CS for SB 86                                     First Engrossed
       
       
       
       
       
       
       
       
       201486e1
       
    1                        A bill to be entitled                      
    2         An act relating to dentists; amending s. 627.6474,
    3         F.S.; prohibiting a contract between a health insurer
    4         and a dentist from requiring the dentist to provide
    5         services at a fee set by the insurer under certain
    6         circumstances; defining the term “covered services” as
    7         it relates to contracts between a health insurer and a
    8         dentist; amending s. 636.035, F.S.; prohibiting a
    9         contract between a prepaid limited health service
   10         organization and a dentist from requiring the dentist
   11         to provide services at a fee set by the organization
   12         under certain circumstances; defining the term
   13         “covered services” as it relates to contracts between
   14         a prepaid limited health service organization and a
   15         dentist; amending s. 641.315, F.S.; prohibiting a
   16         contract between a health maintenance organization and
   17         a dentist from requiring the dentist to provide
   18         services at a fee set by the organization under
   19         certain circumstances; defining the term “covered
   20         services” as it relates to contracts between a health
   21         maintenance organization and a dentist; providing
   22         applicability; providing an effective date.
   23          
   24  Be It Enacted by the Legislature of the State of Florida:
   25  
   26         Section 1. Section 627.6474, Florida Statutes, is amended
   27  to read:
   28         627.6474 Provider contracts.—
   29         (1) A health insurer may shall not require a contracted
   30  health care practitioner as defined in s. 456.001(4) to accept
   31  the terms of other health care practitioner contracts with the
   32  insurer or any other insurer, or health maintenance
   33  organization, under common management and control with the
   34  insurer, including Medicare and Medicaid practitioner contracts
   35  and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
   36  s. 641.315, except for a practitioner in a group practice as
   37  defined in s. 456.053 who must accept the terms of a contract
   38  negotiated for the practitioner by the group, as a condition of
   39  continuation or renewal of the contract. Any contract provision
   40  that violates this section is void. A violation of this
   41  subsection section is not subject to the criminal penalty
   42  specified in s. 624.15.
   43         (2) A contract between a health insurer and a dentist
   44  licensed under chapter 466 for the provision of services to an
   45  insured may not contain a provision that requires the dentist to
   46  provide services to the insured under such contract at a fee set
   47  by the health insurer unless such services are covered services
   48  under the applicable contract. As used in this paragraph, the
   49  term “covered services” means dental care services for which a
   50  reimbursement is available under the insured’s contract, or for
   51  which a reimbursement would be available but for the application
   52  of contractual limitations such as deductibles, coinsurance,
   53  waiting periods, annual or lifetime maximums, frequency
   54  limitations, alternative benefit payments, or any other
   55  limitation.
   56         Section 2. Subsection (13) is added to section 636.035,
   57  Florida Statutes, to read:
   58         636.035 Provider arrangements.—
   59         (13) A contract between a prepaid limited health service
   60  organization and a dentist licensed under chapter 466 for the
   61  provision of services to a subscriber of the prepaid limited
   62  health service organization may not contain a provision that
   63  requires the dentist to provide services to the subscriber of
   64  the prepaid limited health service organization at a fee set by
   65  the prepaid limited health service organization unless such
   66  services are covered services under the applicable contract. As
   67  used in this paragraph, the term “covered services” means dental
   68  care services for which a reimbursement is available under the
   69  subscriber’s contract, or for which a reimbursement would be
   70  available but for the application of contractual limitations
   71  such as deductibles, coinsurance, waiting periods, annual or
   72  lifetime maximums, frequency limitations, alternative benefit
   73  payments, or any other limitation.
   74         Section 3. Subsection (11) is added to section 641.315,
   75  Florida Statutes, to read:
   76         641.315 Provider contracts.—
   77         (11) A contract between a health maintenance organization
   78  and a dentist licensed under chapter 466 for the provision of
   79  services to a subscriber of the health maintenance organization
   80  may not contain a provision that requires the dentist to provide
   81  services to the subscriber of the health maintenance
   82  organization at a fee set by the health maintenance organization
   83  unless such services are covered services under the applicable
   84  contract. As used in this paragraph, the term “covered services”
   85  means dental care services for which a reimbursement is
   86  available under the subscriber’s contract, or for which a
   87  reimbursement would be available but for the application of
   88  contractual limitations such as deductibles, coinsurance,
   89  waiting periods, annual or lifetime maximums, frequency
   90  limitations, alternative benefit payments, or any other
   91  limitation.
   92         Section 4. This act applies to contracts entered into or
   93  renewed on or after July 1, 2014.
   94         Section 5. This act shall take effect July 1, 2014.