rating methodology in which the premium for each small employer
2329	must be determined solely on the basis of the eligible
2330	employee's and eligible dependent's gender, age, family
2331	composition, tobacco use, or geographic area as determined under
2332	paragraph (5)(j) and in which the premium may be adjusted as
2333	permitted by this paragraph.
2334	2.  Rating factors related to age, gender, family
2335	composition, tobacco use, or geographic location may be
2336	developed by each carrier to reflect the carrier's experience.
2337	The factors used by carriers are subject to office review and
2338	approval.
2339	3.  Small employer carriers may not modify the rate for a
2340	small employer for 12 months from the initial issue date or
2341	renewal date, unless the composition of the group changes or
2342	benefits are changed. However, a small employer carrier may
2343	modify the rate one time prior to 12 months after the initial
2344	issue date for a small employer who enrolls under a previously
2345	issued group policy that has a common anniversary date for all
2346	employers covered under the policy if:
2347	a.  The carrier discloses to the employer in a clear and
2348	conspicuous manner the date of the first renewal and the fact
2349	that the premium may increase on or after that date.
2350	b.  The insurer demonstrates to the office that
2351	efficiencies in administration are achieved and reflected in the
2352	rates charged to small employers covered under the policy.
2353	4.  A carrier may issue a group health insurance policy to
2354	a small employer health alliance or other group association with
2355	rates that reflect a premium credit for expense savings
2356	attributable to administrative activities being performed by the
2357	alliance or group association if such expense savings are
2358	specifically documented in the insurer's rate filing and are
2359	approved by the office. Any such credit may not be based on
2360	different morbidity assumptions or on any other factor related
2361	to the health status or claims experience of any person covered
2362	under the policy. Nothing in this subparagraph exempts an
2363	alliance or group association from licensure for any activities
2364	that require licensure under the insurance code. A carrier
2365	issuing a group health insurance policy to a small employer
2366	health alliance or other group association shall allow any
2367	properly licensed and appointed agent of that carrier to market
2368	and sell the small employer health alliance or other group
2369	association policy. Such agent shall be paid the usual and
2370	customary commission paid to any agent selling the policy.
2371	5.  Any adjustments in rates for claims experience, health
2372	status, or duration of coverage may not be charged to individual
2373	employees or dependents. For a small employer's policy, such
2374	adjustments may not result in a rate for the small employer
2375	which deviates more than 15 percent from the carrier's approved
2376	rate. Any such adjustment must be applied uniformly to the rates
2377	charged for all employees and dependents of the small employer.
2378	A small employer carrier may make an adjustment to a small
2379	employer's renewal premium, not to exceed 10 percent annually,
2380	due to the claims experience, health status, or duration of
2381	coverage of the employees or dependents of the small employer.
2382	Semiannually, small group carriers shall report information on
2383	forms adopted by rule by the commission, to enable the office to
2384	monitor the relationship of aggregate adjusted premiums actually
2385	charged policyholders by each carrier to the premiums that would
2386	have been charged by application of the carrier's approved
2387	modified community rates. If the aggregate resulting from the
2388	application of such adjustment exceeds the premium that would
2389	have been charged by application of the approved modified
2390	community rate by 4 5 percent for the current reporting period,
2391	the carrier shall limit the application of such adjustments only
2392	to minus adjustments beginning not more than 60 days after the
2393	report is sent to the office. For any subsequent reporting
2394	period, if the total aggregate adjusted premium actually charged
2395	does not exceed the premium that would have been charged by
2396	application of the approved modified community rate by 4 5
2397	percent, the carrier may apply both plus and minus adjustments.
2398	A small employer carrier may provide a credit to a small
2399	employer's premium based on administrative and acquisition
2400	expense differences resulting from the size of the group. Group
2401	size administrative and acquisition expense factors may be
2402	developed by each carrier to reflect the carrier's experience
2403	and are subject to office review and approval.
2404	6.  A small employer carrier rating methodology may include
2405	separate rating categories for one dependent child, for two
2406	dependent children, and for three or more dependent children for
2407	family coverage of employees having a spouse and dependent
2408	children or employees having dependent children only. A small
2409	employer carrier may have fewer, but not greater, numbers of
2410	categories for dependent children than those specified in this
2411	subparagraph.
2412	7.  Small employer carriers may not use a composite rating
2413	methodology to rate a small employer with fewer than 10
2414	employees. For the purposes of this subparagraph, a "composite
2415	rating methodology" means a rating methodology that averages the
2416	impact of the rating factors for age and gender in the premiums
2417	charged to all of the employees of a small employer.
2418	8.a.  A carrier may separate the experience of small
2419	employer groups with less than 2 eligible employees from the
2420	experience of small employer groups with 2-50 eligible employees
2421	for purposes of determining an alternative modified community
2422	rating.
2423	b.  If a carrier separates the experience of small employer
2424	groups as provided in sub-subparagraph a., the rate to be
2425	charged to small employer groups of less than 2 eligible
2426	employees may not exceed 150 percent of the rate determined for
2427	small employer groups of 2-50 eligible employees. However, the
2428	carrier may charge excess losses of the experience pool
2429	consisting of small employer groups with less than 2 eligible
2430	employees to the experience pool consisting of small employer
2431	groups with 2-50 eligible employees so that all losses are
2432	allocated and the 150-percent rate limit on the experience pool
2433	consisting of small employer groups with less than 2 eligible
2434	employees is maintained. Notwithstanding s. 627.411(1), the rate
2435	to be charged to a small employer group of fewer than 2 eligible
2436	employees, insured as of July 1, 2002, may be up to 125 percent
2437	of the rate determined for small employer groups of 2-50
2438	eligible employees for the first annual renewal and 150 percent
2439	for subsequent annual renewals.
2440	(12)  STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH
2441	BENEFIT PLANS.--
2442	(a)1.  The Chief Financial Officer shall appoint a health
2443	benefit plan committee composed of four representatives of
2444	carriers which shall include at least two representatives of
2445	HMOs, at least one of which is a staff model HMO, two
2446	representatives of agents, four representatives of small
2447	employers, and one employee of a small employer. The carrier
2448	members shall be selected from a list of individuals recommended
2449	by the board. The Chief Financial Officer may require the board
2450	to submit additional recommendations of individuals for
2451	appointment.
2452	2.  The plans shall comply with all of the requirements of
2453	this subsection.
2454	3.  The plans must be filed with and approved by the office
2455	prior to issuance or delivery by any small employer carrier.
2456	4.  After approval of the revised health benefit plans, if
2457	the office determines that modifications to a plan might be
2458	appropriate, the Chief Financial Officer shall appoint a new
2459	health benefit plan committee in the manner provided in
2460	subparagraph 1. to submit recommended modifications to the
2461	office for approval.
2462	(b)1.  Each small employer carrier issuing new health
2463	benefit plans shall offer to any small employer, upon request, a
2464	standard health benefit plan, and a basic health benefit plan,
2465	and a high deductible plan that meets the requirements of a
2466	health savings account plan as defined by federal law or a
2467	health reimbursement arrangement as authorized by the Internal
2468	Revenue Service, that meet meets the criteria set forth in this
2469	section.
2470	2.  For purposes of this subsection, the terms "standard
2471	health benefit plan," and "basic health benefit plan," and "high
2472	deductible plan" mean policies or contracts that a small
2473	employer carrier offers to eligible small employers that
2474	contain:
2475	a.  An exclusion for services that are not medically
2476	necessary or that are not covered preventive health services;
2477	and
2478	b.  A procedure for preauthorization by the small employer
2479	carrier, or its designees.
2480	3.  A small employer carrier may include the following
2481	managed care provisions in the policy or contract to control
2482	costs:
2483	a.  A preferred provider arrangement or exclusive provider
2484	organization or any combination thereof, in which a small
2485	employer carrier enters into a written agreement with the
2486	provider to provide services at specified levels of
2487	reimbursement or to provide reimbursement to specified
2488	providers. Any such written agreement between a provider and a
2489	small employer carrier must contain a provision under which the
2490	parties agree that the insured individual or covered member has
2491	no obligation to make payment for any medical service rendered
2492	by the provider which is determined not to be medically
2493	necessary. A carrier may use preferred provider arrangements or
2494	exclusive provider arrangements to the same extent as allowed in
2495	group products that are not issued to small employers.
