Florida Senate - 2017                       CS for CS for SB 240
       By the Committees on Health Policy; and Banking and Insurance;
       and Senators Lee and Mayfield
       588-01932-17                                           2017240c2
    1                        A bill to be entitled                      
    2         An act relating to direct primary care; amending s.
    3         409.977, F.S.; requiring the Agency for Health Care
    4         Administration to provide specified financial
    5         assistance to certain Medicaid recipients; requiring
    6         the agency to resubmit, by a specified date, certain
    7         federal waivers or waiver amendments to specified
    8         federal entities to incorporate recipient elections of
    9         certain direct primary care agreements; creating s.
   10         456.0625, F.S.; defining terms; authorizing primary
   11         care providers or their agents to enter into direct
   12         primary care agreements for providing primary care
   13         services; providing applicability; specifying
   14         requirements for direct primary care agreements;
   15         creating s. 624.27, F.S.; providing construction and
   16         applicability of the Florida Insurance Code as to
   17         direct primary care agreements; providing an exception
   18         for primary care providers or their agents from
   19         certain requirements under the code under certain
   20         circumstances; providing an effective date.
   22  Be It Enacted by the Legislature of the State of Florida:
   24         Section 1. Subsection (4) of section 409.977, Florida
   25  Statutes, is amended to read:
   26         409.977 Enrollment.—
   27         (4) The agency shall:
   28         (a) Develop a process to enable a recipient with access to
   29  employer-sponsored health care coverage to opt out of all
   30  managed care plans and to use Medicaid financial assistance to
   31  pay for the recipient’s share of the cost in such employer
   32  sponsored coverage.
   33         (b) Contingent upon federal approval, the agency shall also
   34  enable recipients with access to other insurance or related
   35  products providing access to health care services created
   36  pursuant to state law, including any product available under the
   37  Florida Health Choices Program, or any health exchange, to opt
   38  out.
   39         (c) Provide The amount of financial assistance provided for
   40  each recipient in an amount may not to exceed the amount of the
   41  Medicaid premium which that would have been paid to a managed
   42  care plan for that recipient opting to receive services under
   43  this subsection.
   44         (d)The agency shall Seek federal approval to require
   45  Medicaid recipients with access to employer-sponsored health
   46  care coverage to enroll in that coverage and use Medicaid
   47  financial assistance to pay for the recipient’s share of the
   48  cost for such coverage. The amount of financial assistance
   49  provided for each recipient may not exceed the amount of the
   50  Medicaid premium that would have been paid to a managed care
   51  plan for that recipient.
   52         (e) By January 1, 2018, resubmit an appropriate federal
   53  waiver or waiver amendment to the Centers for Medicare and
   54  Medicaid Services, the United States Department of Health and
   55  Human Services, or any other designated federal entity to
   56  incorporate the election by a recipient for a direct primary
   57  care agreement, as defined in s. 456.0625, within the Statewide
   58  Medicaid Managed Care program.
   59         Section 2. Section 456.0625, Florida Statutes, is created
   60  to read:
   61         456.0625 Direct primary care agreements.—
   62         (1) As used in this section, the term:
   63         (a) “Direct primary care agreement” means a contract
   64  between a primary care provider and a patient, the patient’s
   65  legal representative, or an employer which meets the
   66  requirements specified under subsection (3) and which does not
   67  indemnify for services provided by a third party.
   68         (b) “Primary care provider” means a health care
   69  practitioner licensed under chapter 458, chapter 459, chapter
   70  460, or chapter 464 or a primary care group practice that
   71  provides medical services to patients which are commonly
   72  provided without referral from another health care provider.
   73         (c) “Primary care service” means the screening, assessment,
   74  diagnosis, and treatment of a patient for the purpose of
   75  promoting health or detecting and managing disease or injury
   76  within the competency and training of the primary care provider.
   77         (2) A primary care provider or an agent of the primary care
   78  provider may enter into a direct primary care agreement for
   79  providing primary care services. Section 624.27 applies to a
   80  direct primary care agreement.
   81         (3)A direct primary care agreement must:
   82         (a) Be in writing.
   83         (b) Be signed by the primary care provider or an agent of
   84  the primary care provider and the patient, the patient’s legal
   85  representative, or an employer.
   86         (c) Allow a party to terminate the agreement by giving the
   87  other party at least 30 days’ advance written notice. The
   88  agreement may provide for immediate termination due to a
   89  violation of the physician-patient relationship or a breach of
   90  the terms of the agreement.
   91         (d) Describe the scope of primary care services that are
   92  covered by the monthly fee.
   93         (e) Specify the monthly fee and any fees for primary care
   94  services not covered by the monthly fee.
   95         (f) Specify the duration of the agreement and any automatic
   96  renewal provisions.
   97         (g) Offer a refund to the patient of monthly fees paid in
   98  advance if the primary care provider ceases to offer primary
   99  care services for any reason.
  100         (h) Contain, in contrasting color and in not less than 12
  101  point type, the following statements on the same page as the
  102  applicant’s signature:
  103         1. This agreement is not health insurance, and the primary
  104  care provider will not file any claims against the patient’s
  105  health insurance policy or plan for reimbursement of any primary
  106  care services covered by this agreement.
  107         2. This agreement does not qualify as minimum essential
  108  coverage to satisfy the individual shared responsibility
  109  provision of the federal Patient Protection and Affordable Care
  110  Act, Pub. L. No. 111-148.
  111         3. This agreement is not workers’ compensation insurance
  112  and may not replace the employer’s obligations under chapter
  113  440, Florida Statutes.
  114         Section 3. Section 624.27, Florida Statutes, is created to
  115  read:
  116         624.27 Application of code as to direct primary care
  117  agreements.—
  118         (1) A direct primary care agreement, as defined in s.
  119  456.0625, does not constitute insurance and is not subject to
  120  any chapter of the Florida Insurance Code. The act of entering
  121  into a direct primary care agreement does not constitute the
  122  business of insurance and is not subject to any chapter of the
  123  Florida Insurance Code.
  124         (2) A primary care provider or an agent of a primary care
  125  provider is not required to obtain a certificate of authority or
  126  license under any chapter of the Florida Insurance Code to
  127  market, sell, or offer to sell a direct primary care agreement
  128  pursuant to s. 456.0625.
  129         Section 4. This act shall take effect July 1, 2017.