Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 1274
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CHAMBER ACTION
Senate House
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03/30/2006 09:27 AM .
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11 The Committee on Banking and Insurance (Atwater) recommended
12 the following amendment:
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14 Senate Amendment (with title amendment)
15 Delete everything after the enacting clause
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17 and insert:
18 Section 1. Effective July 1, 2006, subsection (5) of
19 section 408.909, Florida Statutes, is amended to read:
20 408.909 Health flex plans.--
21 (5) ELIGIBILITY.--Eligibility to enroll in an approved
22 health flex plan is limited to residents of this state who
23 meet all of the following requirements:
24 (a) Are 64 years of age or younger.;
25 (b) Have a family income equal to or less than 250 200
26 percent of the federal poverty level.;
27 (c) Are eligible under a federally approved Medicaid
28 demonstration waiver and reside in Palm Beach County or
29 Miami-Dade County.;
30 (d) Are not covered by a private insurance policy and
31 are not eligible for coverage through a public health
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 1274
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1 insurance program, such as Medicare or Medicaid, unless
2 specifically authorized under paragraph (c), or another public
3 health care program, such as KidCare, and have not been
4 covered at any time during the past 6 months.; and
5 (e) Have applied for health care coverage through an
6 approved health flex plan and have agreed to make any payments
7 required for participation, including periodic payments or
8 payments due at the time health care services are provided.
9 (f) Are part of an employer group where at least 75
10 percent of the employees have a family income equal to or less
11 than 250 percent of the federal poverty level.
12 Section 2. Subsection (3) is added to section 627.642,
13 Florida Statutes, to read:
14 627.642 Outline of coverage.--
15 (3) In addition to the outline of coverage, a policy
16 as specified in s. 627.6699(3)(k) must be accompanied by an
17 identification card that contains, at a minimum:
18 (a) The name of the organization issuing the policy or
19 the name of the organization administering the policy,
20 whichever applies.
21 (b) The name of the contract holder.
22 (c) The type of plan only if the plan is filed in the
23 state, an indication that the plan is self-funded, or the name
24 of the network.
25 (d) The member identification number, contract number,
26 and policy or group number, if applicable.
27 (e) A contact phone number or electronic address for
28 authorizations.
29 (f) A phone number or electronic address whereby the
30 covered person or hospital, physician, or other person
31 rendering services covered by the policy may determine if the
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 1274
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1 plan is insured and may obtain a benefits verification in
2 order to estimate patient financial responsibility, in
3 compliance with privacy rules under the Health Insurance
4 Portability and Accountability Act.
5 (g) The national plan identifier, in accordance with
6 the compliance date set forth by the federal Department of
7 Health and Human Services.
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9 The identification card must present the information in a
10 readily identifiable manner or, alternatively, the information
11 may be embedded on the card and available through magnetic
12 stripe or smart card. The information may also be provided
13 through other electronic technology.
14 Section 3. Present subsection (2) of section 627.657,
15 Florida Statutes, is renumbered as subsection (3), and a new
16 subsection (2) is added to that section, to read:
17 627.657 Provisions of group health insurance
18 policies.--
19 (2) The medical policy as specified in s.
20 627.6699(3)(k) must be accompanied by an identification card
21 that contains, at a minimum:
22 (a) The name of the organization issuing the policy or
23 name of the organization administering the policy, whichever
24 applies.
25 (b) The name of the certificateholder.
26 (c) The type of plan only if the plan is filed in the
27 state, an indication that the plan is self-funded, or the name
28 of the network.
29 (d) The member identification number, contract number,
30 and policy or group number, if applicable.
31 (e) A contact phone number or electronic address for
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 1274
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1 authorizations.
2 (f) A phone number or electronic address whereby the
3 covered person or hospital, physician, or other person
4 rendering services covered by the policy may determine if the
5 plan is insured and may obtain a benefits verification in
6 order to estimate patient financial responsibility, in
7 compliance with privacy rules under the Health Insurance
8 Portability and Accountability Act.
9 (g) The national plan identifier, in accordance with
10 the compliance date set forth by the federal Department of
11 Health and Human Services.
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13 The identification card must present the information in a
14 readily identifiable manner or, alternatively, the information
15 may be embedded on the card and available through magnetic
16 stripe or smart card. The information may also be provided
17 through other electronic technology.
