HB 805

1	A bill to be entitled
2	An act relating to plans, policies, contracts, and
3	programs for the provision of health care services;
4	amending s. 408.909, F.S.; revising eligibility
5	requirements for participation in health flex plans;
6	amending s. 627.4236, F.S.; redefining the term "bone
7	marrow transplant" for purposes of required coverage for
8	certain procedures to include nonablative therapy having
9	life-prolonging intent; amending s. 627.642, F.S.;
10	requiring an identification card containing specified
11	information to be given to insureds who have health and
12	accident insurance; requiring certain insurers to provide
13	to certain service providers by an Internet website
14	certain information relating to a covered person;
15	providing criteria; specifying time requirements for such
16	insurers to implement such requirements; amending s.
17	627.657, F.S.; requiring an identification card containing
18	specified information to be given to insureds under group
19	health insurance policies; requiring certain insurers to
20	provide to certain service providers by an Internet
21	website certain information relating to a covered person;
22	providing criteria; specifying time requirements for such
23	insurers to implement such requirements; amending s.
24	627.6699, F.S.; revising a provision relating to
25	applicability and scope of the Employee Health Care Access
26	Act; amending s. 636.204, F.S.; revising a license
27	application provision for discount medical plan
28	organizations; amending s. 636.206, F.S.; revising
29	examination and investigative authority; amending s.
30	636.210, F.S.; providing an exception to prohibited
31	activities; amending s. 636.216, F.S.; providing exception
32	to review of certain charges to members of the plan;
33	amending s. 636.218, F.S.; removing certain information
34	from the annual report; amending s. 636.220, F.S.;
35	revising certain minimum capital requirements of discount
36	medical plan organizations; revising commission rulemaking
37	authority; amending s. 636.230, F.S.; providing
38	requirements with respect to the bundling of discount
39	medical plans with insurance products; amending s. 641.31,
40	F.S.; requiring an identification card to be given to
41	persons having health care services through a health
42	maintenance contract; requiring certain health maintenance
43	organizations to provide to certain service providers by
44	an Internet website certain information relating to a
45	covered person; providing criteria; specifying time
46	requirements for such health maintenance organizations to
47	implement such requirements; amending s. 641.316, F.S.;
48	redefining the term "fiscal intermediary services
49	organization"; revising registration requirements for
50	fiscal intermediary services organizations; amending ss.
51	383.145, 641.185, 641.2018, 641.3107, 641.3922, and
52	641.513, F.S.; conforming cross-references to changes made
53	by the act; providing application; reenacting and amending
54	s. 409.9102, F.S.; directing the Agency for Health Care
55	Administration, in consultation with the Office of
56	Insurance Regulation and the Department of Children and
57	Family Services, to amend the Medicaid state plan that
58	established the Florida Long-Term Care Partnership Program
59	for purposes of compliance with provisions of the Social
60	Security Act; establishing a qualified state Long-Term
61	Care Insurance Partnership Program in Florida; providing
62	duties of the program; requiring consultation with the
63	Office of Insurance Regulation and the Department of
64	Children and Family Services for the creation of standards
65	for certain information; providing rulemaking authority to
66	the agency for implementation of s. 409.9102, F.S.;
67	providing rulemaking authority to the department regarding
68	determination of eligibility for certain services;
69	creating s. 627.94075, F.S.; providing rulemaking
70	authority to the Financial Services Commission for the
71	implementation of a qualified state Long-Term Care
72	Insurance Partnership Program in Florida; repealing ss. 1
73	and 2 of ch. 2005-252, Laws of Florida, to delete
74	conflicting provisions relating to the determination of
75	eligibility for nursing and rehabilitative services and
76	the establishment of the Florida Long-Term Care
77	Partnership Program that were contingent upon amendment to
78	the Social Security Act; amending s. 4 of ch. 2005-252,
79	Laws of Florida, to delete a contingency in an effective
80	date; requiring the Office of Program Policy Analysis and
81	Government Accountability to submit a report on the
82	implementation of a qualified state Long-Term Care
83	Insurance Partnership Program in Florida to the Governor
84	and Legislature; providing an effective date.
