Senate Bill sb1274c1
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Florida Senate - 2006 CS for SB 1274
By the Committee on Banking and Insurance; and Senator Atwater
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1 A bill to be entitled
2 An act relating to plans, policies, contracts,
3 and programs for the provision of health care
4 services; amending s. 408.909, F.S.; revising
5 eligibility requirements for participation in
6 health flex plans; amending s. 627.642, F.S.;
7 requiring an identification card containing
8 specified information to be given to insureds
9 who have health and accident insurance;
10 amending s. 627.657, F.S.; requiring an
11 identification card containing specified
12 information to be given to insureds under group
13 health insurance policies; amending s. 641.31,
14 F.S.; requiring an identification card to be
15 given to persons having health care services
16 through a health maintenance contract; amending
17 ss. 383.145, 641.185, 641.2018, 641.3107,
18 641.3922, and 641.513, F.S.; conforming
19 cross-references to changes made by the act;
20 providing application; providing effective
21 dates.
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23 Be It Enacted by the Legislature of the State of Florida:
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25 Section 1. Effective July 1, 2006, subsection (5) of
26 section 408.909, Florida Statutes, is amended to read:
27 408.909 Health flex plans.--
28 (5) ELIGIBILITY.--Eligibility to enroll in an approved
29 health flex plan is limited to residents of this state who
30 meet all of the following requirements:
31 (a) Are 64 years of age or younger.;
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Florida Senate - 2006 CS for SB 1274
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1 (b) Have a family income equal to or less than 250 200
2 percent of the federal poverty level.;
3 (c) Are eligible under a federally approved Medicaid
4 demonstration waiver and reside in Palm Beach County or
5 Miami-Dade County.;
6 (d) Are not covered by a private insurance policy and
7 are not eligible for coverage through a public health
8 insurance program, such as Medicare or Medicaid, unless
9 specifically authorized under paragraph (c), or another public
10 health care program, such as KidCare, and have not been
11 covered at any time during the past 6 months.; and
12 (e) Have applied for health care coverage through an
13 approved health flex plan and have agreed to make any payments
14 required for participation, including periodic payments or
15 payments due at the time health care services are provided.
16 (f) Are part of an employer group where at least 75
17 percent of the employees have a family income equal to or less
18 than 250 percent of the federal poverty level.
19 Section 2. Subsection (3) is added to section 627.642,
20 Florida Statutes, to read:
21 627.642 Outline of coverage.--
22 (3) In addition to the outline of coverage, a policy
23 as specified in s. 627.6699(3)(k) must be accompanied by an
24 identification card that contains, at a minimum:
25 (a) The name of the organization issuing the policy or
26 the name of the organization administering the policy,
27 whichever applies.
28 (b) The name of the contract holder.
29 (c) The type of plan only if the plan is filed in the
30 state, an indication that the plan is self-funded, or the name
31 of the network.
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Florida Senate - 2006 CS for SB 1274
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1 (d) The member identification number, contract number,
2 and policy or group number, if applicable.
3 (e) A contact phone number or electronic address for
4 authorizations.
5 (f) A phone number or electronic address whereby the
6 covered person or hospital, physician, or other person
7 rendering services covered by the policy may determine if the
8 plan is insured and may obtain a benefits verification in
9 order to estimate patient financial responsibility, in
10 compliance with privacy rules under the Health Insurance
11 Portability and Accountability Act.
12 (g) The national plan identifier, in accordance with
13 the compliance date set forth by the federal Department of
14 Health and Human Services.
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16 The identification card must present the information in a
17 readily identifiable manner or, alternatively, the information
18 may be embedded on the card and available through magnetic
19 stripe or smart card. The information may also be provided
20 through other electronic technology.
21 Section 3. Present subsection (2) of section 627.657,
22 Florida Statutes, is renumbered as subsection (3), and a new
23 subsection (2) is added to that section, to read:
24 627.657 Provisions of group health insurance
25 policies.--
26 (2) The medical policy as specified in s.
27 627.6699(3)(k) must be accompanied by an identification card
28 that contains, at a minimum:
29 (a) The name of the organization issuing the policy or
30 name of the organization administering the policy, whichever
31 applies.
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1 (b) The name of the certificateholder.
2 (c) The type of plan only if the plan is filed in the
3 state, an indication that the plan is self-funded, or the name
4 of the network.
