HB 1629

CS

CHAMBER ACTION

1	The Committee on Health Care recommends the following:
2
3	Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to affordable health care; providing a
7	popular name; providing purpose; amending s. 381.026,
8	F.S.; requiring certain licensed facilities to provide
9	public Internet access to certain financial information;
10	amending s. 381.734, F.S.; including participation by
11	health care providers, small businesses, and health
12	insurers in the Healthy Communities, Healthy People
13	Program; requiring the Department of Health to provide
14	public Internet access to certain public health programs;
15	requiring the department to monitor and assess the
16	effectiveness of such programs; requiring a report;
17	requiring the Office of Program Policy and Government
18	Accountability to evaluate the effectiveness of such
19	programs; requiring a report; amending s. 395.1041, F.S.;
20	authorizing hospitals to develop certain emergency room
21	diversion programs; amending s. 395.301, F.S.; requiring
22	certain licensed facilities to provide public Internet
23	access to certain financial information; requiring certain
24	licensed facilities to provide prospective patients
25	certain estimates of charges for services; amending s.
26	408.061, F.S.; requiring the Agency for Health Care
27	Administration to require health care facilities, health
28	care providers, and health insurers to submit certain
29	information; requiring the agency to adopt certain rules;
30	amending s. 408.062, F.S.; requiring the agency to conduct
31	certain health care costs and access research, analyses,
32	and studies; expanding the scope of such studies to
33	include collection of pharmacy retail price data, use of
34	emergency departments, and Internet patient charge
35	information availability; requiring a report; requiring
36	the agency to conduct additional data-based studies and
37	make recommendations to the Legislature; amending s.
38	408.05, F.S.; requiring the agency to develop a plan to
39	make performance outcome and financial data available to
40	consumers for health care services comparison purposes;
41	requiring submittal of the plan to the Governor and
42	Legislature; requiring the agency to update the plan;
43	requiring the agency to make the plan available
44	electronically; providing plan requirements; amending s.
45	409.9066, F.S.; requiring the agency to provide certain
46	information relating to the Medicare prescription discount
47	program; amending s. 408.7056, F.S.; renaming the
48	Statewide Provider and Subscriber Assistance Program as
49	the Subscriber Assistance Program; revising provisions to
50	conform; expanding certain records availability
51	provisions; revising membership provisions relating to a
52	subscriber grievance hearing panel; providing hearing
53	procedures; amending s. 641.3154, F.S., to conform to the
54	renaming of the Subscriber Assistance Program; amending s.
55	641.511, F.S., to conform to the renaming of the
56	Subscriber Assistance Program; adopting and incorporating
57	by reference the Employee Retirement Income Security Act
58	of 1974, as implemented by federal regulations; amending
59	s. 641.58, F.S., to conform to the renaming of the
60	Subscriber Assistance Program; amending s. 408.909, F.S.;
61	expanding a definition of "health flex plan entity" to
62	include public-private partnerships; making a pilot health
63	flex plan program apply permanently statewide; providing
64	additional program requirements; creating s. 381.0271,
65	F.S.; providing definitions; creating the Florida Patient
66	Safety Corporation; authorizing the corporation to create
67	additional not-for-profit corporate subsidiaries for
68	certain purposes; specifying application of public records
69	and public meetings requirements; exempting the
70	corporation and subsidiaries from public procurement
71	provisions; providing purposes; providing for a board of
72	directors; providing for membership; authorizing the
73	corporation to establish certain advisory committees;
74	providing for organization of the corporation; providing
75	for meetings; providing powers and duties of the
76	corporation; requiring the corporation to collect,
77	analyze, and evaluate patient safety data and related
78	information; requiring the corporation to establish a
79	pilot project to identify and report near misses relating
80	to patient safety; requiring the corporation to develop a
81	statewide electronic medical record system; providing
82	requirements; providing for an active library of evidence-
83	based medicine and patient safety practices; requiring the
84	corporation to develop and recommend core competencies in
85	patient safety and public education programs; requiring an
86	annual report; providing report requirements; authorizing
87	the corporation to seek funding and apply for grants;
88	requiring the Office of Program Policy Analysis and
89	Government Accountability, the Department of Health, and
90	the Agency for Health Care Administration to develop
91	performance standards to evaluate the corporation;
92	amending s. 409.91255, F.S.; expanding assistance to
93	certain health centers to include community emergency room
94	diversion programs and urgent care services; amending s.
95	627.410, F.S.; requiring insurers to file certain rates
96	with the Office of Insurance Regulation; amending s.
97	627.6487, F.S.; revising a definition; creating s.
98	627.64872, F.S.; providing legislative intent; creating
99	the Florida Health Insurance Plan for certain purposes;
100	providing definitions; providing requirements for
101	operation of the plan; providing for a board of directors;
102	providing for appointment of members; providing for terms;
103	specifying service without compensation; providing for
104	travel and per diem expenses; requiring a plan of
105	operation; providing requirements; providing for powers of
106	the plan; requiring reports to the Governor and
107	Legislature; providing certain immunity from liability for
108	plan obligations; authorizing the board to provide for
109	indemnification of certain costs; requiring an annually
110	audited financial statement; providing for eligibility for
111	coverage under the plan; providing criteria; requirements,
112	and limitations; specifying certain activity as an unfair
113	trade practice; providing for a plan administrator;
114	providing criteria; providing requirements; providing term
115	limits for the plan administrator; providing duties;
116	providing for paying the administrator; providing for
117	funding mechanisms of the plan; providing for premium
118	rates for plan coverage; providing rate limitations;
119	providing for assessing certain insurers providing
120	coverage for persons under the Health Insurance
121	Portability and Accountability Act; specifying benefits
122	under the plan; providing criteria, requirements, and
123	limitations; providing for nonduplication of benefits;
124	providing for annual and maximum lifetime benefits;
125	providing for tax exempt status; providing for abolition
126	of the Florida Comprehensive Health Association upon
127	implementation of the plan; providing for enrollment in
128	the plan of persons enrolled in the association; requiring
129	insurers to pay certain assessments to the board for
130	certain purposes; providing criteria, requirements, and
131	limitations for such assessments; providing for repeal of
132	ss. 627.6488, 627.6489, 627.649, 627.6492, 627.6494,
133	627.6496, and 627.6498, F.S., relating to the Florida
134	Comprehensive Health Association, upon implementation of
135	the plan; amending s. 627.662, F.S.; providing for
136	application of certain claim payment methodologies to
137	certain types of insurance; amending s. 627.6699, F.S.;
138	revising provisions requiring small employer carriers to
139	offer certain health benefit plans; preserving a right to
140	open enrollment for certain small groups; requiring small
141	employer carriers to file and provide coverage under
142	certain high deductible plans; including high deductible
143	plans under certain required plan provisions; creating the
144	Small Employers Access Program; providing legislative
145	intent; providing definitions; providing participation
146	eligibility requirements and criteria; requiring the
147	Office of Insurance Regulation to administer the program
148	by selecting an insurer through competitive bidding;
149	providing requirements; specifying insurer qualifications;
150	providing duties of the insurer; providing a contract
151	term; providing insurer reporting requirements; providing
152	application requirements; providing for benefits under the
153	program; requiring the office to annually report to the
154	Governor and Legislature; providing for decreases in
155	inappropriate use of emergency care; providing legislative
156	intent; requiring health insurers to provide certain
157	information electronically and develop community emergency
158	department diversion programs; authorizing health insurers
159	to require higher copayments for certain uses of emergency
160	departments; amending s. 627.9175, F.S.; requiring certain
161	health insurers to annually report certain coverage
162	information to the office; providing requirements;
163	deleting certain reporting requirements; amending s.
164	636.003, F.S.; revising the definition of "prepaid limited
165	health service organization" to exclude provision of
166	discounted medical service programs; creating ss.
167	627.65626 and 627.6402, F.S.; providing for insurance
168	rebates for healthy lifestyles; providing for rebate of
169	certain premiums for participation in health wellness,
170	maintenance, or improvement programs under certain
171	circumstances; providing requirements; amending s. 641.31,
172	F.S.; authorizing health maintenance organizations
173	offering certain point-of-service riders to offer such
174	riders to certain employers for certain employees;
175	providing requirements and limitations; providing for
176	application of certain claim payment methodologies to
177	certain types of insurance; providing for rebate of
178	certain premiums for participation in health wellness,
179	maintenance, or improvement programs under certain
180	circumstances; providing requirements; amending s.
181	626.015, F.S.; defining insurance advisor; amending ss.
182	626.016, 626.342, 626.536, 626.561, 626.572, and 626.601,
183	F.S., to include application of such provisions to
184	insurance advisors; providing penalties; creating s.
185	626.593, F.S.; providing fee and commission limitations
186	for health insurance advisors; requiring a written
187	contract for compensation; providing contract
188	requirements; amending ss. 626.171, 626.191, and 626.201,
189	F.S.; clarifying certain application requirements;
190	amending s. 626.6115, F.S.; providing additional grounds
191	for adverse actions against insurance agency licensure;
192	amending ss. 624.509, 626.7845, 626.292, and 626.321,
193	F.S.; correcting cross references; preserving certain
194	rights to enrollment in certain health benefit coverage
195	for certain groups under certain circumstances; creating
196	s. 465.0244, F.S.; requiring each pharmacy to make
197	available on its Internet website a link to certain
198	performance outcome and financial data of the Agency for
199	Health Care Administration and a notice of the
200	availability of such information; amending s. 627.6499,
201	F.S.; requiring each health insurer to make available on
202	its Internet website a link to certain performance outcome
203	and financial data of the Agency for Health Care
204	Administration and a notice in policies of the
205	availability of such information; amending s. 641.54,
206	F.S.; requiring health maintenance organizations to make
207	certain insurance financial information available to
208	subscribers; requiring health maintenance organizations to
209	make available on its Internet website a link to certain
210	performance outcome and financial data of the Agency for
211	Health Care Administration and a notice in policies of the
212	availability of such information; repealing s. 408.02,
213	F.S., relating to the development, endorsement,
214	implementation, and evaluation of patient management
215	practice parameters by the Agency for Health Care
216	Administration; providing appropriations; providing an
217	effective date.
218
219	WHEREAS, according to the Kaiser Family Foundation, eight
220	out of ten uninsured Americans are workers or dependents of
221	workers and nearly eight out of ten uninsured Americans have
222	family incomes above the poverty level, and
223	WHEREAS, fifty-five percent of those who do not have
224	insurance state the reason they don't have insurance is lack of
225	affordability, and
226	WHEREAS, average health insurance premium increases for the
227	last two years have been in the range of ten to twenty percent
228	for Florida's employers, and
229	WHEREAS, an increasing number of employers are opting to
230	cease providing insurance coverage to their employees due to the
231	high cost, and
232	WHEREAS, an increasing number of employers who continue
233	providing coverage are forced to shift more premium cost to
234	their employees, thus diminishing the value of employee wage
235	increases, and
236	WHEREAS, according to studies, the rate of avoidable
237	hospitalization is fifty to seventy percent lower for the
238	insured versus the uninsured, and
239	WHEREAS, according to Florida Cancer Registry data, the
240	uninsured have a seventy percent greater chance of a late
241	diagnosis, thus decreasing the chances of a positive health
242	outcome, and
243	WHEREAS, according to the Agency for Health Care
244	Administration's 2002 financial data, uncompensated care in
245	Florida's hospitals is growing at the rate of twelve to thirteen
246	percent per year, and, at $4.3 billion in 2001, this cost, when
247	shifted to Floridians who remain insured, is not sustainable,
248	and
249	WHEREAS, the Florida Legislature, through the creation of
250	Health Flex, has already identified the need for lower cost
251	alternatives, and
252	WHEREAS, it is of vital importance and in the best
253	interests of the people of the State of Florida that the issue
254	of available, affordable health care insurance be addressed in a
255	cohesive and meaningful manner, and
256	WHEREAS, there is general recognition that the issues
257	surrounding the problem of access to affordable health insurance
258	are complicated and multifaceted, and
259	WHEREAS, on August 14, 2003, Speaker Johnnie Byrd created
260	the Select Committee on Affordable Health Care for Floridians in
261	an effort to address the issue of affordable and accessible
262	employment-based insurance, and
263	WHEREAS, the Select Committee on Affordable Health Care for
264	Floridians held public hearings with predetermined themes around
265	the state, specifically, in Orlando, Miami, Jacksonville, Tampa,
266	Pensacola, Boca Raton, and Tallahassee, from October through
267	November 2003 to effectively probe the operation of the private
268	insurance marketplace, to understand the health insurance market
269	trends, to learn from past policy initiatives, and to identify,
270	explore, and debate new ideas for change, and
271	WHEREAS, recommendations from the Select Committee on
272	Affordable Health Care were adopted on February 4, 2004, to
273	address the multifaceted issues attributed to the increase in
274	health care cost, and
275	WHEREAS, these recommendations were presented to the
276	Speaker of the House of Representatives in a final report from
277	the committee on February 18, 2004, and subsequent legislation
278	was drafted creating the "The 2004 Affordable Health Care for
279	Floridians Act," NOW, THEREFORE,
280
281	Be It Enacted by the Legislature of the State of Florida:
282
283	Section 1.  This act may be referred to by the popular name
284	"The 2004 Affordable Health Care for Floridians Act."
285	Section 2.  The purpose of this act is to address the
286	underlying cause of the double-digit increases in health
287	insurance premiums by mitigating the overall growth in health
288	care costs.
289	Section 3.  Paragraph (c) of subsection (4) of section
290	381.026, Florida Statutes, is amended to read:
291	381.026  Florida Patient's Bill of Rights and
292	Responsibilities.--
293	(4)  RIGHTS OF PATIENTS.--Each health care facility or
294	provider shall observe the following standards:
295	(c)  Financial information and disclosure.--
296	1.  A patient has the right to be given, upon request, by
297	the responsible provider, his or her designee, or a
298	representative of the health care facility full information and
299	necessary counseling on the availability of known financial
300	resources for the patient's health care.
301	2.  A health care provider or a health care facility shall,
302	upon request, disclose to each patient who is eligible for
303	Medicare, in advance of treatment, whether the health care
304	provider or the health care facility in which the patient is
305	receiving medical services accepts assignment under Medicare
306	reimbursement as payment in full for medical services and
307	treatment rendered in the health care provider's office or
308	health care facility.
309	3.  A health care provider or a health care facility shall,
310	upon request, furnish a patient, prior to provision of medical
311	services, a reasonable estimate of charges for such services.
312	Such reasonable estimate shall not preclude the health care
313	provider or health care facility from exceeding the estimate or
314	making additional charges based on changes in the patient's
315	condition or treatment needs.
316	4.  Each licensed facility not operated by the state shall
317	make available to the public on its Internet website or by other
318	electronic means information regarding cost of service. The
319	facility shall maintain on its website a description of and a
320	link to the agency's website which provides an average cost of
321	the top 50 inpatient and outpatient services provided. The
322	facility shall place a notice in the reception areas that such
323	information is available electronically and the website address.
324	The licensed facility may indicate that the pricing information
325	is based on a compilation of charges for the average patient and
326	that each patient's bill may vary from the average depending
327	upon the severity of illness and individual resources consumed.
328	The licensed facility may also indicate that the price of
329	service is negotiable for eligible patients based upon the
330	patient's ability to pay.
331	5.4.  A patient has the right to receive a copy of an
332	itemized bill upon request. A patient has a right to be given an
333	explanation of charges upon request.
334	Section 4.  Subsection (1) and paragraph (g) of subsection
335	(3) of section 381.734, Florida Statutes, are amended, and
336	subsections (4), (5), and (6) are added to said section, to
337	read:
338	381.734  Healthy Communities, Healthy People Program.--
339	(1)  The department shall develop and implement the Healthy
340	Communities, Healthy People Program, a comprehensive and
341	community-based health promotion and wellness program. The
342	program shall be designed to reduce major behavioral risk
343	factors associated with chronic diseases, including those
344	chronic diseases identified in chapter 385, by enhancing the
345	knowledge, skills, motivation, and opportunities for
346	individuals, organizations, health care providers, small
347	businesses, health insurers, and communities to develop and
348	maintain healthy lifestyles.
349	(3)  The program shall include:
350	(g)  The establishment of a comprehensive program to inform
351	the public, health care professionals, health insurers, and
352	communities about the prevalence of chronic diseases in the
353	state; known and potential risks, including social and
354	behavioral risks; and behavior changes that would reduce risks.
355	(4)  The department shall make available on its Internet
356	website, no later than October 1, 2004, and in a hard-copy
357	format upon request, a listing of age-specific, disease-
358	specific, and community-specific health promotion, preventive
359	care, and wellness programs offered and established under the
360	Healthy Communities, Healthy People Program. The website shall
361	also provide residents with information to identify behavior
362	risk factors that lead to diseases that are preventable by
363	maintaining a healthy lifestyle. The website shall allow
364	consumers to select by county or region disease-specific
365	statistical information.
366	(5)  The department shall monitor and assess the
367	effectiveness of such programs. The department shall submit a
368	status report based on this monitoring and assessment to the
369	Governor, the Speaker of the House of Representatives, the
370	President of the Senate, and the substantive committees of each
371	house of the Legislature, with the first annual report due
372	January 31, 2005.
373	(6)  The Office of Program Policy and Government
374	Accountability shall evaluate and report to the Governor, the
375	President of the Senate, and the Speaker of the House of
376	Representatives, by March 1, 2005, on the effectiveness of the
377	department's monitoring and assessment of the program's
378	effectiveness.
379	Section 5.  Subsection (7) is added to section 395.1041,
380	Florida Statutes, to read:
381	395.1041  Access to emergency services and care.--
382	(7)  EMERGENCY ROOM DIVERSION PROGRAMS.--Hospitals may
383	develop emergency room diversion programs, including, but not
384	limited to, an "Emergency Hotline" which allows patients to help
385	determine if emergency department services are appropriate or if
386	other health care settings may be more appropriate for care, and
387	a "Fast Track" program allowing nonemergency patients to be
388	treated at an alternative site. Alternative sites may include
389	health care programs funded with local tax revenue and federally
390	funded community health centers, county health departments, or
391	other nonhospital providers of health care services. The program
392	may include provisions for followup care and case management.
