HB 0805

CS

CHAMBER ACTION

1	The Insurance Committee recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to policies, contracts, and programs for
7	the provision of health care services; amending s.
8	627.642, F.S.; requiring an identification card containing
9	specified information to be given to insureds who have
10	health and accident insurance; amending s. 627.657, F.S.;
11	requiring an identification card containing specified
12	information to be given to insureds under group health
13	insurance policies; amending s. 641.31, F.S.; requiring an
14	identification card to be given to persons having health
15	care services through a health maintenance contract;
16	amending ss. 383.145, 641.185, 641.2018, 641.3107,
17	641.3922, and 641.513, F.S.; conforming cross-references
18	to changes made by the act; providing an effective date.
19
20	Be It Enacted by the Legislature of the State of Florida:
21
22	Section 1.  Subsection (3) is added to section 627.642,
23	Florida Statutes, to read:
24	627.642  Outline of coverage.--
25	(3)  In addition to the outline of coverage, a major
26	medical policy must be accompanied by an identification card
27	that contains, at a minimum:
28	(a)  The name of the organization issuing the policy or
29	name of the organization administering the policy, whichever
30	applies.
31	(b)  The name of the covered person or covered family,
32	whichever applies.
33	(c)  Type of plan or name of network.
34	(d)  The member identification number, contract number, and
35	policy or group number, if applicable.
36	(e)  A contact phone number or electronic address for
37	authorizations.
38	(f)  A phone number or electronic address whereby the
39	covered person or hospital, physician, or other person rendering
40	services covered by the policy may obtain information necessary
41	to estimate patient financial responsibility, in compliance with
42	privacy rules under the Health Insurance Portability and
43	Accountability Act.
44	(g)  The national plan identifier, when available.
45
46	The identification card must present the information in a
47	readily identifiable manner or, alternatively, the information
48	may be embedded on the card and available through magnetic
49	stripe or smart card. The information may also be provided
50	through other electronic technology.
51	Section 2.  Present subsection (2) of section 627.657,
52	Florida Statutes, is renumbered as subsection (3), and a new
53	subsection (2) is added to that section, to read:
54	627.657  Provisions of group health insurance policies.--
55	(2)  The policy must be accompanied by an identification
56	card that contains, at a minimum:
57	(a)  The name of the organization issuing the policy or
58	name of the organization administering the policy, whichever
59	applies.
60	(b)  The name of the covered person or covered family,
61	whichever applies.
62	(c)  Type of plan or name of network.
63	(d)  The member identification number, contract number, and
64	policy or group number, if applicable.
65	(e)  A contact phone number or electronic address for
66	authorizations.
67	(f)  A phone number or electronic address whereby the
68	covered person or hospital, physician, or other person rendering
69	services covered by the policy may obtain information necessary
70	to estimate patient financial responsibility, in compliance with
71	privacy rules under the Health Insurance Portability and
72	Accountability Act.
73	(g)  The national plan identifier, when available.
74
75	The identification card must present the information in a
76	readily identifiable manner or, alternatively, the information
77	may be embedded on the card and available through magnetic
78	stripe or smart card. The information may also be provided
79	through other electronic technology.
80	Section 3.  Present subsections (5) through (40) of section
81	641.31, Florida Statutes, are renumbered as subsections (6)
82	through (41), respectively, and a new subsection (5) is added to
83	that section, to read:
84	641.31  Health maintenance contracts.--
85	(5)  The contract, certificate, or member handbook must be
86	accompanied by an identification card that contains, at a
87	minimum:
88	(a)  The name of the organization offering the contract or
89	name of the organization administering the contract, whichever
90	applies.
91	(b)  The name of the covered person or covered family,
92	whichever applies.
93	(c)  A statement that the health plan is a health
94	maintenance organization.
95	(d)  The member identification number, contract number, and
96	group number, if applicable.
97	(e)  A contact phone number or electronic address for
98	authorizations.
99	(f)  A phone number or electronic address whereby the
100	covered person or hospital, physician, or other person rendering
101	services covered by the contract may obtain information
102	necessary to estimate patient financial responsibility, in
103	compliance with privacy rules under the Health Insurance
104	Portability and Accountability Act.
105	(g)  The national plan identifier, when available.
106
107	The identification card must present the information in a
108	readily identifiable manner or, alternatively, the information
109	may be embedded on the card and available through magnetic
110	stripe or smart card. The information may also be provided
111	through other electronic technology.
112	Section 4.  Paragraph (j) of subsection (3) of section
113	383.145, Florida Statutes, is amended to read:
114	383.145  Newborn and infant hearing screening.--
115	(3)  REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE
116	COVERAGE; REFERRAL FOR ONGOING SERVICES.--