85
86	Be It Enacted by the Legislature of the State of Florida:
87
88	Section 1.  Subsection (5) of section 408.909, Florida
89	Statutes, is amended to read:
90	408.909  Health flex plans.--
91	(5)  ELIGIBILITY.--Eligibility to enroll in an approved
92	health flex plan is limited to residents of this state who:
93	(a)1.  Are 64 years of age or younger;
94	2.(b)  Have a family income equal to or less than 250 200
95	percent of the federal poverty level;
96	3.(c)  Are eligible under a federally approved Medicaid
97	demonstration waiver and reside in Palm Beach County or Miami-
98	Dade County;
99	4.(d)  Are not covered by a private insurance policy and
100	are not eligible for coverage through a public health insurance
101	program, such as Medicare or Medicaid, unless specifically
102	authorized under subparagraph 3. paragraph (c), or another
103	public health care program, such as KidCare, and have not been
104	covered at any time during the past 6 months; and
105	5.(e)  Have applied for health care coverage through an
106	approved health flex plan and have agreed to make any payments
107	required for participation, including periodic payments or
108	payments due at the time health care services are provided; or
109	(b)  Are part of an employer group where at least 75
110	percent of the employees have a family income equal to or less
111	than 250 percent of the federal poverty level and the employee
112	group is not covered by a private health insurance policy and
113	has not been covered at any time during the past 6 months. If
114	the health flex plan entity is a health insurer, health plan, or
115	health maintenance organization properly licensed under Florida
116	law, only 50 percent of the employees must meet the income
117	requirements for the purposes of this paragraph.
118	Section 2.  Subsection (1) of section 627.4236, Florida
119	Statutes, is amended to read:
120	627.4236  Coverage for bone marrow transplant procedures.--
121	(1)  As used in this section, the term "bone marrow
122	transplant" means human blood precursor cells administered to a
123	patient to restore normal hematological and immunological
124	functions following ablative or nonablative therapy with
125	curative or life-prolonging intent. Human blood precursor cells
126	may be obtained from the patient in an autologous transplant or
127	from a medically acceptable related or unrelated donor, and may
128	be derived from bone marrow, circulating blood, or a combination
129	of bone marrow and circulating blood. If chemotherapy is an
130	integral part of the treatment involving bone marrow
131	transplantation, the term "bone marrow transplant" includes both
132	the transplantation and the chemotherapy.
133	Section 3.  Subsections (3) and (4) are added to section
134	627.642, Florida Statutes, to read:
135	627.642  Outline of coverage.--
136	(3)  In addition to the outline of coverage, a policy as
137	specified in s. 627.6699(3)(k) must be accompanied by an
138	identification card that contains, at a minimum:
139	(a)  The name of the organization issuing the policy or
140	name of the organization administering the policy, whichever
141	applies.
142	(b)  The name of the contract holder.
143	(c)  The type of plan only if the health plan is filed with
144	the state, an indication that the plan is self-funded, or the
145	name of the network.
146	(d)  The member identification number, contract number, and
147	policy or group number, if applicable.
148	(e)  A contact phone number or electronic address for
149	authorizations.
150	(f)  A phone number or electronic address whereby the
151	covered person or hospital, physician, or other person rendering
152	services covered by the policy may determine if the plan is
153	insured and may obtain a benefits verification in order to
154	estimate patient financial responsibility, in compliance with
155	privacy rules under the Health Insurance Portability and
156	Accountability Act.
157	(g)  The national plan identifier, in accordance with the
158	compliance date set forth by the federal Department of Health
159	and Human Services.
160
161	The identification card must present the information in a
162	readily identifiable manner or, alternatively, the information
163	may be embedded on the card and available through magnetic
164	stripe or smart card. The information may also be provided
165	through other electronic technology.