393	Section 6.  Subsections (7) and (8) are added to section
394	395.301, Florida Statutes, to read:
395	395.301  Itemized patient bill; form and content prescribed
396	by the agency.--
397	(7)  Each licensed facility not operated by the state shall
398	provide, prior to provision of any medical services, an estimate
399	of charges for the proposed service upon request of a
400	prospective patient who does not have insurance coverage or
401	whose insurer or health maintenance organization does not have a
402	contract with the hospital and an emergency medical condition
403	does not exist or the service is not a covered service. The
404	estimate may be the average charges for that diagnosis-related
405	group or the average charges for that procedure. Such estimate
406	shall not preclude the actual charges from exceeding the
407	estimate. The facility shall place a notice in reception areas
408	that such information is available electronically and the
409	website address.
410	(8)  Each licensed facility shall make available on its
411	Internet website a link to the performance outcome and financial
412	data that is published by the Agency for Health Care
413	Administration pursuant to s. 408.05(3)(l).
414	Section 7.  Subsection (1) of section 408.061, Florida
415	Statutes, is amended to read:
416	408.061  Data collection; uniform systems of financial
417	reporting; information relating to physician charges;
418	confidential information; immunity.--
419	(1)  The agency shall may require the submission by health
420	care facilities, health care providers, and health insurers of
421	data necessary to carry out the agency's duties. Specifications
422	for data to be collected under this section shall be developed
423	by the agency with the assistance of technical advisory panels
424	including representatives of affected entities, consumers,
425	purchasers, and such other interested parties as may be
426	determined by the agency.
427	(a)  Data to be submitted by health care facilities,
428	including the facilities as defined in chapter 395, shall may
429	include, but are not limited to: case-mix data, patient
430	admission and or discharge data, outpatient data which shall
431	include the number of patients treated in the emergency
432	department of a licensed hospital reported by patient acuity
433	level, data on hospital-acquired infections including date of
434	diagnosis as specified by rule, data on complications including
435	date of diagnosis as specified by rule, data on readmissions as
436	specified by rule, with patient and provider-specific
437	identifiers included, actual charge data by diagnostic groups,
438	financial data, accounting data, operating expenses, expenses
439	incurred for rendering services to patients who cannot or do not
440	pay, interest charges, depreciation expenses based on the
441	expected useful life of the property and equipment involved, and
442	demographic data. The agency shall adopt rules for a risk and
443	morbidity adjustment methodology for all data submitted as
444	required by this section. Such methodology may be a nationally
445	recognized formula published by the Agency for Healthcare
446	Research and Quality of the United States Department of Health
447	and Human Services or any other nationally recognized
448	organization. Data may be obtained from documents such as, but
449	not limited to: leases, contracts, debt instruments, itemized
450	patient bills, medical record abstracts, and related diagnostic
451	information. Reported data elements shall be reported
452	electronically in accordance with Rule 59E-7.012, Florida
453	Administrative Code.
454	(b)  Data to be submitted by health care providers may
455	include, but are not limited to: Medicare and Medicaid
456	participation, types of services offered to patients, amount of
457	revenue and expenses of the health care provider, and such other
458	data which are reasonably necessary to study utilization
459	patterns.
460	(c)  Data to be submitted by health insurers may include
461	percentage of claims denied, percentage of claims meeting prompt
462	pay requirements, and medical and administrative loss ratios,
463	but are not limited to: claims, premium, administration, and
464	financial information.
465	(d)  Data required to be submitted by health care
466	facilities, health care providers, or health insurers shall not
467	include specific provider contract reimbursement information.
468	However, such specific provider reimbursement data shall be
469	reasonably available for onsite inspection by the agency as is
470	necessary to carry out the agency's regulatory duties. Any such
471	data obtained by the agency as a result of onsite inspections
472	may not be used by the state for purposes of direct provider
473	contracting and are confidential and exempt from the provisions
474	of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
475	(e)  A requirement to submit data shall be adopted by rule
476	if the submission of data is being required of all members of
477	any type of health care facility, health care provider, or
478	health insurer. Rules are not required, however, for the
479	submission of data for a special study mandated by the
480	Legislature or when information is being requested for a single
481	health care facility, health care provider, or health insurer.
482	Section 8.  Subsections (1) and (4) of section 408.062,
483	Florida Statutes, are amended to read:
484	408.062  Research, analyses, studies, and reports.--
485	(1)  The agency shall have the authority to conduct
486	research, analyses, and studies relating to health care costs
487	and access to and quality of health care services as access and
488	quality are affected by changes in health care costs. Such
489	research, analyses, and studies shall include, but not be
490	limited to, research and analysis relating to:
491	(a)  The financial status of any health care facility or
492	facilities subject to the provisions of this chapter.
493	(b)  The impact of uncompensated charity care on health
494	care facilities and health care providers.
495	(c)  The state's role in assisting to fund indigent care.
496	(d)  In conjunction with the Office of Insurance
497	Regulation, the availability and affordability of health
498	insurance for small businesses.
499	(e)  Total health care expenditures in the state according
500	to the sources of payment and the type of expenditure.
501	(f)  The quality of health services, using techniques such
502	as small area analysis, severity adjustments, and risk-adjusted
503	mortality rates.
504	(g)  The development of physician payment systems which are
505	capable of taking into account the amount of resources consumed
506	and the outcomes produced in the delivery of care.
507	(h)  The collection of a statistically valid sample of data
508	on the retail prices charged by pharmacies for the 50 most
509	frequently prescribed medicines from any pharmacy licensed by
510	this state as a special study authorized by the Legislature to
511	be performed by the agency quarterly. If the drug is available
512	generically, price data shall be reported for the generic drug
513	and price data of a brand-named drug for which the generic drug
514	is the equivalent shall be reported. The data collected shall be
515	reported for each drug by pharmacy and by metropolitan
516	statistical area or region and updated quarterly The impact of
517	subacute admissions on hospital revenues and expenses for
518	purposes of calculating adjusted admissions as defined in s.
519	408.07.
520	(i)  The use of emergency department services by patient
521	acuity level and the implication of increasing hospital cost by
522	providing nonurgent care in emergency departments. The agency
523	shall submit an annual report based on this monitoring and
524	assessment to the Governor, the Speaker of the House of
525	Representatives, the President of the Senate, and the
526	substantive legislative committees with the first report due
527	January 1, 2006.
528	(j)  The making available on its Internet website no later
529	than October 1, 2004, and in a hard-copy format upon request, of
530	patient charge, volumes, length of stay, and performance outcome
531	indicators collected from health care facilities pursuant to s.
532	408.061(1)(a) for specific medical conditions, surgeries, and
533	procedures provided in inpatient and outpatient facilities as
534	determined by the agency. In making the determination of
535	specific medical conditions, surgeries, and procedures to
536	include, the agency shall consider such factors as volume,
537	severity of the illness, urgency of admission, individual and
538	societal costs, and whether the condition is acute or chronic.
539	Performance outcome indicators shall be risk adjusted. The
540	website shall also provide an interactive search that allows
541	consumers to view and compare the information for specific
542	facilities, a map that allows consumers to select a county or
543	region, definitions of all of the data, descriptions of each
544	procedure, and an explanation about why the data may differ from
545	facility to facility. Such public data shall be updated
546	quarterly. The agency shall submit an annual status report on
547	the collection of data and publication of performance outcome
548	indicators to the Governor, the Speaker of the House of
549	Representatives, the President of the Senate, and the
550	substantive legislative committees with the first status report
551	due January 1, 2005.
552	(4)(a)  The agency shall may conduct data-based studies and
553	evaluations and make recommendations to the Legislature and the
554	Governor concerning exemptions, the effectiveness of limitations
555	of referrals, restrictions on investment interests and
556	compensation arrangements, and the effectiveness of public
557	disclosure. Such analysis shall may include, but need not be
558	limited to, utilization of services, cost of care, quality of
559	care, and access to care. The agency may require the submission
560	of data necessary to carry out this duty, which may include, but
561	need not be limited to, data concerning ownership, Medicare and
562	Medicaid, charity care, types of services offered to patients,
563	revenues and expenses, patient-encounter data, and other data
564	reasonably necessary to study utilization patterns and the
565	impact of health care provider ownership interests in health-
566	care-related entities on the cost, quality, and accessibility of
567	health care.
568	(b)  The agency may collect such data from any health
569	facility or licensed health care provider as a special study.
570	Section 9.  Paragraph (l) is added to subsection (3) of
571	section 408.05, Florida Statutes, to read:
572	408.05  State Center for Health Statistics.--
573	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
574	produce comparable and uniform health information and
575	statistics, the agency shall perform the following functions:
576	(l)  Develop, in conjunction with the State Comprehensive
577	Health Information System Advisory Council, and implement a
578	long-range plan for making available performance, including, at
579	a minimum, pharmaceuticals, physicians, health care facilities,
580	and health plans and managed care entities. The agency shall
581	submit the initial plan to the Governor, the President of the
582	Senate, and the Speaker of the House of Representatives by March
583	1, 2005, and shall update the plan and report on the status of
584	its implementation annually thereafter. The agency shall also
585	make the plan and status report available to the public on its
586	Internet website. As part of the plan, the agency shall identify
587	the process and timeframes for implementation, any barriers to
588	implementation, and recommendations of changes in the law that
589	may be enacted by the Legislature to eliminate the barriers. As
590	preliminary elements of the plan, the agency shall:
591	1.  Make available performance outcome and patient charge
592	data collected from health care facilities pursuant to s.
593	408.061(1)(a) and (2). The agency shall determine which
594	conditions and procedures, performance outcomes, and patient
595	charge data to disclose based upon input from the council. When
596	determining which conditions and procedures are to be disclosed,
597	the council and the agency shall consider variation in costs,
598	variation in outcomes, and magnitude of variations and other
599	relevant information. When determining which performance
600	outcomes to disclose, the agency:
601	a.  Shall consider such factors as volume of cases; average
602	patient charges; average length of stay; complication rates;
603	mortality rates; and infection rates, among others, which shall
604	be adjusted for case mix and severity, if applicable.
605	b.  May consider such additional measures that are adopted
606	by the Centers for Medicare and Medicaid Studies, National
607	Quality Forum, the Joint Commission on Accreditation of
608	Healthcare Organizations, the Agency for Healthcare Research and
609	Quality, or a similar national entity that establishes standards
610	to measure the performance of health care providers, or by other
611	states.
612
613	When determining which patient charge data to disclose, the
614	agency shall consider such measures as average charge, average
615	net revenue per adjusted patient day, average cost per adjusted
616	patient day, and average cost per admission, among others.
617	2.  Make available performance measures, benefit design,
618	and premium cost data from health plans licensed pursuant to
619	chapter 627 or chapter 641. The agency shall determine which
620	performance outcome and member and subscriber cost data to
621	disclose, based upon input from the council. When determining
622	which data to disclose, the agency shall consider information
623	that may be required by either individual or group purchasers to
624	assess the value of the product, which may include membership
625	satisfaction, quality of care, current enrollment or membership,
626	coverage areas, accreditation status, premium costs, plan costs,
627	premium increases, range of benefits, copayments and
628	deductibles, accuracy and speed of claims payment, credentials
629	of physicians, number of providers, names of network providers,
630	and hospitals in the network.
631	3.  Determine the method and format for public disclosure
632	of data reported pursuant to this paragraph. The agency shall
633	make its determination based upon input from the Comprehensive
634	Health Information System Advisory Council. At a minimum, the
635	data shall be made available on the agency's Internet website in
636	a manner that allows consumers to conduct an interactive search
637	that allows them to view and compare the information for
638	specific providers. The website must include such additional
639	information as is determined necessary to ensure that the
640	website enhances informed decision making among consumers and
641	health care purchasers, which shall include, at a minimum,
642	appropriate guidance on how to use the data and an explanation
643	of why the data may vary from provider to provider. The data
644	specified in subparagraphs 1. and 2. shall be released no later
645	than March 1, 2005.
646	Section 10.  Subsection (3) of section 409.9066, Florida
647	Statutes, is amended to read:
648	409.9066  Medicare prescription discount program.--
649	(3)  The Agency for Health Care Administration shall
650	publish, on a free website available to the public, the most
651	recent average wholesale prices for the 200 drugs most
652	frequently dispensed to the elderly and, to the extent possible,
653	shall provide a mechanism that consumers may use to calculate
654	the retail price and the price that should be paid after the
655	discount required in subsection (1) is applied. The agency shall
656	provide retail information by geographic area and retail
657	information by provider within geographical areas.
658	Section 11.  Section 408.7056, Florida Statutes, is amended
659	to read:
660	408.7056  Statewide Provider and Subscriber Assistance
661	Program.--
662	(1)  As used in this section, the term:
663	(a)  "Agency" means the Agency for Health Care
664	Administration.
665	(b)  "Department" means the Department of Financial
666	Services.
667	(c)  "Grievance procedure" means an established set of
668	rules that specify a process for appeal of an organizational
669	decision.
670	(d)  "Health care provider" or "provider" means a state-
671	licensed or state-authorized facility, a facility principally
672	supported by a local government or by funds from a charitable
673	organization that holds a current exemption from federal income
674	tax under s. 501(c)(3) of the Internal Revenue Code, a licensed
675	practitioner, a county health department established under part
676	I of chapter 154, a prescribed pediatric extended care center
677	defined in s. 400.902, a federally supported primary care
678	program such as a migrant health center or a community health
679	center authorized under s. 329 or s. 330 of the United States
680	Public Health Services Act that delivers health care services to
681	individuals, or a community facility that receives funds from
682	the state under the Community Alcohol, Drug Abuse, and Mental
683	Health Services Act and provides mental health services to
684	individuals.
685	(e)  "Managed care entity" means a health maintenance
686	organization or a prepaid health clinic certified under chapter
687	641, a prepaid health plan authorized under s. 409.912, or an
688	exclusive provider organization certified under s. 627.6472.
689	(f)  "Office" means the Office of Insurance Regulation of
690	the Financial Services Commission.
691	(g)  "Panel" means a statewide provider and subscriber
692	assistance panel selected as provided in subsection (11).
693	(2)  The agency shall adopt and implement a program to
694	provide assistance to subscribers and providers, including those
695	whose grievances are not resolved by the managed care entity to
696	the satisfaction of the subscriber or provider. The program
697	shall consist of one or more panels that meet as often as
698	necessary to timely review, consider, and hear grievances and
699	recommend to the agency or the office any actions that should be
700	taken concerning individual cases heard by the panel. The panel
701	shall hear every grievance filed by subscribers and providers on
702	behalf of subscribers, unless the grievance:
703	(a)  Relates to a managed care entity's refusal to accept a
704	provider into its network of providers;
705	(b)  Is part of an internal grievance in a Medicare managed
706	care entity or a reconsideration appeal through the Medicare
707	appeals process which does not involve a quality of care issue;
708	(c)  Is related to a health plan not regulated by the state
709	such as an administrative services organization, third-party
710	administrator, or federal employee health benefit program;
711	(d)  Is related to appeals by in-plan suppliers and
712	providers, unless related to quality of care provided by the
713	plan;
714	(e)  Is part of a Medicaid fair hearing pursued under 42
715	C.F.R. ss. 431.220 et seq.;
716	(f)  Is the basis for an action pending in state or federal
717	court;
718	(g)  Is related to an appeal by nonparticipating providers,
719	unless related to the quality of care provided to a subscriber
720	by the managed care entity and the provider is involved in the
721	care provided to the subscriber;
722	(h)  Was filed before the subscriber or provider completed
723	the entire internal grievance procedure of the managed care
724	entity, the managed care entity has complied with its timeframes
725	for completing the internal grievance procedure, and the
726	circumstances described in subsection (6) do not apply;
727	(i)  Has been resolved to the satisfaction of the
728	subscriber or provider who filed the grievance, unless the
729	managed care entity's initial action is egregious or may be
730	indicative of a pattern of inappropriate behavior;
731	(j)  Is limited to seeking damages for pain and suffering,
732	lost wages, or other incidental expenses, including accrued
733	interest on unpaid balances, court costs, and transportation
734	costs associated with a grievance procedure;
735	(k)  Is limited to issues involving conduct of a health
736	care provider or facility, staff member, or employee of a
737	managed care entity which constitute grounds for disciplinary
738	action by the appropriate professional licensing board and is
739	not indicative of a pattern of inappropriate behavior, and the
740	agency, office, or department has reported these grievances to
741	the appropriate professional licensing board or to the health
742	facility regulation section of the agency for possible
743	investigation; or
744	(l)  Is withdrawn by the subscriber or provider. Failure of
745	the subscriber or the provider to attend the hearing shall be
746	considered a withdrawal of the grievance.
747	(3)  The agency shall review all grievances within 60 days
748	after receipt and make a determination whether the grievance
749	shall be heard. Once the agency notifies the panel, the
750	subscriber or provider, and the managed care entity that a
751	grievance will be heard by the panel, the panel shall hear the
752	grievance either in the network area or by teleconference no
753	later than 120 days after the date the grievance was filed. The
754	agency shall notify the parties, in writing, by facsimile
755	transmission, or by phone, of the time and place of the hearing.
756	The panel may take testimony under oath, request certified
757	copies of documents, and take similar actions to collect
758	information and documentation that will assist the panel in
759	making findings of fact and a recommendation. The panel shall
760	issue a written recommendation, supported by findings of fact,
761	to the provider or subscriber, to the managed care entity, and
762	to the agency or the office no later than 15 working days after
763	hearing the grievance. If at the hearing the panel requests
764	additional documentation or additional records, the time for
765	issuing a recommendation is tolled until the information or
766	documentation requested has been provided to the panel. The
767	proceedings of the panel are not subject to chapter 120.
768	(4)  If, upon receiving a proper patient authorization
769	along with a properly filed grievance, the agency requests
770	medical records from a health care provider or managed care
771	entity, the health care provider or managed care entity that has
772	custody of the records has 10 days to provide the records to the
773	agency. Records include medical records, communication logs
774	associated with the grievance both to and from the subscriber,
775	contracts, and any other contents of the internal grievance file
776	associated with the complaint filed with the Subscriber
777	Assistance Program. Failure to provide requested medical records
778	may result in the imposition of a fine of up to $500. Each day
779	that records are not produced is considered a separate
780	violation.
781	(5)  Grievances that the agency determines pose an
782	immediate and serious threat to a subscriber's health must be
783	given priority over other grievances. The panel may meet at the
784	call of the chair to hear the grievances as quickly as possible
785	but no later than 45 days after the date the grievance is filed,
786	unless the panel receives a waiver of the time requirement from
787	the subscriber. The panel shall issue a written recommendation,
788	supported by findings of fact, to the office or the agency
789	within 10 days after hearing the expedited grievance.