2496	b.  A procedure for utilization review by the small
2497	employer carrier or its designees.
2498
2499	This subparagraph does not prohibit a small employer carrier
2500	from including in its policy or contract additional managed care
2501	and cost containment provisions, subject to the approval of the
2502	office, which have potential for controlling costs in a manner
2503	that does not result in inequitable treatment of insureds or
2504	subscribers. The carrier may use such provisions to the same
2505	extent as authorized for group products that are not issued to
2506	small employers.
2507	4.  The standard health benefit plan shall include:
2508	a.  Coverage for inpatient hospitalization;
2509	b.  Coverage for outpatient services;
2510	c.  Coverage for newborn children pursuant to s. 627.6575;
2511	d.  Coverage for child care supervision services pursuant
2512	to s. 627.6579;
2513	e.  Coverage for adopted children upon placement in the
2514	residence pursuant to s. 627.6578;
2515	f.  Coverage for mammograms pursuant to s. 627.6613;
2516	g.  Coverage for handicapped children pursuant to s.
2517	627.6615;
2518	h.  Emergency or urgent care out of the geographic service
2519	area; and
2520	i.  Coverage for services provided by a hospice licensed
2521	under s. 400.602 in cases where such coverage would be the most
2522	appropriate and the most cost-effective method for treating a
2523	covered illness.
2524	5.  The standard health benefit plan and the basic health
2525	benefit plan may include a schedule of benefit limitations for
2526	specified services and procedures. If the committee develops
2527	such a schedule of benefits limitation for the standard health
2528	benefit plan or the basic health benefit plan, a small employer
2529	carrier offering the plan must offer the employer an option for
2530	increasing the benefit schedule amounts by 4 percent annually.
2531	6.  The basic health benefit plan shall include all of the
2532	benefits specified in subparagraph 4.; however, the basic health
2533	benefit plan shall place additional restrictions on the benefits
2534	and utilization and may also impose additional cost containment
2535	measures.
2536	7.  Sections 627.419(2), (3), and (4), 627.6574, 627.6612,
2537	627.66121, 627.66122, 627.6616, 627.6618, 627.668, and 627.66911
2538	apply to the standard health benefit plan and to the basic
2539	health benefit plan. However, notwithstanding said provisions,
2540	the plans may specify limits on the number of authorized
2541	treatments, if such limits are reasonable and do not
2542	discriminate against any type of provider.
2543	8.  The high deductible plan associated with a health
2544	savings account or a health reimbursement arrangement shall
2545	include all the benefits specified in subparagraph 4.
2546	9.8.  Each small employer carrier that provides for
2547	inpatient and outpatient services by allopathic hospitals may
2548	provide as an option of the insured similar inpatient and
2549	outpatient services by hospitals accredited by the American
2550	Osteopathic Association when such services are available and the
2551	osteopathic hospital agrees to provide the service.
2552	(c)  If a small employer rejects, in writing, the standard
2553	health benefit plan, and the basic health benefit plan, and the
2554	high deductible health savings account plan or a health
2555	reimbursement arrangement, the small employer carrier may offer
2556	the small employer a limited benefit policy or contract.
2557	(d)1.  Upon offering coverage under a standard health
2558	benefit plan, a basic health benefit plan, or a limited benefit
2559	policy or contract for any small employer, the small employer
2560	carrier shall provide such employer group with a written
2561	statement that contains, at a minimum:
2562	a.  An explanation of those mandated benefits and providers
2563	that are not covered by the policy or contract;
2564	b.  An explanation of the managed care and cost control
2565	features of the policy or contract, along with all appropriate
2566	mailing addresses and telephone numbers to be used by insureds
2567	in seeking information or authorization; and
2568	c.  An explanation of the primary and preventive care
2569	features of the policy or contract.
2570
2571	Such disclosure statement must be presented in a clear and
2572	understandable form and format and must be separate from the
2573	policy or certificate or evidence of coverage provided to the
2574	employer group.
2575	2.  Before a small employer carrier issues a standard
2576	health benefit plan, a basic health benefit plan, or a limited
2577	benefit policy or contract, it must obtain from the prospective
2578	policyholder a signed written statement in which the prospective
2579	policyholder:
2580	a.  Certifies as to eligibility for coverage under the
2581	standard health benefit plan, basic health benefit plan, or
2582	limited benefit policy or contract;
2583	b.  Acknowledges the limited nature of the coverage and an
2584	understanding of the managed care and cost control features of
2585	the policy or contract;
2586	c.  Acknowledges that if misrepresentations are made
2587	regarding eligibility for coverage under a standard health
2588	benefit plan, a basic health benefit plan, or a limited benefit
2589	policy or contract, the person making such misrepresentations
2590	forfeits coverage provided by the policy or contract; and
2591	d.  If a limited plan is requested, acknowledges that the
2592	prospective policyholder had been offered, at the time of
2593	application for the insurance policy or contract, the
2594	opportunity to purchase any health benefit plan offered by the
2595	carrier and that the prospective policyholder had rejected that
2596	coverage.
2597
2598	A copy of such written statement shall be provided to the
2599	prospective policyholder no later than at the time of delivery
2600	of the policy or contract, and the original of such written
2601	statement shall be retained in the files of the small employer
2602	carrier for the period of time that the policy or contract
2603	remains in effect or for 5 years, whichever period is longer.
2604	3.  Any material statement made by an applicant for
2605	coverage under a health benefit plan which falsely certifies as
2606	to the applicant's eligibility for coverage serves as the basis
2607	for terminating coverage under the policy or contract.
2608	4.  Each marketing communication that is intended to be
2609	used in the marketing of a health benefit plan in this state
2610	must be submitted for review by the office prior to use and must
2611	contain the disclosures stated in this subsection.
2612	(e)  A small employer carrier may not use any policy,
2613	contract, form, or rate under this section, including
2614	applications, enrollment forms, policies, contracts,
2615	certificates, evidences of coverage, riders, amendments,
2616	endorsements, and disclosure forms, until the insurer has filed
2617	it with the office and the office has approved it under ss.
2618	627.410 and 627.411 and this section.
2619	(15)  SMALL EMPLOYERS ACCESS PROGRAM.--
2620	(a)  Popular name.--This subsection may be referred to by
2621	the popular name "The Small Employers Access Program."
2622	(b)  Intent.--The Legislature finds that increased access
2623	to health care coverage for small employers with up to 25
2624	employees could improve employees' health and reduce the
2625	incidence and costs of illness and disabilities among residents
2626	in this state. Many employers do not offer health care benefits
2627	to their employees citing the increased cost of this benefit. It
2628	is the intent of the Legislature to create the Small Business
2629	Health Plan to provide small employers the option and ability to
2630	provide health care benefits to their employees at an affordable
2631	cost through the creation of purchasing pools for employers with
2632	up to 25 employees, and rural hospital employers and nursing
2633	home employers regardless of the number of employees.
2634	(c)  Definitions.--For purposes of this subsection:
2635	1.  "Fair commission" means a commission structure
2636	determined by the insurers and reflected in the insurers' rate
2637	filings made pursuant to this subsection.
2638	2.  "Insurer" means any entity that provides health
2639	insurance in this state. For purposes of this subsection,
2640	insurer includes an insurance company holding a certificate of
2641	authority pursuant to chapter 624 or a health maintenance
2642	organization holding a certificate of authority pursuant to
2643	chapter 641, which qualifies to provide coverage to small
2644	employer groups pursuant to this section.
2645	3.  "Mutually supported benefit plan" means an optional
2646	alternative coverage plan developed within a defined geographic
2647	region which may include, but is not limited to, a minimum level
2648	of primary care coverage in which the percentage of the premium
2649	is distributed among the employer, the employee, and community-
2650	generated revenue either alone or in conjunction with federal
2651	matching funds.
2652	4.  "Office" means the Office of Insurance Regulation of
2653	the Department of Financial Services.
2654	5.  "Participating insurer" means any insurer providing
2655	health insurance to small employers that has been selected by
2656	the office in accordance with this subsection for its designated
2657	region.