166	(4)(a)  An insurer that issues a health insurance policy
167	shall provide a hospital, physician, or other person rendering
168	services covered by the policy electronic access to the covered
169	person's eligibility and benefits information through a secure
170	Internet website. The eligibility and benefits information shall
171	comply with the transaction standards specified in ANSI ASC X12N
172	270 for health care claim eligibility inquiries and ANSI ASC
173	X12N 271 for health care claim eligibility responses, or
174	successor transaction standards, pursuant to the Health
175	Insurance Portability and Accountability Act.
176	(b)  An insurer shall develop an implementation plan to
177	comply with paragraph (a) no later than March 31, 2007, and
178	shall make the eligibility and benefits information described in
179	this subsection available through a secure Internet website no
180	later than July 1, 2007.
181	Section 4.  Present subsection (2) of section 627.657,
182	Florida Statutes, is renumbered as subsection (4), and new
183	subsections (2) and (3) are added to that section, to read:
184	627.657  Provisions of group health insurance policies.--
185	(2)  The medical policy as specified in s. 627.6699(3)(k)
186	must be accompanied by an identification card that contains, at
187	a minimum:
188	(a)  The name of the organization issuing the policy or
189	name of the organization administering the policy, whichever
190	applies.
191	(b)  The name of the certificateholder.
192	(c)  The type of plan only if the health plan is filed with
193	the state, an indication that the plan is self-funded, or the
194	name of the network.
195	(d)  The member identification number, contract number, and
196	policy or group number, if applicable.
197	(e)  A contact phone number or electronic address for
198	authorizations.
199	(f)  A phone number or electronic address whereby the
200	covered person or hospital, physician, or other person rendering
201	services covered by the policy may determine if the plan is
202	insured and may obtain a benefits verification in order to
203	estimate patient financial responsibility, in compliance with
204	privacy rules under the Health Insurance Portability and
205	Accountability Act.
206	(g)  The national plan identifier, in accordance with the
207	compliance date set forth by the federal Department of Health
208	and Human Services.
209
210	The identification card must present the information in a
211	readily identifiable manner or, alternatively, the information
212	may be embedded on the card and available through magnetic
213	stripe or smart card. The information may also be provided
214	through other electronic technology.
215	(3)(a)  An insurer that issues a group health insurance
216	policy shall provide a hospital, physician, or other person
217	rendering services covered by the policy electronic access to
218	the covered person's eligibility and benefits information
219	through a secure Internet website. The eligibility and benefits
220	information shall comply with the transaction standards
221	specified in ANSI ASC X12N 270 for health care claim eligibility
222	inquiries and ANSI ASC X12N 271 for health care claim
223	eligibility responses, or successor transaction standards,
224	pursuant to the Health Insurance Portability and Accountability
225	Act.
226	(b)  An insurer shall develop an implementation plan to
227	comply with paragraph (a) no later than March 31, 2007, and
228	shall make the eligibility and benefits information described in
229	this subsection available through a secure Internet website no
230	later than July 1, 2007.
231	Section 5.  Paragraph (a) of subsection (4) of section
232	627.6699, Florida Statutes, is amended to read:
233	627.6699  Employee Health Care Access Act.--
234	(4)  APPLICABILITY AND SCOPE.--
235	(a)1.  This section applies to a health benefit plan that
236	provides coverage to employees of a small employer in this
237	state, unless the coverage is marketed directly to the
238	individual employee, and the employer does not contribute
239	directly or indirectly to the premiums or facilitate the
240	administration of the coverage in any manner. For the purposes
241	of this subparagraph, an employer is not deemed to be
242	contributing to the premiums or facilitating the administration
243	of coverage if the employer:
244	a.  Does not contribute to the premium and merely collects
245	the premiums for coverage from an employee's wages or salary
246	through payroll deduction and submits payment for the premiums
247	of one or more employees in a lump sum to a carrier; or
248	b.  Directly or indirectly establishes or administers a
249	health reimbursement account plan for its employees.
250	2.  A carrier authorized to issue group or individual
251	health benefit plans under this chapter or chapter 641 may offer
252	coverage as described in this paragraph to individual employees
253	without being subject to this section if the employer has not
254	had a group health benefit plan in place in the prior 6 months.
