Senate Bill sb0560c1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2005 CS for SB 560
By the Committee on Banking and Insurance; and Senator Bullard
597-2088-05
1 A bill to be entitled
2 An act relating to congenital craniofacial
3 anomalies; requiring that the Agency for Health
4 Care Administration, in consultation with the
5 Office of Insurance Regulation, conduct a study
6 concerning the medical necessity, costs, and
7 efficacy of mandating coverage for certain
8 treatments and therapies; providing an
9 appropriation; requiring that the agency report
10 its findings and recommendations to the
11 Legislature; providing an effective date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. (1) The Agency for Health Care
16 Administration, in consultation with the Office of Insurance
17 Regulation, shall conduct a study evaluating the medical
18 necessity, efficacy, and costs associated with mandating
19 health insurers and health maintenance organizations to
20 provide coverage for cranial skull molding orthotics and other
21 therapies used in the treatment of deformational or positional
22 plagiocephaly. The agency and office shall evaluate whether or
23 not gaps in coverage currently exist in the small and large
24 group insurance markets for medically necessary care and
25 treatment of plagiocephaly. The agency shall provide
26 information concerning the types of benefits, including the
27 cost of such benefits, provided to Medicaid recipients for the
28 treatment of plagiocephaly, and the demographic
29 characteristics of such Medicaid recipients. The Department of
30 Health shall coordinate with the agency to provide such
31 information concerning coverage and costs provided to children
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2005 CS for SB 560
597-2088-05
1 having plagiocephaly who are enrolled in the Children's
2 Medical Services Program.
3 (2) The agency, in consultation with the office, may
4 contract with an actuary who is a member of the American
5 Academy of Actuaries and other persons who have an extensive
6 background in health insurance for the purpose of assisting
7 the agency in evaluating the medically necessity, efficacy,
8 and costs of such coverage. The agency shall report its
9 findings and recommendations related to mandating insurance
10 coverage for the treatment of plagiocephaly to the President
11 of the Senate and the Speaker of the House of Representatives
12 no later than January 1, 2006.
13 Section 2. For the 2005-2006 fiscal year, the sum of
14 $25,000 is appropriated in nonrecurring funds from the
15 Insurance Regulatory Trust Fund to the Office of Insurance
16 Regulation for the purpose of funding the study conducted by
17 the Agency for Health Care Administration as provided in this
18 act.
19 Section 3. This act shall take effect on July 1, 2005.
20
21
22
23
24
25
26
27
28
29
30
31
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2005 CS for SB 560
597-2088-05
1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 560
3
4 The committee substitute provides the following changes:
5 1. Eliminates the requirement that health insurers and
health maintenance organizations provide individual and
6 group coverage for all medically necessary equipment,
supplies, supplements, and patient self-management
7 training and educational services used to treat a
congenital craniofacial anomaly if the treating physician
8 or the physician specializing in such treatment certifies
that such services are necessary.
9
2. Requires the Agency for Health Care Administration
10 (agency), in consultation with the Office of Insurance
Regulation, to conduct a study evaluating the medical
11 necessity, efficacy, and costs associated with mandating
health insurance coverage for cranial skull molding
12 orthotics and other therapies used in the treatment of
certain craniofacial anomalies. The agency and office are
13 required to submit a report that includes findings and
legislative recommendations to the Legislature by January
14 1, 2006.
15 3. The bill appropriates $25,000 from the Insurance
Regulatory Trust Fund to the Office of Insurance
16 Regulation for the purpose of funding the study.
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
3
CODING: Words stricken are deletions; words underlined are additions.