Florida Senate - 2013                          SENATOR AMENDMENT
       Bill No. CS for SB 422
       
       
       
       
       
       
                                Barcode 448130                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/AD/2R         .                                
             03/27/2013 05:06 PM       .                                
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       Senators Benacquisto and Bean moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. This act may be cited as the “Cancer Treatment
    6  Fairness Act.”
    7         Section 2. Section 627.42391, Florida Statutes, is created
    8  to read:
    9         627.42391Cancer treatment parity; orally administered
   10  cancer treatment medications.—
   11         (1) As used in this section, the term:
   12         (a) “Cancer treatment medication” means medication
   13  prescribed by a treating physician who determines that the
   14  medication is medically necessary to kill or slow the growth of
   15  cancerous cells in a manner consistent with nationally accepted
   16  standards of practice.
   17         (b) “Cost sharing” includes copayments, coinsurance, dollar
   18  limits, and deductibles imposed on the covered person.
   19         (2) Beginning January 1, 2014, an individual or group
   20  insurance policy, including a policy issued to a small employer
   21  as defined in s. 627.6699, delivered, issued for delivery,
   22  renewed, amended, or continued in this state which provides
   23  medical, major medical, or similar comprehensive coverage and
   24  includes coverage for cancer treatment medications, must also
   25  cover prescribed, orally administered cancer treatment
   26  medications and may not apply cost-sharing requirements for
   27  prescribed, orally administered cancer treatment medications
   28  which are less favorable to the covered person than cost-sharing
   29  requirements for intravenous or injected cancer treatment
   30  medications covered under the policy.
   31         (3) An insurer that provides a policy described in
   32  subsection (2), and any participating entity through which the
   33  insurer offers health services, may not:
   34         (a) Vary the terms of a policy in effect on July 1, 2013,
   35  in order to avoid compliance with this section.
   36         (b) Provide any incentive, including, but not limited to, a
   37  monetary incentive, or impose treatment limitations to encourage
   38  a covered person to accept less than the minimum protections
   39  available under this section.
   40         (c) Penalize a health care practitioner or reduce or limit
   41  the compensation of a health care practitioner for recommending
   42  or providing services or care to a covered person as required
   43  under this section.
   44         (d) Provide any incentive, including, but not limited to, a
   45  monetary incentive, to induce a health care practitioner to
   46  provide care or services that do not comply with this section.
   47         (e) Change the classification of any intravenous or
   48  injected cancer treatment medication or increase the amount of
   49  cost sharing applicable to any intravenous or injected cancer
   50  treatment medication in effect on July 1, 2013, in order to
   51  comply with this section.
   52         Section 3. Section 641.313, Florida Statutes, is created to
   53  read:
   54         641.313Cancer treatment parity; orally administered cancer
   55  treatment medications.—
   56         (1) As used in this section, the term:
   57         (a) “Cancer treatment medication” means medication
   58  prescribed by a treating physician who determines that the
   59  medication is medically necessary to kill or slow the growth of
   60  cancerous cells in a manner consistent with nationally accepted
   61  standards of practice.
   62         (b) “Cost sharing” includes copayments, coinsurance, dollar
   63  limits, and deductibles imposed on the covered person.
   64         (2) Beginning January 1, 2014, a health maintenance
   65  contract, including a contract issued to a small employer as
   66  defined in s. 627.6699, delivered, issued for delivery, renewed,
   67  amended, or continued in this state which provides medical,
   68  major medical, or similar comprehensive coverage and includes
   69  coverage for cancer treatment medications, must also cover
   70  prescribed, orally administered cancer treatment medications and
   71  may not apply cost-sharing requirements for prescribed, orally
   72  administered cancer treatment medications which are less
   73  favorable to the covered person than cost-sharing requirements
   74  for intravenous or injected cancer treatment medications covered
   75  under the contract.
   76         (3) A health maintenance organization that provides a
   77  contract described in subsection (2), and any participating
   78  entity through which the health maintenance organization offers
   79  health services, may not:
   80         (a) Vary the terms of a contract in effect on July 1, 2013,
   81  in order to avoid compliance with this section.
   82         (b) Provide any incentive, including, but not limited to, a
   83  monetary incentive, or impose treatment limitations to encourage
   84  a covered person to accept less than the minimum protections
   85  available under this section.
   86         (c) Penalize a health care practitioner or reduce or limit
   87  the compensation of a health care practitioner for recommending
   88  or providing services or care to a covered person as required
   89  under this section.
   90         (d) Provide any incentive, including, but not limited to, a
   91  monetary incentive, to induce a health care practitioner to
   92  provide care or services that do not comply with this section.
   93         (e) Change the classification of any intravenous or
   94  injected cancer treatment medication or increase the amount of
   95  cost sharing applicable to any intravenous or injected cancer
   96  treatment medication in effect on July 1, 2013, in order to
   97  comply with this section.
   98         Section 4. Subsection (2) of section 627.6515, Florida
   99  Statutes, is amended to read:
  100         627.6515 Out-of-state groups.—
