The Florida Senate

641.316  Fiscal intermediary services.--

(1)  It is the intent of the Legislature, through the adoption of this section, to ensure the financial soundness of fiscal intermediary services organizations established to develop, manage, and administer the business affairs of health care professional providers such as medical doctors, doctors of osteopathy, doctors of chiropractic, doctors of podiatric medicine, doctors of dentistry, or other health professionals regulated by the Department of Health.

(2)

(a)  The term "fiduciary" or "fiscal intermediary services" means reimbursements received or collected on behalf of health care professionals for services rendered, patient and provider accounting, financial reporting and auditing, receipts and collections management, compensation and reimbursement disbursement services, or other related fiduciary services pursuant to health care professional contracts with health maintenance organizations.

(b)  The term "fiscal intermediary services organization" means a person or entity which performs fiduciary or fiscal intermediary services to health care professionals who contract with health maintenance organizations other than a fiscal intermediary services organization owned, operated, or controlled by a hospital licensed under chapter 395, an insurer licensed under chapter 624, a third-party administrator licensed under chapter 626, a prepaid limited health organization licensed under chapter 636, a health maintenance organization licensed under this chapter, or physician group practices as defined in ¹s. 455.236(3)(f).

(3)  A fiscal intermediary services organization which is operated for the purpose of acquiring and administering provider contracts with managed care plans for professional health care services, including, but not limited to, medical, surgical, chiropractic, dental, and podiatric care, and which performs fiduciary or fiscal intermediary services shall be required to secure and maintain a fidelity bond in the minimum amount of $10 million. This requirement shall apply to all persons or entities engaged in the business of providing fiduciary or fiscal intermediary services to any contracted provider or provider panel. The fidelity bond shall provide coverage against misappropriation of funds by the fiscal intermediary or its officers, agents, or employees; must be posted with the department for the benefit of managed care plans, subscribers, and providers; and must be on a form approved by the department. The fidelity bond must be maintained and remain unimpaired as long as the fiscal intermediary services organization continues in business in this state and until the termination of its registration.

(4)  A fiscal intermediary services organization may not collect from the subscriber any payment other than the copayment or deductible specified in the subscriber agreement.

(5)  Any fiscal intermediary services organization, other than a fiscal intermediary services organization owned, operated, or controlled by a hospital licensed under chapter 395, an insurer licensed under chapter 624, a third-party administrator licensed under chapter 626, a prepaid limited health organization licensed under chapter 636, a health maintenance organization licensed under this chapter, or physician group practices as defined in ¹s. 455.236(3)(f), must register with the department and meet the requirements of this section. In order to register as a fiscal intermediary services organization, the organization must comply with ss. 641.21(1)(c) and (d) and 641.22(6). Should the department determine that the fiscal intermediary services organization does not meet the requirements of this section, the registration shall be denied. In the event that the registrant fails to maintain compliance with the provisions of this section, the department may revoke or suspend the registration. In lieu of revocation or suspension of the registration, the department may levy an administrative penalty in accordance with s. 641.25.

(6)  The department shall promulgate rules necessary to implement the provisions of this section.

History.--s. 3, ch. 97-159.

¹Note.--Redesignated as s. 455.654(3)(f) by s. 78, ch. 97-261.