Florida Senate - 2019 COMMITTEE AMENDMENT Bill No. SB 524 Ì441564.Î441564 LEGISLATIVE ACTION Senate . House . . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Banking and Insurance (Diaz) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete everything after the enacting clause 4 and insert: 5 Section 1. Section 627.6387, Florida Statutes, is created 6 to read: 7 627.6387 Shared savings incentive program.— 8 (1) This section may be cited as the “Patient Savings Act.” 9 (2) As used in this section, the term: 10 (a) “Health care provider” means a hospital, a facility 11 licensed under chapter 395; an entity licensed under chapter 12 400; a health care practitioner as defined in s. 456.001; a 13 blood bank, plasma center, industrial clinic, and renal dialysis 14 facility; or a professional association, partnership, 15 corporation, joint venture, or other association for 16 professional activity by health care providers. The term 17 includes entities and professionals outside of this state with 18 an active, unencumbered license for an equivalent facility or 19 practitioner type issued by another state, the District of 20 Columbia, or a possession or territory of the United States. 21 (b) “Health insurer” means an authorized insurer offering 22 health insurance as defined in s. 624.603 or a health 23 maintenance organization as defined in s. 641.19. The term does 24 not include the state group health insurance program provided 25 under s. 110.123. 26 (c) “Shared savings incentive” means a voluntary and 27 optional financial incentive that a health insurer may provide 28 to an insured for choosing certain shoppable health care 29 services under a shared savings incentive program and may 30 include, but is not limited to, the incentives described in s. 31 626.9541(4)(a). 32 (d) “Shared savings incentive program” means a voluntary 33 and optional incentive program established by a health insurer 34 pursuant to this section. 35 (e) “Shoppable health care service” means a lower-cost, 36 high-quality nonemergency health care service for which a shared 37 savings incentive is available for insureds under a health 38 insurer’s shared savings incentive program. Shoppable health 39 care services may be provided within or outside of this state 40 and include, but are not limited to: 41 1. Clinical laboratory services. 42 2. Infusion therapy. 43 3. Inpatient and outpatient surgical procedures. 44 4. Obstetrical and gynecological services. 45 5. Inpatient and outpatient nonsurgical diagnostic tests 46 and procedures. 47 6. Physical and occupational therapy services. 48 7. Radiology and imaging services. 49 8. Prescription drugs. 50 9. Services provided through telehealth. 51 (3) A health insurer may offer a shared savings incentive 52 program to provide incentives to an insured when the insured 53 obtains a shoppable health care service from the health 54 insurer’s shared savings list. An insured may not be required to 55 participate in a shared savings incentive program. A health 56 insurer that offers a shared savings incentive program must: 57 (a) Establish the program as a component part of the 58 policy, contract, or certificate of insurance provided by the 59 health insurer and notify the insureds and the office at least 60 30 days before program termination. 61 (b) File a description of the program on a form prescribed 62 by commission rule. The office must review the filing and 63 determine whether the shared savings incentive program complies 64 with this section. 65 (c) Notify an insured annually and at the time of renewal, 66 and an applicant for insurance at the time of enrollment, of the 67 availability of the shared savings incentive program and the 68 procedure to participate in the program. 69 (d) Publish on a webpage easily accessible to insureds and 70 to applicants for insurance a list of shoppable health care 71 services and health care providers and the shared savings 72 incentive amount applicable for each service. A shared savings 73 incentive may not be less than 25 percent of the savings 74 generated by the insured’s participation in any shared savings 75 incentive offered by the health insurer. The baseline for the 76 savings calculation is the average in-network amount paid for 77 that service in the most recent 12-month period or some other 78 methodology established by the health insurer and approved by 79 the Commissioner of Insurance Regulation. 80 (e) At least quarterly, credit or deposit the shared 81 savings incentive amount to the insured’s account as a return or 82 reduction in premium, or credit the shared savings incentive 83 amount to the insured’s flexible spending account, health 84 savings account, or health reimbursement account, such that the 85 amount does not constitute income to the insured. 86 (f) Submit an annual report to the office within 90 87 business days after the close of each plan year. At a minimum, 88 the report must include the following information: 89 1. The number of insureds who participated in the program 90 during the plan year and the number of instances of 91 participation. 92 2. The total cost of services provided as a part of the 93 program. 94 3. The total value of the shared savings incentive payments 95 made to insureds participating in the program and the values 96 distributed as premium reductions, credits to flexible spending 97 accounts, credits to health savings accounts, or credits to 98 health reimbursement accounts. 99 4. An inventory of the shoppable health care services 100 offered by the health insurer. 101 (4)(a) A shared savings incentive offered by a health 102 insurer in accordance with this section: 103 1. Is not an administrative expense for rate development or 104 rate filing purposes. 105 2. Does not constitute an unfair method of competition or 106 an unfair or deceptive act or practice under s. 626.9541 and is 107 presumed to be appropriate unless credible data clearly 108 demonstrates otherwise. 109 (b) A shared saving incentive amount provided as a return 110 or reduction in premium reduces the health insurer’s direct 111 written premium by the shared saving incentive dollar amount for 112 the purposes of the taxes in ss. 624.509 and 624.5091. 113 (5) The commission may adopt rules necessary to implement 114 and enforce this section. 115 Section 2. This act shall take effect January 1, 2020. 116 117 ================= T I T L E A M E N D M E N T ================ 118 And the title is amended as follows: 119 Delete everything before the enacting clause 120 and insert: 121 A bill to be entitled 122 An act relating to health insurance savings programs; 123 creating s. 627.6387, F.S.; providing a short title; 124 defining terms; authorizing health insurers, which 125 include health maintenance organizations, to offer 126 shared savings incentive programs to insureds; 127 providing that insureds are not required to 128 participate in such programs; specifying requirements 129 for health insurers offering such programs; requiring 130 the Office of Insurance Regulation to review filed 131 descriptions of programs and make a certain 132 determination; providing notification and account 133 credit or deposit requirements for insurers; 134 specifying the minimum shared savings incentive and 135 the basis for calculating savings; specifying 136 requirements for annual reports submitted by insurers 137 to the office; providing construction; providing that 138 certain shared saving incentive amounts reduce an 139 insurer’s direct written premium for purposes of the 140 insurance premium tax and the retaliatory tax; 141 authorizing the Financial Services Commission to adopt 142 rules; providing an effective date.