Florida Senate - 2017 COMMITTEE AMENDMENT
Bill No. CS for CS for SB 182
Ì220914ÇÎ220914
LEGISLATIVE ACTION
Senate . House
Comm: WD .
04/19/2017 .
.
.
.
—————————————————————————————————————————————————————————————————
—————————————————————————————————————————————————————————————————
The Committee on Rules (Lee) recommended the following:
1 Senate Amendment (with title amendment)
2
3 Delete lines 20 - 165
4 and insert:
5 Section 1. Effective January 1, 2018, section 627.42393,
6 Florida Statutes, is created to read:
7 627.42393 Insurance policies; limiting changes to
8 prescription drug formularies.—
9 (1) Other than at the time of coverage renewal, an
10 individual or group insurance policy that is delivered, issued
11 for delivery, renewed, amended, or continued in this state and
12 that provides medical, major medical, or similar comprehensive
13 coverage may not:
14 (a) Remove a covered prescription drug from its list of
15 covered drugs during the policy year unless the United States
16 Food and Drug Administration has issued a statement about the
17 drug which calls into question the clinical safety of the drug,
18 or the manufacturer of the drug has notified the United States
19 Food and Drug Administration of a manufacturing discontinuance
20 or potential discontinuance of the drug as required by s. 506C
21 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
22 (b) Reclassify a drug to a more restrictive drug tier or
23 increase the amount that an insured must pay for a copayment,
24 coinsurance, or deductible for prescription drug benefits, or
25 reclassify a drug to a higher cost-sharing tier during the
26 policy year.
27 (2) This section does not prohibit the addition of
28 prescription drugs to the list of drugs covered under the policy
29 during the policy year.
30 (3) This section does not apply to a grandfathered health
31 plan as defined in s. 627.402 or to benefits set forth in s.
32 627.6513(1)-(14).
33 (4) This section does not alter or amend s. 465.025, which
34 provides conditions under which a pharmacist may substitute a
35 generically equivalent drug product for a brand name drug
36 product.
37 (5) This section does not alter or amend s. 465.0252, which
38 provides conditions under which a pharmacist may dispense a
39 substitute biological product for the prescribed biological
40 product.
41 Section 2. Effective January 1, 2018, paragraph (e) of
42 subsection (5) of section 627.6699, Florida Statutes, is amended
43 to read:
44 627.6699 Employee Health Care Access Act.—
45 (5) AVAILABILITY OF COVERAGE.—
46 (e) All health benefit plans issued under this section must
47 comply with the following conditions:
48 1. For employers who have fewer than two employees, a late
49 enrollee may be excluded from coverage for no longer than 24
50 months if he or she was not covered by creditable coverage
51 continually to a date not more than 63 days before the effective
52 date of his or her new coverage.
53 2. Any requirement used by a small employer carrier in
54 determining whether to provide coverage to a small employer
55 group, including requirements for minimum participation of
56 eligible employees and minimum employer contributions, must be
57 applied uniformly among all small employer groups having the
58 same number of eligible employees applying for coverage or
59 receiving coverage from the small employer carrier, except that
60 a small employer carrier that participates in, administers, or
61 issues health benefits pursuant to s. 381.0406 which do not
62 include a preexisting condition exclusion may require as a
63 condition of offering such benefits that the employer has had no
64 health insurance coverage for its employees for a period of at
65 least 6 months. A small employer carrier may vary application of
66 minimum participation requirements and minimum employer
67 contribution requirements only by the size of the small employer
68 group.
69 3. In applying minimum participation requirements with
70 respect to a small employer, a small employer carrier shall not
71 consider as an eligible employee employees or dependents who
72 have qualifying existing coverage in an employer-based group
73 insurance plan or an ERISA qualified self-insurance plan in
74 determining whether the applicable percentage of participation
75 is met. However, a small employer carrier may count eligible
76 employees and dependents who have coverage under another health
77 plan that is sponsored by that employer.
78 4. A small employer carrier shall not increase any
79 requirement for minimum employee participation or any
80 requirement for minimum employer contribution applicable to a
81 small employer at any time after the small employer has been
82 accepted for coverage, unless the employer size has changed, in
83 which case the small employer carrier may apply the requirements
84 that are applicable to the new group size.
85 5. If a small employer carrier offers coverage to a small
86 employer, it must offer coverage to all the small employer’s
87 eligible employees and their dependents. A small employer
88 carrier may not offer coverage limited to certain persons in a
89 group or to part of a group, except with respect to late
90 enrollees.
91 6. A small employer carrier may not modify any health
92 benefit plan issued to a small employer with respect to a small
93 employer or any eligible employee or dependent through riders,
94 endorsements, or otherwise to restrict or exclude coverage for
95 certain diseases or medical conditions otherwise covered by the
96 health benefit plan.