255	A carrier authorized to issue group or individual health benefit
256	plans under this chapter or chapter 641 may offer coverage as
257	described in this subparagraph to employees that are not
258	eligible employees as defined in this section, whether or not
259	the small employer has a group health benefit plan in place. A
260	carrier that offers coverage as described in this subparagraph
261	must provide a cancellation notice to the primary insured at
262	least 10 days prior to canceling the coverage for nonpayment of
263	premium.
264	Section 6.  Paragraph (i) of subsection (2) of section
265	636.204, Florida Statutes, is amended to read:
266	636.204  License required.--
267	(2)  An application for a license to operate as a discount
268	medical plan organization must be filed with the office on a
269	form prescribed by the commission. Such application must be
270	sworn to by an officer or authorized representative of the
271	applicant and be accompanied by the following, if applicable:
272	(i)  A copy of the applicant's most recent financial
273	statements audited by an independent certified public
274	accountant. An applicant that is a subsidiary of a parent entity
275	that is publicly traded and that prepares audited financial
276	statements reflecting the consolidated operations of the parent
277	entity and the subsidiary may submit petition the office to
278	accept, in lieu of the audited financial statement of the
279	applicant, the audited financial statement of the parent entity
280	and a written guaranty by the parent entity that the minimum
281	capital requirements of the applicant required by this part will
282	be met by the parent entity.
283	Section 7.  Subsection (1) of section 636.206, Florida
284	Statutes, is amended to read:
285	636.206  Examinations and investigations.--
286	(1)  The office may examine or investigate the business and
287	affairs of any discount medical plan organization if the
288	commissioner has reason to believe that the discount medical
289	plan organization is not complying with the requirements of this
290	act. The office may order any discount medical plan organization
291	or applicant to produce any records, books, files, advertising
292	and solicitation materials, or other information and may take
293	statements under oath to determine whether the discount medical
294	plan organization or applicant is in violation of the law or is
295	acting contrary to the public interest. The expenses incurred in
296	conducting any examination or investigation must be paid by the
297	discount medical plan organization or applicant. Examinations
298	and investigations must be conducted as provided in chapter 624.
299	Section 8.  Subsection (1) of section 636.210, Florida
300	Statutes, is amended to read:
301	636.210  Prohibited activities of a discount medical plan
302	organization.--
303	(1)  A discount medical plan organization may not:
304	(a)  Use in its advertisements, marketing material,
305	brochures, and discount cards the term "insurance" except as
306	otherwise provided in this part or as a disclaimer of any
307	relationship between discount medical plan organization benefits
308	and insurance;
309	(b)  Use in its advertisements, marketing material,
310	brochures, and discount cards the terms "health plan,"
311	"coverage," "copay," "copayments," "preexisting conditions,"
312	"guaranteed issue," "premium," "PPO," "preferred provider
313	organization," or other terms in a manner that could reasonably
314	mislead a person into believing the discount medical plan was
315	health insurance;
316	(c)  Have restrictions on free access to plan providers,
317	except for hospital services, including, but not limited to,
318	waiting periods and notification periods; or
319	(d)  Pay providers any fees for medical services.
320	Section 9.  Subsection (1) of section 636.216, Florida
321	Statutes, is amended to read:
322	636.216  Charge or form filings.--
323	(1)  All charges to members must be filed with the office.
324	and Any charge to members greater than $30 per month or $360 per
325	year for access to healthcare services, other than those
326	provided by physicians licensed under chapter 458 or chapter 459
327	or by hospitals licensed under chapter 395, must be approved by
328	the office before the charges can be used. Any charge to members
329	greater than $60 dollars per month or $720 per year for
330	healthcare services that include services provided by physicians
331	licensed under chapters 458 and 459 or by hospitals licensed
332	under chapter 395 must be approved by the office before the
333	charges can be used. The discount medical plan organization has
334	the burden of proof that the charges bear a reasonable relation
335	to the benefits received by the member.
