Senate Bill sb2094c1
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Florida Senate - 2007 CS for SB 2094
By the Committee on Banking and Insurance; and Senator Peaden
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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. 408.909, F.S.;
5 authorizing certain licensed entities to offer
6 the health flex plan; revising criteria for
7 eligibility for enrollment in a health flex
8 plan; creating s. 445.015, F.S.; establishing a
9 small business health insurance plan grant
10 program; providing purposes of the grant
11 program; providing conditions for use of grant
12 funds; providing duties of the Agency for
13 Workforce Innovation and the Office of
14 Insurance Regulation; requiring a report to the
15 Governor and Legislature; providing an
16 appropriation; amending s. 627.642, F.S.;
17 requiring an identification card containing
18 specified information to be given to insureds
19 who have health and accident insurance;
20 amending s. 627.4236, F.S.; redefining the term
21 "bone marrow transplant" for purposes of
22 required coverage for certain procedures to
23 include nonablative therapy having
24 life-prolonging intent; amending s. 627.657,
25 F.S.; requiring an identification card
26 containing specified information to be given to
27 insureds under group health insurance policies;
28 amending s. 641.31, F.S.; requiring an
29 identification card to be given to persons
30 having health care services through a health
31 maintenance contract; amending ss. 383.145,
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1 641.185, 641.2018, 641.3107, 641.3922, and
2 641.513, F.S.; conforming cross-references to
3 changes made by the act; providing application;
4 providing effective dates.
5
6 Be It Enacted by the Legislature of the State of Florida:
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8 Section 1. Effective July 1, 2007, subsections (3) and
9 (5) of section 408.909, Florida Statutes, are amended to read:
10 408.909 Health flex plans.--
11 (3) PROGRAM.--The agency and the office shall each
12 approve or disapprove health flex plans that provide health
13 care coverage for eligible participants. A health flex plan
14 may limit or exclude benefits otherwise required by law for
15 insurers offering coverage in this state, may cap the total
16 amount of claims paid per year per enrollee, may limit the
17 number of enrollees, or may take any combination of those
18 actions. A health flex plan offering may include the option of
19 a catastrophic plan supplementing the health flex plan.
20 (a) The agency shall develop guidelines for the review
21 of applications for health flex plans and shall disapprove or
22 withdraw approval of plans that do not meet or no longer meet
23 minimum standards for quality of care and access to care. The
24 agency shall ensure that the health flex plans follow
25 standardized grievance procedures similar to those required of
26 health maintenance organizations.
27 (b) The office shall develop guidelines for the review
28 of health flex plan applications and provide regulatory
29 oversight of health flex plan advertisement and marketing
30 procedures. The office shall disapprove or shall withdraw
31 approval of plans that:
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1 1. Contain any ambiguous, inconsistent, or misleading
2 provisions or any exceptions or conditions that deceptively
3 affect or limit the benefits purported to be assumed in the
4 general coverage provided by the health flex plan;
5 2. Provide benefits that are unreasonable in relation
6 to the premium charged or contain provisions that are unfair
7 or inequitable or contrary to the public policy of this state,
8 that encourage misrepresentation, or that result in unfair
9 discrimination in sales practices;
10 3. Cannot demonstrate that the health flex plan is
11 financially sound and that the applicant is able to underwrite
12 or finance the health care coverage provided; or
13 4. Cannot demonstrate that the applicant and its
14 management are in compliance with the standards required under
15 s. 624.404(3).
16 (c) In order to expedite financial determinations and
17 immediately qualify a large base of eligible entities to offer
18 the health flex program, entities licensed under chapter 627,
19 chapter 632, chapter 636, or chapter 641 shall be deemed in
20 compliance with the financial requirements for offering a
21 health flex plan. In addition, any local government or health
22 care district that has the initial operating funds and taxing
23 authority to fulfill its obligations under the proposed health
24 flex plan shall be deemed in compliance with the financial
25 requirements for offering a health flex plan.
26 (d)(c) The agency and the Financial Services
27 Commission may adopt rules as needed to administer this
28 section.
