Florida Senate - 2019 CS for SB 524 By the Committee on Banking and Insurance; and Senators Diaz and Farmer 597-02919-19 2019524c1 1 A bill to be entitled 2 An act relating to health insurance savings programs; 3 creating s. 627.6387, F.S.; providing a short title; 4 defining terms; authorizing health insurers, which 5 include health maintenance organizations, to offer 6 shared savings incentive programs to insureds; 7 providing that insureds are not required to 8 participate in such programs; specifying requirements 9 for health insurers offering such programs; requiring 10 the Office of Insurance Regulation to review filed 11 descriptions of programs and make a certain 12 determination; providing notification and account 13 credit or deposit requirements for insurers; 14 specifying the minimum shared savings incentive and 15 the basis for calculating savings; specifying 16 requirements for annual reports submitted by insurers 17 to the office; providing construction; providing that 18 certain shared saving incentive amounts reduce an 19 insurer’s direct written premium for purposes of the 20 insurance premium tax and the retaliatory tax; 21 authorizing the Financial Services Commission to adopt 22 rules; providing an effective date. 23 24 Be It Enacted by the Legislature of the State of Florida: 25 26 Section 1. Section 627.6387, Florida Statutes, is created 27 to read: 28 627.6387 Shared savings incentive program.— 29 (1) This section may be cited as the “Patient Savings Act.” 30 (2) As used in this section, the term: 31 (a) “Health care provider” means a hospital, a facility 32 licensed under chapter 395; an entity licensed under chapter 33 400; a health care practitioner as defined in s. 456.001; a 34 blood bank, plasma center, industrial clinic, and renal dialysis 35 facility; or a professional association, partnership, 36 corporation, joint venture, or other association for 37 professional activity by health care providers. The term 38 includes entities and professionals outside of this state with 39 an active, unencumbered license for an equivalent facility or 40 practitioner type issued by another state, the District of 41 Columbia, or a possession or territory of the United States. 42 (b) “Health insurer” means an authorized insurer offering 43 health insurance as defined in s. 624.603 or a health 44 maintenance organization as defined in s. 641.19. The term does 45 not include the state group health insurance program provided 46 under s. 110.123. 47 (c) “Shared savings incentive” means a voluntary and 48 optional financial incentive that a health insurer may provide 49 to an insured for choosing certain shoppable health care 50 services under a shared savings incentive program and may 51 include, but is not limited to, the incentives described in s. 52 626.9541(4)(a). 53 (d) “Shared savings incentive program” means a voluntary 54 and optional incentive program established by a health insurer 55 pursuant to this section. 56 (e) “Shoppable health care service” means a lower-cost, 57 high-quality nonemergency health care service for which a shared 58 savings incentive is available for insureds under a health 59 insurer’s shared savings incentive program. Shoppable health 60 care services may be provided within or outside of this state 61 and include, but are not limited to: 62 1. Clinical laboratory services. 63 2. Infusion therapy. 64 3. Inpatient and outpatient surgical procedures. 65 4. Obstetrical and gynecological services. 66 5. Inpatient and outpatient nonsurgical diagnostic tests 67 and procedures. 68 6. Physical and occupational therapy services. 69 7. Radiology and imaging services. 70 8. Prescription drugs. 71 9. Services provided through telehealth. 72 (3) A health insurer may offer a shared savings incentive 73 program to provide incentives to an insured when the insured 74 obtains a shoppable health care service from the health 75 insurer’s shared savings list. An insured may not be required to 76 participate in a shared savings incentive program. A health 77 insurer that offers a shared savings incentive program must: 78 (a) Establish the program as a component part of the 79 policy, contract, or certificate of insurance provided by the 80 health insurer and notify the insureds and the office at least 81 30 days before program termination. 82 (b) File a description of the program on a form prescribed 83 by commission rule. The office must review the filing and 84 determine whether the shared savings incentive program complies 85 with this section. 86 (c) Notify an insured annually and at the time of renewal, 87 and an applicant for insurance at the time of enrollment, of the 88 availability of the shared savings incentive program and the 89 procedure to participate in the program. 90 (d) Publish on a webpage easily accessible to insureds and 91 to applicants for insurance a list of shoppable health care 92 services and health care providers and the shared savings 93 incentive amount applicable for each service. A shared savings 94 incentive may not be less than 25 percent of the savings 95 generated by the insured’s participation in any shared savings 96 incentive offered by the health insurer. The baseline for the 97 savings calculation is the average in-network amount paid for 98 that service in the most recent 12-month period or some other 99 methodology established by the health insurer and approved by 100 the office. 101 (e) At least quarterly, credit or deposit the shared 102 savings incentive amount to the insured’s account as a return or 103 reduction in premium, or credit the shared savings incentive 104 amount to the insured’s flexible spending account, health 105 savings account, or health reimbursement account, such that the 106 amount does not constitute income to the insured. 107 (f) Submit an annual report to the office within 90 108 business days after the close of each plan year. At a minimum, 109 the report must include the following information: 110 1. The number of insureds who participated in the program 111 during the plan year and the number of instances of 112 participation. 113 2. The total cost of services provided as a part of the 114 program. 115 3. The total value of the shared savings incentive payments 116 made to insureds participating in the program and the values 117 distributed as premium reductions, credits to flexible spending 118 accounts, credits to health savings accounts, or credits to 119 health reimbursement accounts. 120 4. An inventory of the shoppable health care services 121 offered by the health insurer. 122 (4)(a) A shared savings incentive offered by a health 123 insurer in accordance with this section: 124 1. Is not an administrative expense for rate development or 125 rate filing purposes. 126 2. Does not constitute an unfair method of competition or 127 an unfair or deceptive act or practice under s. 626.9541 and is 128 presumed to be appropriate unless credible data clearly 129 demonstrates otherwise. 130 (b) A shared saving incentive amount provided as a return 131 or reduction in premium reduces the health insurer’s direct 132 written premium by the shared saving incentive dollar amount for 133 the purposes of the taxes in ss. 624.509 and 624.5091. 134 (5) The commission may adopt rules necessary to implement 135 and enforce this section. 136 Section 2. This act shall take effect January 1, 2020.