117	(j)  The initial procedure for screening the hearing of the
118	newborn or infant and any medically necessary followup
119	reevaluations leading to diagnosis shall be a covered benefit,
120	reimbursable under Medicaid as an expense compensated
121	supplemental to the per diem rate for Medicaid patients enrolled
122	in MediPass or Medicaid patients covered by a fee for service
123	program. For Medicaid patients enrolled in HMOs, providers shall
124	be reimbursed directly by the Medicaid Program Office at the
125	Medicaid rate. This service may not be considered a covered
126	service for the purposes of establishing the payment rate for
127	Medicaid HMOs. All health insurance policies and health
128	maintenance organizations as provided under ss. 627.6416,
129	627.6579, and 641.31(31)(30), except for supplemental policies
130	that only provide coverage for specific diseases, hospital
131	indemnity, or Medicare supplement, or to the supplemental
132	polices, shall compensate providers for the covered benefit at
133	the contracted rate. Nonhospital-based providers shall be
134	eligible to bill Medicaid for the professional and technical
135	component of each procedure code.
136	Section 5.  Paragraphs (b) and (i) of subsection (1) of
137	section 641.185, Florida Statutes, are amended to read:
138	641.185  Health maintenance organization subscriber
139	protections.--
140	(1)  With respect to the provisions of this part and part
141	III, the principles expressed in the following statements shall
142	serve as standards to be followed by the commission, the office,
143	the department, and the Agency for Health Care Administration in
144	exercising their powers and duties, in exercising administrative
145	discretion, in administrative interpretations of the law, in
146	enforcing its provisions, and in adopting rules:
147	(b)  A health maintenance organization subscriber should
148	receive quality health care from a broad panel of providers,
149	including referrals, preventive care pursuant to s. 641.402(1),
150	emergency screening and services pursuant to ss. 641.31(13)(12)
151	and 641.513, and second opinions pursuant to s. 641.51.
152	(i)  A health maintenance organization subscriber should
153	receive timely and, if necessary, urgent grievances and appeals
154	within the health maintenance organization pursuant to ss.
155	641.228, 641.31(6)(5), 641.47, and 641.511.
156	Section 6.  Subsection (1) of section 641.2018, Florida
157	Statutes, is amended to read:
158	641.2018  Limited coverage for home health care
159	authorized.--
160	(1)  Notwithstanding other provisions of this chapter, a
161	health maintenance organization may issue a contract that limits
162	coverage to home health care services only. The organization and
163	the contract shall be subject to all of the requirements of this
164	part that do not require or otherwise apply to specific benefits
165	other than home care services. To this extent, all of the
166	requirements of this part apply to any organization or contract
167	that limits coverage to home care services, except the
168	requirements for providing comprehensive health care services as
169	provided in ss. 641.19(4), (11), and (12), and 641.31(1), except
170	ss. 641.31(10)(9), (13)(12), (17), (18), (19), (20), (21), (22),
171	and (25)(24) and 641.31095.
172	Section 7.  Section 641.3107, Florida Statutes, is amended
173	to read:
174	641.3107  Delivery of contract.--Unless delivered upon
175	execution or issuance, a health maintenance contract,
176	certificate of coverage, or member handbook shall be mailed or
177	delivered to the subscriber or, in the case of a group health
178	maintenance contract, to the employer or other person who will
179	hold the contract on behalf of the subscriber group within 10
180	working days from approval of the enrollment form by the health
181	maintenance organization or by the effective date of coverage,
182	whichever occurs first. However, if the employer or other person
183	who will hold the contract on behalf of the subscriber group
184	requires retroactive enrollment of a subscriber, the
185	organization shall deliver the contract, certificate, or member
186	handbook to the subscriber within 10 days after receiving notice
187	from the employer of the retroactive enrollment. This section
188	does not apply to the delivery of those contracts specified in
189	s. 641.31(14)(13).
190	Section 8.  Paragraph (a) of subsection (7) of section
191	641.3922, Florida Statutes, is amended to read:
192	641.3922  Conversion contracts; conditions.--Issuance of a
193	converted contract shall be subject to the following conditions:
194	(7)  REASONS FOR CANCELLATION; TERMINATION.--The converted
195	health maintenance contract must contain a cancellation or
196	nonrenewability clause providing that the health maintenance
197	organization may refuse to renew the contract of any person
198	covered thereunder, but cancellation or nonrenewal must be
199	limited to one or more of the following reasons:
200	(a)  Fraud or intentional misrepresentation, subject to the
201	limitations of s. 641.31(24)(23), in applying for any benefits
202	under the converted health maintenance contract.;
203	Section 9.  Subsection (4) of section 641.513, Florida
204	Statutes, is amended to read:
205	641.513  Requirements for providing emergency services and
206	care.--
207	(4)  A subscriber may be charged a reasonable copayment, as
208	provided in s. 641.31(13)(12), for the use of an emergency room.
209	Section 10.  This act shall take effect July 1, 2006.

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