2658	6.  "Program" means the Small Employer Access Program as
2659	created by this subsection.
2660	(d)  Eligibility.--
2661	1.  Any small employer that is actively engaged in
2662	business, has its principal place of business in this state,
2663	employs up to 25 eligible employees on business days during the
2664	preceding calendar year, employs at least 2 employees on the
2665	first day of the plan year, and has had no prior coverage for
2666	the last 6 months may participate.
2667	2.  Any municipality, county, school district, or hospital
2668	employer located in a rural community as defined in s.
2669	288.0656(2)(b), may participate.
2670	3.  Nursing home employers may participate.
2671	4.  Each dependent of a person eligible for coverage is
2672	also eligible to participate.
2673
2674	Any employer participating in the program must do so until the
2675	end of the term for which the carrier providing the coverage is
2676	obligated to provide such coverage to the program. Coverage for
2677	a small employer group that ceases to meet the eligibility
2678	requirements of this section may be terminated at the end of the
2679	policy period for which the necessary premiums have been paid.
2680	(e)  Administration.--
2681	1.  The office shall by competitive bid, in accordance with
2682	current state law, select an insurer to provide coverage through
2683	the program to eligible small employers within an established
2684	geographical area of this state. The office may develop
2685	exclusive regions for the program similar to those used by the
2686	Healthy Kids Corporation. However the office is not precluded
2687	from developing, in conjunction with insurers, regions different
2688	from those used by the Healthy Kids Corporation if the office
2689	deems that such a region will carry out the intentions of this
2690	subsection.
2691	2.  The office shall evaluate bids submitted based upon
2692	criteria established by the office, which shall include, but not
2693	be limited to:
2694	a.  The insurer's proven ability to handle health insurance
2695	coverage to small employer groups.
2696	b.  The efficiency and timeliness of the insurer's claim
2697	processing procedures.
2698	c.  The insurer's ability to apply effective cost-
2699	containment programs and procedures and to administer the
2700	program in a cost-efficient manner.
2701	d.  The financial condition and stability of the insurer.
2702	e.  The insurer's ability to develop an optional mutually
2703	supported benefit plan.
2704
2705	The office may use any financial information available to it
2706	through its regulatory duties to make this evaluation.
2707	(f)  Insurer qualifications.--The insurer shall be a duly
2708	authorized insurer or health maintenance organization.
2709	(g)  Duties of the insurer.--The insurer shall:
2710	1.  Develop and implement a program to publicize the
2711	existence of the program, program eligibility requirements, and
2712	procedures for enrollment and maintain public awareness of the
2713	program.
2714	2.  Maintain employer awareness of the program.
2715	3.  Demonstrate the ability to use delivery of cost-
2716	effective health care services.
2717	4.  Encourage, educate, advise, and administer the
2718	effective use of health savings accounts by covered employees
2719	and dependents.
2720	5.  Serve for a period specified in the contract between
2721	the office and the insurer, subject to removal for cause and
2722	subject to any terms, conditions, and limitations of the
2723	contract between the office and the insurer as may be specified
2724	in the request for proposal.
2725	(h)  Contract term.--The contract term shall not exceed 3
2726	years. At least 6 months prior to the expiration of each
2727	contract period, the office shall invite eligible entities,
2728	including the current insurer, to submit bids to serve as the
2729	insurer for a designated geographic area. Selection of the
2730	insurer for the succeeding period shall be made at least 3
2731	months prior to the end of the current period. If a protest is
2732	filed and not resolved by the end of the contract period, the
2733	contract with the existing administrator may be extended for a
2734	period not to exceed 6 months. During the contract extension
2735	period, the administrator shall be paid at a rate to be
2736	negotiated by the office.
2737	(i)  Insurer reporting requirements.--On March 1 following
2738	the close of each calendar year, the insurer shall determine net
2739	written and earned premiums, the expense of administration, and
2740	the paid and incurred losses for the year and report this
2741	information to the office on a form prescribed by the office.
2742	(j)  Application requirements.--The insurer shall permit or
2743	allow any licensed and duly appointed health insurance agent
2744	residing in the designated region to submit applications for
2745	coverage, and such agent shall be paid a fair commission if
2746	coverage is written. The agent must be appointed to at least one
2747	insurer.
2748	(k)  Benefits.--The benefits provided by the plan shall be
2749	the same as the coverage required for small employers under
2750	subsection (12). Upon the approval of the office, the insurer
2751	may also establish an optional mutually supported benefit plan
2752	which is an alternative plan developed within a defined
2753	geographic region of this state or any other such alternative
2754	plan which will carry out the intent of this subsection. Any
2755	small employer carrier issuing new health benefit plans may
2756	offer a benefit plan with coverages similar to, but not less
2757	than, any alternative coverage plan developed pursuant to this
2758	subsection.
2759	(l)  Annual reporting.--The office shall make an annual
2760	report to the Governor, the President of the Senate, and the
2761	Speaker of the House of Representatives. The report shall
2762	summarize the activities of the program in the preceding
2763	calendar year, including the net written and earned premiums,
2764	program enrollment, the expense of administration, and the paid
2765	and incurred losses. The report shall be submitted no later than
2766	March 15 following the close of the prior calendar year.
2767	(16)(15)  APPLICABILITY OF OTHER STATE LAWS.--
2768	(a)  Except as expressly provided in this section, a law
2769	requiring coverage for a specific health care service or
2770	benefit, or a law requiring reimbursement, utilization, or
2771	consideration of a specific category of licensed health care
2772	practitioner, does not apply to a standard or basic health
2773	benefit plan policy or contract or a limited benefit policy or
2774	contract offered or delivered to a small employer unless that
2775	law is made expressly applicable to such policies or contracts.
2776	A law restricting or limiting deductibles, coinsurance,
2777	copayments, or annual or lifetime maximum payments does not
2778	apply to any health plan policy, including a standard or basic
2779	health benefit plan policy or contract, offered or delivered to
2780	a small employer unless such law is made expressly applicable to
2781	such policy or contract. However, every small employer carrier
2782	must offer to eligible small employers the standard benefit plan
2783	and the basic benefit plan, as required by subsection (5), as
2784	such plans have been approved by the office pursuant to
2785	subsection (12).
2786	(b)  Except as provided in this section, a standard or
2787	basic health benefit plan policy or contract or limited benefit
2788	policy or contract offered to a small employer is not subject to
2789	any provision of this code which:
2790	1.  Inhibits a small employer carrier from contracting with
2791	providers or groups of providers with respect to health care
2792	services or benefits;
2793	2.  Imposes any restriction on a small employer carrier's
2794	ability to negotiate with providers regarding the level or
2795	method of reimbursing care or services provided under a health
2796	benefit plan; or
2797	3.  Requires a small employer carrier to either include a
2798	specific provider or class of providers when contracting for
2799	health care services or benefits or to exclude any class of
2800	providers that is generally authorized by statute to provide
2801	such care.
2802	(c)  Any second tier assessment paid by a carrier pursuant
2803	to paragraph (11)(j) may be credited against assessments levied
2804	against the carrier pursuant to s. 627.6494.
2805	(d)  Notwithstanding chapter 641, a health maintenance
2806	organization is authorized to issue contracts providing benefits
2807	equal to the standard health benefit plan, the basic health
2808	benefit plan, and the limited benefit policy authorized by this
2809	section.
2810	(17)(16)  RULEMAKING AUTHORITY.--The commission may adopt
2811	rules to administer this section, including rules governing
2812	compliance by small employer carriers and small employers.
2813	Section 25.  Section 627.6405, Florida Statutes, is created
2814	to read:
2815	627.6405  Decreasing inappropriate utilization of emergency
2816	care.--
2817	(1)  The Legislature finds and declares it to be of vital
2818	importance that emergency services and care be provided by
2819	hospitals and physicians to every person in need of such care,
2820	but with the double-digit increases in health insurance
2821	premiums, health care providers and insurers should encourage
2822	patients and the insured to assume responsibility for their
2823	treatment, including emergency care. The Legislature finds that
2824	inappropriate utilization of emergency department services
2825	increases the overall cost of providing health care and these
2826	costs are ultimately borne by the hospital, the insured
2827	patients, and, many times, by the taxpayers of this state.