29 (5) ELIGIBILITY.--Eligibility to enroll in an approved
30 health flex plan is limited to residents of this state who:
31 (a) Are 64 years of age or younger;
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1 (b) Have a family income equal to or less than 250 200
2 percent of the federal poverty level;
3 (c) Are eligible under a federally approved Medicaid
4 demonstration waiver and reside in Palm Beach County or
5 Miami-Dade County;
6 (d) Are not covered by a private insurance policy and
7 are not eligible for coverage through a public health
8 insurance program, such as Medicare or Medicaid, unless
9 specifically authorized under paragraph (c), or another public
10 health care program, such as Kidcare, and have not been
11 covered at any time during the past 6 months; and
12 (d)(e) Have applied for health care coverage through
13 an approved health flex plan and have agreed to make any
14 payments required for participation, including periodic
15 payments or payments due at the time health care services are
16 provided; and
17 (e) Are either:
18 1. Not covered by a private insurance policy and not
19 eligible for coverage through a public health insurance
20 program, such as Medicare or Medicaid, unless specifically
21 authorized under paragraph (c), or another public health care
22 program, such as Kidcare, and have not been covered at any
23 time during the past 6 months; or
24 2. Part of an employer group that is not covered by a
25 private health insurance policy and has not been covered at
26 any time during the past 6 months and in which at least 75
27 percent of the employees have a family income equal to or less
28 than 250 percent of the federal poverty level. If the health
29 flex plan entity is a properly licensed health insurer, health
30 plan, or health maintenance organization, this subparagraph
31 applies when only 50 percent of the employees have a family
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1 income equal to or less than 250 percent of the federal
2 poverty level.
3 Section 2. Effective July 1, 2007, section 445.015,
4 Florida Statutes, is created to read:
5 445.015 Small business health insurance plan grant
6 program.--
7 (1) The agency shall establish a small business health
8 insurance plan grant program to award, administer, and monitor
9 grants to small employers and small businesses to develop and
10 offer cafeteria health plans that qualify under s. 125 of the
11 Internal Revenue Code and include options such as prepaid
12 health clinic services licensed under part II of chapter 641
13 for the purpose of improving access to health insurance for
14 uninsured employees. The agency shall give priority to
15 employer proposals that would improve access for previously
16 uninsured employees or include long-term commitments to insure
17 employees. Grant funds shall not be used for ongoing
18 maintenance of the plans or for employer contributions. Health
19 plans may identify and assist eligible small employers and
20 small businesses in obtaining grants. The agency, in
21 consultation with the Office of Insurance Regulation, shall
22 evaluate each project funded by a grant to measure any
23 increases in access to insurance and the long-term viability
24 of such increases. The agency shall design materials and
25 interactive programs to inform small employers and small
26 businesses about such cafeteria health plans and shall provide
27 training to assist small employers and small businesses in
28 developing such plans. Training shall include technical
29 assistance in establishing relationships with health plans and
30 individualized guidance on operational methods and
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1 infrastructure that will best support and ensure the long-term
2 success of using these plans.
3 (2) The agency shall submit a report that documents
4 the specific activities undertaken during the fiscal year
5 pursuant to this section annually to the Governor, the
6 President of the Senate, and the Speaker of the House of
7 Representatives no later than February 1.
8 Section 3. Effective July 1, 2007, the sum of $250,000
9 in nonrecurring revenue is appropriated from the General
10 Revenue Fund to the Agency for Workforce Innovation for the
11 2007-2008 fiscal year to award Small Business Health Insurance
12 Plan Grants to eligible businesses.
13 Section 4. Subsection (3) is added to section 627.642,
14 Florida Statutes, to read:
15 627.642 Outline of coverage.--
16 (3) In addition to the outline of coverage, a policy
17 as specified in s. 627.6699(3)(k) must be accompanied by an
18 identification card that contains, at a minimum:
19 (a) The name of the organization issuing the policy or
20 the name of the organization administering the policy,
21 whichever applies.
22 (b) The name of the contract holder.
23 (c) The type of plan only if the plan is filed in the
24 state, an indication that the plan is self-funded, or the name
25 of the network.
26 (d) The member identification number, contract number,
27 and policy or group number, if applicable.
28 (e) A contact phone number or electronic address for
29 authorizations.
30 (f) A phone number or electronic address whereby the
31 covered person or hospital, physician, or other person
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1 rendering services covered by the policy may determine if the
2 plan is insured and may obtain a benefits verification in
3 order to estimate patient financial responsibility, in
4 compliance with privacy rules under the Health Insurance
5 Portability and Accountability Act.
6 (g) The national plan identifier, in accordance with
7 the compliance date set forth by the federal Department of
8 Health and Human Services.
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10 The identification card must present the information in a
11 readily identifiable manner or, alternatively, the information
12 may be embedded on the card and available through magnetic
13 stripe or smart card. The information may also be provided
14 through other electronic technology.
