Florida Senate - 2007                        SENATOR AMENDMENT
    Bill No. HB 7087, 2nd Eng.
                        Barcode 963080
                            CHAMBER ACTION
              Senate                               House
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 3         Floor: WD/2R            .                    
       05/03/2007 12:55 PM         .                    
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11  Senator Peaden moved the following amendment:
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13         Senate Amendment (with title amendment) 
14         Lines 462, delete that line
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16  and insert:  
17         Section 17.  Subsection (3) is added to section
18  627.642, Florida Statutes, to read:
19         627.642  Outline of coverage.--
20         (3)  In addition to the outline of coverage, a policy
21  as specified in s. 627.6699(3)(k) must be accompanied by an
22  identification card that contains, at a minimum:
23         (a)  The name of the organization issuing the policy or
24  the name of the organization administering the policy,
25  whichever applies.
26         (b)  The name of the contract holder.
27         (c)  The type of plan only if the plan is filed in the
28  state, an indication that the plan is self-funded, or the name
29  of the network.
30         (d)  The member identification number, contract number,
31  and policy or group number, if applicable.
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Florida Senate - 2007 SENATOR AMENDMENT Bill No. HB 7087, 2nd Eng. Barcode 963080 1 (e) A contact phone number or electronic address for 2 authorizations. 3 (f) A phone number or electronic address whereby the 4 covered person or hospital, physician, or other person 5 rendering services covered by the policy may determine if the 6 plan is insured and may obtain a benefits verification in 7 order to estimate patient financial responsibility, in 8 compliance with privacy rules under the Health Insurance 9 Portability and Accountability Act. 10 (g) The national plan identifier, in accordance with 11 the compliance date set forth by the federal Department of 12 Health and Human Services. 13 14 The identification card must present the information in a 15 readily identifiable manner or, alternatively, the information 16 may be embedded on the card and available through magnetic 17 stripe or smart card. The information may also be provided 18 through other electronic technology. 19 Section 18. Present subsection (2) of section 627.657, 20 Florida Statutes, is renumbered as subsection (3), and a new 21 subsection (2) is added to that section, to read: 22 627.657 Provisions of group health insurance 23 policies.-- 24 (2) The medical policy as specified in s. 25 627.6699(3)(k) must be accompanied by an identification card 26 that contains, at a minimum: 27 (a) The name of the organization issuing the policy or 28 name of the organization administering the policy, whichever 29 applies. 30 (b) The name of the certificateholder. 31 (c) The type of plan only if the plan is filed in the 2 5:26 PM 05/02/07 h708702e2c-02-j01
Florida Senate - 2007 SENATOR AMENDMENT Bill No. HB 7087, 2nd Eng. Barcode 963080 1 state, an indication that the plan is self-funded, or the name 2 of the network. 3 (d) The member identification number, contract number, 4 and policy or group number, if applicable. 5 (e) A contact phone number or electronic address for 6 authorizations. 7 (f) A phone number or electronic address whereby the 8 covered person or hospital, physician, or other person 9 rendering services covered by the policy may determine if the 10 plan is insured and may obtain a benefits verification in 11 order to estimate patient financial responsibility, in 12 compliance with privacy rules under the Health Insurance 13 Portability and Accountability Act. 14 (g) The national plan identifier, in accordance with 15 the compliance date set forth by the federal Department of 16 Health and Human Services. 17 18 The identification card must present the information in a 19 readily identifiable manner or, alternatively, the information 20 may be embedded on the card and available through magnetic 21 stripe or smart card. The information may also be provided 22 through other electronic technology. 23 Section 19. Present subsections (5) through (40) of 24 section 641.31, Florida Statutes, are renumbered as 25 subsections (6) through (41), respectively, and a new 26 subsection (5) is added to that section, to read: 27 641.31 Health maintenance contracts.-- 28 (5) The contract, certificate, or member handbook must 29 be accompanied by an identification card that contains, at a 30 minimum: 31 (a) The name of the organization offering the contract 3 5:26 PM 05/02/07 h708702e2c-02-j01