790	(6)  When the agency determines that the life of a
791	subscriber is in imminent and emergent jeopardy, the chair of
792	the panel may convene an emergency hearing, within 24 hours
793	after notification to the managed care entity and to the
794	subscriber, to hear the grievance. The grievance must be heard
795	notwithstanding that the subscriber has not completed the
796	internal grievance procedure of the managed care entity. The
797	panel shall, upon hearing the grievance, issue a written
798	emergency recommendation, supported by findings of fact, to the
799	managed care entity, to the subscriber, and to the agency or the
800	office for the purpose of deferring the imminent and emergent
801	jeopardy to the subscriber's life. Within 24 hours after receipt
802	of the panel's emergency recommendation, the agency or office
803	may issue an emergency order to the managed care entity. An
804	emergency order remains in force until:
805	(a)  The grievance has been resolved by the managed care
806	entity;
807	(b)  Medical intervention is no longer necessary; or
808	(c)  The panel has conducted a full hearing under
809	subsection (3) and issued a recommendation to the agency or the
810	office, and the agency or office has issued a final order.
811	(7)  After hearing a grievance, the panel shall make a
812	recommendation to the agency or the office which may include
813	specific actions the managed care entity must take to comply
814	with state laws or rules regulating managed care entities.
815	(8)  A managed care entity, subscriber, or provider that is
816	affected by a panel recommendation may within 10 days after
817	receipt of the panel's recommendation, or 72 hours after receipt
818	of a recommendation in an expedited grievance, furnish to the
819	agency or office written evidence in opposition to the
820	recommendation or findings of fact of the panel.
821	(9)  No later than 30 days after the issuance of the
822	panel's recommendation and, for an expedited grievance, no later
823	than 10 days after the issuance of the panel's recommendation,
824	the agency or the office may adopt the panel's recommendation or
825	findings of fact in a proposed order or an emergency order, as
826	provided in chapter 120, which it shall issue to the managed
827	care entity. The agency or office may issue a proposed order or
828	an emergency order, as provided in chapter 120, imposing fines
829	or sanctions, including those contained in ss. 641.25 and
830	641.52. The agency or the office may reject all or part of the
831	panel's recommendation. All fines collected under this
832	subsection must be deposited into the Health Care Trust Fund.
833	(10)  In determining any fine or sanction to be imposed,
834	the agency and the office may consider the following factors:
835	(a)  The severity of the noncompliance, including the
836	probability that death or serious harm to the health or safety
837	of the subscriber will result or has resulted, the severity of
838	the actual or potential harm, and the extent to which provisions
839	of chapter 641 were violated.
840	(b)  Actions taken by the managed care entity to resolve or
841	remedy any quality-of-care grievance.
842	(c)  Any previous incidents of noncompliance by the managed
843	care entity.
844	(d)  Any other relevant factors the agency or office
845	considers appropriate in a particular grievance.
846	(11)(a)  The panel shall consist of the Insurance Consumer
847	Advocate, or designee thereof, established by s. 627.0613; at
848	least two members employed by the agency and at least two
849	members employed by the department, chosen by their respective
850	agencies; a consumer appointed by the Governor; a physician
851	appointed by the Governor, as a standing member; and, if
852	necessary, physicians who have expertise relevant to the case to
853	be heard, on a rotating basis. The agency may contract with a
854	medical director, and a primary care physician, or both, who
855	shall provide additional technical expertise to the panel but
856	shall not be voting members of the panel. The medical director
857	shall be selected from a health maintenance organization with a
858	current certificate of authority to operate in Florida.
859	(b)  A majority of those panel members required under
860	paragraph (a) shall constitute a quorum for any meeting or
861	hearing of the panel. A grievance may not be heard or voted upon
862	at any panel meeting or hearing unless a quorum is present,
863	except that a minority of the panel may adjourn a meeting or
864	hearing until a quorum is present. A panel convened for the
865	purpose of hearing a subscriber's grievance in accordance with
866	subsections (2) and (3) shall not consist of more than 11
867	members.
868	(12)  Every managed care entity shall submit a quarterly
869	report to the agency, the office, and the department listing the
870	number and the nature of all subscribers' and providers'
871	grievances which have not been resolved to the satisfaction of
872	the subscriber or provider after the subscriber or provider
873	follows the entire internal grievance procedure of the managed
874	care entity. The agency shall notify all subscribers and
875	providers included in the quarterly reports of their right to
876	file an unresolved grievance with the panel.
877	(13)  A proposed order issued by the agency or office which
878	only requires the managed care entity to take a specific action
879	under subsection (7) is subject to a summary hearing in
880	accordance with s. 120.574, unless all of the parties agree
881	otherwise. If the managed care entity does not prevail at the
882	hearing, the managed care entity must pay reasonable costs and
883	attorney's fees of the agency or the office incurred in that
884	proceeding.
885	(14)(a)  Any information that identifies a subscriber which
886	is held by the panel, agency, or department pursuant to this
887	section is confidential and exempt from the provisions of s.
888	119.07(1) and s. 24(a), Art. I of the State Constitution.
889	However, at the request of a subscriber or managed care entity
890	involved in a grievance procedure, the panel, agency, or
891	department shall release information identifying the subscriber
892	involved in the grievance procedure to the requesting subscriber
893	or managed care entity.
894	(b)  Meetings of the panel shall be open to the public
895	unless the provider or subscriber whose grievance will be heard
896	requests a closed meeting or the agency or the department
897	determines that information which discloses the subscriber's
898	medical treatment or history or information relating to internal
899	risk management programs as defined in s. 641.55(5)(c), (6), and
900	(8) may be revealed at the panel meeting, in which case that
901	portion of the meeting during which a subscriber's medical
902	treatment or history or internal risk management program
903	information is discussed shall be exempt from the provisions of
904	s. 286.011 and s. 24(b), Art. I of the State Constitution. All
905	closed meetings shall be recorded by a certified court reporter.
906	Section 12.  Paragraph (c) of subsection (4) of section
907	641.3154, Florida Statutes, is amended to read:
908	641.3154  Organization liability; provider billing
909	prohibited.--
910	(4)  A provider or any representative of a provider,
911	regardless of whether the provider is under contract with the
912	health maintenance organization, may not collect or attempt to
913	collect money from, maintain any action at law against, or
914	report to a credit agency a subscriber of an organization for
915	payment of services for which the organization is liable, if the
916	provider in good faith knows or should know that the
917	organization is liable. This prohibition applies during the
918	pendency of any claim for payment made by the provider to the
919	organization for payment of the services and any legal
920	proceedings or dispute resolution process to determine whether
921	the organization is liable for the services if the provider is
922	informed that such proceedings are taking place. It is presumed
923	that a provider does not know and should not know that an
924	organization is liable unless:
925	(c)  The office or agency makes a final determination that
926	the organization is required to pay for such services subsequent
927	to a recommendation made by the Statewide Provider and
928	Subscriber Assistance Panel pursuant to s. 408.7056; or
929	Section 13.  Subsection (1), paragraphs (b) and (e) of
930	subsection (3), paragraph (d) of subsection (4), subsection (5),
931	paragraph (g) of subsection (6), and subsections  (9), (10), and
932	(11) of section 641.511, Florida Statutes, are amended to read:
933	641.511  Subscriber grievance reporting and resolution
934	requirements.--
935	(1)  Every organization must have a grievance procedure
936	available to its subscribers for the purpose of addressing
937	complaints and grievances. Every organization must notify its
938	subscribers that a subscriber must submit a grievance within 1
939	year after the date of occurrence of the action that initiated
940	the grievance, and may submit the grievance for review to the
941	Statewide Provider and Subscriber Assistance Program panel as
942	provided in s. 408.7056 after receiving a final disposition of
943	the grievance through the organization's grievance process. An
944	organization shall maintain records of all grievances and shall
945	report annually to the agency the total number of grievances
946	handled, a categorization of the cases underlying the
947	grievances, and the final disposition of the grievances.
948	(3)  Each organization's grievance procedure, as required
949	under subsection (1), must include, at a minimum:
950	(b)  The names of the appropriate employees or a list of
951	grievance departments that are responsible for implementing the
952	organization's grievance procedure. The list must include the
953	address and the toll-free telephone number of each grievance
954	department, the address of the agency and its toll-free
955	telephone hotline number, and the address of the Statewide
956	Provider and Subscriber Assistance Program and its toll-free
957	telephone number.
958	(e)  A notice that a subscriber may voluntarily pursue
959	binding arbitration in accordance with the terms of the contract
960	if offered by the organization, after completing the
961	organization's grievance procedure and as an alternative to the
962	Statewide Provider and Subscriber Assistance Program. Such
963	notice shall include an explanation that the subscriber may
964	incur some costs if the subscriber pursues binding arbitration,
965	depending upon the terms of the subscriber's contract.
966	(4)
967	(d)  In any case when the review process does not resolve a
968	difference of opinion between the organization and the
969	subscriber or the provider acting on behalf of the subscriber,
970	the subscriber or the provider acting on behalf of the
971	subscriber may submit a written grievance to the Statewide
972	Provider and Subscriber Assistance Program.
973	(5)  Except as provided in subsection (6), the organization
974	shall resolve a grievance within 60 days after receipt of the
975	grievance, or within a maximum of 90 days if the grievance
976	involves the collection of information outside the service area.
977	These time limitations are tolled if the organization has
978	notified the subscriber, in writing, that additional information
979	is required for proper review of the grievance and that such
980	time limitations are tolled until such information is provided.
981	After the organization receives the requested information, the
982	time allowed for completion of the grievance process resumes.
983	The Employee Retirement Income Security Act of 1974, as
984	implemented by 29 C.F.R. 2560.503-1, is adopted and incorporated
985	by reference as applicable to all organizations that administer
986	small and large group health plans that are subject to 29 C.F.R.
987	2560.503-1. The claims procedures of the regulations of the
988	Employee Retirement Income Security Act of 1974 as implemented
989	by 29 C.F.R. 2560.503-1 shall be the minimum standards for
990	grievance processes for claims for benefits for small and large
991	group health plans that are subject to 29 C.F.R. 2560.503-1.
992	(6)
993	(g)  In any case when the expedited review process does not
994	resolve a difference of opinion between the organization and the
995	subscriber or the provider acting on behalf of the subscriber,
996	the subscriber or the provider acting on behalf of the
997	subscriber may submit a written grievance to the Statewide
998	Provider and Subscriber Assistance Program.
999	(9)(a)  The agency shall advise subscribers with grievances
1000	to follow their organization's formal grievance process for
1001	resolution prior to review by the Statewide Provider and
1002	Subscriber Assistance Program. The subscriber may, however,
1003	submit a copy of the grievance to the agency at any time during
1004	the process.
1005	(b)  Requiring completion of the organization's grievance
1006	process before the Statewide Provider and Subscriber Assistance
1007	Program panel's review does not preclude the agency from
1008	investigating any complaint or grievance before the organization
1009	makes its final determination.
1010	(10)  Each organization must notify the subscriber in a
1011	final decision letter that the subscriber may request review of
1012	the organization's decision concerning the grievance by the
1013	Statewide Provider and Subscriber Assistance Program, as
1014	provided in s. 408.7056, if the grievance is not resolved to the
1015	satisfaction of the subscriber. The final decision letter must
1016	inform the subscriber that the request for review must be made
1017	within 365 days after receipt of the final decision letter, must
1018	explain how to initiate such a review, and must include the
1019	addresses and toll-free telephone numbers of the agency and the
1020	Statewide Provider and Subscriber Assistance Program.
1021	(11)  Each organization, as part of its contract with any
1022	provider, must require the provider to post a consumer
1023	assistance notice prominently displayed in the reception area of
1024	the provider and clearly noticeable by all patients. The
1025	consumer assistance notice must state the addresses and toll-
1026	free telephone numbers of the Agency for Health Care
1027	Administration, the Statewide Provider and Subscriber Assistance
1028	Program, and the Department of Financial Services. The consumer
1029	assistance notice must also clearly state that the address and
1030	toll-free telephone number of the organization's grievance
1031	department shall be provided upon request. The agency may adopt
1032	rules to implement this section.
1033	Section 14.  Subsection (4) of section 641.58, Florida
1034	Statutes, is amended to read:
1035	641.58  Regulatory assessment; levy and amount; use of
1036	funds; tax returns; penalty for failure to pay.--
1037	(4)  The moneys received and deposited into the Health Care
1038	Trust Fund shall be used to defray the expenses of the agency in
1039	the discharge of its administrative and regulatory powers and
1040	duties under this part, including conducting an annual survey of
1041	the satisfaction of members of health maintenance organizations;
1042	contracting with physician consultants for the Statewide
1043	Provider and Subscriber Assistance Panel; maintaining offices
1044	and necessary supplies, essential equipment, and other
1045	materials, salaries and expenses of required personnel; and
1046	discharging the administrative and regulatory powers and duties
1047	imposed under this part.
1048	Section 15.  Paragraph (f) of subsection (2) and
1049	subsections (3) and (9) of section 408.909, Florida Statutes,
1050	are amended to read:
1051	408.909  Health flex plans.--
1052	(2)  DEFINITIONS.--As used in this section, the term:
1053	(f)  "Health flex plan entity" means a health insurer,
1054	health maintenance organization, health-care-provider-sponsored
1055	organization, local government, health care district, or other
1056	public or private community-based organization, or public-
1057	private partnership that develops and implements an approved
1058	health flex plan and is responsible for administering the health
1059	flex plan and paying all claims for health flex plan coverage by
1060	enrollees of the health flex plan.
1061	(3)  PILOT PROGRAM.--The agency and the office shall each
1062	approve or disapprove health flex plans that provide health care
1063	coverage for eligible participants who reside in the three areas
1064	of the state that have the highest number of uninsured persons,
1065	as identified in the Florida Health Insurance Study conducted by
1066	the agency and in Indian River County. A health flex plan may
1067	limit or exclude benefits otherwise required by law for insurers
1068	offering coverage in this state, may cap the total amount of
1069	claims paid per year per enrollee, may limit the number of
1070	enrollees, or may take any combination of those actions. A
1071	health flex plan offering may include the option of a
1072	catastrophic plan supplementing the health flex plan.
1073	(a)  The agency shall develop guidelines for the review of
1074	applications for health flex plans and shall disapprove or
1075	withdraw approval of plans that do not meet or no longer meet
1076	minimum standards for quality of care and access to care. The
1077	agency shall ensure that the health flex plans follow
1078	standardized grievance procedures similar to those required of
1079	health maintenance organizations.
1080	(b)  The office shall develop guidelines for the review of
1081	health flex plan applications and provide regulatory oversight
1082	of health flex plan advertisement and marketing procedures. The
1083	office shall disapprove or shall withdraw approval of plans
1084	that:
1085	1.  Contain any ambiguous, inconsistent, or misleading
1086	provisions or any exceptions or conditions that deceptively
1087	affect or limit the benefits purported to be assumed in the
1088	general coverage provided by the health flex plan;
1089	2.  Provide benefits that are unreasonable in relation to
1090	the premium charged or contain provisions that are unfair or
1091	inequitable or contrary to the public policy of this state, that
1092	encourage misrepresentation, or that result in unfair
1093	discrimination in sales practices; or
1094	3.  Cannot demonstrate that the health flex plan is
1095	financially sound and that the applicant is able to underwrite
1096	or finance the health care coverage provided.
1097	(c)  The agency and the Financial Services Commission may
1098	adopt rules as needed to administer this section.
1099	(9)  PROGRAM EVALUATION.--The agency and the office shall
1100	evaluate the pilot program and its effect on the entities that
1101	seek approval as health flex plans, on the number of enrollees,
1102	and on the scope of the health care coverage offered under a
1103	health flex plan; shall provide an assessment of the health flex
1104	plans and their potential applicability in other settings; shall
1105	use health flex plans to gather more information to evaluate
1106	low-income consumer driven benefit packages; and shall, by
1107	January 1, 2005 2004, jointly submit a report to the Governor,
1108	the President of the Senate, and the Speaker of the House of
1109	Representatives.
1110	Section 16.  Section 381.0271, Florida Statutes, is created
1111	to read:
1112	381.0271  Florida Patient Safety Corporation.--
1113	(1)  DEFINITIONS.--As used in this section, the term:
1114	(a)  "Adverse incident" has the same meanings provided in
1115	ss. 395.0197, 458.351, and 459.026.
1116	(b)  "Corporation" means the Florida Patient Safety
1117	Corporation.
1118	(c)  "Patient safety data" has the same meaning provided in
1119	s. 766.1016.
1120	(2)  CREATION.--
1121	(a)  The Florida Patient Safety Corporation is created as a
1122	not-for-profit corporation and shall be registered,
1123	incorporated, organized, and operated in compliance with chapter
1124	617. The corporation may create not-for-profit corporate
1125	subsidiaries that are organized under the provisions of chapter
1126	617, upon the prior approval of the board of directors, as
1127	necessary, to fulfill its mission.
1128	(b)  The corporation and any authorized and approved
1129	subsidiary are not an agency as defined in s. 20.03(11).
1130	(c)  The corporation and any authorized and approved
1131	subsidiary are subject to the public meetings and records
1132	requirements of s. 24, Art. I of the State Constitution, chapter
1133	119, and s. 286.011.
1134	(d)  The corporation and any authorized and approved
1135	subsidiary are not subject to the provisions of chapter 287.
1136	(e)  The corporation is a patient safety organization as
1137	defined in s. 766.1016.
1138	(3)  PURPOSE.--
1139	(a)  The purpose of the corporation is to serve as a
1140	learning organization dedicated to assisting health care
1141	providers in this state to improve the quality and safety of
1142	health care rendered and to reduce harm to patients. The
1143	corporation shall promote the development of a culture of
1144	patient safety in the health care system in this state. The
1145	corporation shall not regulate health care providers in this
1146	state.
1147	(b)  In fulfilling its purpose, the corporation shall work
1148	with a consortium of patient safety centers and other patient
1149	safety programs.
1150	(4)  BOARD OF DIRECTORS; MEMBERSHIP.--The corporation shall
1151	be governed by a board of directors. The board of directors
1152	shall consist of:
1153	(a)  The chair of the Florida Council of Medical School
1154	Deans.
1155	(b)  The person responsible for patient safety issues for
1156	the authorized health insurer with the largest market share as
1157	measured by premiums written in the state for the most recent
1158	calendar year, appointed by such insurer.
1159	(c)  A representative of an authorized medical malpractice
1160	insurer appointed by the insurers.
1161	(d)  The president of the Central Florida Health Care
1162	Coalition.
1163	(e)  A representative of a hospital in this state that is
1164	implementing innovative patient safety initiatives, appointed by
1165	the Florida Hospital Association.
