HB 0805

CS

CHAMBER ACTION

1	The Health Care Regulation 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 plans, policies, contracts, and
7	programs for the provision of health care services;
8	amending s. 408.909, F.S.; revising eligibility
9	requirements for participation in health flex plans;
10	amending s. 627.642, F.S.; requiring an identification
11	card containing specified information to be given to
12	insureds who have health and accident insurance; amending
13	s. 627.657, F.S.; requiring an identification card
14	containing specified information to be given to insureds
15	under group health insurance policies; amending s. 641.31,
16	F.S.; requiring an identification card to be given to
17	persons having health care services through a health
18	maintenance contract; amending ss. 383.145, 641.185,
19	641.2018, 641.3107, 641.3922, and 641.513, F.S.;
20	conforming cross-references to changes made by the act;
21	providing application; providing effective dates.
22
23	Be It Enacted by the Legislature of the State of Florida:
24
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 meet
30	all of the following requirements:
31	(a)  Are 64 years of age or younger.;
32	(b)  Have a family income equal to or less than 250 200
33	percent of the federal poverty level.;
34	(c)  Are eligible under a federally approved Medicaid
35	demonstration waiver and reside in Palm Beach County or Miami-
36	Dade County.;
37	(d)  Are not covered by a private insurance policy and are
38	not eligible for coverage through a public health insurance
39	program, such as Medicare or Medicaid, unless specifically
40	authorized under paragraph (c), or another public health care
41	program, such as KidCare, and have not been covered at any time
42	during the past 6 months.; and
43	(e)  Have applied for health care coverage through an
44	approved health flex plan and have agreed to make any payments
45	required for participation, including periodic payments or
46	payments due at the time health care services are provided.
47	(f)  Are part of an employer group where at least 75
48	percent of the employees have a family income equal to or less
49	than 250 percent of the federal poverty level.
50	Section 2.  Subsection (3) is added to section 627.642,
51	Florida Statutes, to read:
52	627.642  Outline of coverage.--
53	(3)  In addition to the outline of coverage, a policy as
54	specified in s. 627.6699(3)(k) must be accompanied by an
55	identification card that contains, at a minimum:
56	(a)  The name of the organization issuing the policy or
57	name of the organization administering the policy, whichever
58	applies.
59	(b)  The name of the contract holder.
60	(c)  Type of plan or name of network, but only health plans
61	filed with the state may be identified on the card.
62	(d)  The member identification number, contract number, and
63	policy or group number, if applicable.
64	(e)  A contact phone number or electronic address for
65	authorizations.
66	(f)  A phone number or electronic address whereby the
67	covered person or hospital, physician, or other person rendering
68	services covered by the policy may determine if the plan is
69	insured and may obtain a benefits verification in order to
70	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, in accordance with the
74	compliance date set forth by the federal Department of Health
75	and Human Services.
76
77	The identification card must present the information in a
78	readily identifiable manner or, alternatively, the information
79	may be embedded on the card and available through magnetic
80	stripe or smart card. The information may also be provided
81	through other electronic technology.
82	Section 3.  Present subsection (2) of section 627.657,
83	Florida Statutes, is renumbered as subsection (3), and a new
84	subsection (2) is added to that section, to read:
85	627.657  Provisions of group health insurance policies.--
86	(2)  The medical policy as specified in s. 627.6699(3)(k)
87	must be accompanied by an identification card that contains, at
88	a minimum:
89	(a)  The name of the organization issuing the policy or
90	name of the organization administering the policy, whichever
91	applies.
92	(b)  The name of the certificateholder.
93	(c)  Type of plan or name of network, but only health plans
94	filed with the state may be identified on the card.
95	(d)  The member identification number, contract number, and
96	policy or 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 policy may determine if the plan is
102	insured and may obtain a benefits verification in order to
103	estimate patient financial responsibility, in compliance with
104	privacy rules under the Health Insurance Portability and
105	Accountability Act.
106	(g)  The national plan identifier, in accordance with the
107	compliance date set forth by the federal Department of Health
108	and Human Services.
109
110	The identification card must present the information in a
111	readily identifiable manner or, alternatively, the information
112	may be embedded on the card and available through magnetic
113	stripe or smart card. The information may also be provided
114	through other electronic technology.
115	Section 4.  Present subsections (5) through (40) of section
116	641.31, Florida Statutes, are renumbered as subsections (6)
117	through (41), respectively, and a new subsection (5) is added to
118	that section, to read:
119	641.31  Health maintenance contracts.--
120	(5)  The contract, certificate, or member handbook must be
121	accompanied by an identification card that contains, at a
122	minimum:
123	(a)  The name of the organization offering the contract or
124	name of the organization administering the contract, whichever
125	applies.
126	(b)  The name of the subscriber.
127	(c)  A statement that the health plan is a health
128	maintenance organization. Only a health plan with a certificate
129	of authority issued under this chapter may be identified as a
130	health maintenance organization.
131	(d)  The member identification number, contract number, and
132	group number, if applicable.
133	(e)  A contact phone number or electronic address for
134	authorizations.
135	(f)  A phone number or electronic address whereby the
136	covered person or hospital, physician, or other person rendering
137	services covered by the contract may determine if the plan is
138	insured and may obtain a benefits verification in order to
139	estimate patient financial responsibility, in compliance with
140	privacy rules under the Health Insurance Portability and