2828	Finally, the Legislature declares that the providers and
2829	insurers must share the responsibility of providing alternative
2830	treatment options to urgent care patients outside of the
2831	emergency department. Therefore, it is the intent of the
2832	Legislature to place the obligation for educating consumers and
2833	creating mechanisms for delivery of care that will decrease the
2834	overutilization of emergency service on health insurers and
2835	providers.
2836	(2)  Health insurers shall provide on their websites
2837	information regarding appropriate utilization of emergency care
2838	services which shall include, but not be limited to, a list of
2839	alternative urgent care contracted providers, the types of
2840	services offered by these providers, and what to do in the event
2841	of a true emergency.
2842	(3)  Health insurers shall develop community emergency
2843	department diversion programs. Such programs may include, at the
2844	discretion of the insurer, but not be limited to, enlisting
2845	providers to be on call to insurers after hours, coordinating
2846	care through local community resources, and providing incentives
2847	to providers for case management.
2848	(4)  As a disincentive for insureds to inappropriately use
2849	emergency department services for nonemergency care, health
2850	insurers may require higher copayments for urgent care or
2851	primary care provided in an emergency department and higher
2852	copayments for use of out-of-network emergency departments.
2853	Higher copayments may not be charged for the utilization of the
2854	emergency department for emergency care. For the purposes of
2855	this section, the term "emergency care" has the same meaning as
2856	provided in s. 395.002, and shall include services provided to
2857	rule out an emergency medical condition.
2858	Section 26.  Section 641.31097, Florida Statutes, is
2859	created to read:
2860	641.31097  Decreasing inappropriate utilization of
2861	emergency care.--
2862	(1)  The Legislature finds and declares it to be of vital
2863	importance that emergency services and care be provided by
2864	hospitals and physicians to every person in need of such care,
2865	but with the double-digit increases in health insurance
2866	premiums, health care providers and insurers should encourage
2867	patients and the insured to assume responsibility for their
2868	treatment, including emergency care. The Legislature finds that
2869	inappropriate utilization of emergency department services
2870	increases the overall cost of providing health care and these
2871	costs are ultimately borne by the hospital, by the insured
2872	patients, and, many times, by the taxpayers of this state.
2873	Finally, the Legislature declares that the providers and
2874	insurers must share the responsibility of providing alternative
2875	treatment options to urgent care patients outside of the
2876	emergency department. Therefore, it is the intent of the
2877	Legislature to place the obligation for educating consumers and
2878	creating mechanisms for delivery of care that will decrease the
2879	overutilization of emergency service on health maintenance
2880	organizations and providers.
2881	(2)  Health maintenance organizations shall provide on
2882	their Internet websites information regarding appropriate
2883	utilization of emergency care services, which shall include, but
2884	not be limited to, a list of alternative urgent care contracted
2885	providers, the types of services offered by these providers, and
2886	what to do in the event of a true emergency.
2887	(3)  Health maintenance organizations shall develop
2888	community emergency department diversion programs. Such programs
2889	may include at the discretion of the health maintenance
2890	organization, but not be limited to, enlisting providers to be
2891	on call to subscribers after hours, coordinating care through
2892	local community resources, and providing incentives to providers
2893	for case management.
2894	(4)  As a disincentive for subscribers to inappropriately
2895	use emergency department services for nonemergency care, health
2896	maintenance organizations may require higher copayments for
2897	urgent care or primary care provided in an emergency department
2898	and higher copayments for use of out-of-network emergency
2899	departments. Higher copayments may not be charged for the
2900	utilization of the emergency department for emergency care. For
2901	the purposes of this section, the term "emergency care" has the
2902	same meaning as provided in s. 395.002 and shall include
2903	services provided to rule out an emergency medical condition.
2904	Section 27.  Subsection (1) of section 627.9175, Florida
2905	Statutes, is amended to read:
2906	627.9175  Reports of information on health and accident
2907	insurance.--
2908	(1)  Each health insurer, prepaid limited health services
2909	organization, and health maintenance organization shall submit,
2910	no later than April 1 of each year, annually to the office
2911	information concerning health and accident insurance coverage
2912	and medical plans being marketed and currently in force in this
2913	state. The required information shall be described by market
2914	segment, to include, but not be limited to:
2915	(a)  Issuing, servicing company, and entity contact
2916	information.
2917	(b)  Information on all health and accident insurance
2918	policies and prepaid limited health service organizations and
2919	health maintenance organization contracts in force and issued in
2920	the previous year. Such information shall include, but not be
2921	limited to, direct premiums earned, direct losses incurred,
2922	number of policies, number of certificates, number of covered
2923	lives, and the average number of days taken to pay claims. as to
2924	policies of individual health insurance:
2925	(a)  A summary of typical benefits, exclusions, and
2926	limitations for each type of individual policy form currently
2927	being issued in the state. The summary shall include, as
2928	appropriate:
2929	1.  The deductible amount;
2930	2.  The coinsurance percentage;
2931	3.  The out-of-pocket maximum;
2932	4.  Outpatient benefits;
2933	5.  Inpatient benefits; and
2934	6.  Any exclusions for preexisting conditions.
2935
2936	The commission shall determine other appropriate benefits,
2937	exclusions, and limitations to be reported for inclusion in the
2938	consumer's guide published pursuant to this section.
2939	(b)  A schedule of rates for each type of individual policy
2940	form reflecting typical variations by age, sex, region of the
2941	state, or any other applicable factor which is in use and is
2942	determined to be appropriate for inclusion by the commission.
2943
2944	The commission may establish rules governing shall provide by
2945	rule a uniform format for the submission of this information
2946	described in this section, including the use of uniform formats
2947	and electronic data transmission order to allow for meaningful
2948	comparisons of premiums charged for comparable benefits. The
2949	office shall provide this information to the department, which
2950	shall publish annually a consumer's guide which summarizes and
2951	compares the information required to be reported under this
2952	subsection.
2953	Section 28.  Chapter 636, Florida Statutes, entitled
2954	"Prepaid Limited Health Service Organizations," is retitled as
2955	"Prepaid Limited Health Service Organizations and Discount
2956	Medical Plan Organizations."
2957	Section 29.  Sections 636.002 through 636.067, Florida
2958	Statutes, are designated as part I of chapter 636, Florida
2959	Statutes, and entitled "Prepaid Limited Health Service
2960	Organizations."
2961	Section 30.  Paragraph (c) of subsection (7) of section
2962	636.003, Florida Statutes, is amended to read:
2963	636.003  Definitions.--As used in this act, the term:
2964	(7)  "Prepaid limited health service organization" means
2965	any person, corporation, partnership, or any other entity which,
2966	in return for a prepayment, undertakes to provide or arrange
2967	for, or provide access to, the provision of a limited health
2968	service to enrollees through an exclusive panel of providers.
2969	Prepaid limited health service organization does not include:
2970	(c)  Any person who is licensed pursuant to part II as a
2971	discount medical plan organization, in exchange for fees, dues,
2972	charges or other consideration, provides access to a limited
2973	health service provider without assuming any responsibility for
2974	payment for the limited health service or any portion thereof.
2975	Section 31.  Effective January 1, 2005, part II of chapter
2976	636, Florida Statutes, consisting of sections 636.202, 636.204,
2977	636.206, 636.208, 636.210, 636.212, 636.214, 636.216, 636.218,
2978	636.220, 636.222, 636.224, 636.226, 636.228, 636.230, 636.232,
2979	636.234, 636.236, 636.238, 636.240, 636.242, and 636.244, is
2980	created to read:
2981	PART II
2982	DISCOUNT MEDICAL PLAN ORGANIZATIONS
2983	636.202  Definitions.--As used in this part, the term:
2984	(1)  "Discount medical plan" means a business arrangement
2985	or contract in which a person, in exchange for fees, dues,
2986	charges, or other consideration, provides access for plan
2987	members to providers of medical services and the right to
2988	receive medical services from those providers at a discount. The
2989	term "discount medical plan" does not include any product
2990	regulated under chapter 627, chapter 641, or part I of chapter
2991	636.
