Florida Senate - 2008 CS for CS for SB 1598
By the Committees on Health Policy; Banking and Insurance; and Senator Peaden
587-07052A-08 20081598c2
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A bill to be entitled
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An act relating to health insurance; amending ss.
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policies and health maintenance contracts in this state to
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provide additional premium coverage for amino-acid-based
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elemental formulas for the treatment of certain medical
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conditions; revising a prerequisite concerning such
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coverage to authorize persons holding certain licenses to
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prescribe or order such formulas; limiting application to
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children of a certain age; amending s. 627.6741, F.S.;
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requiring an insurer issuing Medicare supplement policies
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to offer a Medicare supplement policy without conditioning
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the issuance or discriminating in the price based on
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health status to individuals who are eligible for Medicare
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due to having end-stage renal disease and who meet other
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conditions; providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 627.42395, Florida Statutes, is amended
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to read:
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627.42395 Coverage for certain prescription and
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nonprescription enteral or amino acid formulas.--
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(1) Notwithstanding any other provision of law, any health
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insurance policy delivered or issued for delivery, to any person
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in this state or any group, blanket, or franchise health
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insurance policy delivered or issued for delivery in this state
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shall make available to the policyholder as part of the
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application, for an appropriate additional premium, coverage for:
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(a) Prescription and nonprescription enteral formulas for
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home use which are ordered or physician prescribed by a
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prescribing practitioner licensed under chapter 458, chapter 459,
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or chapter 464, as medically necessary for the treatment of
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inherited diseases of amino acid, organic acid, carbohydrate, or
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fat metabolism as well as malabsorption originating from
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congenital defects present at birth or acquired during the
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neonatal period. Such coverage for inherited diseases of amino
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acids and organic acids shall include food products modified to
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be low protein, in an amount not to exceed $2,500 annually for
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any insured individual, through the age of 24.
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(b) Amino-acid-based elemental formulas, regardless of the
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method of intake, for the medically necessary treatment of
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medically diagnosed conditions of severe multiple food protein
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allergies, gastroesophageal reflux, eosinophilic disorders, and
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short bowel syndrome when ordered or prescribed by a prescribing
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practitioner licensed under chapter 458, chapter 459, or chapter
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464. Treatments using amino-acid-based elemental formulas must be
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medically necessary and appropriate treatment that is consistent
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with the person's symptoms, diagnosis, and condition, and may not
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be furnished primarily for the convenience of the person or
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provider. Conditions for which these formulas are used in
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experimental or investigational services do not meet the
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criterion of medical necessity.
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The provisions of paragraph (b) apply only to children younger
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than 6 years of age who have severe multiple food protein
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allergies, gastroesophageal reflux, or short bowel syndrome, and
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to children younger than 9 years of age who have eosinophilic
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disorders.
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(2) This section applies to any person or family
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notwithstanding the existence of any preexisting condition.
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Section 2. Subsection (41) is added to section 641.31,
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Florida Statutes, to read:
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641.31 Health maintenance contracts.--
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(41) A health maintenance contract must make available
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coverage of amino-acid-based elemental formulas, regardless of
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the method of intake, for the medically necessary treatment of
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medically diagnosed conditions of severe multiple food protein
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allergies, gastroesophageal reflux, eosinophilic disorders, and
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short bowel syndrome when ordered or prescribed by a prescribing
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practitioner licensed under chapter 458, chapter 459, or chapter
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464. Treatments using amino-acid-based elemental formulas must be
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medically necessary and appropriate treatment that is consistent
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with the person's symptoms, diagnosis, and condition, and may not
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be furnished primarily for the convenience of the person or
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provider. Conditions for which these formulas are used in
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experimental or investigational services do not meet the
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criterion of medical necessity. The provisions of this subsection
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apply only to children younger than 6 years of age who have
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severe multiple food protein allergies, gastroesophageal reflux,
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or short bowel syndrome, and to children younger than 9 years of
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age who have eosinophilic disorders.
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Section 3. Subsection (1) of section 627.6741, Florida
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Statutes, is amended to read:
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627.6741 Issuance, cancellation, nonrenewal, and
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replacement.--
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(1) An insurer issuing Medicare supplement policies in this
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state shall offer the opportunity of enrolling in a Medicare
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supplement policy, without conditioning the issuance or
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effectiveness of the policy on, and without discriminating in the
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price of the policy based on, the medical or health status or
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receipt of health care by the individual:
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(a) To any individual who is 65 years of age or older and
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who resides in this state, upon the request of the individual
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during the 6-month period beginning with the first month in which
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the individual has attained 65 years of age and is enrolled in
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Medicare part B; or
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(b) To any individual who is 65 years of age or older and
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is enrolled in Medicare part B, who resides in this state, upon
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the request of the individual during the 2-month period following
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termination of coverage under a group health insurance policy;
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or.
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(c) To any individual who resides in this state, who is
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eligible for Medicare due to having end-stage renal disease, and
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who is enrolled in Medicare part B, upon the request of the
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individual within 6 months after becoming eligible for Medicare,
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or by January 1, 2009, whichever is later.
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A Medicare supplement policy issued to an individual under
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paragraph (a) or paragraph (b) may not exclude benefits based on
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a preexisting condition if the individual has a continuous period
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of creditable coverage, as defined in s. 627.6561(5), of at least
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6 months as of the date of application for coverage.
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Section 4. This act shall take effect October 1, 2008.
CODING: Words stricken are deletions; words underlined are additions.