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

1

A bill to be entitled

2

An act relating to health insurance; amending ss.

3

627.42395 and 641.31, F.S.; requiring health insurance

4

policies and health maintenance contracts in this state to

5

provide additional premium coverage for amino-acid-based

6

elemental formulas for the treatment of certain medical

7

conditions; revising a prerequisite concerning such

8

coverage to authorize persons holding certain licenses to

9

prescribe or order such formulas; limiting application to

10

children of a certain age; amending s. 627.6741, F.S.;

11

requiring an insurer issuing Medicare supplement policies

12

to offer a Medicare supplement policy without conditioning

13

the issuance or discriminating in the price based on

14

health status to individuals who are eligible for Medicare

15

due to having end-stage renal disease and who meet other

16

conditions; providing an effective date.

17

18

Be It Enacted by the Legislature of the State of Florida:

19

20

     Section 1.  Section 627.42395, Florida Statutes, is amended

21

to read:

22

     627.42395  Coverage for certain prescription and

23

nonprescription enteral or amino acid formulas.--

24

     (1) Notwithstanding any other provision of law, any health

25

insurance policy delivered or issued for delivery, to any person

26

in this state or any group, blanket, or franchise health

27

insurance policy delivered or issued for delivery in this state

28

shall make available to the policyholder as part of the

29

application, for an appropriate additional premium, coverage for:

30

     (a) Prescription and nonprescription enteral formulas for

31

home use which are ordered or physician prescribed by a

32

prescribing practitioner licensed under chapter 458, chapter 459,

33

or chapter 464, as medically necessary for the treatment of

34

inherited diseases of amino acid, organic acid, carbohydrate, or

35

fat metabolism as well as malabsorption originating from

36

congenital defects present at birth or acquired during the

37

neonatal period. Such coverage for inherited diseases of amino

38

acids and organic acids shall include food products modified to

39

be low protein, in an amount not to exceed $2,500 annually for

40

any insured individual, through the age of 24.

41

     (b) Amino-acid-based elemental formulas, regardless of the

42

method of intake, for the medically necessary treatment of

43

medically diagnosed conditions of severe multiple food protein

44

allergies, gastroesophageal reflux, eosinophilic disorders, and

45

short bowel syndrome when ordered or prescribed by a prescribing

46

practitioner licensed under chapter 458, chapter 459, or chapter

47

464. Treatments using amino-acid-based elemental formulas must be

48

medically necessary and appropriate treatment that is consistent

49

with the person's symptoms, diagnosis, and condition, and may not

50

be furnished primarily for the convenience of the person or

51

provider. Conditions for which these formulas are used in

52

experimental or investigational services do not meet the

53

criterion of medical necessity.

54

55

The provisions of paragraph (b) apply only to children younger

56

than 6 years of age who have severe multiple food protein

57

allergies, gastroesophageal reflux, or short bowel syndrome, and

58

to children younger than 9 years of age who have eosinophilic

59

disorders.

60

     (2) This section applies to any person or family

61

notwithstanding the existence of any preexisting condition.

62

     Section 2.  Subsection (41) is added to section 641.31,

63

Florida Statutes, to read:

64

     641.31  Health maintenance contracts.--

65

     (41) A health maintenance contract must make available

66

coverage of amino-acid-based elemental formulas, regardless of

67

the method of intake, for the medically necessary treatment of

68

medically diagnosed conditions of severe multiple food protein

69

allergies, gastroesophageal reflux, eosinophilic disorders, and

70

short bowel syndrome when ordered or prescribed by a prescribing

71

practitioner licensed under chapter 458, chapter 459, or chapter

72

464. Treatments using amino-acid-based elemental formulas must be

73

medically necessary and appropriate treatment that is consistent

74

with the person's symptoms, diagnosis, and condition, and may not

75

be furnished primarily for the convenience of the person or

76

provider. Conditions for which these formulas are used in

77

experimental or investigational services do not meet the

78

criterion of medical necessity. The provisions of this subsection

79

apply only to children younger than 6 years of age who have

80

severe multiple food protein allergies, gastroesophageal reflux,

81

or short bowel syndrome, and to children younger than 9 years of

82

age who have eosinophilic disorders.

83

     Section 3.  Subsection (1) of section 627.6741, Florida

84

Statutes, is amended to read:

85

     627.6741  Issuance, cancellation, nonrenewal, and

86

replacement.--

87

     (1)  An insurer issuing Medicare supplement policies in this

88

state shall offer the opportunity of enrolling in a Medicare

89

supplement policy, without conditioning the issuance or

90

effectiveness of the policy on, and without discriminating in the

91

price of the policy based on, the medical or health status or

92

receipt of health care by the individual:

93

     (a)  To any individual who is 65 years of age or older and

94

who resides in this state, upon the request of the individual

95

during the 6-month period beginning with the first month in which

96

the individual has attained 65 years of age and is enrolled in

97

Medicare part B; or

98

     (b)  To any individual who is 65 years of age or older and

99

is enrolled in Medicare part B, who resides in this state, upon

100

the request of the individual during the 2-month period following

101

termination of coverage under a group health insurance policy;

102

or.

103

     (c) To any individual who resides in this state, who is

104

eligible for Medicare due to having end-stage renal disease, and

105

who is enrolled in Medicare part B, upon the request of the

106

individual within 6 months after becoming eligible for Medicare,

107

or by January 1, 2009, whichever is later.

108

109

A Medicare supplement policy issued to an individual under

110

paragraph (a) or paragraph (b) may not exclude benefits based on

111

a preexisting condition if the individual has a continuous period

112

of creditable coverage, as defined in s. 627.6561(5), of at least

113

6 months as of the date of application for coverage.

114

     Section 4.  This act shall take effect October 1, 2008.

CODING: Words stricken are deletions; words underlined are additions.