2992	(2)  "Discount medical plan organization" means an entity
2993	which, in exchange for fees, dues, charges, or other
2994	consideration, provides access for plan members to providers of
2995	medical services and the right to receive medical services from
2996	those providers at a discount. The term "discount medical plan"
2997	does not include any product regulated under chapter 627,
2998	chapter 641, or part I of chapter 636.
2999	(3)  "Marketer" means a person or entity which markets,
3000	promotes, sells, or distributes a discount medical plan,
3001	including a private label entity which places its name on and
3002	markets or distributes a discount medical plan but does not
3003	operate a discount medical plan.
3004	(4)  "Medical services" means any care, service, or
3005	treatment of illness or dysfunction of, or injury to, the human
3006	body, including, but not limited to, physician care, inpatient
3007	care, hospital surgical services, emergency services, ambulance
3008	services, dental care services, vision care services, mental
3009	health services, substance abuse services, chiropractic
3010	services, podiatric care services, laboratory services, and
3011	medical equipment and supplies. The term does not include
3012	pharmaceutical supplies or prescriptions.
3013	(5)  "Member" means any person who pays fees, dues,
3014	charges, or other consideration for the right to receive the
3015	purported benefits of a discount medical plan.
3016	(6)  "Provider" means any person or institution which is
3017	contracted, directly or indirectly, with a discount medical plan
3018	organization to provide medical services to members.
3019	(7)  "Provider network" means an entity which negotiates on
3020	behalf of more than one provider with a discount medical plan
3021	organization to provide medical services to members.
3022	636.204  License required.--
3023	(1)  Before doing business in this state as a discount
3024	medical plan organization, an entity must be a corporation,
3025	incorporated under the laws of this state or, if a foreign
3026	corporation, authorized to transact business in this state, and
3027	must possess a license as a discount medical plan organization
3028	from the office.
3029	(2)  An application for a license to operate as a discount
3030	medical plan organization must be filed with the office on a
3031	form prescribed by the commission. Such application must be
3032	sworn to by an officer or authorized representative of the
3033	applicant and be accompanied by the following:
3034	(a)  A copy of the applicant's articles of incorporation,
3035	including all amendments.
3036	(b)  A copy of the corporation's bylaws.
3037	(c)  A list of the names, addresses, official positions,
3038	and biographical information of the individuals who are
3039	responsible for conducting the applicant's affairs, including,
3040	but not limited to, all members of the board of directors, board
3041	of trustees, executive committee, or other governing board or
3042	committee, the officers, contracted management company
3043	personnel, and any person or entity owning or having the right
3044	to acquire 10 percent or more of the voting securities of the
3045	applicant. Such listing must fully disclose the extent and
3046	nature of any contracts or arrangements between any individual
3047	who is responsible for conducting the applicant's affairs and
3048	the discount medical plan organization, including any possible
3049	conflicts of interest.
3050	(d)  A complete biographical statement, on forms prescribed
3051	by the commission, an independent investigation report, and a
3052	set of fingerprints, as provided in chapter 624, with respect to
3053	each individual identified under paragraph (c).
3054	(e)  A statement generally describing the applicant, its
3055	facilities and personnel, and the medical services to be
3056	offered.
3057	(f)  A copy of the form of all contracts made or to be made
3058	between the applicant and any providers or provider networks
3059	regarding the provision of medical services to members.
3060	(g)  A copy of the form of any contract made or arrangement
3061	to be made between the applicant and any person listed in
3062	paragraph (c).
3063	(h)  A copy of the form of any contract made or to be made
3064	between the applicant and any person, corporation, partnership,
3065	or other entity for the performance on the applicant's behalf of
3066	any function, including, but not limited to, marketing,
3067	administration, enrollment, investment management, and
3068	subcontracting for the provision of health services to members.
3069	(i)  A copy of the applicant's most recent financial
3070	statements audited by an independent certified public
3071	accountant.
3072	(j)  A description of the proposed method of marketing.
3073	(k)  A description of the subscriber complaint procedures
3074	to be established and maintained.
3075	(l)  The fee for issuance of a license.
3076	(m)  Such other information as the commission or office may
3077	reasonably require to make the determinations required by this
3078	part.
3079	(3)  The office shall issue a license which shall expire 1
3080	year later, and each year on that date thereafter, and which the
3081	office shall renew if the licensee pays the annual license fee
3082	of $50 and if the office is satisfied that the licensee is in
3083	compliance with this part.
3084	(4)  Prior to licensure by the office, each discount
3085	medical plan organization must establish an Internet website so
3086	as to conform to the requirements of s. 636.226.
3087	(5)  The license fee under subsection (2) is $50 per year
3088	per licensee. All amounts collected shall be deposited into the
3089	General Revenue Fund.
3090	(6)  Nothing in this part requires a provider who provides
3091	discounts to his or her own patients to obtain and maintain a
3092	license as a discount medical plan organization.
3093	636.206  Examinations and investigations.--
3094	(1)  The office may examine or investigate the business and
3095	affairs of any discount medical plan organization. The office
3096	may order any discount medical plan organization or applicant to
3097	produce any records, books, files, advertising and solicitation
3098	materials, or other information and may take statements under
3099	oath to determine whether the discount medical plan organization
3100	or applicant is in violation of the law or is acting contrary to
3101	the public interest. The expenses incurred in conducting any
3102	examination or investigation must be paid by the discount
3103	medical plan organization or applicant. Examinations and
3104	investigations must be conducted as provided in chapter 624, and
3105	discount medical plan organizations are subject to all
3106	applicable provisions of the insurance code.
3107	(2)  Failure by the discount medical plan organization to
3108	pay the expenses incurred under subsection (1) is grounds for
3109	denial or revocation.
3110	636.208  Fees.--A discount medical plan organization may
3111	charge a reasonable one-time processing fee and a periodic
3112	charge. If a discount medical plan charges for a time period in
3113	excess of one month, the plan must, in the event of cancellation
3114	of the membership by either party, make a pro rata reimbursement
3115	of the fees to the member.
3116	636.210  Prohibited activities of a discount medical plan
3117	organization.--
3118	(1)  A discount medical plan organization may not:
3119	(a)  Use in its advertisements, marketing material,
3120	brochures, and discount cards the term "insurance" except as
3121	otherwise provided in this part;
3122	(b)  Use in its advertisements, marketing material,
3123	brochures, and discount cards the terms "health plan,"
3124	"coverage," "copay," "copayments," "preexisting conditions,"
3125	"guaranteed issue," "premium," "enrollment," "PPO," "preferred
3126	provider organization," or other terms that could reasonably
3127	mislead a person into believing the discount medical plan was
3128	health insurance;
3129	(c)  Have restrictions on free access to plan providers,
3130	including, but not limited to, waiting periods and notification
3131	periods; or
3132	(d)  Pay providers any fees for medical services.
3133	(2)  A discount medical plan organization may not collect
3134	or accept money from a member for payment to a provider for
3135	specific medical services furnished or to be furnished to the
3136	member unless the organization has an active certificate of
3137	authority from the office to act as an administrator.
3138	636.212  Disclosures.--The following disclosures must be
3139	made in writing to any prospective member and must be on the
3140	first page of any advertisements, marketing materials, or
3141	brochures relating to a discount medical plan. The disclosures
3142	must be printed in not less than 12-point type or no smaller
3143	than the largest type on the page if larger than 12-point type:
3144	(1)  That the plan is not a health insurance policy.
3145	(2)  That the plan provides discounts at certain health
3146	care providers for medical services.
3147	(3)  That the plan does not make payments directly to the
3148	providers of medical services.
3149	(4)  That the plan member is obligated to pay for all
3150	health care services but will receive a discount from those
3151	health care providers who have contracted with the discount plan
3152	organization.
3153	(5)  The corporate name and the locations of the licensed
3154	discount medical plan organization.
3155	636.214  Provider agreements.--
3156	(1)  All providers offering medical services to members
3157	under a discount medical plan must provide such services
3158	pursuant to a written agreement. The agreement may be entered
3159	into directly by the provider or by a provider network to which
3160	the provider belongs.
3161	(2)  A provider agreement must provide the following:
3162	(a)  A list of the services and products to be provided at
3163	a discount.
3164	(b)  The amount or amounts of the discounts or,
3165	alternatively, a fee schedule which reflects the provider's
3166	discounted rates.