1166	(f)  A physician with expertise in patient safety,
1167	appointed by the Florida Medical Association.
1168	(g)  A physician with expertise in patient safety,
1169	appointed by the Florida Osteopathic Medical Association.
1170	(h)  A physician with expertise in patient safety,
1171	appointed by the Florida Podiatric Medical Association.
1172	(i)  A physician with expertise in patient safety,
1173	appointed by the Florida Chiropractic Association.
1174	(j)  A dentist with expertise in patient safety, appointed
1175	by the Florida Dental Association.
1176	(k)  A nurse with expertise in patient safety, appointed by
1177	the Florida Nurses Association.
1178	(l)  An institutional pharmacist, appointed by the Florida
1179	Society of Health-System Pharmacists.
1180	(m)  A representative of Florida AARP, appointed by the
1181	state director of Florida AARP.
1182	(5)  ADVISORY COMMITTEES.--In addition to any committees
1183	that the corporation may establish, the corporation shall
1184	establish the following advisory committees:
1185	(a)  A scientific research advisory committee that
1186	includes, at a minimum, a representative from each patient
1187	safety center or other patient safety program in the
1188	universities of the state. The duties of the advisory committee
1189	shall include, but not be limited to, the analysis of existing
1190	data and research to improve patient safety and encourage
1191	evidence-based medicine.
1192	(b)  A technology advisory committee that includes, at a
1193	minimum, a representative of a hospital that has implemented a
1194	computerized physician order entry system and a health care
1195	provider that has implemented an electronic medical records
1196	system. The duties of the advisory committee shall include, but
1197	not be limited to, implementation of new technologies, including
1198	electronic medical records.
1199	(c)  A health care provider advisory committee that
1200	includes, at a minimum, representatives of hospitals, ambulatory
1201	surgical centers, physicians, nurses, and pharmacists licensed
1202	in this state and a representative of the Veterans Integrated
1203	Service Network 8, Virginia Patient Safety Center. The duties of
1204	the advisory committee shall include, but not be limited to,
1205	promotion of a culture of patient safety that reduces errors.
1206	(d)  A health care consumer advisory committee that
1207	includes, at a minimum, representatives of businesses that
1208	provide health insurance coverage to their employees, consumer
1209	advocacy groups, and representatives of patient safety
1210	organizations. The duties of the advisory committee shall
1211	include, but not be limited to, incentives to encourage patient
1212	safety and the efficiency and quality of care.
1213	(e)  A state agency advisory committee that includes, at a
1214	minimum, a representative from each state agency that has
1215	regulatory responsibilities related to patient safety. The
1216	duties of the advisory committee shall include, but not be
1217	limited to, interagency coordination of patient safety efforts.
1218	(f)  A tort advisory committee that includes, at a minimum,
1219	representatives of medical malpractice attorneys for plaintiffs
1220	and defendants and a representative of each law school in the
1221	state. The duties of the advisory committee shall include, but
1222	not be limited to, alternatives systems to compensate for
1223	injuries.
1224	(6)  ORGANIZATION; MEETINGS.--
1225	(a)  The Agency for Health Care Administration shall assist
1226	the corporation in its organizational activities required under
1227	chapter 617, including, but not limited to:
1228	1.  Eliciting appointments for the initial board of
1229	directors.
1230	2.  Convening the first meeting of the board of directors
1231	and assisting with other meetings of the board of directors,
1232	upon request of the board of directors, during the first year of
1233	operation of the corporation.
1234	3.  Drafting articles of incorporation for the board of
1235	directors and, upon request of the board of directors,
1236	delivering articles of incorporation to the Department of State
1237	for filing.
1238	4.  Drafting proposed bylaws for the corporation.
1239	5.  Paying fees related to incorporation.
1240	6.  Providing office space and administrative support, at
1241	the request of the board of directors, but not beyond July 1,
1242	2005.
1243	(b)  The board of directors must conduct its first meeting
1244	no later than August 1, 2004, and shall meet thereafter as
1245	frequently as necessary to carry out the duties of the
1246	corporation.
1247	(7)  POWERS AND DUTIES.--
1248	(a)  In addition to the powers and duties prescribed in
1249	chapter 617, and the articles and bylaws adopted under that
1250	chapter, the corporation shall, directly or through contract:
1251	1.  Secure staff necessary to properly administer the
1252	corporation.
1253	2.  Collect, analyze, and evaluate patient safety data and
1254	quality and patient safety indicators, medical malpractice
1255	closed claims, and adverse incidents reported to the Agency for
1256	Health Care Administration and the Department of Health for the
1257	purpose of recommending changes in practices and procedures that
1258	may be implemented by health care practitioners and health care
1259	facilities to improve health care quality and to prevent future
1260	adverse incidents. Notwithstanding any other provision of law,
1261	the Agency for Health Care Administration and the Department of
1262	Health shall make available to the corporation any adverse
1263	incident report submitted under ss. 395.0197, 458.351, and
1264	459.026. To the extent that adverse incident reports submitted
1265	under s. 395.0197 are confidential and exempt, the confidential
1266	and exempt status of such reports shall be maintained by the
1267	corporation.
1268	3.  Establish a 3-year pilot project of a "near-miss,"
1269	patient safety reporting system. The purpose of the near-miss
1270	reporting system is to: identify potential systemic problems
1271	that could lead to adverse incidents; enable publication of
1272	systemwide alerts of potential harm; and facilitate development
1273	of both facility-specific and statewide options to avoid adverse
1274	incidents and improve patient safety. The reporting system shall
1275	record "near misses" submitted by hospitals, birthing centers,
1276	and ambulatory surgical facilities and other providers. For the
1277	purpose of the reporting system:
1278	a.  A "near miss" means any potentially harmful event that
1279	could have had an adverse result but, through chance or
1280	intervention in which, harm was prevented.
1281	b.  The near-miss reporting system shall be voluntary and
1282	anonymous and independent of mandatory reporting systems used
1283	for regulatory purposes.
1284	c.  Information in data submitted to the authority shall be
1285	redacted and shall not be discoverable or admissible in any
1286	civil or administrative action.
1287	d.  Reports of near-miss data shall be published on a
1288	regular basis and special alerts shall be published as needed
1289	regarding newly identified, significant risks.
1290	e.  Aggregated data shall be made available publicly.
1291	f.  The corporation shall report the performance and
1292	results of the pilot project in its annual report.
1293	4.  Foster the development of a statewide electronic
1294	infrastructure, including implementation of statewide electronic
1295	medical records systems, that may be implemented in phases over
1296	a multiyear period and that is designed to improve patient care
1297	and the delivery and quality of health care services by health
1298	care facilities and health care practitioners. Support for
1299	implementation of electronic medical records systems shall
1300	include:
1301	a.  A report to the Governor, the President of the Senate,
1302	the Speaker of the House of Representatives, and the Agency for
1303	Health Care Administration by January 1, 2005, on:
1304	(I)  Public and private sector initiatives relating to
1305	electronic medical records and the communication systems used to
1306	share clinical information among caregivers.
1307	(II)  Regulatory barriers that interfere with the sharing
1308	of clinical information among caregivers.
1309	(III)  Investment incentives that might be used to promote
1310	the use of recommended technologies by health care providers.
1311	(IV)  Educational strategies that could be implemented to
1312	educate health care providers about the recommended technologies
1313	for sharing clinical information.
1314	b.  An implementation plan reported to the Governor, the
1315	President of the Senate, the Speaker of the House of
1316	Representatives, and the Agency for Health Care Administration
1317	by September 1, 2005, that must include, but need not be limited
1318	to, the capital investment required to begin implementing the
1319	system; the costs to operate the system; the financial
1320	incentives recommended to increase capital investment; data
1321	concerning the providers initially committed to participate in
1322	the system, by region; the standards for systemic functionality
1323	and features; any marketing plan to increase participation; and
1324	implementation schedules for key components.
1325	5.  Provide for access to an active library of evidence-
1326	based medicine and patient safety practices, together with the
1327	emerging evidence supporting their retention or modification,
1328	and make this information available to health care
1329	practitioners, health care facilities, and the public. Support
1330	for implementation of evidence-based medicine shall include:
1331	a.  A report to the Governor, the President of the Senate,
1332	the Speaker of the House of Representatives, and the Agency for
1333	Health Care Administration by January 1, 2005, on:
1334	(I)  The ability to join or support efforts for the use of
1335	evidence-based medicine already underway, such as those of the
1336	Leapfrog Group, the international group Bandolier, and the
1337	Healthy Florida Foundation.
1338	(II)  The means by which to promote research using Medicaid
1339	and other data collected by the Agency for Health Care
1340	Administration to identify and quantify the most cost-effective
1341	treatment and interventions, including disease management and
1342	prevention programs.
1343	(III)  The means by which to encourage development of
1344	systems to measure and reward providers who implement evidence-
1345	based medical practices.
1346	(IV)  The review of other state and private initiatives and
1347	published literature for promising approaches and the
1348	dissemination of information about them to providers.
1349	(V)  The encouragement of the Florida health care boards
1350	under the Department of Health to regularly publish findings
1351	related to the cost-effectiveness of disease-specific, evidence-
1352	based standards.
1353	(VI)  Public and private sector initiatives related to
1354	evidence-based medicine and communication systems for the
1355	sharing of clinical information among caregivers.
1356	(VII)  Regulatory barriers that interfere with the sharing
1357	of clinical information among caregivers.
1358	b.  An implementation plan reported to the Governor, the
1359	President of the Senate, the Speaker of the House of
1360	Representatives, and the Agency for Health Care Administration
1361	by September 1, 2005, that must include, but need not be limited
1362	to: estimated costs and savings, capital investment
1363	requirements, recommended investment incentives, initial
1364	committed provider participation by region, standards of
1365	functionality and features, a marketing plan, and implementation
1366	schedules for key components.
1367	6.  Develop and recommend core competencies in patient
1368	safety that can be incorporated into the curricula in schools of
1369	medicine, nursing, and allied health in the state.
1370	7.  Develop and recommend programs to educate the public
1371	about the role of health care consumers in promoting patient
1372	safety.
1373	8.  Provide recommendations for interagency coordination of
1374	patient safety efforts in the state.
1375	(b)  In carrying out its powers and duties, the corporation
1376	may also:
1377	1.  Assess the patient safety culture at volunteering
1378	hospitals and recommend methods to improve the working
1379	environment related to patient safety at these hospitals.
1380	2.  Inventory the information technology capabilities
1381	related to patient safety of health care facilities and health
1382	care practitioners and recommend a plan for expediting the
1383	implementation of patient safety technologies statewide.
1384	3.  Recommend continuing medical education regarding
1385	patient safety to practicing health care practitioners.
1386	4.  Study and facilitate the testing of alternative systems
1387	of compensating injured patients as a means of reducing and
1388	preventing medical errors and promoting patient safety.
1389	(8)  ANNUAL REPORT.--By December 1, 2004, the corporation
1390	shall prepare a report on the startup activities of the
1391	corporation and any proposals for legislative action that are
1392	needed for the corporation to fulfill its purposes under this
1393	section. By December 1 of each year thereafter, the corporation
1394	shall prepare a report for the preceding fiscal year. The
1395	report, at a minimum, must include:
1396	(a)  A description of the activities of the corporation
1397	under this section.
1398	(b)  Progress made in improving patient safety and reducing
1399	medical errors.
1400	(c)  Policies and programs that have been implemented and
1401	their outcomes.
1402	(d)  A compliance and financial audit of the accounts and
1403	records of the corporation at the end of the preceding fiscal
1404	year conducted by an independent certified public accountant.
1405	(e)  Recommendations for legislative action needed to
1406	improve patient safety in the state.
1407
1408	The corporation shall submit the report to the Governor, the
1409	President of the Senate, and the Speaker of the House of
1410	Representatives.
1411	(9)  FUNDING.--The corporation is required to seek private
1412	sector funding and apply for grants to accomplish its goals and
1413	duties.
1414	(10)  PERFORMANCE EXPECTATIONS.--The Office of Program
1415	Policy Analysis and Government Accountability, the Agency for
1416	Health Care Administration, and the Department of Health shall
1417	develop performance standards by which to measure the success of
1418	the corporation in fulfilling the purposes established in this
1419	section. Using the performance standards, the Office of Program
1420	Policy Analysis and Government Accountability shall conduct a
1421	performance audit of the corporation during 2006 and shall
1422	submit a report to the Governor, the President of the Senate,
1423	and the Speaker of the House of Representatives by January 1,
1424	2007.
1425	Section 17.  Subsection (3) of section 409.91255, Florida
1426	Statutes, is amended to read:
1427	409.91255  Federally qualified health center access
1428	program.--
1429	(3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.--The
1430	Department of Health shall develop a program for the expansion
1431	of federally qualified health centers for the purpose of
1432	providing comprehensive primary and preventive health care and
1433	urgent care services, including services that may reduce the
1434	morbidity, mortality, and cost of care among the uninsured
1435	population of the state. The program shall provide for
1436	distribution of financial assistance to federally qualified
1437	health centers that apply and demonstrate a need for such
1438	assistance in order to sustain or expand the delivery of primary
1439	and preventive health care services. In selecting centers to
1440	receive this financial assistance, the program:
1441	(a)  Shall give preference to communities that have few or
1442	no community-based primary care services or in which the current
1443	services are unable to meet the community's needs.
1444	(b)  Shall require that primary care services be provided
1445	to the medically indigent using a sliding fee schedule based on
1446	income.
1447	(c)  Shall allow innovative and creative uses of federal,
1448	state, and local health care resources.
1449	(d)  Shall require that the funds provided be used to pay
1450	for operating costs of a projected expansion in patient
1451	caseloads or services or for capital improvement projects.
1452	Capital improvement projects may include renovations to existing
1453	facilities or construction of new facilities, provided that an
1454	expansion in patient caseloads or services to a new patient
1455	population will occur as a result of the capital expenditures.
1456	The department shall include in its standard contract document a
1457	requirement that any state funds provided for the purchase of or
1458	improvements to real property are contingent upon the contractor
1459	granting to the state a security interest in the property at
1460	least to the amount of the state funds provided for at least 5
1461	years from the date of purchase or the completion of the
1462	improvements or as further required by law. The contract must
1463	include a provision that, as a condition of receipt of state
1464	funding for this purpose, the contractor agrees that, if it
1465	disposes of the property before the department's interest is
1466	vacated, the contractor will refund the proportionate share of
1467	the state's initial investment, as adjusted by depreciation.
1468	(e)  May require in-kind support from other sources.
1469	(f)  May encourage coordination among federally qualified
1470	health centers, other private-sector providers, and publicly
1471	supported programs.
1472	(g)  Shall allow the development of community emergency
1473	room diversion programs in conjunction with local resources,
1474	providing extended hours of operation to urgent care patients.
1475	Diversion programs shall include case management for emergency
1476	room followup care.
1477	Section 18.  Paragraph (a) of subsection (6) of section
1478	627.410, Florida Statutes, is amended to read:
1479	627.410  Filing, approval of forms.--
1480	(6)(a)  An insurer shall not deliver or issue for delivery
1481	or renew in this state any health insurance policy form until it
1482	has filed with the office a copy of every applicable rating
1483	manual, rating schedule, change in rating manual, and change in
1484	rating schedule; if rating manuals and rating schedules are not
1485	applicable, the insurer must file with the office order
1486	applicable premium rates and any change in applicable premium
1487	rates. This paragraph does not apply to group health insurance
1488	policies, effectuated and delivered in this state, insuring
1489	groups of 51 or more persons, except for Medicare supplement
1490	insurance, long-term care insurance, and any coverage under
1491	which the increase in claim costs over the lifetime of the
1492	contract due to advancing age or duration is prefunded in the
1493	premium.
1494	Section 19.  Paragraph (b) of subsection (3) of section
1495	627.6487, Florida Statutes, is amended to read:
1496	627.6487  Guaranteed availability of individual health
1497	insurance coverage to eligible individuals.--
1498	(3)  For the purposes of this section, the term "eligible
1499	individual" means an individual:
1500	(b)  Who is not eligible for coverage under:
1501	1.  A group health plan, as defined in s. 2791 of the
1502	Public Health Service Act;
1503	2.  A conversion policy or contract issued by an authorized
1504	insurer or health maintenance organization under s. 627.6675 or
1505	s. 641.3921, respectively, offered to an individual who is no
1506	longer eligible for coverage under either an insured or self-
1507	insured employer plan;
1508	3.  Part A or part B of Title XVIII of the Social Security
1509	Act; or
1510	4.  A state plan under Title XIX of such act, or any
1511	successor program, and does not have other health insurance
1512	coverage; or
1513	5.  The Florida Health Insurance Plan as specified in s.
1514	627.64872 and such plan is accepting new enrollment;
1515	Section 20.  Section 627.64872, Florida Statutes, is
1516	created to read:
1517	627.64872  Uninsurable risk assumption plan.--
1518	(1)  LEGISLATIVE INTENT; FLORIDA HEALTH INSURANCE PLAN.--
1519	(a)  The Legislature recognizes that to secure a more
1520	stable and orderly health insurance market, the establishment of
1521	a plan to assume risks deemed uninsurable by the private
1522	marketplace is required.
1523	(b)  The Florida Health Insurance Plan is created within
1524	the Office of Insurance Regulation. The plan shall make coverage
1525	available to individuals who have no other option for similar
1526	coverage, at a premium that is commensurate with the risk and
1527	benefits provided, and with benefit designs that are reasonable
1528	in relation to the general market. While plan operations may
1529	include supplementary funding, the plan shall fundamentally
1530	operate on sound actuarial principles, using basic insurance
1531	management techniques to ensure that the plan is run in an
1532	economical, cost-efficient, and sound manner, conserving plan
1533	resources to serve the maximum number of people possible in a
1534	sustainable fashion.
1535	(2)  DEFINITIONS.--As used in this section:
1536	(a)  "Board" means the board of directors of the plan.
1537	(b)  "Chief Financial Officer" means the Chief Financial
1538	Officer of this state.
1539	(c)  "Dependent" means a resident spouse or resident
1540	unmarried child under the age of 19 years, a child who is a
1541	student under the age of 25 years and who is financially
1542	dependent upon the parent, or a child of any age who is disabled
1543	and dependent upon the parent.
1544	(d)  "Director" means the director of the Office of
1545	Insurance Regulation.
1546	(e)  "Governor" means the Governor of this state.