336	Section 10.  Subsection (2) of section 636.218, Florida
337	Statutes, is amended to read:
338	636.218  Annual reports.--
339	(2)  Such reports must be on forms prescribed by the
340	commission and must include:
341	(a)  Audited financial statements prepared in accordance
342	with generally accepted accounting principles certified by an
343	independent certified public accountant, including the
344	organization's balance sheet, income statement, and statement of
345	changes in cash flow for the preceding year. An organization
346	that is a subsidiary of a parent entity that is publicly traded
347	and that prepares audited financial statements reflecting the
348	consolidated operations of the parent entity and the
349	organization may petition the office to accept, in lieu of the
350	audited financial statement of the organization, the audited
351	financial statement of the parent entity and a written guaranty
352	by the parent entity that the minimum capital requirements of
353	the organization required by this part will be met by the parent
354	entity.
355	(a)(b)  If different from the initial application or the
356	last annual report, a list of the names and residence addresses
357	of all persons responsible for the conduct of the organization's
358	affairs, together with a disclosure of the extent and nature of
359	any contracts or arrangements between such persons and the
360	discount medical plan organization, including any possible
361	conflicts of interest.
362	(b)(c)  The number of discount medical plan members in the
363	state.
364	(c)(d)  Such other information relating to the performance
365	of the discount medical plan organization as is reasonably
366	required by the commission or office.
367	Section 11.  Subsection (1) of section 636.220, Florida
368	Statutes, is amended to read:
369	636.220  Minimum capital requirements.--
370	(1)  Each discount medical plan organization must at all
371	times maintain a net worth of at least $150,000 and each
372	discount medical plan organization shall certify in writing
373	under oath at licensure and annually that the minimum
374	capitalization requirements of this part are satisfied.
375	Section 12.  Section 636.230, Florida Statutes, is amended
376	to read:
377	636.230  Bundling discount medical plans with insurance
378	other products.--When a marketer or discount medical plan
379	organization sells a discount medical plan together with any
380	insurance other product, the fees for the discount medical plan
381	must be provided in writing to the member if the fees exceed $30
382	per month for access to healthcare services other than those
383	provided by physicians licensed under chapter 458 or chapter 459
384	or by hospitals licensed under chapter 395 or $60 dollars per
385	month for healthcare services which include services provided by
386	physicians licensed under chapter 458 or chapter 459 or by
387	hospitals licensed under chapter 395.
388	Section 13.  Present subsections (5) through (40) of
389	section 641.31, Florida Statutes, are renumbered as subsections
390	(7) through (42), respectively, and new subsections (5) and (6)
391	are added to that section, to read:
392	641.31  Health maintenance contracts.--
393	(5)  The contract, certificate, or member handbook must be
394	accompanied by an identification card that contains, at a
395	minimum:
396	(a)  The name of the organization offering the contract or
397	name of the organization administering the contract, whichever
398	applies.
399	(b)  The name of the subscriber.
400	(c)  A statement that the health plan is a health
401	maintenance organization. Only a health plan with a certificate
402	of authority issued under this chapter may be identified as a
403	health maintenance organization.
404	(d)  The member identification number, contract number, and
405	group number, if applicable.
406	(e)  A contact phone number or electronic address for
407	authorizations.
408	(f)  A phone number or electronic address whereby the
409	covered person or hospital, physician, or other person rendering
410	services covered by the contract may determine if the plan is
411	insured and may obtain a benefits verification in order to
412	estimate patient financial responsibility, in compliance with
413	privacy rules under the Health Insurance Portability and
414	Accountability Act.
415	(g)  The national plan identifier, in accordance with the
416	compliance date set forth by the federal Department of Health
417	and Human Services.
418
419	The identification card must present the information in a
420	readily identifiable manner or, alternatively, the information
421	may be embedded on the card and available through magnetic
422	stripe or smart card. The information may also be provided
423	through other electronic technology.