18 Section 4. Present subsections (5) through (40) of
19 section 641.31, Florida Statutes, are renumbered as
20 subsections (6) through (41), respectively, and a new
21 subsection (5) is added to that section, to read:
22 641.31 Health maintenance contracts.--
23 (5) The contract, certificate, or member handbook must
24 be accompanied by an identification card that contains, at a
25 minimum:
26 (a) The name of the organization offering the contract
27 or name of the organization administering the contract,
28 whichever applies.
29 (b) The name of the subscriber.
30 (c) A statement that the health plan is a health
31 maintenance organization. Only a health plan with a
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Florida Senate - 2006 COMMITTEE AMENDMENT
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1 certificate of authority issued under this chapter may be
2 identified as a health maintenance organization.
3 (d) The member identification number, contract number,
4 and group number, if applicable.
5 (e) A contact phone number or electronic address for
6 authorizations.
7 (f) A phone number or electronic address whereby the
8 covered person or hospital, physician, or other person
9 rendering services covered by the contract may determine if
10 the plan is insured and may obtain a benefits verification in
11 order to estimate patient financial responsibility, in
12 compliance with privacy rules under the Health Insurance
13 Portability and Accountability Act.
14 (g) The national plan identifier, in accordance with
15 the compliance date set forth by the federal Department of
16 Health and Human Services.
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18 The identification card must present the information in a
19 readily identifiable manner or, alternatively, the information
20 may be embedded on the card and available through magnetic
21 stripe or smart card. The information may also be provided
22 through other electronic technology.
23 Section 5. Paragraph (j) of subsection (3) of section
24 383.145, Florida Statutes, is amended to read:
25 383.145 Newborn and infant hearing screening.--
26 (3) REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE
27 COVERAGE; REFERRAL FOR ONGOING SERVICES.--
28 (j) The initial procedure for screening the hearing of
29 the newborn or infant and any medically necessary followup
30 reevaluations leading to diagnosis shall be a covered benefit,
31 reimbursable under Medicaid as an expense compensated
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Florida Senate - 2006 COMMITTEE AMENDMENT
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1 supplemental to the per diem rate for Medicaid patients
2 enrolled in MediPass or Medicaid patients covered by a fee for
3 service program. For Medicaid patients enrolled in HMOs,
4 providers shall be reimbursed directly by the Medicaid Program
5 Office at the Medicaid rate. This service may not be
6 considered a covered service for the purposes of establishing
7 the payment rate for Medicaid HMOs. All health insurance
8 policies and health maintenance organizations as provided
9 under ss. 627.6416, 627.6579, and 641.31(31)(30), except for
10 supplemental policies that only provide coverage for specific
11 diseases, hospital indemnity, or Medicare supplement, or to
12 the supplemental polices, shall compensate providers for the
13 covered benefit at the contracted rate. Nonhospital-based
14 providers shall be eligible to bill Medicaid for the
15 professional and technical component of each procedure code.
16 Section 6. Paragraphs (b) and (i) of subsection (1) of
17 section 641.185, Florida Statutes, are amended to read:
18 641.185 Health maintenance organization subscriber
19 protections.--
20 (1) With respect to the provisions of this part and
21 part III, the principles expressed in the following statements
22 shall serve as standards to be followed by the commission, the
23 office, the department, and the Agency for Health Care
24 Administration in exercising their powers and duties, in
25 exercising administrative discretion, in administrative
26 interpretations of the law, in enforcing its provisions, and
27 in adopting rules:
28 (b) A health maintenance organization subscriber
29 should receive quality health care from a broad panel of
30 providers, including referrals, preventive care pursuant to s.
31 641.402(1), emergency screening and services pursuant to ss.
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Florida Senate - 2006 COMMITTEE AMENDMENT
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1 641.31(13)(12) and 641.513, and second opinions pursuant to s.
2 641.51.
