Senate Bill sb2094
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Florida Senate - 2007 SB 2094
By Senator Peaden
2-214-07
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. 627.642, F.S.; requiring
5 an identification card containing specified
6 information to be given to insureds who have
7 health and accident insurance; amending s.
8 627.657, F.S.; requiring an identification card
9 containing specified information to be given to
10 insureds under group health insurance policies;
11 amending s. 641.31, F.S.; requiring an
12 identification card to be given to persons
13 having health care services through a health
14 maintenance contract; amending ss. 383.145,
15 641.185, 641.2018, 641.3107, 641.3922, and
16 641.513, F.S.; conforming cross-references to
17 changes made by the act; providing application;
18 providing effective dates.
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 policy
26 as specified in s. 627.6699(3)(k) must be accompanied by an
27 identification card that contains, at a minimum:
28 (a) The name of the organization issuing the policy or
29 the name of the organization administering the policy,
30 whichever applies.
31 (b) The name of the contract holder.
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Florida Senate - 2007 SB 2094
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1 (c) The type of plan only if the plan is filed in the
2 state, an indication that the plan is self-funded, or the name
3 of the network.
4 (d) The member identification number, contract number,
5 and policy or group number, if applicable.
6 (e) A contact phone number or electronic address for
7 authorizations.
8 (f) A phone number or electronic address whereby the
9 covered person or hospital, physician, or other person
10 rendering services covered by the policy may determine if the
11 plan is insured and may obtain a benefits verification in
12 order to estimate patient financial responsibility, in
13 compliance with privacy rules under the Health Insurance
14 Portability and Accountability Act.
15 (g) The national plan identifier, in accordance with
16 the compliance date set forth by the federal Department of
17 Health and Human Services.
18
19 The identification card must present the information in a
20 readily identifiable manner or, alternatively, the information
21 may be embedded on the card and available through magnetic
22 stripe or smart card. The information may also be provided
23 through other electronic technology.
24 Section 2. Present subsection (2) of section 627.657,
25 Florida Statutes, is renumbered as subsection (3), and a new
26 subsection (2) is added to that section, to read:
27 627.657 Provisions of group health insurance
28 policies.--
29 (2) The medical policy as specified in s.
30 627.6699(3)(k) must be accompanied by an identification card
31 that contains, at a minimum:
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Florida Senate - 2007 SB 2094
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1 (a) The name of the organization issuing the policy or
2 name of the organization administering the policy, whichever
3 applies.
4 (b) The name of the certificateholder.
5 (c) The type of plan only if the plan is filed in the
6 state, an indication that the plan is self-funded, or the name
7 of the network.
8 (d) The member identification number, contract number,
9 and policy or group number, if applicable.
10 (e) A contact phone number or electronic address for
11 authorizations.
12 (f) A phone number or electronic address whereby the
13 covered person or hospital, physician, or other person
14 rendering services covered by the policy may determine if the
15 plan is insured and may obtain a benefits verification in
16 order to estimate patient financial responsibility, in
17 compliance with privacy rules under the Health Insurance
18 Portability and Accountability Act.
19 (g) The national plan identifier, in accordance with
20 the compliance date set forth by the federal Department of
21 Health and Human Services.
22
23 The identification card must present the information in a
24 readily identifiable manner or, alternatively, the information
25 may be embedded on the card and available through magnetic
26 stripe or smart card. The information may also be provided
27 through other electronic technology.
28 Section 3. Present subsections (5) through (40) of
29 section 641.31, Florida Statutes, are renumbered as
30 subsections (6) through (41), respectively, and a new
31 subsection (5) is added to that section, to read:
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Florida Senate - 2007 SB 2094
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1 641.31 Health maintenance contracts.--
2 (5) The contract, certificate, or member handbook must
3 be accompanied by an identification card that contains, at a
4 minimum:
5 (a) The name of the organization offering the contract
6 or name of the organization administering the contract,
7 whichever applies.
8 (b) The name of the subscriber.
9 (c) A statement that the health plan is a health
10 maintenance organization. Only a health plan with a
11 certificate of authority issued under this chapter may be
12 identified as a health maintenance organization.
13 (d) The member identification number, contract number,
14 and group number, if applicable.
15 (e) A contact phone number or electronic address for
16 authorizations.
17 (f) A phone number or electronic address whereby the
18 covered person or hospital, physician, or other person
19 rendering services covered by the contract may determine if
20 the plan is insured and may obtain a benefits verification in
21 order to estimate patient financial responsibility, in
22 compliance with privacy rules under the Health Insurance
23 Portability and Accountability Act.
24 (g) The national plan identifier, in accordance with
25 the compliance date set forth by the federal Department of
26 Health and Human Services.
27
28 The identification card must present the information in a
29 readily identifiable manner or, alternatively, the information
30 may be embedded on the card and available through magnetic
31
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1 stripe or smart card. The information may also be provided
2 through other electronic technology.