141	Accountability Act.
142	(g)  The national plan identifier, in accordance with the
143	compliance date set forth by the federal Department of Health
144	and Human Services.
145
146	The identification card must present the information in a
147	readily identifiable manner or, alternatively, the information
148	may be embedded on the card and available through magnetic
149	stripe or smart card. The information may also be provided
150	through other electronic technology.
151	Section 5.  Paragraph (j) of subsection (3) of section
152	383.145, Florida Statutes, is amended to read:
153	383.145  Newborn and infant hearing screening.--
154	(3)  REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE
155	COVERAGE; REFERRAL FOR ONGOING SERVICES.--
156	(j)  The initial procedure for screening the hearing of the
157	newborn or infant and any medically necessary followup
158	reevaluations leading to diagnosis shall be a covered benefit,
159	reimbursable under Medicaid as an expense compensated
160	supplemental to the per diem rate for Medicaid patients enrolled
161	in MediPass or Medicaid patients covered by a fee for service
162	program. For Medicaid patients enrolled in HMOs, providers shall
163	be reimbursed directly by the Medicaid Program Office at the
164	Medicaid rate. This service may not be considered a covered
165	service for the purposes of establishing the payment rate for
166	Medicaid HMOs. All health insurance policies and health
167	maintenance organizations as provided under ss. 627.6416,
168	627.6579, and 641.31(31)(30), except for supplemental policies
169	that only provide coverage for specific diseases, hospital
170	indemnity, or Medicare supplement, or to the supplemental
171	polices, shall compensate providers for the covered benefit at
172	the contracted rate. Nonhospital-based providers shall be
173	eligible to bill Medicaid for the professional and technical
174	component of each procedure code.
175	Section 6.  Paragraphs (b) and (i) of subsection (1) of
176	section 641.185, Florida Statutes, are amended to read:
177	641.185  Health maintenance organization subscriber
178	protections.--
179	(1)  With respect to the provisions of this part and part
180	III, the principles expressed in the following statements shall
181	serve as standards to be followed by the commission, the office,
182	the department, and the Agency for Health Care Administration in
183	exercising their powers and duties, in exercising administrative
184	discretion, in administrative interpretations of the law, in
185	enforcing its provisions, and in adopting rules:
186	(b)  A health maintenance organization subscriber should
187	receive quality health care from a broad panel of providers,
188	including referrals, preventive care pursuant to s. 641.402(1),
189	emergency screening and services pursuant to ss. 641.31(13)(12)
190	and 641.513, and second opinions pursuant to s. 641.51.
191	(i)  A health maintenance organization subscriber should
192	receive timely and, if necessary, urgent grievances and appeals
193	within the health maintenance organization pursuant to ss.
194	641.228, 641.31(6)(5), 641.47, and 641.511.
195	Section 7.  Subsection (1) of section 641.2018, Florida
196	Statutes, is amended to read:
197	641.2018  Limited coverage for home health care
198	authorized.--
199	(1)  Notwithstanding other provisions of this chapter, a
200	health maintenance organization may issue a contract that limits
201	coverage to home health care services only. The organization and
202	the contract shall be subject to all of the requirements of this
203	part that do not require or otherwise apply to specific benefits
204	other than home care services. To this extent, all of the
205	requirements of this part apply to any organization or contract
206	that limits coverage to home care services, except the
207	requirements for providing comprehensive health care services as
208	provided in ss. 641.19(4), (11), and (12), and 641.31(1), except
209	ss. 641.31(10)(9), (13)(12), (17), (18), (19), (20), (21), (22),
210	and (25)(24) and 641.31095.
211	Section 8.  Section 641.3107, Florida Statutes, is amended
212	to read:
213	641.3107  Delivery of contract.--Unless delivered upon
214	execution or issuance, a health maintenance contract,
215	certificate of coverage, or member handbook shall be mailed or
216	delivered to the subscriber or, in the case of a group health
217	maintenance contract, to the employer or other person who will
218	hold the contract on behalf of the subscriber group within 10
219	working days from approval of the enrollment form by the health
220	maintenance organization or by the effective date of coverage,
221	whichever occurs first. However, if the employer or other person
222	who will hold the contract on behalf of the subscriber group
223	requires retroactive enrollment of a subscriber, the
224	organization shall deliver the contract, certificate, or member
225	handbook to the subscriber within 10 days after receiving notice
226	from the employer of the retroactive enrollment. This section
227	does not apply to the delivery of those contracts specified in
228	s. 641.31(14)(13).
229	Section 9.  Paragraph (a) of subsection (7) of section
230	641.3922, Florida Statutes, is amended to read:
231	641.3922  Conversion contracts; conditions.--Issuance of a
232	converted contract shall be subject to the following conditions:
233	(7)  REASONS FOR CANCELLATION; TERMINATION.--The converted
234	health maintenance contract must contain a cancellation or
235	nonrenewability clause providing that the health maintenance
236	organization may refuse to renew the contract of any person
237	covered thereunder, but cancellation or nonrenewal must be
238	limited to one or more of the following reasons:
239	(a)  Fraud or intentional misrepresentation, subject to the
240	limitations of s. 641.31(24)(23), in applying for any benefits
241	under the converted health maintenance contract.;
242	Section 10.  Subsection (4) of section 641.513, Florida
243	Statutes, is amended to read:
244	641.513  Requirements for providing emergency services and
245	care.--
246	(4)  A subscriber may be charged a reasonable copayment, as
247	provided in s. 641.31(13)(12), for the use of an emergency room.
248	Section 11.  Except as otherwise expressly provided in this
249	act, this act shall take effect January 1, 2007, and shall apply
250	to identification cards issued for policies or certificates
251	issued or renewed on or after that date.

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