1 | A bill to be entitled |
2 | An act relating to provider contracts; amending ss. |
3 | 627.6474, 636.035, and 641.315, F.S.; proscribing certain |
4 | fee setting provisions in certain contracts between health |
5 | care practitioners and certain health insurance entities |
6 | under certain circumstances; providing a definition; |
7 | providing application; providing an effective date. |
8 |
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9 | Be It Enacted by the Legislature of the State of Florida: |
10 |
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11 | Section 1. Section 627.6474, Florida Statutes, is amended |
12 | to read: |
13 | 627.6474 Provider contracts.-- |
14 | (1) A health insurer shall not require a contracted health |
15 | care practitioner as defined in s. 456.001(4) to accept the |
16 | terms of other health care practitioner contracts with the |
17 | insurer or any other insurer, or health maintenance |
18 | organization, under common management and control with the |
19 | insurer, including Medicare and Medicaid practitioner contracts |
20 | and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or |
21 | s. 641.315, except for a practitioner in a group practice as |
22 | defined in s. 456.053 who must accept the terms of a contract |
23 | negotiated for the practitioner by the group, as a condition of |
24 | continuation or renewal of the contract. Any contract provision |
25 | that violates this section is void. A violation of this section |
26 | is not subject to the criminal penalty specified in s. 624.15. |
27 | (2) A contract between a health insurer and a health care |
28 | practitioner as defined in s. 456.001 for the provision of |
29 | services to patients may not contain any provision that requires |
30 | the practitioner to provide services to the policyholders of the |
31 | health insurer at a fee set by the health insurer unless such |
32 | services are covered services under the applicable health |
33 | insurance policy. For purposes of this subsection, the term |
34 | "covered services" means services reimbursable under the |
35 | applicable health insurance policy, subject to any contractual |
36 | limitations on an insured's benefits that may apply. This |
37 | subsection applies to all contracts entered into or renewed on |
38 | or after July 1, 2010. |
39 | Section 2. Subsection (13) is added to section 636.035, |
40 | Florida Statutes, to read: |
41 | 636.035 Provider contracts arrangements.-- |
42 | (13) A contract between a prepaid limited health service |
43 | organization and a health care practitioner as defined in s. |
44 | 456.001 for the provision of services to patients may not |
45 | contain any provision that requires the practitioner to provide |
46 | services to the organization's subscribers at a fee set by the |
47 | organization unless such services are covered services under the |
48 | applicable subscriber agreement. For purposes of this |
49 | subsection, the term "covered services" means services |
50 | reimbursable under the applicable subscriber agreement, subject |
51 | to any contractual limitations on subscriber benefits that may |
52 | apply. This subsection applies to all contracts entered into or |
53 | renewed on or after July 1, 2010. |
54 | Section 3. Subsection (11) is added to section 641.315, |
55 | Florida Statutes, read: |
56 | 641.315 Provider contracts.-- |
57 | (11) A contract between a health maintenance organization |
58 | and a health care practitioner as defined in s. 456.001 for the |
59 | provision of services to patients may not contain any provision |
60 | that requires the practitioner to provide services to the |
61 | organization's subscribers at a fee set by the organization |
62 | unless such services are covered services under the applicable |
63 | subscriber agreement. For purposes of this subsection, the term |
64 | "covered services" means services reimbursable under the |
65 | applicable subscriber agreement, subject to any contractual |
66 | limitations on subscriber benefits that may apply. This |
67 | subsection applies to all contracts entered into or renewed on |
68 | or after July 1, 2010. |
69 | Section 4. This act shall take effect July 1, 2010. |