3 Section 4. Paragraph (j) of subsection (3) of section
4 383.145, Florida Statutes, is amended to read:
5 383.145 Newborn and infant hearing screening.--
6 (3) REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE
7 COVERAGE; REFERRAL FOR ONGOING SERVICES.--
8 (j) The initial procedure for screening the hearing of
9 the newborn or infant and any medically necessary followup
10 reevaluations leading to diagnosis shall be a covered benefit,
11 reimbursable under Medicaid as an expense compensated
12 supplemental to the per diem rate for Medicaid patients
13 enrolled in MediPass or Medicaid patients covered by a fee for
14 service program. For Medicaid patients enrolled in HMOs,
15 providers shall be reimbursed directly by the Medicaid Program
16 Office at the Medicaid rate. This service may not be
17 considered a covered service for the purposes of establishing
18 the payment rate for Medicaid HMOs. All health insurance
19 policies and health maintenance organizations as provided
20 under ss. 627.6416, 627.6579, and 641.31(31) 641.31(30),
21 except for supplemental policies that only provide coverage
22 for specific diseases, hospital indemnity, or Medicare
23 supplement, or to the supplemental polices, shall compensate
24 providers for the covered benefit at the contracted rate.
25 Nonhospital-based providers shall be eligible to bill Medicaid
26 for the professional and technical component of each procedure
27 code.
28 Section 5. Paragraphs (b) and (i) of subsection (1) of
29 section 641.185, Florida Statutes, are amended to read:
30 641.185 Health maintenance organization subscriber
31 protections.--
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1 (1) With respect to the provisions of this part and
2 part III, the principles expressed in the following statements
3 shall serve as standards to be followed by the commission, the
4 office, the department, and the Agency for Health Care
5 Administration in exercising their powers and duties, in
6 exercising administrative discretion, in administrative
7 interpretations of the law, in enforcing its provisions, and
8 in adopting rules:
9 (b) A health maintenance organization subscriber
10 should receive quality health care from a broad panel of
11 providers, including referrals, preventive care pursuant to s.
12 641.402(1), emergency screening and services pursuant to ss.
13 641.31(13) 641.31(12) and 641.513, and second opinions
14 pursuant to s. 641.51.
15 (i) A health maintenance organization subscriber
16 should receive timely and, if necessary, urgent grievances and
17 appeals within the health maintenance organization pursuant to
18 ss. 641.228, 641.31(6) 641.31(5), 641.47, and 641.511.
19 Section 6. Subsection (1) of section 641.2018, Florida
20 Statutes, is amended to read:
21 641.2018 Limited coverage for home health care
22 authorized.--
23 (1) Notwithstanding other provisions of this chapter,
24 a health maintenance organization may issue a contract that
25 limits coverage to home health care services only. The
26 organization and the contract shall be subject to all of the
27 requirements of this part that do not require or otherwise
28 apply to specific benefits other than home care services. To
29 this extent, all of the requirements of this part apply to any
30 organization or contract that limits coverage to home care
31 services, except the requirements for providing comprehensive
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1 health care services as provided in ss. 641.19(4), (11), and
2 (12), and 641.31(1), except ss. 641.31(10) 641.31(9),
3 (13)(12), (17), (18), (19), (20), (21), (22), and (25)(24) and
4 641.31095.
5 Section 7. Section 641.3107, Florida Statutes, is
6 amended to read:
7 641.3107 Delivery of contract.--Unless delivered upon
8 execution or issuance, a health maintenance contract,
9 certificate of coverage, or member handbook shall be mailed or
10 delivered to the subscriber or, in the case of a group health
11 maintenance contract, to the employer or other person who will
12 hold the contract on behalf of the subscriber group within 10
13 working days from approval of the enrollment form by the
14 health maintenance organization or by the effective date of
15 coverage, whichever occurs first. However, if the employer or
16 other person who will hold the contract on behalf of the
17 subscriber group requires retroactive enrollment of a
18 subscriber, the organization shall deliver the contract,
19 certificate, or member handbook to the subscriber within 10
20 days after receiving notice from the employer of the
21 retroactive enrollment. This section does not apply to the
22 delivery of those contracts specified in s. 641.31(14) s.
23 641.31(13).
24 Section 8. Paragraph (a) of subsection (7) of section
25 641.3922, Florida Statutes, is amended to read:
26 641.3922 Conversion contracts; conditions.--Issuance
27 of a converted contract shall be subject to the following
28 conditions:
29 (7) REASONS FOR CANCELLATION; TERMINATION.--The
30 converted health maintenance contract must contain a
31 cancellation or nonrenewability clause providing that the
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1 health maintenance organization may refuse to renew the
2 contract of any person covered thereunder, but cancellation or
3 nonrenewal must be limited to one or more of the following
4 reasons:
5 (a) Fraud or intentional misrepresentation, subject to
6 the limitations of s. 641.31(24) s. 641.31(23), in applying
7 for any benefits under the converted health maintenance
8 contract.;
9 Section 9. Subsection (4) of section 641.513, Florida
10 Statutes, is amended to read:
11 641.513 Requirements for providing emergency services
12 and care.--
13 (4) A subscriber may be charged a reasonable
14 copayment, as provided in s. 641.31(13) s. 641.31(12), for the
15 use of an emergency room.
16 Section 10. This act shall take effect January 1,
17 2008, and shall apply to identification cards issued for
18 policies or certificates issued or renewed on or after that
19 date.
20
21 *****************************************
22 SENATE SUMMARY
23 Requires an identification card containing specified
information to be given to insureds who have health and
24 accident insurance. Requires an identification card
containing specified information to be given to insureds
25 under group health insurance policies. Requires an
identification card to be given to persons having health
26 care services through a health maintenance contract.
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