1547	(f)  "Health insurance" means any hospital or medical
1548	expense incurred policy, health maintenance organization
1549	subscriber contract pursuant to chapter 627 or chapter 641, or
1550	any other health care plan or arrangement that pays for or
1551	furnishes medical or health care services, whether by insurance
1552	or otherwise. The term does not include short term, accident,
1553	dental-only, vision-only, fixed indemnity, limited benefit, or
1554	credit insurance, coverage issued as a supplement to liability
1555	insurance, insurance arising out of a workers' compensation or
1556	similar law, automobile medical payment insurance, or insurance
1557	under which benefits are payable with or without regard to fault
1558	and which is statutorily required to be contained in any
1559	liability insurance policy or equivalent selfinsurance.
1560	(g)  "Implementation" means the enrollment of eligible
1561	individuals in the plan and provision of the benefits described
1562	in this section.
1563	(h)  "Insurer" means any entity that provides health
1564	insurance in this state. For purposes of this section, insurer
1565	includes an insurance company with a valid certificate in
1566	accordance with chapter 624, a health maintenance organization
1567	with a valid certificate of authority in accordance with part I
1568	or part III of chapter 641, a prepaid health clinic authorized
1569	to transact business in this state pursuant to part II of
1570	chapter 641, multiple employer welfare arrangements authorized
1571	to transact business in this state pursuant to ss. 624.436-
1572	624.45, or a fraternal benefit society providing health benefits
1573	to its members as authorized pursuant to chapter 632.
1574	(i)  "Medicare" means coverage under both Parts A and B of
1575	Title XVIII of the Social Security Act, 42 USC 1395 et seq., as
1576	amended.
1577	(j)  "Medicaid" means coverage under Title XIX of the
1578	Social Security Act.
1579	(k)  "Office" means the Office of Insurance Regulation of
1580	the Financial Services Commission.
1581	(l)  "Participating insurer" means any insurer providing
1582	health insurance to citizens of this state.
1583	(m)  "Provider" means any physician, hospital, or other
1584	institution, organization, or person that furnishes health care
1585	services and is licensed or otherwise authorized to practice in
1586	the state.
1587	(n)  "Plan" means the Florida Health Insurance Plan created
1588	in subsection (1).
1589	(o)  "Plan of operation" means the articles, bylaws, and
1590	operating rules and procedures adopted by the board pursuant to
1591	this section.
1592	(p)  "Resident" means an individual who has been legally
1593	domiciled in this state for a period of at least 12 months with
1594	exception of residents deemed eligible under the federal Health
1595	Insurance Portability and Accountability Act of 1996.
1596	(3)  BOARD OF DIRECTORS.--
1597	(a)  The plan shall operate subject to the supervision and
1598	control of the board. The board shall consist of the director or
1599	his or her designated representative, who shall serve as a
1600	member of the board and shall be its chair, and an additional
1601	eight members, four of whom shall be appointed by the Governor,
1602	at least two of whom shall be individuals not representative of
1603	insurers or health care providers, two of whom shall be
1604	appointed by the President of the Senate, at least one of whom
1605	shall not be a representative of an insurer or health care
1606	provider, and two of whom shall be appointed by the Speaker of
1607	the House of Representatives, at least one of whom shall not be
1608	a representative of an insurer or health care provider.
1609	(b)  The initial board members shall be appointed as
1610	follows: one-third of the members to serve a term of 2 years;
1611	one-third of the members to serve a term of 4 years; and one-
1612	third of the members to serve a term of 6 years. Subsequent
1613	board members shall serve for a term of 3 years. A board
1614	member's term shall continue until his or her successor is
1615	appointed.
1616	(c)  Vacancies in the board shall be filled by the
1617	appointing authority, such authority being the Governor, the
1618	President of the Senate, or the Speaker of the House of
1619	Representatives. Board members may be removed by the appointing
1620	authority for cause.
1621	(d)  The board shall conduct its first meeting by December
1622	1, 2004.
1623	(e)  Members shall not be compensated in their capacity as
1624	board members but shall be reimbursed for reasonable expenses
1625	incurred in the necessary performance of their duties in
1626	accordance with s. 112.061.
1627	(f)  The board shall submit to the Chief Financial Officer
1628	a plan of operation for the plan and any amendments thereto
1629	necessary or suitable to ensure the fair, reasonable, and
1630	equitable administration of the plan. The plan of operation
1631	shall ensure that the plan qualifies to apply for any available
1632	funding from the Federal Government that adds to the financial
1633	viability of the plan. The plan of operation shall become
1634	effective upon approval in writing by the Chief Financial
1635	Officer consistent with the date on which the coverage under
1636	this section must be made available. If the board fails to
1637	submit a suitable plan of operation within 180 days after the
1638	appointment of the board of directors, or at any time thereafter
1639	fails to submit suitable amendments to the plan of operation,
1640	the office shall adopt such rules as are necessary or advisable
1641	to effectuate the provisions of this section. Such rules shall
1642	continue in force until modified by the office or superseded by
1643	a plan of operation submitted by the board and approved by the
1644	Chief Financial Officer.
1645	(4)  PLAN OF OPERATION.--The plan of operation shall:
1646	(a)  Establish procedures for operation of the plan.
1647	(b)  Establish procedures for selecting an administrator in
1648	accordance with subsection (11).
1649	(c)  Establish procedures to create a fund, under
1650	management of the board, for administrative expenses.
1651	(d)  Establish procedures for the handling, accounting, and
1652	auditing of assets, moneys, and claims of the plan and the plan
1653	administrator.
1654	(e)  Develop and implement a program to publicize the
1655	existence of the plan, plan eligibility requirements, and
1656	procedures for enrollment and maintain public awareness of the
1657	plan.
1658	(f)  Establish procedures under which applicants and
1659	participants may have grievances reviewed by a grievance
1660	committee appointed by the board. The grievances shall be
1661	reported to the board after completion of the review, with the
1662	committee's recommendation for grievance resolution. The board
1663	shall retain all written grievances regarding the plan for at
1664	least 3 years.
1665	(g)  Provide for other matters as may be necessary and
1666	proper for the execution of the board's powers, duties, and
1667	obligations under this section.
1668	(5)  POWERS OF THE PLAN.--The plan shall have the general
1669	powers and authority granted under the laws of this state to
1670	health insurers and, in addition thereto, the specific authority
1671	to:
1672	(a)  Enter into such contracts as are necessary or proper
1673	to carry out the provisions and purposes of this section,
1674	including the authority, with the approval of the Chief
1675	Financial Officer, to enter into contracts with similar plans of
1676	other states for the joint performance of common administrative
1677	functions, or with persons or other organizations for the
1678	performance of administrative functions.
1679	(b)  Take any legal actions necessary or proper to recover
1680	or collect assessments due the plan.
1681	(c)  Take such legal action as is necessary to:
1682	1.  Avoid payment of improper claims against the plan or
1683	the coverage provided by or through the plan;
1684	2.  Recover any amounts erroneously or improperly paid by
1685	the plan;
1686	3.  Recover any amounts paid by the plan as a result of
1687	mistake of fact or law; or
1688	4.  Recover other amounts due the plan.
1689	(d)  Establish, and modify as appropriate, rates, rate
1690	schedules, rate adjustments, expense allowances, agents'
1691	commissions, claims reserve formulas, and any other actuarial
1692	functions appropriate to the operation of the plan. Rates and
1693	rate schedules may be adjusted for appropriate factors such as
1694	age, sex, and geographic variation in claim cost and shall take
1695	into consideration appropriate factors in accordance with
1696	established actuarial and underwriting practices. For purposes
1697	of this paragraph, usual and customary agent's commissions shall
1698	be paid for the initial placement of coverage with the plan and
1699	for one renewal only.
1700	(e)  Issue policies of insurance in accordance with the
1701	requirements of this section.
1702	(f)  Appoint appropriate legal, actuarial, investment, and
1703	other committees as necessary to provide technical assistance in
1704	the operation of the plan and develop and educate its
1705	policyholders regarding health savings accounts, policy and
1706	contract design, and any other function within the authority of
1707	the plan.
1708	(g)  Borrow money to effectuate the purposes of the plan.
1709	Any notes or other evidence of indebtedness of the plan not in
1710	default shall be legal investments for insurers and may be
1711	carried as admitted assets.
1712	(h)  Employ and fix the compensation of employees.
1713	(i)  Prepare and distribute certificate of eligibility
1714	forms and enrollment instruction forms to insurance producers
1715	and to the general public.
1716	(j)  Provide for reinsurance of risks incurred by the plan.
1717	(k)  Provide for and employ cost-containment measures and
1718	requirements, including, but not limited to, preadmission
1719	screening, second surgical opinion, concurrent utilization
1720	review, and individual case management for the purpose of making
1721	the plan more cost-effective.
1722	(l)  Design, use, contract, or otherwise arrange for the
1723	delivery of cost-effective health care services, including, but
1724	not limited to, establishing or contracting with preferred
1725	provider organizations, health maintenance organizations, and
1726	other limited network provider arrangements.
1727	(m)  Adopt such bylaws, policies, and procedures as may be
1728	necessary or convenient for the implementation of this section
1729	and the operation of the plan.
1730	(6)  ANNUAL REPORT.--No later than December 1, 2005, and
1731	annually thereafter, the board shall submit to the Governor, the
1732	President of the Senate, the Speaker of the House of
1733	Representatives, and the substantive legislative committees of
1734	the Legislature a report which includes an independent actuarial
1735	study to determine, including, but not be limited to:
1736	(a)  The impact the creation of the plan has on the small
1737	group and individual insurance market, specifically on the
1738	premiums paid by insureds. This shall include an estimate of the
1739	total anticipated aggregate savings for all small employers in
1740	the state.
1741	(b)  The actual number of individuals covered at the
1742	current funding and benefit level, the projected number of
1743	individuals that may seek coverage in the forthcoming fiscal
1744	year, and the projected funding needed to cover anticipated
1745	increase or decrease in plan participation.
1746	(c)  A recommendation as to the best source of funding for
1747	the anticipated deficits of the pool.
1748	(d)  A summarization of the activities of the plan in the
1749	preceding calendar year, including the net written and earned
1750	premiums, plan enrollment, the expense of administration, and
1751	the paid and incurred losses.
1752	(e)  A review of the operation of the plan as to whether
1753	the plan has met the intent of this section.
1754	(7)  LIABILITY OF THE PLAN.--Neither the board nor its
1755	employees shall be liable for any obligations of the plan. No
1756	member or employee of the board shall be liable, and no cause of
1757	action of any nature may arise against a member or employee of
1758	the board, for any act or omission related to the performance of
1759	any powers and duties under this section, unless such act or
1760	omission constitutes willful or wanton misconduct. The board may
1761	provide in its bylaws or rules for indemnification of, and legal
1762	representation for, its members and employees.
1763	(8)  AUDITED FINANCIAL STATEMENT.--No later than June 1
1764	following the close of each calendar year, the plan shall submit
1765	to the Governor an audited financial statement prepared in
1766	accordance with statutory accounting principles as adopted by
1767	the National Association of Insurance Commissioners.
1768	(9)  ELIGIBILITY.--
1769	(a)  Any individual person who is and continues to be a
1770	resident of this state shall be eligible for coverage under the
1771	plan if:
1772	1.  Evidence is provided that the person received:
1773	a.  A notice of rejection or refusal to issue substantially
1774	similar insurance for health reasons by one insurer; or
1775	b.  A refusal by an insurer to issue insurance.
1776
1777	A rejection or refusal by an insurer offering only stoploss,
1778	excess of loss, or reinsurance coverage with respect to the
1779	applicant shall not be sufficient evidence under this paragraph.
1780	2.  The person is eligible for individual coverage in
1781	accordance with s. 627.6487. The Office of Insurance Regulation
1782	shall submit to the Federal Government a request for the
1783	required waiver under the Health Insurance Portability and
1784	Accountability Act of 1996.
1785	3.  The person is enrolled in the Florida Comprehensive
1786	Health Association as of the date the plan is implemented.
1787	(b)  The board may provide a list of medical or health
1788	conditions for which a person shall be eligible for coverage
1789	under the plan without applying for health insurance pursuant to
1790	paragraph (a). A person who can demonstrate the existence or
1791	history of any medical or health conditions on the list provided
1792	by the board shall not be required to provide the evidence
1793	specified in paragraph (a). The list shall be effective on the
1794	first day of the operation of the plan and may be amended as
1795	appropriate.
1796	(c)  Each resident dependent of a person who is eligible
1797	for coverage under the plan shall also be eligible for such
1798	coverage.
1799	(d)  A person shall not be eligible for coverage under the
1800	plan if:
1801	1.  The person has or obtains health insurance coverage
1802	substantially similar to or more comprehensive than a plan
1803	policy, or would be eligible to obtain such coverage, unless a
1804	person may maintain other coverage for the period of time the
1805	person is satisfying any preexisting condition waiting period
1806	under a plan policy or may maintain plan coverage for the period
1807	of time the person is satisfying a preexisting condition waiting
1808	period under another health insurance policy intended to replace
1809	the plan policy.
1810	2.  The person is determined to be eligible for health care
1811	benefits under Medicaid, the state's children's health insurance
1812	program, or any other federal, state, or local government
1813	program that provides health benefits;
1814	3.  The person voluntarily terminated plan coverage unless
1815	12 months have elapsed since such termination;
1816	4.  The person is an inmate or resident of a public
1817	institution; or
1818	5.  The person's premiums are paid for or reimbursed under
1819	any government-sponsored program or by any government agency or
1820	health care provider, except as an otherwise qualifying fulltime
1821	employee, or dependent thereof, of a government agency or health
1822	care provider.
1823	(e)  Coverage shall cease:
1824	1.  On the date a person is no longer a resident of this
1825	state;
1826	2.  On the date a person requests coverage to end;
1827	3.  Upon the death of the covered person;
1828	4.  On the date state law requires cancellation of the
1829	policy; or
1830	5.  At the option of the plan, 30 days after the plan makes
1831	any inquiry concerning the person's eligibility or place of
1832	residence to which the person does not reply.
1833	(f)  Except under the circumstances described in this
1834	subsection, coverage of a person who ceases to meet the
1835	eligibility requirements of this subsection may be terminated at
1836	the end of the policy period for which the necessary premiums
1837	have been paid.
1838	(10)  UNFAIR REFERRAL TO PLAN.--It is an unfair trade
1839	practice for the purposes of part IX of chapter 626 or s.
1840	641.3901 for an insurer, health maintenance organization
1841	insurance agent, insurance broker, or third-party administrator
1842	to refer an individual employee to the plan, or arrange for an
1843	individual employee to apply to the plan, for the purpose of
1844	separating that employee from group health insurance coverage
1845	provided in connection with the employee's employment.
1846	(11)  PLAN ADMINISTRATOR.--The board shall select through a
1847	competitive bidding process a plan administrator to administer
1848	the plan. The board shall evaluate bids submitted based on
1849	criteria established by the board, which shall include:
1850	(a)  The plan administrator's proven ability to handle
1851	health insurance coverage to individuals.
1852	(b)  The efficiency and timeliness of the plan
1853	administrator's claim processing procedures.
1854	(c)  An estimate of total charges for administering the
1855	plan.
1856	(d)  The plan administrator's ability to apply effective
1857	cost-containment programs and procedures and to administer the
1858	plan in a cost-efficient manner.
1859	(e)  The financial condition and stability of the plan
1860	administrator.
1861
1862	The administrator shall be an insurer, a health maintenance
1863	organization, or a third-party administrator, or another
1864	organization duly authorized to provide insurance pursuant to
1865	the Florida Insurance Code.
1866	(12)  ADMINISTRATOR TERM LIMITS.--The plan administrator
1867	shall serve for a period specified in the contract between the
1868	plan and the plan administrator subject to removal for cause and
1869	subject to any terms, conditions, and limitations of the
1870	contract between the plan and the plan administrator. At least 1
1871	year prior to the expiration of each period of service by a plan
1872	administrator, the board shall invite eligible entities,
1873	including the current plan administrator, to submit bids to
1874	serve as the plan administrator. Selection of the plan
1875	administrator for each succeeding period shall be made at least
1876	6 months prior to the end of the current period.
1877	(13)  DUTIES OF THE PLAN ADMINISTRATOR.--
1878	(a)  The plan administrator shall perform such functions
1879	relating to the plan as may be assigned to it, including, but
1880	not limited to:
1881	1.  Determination of eligibility.
1882	2.  Payment of claims.
1883	3.  Establishment of a premium billing procedure for
1884	collection of premiums from persons covered under the plan.
1885	4.  Other necessary functions to ensure timely payment of
1886	benefits to covered persons under the plan.
1887	(b)  The plan administrator shall submit regular reports to
1888	the board regarding the operation of the plan. The frequency,
1889	content, and form of the reports shall be specified in the
1890	contract between the board and the plan administrator.
1891	(c)  On March 1 following the close of each calendar year,
1892	the plan administrator shall determine net written and earned
1893	premiums, the expense of administration, and the paid and
1894	incurred losses for the year and report this information to the
1895	board and the Governor on a form prescribed by the Governor.
1896	(14)  PAYMENT OF THE PLAN ADMINISTRATOR.--The plan
1897	administrator shall be paid as provided in the contract between
1898	the plan and the plan administrator.
1899	(15)  FUNDING OF THE PLAN.--
1900	(a)  Premiums.--
1901	1.  The plan shall establish premium rates for plan
1902	coverage as provided in this section. Separate schedules of
1903	premium rates based on age, sex, and geographical location may
1904	apply for individual risks. Premium rates and schedules shall be
1905	submitted to the office for approval prior to use.
1906	2.  Initial rates for plan coverage shall be limited to 200
1907	percent of rates established as applicable for individual
1908	standard risks as specified in s. 627.6675(3)(c). Subject to the
1909	limits provided in this paragraph, subsequent rates shall be
1910	established to provide fully for the expected costs of claims,
1911	including recovery of prior losses, expenses of operation,
1912	investment income of claim reserves, and any other cost factors
1913	subject to the limitations described herein, but in no event
1914	shall premiums exceed the 200-percent rate limitation provided
1915	in this section. Notwithstanding the 200-percent rate
1916	limitation, sliding scale premium surcharges based upon the
1917	insured's income may apply to all enrollees except those
1918	obtaining coverage in accordance with s. 627.6487.