424	(6)(a)  A health maintenance organization shall provide a
425	hospital, physician, or other person rendering services covered
426	by the policy electronic access to the covered person's
427	eligibility and benefits information through a secure Internet
428	website. The eligibility and benefits information shall comply
429	with the transaction standards specified in ANSI ASC X12N 270
430	for health care claim eligibility inquiries and ANSI ASC X12N
431	271 for health care claim eligibility responses, or successor
432	transaction standards, pursuant to the Health Insurance
433	Portability and Accountability Act.
434	(b)  A health maintenance organization shall develop an
435	implementation plan to comply with paragraph (a) no later than
436	March 31, 2007, and shall make the eligibility and benefits
437	information described in this subsection available through a
438	secure Internet website no later than July 1, 2007.
439	Section 14.  Paragraph (j) of subsection (3) of section
440	383.145, Florida Statutes, is amended to read:
441	383.145  Newborn and infant hearing screening.--
442	(3)  REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE
443	COVERAGE; REFERRAL FOR ONGOING SERVICES.--
444	(j)  The initial procedure for screening the hearing of the
445	newborn or infant and any medically necessary followup
446	reevaluations leading to diagnosis shall be a covered benefit,
447	reimbursable under Medicaid as an expense compensated
448	supplemental to the per diem rate for Medicaid patients enrolled
449	in MediPass or Medicaid patients covered by a fee for service
450	program. For Medicaid patients enrolled in HMOs, providers shall
451	be reimbursed directly by the Medicaid Program Office at the
452	Medicaid rate. This service may not be considered a covered
453	service for the purposes of establishing the payment rate for
454	Medicaid HMOs. All health insurance policies and health
455	maintenance organizations as provided under ss. 627.6416,
456	627.6579, and 641.31(32)(30), except for supplemental policies
457	that only provide coverage for specific diseases, hospital
458	indemnity, or Medicare supplement, or to the supplemental
459	polices, shall compensate providers for the covered benefit at
460	the contracted rate. Nonhospital-based providers shall be
461	eligible to bill Medicaid for the professional and technical
462	component of each procedure code.
463	Section 15.  Paragraphs (b) and (i) of subsection (1) of
464	section 641.185, Florida Statutes, are amended to read:
465	641.185  Health maintenance organization subscriber
466	protections.--
467	(1)  With respect to the provisions of this part and part
468	III, the principles expressed in the following statements shall
469	serve as standards to be followed by the commission, the office,
470	the department, and the Agency for Health Care Administration in
471	exercising their powers and duties, in exercising administrative
472	discretion, in administrative interpretations of the law, in
473	enforcing its provisions, and in adopting rules:
474	(b)  A health maintenance organization subscriber should
475	receive quality health care from a broad panel of providers,
476	including referrals, preventive care pursuant to s. 641.402(1),
477	emergency screening and services pursuant to ss. 641.31(14)(12)
478	and 641.513, and second opinions pursuant to s. 641.51.
479	(i)  A health maintenance organization subscriber should
480	receive timely and, if necessary, urgent grievances and appeals
481	within the health maintenance organization pursuant to ss.
482	641.228, 641.31(7)(5), 641.47, and 641.511.
483	Section 16.  Subsection (1) of section 641.2018, Florida
484	Statutes, is amended to read:
485	641.2018  Limited coverage for home health care
486	authorized.--
487	(1)  Notwithstanding other provisions of this chapter, a
488	health maintenance organization may issue a contract that limits
489	coverage to home health care services only. The organization and
490	the contract shall be subject to all of the requirements of this
491	part that do not require or otherwise apply to specific benefits
492	other than home care services. To this extent, all of the
493	requirements of this part apply to any organization or contract
494	that limits coverage to home care services, except the
495	requirements for providing comprehensive health care services as
496	provided in ss. 641.19(4), (11), and (12), and 641.31(1), except
497	ss. 641.31(11)(9), (14)(12), (17), (18), (19), (20), (21), (23),
498	and (26)(24) and 641.31095.