3 (i) A health maintenance organization subscriber
4 should receive timely and, if necessary, urgent grievances and
5 appeals within the health maintenance organization pursuant to
6 ss. 641.228, 641.31(6)(5), 641.47, and 641.511.
7 Section 7. Subsection (1) of section 641.2018, Florida
8 Statutes, is amended to read:
9 641.2018 Limited coverage for home health care
10 authorized.--
11 (1) Notwithstanding other provisions of this chapter,
12 a health maintenance organization may issue a contract that
13 limits coverage to home health care services only. The
14 organization and the contract shall be subject to all of the
15 requirements of this part that do not require or otherwise
16 apply to specific benefits other than home care services. To
17 this extent, all of the requirements of this part apply to any
18 organization or contract that limits coverage to home care
19 services, except the requirements for providing comprehensive
20 health care services as provided in ss. 641.19(4), (11), and
21 (12), and 641.31(1), except ss. 641.31(10)(9), (13)(12), (17),
22 (18), (19), (20), (21), (22), and (25)(24) and 641.31095.
23 Section 8. Section 641.3107, Florida Statutes, is
24 amended to read:
25 641.3107 Delivery of contract.--Unless delivered upon
26 execution or issuance, a health maintenance contract,
27 certificate of coverage, or member handbook shall be mailed or
28 delivered to the subscriber or, in the case of a group health
29 maintenance contract, to the employer or other person who will
30 hold the contract on behalf of the subscriber group within 10
31 working days from approval of the enrollment form by the
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Florida Senate - 2006 COMMITTEE AMENDMENT
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1 health maintenance organization or by the effective date of
2 coverage, whichever occurs first. However, if the employer or
3 other person who will hold the contract on behalf of the
4 subscriber group requires retroactive enrollment of a
5 subscriber, the organization shall deliver the contract,
6 certificate, or member handbook to the subscriber within 10
7 days after receiving notice from the employer of the
8 retroactive enrollment. This section does not apply to the
9 delivery of those contracts specified in s. 641.31(14)(13).
10 Section 9. Paragraph (a) of subsection (7) of section
11 641.3922, Florida Statutes, is amended to read:
12 641.3922 Conversion contracts; conditions.--Issuance
13 of a converted contract shall be subject to the following
14 conditions:
15 (7) REASONS FOR CANCELLATION; TERMINATION.--The
16 converted health maintenance contract must contain a
17 cancellation or nonrenewability clause providing that the
18 health maintenance organization may refuse to renew the
19 contract of any person covered thereunder, but cancellation or
20 nonrenewal must be limited to one or more of the following
21 reasons:
22 (a) Fraud or intentional misrepresentation, subject to
23 the limitations of s. 641.31(24)(23), in applying for any
24 benefits under the converted health maintenance contract.;
25 Section 10. Subsection (4) of section 641.513, Florida
26 Statutes, is amended to read:
27 641.513 Requirements for providing emergency services
28 and care.--
29 (4) A subscriber may be charged a reasonable
30 copayment, as provided in s. 641.31(13)(12), for the use of an
31 emergency room.
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 1274
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1 Section 11. Except as otherwise expressly provided in
2 this act, this act shall take effect January 1, 2007, and
3 shall apply to identification cards issued for policies or
4 certificates issued or renewed on or after that date.
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7 ================ T I T L E A M E N D M E N T ===============
8 And the title is amended as follows:
9 Delete everything before the enacting clause
10
11 and insert:
12 A bill to be entitled
13 An act relating to plans, policies, contracts,
14 and programs for the provision of health care
15 services; amending s. 408.909, F.S.; revising
16 eligibility requirements for participation in
17 health flex plans; amending s. 627.642, F.S.;
18 requiring an identification card containing
19 specified information to be given to insureds
20 who have health and accident insurance;
21 amending s. 627.657, F.S.; requiring an
22 identification card containing specified
23 information to be given to insureds under group
24 health insurance policies; amending s. 641.31,
25 F.S.; requiring an identification card to be
26 given to persons having health care services
27 through a health maintenance contract; amending
28 ss. 383.145, 641.185, 641.2018, 641.3107,
29 641.3922, and 641.513, F.S.; conforming
30 cross-references to changes made by the act;
31 providing application; providing effective
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