1919	(b)  Assessment for Health Insurance Portability and
1920	Accountability Act of 1996 individuals.--As a condition of doing
1921	business in this state an insurer or an administrative service
1922	only organization providing services for a health insurer
1923	operating in this state shall pay an assessment to the board in
1924	the amount prescribed by this section. For operating losses
1925	incurred on July 1, 2004, and thereafter, by persons qualified
1926	for guaranteed availability pursuant to s. 627.6487, each
1927	insurer or an administrative service only organization providing
1928	services for a health insurer operating in this state shall
1929	annually be assessed by the board in the following calendar year
1930	a portion of such incurred operating losses of the plan. Such
1931	portion shall be determined by multiplying such operating losses
1932	by a fraction, the numerator of which equals the insurer's
1933	earned premium pertaining to direct writings of health insurance
1934	in the state during the calendar year preceding that for which
1935	the assessment is levied and the denominator of which equals the
1936	total of all such premiums earned by participating insurers in
1937	the state during such calendar year.
1938	1.  The total of all assessments in this section upon a
1939	participating insurer or an administrative service only
1940	organization providing services for a health insurer operating
1941	in this state shall not exceed 1 percent of such insurer's
1942	health insurance premium earned in this state during the
1943	calendar year preceding the year for which the assessments were
1944	levied.
1945	2.  All rights, title, and interest in the assessment funds
1946	collected shall vest in this state. However, all of such funds
1947	and interest earned shall be used by the plan to pay claims and
1948	administrative expenses.
1949	3.  If assessments and other receipts by the plan, board,
1950	or administrator exceed the actual losses and administrative
1951	expenses of the plan, the excess shall be held in interest and
1952	used by the board to offset future losses. As used in this
1953	subsection, the term "future losses" includes reserves for
1954	claims incurred but not reported.
1955	4.  Each assessment shall be determined annually by the
1956	board or administrator based on annual statements and other
1957	reports deemed necessary by the board or administrator and filed
1958	with it by the insurer. Any deficit incurred under the plan by
1959	persons qualified for guaranteed availability pursuant to s.
1960	627.6487 shall be recouped by the assessments against
1961	participating insurers by the board or administrator in the
1962	manner provided in subsection (2) and the insurer may recover
1963	the assessment in the normal course of the respective business
1964	without time limitation.
1965	(c)  Sources of additional revenue.--Any deficit incurred
1966	by the plan shall be primarily funded through amounts
1967	appropriated by the Legislature from general revenue sources,
1968	including, but not limited to, a portion of the annual growth in
1969	existing net insurance premium taxes. The board shall operate
1970	the plan in such a manner that the estimated cost of providing
1971	health insurance during any fiscal year will not exceed total
1972	income the plan expects to receive from policy premiums and
1973	funds appropriated by the Legislature, including any interest on
1974	investments. After determining the amount of funds appropriated
1975	to the board for a fiscal year, the board shall estimate the
1976	number of new policies it believes the plan has the financial
1977	capacity to insure during that year so that costs do not exceed
1978	income. The board shall take steps necessary to ensure that plan
1979	enrollment does not exceed the number of residents it has
1980	estimated it has the financial capacity to insure.
1981	(16)  BENEFITS.--
1982	(a)  The benefits provided shall be the same as the
1983	standard and basic plans for small employers as outlined in s.
1984	627.6699. The board shall also establish an option of
1985	alternative coverage such as catastrophic coverage that includes
1986	a minimum level of primary care coverage and a high deductible
1987	plan that meets the federal requirements of a health savings
1988	account.
1989	(b)  In establishing the plan coverage, the board shall
1990	take into consideration the levels of health insurance provided
1991	in the state and such medical economic factors as may be deemed
1992	appropriate and adopt benefit levels, deductibles, copayments,
1993	coinsurance factors, exclusions, and limitations determined to
1994	be generally reflective of and commensurate with health
1995	insurance provided through a representative number of large
1996	employers in the state.
1997	(c)  The board may adjust any deductibles and coinsurance
1998	factors annually according to the medical component of the
1999	Consumer Price Index.
2000	(d)1.  Plan coverage shall exclude charges or expenses
2001	incurred during the first 6 months following the effective date
2002	of coverage for any condition for which medical advice, care, or
2003	treatment was recommended or received for such condition during
2004	the 6-month period immediately preceding the effective date of
2005	coverage.
2006	2.  Such preexisting condition exclusions shall be waived
2007	to the extent that similar exclusions, if any, have been
2008	satisfied under any prior health insurance coverage which was
2009	involuntarily terminated, provided application for pool coverage
2010	is made not later than 63 days following such involuntary
2011	termination. In such case, coverage under the plan shall be
2012	effective from the date on which such prior coverage was
2013	terminated and the applicant is not eligible for continuation or
2014	conversion rights that would provide coverage substantially
2015	similar to plan coverage.
2016	(17)  NONDUPLICATION OF BENEFITS.--
2017	(a)  The plan shall be payor of last resort of benefits
2018	whenever any other benefit or source of third-party payment is
2019	available. Benefits otherwise payable under plan coverage shall
2020	be reduced by all amounts paid or payable through any other
2021	health insurance, by all hospital and medical expense benefits
2022	paid or payable under any workers' compensation coverage,
2023	automobile medical payment, or liability insurance, whether
2024	provided on the basis of fault or nonfault, and by any hospital
2025	or medical benefits paid or payable under or provided pursuant
2026	to any state or federal law or program.
2027	(b)  The plan shall have a cause of action against an
2028	eligible person for the recovery of the amount of benefits paid
2029	that are not for covered expenses. Benefits due from the plan
2030	may be reduced or refused as a setoff against any amount
2031	recoverable under this paragraph.
2032	(18)  ANNUAL AND MAXIMUM BENEFITS.--Maximum benefits under
2033	the plan shall be determined by the board.
2034	(19)  TAXATION.--The plan is exempt from any tax imposed by
2035	this state. The plan shall apply for federal tax exemption
2036	status.
2037	(20)  COMBINING MEMBERSHIP OF THE FLORIDA COMPREHENSIVE
2038	HEALTH ASSOCIATION.--
2039	(a)1. Upon implementation of the plan, the Florida
2040	Comprehensive Health Association is abolished and all high-risk
2041	individuals actively enrolled in the Florida Comprehensive
2042	Health Association shall be enrolled in the plan subject to its
2043	rules and requirements.
2044	2.  Persons formerly enrolled in the Florida Comprehensive
2045	Health Association are only eligible for the benefits authorized
2046	under subsection (18).
2047	(b)1.  As a condition of doing business in this state, an
2048	insurer shall pay an assessment to the board in the amount
2049	prescribed by this paragraph. For operating losses incurred on
2050	or after July 1, 2004, by persons previously enrolled in the
2051	Florida Comprehensive Health Association, each insurer shall
2052	annually be assessed by the board in the following calendar year
2053	a portion of such incurred operating losses of the plan. Such
2054	portion shall be determined by multiplying such operating losses
2055	by a fraction, the numerator of which equals the insurer's
2056	earned premium pertaining to direct writings of health insurance
2057	in the state during the calendar year proceeding that for which
2058	the assessment is levied, and the denominator of which equals
2059	the total of all such premiums earned by participating insurers
2060	in the state during such calendar year.
2061	2.  The total of all assessments under this paragraph upon
2062	a participating insurer shall not exceed 1 percent of such
2063	insurer's health insurance premium earned in this state during
2064	the calendar year preceding the year for which the assessments
2065	were levied.
2066	3.  All rights, title, and interest in the assessment funds
2067	collected under this paragraph shall vest in this state.
2068	However, all of such funds and interest earned shall be used by
2069	the plan to pay claims and administrative expenses.
2070	(c)  If assessments and other receipts by the plan, board,
2071	or plan administrator exceed the actual losses and
2072	administrative expenses of the plan, the excess shall be held in
2073	interest and used by the board to offset future losses. As used
2074	in this subsection, the term "future losses" includes reserves
2075	for claims incurred but not reported.
2076	(d)  Each insurer's assessment shall be determined annually
2077	by the board or plan administrator based on annual statements
2078	and other reports deemed necessary by the board or plan
2079	administrator and filed with the board or plan administrator by
2080	the insurer. Any deficit incurred under the plan by persons
2081	previously enrolled in the Florida Comprehensive Health
2082	Association shall be recouped by the assessments against
2083	participating insurers by the board or plan administrator in the
2084	manner provided in paragraph (b), and the insurers may recover
2085	the assessment in the normal course of their respective
2086	businesses without time limitation.
2087	(e)  If a person enrolled in the Florida Comprehensive
2088	Health Association as of July 1, 2004, loses eligibility for
2089	participation in the plan, such person shall not be included in
2090	the calculation of incurred operational losses as described in
2091	paragraph (b) if the person later regains eligibility for
2092	participation in the plan.
2093	(f)  After all persons enrolled in the Florida
2094	Comprehensive Health Association as of July 1, 2004, are no
2095	longer eligible for participation in the plan, the plan, board,
2096	or plan administrator shall no longer be allowed to assess
2097	insurers in this state for incurred losses as described in
2098	paragraph (b).
2099	Section 21.  Upon implementation, as defined in s.
2100	627.64872(2), Florida Statutes, and provided in s.
2101	627.64872(20), Florida Statutes, of the Florida Health Benefit
2102	Plan created under s. 627.64872, Florida Statutes, sections
2103	627.6488, 627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
2104	627.6498, Florida Statutes, are repealed.
2105	Section 22.  Subsection (12) is added to section 627.662,
2106	Florida Statutes, to read:
2107	627.662  Other provisions applicable.--The following
2108	provisions apply to group health insurance, blanket health
2109	insurance, and franchise health insurance:
2110	(12)  Section 627.6044, relating to the use of specific
2111	methodology for payment of claims.
2112	Section 23.  Paragraphs (c) and (d) of subsection (5),
2113	paragraph (b) of subsection (6), and subsection (12) of section
2114	627.6699, Florida Statutes, are amended, subsections (15) and
2115	(16) of said section are renumbered as subsections (16) and
2116	(17), respectively, present subsection (15) of said section is
2117	amended, and new subsections (15) and (18) are added to said
2118	section, to read:
2119	627.6699  Employee Health Care Access Act.--
2120	(5)  AVAILABILITY OF COVERAGE.--
2121	(c)  Every small employer carrier must, as a condition of
2122	transacting business in this state:
2123	1.  Offer and issue all small employer health benefit plans
2124	on a guaranteed-issue basis to every eligible small employer,
2125	with 2 to 50 eligible employees, that elects to be covered under
2126	such plan, agrees to make the required premium payments, and
2127	satisfies the other provisions of the plan. A rider for
2128	additional or increased benefits may be medically underwritten
2129	and may only be added to the standard health benefit plan. The
2130	increased rate charged for the additional or increased benefit
2131	must be rated in accordance with this section.
2132	2.  In the absence of enrollment availability in the
2133	Florida Health Insurance Plan, offer and issue basic and
2134	standard small employer health benefit plans on a guaranteed-
2135	issue basis, during a 31-day open enrollment period of August 1
2136	through August 31 of each year, to every eligible small
2137	employer, with fewer than two eligible employees, which small
2138	employer is not formed primarily for the purpose of buying
2139	health insurance and which elects to be covered under such plan,
2140	agrees to make the required premium payments, and satisfies the
2141	other provisions of the plan. Coverage provided under this
2142	subparagraph shall begin on October 1 of the same year as the
2143	date of enrollment, unless the small employer carrier and the
2144	small employer agree to a different date. A rider for additional
2145	or increased benefits may be medically underwritten and may only
2146	be added to the standard health benefit plan. The increased rate
2147	charged for the additional or increased benefit must be rated in
2148	accordance with this section. For purposes of this subparagraph,
2149	a person, his or her spouse, and his or her dependent children
2150	constitute a single eligible employee if that person and spouse
2151	are employed by the same small employer and either that person
2152	or his or her spouse has a normal work week of less than 25
2153	hours. Any right to an open enrollment of health benefit
2154	coverage for groups of fewer than two employees, pursuant to
2155	this section, shall remain in full force and effect in the
2156	absence of the availability of new enrollment into the Florida
2157	Health Insurance Plan.
2158	3.  This paragraph does not limit a carrier's ability to
2159	offer other health benefit plans to small employers if the
2160	standard and basic health benefit plans are offered and
2161	rejected.
2162	(d)  A small employer carrier must file with the office, in
2163	a format and manner prescribed by the committee, a standard
2164	health care plan, a high deductible plan that meets the federal
2165	requirements of a health savings account plan, and a basic
2166	health care plan to be used by the carrier.
2167	(6)  RESTRICTIONS RELATING TO PREMIUM RATES.--
2168	(b)  For all small employer health benefit plans that are
2169	subject to this section and are issued by small employer
2170	carriers on or after January 1, 1994, premium rates for health
2171	benefit plans subject to this section are subject to the
2172	following:
2173	1.  Small employer carriers must use a modified community
2174	rating methodology in which the premium for each small employer
2175	must be determined solely on the basis of the eligible
2176	employee's and eligible dependent's gender, age, family
2177	composition, tobacco use, or geographic area as determined under
2178	paragraph (5)(j) and in which the premium may be adjusted as
2179	permitted by this paragraph.
2180	2.  Rating factors related to age, gender, family
2181	composition, tobacco use, or geographic location may be
2182	developed by each carrier to reflect the carrier's experience.
2183	The factors used by carriers are subject to office review and
2184	approval.
2185	3.  Small employer carriers may not modify the rate for a
2186	small employer for 12 months from the initial issue date or
2187	renewal date, unless the composition of the group changes or
2188	benefits are changed. However, a small employer carrier may
2189	modify the rate one time prior to 12 months after the initial
2190	issue date for a small employer who enrolls under a previously
2191	issued group policy that has a common anniversary date for all
2192	employers covered under the policy if:
2193	a.  The carrier discloses to the employer in a clear and
2194	conspicuous manner the date of the first renewal and the fact
2195	that the premium may increase on or after that date.
2196	b.  The insurer demonstrates to the office that
2197	efficiencies in administration are achieved and reflected in the
2198	rates charged to small employers covered under the policy.
2199	4.  A carrier may issue a group health insurance policy to
2200	a small employer health alliance or other group association with
2201	rates that reflect a premium credit for expense savings
2202	attributable to administrative activities being performed by the
2203	alliance or group association if such expense savings are
2204	specifically documented in the insurer's rate filing and are
2205	approved by the office. Any such credit may not be based on
2206	different morbidity assumptions or on any other factor related
2207	to the health status or claims experience of any person covered
2208	under the policy. Nothing in this subparagraph exempts an
2209	alliance or group association from licensure for any activities
2210	that require licensure under the insurance code. A carrier
2211	issuing a group health insurance policy to a small employer
2212	health alliance or other group association shall allow any
2213	properly licensed and appointed agent of that carrier to market
2214	and sell the small employer health alliance or other group
2215	association policy. Such agent shall be paid the usual and
2216	customary commission paid to any agent selling the policy.
2217	5.  Any adjustments in rates for claims experience, health
2218	status, or duration of coverage may not be charged to individual
2219	employees or dependents. For a small employer's policy, such
2220	adjustments may not result in a rate for the small employer
2221	which deviates more than 15 percent from the carrier's approved
2222	rate. Any such adjustment must be applied uniformly to the rates
2223	charged for all employees and dependents of the small employer.
2224	A small employer carrier may make an adjustment to a small
2225	employer's renewal premium, not to exceed 10 percent annually,
2226	due to the claims experience, health status, or duration of
2227	coverage of the employees or dependents of the small employer.
2228	Semiannually, small group carriers shall report information on
2229	forms adopted by rule by the commission, to enable the office to
2230	monitor the relationship of aggregate adjusted premiums actually
2231	charged policyholders by each carrier to the premiums that would
2232	have been charged by application of the carrier's approved
2233	modified community rates. If the aggregate resulting from the
2234	application of such adjustment exceeds the premium that would
2235	have been charged by application of the approved modified
2236	community rate by 5 percent for the current reporting period,
2237	the carrier shall limit the application of such adjustments only
2238	to minus adjustments beginning not more than 60 days after the
2239	report is sent to the office. For any subsequent reporting
2240	period, if the total aggregate adjusted premium actually charged
2241	does not exceed the premium that would have been charged by
2242	application of the approved modified community rate by 4 5
2243	percent, the carrier may apply both plus and minus adjustments.
2244	A small employer carrier may provide a credit to a small
2245	employer's premium based on administrative and acquisition
2246	expense differences resulting from the size of the group. Group
2247	size administrative and acquisition expense factors may be
2248	developed by each carrier to reflect the carrier's experience
2249	and are subject to office review and approval.
2250	6.  A small employer carrier rating methodology may include
2251	separate rating categories for one dependent child, for two
2252	dependent children, and for three or more dependent children for
2253	family coverage of employees having a spouse and dependent
2254	children or employees having dependent children only. A small
2255	employer carrier may have fewer, but not greater, numbers of
2256	categories for dependent children than those specified in this
2257	subparagraph.
2258	7.  Small employer carriers may not use a composite rating
2259	methodology to rate a small employer with fewer than 10
2260	employees. For the purposes of this subparagraph, a "composite
2261	rating methodology" means a rating methodology that averages the
2262	impact of the rating factors for age and gender in the premiums
2263	charged to all of the employees of a small employer.
2264	8.a.  A carrier may separate the experience of small
2265	employer groups with less than 2 eligible employees from the
2266	experience of small employer groups with 2-50 eligible employees
2267	for purposes of determining an alternative modified community
2268	rating.
2269	b.  If a carrier separates the experience of small employer
2270	groups as provided in sub-subparagraph a., the rate to be
2271	charged to small employer groups of less than 2 eligible
2272	employees may not exceed 150 percent of the rate determined for
2273	small employer groups of 2-50 eligible employees. However, the
2274	carrier may charge excess losses of the experience pool
2275	consisting of small employer groups with less than 2 eligible
2276	employees to the experience pool consisting of small employer
2277	groups with 2-50 eligible employees so that all losses are
2278	allocated and the 150-percent rate limit on the experience pool
2279	consisting of small employer groups with less than 2 eligible
2280	employees is maintained. Notwithstanding s. 627.411(1), the rate
2281	to be charged to a small employer group of fewer than 2 eligible
2282	employees, insured as of July 1, 2002, may be up to 125 percent
2283	of the rate determined for small employer groups of 2-50
2284	eligible employees for the first annual renewal and 150 percent
2285	for subsequent annual renewals.
2286	(12)  STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH
2287	BENEFIT PLANS.--
2288	(a)1.  The Chief Financial Officer shall appoint a health
2289	benefit plan committee composed of four representatives of
2290	carriers which shall include at least two representatives of
2291	HMOs, at least one of which is a staff model HMO, two
2292	representatives of agents, four representatives of small
2293	employers, and one employee of a small employer. The carrier
2294	members shall be selected from a list of individuals recommended
2295	by the board. The Chief Financial Officer may require the board
2296	to submit additional recommendations of individuals for
2297	appointment.
