HB 367

1
A bill to be entitled
2An act relating to health care provider contracts;
3amending s. 627.6474, F.S.; prohibiting insurers from
4requiring contracted health care practitioners to accept
5the terms of other contracts between prepaid limited
6health service organizations and providers of limited
7health care services; prohibiting contracts between health
8insurers and dentists from containing certain fee
9requirements set by the insurer under certain
10circumstances; providing a definition; providing
11application; amending s. 636.035, F.S.; prohibiting
12contracts between prepaid limited health service
13organizations and dentists from containing certain fee
14requirements set by the organization under certain
15circumstances; providing a definition; providing
16application; amending s. 641.315, F.S.; prohibiting
17contracts between health maintenance organizations and
18dentists from containing certain fee requirements set by
19the organization under certain circumstances; providing a
20definition; providing application; providing an effective
21date.
22
23Be It Enacted by the Legislature of the State of Florida:
24
25     Section 1.  Section 627.6474, Florida Statutes, is amended
26to read:
27     627.6474  Provider contracts.-
28     (1)  A health insurer may shall not require a contracted
29health care practitioner as defined in s. 456.001(4) to accept
30the terms of other health care practitioner contracts with the
31insurer or any other insurer, or health maintenance
32organization, under common management and control with the
33insurer, including Medicare and Medicaid practitioner contracts
34and those authorized by s. s. 636.035, 627.6471, s. 627.6472, or
35s. 641.315, except for a practitioner in a group practice as
36defined in s. 456.053 who must accept the terms of a contract
37negotiated for the practitioner by the group, as a condition of
38continuation or renewal of the contract. Any contract provision
39that violates this section is void. A violation of this section
40is not subject to the criminal penalty specified in s. 624.15.
41     (2)  A contract between a health insurer and a dentist
42licensed under chapter 466 for the provision of services to
43patients may not contain any provision that requires the dentist
44to provide services to the insured under such contract at a fee
45set by the health insurer unless such services are covered
46services under the applicable contract. As used in this
47subsection, the term "covered services" means services
48reimbursable under the applicable contract, subject to
49contractual limitations on benefits, such as deductibles,
50coinsurance, and copayments, as may apply. However, the term
51"covered services" does not include any dental services provided
52by a dentist to a covered person who has met or exceeded the
53annual or other periodic payment maximum established by the
54contract or services that are not listed as a benefit that the
55covered person is entitled to receive under the contract. This
56subsection applies to all contracts entered into or renewed on
57or after July 1, 2011.
58     Section 2.  Subsection (13) is added to section 636.035,
59Florida Statutes, to read:
60     636.035  Provider arrangements.-
61     (13)  A contract between a prepaid limited health service
62organization and a dentist licensed under chapter 466 for the
63provision of services to subscribers of the prepaid limited
64health service organization may not contain any provision that
65requires the dentist to provide services to subscribers of the
66prepaid limited health service organization at a fee set by the
67prepaid limited health service organization unless such services
68are covered services under the applicable contract. As used in
69this subsection, the term "covered services" means services
70reimbursable under the applicable contract, subject to
71contractual limitations on benefits, such as deductibles,
72coinsurance, and copayments, as may apply. However, the term
73"covered services" does not include any dental services provided
74by a dentist to a covered person who has met or exceeded the
75annual or other periodic payment maximum established by the
76contract or services that are not listed as a benefit that the
77covered person is entitled to receive under the contract. This
78subsection applies to all contracts entered into or renewed on
79or after July 1, 2011.
80     Section 3.  Subsection (11) is added to section 641.315,
81Florida Statutes, to read:
82     641.315  Provider contracts.-
83     (11)  A contract between a health maintenance organization
84and a dentist licensed under chapter 466 for the provision of
85services to subscribers of the health maintenance organization
86may not contain any provision that requires the dentist to
87provide services to subscribers of the health maintenance
88organization at a fee set by the health maintenance organization
89unless such services are covered services under the applicable
90contract. As used in this subsection, the term "covered
91services" means services reimbursable under the applicable
92contract, subject to contractual limitations on benefits, such
93as deductibles, coinsurance, and copayments, as may apply.
94However, the term "covered services" does not include any dental
95services provided by a dentist to a covered person who has met
96or exceeded the annual or other periodic payment maximum
97established by the contract or services that are not listed as a
98benefit that the covered person is entitled to receive under the
99contract. This subsection applies to all contracts entered into
100or renewed on or after July 1, 2011.
101     Section 4.  This act shall take effect July 1, 2011.


CODING: Words stricken are deletions; words underlined are additions.