HB 1167

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