Florida Senate - 2013                        COMMITTEE AMENDMENT
       Bill No. PCS (856836) for CS for SB 896
       
       
       
       
       
       
                                Barcode 297676                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  04/22/2013           .                                
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       The Committee on Appropriations (Hays) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Between lines 104 and 105
    4  insert:
    5         Section 2. Section 627.6474, Florida Statutes, is amended
    6  to read:
    7         627.6474 Provider contracts.—
    8         (1) A health insurer may shall not require a contracted
    9  health care practitioner as defined in s. 456.001(4) to accept
   10  the terms of other health care practitioner contracts with the
   11  insurer or any other insurer, or health maintenance
   12  organization, under common management and control with the
   13  insurer, including Medicare and Medicaid practitioner contracts
   14  and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
   15  s. 641.315, except for a practitioner in a group practice as
   16  defined in s. 456.053 who must accept the terms of a contract
   17  negotiated for the practitioner by the group, as a condition of
   18  continuation or renewal of the contract. Any contract provision
   19  that violates this section is void. A violation of this
   20  subsection section is not subject to the criminal penalty
   21  specified in s. 624.15.
   22         (2)(a)A contract between a health insurer and a dentist
   23  licensed under chapter 466 for the provision of services to an
   24  insured may not contain any provision that requires the dentist
   25  to provide services to the insured under such contract at a fee
   26  set by the health insurer unless such services are covered
   27  services under the applicable contract.
   28         (b) Covered services are those services that are listed as
   29  a benefit that the insured is entitled to receive under the
   30  contract. An insurer may not provide merely de minimis
   31  reimbursement or coverage in order to avoid the requirements of
   32  this section. Fees for covered services shall be set in good
   33  faith and must not be nominal.
   34         (c) A health insurer may not require as a condition of the
   35  contract that the dentist participate in a discount medical plan
   36  under part II of chapter 636.
   37         Section 3. Subsection (13) is added to section 636.035,
   38  Florida Statutes, to read:
   39         636.035 Provider arrangements.—
   40         (13)(a)A contract between a prepaid limited health service
   41  organization and a dentist licensed under chapter 466 for the
   42  provision of services to a subscriber of the prepaid limited
   43  health service organization may not contain any provision that
   44  requires the dentist to provide services to the subscriber of
   45  the prepaid limited health service organization at a fee set by
   46  the prepaid limited health service organization unless such
   47  services are covered services under the applicable contract.
   48         (b) Covered services are those services that are listed as
   49  a benefit that the subscriber is entitled to receive under the
   50  contract. A prepaid limited health service organization may not
   51  provide merely de minimis reimbursement or coverage in order to
   52  avoid the requirements of this section. Fees for covered
   53  services shall be set in good faith and must not be nominal.
   54         (c) A prepaid limited health service organization may not
   55  require as a condition of the contract that the dentist
   56  participate in a discount medical plan under part II of this
   57  chapter.
   58         Section 4. Subsection (11) is added to section 641.315,
   59  Florida Statutes, to read:
   60         641.315 Provider contracts.—
   61         (11)(a)A contract between a health maintenance
   62  organization and a dentist licensed under chapter 466 for the
   63  provision of services to a subscriber of the health maintenance
   64  organization may not contain any provision that requires the
   65  dentist to provide services to the subscriber of the health
   66  maintenance organization at a fee set by the health maintenance
   67  organization unless such services are covered services under the
   68  applicable contract.
   69         (b) Covered services are those services that are listed as
   70  a benefit that the subscriber is entitled to receive under the
   71  contract. A health maintenance organization may not provide
   72  merely de minimis reimbursement or coverage in order to avoid
   73  the requirements of this section. Fees for covered services
   74  shall be set in good faith and must not be nominal.
   75         (c) A health maintenance organization may not require as a
   76  condition of the contract that the dentist participate in a
   77  discount medical plan under part II of chapter 636.
   78         Section 5. Paragraph (a) of subsection (3) of section
   79  766.1115, Florida Statutes, is amended, and paragraph (h) is
   80  added to subsection (4) of that section, to read:
   81         766.1115 Health care providers; creation of agency
   82  relationship with governmental contractors.—
   83         (3) DEFINITIONS.—As used in this section, the term:
   84         (a) “Contract” means an agreement executed in compliance
   85  with this section between a health care provider and a
   86  governmental contractor which allows. This contract shall allow
   87  the health care provider to deliver health care services to low
   88  income recipients as an agent of the governmental contractor.
   89  The contract must be for volunteer, uncompensated services. For
