Florida Senate - 2015                                     SB 516
       By Senators Bean and Garcia
       4-00341C-15                                            2015516__
    1                        A bill to be entitled                      
    2         An act relating to health insurance coverage for
    3         emergency services; creating s. 627.64194, F.S.;
    4         defining terms; prohibiting coverage for emergency
    5         services from requiring a prior authorization
    6         determination; requiring such coverage to be provided
    7         regardless of whether the service is furnished by a
    8         participating or nonparticipating provider; specifying
    9         coinsurance, copayment, limitation of benefits, and
   10         reimbursement requirements for nonparticipating
   11         providers; prohibiting a nonparticipating provider
   12         from collecting or attempting to collect an amount in
   13         excess of specified amounts; providing an effective
   14         date.
   16  Be It Enacted by the Legislature of the State of Florida:
   18         Section 1. Section 627.64194, Florida Statutes, is created
   19  to read:
   20         627.64194Coverage for emergency services.—
   21         (1) As used in this section, the term:
   22         (a) “Coverage for emergency services” means the coverage
   23  provided by a health insurance policy for “emergency services
   24  and care” as that term is defined in s. 641.47 or emergency
   25  medical transportation services, which include transport by an
   26  ambulance, emergency medical services vehicle, or air ambulance,
   27  as those terms are defined in s. 401.23.
   28         (b) “Participating provider” means a “preferred provider”
   29  as defined in s. 627.6471 and an “exclusive provider” as defined
   30  in s. 627.6472.
   31         (2) Coverage for emergency services:
   32         (a) May not require a prior authorization determination.
   33         (b) Must be provided regardless of whether the service is
   34  furnished by a participating or nonparticipating provider.
   35         (c) May impose a coinsurance amount, copayment, or
   36  limitation of benefits requirement for a nonparticipating
   37  provider only if the same requirement applies to a participating
   38  provider.
   39         (d) Must reimburse a nonparticipating provider the greater
   40  of the following:
   41         1. The amount negotiated with a participating provider or a
   42  nonparticipating provider for the service, excluding any
   43  coinsurance amount or copayment imposed by a participating
   44  provider on the participant, beneficiary, or enrollee.
   45         2. The amount calculated under the methodology generally
   46  used by the insurer to determine the reimbursement amount to a
   47  nonparticipating provider for the service, such as the usual,
   48  customary, and reasonable amount, reduced only by a coinsurance
   49  amount or copayment that applies to a participating provider.
   50         3. The amount that would be paid under Medicare for the
   51  service, reduced only by a coinsurance amount or copayment that
   52  applies to a participating provider.
   53         (3) A nonparticipating provider may not be reimbursed an
   54  amount greater than that provided under paragraph (2)(d) and may
   55  not collect or attempt to collect, directly or indirectly, any
   56  excess amount.
   57         Section 2. This act shall take effect October 1, 2015.