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.
21
22 Be It Enacted by the Legislature of the State of Florida:
23
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.