3167	(c)  That the provider will not charge members more than
3168	the discounted rates.
3169	(3)  A provider agreement between a discount medical plan
3170	organization and a provider network shall require that the
3171	provider network have written agreements with its providers
3172	which:
3173	(a)  Contain the terms described in subsection (2).
3174	(b)  Authorize the provider network to contract with the
3175	discount medical plan organization on behalf of the provider.
3176	(c)  Require the network to maintain an up-to-date list of
3177	its contracted providers and to provide that list on a monthly
3178	basis to the discount medical plan organization.
3179	(4)  The discount medical plan organization shall maintain
3180	a copy of each active provider agreement.
3181	636.216  Form filings.--
3182	(1)  All charges to members must be filed with the office
3183	and any charge to members greater than $30 per month or $360 per
3184	year must be approved by the office before the charges can be
3185	used. The discount medical plan organization has the burden of
3186	proof that the charges bear a reasonable relation to the
3187	benefits received by the member.
3188	(2)  There must be a written agreement between the discount
3189	medical plan organization and the member specifying the benefits
3190	under the discount medical plan and complying with the
3191	disclosure requirements of this part.
3192	(3)  All forms used, including the written agreement
3193	pursuant to subsection (2), must first be filed with and
3194	approved by the office. Every form filed shall be identified by
3195	a unique form number placed in the lower left corner of each
3196	form.
3197	(4)  If such filings are disapproved, the office shall
3198	notify the discount medical plan organization and shall specify
3199	in the notice the reasons for disapproval. The discount medical
3200	plan organization has 21 days from the date of receipt of notice
3201	to request a hearing before the office pursuant to chapter 120.
3202	636.218  Annual reports.--
3203	(1)  Each discount medical plan organization must file with
3204	the office, within 3 months after the end of each fiscal year,
3205	an annual report.
3206	(2)  Such reports must be on forms prescribed by the
3207	commission and must include:
3208	(a)  Audited financial statements prepared in accordance
3209	with generally accepted accounting principles certified by an
3210	independent certified public accountant, including the
3211	organization's balance sheet, income statement, and statement of
3212	changes in cash flow for the preceding year.
3213	(b)  A list of the names and residence addresses of all
3214	persons responsible for the conduct of the organization's
3215	affairs, together with a disclosure of the extent and nature of
3216	any contracts or arrangements between such persons and the
3217	discount medical plan organization, including any possible
3218	conflicts of interest.
3219	(c)  The number of discount medical plan members.
3220	(d)  Such other information relating to the performance of
3221	the discount medical plan organization as is reasonably required
3222	by the commission or office.
3223	(3)  Every discount medical plan organization which fails
3224	to file an annual report in the form and within the time
3225	required by this section shall forfeit up to $500 for each day
3226	for the first 10 days during which the neglect continues and
3227	shall forfeit up to $1,000 for each day after the first 10 days
3228	during which the neglect continues; and, upon notice by the
3229	office to that effect, the organization's authority to enroll
3230	new members or to do business in this state ceases while such
3231	default continues. The office shall deposit all sums collected
3232	by the office under this section to the credit of the Insurance
3233	Regulatory Trust Fund. The office may not collect more than
3234	$50,000 for each report.
3235	636.220  Minimum capital requirements.?-
3236	(1)  Each discount medical plan organization must at all
3237	times maintain a net worth of at least $150,000.
3238	(2)  The office may not issue a license unless the discount
3239	medical plan organization has a net worth of at least $150,000.
3240	636.222  Suspension or revocation of license; suspension of
3241	enrollment of new members; terms of suspension.--
3242	(1)  The office may suspend the authority of a discount
3243	medical plan organization to enroll new members, revoke any
3244	license issued to a discount medical plan organization, or order
3245	compliance if the office finds that any of the following
3246	conditions exist:
3247	(a)  The organization is not operating in compliance with
3248	this part.
3249	(b)  The organization does not have the minimum net worth
3250	as required by this part.
3251	(c)  The organization has advertised, merchandised, or
3252	attempted to merchandise its services in such a manner as to
3253	misrepresent its services or capacity for service or has engaged
3254	in deceptive, misleading, or unfair practices with respect to
3255	advertising or merchandising.
3256	(d)  The organization is not fulfilling its obligations as
3257	a medical discount medical plan organization.
3258	(e)  The continued operation of the organization would be
3259	hazardous to its members.
3260	(2)  If the office has cause to believe that grounds for
3261	the suspension or revocation of a license exist, the office
3262	shall notify the discount medical plan organization in writing
3263	specifically stating the grounds for suspension or revocation
3264	and shall pursue a hearing on the matter in accordance with the
3265	provisions of chapter 120.
3266	(3)  When the license of a discount medical plan
3267	organization is surrendered or revoked, such organization must
3268	proceed, immediately following the effective date of the order
3269	of revocation, to wind up its affairs transacted under the
3270	license. The organization may not engage in any further
3271	advertising, solicitation, collecting of fees, or renewal of
3272	contracts.
3273	(4)  The office shall, in its order suspending the
3274	authority of a discount medical plan organization to enroll new
3275	members, specify the period during which the suspension is to be
3276	in effect and the conditions, if any, which must be met by the
3277	discount medical plan organization prior to reinstatement of its
3278	license to enroll new members. The order of suspension is
3279	subject to rescission or modification by further order of the
3280	office prior to the expiration of the suspension period.
3281	Reinstatement may not be made unless requested by the discount
3282	medical plan organization; however, the office may not grant
3283	reinstatement if it finds that the circumstances for which the
3284	suspension occurred still exist or are likely to recur.
3285	636.224  Notice of change of name or address of discount
3286	medical plan organization.--Each discount medical plan
3287	organization must provide the office at least 30 days' advance
3288	notice of any change in the discount medical plan organization's
3289	name, address, principal business address, or mailing address.
3290	636.226  Provider name listing.?-Each discount medical plan
3291	organization must maintain an up-to-date list of the names and
3292	addresses of the providers with which it has contracted, on an
3293	Internet website page, the address of which shall be prominently
3294	displayed on all its advertisements, marketing materials,
3295	brochures, and discount cards. This section applies to those
3296	providers with whom the discount medical plan organization has
3297	contracted directly, as well as those who are members of a
3298	provider network with which the discount medical plan
3299	organization has contracted.
3300	636.228  Marketing of discount medical plans.--
3301	(1)  All advertisements, marketing materials, brochures,
3302	and discount cards used by marketers must be approved in writing
3303	for such use by the discount medical plan organization.
3304	(2)  The discount medical plan organization shall have an
3305	executed written agreement with a marketer prior to the
3306	marketer's marketing, promoting, selling, or distributing the
3307	discount medical plan and shall be responsible and financially
3308	liable for any acts of its marketers that do not comply with the
3309	provisions of this part.
3310	636.230  Bundling discount medical plans with other
3311	insurance products.?-When a marketer or discount medical plan
3312	organization sells a discount medical plan together with any
3313	other product, the fees for each individual product must be
3314	provided in writing to the member and itemized.
3315	636.232  Rules.--The commission may adopt rules to
3316	administer this part, including rules for the licensing of
3317	discount medical plan organizations; establishing standards for
3318	evaluating forms, advertisements, marketing materials,
3319	brochures, and discount cards; providing for the collection of
3320	data; relating to disclosures to plan members; and defining
3321	terms used in this part.
3322	636.234  Service of process on a discount medical plan
3323	organization.-?Sections 624.422 and 624.423 apply to a discount
3324	medical plan organization as if the discount medical plan
3325	organization were an insurer.
3326	636.236  Security deposit.--
3327	(1)  A licensed discount medical plan organization must
3328	deposit and maintain deposited in trust with the department
3329	securities eligible for deposit under s. 625.52, having at all
3330	times a value of not less than $35,000, for use by the office in
3331	protecting plan members.
3332	(2)  No judgment creditor or other claimant of a discount
3333	medical plan organization, other than the office or department,
3334	shall have the right to levy upon any of the assets or
3335	securities held in this state as a deposit under subsection (1).
3336	636.238  Penalties for violation of this part.--
3337	(1)  Except as provided in subsection (2), a person who
3338	violates any provision of this part commits a misdemeanor of the
3339	second degree, punishable as provided in s. 775.082 or s.
