Senate Bill sb0094
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Florida Senate - 2006 (Corrected Copy) SB 94
By Senator Fasano
11-94-06
1 A bill to be entitled
2 An act relating to health maintenance
3 organizations; amending s. 641.316, F.S.;
4 redefining the term "fiscal intermediary
5 services organization"; amending s. 641.234,
6 F.S.; expanding the requirement that a health
7 maintenance organization remains responsible
8 for violations of certain statutory
9 requirements if the organization transfers to
10 any entity the obligations to pay any provider
11 for claims arising from services to subscribers
12 of the organization; amending s. 626.88, F.S.,
13 relating to the regulation of insurance
14 administrators; conforming provisions to
15 changes made by the act; providing an effective
16 date.
17
18 Be It Enacted by the Legislature of the State of Florida:
19
20 Section 1. Paragraph (b) of subsection (2) of section
21 641.316, Florida Statutes, is amended to read:
22 641.316 Fiscal intermediary services.--
23 (2)
24 (b) The term "fiscal intermediary services
25 organization" means a person or entity that which performs
26 fiduciary or fiscal intermediary services to health care
27 professionals who contract with health maintenance
28 organizations other than a fiscal intermediary services
29 organization owned, operated, or controlled by a hospital
30 licensed under chapter 395, an insurer licensed under chapter
31 624, a third-party administrator licensed under chapter 626, a
1
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Florida Senate - 2006 (Corrected Copy) SB 94
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1 prepaid limited health service organization licensed under
2 chapter 636, a health maintenance organization licensed under
3 this chapter, or physician group practices as defined in s.
4 456.053(3)(h) and providing services under the scope of
5 licenses of the members of the group practice.
6 Section 2. Subsection (4) of section 641.234, Florida
7 Statutes, is amended to read:
8 641.234 Administrative, provider, and management
9 contracts.--
10 (4)(a) If a health maintenance organization, through a
11 health care risk contract, transfers to any entity the
12 obligations to pay any provider for any claims arising from
13 services provided to or for the benefit of any subscriber of
14 the organization, the health maintenance organization remains
15 shall remain responsible for any violations of ss. 641.3155,
16 641.3156, and 641.51(4). The provisions of ss.
17 624.418-624.4211 and 641.52 shall apply to any such
18 violations.
19 (b) As used in this subsection,:
20 1. The term "health care risk contract" means a
21 contract under which an entity receives compensation in
22 exchange for providing to the health maintenance organization
23 a provider network or other services, which may include
24 administrative services.
25 2. the term "entity" means a person licensed as an
26 administrator under s. 626.88 and does not include any
27 provider or group practice, as defined in s. 456.053,
28 providing services under the scope of the license of the
29 provider or the members of the group practice. The term does
30 not include a hospital providing billing, claims, and
31
2
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Florida Senate - 2006 (Corrected Copy) SB 94
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1 collection services solely on its own and its physicians'
2 behalf and providing services under the scope of its license.
3 Section 3. Subsection (1) of section 626.88, Florida
4 Statutes, is amended to read:
5 626.88 Definitions.--For the purposes of this part,
6 the term:
7 (1) "Administrator" is any person who directly or
8 indirectly solicits or effects coverage of, collects charges
9 or premiums from, or adjusts or settles claims on residents of
10 this state in connection with authorized commercial
11 self-insurance funds or with insured or self-insured programs
12 which provide life or health insurance coverage or coverage of
13 any other expenses described in s. 624.33(1) or any person
14 who, through a health care risk contract as defined in s.
15 641.234 with an insurer or health maintenance organization,
16 provides billing and collection services to health insurers
17 and health maintenance organizations on behalf of health care
18 providers, other than any of the following persons:
19 (a) An employer or wholly owned direct or indirect
20 subsidiary of an employer, on behalf of such employer's
21 employees or the employees of one or more subsidiary or
22 affiliated corporations of such employer.
23 (b) A union on behalf of its members.
24 (c) An insurance company which is either authorized to
25 transact insurance in this state or is acting as an insurer
26 with respect to a policy lawfully issued and delivered by such
27 company in and pursuant to the laws of a state in which the
28 insurer was authorized to transact an insurance business.
