Florida Senate - 2017                CS for CS for CS for SB 240
       By the Committees on Appropriations; Health Policy; and Banking
       and Insurance; and Senators Lee and Mayfield
       576-04398-17                                           2017240c3
    1                        A bill to be entitled                      
    2         An act relating to direct primary care; amending s.
    3         409.973, F.S.; requiring plans operating in the
    4         managed medical assistance program to provide
    5         enrollees an opportunity to enter into a direct
    6         primary care agreement with identified network primary
    7         care providers; encouraging such plans to enter into
    8         alternative payment arrangements with network primary
    9         care providers for a specified purpose; 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 409.973, Florida
   25  Statutes, is amended to read:
   26         409.973 Benefits.—
   27         (4) PRIMARY CARE INITIATIVE.—Each plan operating in the
   28  managed medical assistance program shall establish a program to
   29  encourage enrollees to establish a relationship with their
   30  primary care provider. Plans shall provide enrollees with the
   31  opportunity to enter into a direct primary care agreement with
   32  identified network primary care providers. Plans are encouraged
   33  to enter into alternative payment arrangements with primary care
   34  providers in their networks to allow for the election by a
   35  recipient for a direct primary care agreement within the
   36  Statewide Medicaid Managed Care program. In addition, each plan
   37  shall:
   38         (a) Provide information to each enrollee on the importance
   39  of and procedure for selecting a primary care provider, and
   40  thereafter automatically assign to a primary care provider any
   41  enrollee who fails to choose a primary care provider.
   42         (b) If the enrollee was not a Medicaid recipient before
   43  enrollment in the plan, assist the enrollee in scheduling an
   44  appointment with the primary care provider. If possible the
   45  appointment should be made within 30 days after enrollment in
   46  the plan. For enrollees who become eligible for Medicaid between
   47  January 1, 2014, and December 31, 2015, the appointment should
   48  be scheduled within 6 months after enrollment in the plan.
   49         (c) Report to the agency the number of enrollees assigned
   50  to each primary care provider within the plan’s network.
   51         (d) Report to the agency the number of enrollees who have
   52  not had an appointment with their primary care provider within
   53  their first year of enrollment.
   54         (e) Report to the agency the number of emergency room
   55  visits by enrollees who have not had at least one appointment
   56  with their primary care provider.
   57         Section 2. Section 456.0625, Florida Statutes, is created
   58  to read:
   59         456.0625 Direct primary care agreements.—
   60         (1) As used in this section, the term:
   61         (a) “Direct primary care agreement” means a contract
   62  between a primary care provider and a patient, the patient’s
   63  legal representative, or an employer which meets the
   64  requirements specified under subsection (3) and which does not
   65  indemnify for services provided by a third party.
   66         (b) “Primary care provider” means a health care
   67  practitioner licensed under chapter 458, chapter 459, chapter
   68  460, or chapter 464 or a primary care group practice that
   69  provides medical services to patients which are commonly
   70  provided without referral from another health care provider.
   71         (c) “Primary care service” means the screening, assessment,
   72  diagnosis, and treatment of a patient for the purpose of
   73  promoting health or detecting and managing disease or injury
   74  within the competency and training of the primary care provider.
   75         (2) A primary care provider or an agent of the primary care
   76  provider may enter into a direct primary care agreement for
   77  providing primary care services. Section 624.27 applies to a
   78  direct primary care agreement.
   79         (3)A direct primary care agreement must:
   80         (a) Be in writing.
   81         (b) Be signed by the primary care provider or an agent of
   82  the primary care provider and the patient, the patient’s legal
   83  representative, or an employer.
   84         (c) Allow a party to terminate the agreement by giving the
   85  other party at least 30 days’ advance written notice. The
   86  agreement may provide for immediate termination due to a
   87  violation of the physician-patient relationship or a breach of
   88  the terms of the agreement.
   89         (d) Describe the scope of primary care services that are
   90  covered by the monthly fee.
   91         (e) Specify the monthly fee and any fees for primary care
   92  services not covered by the monthly fee.
   93         (f) Specify the duration of the agreement and any automatic
   94  renewal provisions.
   95         (g) Offer a refund to the patient of monthly fees paid in
   96  advance if the primary care provider ceases to offer primary
   97  care services for any reason.
   98         (h) Contain, in contrasting color and in not less than 12
   99  point type, the following statements on the same page as the
  100  applicant’s signature:
  101         1. This agreement is not health insurance, and the primary
  102  care provider will not file any claims against the patient’s
  103  health insurance policy or plan for reimbursement of any primary
  104  care services covered by this agreement.
  105         2. This agreement does not qualify as minimum essential
  106  coverage to satisfy the individual shared responsibility
  107  provision of the federal Patient Protection and Affordable Care
  108  Act, Pub. L. No. 111-148.
  109         3. This agreement is not workers’ compensation insurance
  110  and may not replace the employer’s obligations under chapter
  111  440, Florida Statutes.
  112         Section 3. Section 624.27, Florida Statutes, is created to
  113  read:
  114         624.27 Application of code as to direct primary care
  115  agreements.—
  116         (1) A direct primary care agreement, as defined in s.
  117  456.0625, does not constitute insurance and is not subject to
  118  any chapter of the Florida Insurance Code. The act of entering
  119  into a direct primary care agreement does not constitute the
  120  business of insurance and is not subject to any chapter of the
  121  Florida Insurance Code.
  122         (2) A primary care provider or an agent of a primary care
  123  provider is not required to obtain a certificate of authority or
  124  license under any chapter of the Florida Insurance Code to
  125  market, sell, or offer to sell a direct primary care agreement
  126  pursuant to s. 456.0625.
  127         Section 4. This act shall take effect July 1, 2017.