2298	2.  The plans shall comply with all of the requirements of
2299	this subsection.
2300	3.  The plans must be filed with and approved by the office
2301	prior to issuance or delivery by any small employer carrier.
2302	4.  After approval of the revised health benefit plans, if
2303	the office determines that modifications to a plan might be
2304	appropriate, the Chief Financial Officer shall appoint a new
2305	health benefit plan committee in the manner provided in
2306	subparagraph 1. to submit recommended modifications to the
2307	office for approval.
2308	(b)1.  Each small employer carrier issuing new health
2309	benefit plans shall offer to any small employer, upon request, a
2310	standard health benefit plan, and a basic health benefit plan,
2311	and a high deductible plan that meets the requirements of a
2312	health savings account plan as defined by federal law, that meet
2313	meets the criteria set forth in this section.
2314	2.  For purposes of this subsection, the terms "standard
2315	health benefit plan," and "basic health benefit plan," and "high
2316	deductible plan" mean policies or contracts that a small
2317	employer carrier offers to eligible small employers that
2318	contain:
2319	a.  An exclusion for services that are not medically
2320	necessary or that are not covered preventive health services;
2321	and
2322	b.  A procedure for preauthorization by the small employer
2323	carrier, or its designees.
2324	3.  A small employer carrier may include the following
2325	managed care provisions in the policy or contract to control
2326	costs:
2327	a.  A preferred provider arrangement or exclusive provider
2328	organization or any combination thereof, in which a small
2329	employer carrier enters into a written agreement with the
2330	provider to provide services at specified levels of
2331	reimbursement or to provide reimbursement to specified
2332	providers. Any such written agreement between a provider and a
2333	small employer carrier must contain a provision under which the
2334	parties agree that the insured individual or covered member has
2335	no obligation to make payment for any medical service rendered
2336	by the provider which is determined not to be medically
2337	necessary. A carrier may use preferred provider arrangements or
2338	exclusive provider arrangements to the same extent as allowed in
2339	group products that are not issued to small employers.
2340	b.  A procedure for utilization review by the small
2341	employer carrier or its designees.
2342
2343	This subparagraph does not prohibit a small employer carrier
2344	from including in its policy or contract additional managed care
2345	and cost containment provisions, subject to the approval of the
2346	office, which have potential for controlling costs in a manner
2347	that does not result in inequitable treatment of insureds or
2348	subscribers. The carrier may use such provisions to the same
2349	extent as authorized for group products that are not issued to
2350	small employers.
2351	4.  The standard health benefit plan shall include:
2352	a.  Coverage for inpatient hospitalization;
2353	b.  Coverage for outpatient services;
2354	c.  Coverage for newborn children pursuant to s. 627.6575;
2355	d.  Coverage for child care supervision services pursuant
2356	to s. 627.6579;
2357	e.  Coverage for adopted children upon placement in the
2358	residence pursuant to s. 627.6578;
2359	f.  Coverage for mammograms pursuant to s. 627.6613;
2360	g.  Coverage for handicapped children pursuant to s.
2361	627.6615;
2362	h.  Emergency or urgent care out of the geographic service
2363	area; and
2364	i.  Coverage for services provided by a hospice licensed
2365	under s. 400.602 in cases where such coverage would be the most
2366	appropriate and the most cost-effective method for treating a
2367	covered illness.
2368	5.  The standard health benefit plan and the basic health
2369	benefit plan may include a schedule of benefit limitations for
2370	specified services and procedures. If the committee develops
2371	such a schedule of benefits limitation for the standard health
2372	benefit plan or the basic health benefit plan, a small employer
2373	carrier offering the plan must offer the employer an option for
2374	increasing the benefit schedule amounts by 4 percent annually.
2375	6.  The basic health benefit plan shall include all of the
2376	benefits specified in subparagraph 4.; however, the basic health
2377	benefit plan shall place additional restrictions on the benefits
2378	and utilization and may also impose additional cost containment
2379	measures.
2380	7.  Sections 627.419(2), (3), and (4), 627.6574, 627.6612,
2381	627.66121, 627.66122, 627.6616, 627.6618, 627.668, and 627.66911
2382	apply to the standard health benefit plan and to the basic
2383	health benefit plan. However, notwithstanding said provisions,
2384	the plans may specify limits on the number of authorized
2385	treatments, if such limits are reasonable and do not
2386	discriminate against any type of provider.
2387	8.  The plan associated with a health savings account shall
2388	include all the benefits specified in subparagraph 4.
2389	9.8.  Each small employer carrier that provides for
2390	inpatient and outpatient services by allopathic hospitals may
2391	provide as an option of the insured similar inpatient and
2392	outpatient services by hospitals accredited by the American
2393	Osteopathic Association when such services are available and the
2394	osteopathic hospital agrees to provide the service.
2395	(c)  If a small employer rejects, in writing, the standard
2396	health benefit plan, and the basic health benefit plan, and the
2397	high deductible health savings account plan, the small employer
2398	carrier may offer the small employer a limited benefit policy or
2399	contract.
2400	(d)1.  Upon offering coverage under a standard health
2401	benefit plan, a basic health benefit plan, or a limited benefit
2402	policy or contract for any small employer, the small employer
2403	carrier shall provide such employer group with a written
2404	statement that contains, at a minimum:
2405	a.  An explanation of those mandated benefits and providers
2406	that are not covered by the policy or contract;
2407	b.  An explanation of the managed care and cost control
2408	features of the policy or contract, along with all appropriate
2409	mailing addresses and telephone numbers to be used by insureds
2410	in seeking information or authorization; and
2411	c.  An explanation of the primary and preventive care
2412	features of the policy or contract.
2413
2414	Such disclosure statement must be presented in a clear and
2415	understandable form and format and must be separate from the
2416	policy or certificate or evidence of coverage provided to the
2417	employer group.
2418	2.  Before a small employer carrier issues a standard
2419	health benefit plan, a basic health benefit plan, or a limited
2420	benefit policy or contract, it must obtain from the prospective
2421	policyholder a signed written statement in which the prospective
2422	policyholder:
2423	a.  Certifies as to eligibility for coverage under the
2424	standard health benefit plan, basic health benefit plan, or
2425	limited benefit policy or contract;
2426	b.  Acknowledges the limited nature of the coverage and an
2427	understanding of the managed care and cost control features of
2428	the policy or contract;
2429	c.  Acknowledges that if misrepresentations are made
2430	regarding eligibility for coverage under a standard health
2431	benefit plan, a basic health benefit plan, or a limited benefit
2432	policy or contract, the person making such misrepresentations
2433	forfeits coverage provided by the policy or contract; and
2434	d.  If a limited plan is requested, acknowledges that the
2435	prospective policyholder had been offered, at the time of
2436	application for the insurance policy or contract, the
2437	opportunity to purchase any health benefit plan offered by the
2438	carrier and that the prospective policyholder had rejected that
2439	coverage.
2440
2441	A copy of such written statement shall be provided to the
2442	prospective policyholder no later than at the time of delivery
2443	of the policy or contract, and the original of such written
2444	statement shall be retained in the files of the small employer
2445	carrier for the period of time that the policy or contract
2446	remains in effect or for 5 years, whichever period is longer.
2447	3.  Any material statement made by an applicant for
2448	coverage under a health benefit plan which falsely certifies as
2449	to the applicant's eligibility for coverage serves as the basis
2450	for terminating coverage under the policy or contract.
2451	4.  Each marketing communication that is intended to be
2452	used in the marketing of a health benefit plan in this state
2453	must be submitted for review by the office prior to use and must
2454	contain the disclosures stated in this subsection.
2455	(e)  A small employer carrier may not use any policy,
2456	contract, form, or rate under this section, including
2457	applications, enrollment forms, policies, contracts,
2458	certificates, evidences of coverage, riders, amendments,
2459	endorsements, and disclosure forms, until the insurer has filed
2460	it with the office and the office has approved it under ss.
2461	627.410 and 627.411 and this section.
2462	(15)  SMALL EMPLOYERS ACCESS PROGRAM.--
2463	(a)  Popular name.--This subsection may be referred to by
2464	the popular name "The Small Employers Access Program."
2465	(b)  Intent.--The Legislature finds that increased access
2466	to health care coverage for small employers with up to 25
2467	employees could improve employees' health and reduce the
2468	incidence and costs of illness and disabilities among residents
2469	in this state. Many employers do not offer health care benefits
2470	to their employees citing the increased cost of this benefit. It
2471	is the intent of the Legislature to create the Small Business
2472	Health Plan to provide small employers the option and ability to
2473	provide health care benefits to their employees at an affordable
2474	cost through the creation of purchasing pools for employers with
2475	up to 25 employees, and rural hospital employers and nursing
2476	home employers regardless of the number of employees.
2477	(c)  Definitions.--For purposes of this subsection:
2478	1.  "Fair commission" means a commission structure
2479	determined by the insurers and reflected in the insurers' rate
2480	filings made pursuant to this subsection.
2481	2.  "Insurer" means any entity that provides health
2482	insurance in this state. For purposes of this subsection,
2483	insurer includes an insurance company holding a certificate of
2484	authority pursuant to chapter 624 or a health maintenance
2485	organization holding a certificate of authority pursuant to
2486	chapter 641, which qualifies to provide coverage to small
2487	employer groups pursuant to this section.
2488	3.  "Mutually supported benefit plan" means an optional
2489	alternative coverage plan developed within a defined geographic
2490	region which may include, but is not limited to, a minimum level
2491	of primary care coverage in which the percentage of the premium
2492	is distributed among the employer, the employee, and community-
2493	generated revenue either alone or in conjunction with federal
2494	matching funds.
2495	4.  "Office" means the Office of Insurance Regulation of
2496	the Department of Financial Services.
2497	5.  "Participating insurer" means any insurer providing
2498	health insurance to small employers that has been selected by
2499	the office in accordance with this subsection for its designated
2500	region.
2501	6.  "Program" means the Small Employer Access Program as
2502	created by this subsection.
2503	(d)  Eligibility.--
2504	1.  Any small employer group of up to 25 employees that has
2505	had no prior coverage for the last 6 months may participate.
2506	2.  Rural hospital employers as defined by law may
2507	participate.
2508	3.  Nursing home employers may participate.
2509	4.  Each dependent of a person eligible for coverage is
2510	also eligible to participate.
2511	5.  Any small employer that is actively engaged in
2512	business, has its principal place of business in this state,
2513	employed up to 25 eligible employees on business days during the
2514	preceding calendar year, and employs at least 2 employees on the
2515	first day of the plan year may participate.
2516
2517	Coverage for a small employer group that ceases to meet the
2518	eligibility requirements of this section may be terminated at
2519	the end of the policy period for which the necessary premiums
2520	have been paid.
2521	(e)  Administration.--
2522	1.  The office shall by competitive bid, in accordance with
2523	current state law, select an insurer to provide coverage through
2524	the program to eligible small employers within an established
2525	geographical area of this state. The office may develop
2526	exclusive regions for the program similar to those used by the
2527	Healthy Kids Corporation. However the office is not precluded
2528	from developing, in conjunction with insurers, regions different
2529	from those used by the Healthy Kids Corporation if the office
2530	deems that such a region will carry out the intentions of this
2531	subsection.
2532	2.  The office shall evaluate bids submitted based upon
2533	criteria established by the office, which shall include, but not
2534	be limited to:
2535	a.  The insurer's proven ability to handle health insurance
2536	coverage to small employer groups.
2537	b.  The efficiency and timeliness of the insurer's claim
2538	processing procedures.
2539	c.  The insurer's ability to apply effective cost-
2540	containment programs and procedures and to administer the
2541	program in a cost-efficient manner.
2542	d.  The financial condition and stability of the insurer.
2543	e.  The insurer's ability to develop an optional mutually
2544	supported benefit plan.
2545
2546	The office may use any financial information available to it
2547	through its regulatory duties to make this evaluation.
2548	(f)  Insurer qualifications.--The insurer shall be a duly
2549	authorized insurer or health maintenance organization.
2550	(g)  Duties of the insurer.--The insurer shall:
2551	1.  Develop and implement a program to publicize the
2552	existence of the program, program eligibility requirements, and
2553	procedures for enrollment and maintain public awareness of the
2554	program.
2555	2.  Maintain employer awareness of the program.
2556	3.  Demonstrate the ability to use delivery of cost-
2557	effective health care services.
2558	4.  Encourage, educate, advise, and administer the
2559	effective use of health savings accounts by covered employees
2560	and dependents.
2561	5.  Serve for a period specified in the contract between
2562	the office and the insurer, subject to removal for cause and
2563	subject to any terms, conditions, and limitations of the
2564	contract between the office and the insurer as may be specified
2565	in the request for proposal.
2566	(h)  Contract term.--The contract term shall not exceed 3
2567	years. At least 6 months prior to the expiration of each
2568	contract period, the office shall invite eligible entities,
2569	including the current insurer, to submit bids to serve as the
2570	insurer for a designated geographic area. Selection of the
2571	insurer for the succeeding period shall be made at least 3
2572	months prior to the end of the current period. If a protest is
2573	filed and not resolved by the end of the contract period, the
2574	contract with the existing administrator may be extended for a
2575	period not to exceed 6 months. During the contract extension
2576	period, the administrator shall be paid at a rate to be
2577	negotiated by the office.
2578	(i)  Insurer reporting requirements.--On March 1 following
2579	the close of each calendar year, the insurer shall determine net
2580	written and earned premiums, the expense of administration, and
2581	the paid and incurred losses for the year and report this
2582	information to the office on a form prescribed by the office.
2583	(j)  Application requirements.--The insurer shall permit or
2584	allow any licensed and duly appointed health insurance agent
2585	residing in the designated region to submit applications for
2586	coverage, and such agent shall be paid a fair commission if
2587	coverage is written. The agent must be appointed to at least one
2588	insurer.
2589	(k)  Benefits.--The benefits provided by the plan shall be
2590	the same as the coverage required for small employers under
2591	subsection (12). Upon the approval of the office, the insurer
2592	may also establish an optional mutually supported benefit plan
2593	which is an alternative plan developed within a defined
2594	geographic region of this state or any other such alternative
2595	plan which will carry out the intent of this subsection. Any
2596	small employer carrier issuing new health benefit plans may
2597	offer a benefit plan with coverages similar to, but not less
2598	than, any alternative coverage plan developed pursuant to this
2599	subsection.
2600	(l)  Annual reporting.--The office shall make an annual
2601	report to the Governor, the President of the Senate, and the
2602	Speaker of the House of Representatives. The report shall
2603	summarize the activities of the program in the preceding
2604	calendar year, including the net written and earned premiums,
2605	program enrollment, the expense of administration, and the paid
2606	and incurred losses. The report shall be submitted no later than
2607	March 15 following the close of the prior calendar year.
2608	(16)(15)  APPLICABILITY OF OTHER STATE LAWS.--
2609	(a)  Except as expressly provided in this section, a law
2610	requiring coverage for a specific health care service or
2611	benefit, or a law requiring reimbursement, utilization, or
2612	consideration of a specific category of licensed health care
2613	practitioner, does not apply to a standard or basic health
2614	benefit plan policy or contract or a limited benefit policy or
2615	contract offered or delivered to a small employer unless that
2616	law is made expressly applicable to such policies or contracts.
2617	A law restricting or limiting deductibles, coinsurance,
2618	copayments, or annual or lifetime maximum payments does not
2619	apply to any health plan policy, including a standard or basic
2620	health benefit plan policy or contract, offered or delivered to
2621	a small employer unless such law is made expressly applicable to
2622	such policy or contract. However, every small employer carrier
2623	must offer to eligible small employers the standard benefit plan
2624	and the basic benefit plan, as required by subsection (5), as
2625	such plans have been approved by the office pursuant to
2626	subsection (12).
2627	(b)  Except as provided in this section, a standard or
2628	basic health benefit plan policy or contract or limited benefit
2629	policy or contract offered to a small employer is not subject to
2630	any provision of this code which:
2631	1.  Inhibits a small employer carrier from contracting with
2632	providers or groups of providers with respect to health care
2633	services or benefits;
2634	2.  Imposes any restriction on a small employer carrier's
2635	ability to negotiate with providers regarding the level or
2636	method of reimbursing care or services provided under a health
2637	benefit plan; or
2638	3.  Requires a small employer carrier to either include a
2639	specific provider or class of providers when contracting for
2640	health care services or benefits or to exclude any class of
2641	providers that is generally authorized by statute to provide
2642	such care.
2643	(c)  Any second tier assessment paid by a carrier pursuant
2644	to paragraph (11)(j) may be credited against assessments levied
2645	against the carrier pursuant to s. 627.6494.
2646	(d)  Notwithstanding chapter 641, a health maintenance
2647	organization is authorized to issue contracts providing benefits
2648	equal to the standard health benefit plan, the basic health
2649	benefit plan, and the limited benefit policy authorized by this
2650	section.
2651	(17)(16)  RULEMAKING AUTHORITY.--The commission may adopt
2652	rules to administer this section, including rules governing
2653	compliance by small employer carriers and small employers.
2654	(18)  DECREASE IN INAPPROPRIATE UTILIZATION OF EMERGENCY
2655	CARE.--
2656	(a)  The Legislature finds and declares it to be of vital
2657	importance that emergency services and care be provided by
2658	hospitals and physicians to every person in need of such care,
2659	but with the double-digit increases in health insurance
2660	premiums, health care providers and insurers should encourage
2661	patients and the insured to assume responsibility for their
2662	treatment, including emergency care. The Legislature finds that
2663	inappropriate utilization of emergency department services
2664	increases the overall cost of providing health care and these
2665	costs are ultimately borne by the hospital, the insured
2666	patients, and, many times, by the taxpayers of this state.
2667	Finally, the Legislature declares that the providers and
2668	insurers must share the responsibility of providing alternative
2669	treatment options to urgent care patients outside of the
2670	emergency department. Therefore, it is the intent of the
2671	Legislature to place the obligation for educating consumers and
2672	creating mechanisms for delivery of care that will decrease the
2673	overutilization of emergency service on health insurers and
2674	providers.
2675	(b)  Health insurers shall provide on their websites
2676	information regarding appropriate utilization of emergency care
2677	services which shall include, but not be limited to, a list of
2678	alternative urgent care contracted providers, the types of
2679	services offered by these providers, and what to do in the event
2680	of a true emergency.