15 Section 5. Subsection (1) of section 627.4236, Florida
16 Statutes, is amended to read:
17 627.4236 Coverage for bone marrow transplant
18 procedures.--
19 (1) As used in this section, the term "bone marrow
20 transplant" means human blood precursor cells administered to
21 a patient to restore normal hematological and immunological
22 functions following ablative or nonablative therapy with
23 curative or life-prolonging intent. Human blood precursor
24 cells may be obtained from the patient in an autologous
25 transplant or from a medically acceptable related or unrelated
26 donor, and may be derived from bone marrow, circulating blood,
27 or a combination of bone marrow and circulating blood. If
28 chemotherapy is an integral part of the treatment involving
29 bone marrow transplantation, the term "bone marrow transplant"
30 includes both the transplantation and the chemotherapy.
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1 Section 6. Present subsection (2) of section 627.657,
2 Florida Statutes, is renumbered as subsection (3), and a new
3 subsection (2) is added to that section, to read:
4 627.657 Provisions of group health insurance
5 policies.--
6 (2) The medical policy as specified in s.
7 627.6699(3)(k) must be accompanied by an identification card
8 that contains, at a minimum:
9 (a) The name of the organization issuing the policy or
10 name of the organization administering the policy, whichever
11 applies.
12 (b) The name of the certificateholder.
13 (c) The type of plan only if the plan is filed in the
14 state, an indication that the plan is self-funded, or the name
15 of the network.
16 (d) The member identification number, contract number,
17 and policy or group number, if applicable.
18 (e) A contact phone number or electronic address for
19 authorizations.
20 (f) A phone number or electronic address whereby the
21 covered person or hospital, physician, or other person
22 rendering services covered by the policy may determine if the
23 plan is insured and may obtain a benefits verification in
24 order to estimate patient financial responsibility, in
25 compliance with privacy rules under the Health Insurance
26 Portability and Accountability Act.
27 (g) The national plan identifier, in accordance with
28 the compliance date set forth by the federal Department of
29 Health and Human Services.
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1 The identification card must present the information in a
2 readily identifiable manner or, alternatively, the information
3 may be embedded on the card and available through magnetic
4 stripe or smart card. The information may also be provided
5 through other electronic technology.
6 Section 7. Present subsections (5) through (40) of
7 section 641.31, Florida Statutes, are renumbered as
8 subsections (6) through (41), respectively, and a new
9 subsection (5) is added to that section, to read:
10 641.31 Health maintenance contracts.--
11 (5) The contract, certificate, or member handbook must
12 be accompanied by an identification card that contains, at a
13 minimum:
14 (a) The name of the organization offering the contract
15 or name of the organization administering the contract,
16 whichever applies.
17 (b) The name of the subscriber.
18 (c) A statement that the health plan is a health
19 maintenance organization. Only a health plan with a
20 certificate of authority issued under this chapter may be
21 identified as a health maintenance organization.
22 (d) The member identification number, contract number,
23 and group number, if applicable.
24 (e) A contact phone number or electronic address for
25 authorizations.
26 (f) A phone number or electronic address whereby the
27 covered person or hospital, physician, or other person
28 rendering services covered by the contract may determine if
29 the plan is insured and may obtain a benefits verification in
30 order to estimate patient financial responsibility, in
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1 compliance with privacy rules under the Health Insurance
2 Portability and Accountability Act.
3 (g) The national plan identifier, in accordance with
4 the compliance date set forth by the federal Department of
5 Health and Human Services.
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7 The identification card must present the information in a
8 readily identifiable manner or, alternatively, the information
9 may be embedded on the card and available through magnetic
10 stripe or smart card. The information may also be provided
11 through other electronic technology.
12 Section 8. Paragraph (j) of subsection (3) of section
13 383.145, Florida Statutes, is amended to read:
14 383.145 Newborn and infant hearing screening.--
15 (3) REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE
16 COVERAGE; REFERRAL FOR ONGOING SERVICES.--
17 (j) The initial procedure for screening the hearing of
18 the newborn or infant and any medically necessary followup
19 reevaluations leading to diagnosis shall be a covered benefit,
20 reimbursable under Medicaid as an expense compensated
21 supplemental to the per diem rate for Medicaid patients
22 enrolled in MediPass or Medicaid patients covered by a fee for
23 service program. For Medicaid patients enrolled in HMOs,
24 providers shall be reimbursed directly by the Medicaid Program
25 Office at the Medicaid rate. This service may not be
26 considered a covered service for the purposes of establishing
27 the payment rate for Medicaid HMOs. All health insurance
28 policies and health maintenance organizations as provided
29 under ss. 627.6416, 627.6579, and 641.31(31) 641.31(30),
30 except for supplemental policies that only provide coverage
31 for specific diseases, hospital indemnity, or Medicare
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1 supplement, or to the supplemental polices, shall compensate
2 providers for the covered benefit at the contracted rate.
3 Nonhospital-based providers shall be eligible to bill Medicaid
4 for the professional and technical component of each procedure
5 code.