499	Section 17.  Section 641.3107, Florida Statutes, is amended
500	to read:
501	641.3107  Delivery of contract.--Unless delivered upon
502	execution or issuance, a health maintenance contract,
503	certificate of coverage, or member handbook shall be mailed or
504	delivered to the subscriber or, in the case of a group health
505	maintenance contract, to the employer or other person who will
506	hold the contract on behalf of the subscriber group within 10
507	working days from approval of the enrollment form by the health
508	maintenance organization or by the effective date of coverage,
509	whichever occurs first. However, if the employer or other person
510	who will hold the contract on behalf of the subscriber group
511	requires retroactive enrollment of a subscriber, the
512	organization shall deliver the contract, certificate, or member
513	handbook to the subscriber within 10 days after receiving notice
514	from the employer of the retroactive enrollment. This section
515	does not apply to the delivery of those contracts specified in
516	s. 641.31(15)(13).
517	Section 18.  Paragraph (a) of subsection (7) of section
518	641.3922, Florida Statutes, is amended to read:
519	641.3922  Conversion contracts; conditions.--Issuance of a
520	converted contract shall be subject to the following conditions:
521	(7)  REASONS FOR CANCELLATION; TERMINATION.--The converted
522	health maintenance contract must contain a cancellation or
523	nonrenewability clause providing that the health maintenance
524	organization may refuse to renew the contract of any person
525	covered thereunder, but cancellation or nonrenewal must be
526	limited to one or more of the following reasons:
527	(a)  Fraud or intentional misrepresentation, subject to the
528	limitations of s. 641.31(25)(23), in applying for any benefits
529	under the converted health maintenance contract.;
530	Section 19.  Subsection (4) of section 641.513, Florida
531	Statutes, is amended to read:
532	641.513  Requirements for providing emergency services and
533	care.--
534	(4)  A subscriber may be charged a reasonable copayment, as
535	provided in s. 641.31(14)(12), for the use of an emergency room.
536	Section 20.  Paragraph (b) of subsection (2) and subsection
537	(6) of section 641.316, Florida Statutes, are amended to read:
538	641.316  Fiscal intermediary services.--
539	(2)
540	(b)  The term "fiscal intermediary services organization"
541	means a person or entity that which performs fiduciary or fiscal
542	intermediary services to health care professionals who contract
543	with health maintenance organizations other than a fiscal
544	intermediary services organization owned, operated, or
545	controlled by a hospital licensed under chapter 395, an insurer
546	licensed under chapter 624, a third-party administrator licensed
547	under chapter 626, a prepaid limited health service organization
548	licensed under chapter 636, a health maintenance organization
549	licensed under this chapter, or physician group practices as
550	defined in s. 456.053(3)(h) and providing services under the
551	scope of licenses of the members of the group practice.
552	(6)  Any fiscal intermediary services organization, other
553	than a fiscal intermediary services organization owned,
554	operated, or controlled by a hospital licensed under chapter
555	395, an insurer licensed under chapter 624, a third-party
556	administrator licensed under chapter 626, a prepaid limited
557	health service organization licensed under chapter 636, a health
558	maintenance organization licensed under this chapter, or
559	physician group practices as defined in s. 456.053(3)(h), and
560	providing services under the scope of licenses of the members of
561	the group practice, must register with the office and meet the
562	requirements of this section. In order to register as a fiscal
563	intermediary services organization, the organization must comply
564	with ss. 641.21(1)(c), and (d), and (j), and 641.22(6), and
565	641.27. The fiscal intermediary services organization must also
566	comply with the provisions of ss. 641.3155, 641.3156, and
567	641.51(4). Should the office determine that the fiscal
568	intermediary services organization does not meet the
569	requirements of this section, the registration shall be denied.
570	In the event that the registrant fails to maintain compliance
571	with the provisions of this section, the office may revoke or
572	suspend the registration. In lieu of revocation or suspension of
573	the registration, the office may levy an administrative penalty
574	in accordance with s. 641.25.