5 (d) The member identification number, contract number,
6 and policy or group number, if applicable.
7 (e) A contact phone number or electronic address for
8 authorizations.
9 (f) A phone number or electronic address whereby the
10 covered person or hospital, physician, or other person
11 rendering services covered by the policy may determine if the
12 plan is insured and may obtain a benefits verification in
13 order to estimate patient financial responsibility, in
14 compliance with privacy rules under the Health Insurance
15 Portability and Accountability Act.
16 (g) The national plan identifier, in accordance with
17 the compliance date set forth by the federal Department of
18 Health and Human Services.
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20 The identification card must present the information in a
21 readily identifiable manner or, alternatively, the information
22 may be embedded on the card and available through magnetic
23 stripe or smart card. The information may also be provided
24 through other electronic technology.
25 Section 4. Present subsections (5) through (40) of
26 section 641.31, Florida Statutes, are renumbered as
27 subsections (6) through (41), respectively, and a new
28 subsection (5) is added to that section, to read:
29 641.31 Health maintenance contracts.--
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1 (5) The contract, certificate, or member handbook must
2 be accompanied by an identification card that contains, at a
3 minimum:
4 (a) The name of the organization offering the contract
5 or name of the organization administering the contract,
6 whichever applies.
7 (b) The name of the subscriber.
8 (c) A statement that the health plan is a health
9 maintenance organization. Only a health plan with a
10 certificate of authority issued under this chapter may be
11 identified as a health maintenance organization.
12 (d) The member identification number, contract number,
13 and group number, if applicable.
14 (e) A contact phone number or electronic address for
15 authorizations.
16 (f) A phone number or electronic address whereby the
17 covered person or hospital, physician, or other person
18 rendering services covered by the contract may determine if
19 the plan is insured and may obtain a benefits verification in
20 order to estimate patient financial responsibility, in
21 compliance with privacy rules under the Health Insurance
22 Portability and Accountability Act.
23 (g) The national plan identifier, in accordance with
24 the compliance date set forth by the federal Department of
25 Health and Human Services.
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27 The identification card must present the information in a
28 readily identifiable manner or, alternatively, the information
29 may be embedded on the card and available through magnetic
30 stripe or smart card. The information may also be provided
31 through other electronic technology.
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1 Section 5. Paragraph (j) of subsection (3) of section
2 383.145, Florida Statutes, is amended to read:
3 383.145 Newborn and infant hearing screening.--
4 (3) REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE
5 COVERAGE; REFERRAL FOR ONGOING SERVICES.--
6 (j) The initial procedure for screening the hearing of
7 the newborn or infant and any medically necessary followup
8 reevaluations leading to diagnosis shall be a covered benefit,
9 reimbursable under Medicaid as an expense compensated
10 supplemental to the per diem rate for Medicaid patients
11 enrolled in MediPass or Medicaid patients covered by a fee for
12 service program. For Medicaid patients enrolled in HMOs,
13 providers shall be reimbursed directly by the Medicaid Program
14 Office at the Medicaid rate. This service may not be
15 considered a covered service for the purposes of establishing
16 the payment rate for Medicaid HMOs. All health insurance
17 policies and health maintenance organizations as provided
18 under ss. 627.6416, 627.6579, and 641.31(31)(30), except for
19 supplemental policies that only provide coverage for specific
20 diseases, hospital indemnity, or Medicare supplement, or to
21 the supplemental polices, shall compensate providers for the
22 covered benefit at the contracted rate. Nonhospital-based
23 providers shall be eligible to bill Medicaid for the
24 professional and technical component of each procedure code.
25 Section 6. Paragraphs (b) and (i) of subsection (1) of
26 section 641.185, Florida Statutes, are amended to read:
27 641.185 Health maintenance organization subscriber
28 protections.--
29 (1) With respect to the provisions of this part and
30 part III, the principles expressed in the following statements
31 shall serve as standards to be followed by the commission, the
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1 office, the department, and the Agency for Health Care
2 Administration in exercising their powers and duties, in
3 exercising administrative discretion, in administrative
4 interpretations of the law, in enforcing its provisions, and
5 in adopting rules:
6 (b) A health maintenance organization subscriber
7 should receive quality health care from a broad panel of
8 providers, including referrals, preventive care pursuant to s.
9 641.402(1), emergency screening and services pursuant to ss.
10 641.31(13)(12) and 641.513, and second opinions pursuant to s.
