HB 367

1	A bill to be entitled
2	An act relating to health care provider contracts;
3	amending s. 627.6474, F.S.; prohibiting insurers from
4	requiring contracted health care practitioners to accept
5	the terms of other contracts between prepaid limited
6	health service organizations and providers of limited
7	health care services; prohibiting contracts between health
8	insurers and dentists from containing certain fee
9	requirements set by the insurer under certain
10	circumstances; providing a definition; providing
11	application; amending s. 636.035, F.S.; prohibiting
12	contracts between prepaid limited health service
13	organizations and dentists from containing certain fee
14	requirements set by the organization under certain
15	circumstances; providing a definition; providing
16	application; amending s. 641.315, F.S.; prohibiting
17	contracts between health maintenance organizations and
18	dentists from containing certain fee requirements set by
19	the organization under certain circumstances; providing a
20	definition; providing application; providing an effective
21	date.
22
23	Be It Enacted by the Legislature of the State of Florida:
24
25	Section 1.  Section 627.6474, Florida Statutes, is amended
26	to read:
27	627.6474  Provider contracts.-
28	(1)  A health insurer may shall not require a contracted
29	health care practitioner as defined in s. 456.001(4) to accept
30	the terms of other health care practitioner contracts with the
31	insurer or any other insurer, or health maintenance
32	organization, under common management and control with the
33	insurer, including Medicare and Medicaid practitioner contracts
34	and those authorized by s. s. 636.035, 627.6471, s. 627.6472, or
35	s. 641.315, except for a practitioner in a group practice as
36	defined in s. 456.053 who must accept the terms of a contract
37	negotiated for the practitioner by the group, as a condition of
38	continuation or renewal of the contract. Any contract provision
39	that violates this section is void. A violation of this section
40	is not subject to the criminal penalty specified in s. 624.15.
41	(2)  A contract between a health insurer and a dentist
42	licensed under chapter 466 for the provision of services to
43	patients may not contain any provision that requires the dentist
44	to provide services to the insured under such contract at a fee
45	set by the health insurer unless such services are covered
46	services under the applicable contract. As used in this
47	subsection, the term "covered services" means services
48	reimbursable under the applicable contract, subject to
49	contractual limitations on benefits, such as deductibles,
50	coinsurance, and copayments, as may apply. However, the term
51	"covered services" does not include any dental services provided
52	by a dentist to a covered person who has met or exceeded the
53	annual or other periodic payment maximum established by the
54	contract or services that are not listed as a benefit that the
55	covered person is entitled to receive under the contract. This
56	subsection applies to all contracts entered into or renewed on
57	or after July 1, 2011.
58	Section 2.  Subsection (13) is added to section 636.035,
59	Florida Statutes, to read:
60	636.035  Provider arrangements.-
61	(13)  A contract between a prepaid limited health service
62	organization and a dentist licensed under chapter 466 for the
63	provision of services to subscribers of the prepaid limited
64	health service organization may not contain any provision that
65	requires the dentist to provide services to subscribers of the
66	prepaid limited health service organization at a fee set by the
67	prepaid limited health service organization unless such services
68	are covered services under the applicable contract. As used in
69	this subsection, the term "covered services" means services
70	reimbursable under the applicable contract, subject to
71	contractual limitations on benefits, such as deductibles,
72	coinsurance, and copayments, as may apply. However, the term
73	"covered services" does not include any dental services provided
74	by a dentist to a covered person who has met or exceeded the
75	annual or other periodic payment maximum established by the
76	contract or services that are not listed as a benefit that the
77	covered person is entitled to receive under the contract. This
78	subsection applies to all contracts entered into or renewed on
79	or after July 1, 2011.
80	Section 3.  Subsection (11) is added to section 641.315,
81	Florida Statutes, to read:
82	641.315  Provider contracts.-
83	(11)  A contract between a health maintenance organization
84	and a dentist licensed under chapter 466 for the provision of
85	services to subscribers of the health maintenance organization
86	may not contain any provision that requires the dentist to
87	provide services to subscribers of the health maintenance
88	organization at a fee set by the health maintenance organization
89	unless such services are covered services under the applicable
90	contract. As used in this subsection, the term "covered
91	services" means services reimbursable under the applicable
92	contract, subject to contractual limitations on benefits, such
93	as deductibles, coinsurance, and copayments, as may apply.
94	However, the term "covered services" does not include any dental
95	services provided by a dentist to a covered person who has met
96	or exceeded the annual or other periodic payment maximum
97	established by the contract or services that are not listed as a
98	benefit that the covered person is entitled to receive under the
99	contract. This subsection applies to all contracts entered into
100	or renewed on or after July 1, 2011.
101	Section 4.  This act shall take effect July 1, 2011.

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