   90  services to qualify as volunteer, uncompensated services under
   91  this section, the health care provider must receive no
   92  compensation from the governmental contractor for any services
   93  provided under the contract and must not bill or accept
   94  compensation from the recipient, or a any public or private
   95  third-party payor, for the specific services provided to the
   96  low-income recipients covered by the contract.
   97         (4) CONTRACT REQUIREMENTS.—A health care provider that
   98  executes a contract with a governmental contractor to deliver
   99  health care services on or after April 17, 1992, as an agent of
  100  the governmental contractor is an agent for purposes of s.
  101  768.28(9), while acting within the scope of duties under the
  102  contract, if the contract complies with the requirements of this
  103  section and regardless of whether the individual treated is
  104  later found to be ineligible. A health care provider under
  105  contract with the state may not be named as a defendant in any
  106  action arising out of medical care or treatment provided on or
  107  after April 17, 1992, under contracts entered into under this
  108  section. The contract must provide that:
  109         (h) As an agent of the governmental contractor for purposes
  110  of s. 768.28(9), while acting within the scope of duties under
  111  the contract, a health care provider licensed under chapter 466
  112  may allow a patient or a parent or guardian of the patient to
  113  voluntarily contribute a fee to cover costs of dental laboratory
  114  work related to the services provided to the patient. This
  115  contribution may not exceed the actual cost of the dental
  116  laboratory charges and is deemed in compliance with this
  117  section.
  118  
  119  A governmental contractor that is also a health care provider is
  120  not required to enter into a contract under this section with
  121  respect to the health care services delivered by its employees.
  122         Section 6. The amendments to ss. 627.6474, 636.035, and
  123  641.315, Florida Statutes, apply to contracts entered into or
  124  renewed on or after July 1, 2013.
  125  
  126  ================= T I T L E  A M E N D M E N T ================
  127         And the title is amended as follows:
  128         Delete line 10
  129  and insert:
  130         Legislature; amending s. 627.6474, F.S.; prohibiting a
  131         contract between a health insurer and a dentist from
  132         requiring the dentist to provide services at a fee set
  133         by the insurer under certain circumstances; providing
  134         that covered services are those services listed as a
  135         benefit that the insured is entitled to receive under
  136         a contract; prohibiting an insurer from providing
  137         merely de minimis reimbursement or coverage; requiring
  138         that fees for covered services be set in good faith
  139         and not be nominal; prohibiting a health insurer from
  140         requiring as a condition of a contract that a dentist
  141         participate in a discount medical plan; amending s.
  142         636.035, F.S.; prohibiting a contract between a
  143         prepaid limited health service organization and a
  144         dentist from requiring the dentist to provide services
  145         at a fee set by the organization under certain
  146         circumstances; providing that covered services are
  147         those services listed as a benefit that a subscriber
  148         of a prepaid limited health service organization is
  149         entitled to receive under a contract; prohibiting a
  150         prepaid limited health service organization from
  151         providing merely de minimis reimbursement or coverage;
  152         requiring that fees for covered services be set in
  153         good faith and not be nominal; prohibiting the prepaid
  154         limited health service organization from requiring as
  155         a condition of a contract that a dentist participate
  156         in a discount medical plan; amending s. 641.315, F.S.;
  157         prohibiting a contract between a health maintenance
  158         organization and a dentist from requiring the dentist
  159         to provide services at a fee set by the organization
  160         under certain circumstances; providing that covered
  161         services are those services listed as a benefit that a
  162         subscriber of a health maintenance organization is
  163         entitled to receive under a contract; prohibiting a
  164         health maintenance organization from providing merely
  165         de minimis reimbursement or coverage; requiring that
  166         fees for covered services be set in good faith and not
  167         be nominal; prohibiting the health maintenance
  168         organization from requiring as a condition of a
  169         contract that a dentist participate in a discount
  170         medical plan; amending s. 766.1115, F.S.; revising a
  171         definition; requiring a contract with a governmental
  172         contractor for health care services to include a
  173         provision for a health care provider licensed under
  174         ch. 466, F.S., as an agent of the governmental
  175         contractor, to allow a patient or a parent or guardian
  176         of the patient to voluntarily contribute a fee to
  177         cover costs of dental laboratory work related to the
  178         services provided to the patient without forfeiting
  179         sovereign immunity; prohibiting the contribution from
  180         exceeding the actual amount of the dental laboratory
  181         charges; providing that the contribution complies with
  182         the requirements of s. 766.1115, F.S.; providing for
  183         applicability; providing an effective date.