575	Section 21.  Section 409.9102, Florida Statutes, as created
576	by section 2 of chapter 2005-252, Laws of Florida, is reenacted
577	and amended to read:
578	(Substantial rewording of section. See
579	s. 409.9102, F.S., for present text.)
580	409.9102  A qualified state Long-Term Care Insurance
581	Partnership Program in Florida.--The Agency for Health Care
582	Administration, in consultation with the Office of Insurance
583	Regulation and the Department of Children and Family Services,
584	is directed to establish a qualified state Long-Term Care
585	Insurance Partnership Program in Florida, in compliance with the
586	requirements of s. 1917(b) of the Social Security Act, as
587	amended.
588	(1)  The program shall:
589	(a)  Provide incentives for an individual to obtain or
590	maintain insurance to cover the cost of long-term care.
591	(b)  Provide a mechanism to qualify for coverage of the
592	costs of long-term care needs under Medicaid without first being
593	required to substantially exhaust his or her assets, including a
594	provision for the disregard of any assets in an amount equal to
595	the insurance benefit payments that are made to or on behalf of
596	an individual who is a beneficiary under the program.
597	(c)  Alleviate the financial burden on the state's medical
598	assistance program by encouraging the pursuit of private
599	initiatives.
600	(2)  The Agency for Health Care Administration, in
601	consultation with the Office of Insurance Regulation and the
602	Department of Children and Family Services, and in accordance
603	with federal guidelines, shall create standards for long-term
604	care partnership program information distributed to individuals
605	through insurance companies offering approved long-term care
606	partnership program policies.
607	(3)  The Agency for Health Care Administration is
608	authorized to amend the Medicaid state plan and adopt rules
609	pursuant to ss. 120.536(1) and 120.54 to implement this section.
610	(4)  The Department of Children and Family Services, when
611	determining eligibility for Medicaid long-term care services for
612	an individual who is the beneficiary of an approved long-term
613	care partnership program policy, shall reduce the total
614	countable assets of the individual by an amount equal to the
615	insurance benefit payments that are made to or on behalf of the
616	individual. The department is authorized to adopt rules pursuant
617	to ss. 120.536(1) and 120.54 to implement this subsection.
618	Section 22.  Section 627.94075, Florida Statutes, is
619	created to read:
620	627.94075  A qualified state Long-Term Care Insurance
621	Partnership Program in Florida.--The commission may adopt rules
622	pursuant to ss. 120.536(1) and 120.54 to implement applicable
623	provisions of a qualified state Long-Term Care Insurance
624	Partnership Program in Florida in accordance with the
625	requirements of s. 1917(b) of the Social Security Act, as
626	amended, any applicable federal guidelines, and any rules
627	necessary to ensure program compliance by insurers as provided
628	in s. 409.9102.
629	Section 23.  Sections 1 and 2 of chapter 2005-252, Laws of
630	Florida, are repealed.
631	Section 24.  Section 4 of chapter 2005-252, Laws of
632	Florida, is amended to read:
633	Section 4.  This act shall take effect upon becoming a law,
634	except that the amendments to section 409.905, Florida Statutes,
635	and the newly created section 409.9102, Florida Statutes,
636	provided in this act shall take effect contingent upon amendment
637	to section 1917(b)(1)(c) of the Social Security Act by the
638	United States Congress to delete the "May 14, 1993," deadline
639	for approval by states of long-term care partnership plans.
640	Section 25.  The Office of Program Policy Analysis and
641	Government Accountability is directed to prepare a report on the
642	implementation of a qualified state Long-Term Care Insurance
643	Partnership Program in Florida. The report shall include data on
644	the number and value of policies sold and the geographic areas
645	in which the policies were purchased, a demographic description
646	of the policyholders, and other information necessary to
647	evaluate the program. The report shall be provided to the
648	Governor, the President of the Senate, and the Speaker of the
649	House of Representatives by January 31, 2009.
650	Section 26.  This act shall take effect January 1, 2007,
651	and shall apply to identification cards issued for policies or
652	certificates issued or renewed on or after that date.

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