29 (d) A health care services plan, health maintenance
30 organization, professional service plan corporation, or person
31 in the business of providing continuing care, possessing a
3
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Florida Senate - 2006 (Corrected Copy) SB 94
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1 valid certificate of authority issued by the office, and the
2 sales representatives thereof, if the activities of such
3 entity are limited to the activities permitted under the
4 certificate of authority.
5 (e) An entity that is affiliated with an insurer and
6 that only performs the contractual duties, between the
7 administrator and the insurer, of an administrator for the
8 direct and assumed insurance business of the affiliated
9 insurer. The insurer is responsible for the acts of the
10 administrator and is responsible for providing all of the
11 administrator's books and records to the insurance
12 commissioner, upon a request from the insurance commissioner.
13 For purposes of this paragraph, the term "insurer" means a
14 licensed insurance company, health maintenance organization,
15 prepaid limited health service organization, or prepaid health
16 clinic.
17 (f) A nonresident entity licensed in its state of
18 domicile as an administrator if its duties in this state are
19 limited to the administration of a group policy or plan of
20 insurance and no more than a total of 100 lives for all plans
21 reside in this state.
22 (g) An insurance agent licensed in this state whose
23 activities are limited exclusively to the sale of insurance.
24 (h) A person licensed as a managing general agent in
25 this state, whose activities are limited exclusively to the
26 scope of activities conveyed under such license.
27 (i) An adjuster licensed in this state whose
28 activities are limited to the adjustment of claims.
29 (j) A creditor on behalf of such creditor's debtors
30 with respect to insurance covering a debt between the creditor
31 and its debtors.
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1 (k) A trust and its trustees, agents, and employees
2 acting pursuant to such trust established in conformity with
3 29 U.S.C. s. 186.
4 (l) A trust exempt from taxation under s. 501(a) of
5 the Internal Revenue Code, a trust satisfying the requirements
6 of ss. 624.438 and 624.439, or any governmental trust as
7 defined in s. 624.33(3), and the trustees and employees acting
8 pursuant to such trust, or a custodian and its agents and
9 employees, including individuals representing the trustees in
10 overseeing the activities of a service company or
11 administrator, acting pursuant to a custodial account which
12 meets the requirements of s. 401(f) of the Internal Revenue
13 Code.
14 (m) A financial institution which is subject to
15 supervision or examination by federal or state authorities or
16 a mortgage lender licensed under chapter 494 who collects and
17 remits premiums to licensed insurance agents or authorized
18 insurers concurrently or in connection with mortgage loan
19 payments.
20 (n) A credit card issuing company which advances for
21 and collects premiums or charges from its credit card holders
22 who have authorized such collection if such company does not
23 adjust or settle claims.
24 (o) A person who adjusts or settles claims in the
25 normal course of such person's practice or employment as an
26 attorney at law and who does not collect charges or premiums
27 in connection with life or health insurance coverage.
28 (p) A person approved by the department who
29 administers only self-insured workers' compensation plans.
30 (q) A service company or service agent and its
31 employees, authorized in accordance with ss. 626.895-626.899,
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Florida Senate - 2006 (Corrected Copy) SB 94
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1 serving only a single employer plan, multiple-employer welfare
2 arrangements, or a combination thereof.
3 (r) Any provider or group practice, as defined in s.
4 456.053, providing services under the scope of the license of
5 the provider or the member of the group practice.
6 (s) Any hospital providing billing, claims, and
7 collection services solely on its own and its physicians'
8 behalf and providing services under the scope of its license.
9
10 A person who provides billing and collection services to
11 health insurers and health maintenance organizations on behalf
12 of health care providers shall comply with the provisions of
13 ss. 627.6131, 641.3155, and 641.51(4).
14 Section 4. This act shall take effect October 1, 2006.
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17 SENATE SUMMARY
18 Redefines the term "fiscal intermediary services
organization" to remove an exclusion provided for certain
19 organizations owned, operated, or controlled by a
hospital and to clarify that the term includes certain
20 group practices. Provides that a health maintenance
organization remains responsible for certain violations
21 regardless of the form of certain transfers of the
obligation to pay claims.
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