  101         (2) Except as otherwise provided in this part, this part
  102  does not apply to a group health insurance policy issued or
  103  delivered outside this state under which a resident of this
  104  state is provided coverage if:
  105         (a) The policy is issued to an employee group the
  106  composition of which is substantially as described in s.
  107  627.653; a labor union group or association group the
  108  composition of which is substantially as described in s.
  109  627.654; an additional group the composition of which is
  110  substantially as described in s. 627.656; a group insured under
  111  a blanket health policy when the composition of the group is
  112  substantially in compliance with s. 627.659; a group insured
  113  under a franchise health policy when the composition of the
  114  group is substantially in compliance with s. 627.663; an
  115  association group to cover persons associated in any other
  116  common group, which common group is formed primarily for
  117  purposes other than providing insurance; a group that is
  118  established primarily for the purpose of providing group
  119  insurance, provided the benefits are reasonable in relation to
  120  the premiums charged thereunder and the issuance of the group
  121  policy has resulted, or will result, in economies of
  122  administration; or a group of insurance agents of an insurer,
  123  which insurer is the policyholder;
  124         (b) Certificates evidencing coverage under the policy are
  125  issued to residents of this state and contain in contrasting
  126  color and not less than 10-point type the following statement:
  127  “The benefits of the policy providing your coverage are governed
  128  primarily by the law of a state other than Florida”; and
  129         (c) The policy provides the benefits specified in ss.
  130  627.419, 627.42391, 627.6574, 627.6575, 627.6579, 627.6612,
  131  627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and
  132  627.66911, and complies with the requirements of s. 627.66996.
  133         (d) Applications for certificates of coverage offered to
  134  residents of this state must contain, in contrasting color and
  135  not less than 12-point type, the following statement on the same
  136  page as the applicant’s signature:
  137  
  138         “This policy is primarily governed by the laws of
  139         ...insert state where the master policy if filed....
  140         As a result, all of the rating laws applicable to
  141         policies filed in this state do not apply to this
  142         coverage, which may result in increases in your
  143         premium at renewal that would not be permissible under
  144         a Florida-approved policy. Any purchase of individual
  145         health insurance should be considered carefully, as
  146         future medical conditions may make it impossible to
  147         qualify for another individual health policy. For
  148         information concerning individual health coverage
  149         under a Florida-approved policy, consult your agent or
  150         the Florida Department of Financial Services.”
  151  
  152  This paragraph applies only to group certificates providing
  153  health insurance coverage which require individualized
  154  underwriting to determine coverage eligibility for an individual
  155  or premium rates to be charged to an individual except for the
  156  following:
  157         1. Policies issued to provide coverage to groups of persons
  158  all of whom are in the same or functionally related licensed
  159  professions, and providing coverage only to such licensed
  160  professionals, their employees, or their dependents;
  161         2. Policies providing coverage to small employers as
  162  defined by s. 627.6699. Such policies shall be subject to, and
  163  governed by, the provisions of s. 627.6699;
  164         3. Policies issued to a bona fide association, as defined
  165  by s. 627.6571(5), provided that there is a person or board
  166  acting as a fiduciary for the benefit of the members, and such
  167  association is not owned, controlled by, or otherwise associated
  168  with the insurance company; or
  169         4. Any accidental death, accidental death and
  170  dismemberment, accident-only, vision-only, dental-only, hospital
  171  indemnity-only, hospital accident-only, cancer, specified
  172  disease, Medicare supplement, products that supplement Medicare,
  173  long-term care, or disability income insurance, or similar
  174  supplemental plans provided under a separate policy,
  175  certificate, or contract of insurance, which cannot duplicate
  176  coverage under an underlying health plan, coinsurance, or
  177  deductibles or coverage issued as a supplement to workers’
  178  compensation or similar insurance, or automobile medical-payment
  179  insurance.
  180         Section 5. Except as otherwise expressly provided in this
  181  act, this act shall take effect July 1, 2013, and applies to
  182  policies and contracts issued or renewed on or after that date.
  183  
  184  ================= T I T L E  A M E N D M E N T ================
  185         And the title is amended as follows:
  186         Delete everything before the enacting clause
  187  and insert:
  188                        A bill to be entitled                      
  189         An act relating to cancer treatment; providing a short
  190         title; creating ss. 627.42391 and 641.313, F.S.;
  191         providing definitions; requiring that an individual or
  192         group insurance policy or a health maintenance
  193         contract that provides coverage for cancer treatment
  194         medications provide coverage for orally administered
  195         cancer treatment medications on a basis no less
  196         favorable than that required by the policy or contract
  197         for intravenously administered or injected cancer
  198         treatment medications; prohibiting insurers, health
  199         maintenance organizations, and certain other entities
  200         from engaging in specified actions to avoid compliance
  201         with this act; amending s. 627.6515, F.S.; adding a
  202         cross-reference to conform to changes made by the act;
  203         providing an effective date.