Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1726
       
       
       
       
       
       
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                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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       Appropriations Subcommittee on Health and Human Services (Rader)
       recommended the following:
       
    1         Senate Amendment to Amendment (441796) (with title
    2  amendment)
    3  
    4         Delete lines 2314 - 2417
    5  and insert:
    6  subsection (2) and paragraphs (d) and (e) of subsection (3) of
    7  section 627.6387, Florida Statutes, are amended to read:
    8         627.6387 Shared savings incentive program.—
    9         (2) As used in this section, the term:
   10         (e) “Shoppable health care service” means a lower-cost,
   11  high-quality nonemergency health care service for which a shared
   12  savings incentive is available for insureds under a health
   13  insurer’s shared savings incentive program. Shoppable health
   14  care services may be provided within or outside this state and
   15  include, but are not limited to:
   16         1. Clinical laboratory services.
   17         2. Infusion therapy.
   18         3. Inpatient and outpatient surgical procedures.
   19         4. Obstetrical and gynecological services.
   20         5. Inpatient and outpatient nonsurgical diagnostic tests
   21  and procedures.
   22         6. Physical and occupational therapy services.
   23         7. Radiology and imaging services.
   24         8. Prescription drugs.
   25         9. Services provided through telehealth.
   26         10. Any additional services published by the Agency for
   27  Health Care Administration that have the most significant price
   28  variation pursuant to s. 408.05(3)(l).
   29         (3) A health insurer may offer a shared savings incentive
   30  program to provide incentives to an insured when the insured
   31  obtains a shoppable health care service from the health
   32  insurer’s shared savings list. An insured may not be required to
   33  participate in a shared savings incentive program. A health
   34  insurer that offers a shared savings incentive program must:
   35         (d) Publish on a webpage easily accessible to insureds and
   36  to applicants for insurance a list of shoppable health care
   37  services and health care providers and the shared savings
   38  incentive amount applicable for each service. A shared savings
   39  incentive may not be less than 50 25 percent of the savings
   40  generated by the insured’s participation in any shared savings
   41  incentive offered by the health insurer. The baseline for the
   42  savings calculation is the average in-network amount paid for
   43  that service in the most recent 12-month period or some other
   44  methodology established by the health insurer and approved by
   45  the office.
   46         (e) At least quarterly, credit or deposit the shared
   47  savings incentive amount to the insured’s account as a return or
   48  reduction in premium, or credit the shared savings incentive
   49  amount to the insured’s flexible spending account, health
   50  savings account, or health reimbursement account, or reward the
   51  insured directly with cash or a cash equivalent such that the
   52  amount does not constitute income to the insured.
   53         Section 52. Effective January 1, 2021, paragraph (e) of
   54  subsection (2) and paragraphs (d) and (e) of subsection (3) of
   55  section 627.6648, Florida Statutes, are amended to read:
   56         627.6648 Shared savings incentive program.—
   57         (2) As used in this section, the term:
   58         (e) “Shoppable health care service” means a lower-cost,
   59  high-quality nonemergency health care service for which a shared
   60  savings incentive is available for insureds under a health
   61  insurer’s shared savings incentive program. Shoppable health
   62  care services may be provided within or outside this state and
   63  include, but are not limited to:
   64         1. Clinical laboratory services.
   65         2. Infusion therapy.
   66         3. Inpatient and outpatient surgical procedures.
   67         4. Obstetrical and gynecological services.
   68         5. Inpatient and outpatient nonsurgical diagnostic tests
   69  and procedures.
   70         6. Physical and occupational therapy services.
   71         7. Radiology and imaging services.
   72         8. Prescription drugs.
   73         9. Services provided through telehealth.
   74         10. Any additional services published by the Agency for
   75  Health Care Administration that have the most significant price
   76  variation pursuant to s. 408.05(3)(l).
   77         (3) A health insurer may offer a shared savings incentive
   78  program to provide incentives to an insured when the insured
   79  obtains a shoppable health care service from the health
   80  insurer’s shared savings list. An insured may not be required to
   81  participate in a shared savings incentive program. A health
   82  insurer that offers a shared savings incentive program must:
   83         (d) Publish on a webpage easily accessible to insureds and
   84  to applicants for insurance a list of shoppable health care
   85  services and health care providers and the shared savings
   86  incentive amount applicable for each service. A shared savings
   87  incentive may not be less than 50 25 percent of the savings
   88  generated by the insured’s participation in any shared savings
   89  incentive offered by the health insurer. The baseline for the
   90  savings calculation is the average in-network amount paid for
   91  that service in the most recent 12-month period or some other
   92  methodology established by the health insurer and approved by
   93  the office.
   94         (e) At least quarterly, credit or deposit the shared
   95  savings incentive amount to the insured’s account as a return or
   96  reduction in premium, or credit the shared savings incentive
   97  amount to the insured’s flexible spending account, health
   98  savings account, or health reimbursement account, or reward the
   99  insured directly with cash or a cash equivalent such that the
  100  amount does not constitute income to the insured.
  101         Section 53. Effective January 1, 2021, paragraph (e) of
  102  subsection (2) and paragraphs (d) and (e) of subsection (3) of
  103  section 641.31076, Florida Statutes, are amended to read:
  104         641.31076 Shared savings incentive program.—
  105         (2) As used in this section, the term:
  106         (e) “Shoppable health care service” means a lower-cost,
  107  high-quality nonemergency health care service for which a shared
  108  savings incentive is available for subscribers under a health
  109  maintenance organization’s shared savings incentive program.
  110  Shoppable health care services may be provided within or outside
  111  this state and include, but are not limited to:
  112         1. Clinical laboratory services.
  113         2. Infusion therapy.
  114         3. Inpatient and outpatient surgical procedures.
  115         4. Obstetrical and gynecological services.
  116         5. Inpatient and outpatient nonsurgical diagnostic tests
  117  and procedures.
  118         6. Physical and occupational therapy services.
  119         7. Radiology and imaging services.
  120         8. Prescription drugs.
  121         9. Services provided through telehealth.
  122         10. Any additional services published by the Agency for
  123  Health Care Administration that have the most significant price
  124  variation pursuant to s. 408.05(3)(l).
  125         (3) A health maintenance organization may offer a shared
  126  savings incentive program to provide incentives to a subscriber
  127  when the subscriber obtains a shoppable health care service from
  128  the health maintenance organization’s shared savings list. A
  129  subscriber may not be required to participate in a shared
  130  savings incentive program. A health maintenance organization
  131  that offers a shared savings incentive program must:
  132         (d) Publish on a webpage easily accessible to subscribers
  133  and to applicants for coverage a list of shoppable health care
  134  services and health care providers and the shared savings
  135  incentive amount applicable for each service. A shared savings
  136  incentive may not be less than 50 25 percent of the savings
  137  generated by the subscriber’s participation in any shared
  138  savings incentive offered by the health maintenance
  139  organization. The baseline for the savings calculation is the
  140  average in-network amount paid for that service in the most
  141  recent 12-month period or some other methodology established by
  142  the health maintenance organization and approved by the office.
  143  
  144  ================= T I T L E  A M E N D M E N T ================
  145  And the title is amended as follows:
  146         Delete line 2698
  147  and insert:
  148         service”; revising the minimum amount of certain
  149         incentives health insurers and health maintenance
  150         organizations may offer insureds or subscribers;
  151         revising duties of certain health insurers