97 7. An initial enrollment period of at least 30 days must be
98 provided. An annual 30-day open enrollment period must be
99 offered to each small employer’s eligible employees and their
100 dependents. A small employer carrier must provide special
101 enrollment periods as required by s. 627.65615.
102 8. A small employer carrier must limit changes to
103 prescription drug formularies as required by s. 627.42393.
104 Section 3. Effective January 1, 2018, subsection (36) of
105 section 641.31, Florida Statutes, is amended to read:
106 641.31 Health maintenance contracts.—
107 (36) A health maintenance organization may increase the
108 copayment for any benefit, or delete, amend, or limit any of the
109 benefits to which a subscriber is entitled under the group
110 contract only, upon written notice to the contract holder at
111 least 45 days in advance of the time of coverage renewal. The
112 health maintenance organization may amend the contract with the
113 contract holder, with such amendment to be effective immediately
114 at the time of coverage renewal. The written notice to the
115 contract holder must shall specifically identify any deletions,
116 amendments, or limitations to any of the benefits provided in
117 the group contract during the current contract period which will
118 be included in the group contract upon renewal. This subsection
119 does not apply to any increases in benefits. The 45-day notice
120 requirement does shall not apply if benefits are amended,
121 deleted, or limited at the request of the contract holder.
122 (a) Other than at the time of coverage renewal, a health
123 maintenance organization that provides medical, major medical,
124 or similar comprehensive coverage may not:
125 1. Remove a covered prescription drug from its list of
126 covered drugs during the contract year unless the United States
127 Food and Drug Administration has issued a statement about the
128 drug which calls into question the clinical safety of the drug,
129 or the manufacturer of the drug has notified the United States
130 Food and Drug Administration of a manufacturing discontinuance
131 or potential discontinuance of the drug as required by s. 506C
132 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. s. 356c.
133 2. Reclassify a drug to a more restrictive drug tier or
134 increase the amount that an insured must pay for a copayment,
135 coinsurance, or deductible for prescription drug benefits, or
136 reclassify a drug to a higher cost-sharing tier during the
137 contract year.
138 (b) This subsection does not:
139 1. Prohibit the addition of prescription drugs to the list
140 of drugs covered during the contract year.
141 2. Apply to a grandfathered health plan as defined in s.
142 627.402 or to benefits set forth in s. 627.6513(1)-(14).
143 3. Alter or amend s. 465.025, which provides conditions
144 under which a pharmacist may substitute a generically equivalent
145 drug product for a brand name drug product.
146 4. Alter or amend s. 465.0252, which provides conditions
147 under which a pharmacist may dispense a substitute biological
148 product for the prescribed biological product.
149 Section 4. The Legislature finds that the creation of
150 section 627.42393, Florida Statutes, and the amendments made by
151 this act to sections 627.6699 and 641.31, Florida Statutes,
152 fulfill an important state interest.
153 Section 5. Subsection (4) of section 409.977, Florida
154 Statutes, is amended to read:
155 409.977 Enrollment.—
156 (4) The agency shall:
157 (a) Develop a process to enable a recipient with access to
158 employer-sponsored health care coverage to opt out of all
159 managed care plans and to use Medicaid financial assistance to
160 pay for the recipient’s share of the cost in such employer
161 sponsored coverage.
162 (b) Contingent upon federal approval, the agency shall also
163 enable recipients with access to other insurance or related
164 products providing access to health care services created
165 pursuant to state law, including any product available under the
166 Florida Health Choices Program, or any health exchange, to opt
167 out.
168 (c) Provide The amount of financial assistance provided for
169 each recipient in an amount may not to exceed the amount of the
170 Medicaid premium which that would have been paid to a managed
171 care plan for that recipient opting to receive services under
172 this subsection.
173 (d) The agency shall Seek federal approval to require
174 Medicaid recipients with access to employer-sponsored health
175 care coverage to enroll in that coverage and use Medicaid
176 financial assistance to pay for the recipient’s share of the
177 cost for such coverage. The amount of financial assistance
178 provided for each recipient may not exceed the amount of the
179 Medicaid premium that would have been paid to a managed care
180 plan for that recipient.
181 (e) By January 1, 2018, resubmit an appropriate federal
182 waiver or waiver amendment to the Centers for Medicare and
183 Medicaid Services, the United States Department of Health and
184 Human Services, or any other designated federal entity to
185 incorporate the election by a recipient for a direct primary
186 care agreement, as defined in s. 456.0625, within the Statewide
187 Medicaid Managed Care program.
188 Section 6. Section 456.0625, Florida Statutes, is created
189 to read:
190 456.0625 Direct primary care agreements.—
191 (1) As used in this section, the term:
192 (a) “Direct primary care agreement” means a contract
193 between a primary care provider and a patient, the patient’s
194 legal representative, or an employer which meets the
195 requirements specified under subsection (3) and which does not
196 indemnify for services provided by a third party.
