HB 1167

1	A bill to be entitled
2	An act relating to renal disease; creating s. 627.64081,
3	F.S.; providing legislative intent; prohibiting an insurer
4	that covers dialysis treatment for patients who have end-
5	stage renal disease from requiring an insured to travel
6	more than a certain number of minutes to obtain dialysis
7	treatment or from requiring an insured to change to
8	another dialysis provider; prohibiting an insurer that
9	provides coverage for dialysis treatment from shifting the
10	responsibility for reimbursement in coverage type to
11	another payer; requiring such insurer to provide written
12	notice of any change in covered services, network access,
13	reimbursement, or patient liability for dialysis or
14	related services; prohibiting an insurer from requiring
15	prior authorization for dialysis services more than a
16	certain number of times each year; providing a definition;
17	providing that the Insurance Code applies to violations of
18	the act; providing that the act does not apply to benefits
19	provided under Medicaid and other governmental programs;
20	amending ss. 627.662 and 641.31, F.S.; providing that the
21	provisions of the act governing dialysis treatment for
22	certain patients apply to group health insurance, blanket
23	health insurance, franchise health insurance, and health
24	maintenance contracts; providing an effective date.
25
26	Be It Enacted by the Legislature of the State of Florida:
27
28	Section 1.  Section 627.64081, Florida Statutes, is created
29	to read:
30	627.64081  Chronic renal disease.-
31	(1)  Chronic renal disease is a life-threatening condition
32	requiring frequent and complex treatment. Access to dialysis
33	treatment is life sustaining and can prevent more expensive
34	complications and treatments. Due to the unique nature of
35	dialysis treatment and the limited responsibility of private
36	payers for these services, the Legislature intends that persons
37	who have chronic renal disease be provided protections under the
38	law to ensure access to the care they need for survival.
39	(2)  Any insurer that offers a health benefit plan that
40	provides coverage for dialysis treatment for patients suffering
41	from end-stage renal disease may not require, as a condition of
42	coverage or reimbursement, an insured to:
43	(a)  Travel more than 30 minutes, under normal
44	circumstances, from the insured's home in order to obtain the
45	needed dialysis treatment modality, or, if the nearest access to
46	the modality is located more than 30 minutes from the insured's
47	home, to travel a greater distance than the distance to the
48	nearest location to obtain that dialysis treatment; or
49	(b)  Change to another dialysis provider.
50	(3)  During the maximum coordination-of-benefits period,
51	any insurer that offers a health benefit plan that provides
52	coverage for dialysis treatment for patients suffering from end-
53	stage renal disease:
54	1.  May not take any action that could shift the primary
55	responsibility for reimbursement in coverage type from the
56	insurer to another payer, including, but not limited to,
57	Medicare, Medicaid, or any other governmental program.
58	2.  Shall provide written notice to an existing insured
59	patient and to the provider of any change in covered services,
60	network access, reimbursement, or patient liability for dialysis
61	or related services by certified mail at least 12 months before
62	the effective date of such proposed change.
63	3.  May not require prior authorization for dialysis
64	services more than twice a year. Such authorization shall, in
65	each instance, be inclusive of all necessary components of
66	clinical treatment as prescribed by the insured's physician.
67
68	As used in this subsection, the term "coordination-of-benefits
69	period" means the length of time during which an employer-
70	sponsored, union-sponsored, or any other health benefit plan is
71	the primary payer and Medicare is the secondary payer for health
72	coverage for a person who has end-stage renal disease and is
73	eligible for Medicare on the basis of the end-stage renal
74	disease.
75	(4)  Chapter 624 applies to violations under this section.
76	(5)  This section does not apply to benefits provided
77	through Medicaid or other governmental programs.
78	Section 2.  Subsection (15) is added to section 627.662,
79	Florida Statutes, to read:
80	627.662  Other provisions applicable.-The following
81	provisions apply to group health insurance, blanket health
82	insurance, and franchise health insurance:
83	(15)  Section 627.64081, relating to dialysis treatment for
84	insureds suffering from end-stage renal disease.
85	Section 3.  Subsection (44) is added to section 641.31,
86	Florida Statutes, to read:
87	641.31  Health maintenance contracts.-
88	(44)  A health maintenance contract that provides coverage
89	for dialysis treatment for patients suffering from end-stage
90	renal disease must comply with s. 627.64081, and the penalty
91	provisions of this chapter apply to this subsection.
92	Section 4.  This act shall take effect October 1, 2010.

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