3340	775.083.
3341	(2)  A person who operates as or aids and abets another
3342	operating as a discount medical plan organization in violation
3343	of s. 636.204(1) commits a felony punishable as provided for in
3344	s. 624.401(4)(b), as if the unlicensed discount medical plan
3345	organization were an unauthorized insurer, and the fees, dues,
3346	charges, or other consideration collected from the members by
3347	the unlicensed discount medical plan organization or marketer
3348	were insurance premium.
3349	(3)  A person who collects fees for purported membership in
3350	a discount medical plan but fails to provide the promised
3351	benefits commits a theft, punishable as provided in s. 812.014.
3352	636.240  Injunctions.--
3353	(1)  In addition to the penalties and other enforcement
3354	provisions of this part, the office may seek both temporary and
3355	permanent injunctive relief when:
3356	(a)  A discount medical plan is being operated by any
3357	person or entity that is not licensed pursuant to this part.
3358	(b)  Any person, entity, or discount medical plan
3359	organization has engaged in any activity prohibited by this part
3360	or any rule adopted pursuant to this part.
3361	(2)  The venue for any proceeding bought pursuant to this
3362	section shall be in the Circuit Court of Leon County.
3363	(3)  The office's authority to seek injunctive relief is
3364	not conditioned on having conducted any proceeding pursuant to
3365	chapter 120.
3366	636.242  Civil remedies.--Any person damaged by the acts of
3367	a person in violation of this part may bring a civil action
3368	against the person committing the violation in the circuit court
3369	of the county in which the alleged violator resides or has a
3370	principal place of business or in the county in which the
3371	alleged violation occurred. Upon an adverse adjudication, the
3372	defendant is liable for damages, together with court costs and
3373	reasonable attorney's fees incurred by the plaintiff. When so
3374	awarded, court costs and attorney's fees must be included in the
3375	judgment or decree rendered in the case. If it appears to the
3376	court that the suit brought by the plaintiff is frivolous or
3377	brought for purposes of harassment, the court may apply
3378	sanctions in accordance with chapter 57.
3379	636.244  Unlicensed discount medical plan
3380	organizations.--The provisions of ss. 626.901-626.912 apply to
3381	The provisions of ss. 626.901-626.912 apply to the activities of
3382	an unlicensed discount medical plan organization as if the
3383	unlicensed discount medical plan organization were an
3384	unauthorized insurer.
3385	Section 32.  Section 627.65626, Florida Statutes, is
3386	created to read:
3387	627.65626  Insurance rebates for healthy lifestyles.--
3388	(1)  Any rate, rating schedule, or rating manual for a
3389	health insurance policy filed with the office shall provide for
3390	an appropriate rebate of premiums paid in the last calendar year
3391	when the majority of members of a health plan have enrolled and
3392	maintained participation in any health wellness, maintenance, or
3393	improvement program offered by the employer. The employer must
3394	provide evidence of demonstrative maintenance or improvement of
3395	the enrollees' health status as determined by assessments of
3396	agreed-upon health status indicators between the employer and
3397	the health insurer, including, but not limited to, reduction in
3398	weight, body mass index, and smoking cessation. Any rebate
3399	provided by the health insurer is presumed to be appropriate
3400	unless credible data demonstrates otherwise, but shall not
3401	exceed 10 percent of paid premiums.
3402	(2)  The premium rebate authorized by this section shall be
3403	effective for an insured on an annual basis, unless the number
3404	of participating employees becomes less than the majority of the
3405	employees eligible for participation in the wellness program.
3406	Section 33.  Section 627.6402, Florida Statutes, is created
3407	to read:
3408	627.6402  Insurance rebates for healthy lifestyles.--
3409	(1)  Any rate, rating schedule, or rating manual for an
3410	individual health insurance policy filed with the office shall
3411	provide for an appropriate rebate of premiums paid in the last
3412	calendar year when the individual covered by such plan is
3413	enrolled in and maintains participation in any health wellness,
3414	maintenance, or improvement program approved by the health plan.
3415	The individual must provide evidence of demonstrative
3416	maintenance or improvement of the individual's health status as
3417	determined by assessments of agreed-upon health status
3418	indicators between the individual and the health insurer,
3419	including, but not limited to, reduction in weight, body mass
3420	index, and smoking cessation. Any rebate provided by the health
3421	insurer is presumed to be appropriate unless credible data
3422	demonstrates otherwise, but shall not exceed 10 percent of paid
3423	premiums.
3424	(2)  The premium rebate authorized by this section shall be
3425	effective for an insured on an annual basis, unless the
3426	individual fails to maintain or improve his or her health status
3427	while participating in an approved wellness program, or credible
3428	evidence demonstrates that the individual is not participating
3429	in the approved wellness program.
3430	Section 34.  Subsection (38) of section 641.31, Florida
3431	Statutes, is amended, and subsection (40) is added to said
3432	section, to read:
3433	641.31  Health maintenance contracts.--
3434	(38)(a)  Notwithstanding any other provision of this part,
3435	a health maintenance organization that meets the requirements of
3436	paragraph (b) may, through a point-of-service rider to its
3437	contract providing comprehensive health care services, include a
3438	point-of-service benefit. Under such a rider, a subscriber or
3439	other covered person of the health maintenance organization may
3440	choose, at the time of covered service, a provider with whom the
3441	health maintenance organization does not have a health
3442	maintenance organization provider contract. The rider may not
3443	require a referral from the health maintenance organization for
3444	the point-of-service benefits.
3445	(b)  A health maintenance organization offering a point-of-
3446	service rider under this subsection must have a valid
3447	certificate of authority issued under the provisions of the
3448	chapter, must have been licensed under this chapter for a
3449	minimum of 3 years, and must at all times that it has riders in
3450	effect maintain a minimum surplus of $5 million. A health
3451	maintenance organization offering a point-of-service rider to
3452	its contract providing comprehensive health care services may
3453	offer the rider to employers who have employees living and
3454	working outside the health maintenance organization's approved
3455	geographic service area without having to obtain a health care
3456	provider certificate, as long as the master group contract is
3457	issued to an employer that maintains its primary place of
3458	business within the health maintenance organization's approved
3459	service area. Any member or subscriber that lives and works
3460	outside the health maintenance organization's service area and
3461	elects coverage under the health maintenance organization's
3462	point-of-service rider must provide a statement to the health
3463	maintenance organization that indicates the member or subscriber
3464	understands the limitations of his or her policy and that only
3465	those benefits under the point-of-service rider will be covered
3466	when services are provided outside the service area.
3467	(c)  Premiums paid in for the point-of-service riders may
3468	not exceed 15 percent of total premiums for all health plan
3469	products sold by the health maintenance organization offering
3470	the rider. If the premiums paid for point-of-service riders
3471	exceed 15 percent, the health maintenance organization must
3472	notify the office and, once this fact is known, must immediately
3473	cease offering such a rider until it is in compliance with the
3474	rider premium cap.
3475	(d)  Notwithstanding the limitations of deductibles and
3476	copayment provisions in this part, a point-of-service rider may
3477	require the subscriber to pay a reasonable copayment for each
3478	visit for services provided by a noncontracted provider chosen
3479	at the time of the service. The copayment by the subscriber may
3480	either be a specific dollar amount or a percentage of the
3481	reimbursable provider charges covered by the contract and must
3482	be paid by the subscriber to the noncontracted provider upon
3483	receipt of covered services. The point-of-service rider may
3484	require that a reasonable annual deductible for the expenses
3485	associated with the point-of-service rider be met and may
3486	include a lifetime maximum benefit amount. The rider must
3487	include the language required by s. 627.6044 and must comply
3488	with copayment limits described in s. 627.6471. Section 641.3154
3489	does not apply to a point-of-service rider authorized under this
3490	subsection.
3491	(e)  The point-of-service rider must contain provisions
3492	that comply with s. 627.6044.
3493	(f)(e)  The term "point of service" may not be used by a
3494	health maintenance organization except with riders permitted
3495	under this section or with forms approved by the office in which
3496	a point-of-service product is offered with an indemnity carrier.
3497	(g)(f)  A point-of-service rider must be filed and approved
3498	under ss. 627.410 and 627.411.