197 (b) “Primary care provider” means a health care
198 practitioner licensed under chapter 458, chapter 459, chapter
199 460, or chapter 464 or a primary care group practice that
200 provides medical services to patients which are commonly
201 provided without referral from another health care provider.
202 (c) “Primary care service” means the screening, assessment,
203 diagnosis, and treatment of a patient for the purpose of
204 promoting health or detecting and managing disease or injury
205 within the competency and training of the primary care provider.
206 (2) A primary care provider or an agent of the primary care
207 provider may enter into a direct primary care agreement for
208 providing primary care services. Section 624.27 applies to a
209 direct primary care agreement.
210 (3) A direct primary care agreement must:
211 (a) Be in writing.
212 (b) Be signed by the primary care provider or an agent of
213 the primary care provider and the patient, the patient’s legal
214 representative, or an employer.
215 (c) Allow a party to terminate the agreement by giving the
216 other party at least 30 days’ advance written notice. The
217 agreement may provide for immediate termination due to a
218 violation of the physician-patient relationship or a breach of
219 the terms of the agreement.
220 (d) Describe the scope of primary care services that are
221 covered by the monthly fee.
222 (e) Specify the monthly fee and any fees for primary care
223 services not covered by the monthly fee.
224 (f) Specify the duration of the agreement and any automatic
225 renewal provisions.
226 (g) Offer a refund to the patient of monthly fees paid in
227 advance if the primary care provider ceases to offer primary
228 care services for any reason.
229 (h) Contain, in contrasting color and in not less than 12
230 point type, the following statements on the same page as the
231 applicant’s signature:
232 1. This agreement is not health insurance, and the primary
233 care provider will not file any claims against the patient’s
234 health insurance policy or plan for reimbursement of any primary
235 care services covered by this agreement.
236 2. This agreement does not qualify as minimum essential
237 coverage to satisfy the individual shared responsibility
238 provision of the federal Patient Protection and Affordable Care
239 Act, Pub. L. No. 111-148.
240 3. This agreement is not workers’ compensation insurance
241 and may not replace the employer’s obligations under chapter
242 440, Florida Statutes.
243 Section 7. Section 624.27, Florida Statutes, is created to
244 read:
245 624.27 Application of code as to direct primary care
246 agreements.—
247 (1) A direct primary care agreement, as defined in s.
248 456.0625, does not constitute insurance and is not subject to
249 any chapter of the Florida Insurance Code. The act of entering
250 into a direct primary care agreement does not constitute the
251 business of insurance and is not subject to any chapter of the
252 Florida Insurance Code.
253 (2) A primary care provider or an agent of a primary care
254 provider is not required to obtain a certificate of authority or
255 license under any chapter of the Florida Insurance Code to
256 market, sell, or offer to sell a direct primary care agreement
257 pursuant to s. 456.0625.
258 Section 8. Except as otherwise expressly provided in this
259 act, this act shall take effect July 1, 2017.
260
261 ================= T I T L E A M E N D M E N T ================
262 And the title is amended as follows:
263 Delete lines 2 - 16
264 and insert:
265 An act relating to health care; creating s. 627.42393,
266 F.S.; limiting, under specified circumstances, changes
267 to a health insurance policy prescription drug
268 formulary during a policy year; providing construction
269 and applicability; amending s. 627.6699, F.S.;
270 requiring small employer carriers to limit changes to
271 prescription drug formularies under certain
272 circumstances; amending s. 641.31, F.S.; limiting,
273 under specified circumstances, changes to a health
274 maintenance contract prescription drug formulary
275 during a contract year; providing construction and
276 applicability; providing a declaration of important
277 state interest; amending s. 409.977, F.S.; requiring
278 the Agency for Health Care Administration to provide
279 specified financial assistance to certain Medicaid
280 recipients; requiring the agency to resubmit, by a
281 specified date, certain federal waivers or waiver
282 amendments to specified federal entities to
283 incorporate recipient elections of certain direct
284 primary care agreements; creating s. 456.0625, F.S.;
285 defining terms; authorizing primary care providers or
286 their agents to enter into direct primary care
287 agreements for providing primary care services;
288 providing applicability; specifying requirements for
289 direct primary care agreements; creating s. 624.27,
290 F.S.; providing construction and applicability of the
291 Florida Insurance Code as to direct primary care
292 agreements; providing an exception for primary care
293 providers or their agents from certain requirements
294 under the code under certain circumstances; providing
295 effective dates.