11 641.51.
12 (i) A health maintenance organization subscriber
13 should receive timely and, if necessary, urgent grievances and
14 appeals within the health maintenance organization pursuant to
15 ss. 641.228, 641.31(6)(5), 641.47, and 641.511.
16 Section 7. Subsection (1) of section 641.2018, Florida
17 Statutes, is amended to read:
18 641.2018 Limited coverage for home health care
19 authorized.--
20 (1) Notwithstanding other provisions of this chapter,
21 a health maintenance organization may issue a contract that
22 limits coverage to home health care services only. The
23 organization and the contract shall be subject to all of the
24 requirements of this part that do not require or otherwise
25 apply to specific benefits other than home care services. To
26 this extent, all of the requirements of this part apply to any
27 organization or contract that limits coverage to home care
28 services, except the requirements for providing comprehensive
29 health care services as provided in ss. 641.19(4), (11), and
30 (12), and 641.31(1), except ss. 641.31(10)(9), (13)(12), (17),
31 (18), (19), (20), (21), (22), and (25)(24) and 641.31095.
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Florida Senate - 2006 CS for SB 1274
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1 Section 8. Section 641.3107, Florida Statutes, is
2 amended to read:
3 641.3107 Delivery of contract.--Unless delivered upon
4 execution or issuance, a health maintenance contract,
5 certificate of coverage, or member handbook shall be mailed or
6 delivered to the subscriber or, in the case of a group health
7 maintenance contract, to the employer or other person who will
8 hold the contract on behalf of the subscriber group within 10
9 working days from approval of the enrollment form by the
10 health maintenance organization or by the effective date of
11 coverage, whichever occurs first. However, if the employer or
12 other person who will hold the contract on behalf of the
13 subscriber group requires retroactive enrollment of a
14 subscriber, the organization shall deliver the contract,
15 certificate, or member handbook to the subscriber within 10
16 days after receiving notice from the employer of the
17 retroactive enrollment. This section does not apply to the
18 delivery of those contracts specified in s. 641.31(14)(13).
19 Section 9. Paragraph (a) of subsection (7) of section
20 641.3922, Florida Statutes, is amended to read:
21 641.3922 Conversion contracts; conditions.--Issuance
22 of a converted contract shall be subject to the following
23 conditions:
24 (7) REASONS FOR CANCELLATION; TERMINATION.--The
25 converted health maintenance contract must contain a
26 cancellation or nonrenewability clause providing that the
27 health maintenance organization may refuse to renew the
28 contract of any person covered thereunder, but cancellation or
29 nonrenewal must be limited to one or more of the following
30 reasons:
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1 (a) Fraud or intentional misrepresentation, subject to
2 the limitations of s. 641.31(24)(23), in applying for any
3 benefits under the converted health maintenance contract.;
4 Section 10. Subsection (4) of section 641.513, Florida
5 Statutes, is amended to read:
6 641.513 Requirements for providing emergency services
7 and care.--
8 (4) A subscriber may be charged a reasonable
9 copayment, as provided in s. 641.31(13)(12), for the use of an
10 emergency room.
11 Section 11. Except as otherwise expressly provided in
12 this act, this act shall take effect January 1, 2007, and
13 shall apply to identification cards issued for policies or
14 certificates issued or renewed on or after that date.
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Florida Senate - 2006 CS for SB 1274
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 1274
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4 The committee substitute makes the following changes:
5 1. Individual major medical health insurance polices, rather
than all individual policies, must provide policyholders
6 with an ID card.
7 2. The bill changes the information to be included by health
insurers on ID cards to terminology frequently used in
8 health policies and recognizes federal regulations
adopted under the Health Insurance Portability and
9 Accountability Act govern the type of information an
insurer may disclose.
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3. An insurer is authorized to provide required information
11 electronically or embedded in magnetic strips on smart
cards.
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4. Any ID card issued by an HMO must identify the insurer as
13 an HMO.
14 5. The eligibility requirements for the Health Flex Plan
Program are revised to expand the pool of potential
15 eligible persons by allowing family income to be equal or
less than 250 percent of the federal poverty level,
16 rather than equal to or less than 200 percent of the
federal poverty level, for a family of four. The bill
17 also requires, as another condition of eligibility, that
the person is part of an employer group where at least 75
18 percent of the employees have a family income equal to or
less than 250 percent of the federal poverty level.
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