3499	(40)(a)  Any rate, rating schedule, or rating manual for a
3500	health maintenance organization policy filed with the office
3501	shall provide for an appropriate rebate of premiums paid in the
3502	last calendar year when the individual covered by such plan is
3503	enrolled in and maintains participation in any health wellness,
3504	maintenance, or improvement program approved by the health plan.
3505	The individual must provide evidence of demonstrative
3506	maintenance or improvement of his or her health status as
3507	determined by assessments of agreed-upon health status
3508	indicators between the individual and the health insurer,
3509	including, but not limited to, reduction in weight, body mass
3510	index, and smoking cessation. Any rebate provided by the health
3511	insurer is presumed to be appropriate unless credible data
3512	demonstrates otherwise, but shall not exceed 10 percent of paid
3513	premiums.
3514	(b)  The premium rebate authorized by this section shall be
3515	effective for an insured on an annual basis, unless the
3516	individual fails to maintain or improve his or her health status
3517	while participating in an approved wellness program, or credible
3518	evidence demonstrates that the individual is not participating
3519	in the approved wellness program.
3520	Section 35.  Section 626.191, Florida Statutes, is amended
3521	to read:
3522	626.191  Repeated applications.--The failure of an
3523	applicant to secure a license upon an application shall not
3524	preclude the applicant him or her from applying again as many
3525	times as desired, but the department or office shall not give
3526	consideration to or accept any further application by the same
3527	individual for a similar license dated or filed within 30 days
3528	subsequent to the date the department or office denied the last
3529	application, except as provided in s. 626.281.
3530	Section 36.  Subsection (1) of section 626.201, Florida
3531	Statutes, is amended to read:
3532	626.201  Investigation.--
3533	(1)  The department or office may propound any reasonable
3534	interrogatories in addition to those contained in the
3535	application, to any applicant for license or appointment, or on
3536	any renewal, reinstatement, or continuation thereof, relating to
3537	the applicant's his or her qualifications, residence,
3538	prospective place of business, and any other matter which, in
3539	the opinion of the department or office, is deemed necessary or
3540	advisable for the protection of the public and to ascertain the
3541	applicant's qualifications.
3542	Section 37.  Section 626.593, Florida Statutes, is created
3543	to read:
3544	626.593  Insurance agent; written contract for
3545	compensation.--
3546	(1)  No person licensed as an insurance agent may receive
3547	any fee or commission or any other thing of value in addition to
3548	the rates filed pursuant to chapter 627 for examining any group
3549	health insurance or any group health benefit plan for the
3550	purpose of giving or offering advice, counsel, recommendation,
3551	or information in respect to terms, conditions, benefits,
3552	coverage, or premium of any such policy or contract unless such
3553	compensation is based upon a written contract signed by the
3554	party to be charged and specifying or clearly defining the
3555	amount or extent of such compensation and informing the party to
3556	be charged that any commission received from an insurer will be
3557	rebated to the party in accordance with subsection (3). In
3558	addition, all compensation to be paid to the insurance agent
3559	must be disclosed in the contract.
3560	(2)  A copy of every such contract shall be retained by the
3561	licensee for not less than 3 years after such services have been
3562	fully performed.
3563	(3)  Notwithstanding the provisions of s. 626.572, all
3564	commissions received by an insurance agent from an insurer in
3565	connection with the issuance of a policy, when a separate fee or
3566	other consideration has been paid to the insurance agent by an
3567	insured, shall be rebated to the insured or other party being
3568	charged within 30 days after receipt of such commission by the
3569	insurance agent.
3570	(4)  This section is subject to the unfair insurance trade
3571	practices provisions of s. 626.9541(1)(g).
3572	Section 38.  Notwithstanding the amendment to s.
3573	627.6699(5)(c), Florida Statutes, by this act, any right to an
3574	open enrollment offer of health benefit coverage for groups of
3575	fewer than two employees, pursuant to s. 627.6699(5)(c), Florida
3576	Statutes, as it existed immediately before the effective date of
3577	this act, shall remain in full force and effect until the
3578	enactment of s. 627.64872, Florida Statutes, and the subsequent
3579	date upon which such plan begins to accept new risks or members.
3580	Section 39.  Section 465.0244, Florida Statutes, is created
3581	to read:
3582	465.0244  Information disclosure.--Every pharmacy shall
3583	make available on its Internet website a link to the performance
3584	outcome and financial data that is published by the Agency for
3585	Health Care Administration pursuant to s. 408.05(3)(l) and shall
3586	place in the area where customers receive filled prescriptions
3587	notice that such information is available electronically and the
3588	address of its Internet website.
3589	Section 40.  Section 627.6499, Florida Statutes, is amended
3590	to read:
3591	627.6499  Reporting by insurers and third-party
3592	administrators.--
3593	(1)  The office may require any insurer, third-party
3594	administrator, or service company to report any information
3595	reasonably required to assist the board in assessing insurers as
3596	required by this act.
3597	(2)  Each health insurance issuer shall make available on
3598	its Internet website a link to the performance outcome and
3599	financial data that is published by the Agency for Health Care
3600	Administration pursuant to s. 408.05(3)(l) and shall include in
3601	every policy delivered or issued for delivery to any person in
3602	the state or any materials provided as required by s. 627.64725
3603	notice that such information is available electronically and the
3604	address of its Internet website.
3605	Section 41.  Subsections (6) and (7) are added to section
3606	641.54, Florida Statutes, to read:
3607	641.54  Information disclosure.--
3608	(6)  Each health maintenance organization shall make
3609	available to its subscribers the estimated copay, coinsurance
3610	percentage, or deductible, whichever is applicable, for any
3611	covered services, the status of the subscriber's maximum annual
3612	out-of-pocket payments for a covered individual or family, and
3613	the status of the subscriber's maximum lifetime benefit. Such
3614	estimate shall not preclude the actual copay, coinsurance
3615	percentage, or deductible, whichever is applicable, from
3616	exceeding the estimate.
3617	(7)  Each health maintenance organization shall make
3618	available on its Internet website a link to the performance
3619	outcome and financial data that is published by the Agency for
3620	Health Care Administration pursuant to s. 408.05(3)(l) and shall
3621	include in every policy delivered or issued for delivery to any
3622	person in the state or any materials provided as required by s.
3623	627.64725 notice that such information is available
3624	electronically and the address of its Internet website.
3625	Section 42.  Section 408.02, Florida Statutes, is repealed.
3626	Section 43.  The sum of $250,000 is appropriated from the
3627	Insurance Regulatory Trust Fund in the Department of Financial
3628	Services to the Office of Insurance Regulation for the purpose
3629	of implementing the provisions in this act relating to the Small
3630	Employers Access Program.
3631	Section 44.  The sum of $250,000 is appropriated from the
3632	Insurance Regulatory Trust Fund to enable the board of the
3633	Florida Health Insurance Plan to conduct an actuarial study
3634	required under s. 627.64872, Florida Statutes.
3635	Section 45.  The sum of $169,069 is appropriated from the
3636	Insurance Regulatory Trust Fund in the Department of Financial
3637	Services to the Office of Insurance Regulation, and three full-
3638	time equivalent positions are authorized, for the purpose of
3639	implementing the provisions in this act relating to the
3640	regulation of Discount Medical Plan Organizations.
3641	Section 46.  The sum of $650,000 is appropriated from the
3642	General Revenue Fund to the Agency for Health Care
3643	Administration for the purposes of implementing the Florida
3644	Patient Safety Corporation. The sum of $350,000 shall be used as
3645	startup funds for the Florida Patient Safety Corporation and
3646	$300,000 shall be used for the "near miss" project within the
3647	Florida Patient Safety Corporation.
3648	Section 47.  The sum of $1,136,171 is appropriated from the
3649	General Revenue Fund to the Agency for Health Care
3650	Administration, and 11 full-time equivalent positions are
3651	authorized, for the purposes of implementing the provisions of
3652	this act relating to the reporting of performance and cost data
3653	for hospitals, physicians, and pharmacies.
3654	Section 48.  Except as otherwise provided herein, this act
3655	shall take effect July 1, 2004.

CODING: Words stricken are deletions; words underlined are additions.