Florida Senate - 2007 SENATOR AMENDMENT Bill No. HB 7087, 2nd Eng. Barcode 963080 1 or name of the organization administering the contract, 2 whichever applies. 3 (b) The name of the subscriber. 4 (c) A statement that the health plan is a health 5 maintenance organization. Only a health plan with a 6 certificate of authority issued under this chapter may be 7 identified as a health maintenance organization. 8 (d) The member identification number, contract number, 9 and 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 contract may determine if 15 the 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 20. Paragraph (j) of subsection (3) of section 29 383.145, Florida Statutes, is amended to read: 30 383.145 Newborn and infant hearing screening.-- 31 (3) REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE 4 5:26 PM 05/02/07 h708702e2c-02-j01
Florida Senate - 2007 SENATOR AMENDMENT Bill No. HB 7087, 2nd Eng. Barcode 963080 1 COVERAGE; REFERRAL FOR ONGOING SERVICES.-- 2 (j) The initial procedure for screening the hearing of 3 the newborn or infant and any medically necessary followup 4 reevaluations leading to diagnosis shall be a covered benefit, 5 reimbursable under Medicaid as an expense compensated 6 supplemental to the per diem rate for Medicaid patients 7 enrolled in MediPass or Medicaid patients covered by a fee for 8 service program. For Medicaid patients enrolled in HMOs, 9 providers shall be reimbursed directly by the Medicaid Program 10 Office at the Medicaid rate. This service may not be 11 considered a covered service for the purposes of establishing 12 the payment rate for Medicaid HMOs. All health insurance 13 policies and health maintenance organizations as provided 14 under ss. 627.6416, 627.6579, and 641.31(31) 641.31(30), 15 except for supplemental policies that only provide coverage 16 for specific diseases, hospital indemnity, or Medicare 17 supplement, or to the supplemental polices, shall compensate 18 providers for the covered benefit at the contracted rate. 19 Nonhospital-based providers shall be eligible to bill Medicaid 20 for the professional and technical component of each procedure 21 code. 22 Section 21. Paragraphs (b) and (i) of subsection (1) 23 of section 641.185, Florida Statutes, are amended to read: 24 641.185 Health maintenance organization subscriber 25 protections.-- 26 (1) With respect to the provisions of this part and 27 part III, the principles expressed in the following statements 28 shall serve as standards to be followed by the commission, the 29 office, the department, and the Agency for Health Care 30 Administration in exercising their powers and duties, in 31 exercising administrative discretion, in administrative 5 5:26 PM 05/02/07 h708702e2c-02-j01
Florida Senate - 2007 SENATOR AMENDMENT Bill No. HB 7087, 2nd Eng. Barcode 963080 1 interpretations of the law, in enforcing its provisions, and 2 in adopting rules: 3 (b) A health maintenance organization subscriber 4 should receive quality health care from a broad panel of 5 providers, including referrals, preventive care pursuant to s. 6 641.402(1), emergency screening and services pursuant to ss. 7 641.31(13) 641.31(12) and 641.513, and second opinions 8 pursuant to s. 641.51. 9 (i) A health maintenance organization subscriber 10 should receive timely and, if necessary, urgent grievances and 11 appeals within the health maintenance organization pursuant to 12 ss. 641.228, 641.31(6) 641.31(5), 641.47, and 641.511. 13 Section 22. Subsection (1) of section 641.2018, 14 Florida Statutes, is amended to read: 15 641.2018 Limited coverage for home health care 16 authorized.-- 17 (1) Notwithstanding other provisions of this chapter, 18 a health maintenance organization may issue a contract that 19 limits coverage to home health care services only. The 20 organization and the contract shall be subject to all of the 21 requirements of this part that do not require or otherwise 22 apply to specific benefits other than home care services. To 23 this extent, all of the requirements of this part apply to any 24 organization or contract that limits coverage to home care 25 services, except the requirements for providing comprehensive 26 health care services as provided in ss. 641.19(4), (11), and 27 (12), and 641.31(1), except ss. 641.31(10) 641.31(9), 28 (13)(12), (17), (18), (19), (20), (21), (22), and (25)(24) and 29 641.31095. 30 Section 23. Section 641.3107, Florida Statutes, is 31 amended to read: 6 5:26 PM 05/02/07 h708702e2c-02-j01