6 Section 9. Paragraphs (b) and (i) of subsection (1) of
7 section 641.185, Florida Statutes, are amended to read:
8 641.185 Health maintenance organization subscriber
9 protections.--
10 (1) With respect to the provisions of this part and
11 part III, the principles expressed in the following statements
12 shall serve as standards to be followed by the commission, the
13 office, the department, and the Agency for Health Care
14 Administration in exercising their powers and duties, in
15 exercising administrative discretion, in administrative
16 interpretations of the law, in enforcing its provisions, and
17 in adopting rules:
18 (b) A health maintenance organization subscriber
19 should receive quality health care from a broad panel of
20 providers, including referrals, preventive care pursuant to s.
21 641.402(1), emergency screening and services pursuant to ss.
22 641.31(13) 641.31(12) and 641.513, and second opinions
23 pursuant to s. 641.51.
24 (i) A health maintenance organization subscriber
25 should receive timely and, if necessary, urgent grievances and
26 appeals within the health maintenance organization pursuant to
27 ss. 641.228, 641.31(6) 641.31(5), 641.47, and 641.511.
28 Section 10. Subsection (1) of section 641.2018,
29 Florida Statutes, is amended to read:
30 641.2018 Limited coverage for home health care
31 authorized.--
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1 (1) Notwithstanding other provisions of this chapter,
2 a health maintenance organization may issue a contract that
3 limits coverage to home health care services only. The
4 organization and the contract shall be subject to all of the
5 requirements of this part that do not require or otherwise
6 apply to specific benefits other than home care services. To
7 this extent, all of the requirements of this part apply to any
8 organization or contract that limits coverage to home care
9 services, except the requirements for providing comprehensive
10 health care services as provided in ss. 641.19(4), (11), and
11 (12), and 641.31(1), except ss. 641.31(10) 641.31(9),
12 (13)(12), (17), (18), (19), (20), (21), (22), and (25)(24) and
13 641.31095.
14 Section 11. Section 641.3107, Florida Statutes, is
15 amended to read:
16 641.3107 Delivery of contract.--Unless delivered upon
17 execution or issuance, a health maintenance contract,
18 certificate of coverage, or member handbook shall be mailed or
19 delivered to the subscriber or, in the case of a group health
20 maintenance contract, to the employer or other person who will
21 hold the contract on behalf of the subscriber group within 10
22 working days from approval of the enrollment form by the
23 health maintenance organization or by the effective date of
24 coverage, whichever occurs first. However, if the employer or
25 other person who will hold the contract on behalf of the
26 subscriber group requires retroactive enrollment of a
27 subscriber, the organization shall deliver the contract,
28 certificate, or member handbook to the subscriber within 10
29 days after receiving notice from the employer of the
30 retroactive enrollment. This section does not apply to the
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1 delivery of those contracts specified in s. 641.31(14) s.
2 641.31(13).
3 Section 12. Paragraph (a) of subsection (7) of section
4 641.3922, Florida Statutes, is amended to read:
5 641.3922 Conversion contracts; conditions.--Issuance
6 of a converted contract shall be subject to the following
7 conditions:
8 (7) REASONS FOR CANCELLATION; TERMINATION.--The
9 converted health maintenance contract must contain a
10 cancellation or nonrenewability clause providing that the
11 health maintenance organization may refuse to renew the
12 contract of any person covered thereunder, but cancellation or
13 nonrenewal must be limited to one or more of the following
14 reasons:
15 (a) Fraud or intentional misrepresentation, subject to
16 the limitations of s. 641.31(24) s. 641.31(23), in applying
17 for any benefits under the converted health maintenance
18 contract.;
19 Section 13. Subsection (4) of section 641.513, Florida
20 Statutes, is amended to read:
21 641.513 Requirements for providing emergency services
22 and care.--
23 (4) A subscriber may be charged a reasonable
24 copayment, as provided in s. 641.31(13) s. 641.31(12), for the
25 use of an emergency room.
26 Section 14. Except as otherwise expressly provided in
27 this act and except for this section, which shall take effect
28 July 1, 2007, this act shall take effect January 1, 2008, and
29 shall apply to policies or certificates issued or renewed on
30 or after that date.
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 2094
3
4 The committee substitute makes the following changes:
5 1. Revises criteria for eligibility for participation in the
Health Flex Plan.
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2. Creates a small business health insurance grant program
7 to be administered by the Agency for Workforce Innovation
and provides a $250,000 nonrecurring general revenue
8 appropriation to be awarded to eligible businesses.
9 3. Revises the definition of bone marrow transplant for
purposes of insurance coverage.
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