Florida Senate - 2011 SB 546
By Senator Hays
20-00518-11 2011546__
1 A bill to be entitled
2 An act relating to dentists; amending s. 627.6474,
3 F.S.; prohibiting contracts between health insurers
4 and dentists from containing certain fee requirements
5 set by the insurer under certain circumstances;
6 providing a definition; amending s. 636.035, F.S.;
7 prohibiting contracts between prepaid limited health
8 service organizations and dentists from containing
9 certain fee requirements set by the organization under
10 certain circumstances; providing a definition;
11 amending s. 641.315, F.S.; prohibiting contracts
12 between health maintenance organizations and dentists
13 from containing certain fee requirements set by the
14 organization under certain circumstances; providing a
15 definition; providing for application of the act;
16 providing an effective date.
17
18 Be It Enacted by the Legislature of the State of Florida:
19
20 Section 1. Section 627.6474, Florida Statutes, is amended
21 to read:
22 627.6474 Provider contracts.—
23 (1) A health insurer may shall not require a contracted
24 health care practitioner as defined in s. 456.001(4) to accept
25 the terms of other health care practitioner contracts with the
26 insurer or any other insurer, or health maintenance
27 organization, under common management and control with the
28 insurer, including Medicare and Medicaid practitioner contracts
29 and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
30 s. 641.315, except for a practitioner in a group practice as
31 defined in s. 456.053 who must accept the terms of a contract
32 negotiated for the practitioner by the group, as a condition of
33 continuation or renewal of the contract. Any contract provision
34 that violates this section is void. A violation of this section
35 is not subject to the criminal penalty specified in s. 624.15.
36 (2) A contract between a health insurer and a dentist
37 licensed under chapter 466 for the provision of services to
38 patients may not contain any provision that requires the dentist
39 to provide services to the insured under such contract at a fee
40 set by the health insurer unless such services are covered
41 services under the applicable contract. As used in this
42 subsection, the term “covered services” means services
43 reimbursable under the applicable contract, subject to such
44 contractual limitations on benefits, such as deductibles,
45 coinsurance, and copayments, as may apply. However, covered
46 services do not include dental services that are provided by a
47 dentist to an insured who has already met or exceeded the annual
48 or other periodic payment maximum established by the contract or
49 dental services that are not listed as a benefit that the
50 insured is entitled to receive under the contract.
51 Section 2. Subsection (13) is added to section 636.035,
52 Florida Statutes, to read:
53 636.035 Provider arrangements.—
54 (13) A contract between a prepaid limited health service
55 organization and a dentist licensed under chapter 466 for the
56 provision of services to subscribers of the prepaid limited
57 health service organization may not contain any provision that
58 requires the dentist to provide services to subscribers of the
59 prepaid limited health service organization at a fee set by the
60 prepaid limited health service organization unless such services
61 are covered services under the applicable contract. As used in
62 this subsection, the term “covered services” means services
63 reimbursable under the applicable contract, subject to such
64 contractual limitations on benefits, such as deductibles,
65 coinsurance, and copayments, as may apply. However, covered
66 services do not include dental services that are provided by a
67 dentist to a subscriber who already has met or exceeded the
68 annual or other periodic payment maximum established by the
69 contract or dental services that are not listed as a benefit
70 that the subscriber is entitled to receive under the contract.
71 Section 3. Subsection (11) is added to section 641.315,
72 Florida Statutes, to read:
73 641.315 Provider contracts.—
74 (11) A contract between a health maintenance organization
75 and a dentist licensed under chapter 466 for the provision of
76 services to subscribers of the health maintenance organization
77 may not contain any provision that requires the dentist to
78 provide services to subscribers of the health maintenance
79 organization at a fee set by the health maintenance organization
80 unless such services are covered services under the applicable
81 contract. As used in this subsection, the term “covered
82 services” means services reimbursable under the applicable
83 contract, subject to such contractual limitations on subscriber
84 benefits, such as deductibles, coinsurance, and copayments, as
85 may apply. However, covered services do not include any dental
86 services provided by a dentist to a subscriber who already has
87 met or exceeded the annual or other periodic payment maximum
88 established by the contract or dental services that are not
89 listed as a benefit that the subscriber is entitled to receive
90 under the contract.
91 Section 4. This act shall take effect July 1, 2011, and
92 applies to contracts entered into or renewed on or after that
93 date.