Florida Senate - 2007 SENATOR AMENDMENT Bill No. HB 7087, 2nd Eng. Barcode 963080 1 641.3107 Delivery of contract.--Unless delivered upon 2 execution or issuance, a health maintenance contract, 3 certificate of coverage, or member handbook shall be mailed or 4 delivered to the subscriber or, in the case of a group health 5 maintenance contract, to the employer or other person who will 6 hold the contract on behalf of the subscriber group within 10 7 working days from approval of the enrollment form by the 8 health maintenance organization or by the effective date of 9 coverage, whichever occurs first. However, if the employer or 10 other person who will hold the contract on behalf of the 11 subscriber group requires retroactive enrollment of a 12 subscriber, the organization shall deliver the contract, 13 certificate, or member handbook to the subscriber within 10 14 days after receiving notice from the employer of the 15 retroactive enrollment. This section does not apply to the 16 delivery of those contracts specified in s. 641.31(14) s. 17 641.31(13). 18 Section 24. Paragraph (a) of subsection (7) of section 19 641.3922, Florida Statutes, is amended to read: 20 641.3922 Conversion contracts; conditions.--Issuance 21 of a converted contract shall be subject to the following 22 conditions: 23 (7) REASONS FOR CANCELLATION; TERMINATION.--The 24 converted health maintenance contract must contain a 25 cancellation or nonrenewability clause providing that the 26 health maintenance organization may refuse to renew the 27 contract of any person covered thereunder, but cancellation or 28 nonrenewal must be limited to one or more of the following 29 reasons: 30 (a) Fraud or intentional misrepresentation, subject to 31 the limitations of s. 641.31(24) s. 641.31(23), in applying 7 5:26 PM 05/02/07 h708702e2c-02-j01
Florida Senate - 2007 SENATOR AMENDMENT Bill No. HB 7087, 2nd Eng. Barcode 963080 1 for any benefits under the converted health maintenance 2 contract.; 3 Section 25. Subsection (4) of section 641.513, Florida 4 Statutes, is amended to read: 5 641.513 Requirements for providing emergency services 6 and care.-- 7 (4) A subscriber may be charged a reasonable 8 copayment, as provided in s. 641.31(13) s. 641.31(12), for the 9 use of an emergency room. 10 Section 26. Effective July 1, 2007, section 627.4108, 11 Florida Statutes, is created to read: 12 627.4108 Credit for administrative efficiencies.--A 13 life or health insurer or health maintenance organization may 14 offer to groups a credit reflecting demonstrable 15 administrative savings resulting from efficiencies that occur 16 when two or more life or health insurance products, or a 17 health maintenance organization contract and one or more life 18 or health insurance products, are purchased from the insurer 19 or its affiliated companies or health maintenance 20 organization. The insurer or health maintenance organization 21 shall be required to demonstrate to the office that the 22 proposed credit is reasonable, does not exceed the 23 administrative savings, and is offered in a nondiscriminatory 24 manner. Such demonstration may be submitted for approval 25 separate from any premium rate filing. Such credit, which 26 results in a reduction of revenue, may not be reflected in the 27 experience used in rate filings. The commission may establish 28 by rule procedures to be used in ascertaining the appropriate 29 amount and reasonableness of the credit in relation to the 30 administrative savings and to ensure that it is offered in a 31 nondiscriminatory manner. 8 5:26 PM 05/02/07 h708702e2c-02-j01
Florida Senate - 2007 SENATOR AMENDMENT Bill No. HB 7087, 2nd Eng. Barcode 963080 1 Section 27. Section 468.807, Florida Statutes, is 2 repealed. 3 Section 28. This section, section 26, and section 27 4 shall take effect July 1, 2007, sections 1 through 16 shall 5 take effect October 1, 2007, and sections 17 through 25 shall 6 take effect January 1, 2008, and the latter shall apply to 7 identification cards issued for policies or certificates 8 issued or renewed on or after that date. 9 10 11 ================ T I T L E A M E N D M E N T =============== 12 And the title is amended as follows: 13 Line 50, delete that line, 14 15 and insert: 16 amending s. 627.642, F.S.; requiring an 17 identification card containing specified 18 information to be given to insureds who have 19 health and accident insurance; amending s. 20 627.657, F.S.; requiring an identification card 21 containing specified information to be given to 22 insureds under group health insurance policies; 23 amending s. 641.31, F.S.; requiring an 24 identification card to be given to persons 25 having health care services through a health 26 maintenance contract; amending ss. 383.145, 27 641.185, 641.2018, 641.3107, 641.3922, and 28 641.513, F.S.; conforming cross-references to 29 changes made by the act; providing application; 30 creating s. 627.4108, F.S.; authorizing life or 31 health insurers or health maintenance 9 5:26 PM 05/02/07 h708702e2c-02-j01
Florida Senate - 2007 SENATOR AMENDMENT Bill No. HB 7087, 2nd Eng. Barcode 963080 1 organizations to offer to groups a credit 2 reflecting demonstrable administrative savings 3 resulting from efficiencies under specified 4 conditions; providing applicability; 5 authorizing the Financial Services Commission 6 to establish certain rules; repealing s. 7 468.807, F.S.; relating to the licensure of 8 orthotists and prosthetists; providing 9 effective dates. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 10 5:26 PM 05/02/07 h708702e2c-02-j01