2681	(c)  Health insurers shall develop community emergency
2682	department diversion programs. Such programs may include, but
2683	not be limited to, enlisting providers to be on call to insurers
2684	after hours, coordinating care through local community
2685	resources, and incentives to providers for case management.
2686	(d)  As a disincentive for insureds to inappropriately use
2687	emergency department services, health insurers may require
2688	higher copayments for nonemergency use of emergency departments
2689	and higher copayments for use of out-of-network emergency
2690	departments. For the purposes of this section, the term
2691	"emergency care" has the same meaning as provided in s. 395.002,
2692	and shall include services provided to rule out an emergency
2693	medical condition.
2694	Section 24.  Subsection (1) of section 627.9175, Florida
2695	Statutes, is amended to read:
2696	627.9175  Reports of information on health and accident
2697	insurance.--
2698	(1)  Each health insurer, prepaid limited health services
2699	organization, and health maintenance organization shall submit,
2700	no later than April 1 of each year, annually to the office
2701	information concerning health and accident insurance coverage
2702	and medical plans being marketed and currently in force in this
2703	state. The required information shall be described by market
2704	segment, to include, but not be limited to:
2705	(a)  Issuing, servicing company, and entity contact
2706	information.
2707	(b)  Information on all health and accident insurance
2708	policies and prepaid limited health service organizations and
2709	health maintenance organization contracts in force and issued in
2710	the previous year. Such information shall include, but not be
2711	limited to, direct premiums earned, direct losses incurred,
2712	number of policies, number of certificates, number of covered
2713	lives, number or the percentage of claims denied and claims
2714	meeting prompt pay requirements, and the average number of days
2715	taken to pay claims. as to policies of individual health
2716	insurance:
2717	(a)  A summary of typical benefits, exclusions, and
2718	limitations for each type of individual policy form currently
2719	being issued in the state. The summary shall include, as
2720	appropriate:
2721	1.  The deductible amount;
2722	2.  The coinsurance percentage;
2723	3.  The out-of-pocket maximum;
2724	4.  Outpatient benefits;
2725	5.  Inpatient benefits; and
2726	6.  Any exclusions for preexisting conditions.
2727
2728	The commission shall determine other appropriate benefits,
2729	exclusions, and limitations to be reported for inclusion in the
2730	consumer's guide published pursuant to this section.
2731	(b)  A schedule of rates for each type of individual policy
2732	form reflecting typical variations by age, sex, region of the
2733	state, or any other applicable factor which is in use and is
2734	determined to be appropriate for inclusion by the commission.
2735
2736	The commission may establish rules governing shall provide by
2737	rule a uniform format for the submission of this information
2738	described in this section, including the use of uniform formats
2739	and electronic data transmission order to allow for meaningful
2740	comparisons of premiums charged for comparable benefits. The
2741	office shall provide this information to the department, which
2742	shall publish annually a consumer's guide which summarizes and
2743	compares the information required to be reported under this
2744	subsection.
2745	Section 25.  Subsection (7) of section 636.003, Florida
2746	Statutes, is amended to read:
2747	636.003  Definitions.--As used in this act, the term:
2748	(7)  "Prepaid limited health service organization" means
2749	any person, corporation, partnership, or any other entity which,
2750	in return for a prepayment, undertakes to provide or arrange
2751	for, or provide access to, the provision of a limited health
2752	service to enrollees through an exclusive panel of providers or
2753	undertakes to provide access to any discounted medical services.
2754	Prepaid limited health service organization does not include:
2755	(a)  An entity otherwise authorized pursuant to the laws of
2756	this state to indemnify for any limited health service;
2757	(b)  A provider or entity when providing limited health
2758	services pursuant to a contract with a prepaid limited health
2759	service organization, a health maintenance organization, a
2760	health insurer, or a self-insurance plan; or
2761	(c)  Any person who, in exchange for fees, dues, charges or
2762	other consideration, provides access to a limited health service
2763	provider without assuming any responsibility for payment for the
2764	limited health service or any portion thereof; or
2765	(d)  Any plan or program of discounted medical services for
2766	which fees, dues, charges, or other consideration paid to the
2767	plan by consumers do not exceed $15 per month or $180 per year
2768	and which, in its advertising and contracts:
2769	1.  Clearly indicates that the plan is not insurance, that
2770	the plan is not obligated to pay any portion of the discounted
2771	medical fees, and that the consumer is responsible for paying
2772	the full amount of the discounted fees.
2773	2.  Does not use the terms "affordable health care" or
2774	"coverage" or other terms which misrepresent the nature of the
2775	program.
2776	3.  Requires a statement, together with the provider
2777	network, on the discount card alerting the network providers and
2778	facilities that the cardholder does not have insurance and is
2779	merely entitled to the network discount rate for services
2780	provided.
2781	Section 26.  Section 627.65626, Florida Statutes, is
2782	created to read:
2783	627.65626  Insurance rebates for healthy lifestyles.--
2784	(1)  Any rate, rating schedule, or rating manual for a
2785	health insurance policy filed with the office shall provide for
2786	an appropriate rebate of premiums paid in the last calendar year
2787	when the majority of members of a health plan have enrolled and
2788	maintained participation in any health wellness, maintenance, or
2789	improvement program offered by the employer. The employer must
2790	provide evidence of demonstrative maintenance or improvement of
2791	the enrollees' health status as determined by assessments of
2792	agreed-upon health status indicators between the employer and
2793	the health insurer, including, but not limited to, reduction in
2794	weight, body mass index, and smoking cessation. Any rebate
2795	provided by the health insurer is presumed to be appropriate
2796	unless credible data demonstrates otherwise, but shall not
2797	exceed 10 percent of paid premiums.
2798	(2)  The premium rebate authorized by this section shall be
2799	effective for an insured on an annual basis, unless the number
2800	of participating employees becomes less than the majority of the
2801	employees eligible for participation in the wellness program.
2802	Section 27.  Section 627.6402, Florida Statutes, is created
2803	to read:
2804	627.6402  Insurance rebates for healthy lifestyles.--
2805	(1)  Any rate, rating schedule, or rating manual for an
2806	individual health insurance policy filed with the office shall
2807	provide for an appropriate rebate of premiums paid in the last
2808	calendar year when the individual covered by such plan is
2809	enrolled in and maintains participation in any health wellness,
2810	maintenance, or improvement program approved by the health plan.
2811	The individual must provide evidence of demonstrative
2812	maintenance or improvement of the individual's health status as
2813	determined by assessments of agreed-upon health status
2814	indicators between the individual and the health insurer,
2815	including, but not limited to, reduction in weight, body mass
2816	index, and smoking cessation. Any rebate provided by the health
2817	insurer is presumed to be appropriate unless credible data
2818	demonstrates otherwise, but shall not exceed 10 percent of paid
2819	premiums.
2820	(2)  The premium rebate authorized by this section shall be
2821	effective for an insured on an annual basis, unless the
2822	individual fails to maintain or improve his or her health status
2823	while participating in an approved wellness program, or credible
2824	evidence demonstrates that the individual is not participating
2825	in the approved wellness program.
2826	Section 28.  Subsection (38) of section 641.31, Florida
2827	Statutes, is amended, and subsection (40) is added to said
2828	section, to read:
2829	641.31  Health maintenance contracts.--
2830	(38)(a)  Notwithstanding any other provision of this part,
2831	a health maintenance organization that meets the requirements of
2832	paragraph (b) may, through a point-of-service rider to its
2833	contract providing comprehensive health care services, include a
2834	point-of-service benefit. Under such a rider, a subscriber or
2835	other covered person of the health maintenance organization may
2836	choose, at the time of covered service, a provider with whom the
2837	health maintenance organization does not have a health
2838	maintenance organization provider contract. The rider may not
2839	require a referral from the health maintenance organization for
2840	the point-of-service benefits.
2841	(b)  A health maintenance organization offering a point-of-
2842	service rider under this subsection must have a valid
2843	certificate of authority issued under the provisions of the
2844	chapter, must have been licensed under this chapter for a
2845	minimum of 3 years, and must at all times that it has riders in
2846	effect maintain a minimum surplus of $5 million. A health
2847	maintenance organization offering a point-of-service rider to
2848	its contract providing comprehensive health care services may
2849	offer the rider to employers who have employees living and
2850	working outside the health maintenance organization's approved
2851	geographic service area without having to obtain a health care
2852	provider certificate, as long as the master group contract is
2853	issued to an employer that maintains its primary place of
2854	business within the health maintenance organization's approved
2855	service area. Any member or subscriber that lives and works
2856	outside the health maintenance organization's service area and
2857	elects coverage under the health maintenance organization's
2858	point-of-service rider must provide a statement to the health
2859	maintenance organization that indicates the member or subscriber
2860	understands the limitations of his or her policy and that only
2861	those benefits under the point-of-service rider will be covered
2862	when services are provided outside the service area.
2863	(c)  Premiums paid in for the point-of-service riders may
2864	not exceed 15 percent of total premiums for all health plan
2865	products sold by the health maintenance organization offering
2866	the rider. If the premiums paid for point-of-service riders
2867	exceed 15 percent, the health maintenance organization must
2868	notify the office and, once this fact is known, must immediately
2869	cease offering such a rider until it is in compliance with the
2870	rider premium cap.
2871	(d)  Notwithstanding the limitations of deductibles and
2872	copayment provisions in this part, a point-of-service rider may
2873	require the subscriber to pay a reasonable copayment for each
2874	visit for services provided by a noncontracted provider chosen
2875	at the time of the service. The copayment by the subscriber may
2876	either be a specific dollar amount or a percentage of the
2877	reimbursable provider charges covered by the contract and must
2878	be paid by the subscriber to the noncontracted provider upon
2879	receipt of covered services. The point-of-service rider may
2880	require that a reasonable annual deductible for the expenses
2881	associated with the point-of-service rider be met and may
2882	include a lifetime maximum benefit amount. The rider must
2883	include the language required by s. 627.6044 and must comply
2884	with copayment limits described in s. 627.6471. Section 641.3154
2885	does not apply to a point-of-service rider authorized under this
2886	subsection.
2887	(e)  The point-of-service rider must contain provisions
2888	that comply with s. 627.6044.
2889	(f)(e)  The term "point of service" may not be used by a
2890	health maintenance organization except with riders permitted
2891	under this section or with forms approved by the office in which
2892	a point-of-service product is offered with an indemnity carrier.
2893	(g)(f)  A point-of-service rider must be filed and approved
2894	under ss. 627.410 and 627.411.
2895	(40)(a)  Any rate, rating schedule, or rating manual for a
2896	health maintenance organization policy filed with the office
2897	shall provide for an appropriate rebate of premiums paid in the
2898	last calendar year when the individual covered by such plan is
2899	enrolled in and maintains participation in any health wellness,
2900	maintenance, or improvement program approved by the health plan.
2901	The individual must provide evidence of demonstrative
2902	maintenance or improvement of his or her health status as
2903	determined by assessments of agreed-upon health status
2904	indicators between the individual and the health insurer,
2905	including, but not limited to, reduction in weight, body mass
2906	index, and smoking cessation. Any rebate provided by the health
2907	insurer is presumed to be appropriate unless credible data
2908	demonstrates otherwise, but shall not exceed 10 percent of paid
2909	premiums.
2910	(b)  The premium rebate authorized by this section shall be
2911	effective for an insured on an annual basis, unless the
2912	individual fails to maintain or improve his or her health status
2913	while participating in an approved wellness program, or credible
2914	evidence demonstrates that the individual is not participating
2915	in the approved wellness program.
2916	Section 29.  Subsection (2) of section 626.015, Florida
2917	Statutes, is amended, subsections (8) through (17) of said
2918	section are renumbered as subsections (9) through (18),
2919	respectively, and a new subsection (8) is added to said section,
2920	to read:
2921	626.015  Definitions.--As used in this part:
2922	(2)  "Agent" means a general lines agent, life agent,
2923	health agent, or title agent, or all such agents, as indicated
2924	by context. The term "agent" includes an insurance producer or
2925	producer, but does not include a customer representative,
2926	limited customer representative, or service representative but
2927	does include an insurance advisor.
2928	(8)  "Insurance advisor" means any person who, for money,
2929	fee, commission, or any other thing of value offers to examine
2930	or examines any policy of life, accident, or health insurance,
2931	any health benefit plan, or any annuity or pure endowment
2932	contract for the purpose of giving, or gives, or offers to give,
2933	any advice, counsel, recommendation, or information in respect
2934	to the terms, conditions, benefits, coverage, or premium of any
2935	such policy or contract, or in respect to the expediency or
2936	advisability of altering, changing, exchanging, converting,
2937	replacing, surrendering, continuing, or rejecting any such
2938	policy, plan, or contract, or of accepting or procuring any such
2939	policy, plan, or contract from any insurer or issuer of a health
2940	benefit plan, or who in or on advertisements, cards, signs,
2941	circulars, or letterheads, or elsewhere, or in any other way or
2942	manner by which public announcements are made, uses the title
2943	"insurance advisor," "insurance specialist," "insurance
2944	counselor," "insurance analyst," "policyholders' adviser,"
2945	"policyholders' counselor," or any other similar title, or any
2946	title indicating that the person gives, or is engaged in the
2947	business of giving advice, counsel, recommendation, or
2948	information to an insured, or a beneficiary, or any person
2949	having any interest in a life, accident, or health insurance
2950	contract, health benefit plan contract, annuity, or pure
2951	endowment contract. This definition is not intended to prevent a
2952	person who has obtained the professional designation of life
2953	underwriter, chartered financial consultant, or certified
2954	financial planner by completing a course of instruction
2955	recognized within the business of insurance from using that
2956	designation to indicate professional achievement.
2957	Section 30.  Subsection (1) of section 626.016, Florida
2958	Statutes, is amended to read:
2959	626.016  Powers and duties of department, commission, and
2960	office.--
2961	(1)  The powers and duties of the Chief Financial Officer
2962	and the department specified in this part apply only with
2963	respect to insurance agents, insurance advisors, managing
2964	general agents, reinsurance intermediaries, viatical settlement
2965	brokers, customer representatives, service representatives, and
2966	agencies.
2967	Section 31.  Section 626.171, Florida Statutes, is amended
2968	to read:
2969	626.171  Application for license.--
2970	(1)  The department or office shall not issue a license as
2971	agent, insurance advisor, customer representative, adjuster,
2972	insurance agency, service representative, managing general
2973	agent, or reinsurance intermediary to any person except upon
2974	written application therefor filed with it, qualification
2975	therefor, and payment in advance of all applicable fees. Any
2976	such application shall be made under the oath of the applicant
2977	and be signed by the applicant. Beginning November 1, 2002, The
2978	department shall accept the uniform application for nonresident
2979	agent licensing. The department may adopt revised versions of
2980	the uniform application by rule.
2981	(2)  In the application, the applicant shall set forth:
2982	(a)  His or her full name, age, social security number,
2983	residence address, business address, and mailing address.
2984	(b)  Proof that he or she has completed or is in the
2985	process of completing any required prelicensing course.
2986	(c)  Whether he or she has been refused or has voluntarily
2987	surrendered or has had suspended or revoked a license to solicit
2988	insurance by the department or by the supervising officials of
2989	any state.
2990	(d)  Whether any insurer or any managing general agent
2991	claims the applicant is indebted under any agency contract or
2992	otherwise and, if so, the name of the claimant, the nature of
2993	the claim, and the applicant's defense thereto, if any.
2994	(e)  Proof that the applicant meets the requirements for
2995	the type of license for which he or she is applying.
2996	(f)  Such other or additional information as the department
2997	or office may deem proper to enable it to determine the
2998	character, experience, ability, and other qualifications of the
2999	applicant to hold himself or herself out to the public as an
3000	insurance representative.
3001	(3)  An application for an insurance agency license shall
3002	be signed by the owner or owners of the agency. If the agency is
3003	incorporated, the application shall be signed by the president
3004	and secretary of the corporation.
3005	(3)(4)  Each application shall be accompanied by payment of
3006	any applicable fee.
3007	(4)(5)  An application for a license as an agent, customer
3008	representative, adjuster, insurance agency, service
3009	representative, managing general agent, or reinsurance
3010	intermediary must be accompanied by a set of the individual
3011	applicant's fingerprints, or, if the applicant is not an
3012	individual, by a set of the fingerprints of the sole proprietor,
3013	majority owner, partners, officers, and directors, on a form
3014	adopted by rule of the department or commission and accompanied
3015	by the fingerprint processing fee set forth in s. 624.501.
3016	Fingerprints shall be used to investigate the applicant's
3017	qualifications pursuant to s. 626.201. The fingerprints shall be
3018	taken by a law enforcement agency or other department-approved
3019	entity.
3020	(5)(6)  The application for license filing fee prescribed
3021	in s. 624.501 is not subject to refund.
3022	(6)(7)  Pursuant to the federal Personal Responsibility and
3023	Work Opportunity Reconciliation Act of 1996, each party is
3024	required to provide his or her social security number in
3025	accordance with this section. Disclosure of social security
3026	numbers obtained through this requirement shall be limited to
3027	the purpose of administration of the Title IV-D program for
3028	child support enforcement.
3029	Section 32.  Section 626.191, Florida Statutes, is amended
3030	to read:
3031	626.191  Repeated applications.--The failure of an
3032	applicant to secure a license upon an application shall not
3033	preclude the applicant him or her from applying again as many
3034	times as desired, but the department or office shall not give
3035	consideration to or accept any further application by the same
3036	individual for a similar license dated or filed within 30 days
3037	subsequent to the date the department or office denied the last
3038	application, except as provided in s. 626.281.
3039	Section 33.  Subsection (1) of section 626.201, Florida
3040	Statutes, is amended to read:
3041	626.201  Investigation.--
3042	(1)  The department or office may propound any reasonable
3043	interrogatories in addition to those contained in the
3044	application, to any applicant for license or appointment, or on
3045	any renewal, reinstatement, or continuation thereof, relating to
3046	the applicant's his or her qualifications, residence,
3047	prospective place of business, and any other matter which, in
3048	the opinion of the department or office, is deemed necessary or
3049	advisable for the protection of the public and to ascertain the
3050	applicant's qualifications.
3051	Section 34.  Subsections (1) and (2) of section 626.342,
3052	Florida Statutes, are amended to read:
3053	626.342  Furnishing supplies to unlicensed life, health, or
3054	general lines agent prohibited; civil liability.--
3055	(1)  An insurer, a managing general agent, an insurance
3056	advisor, or an agent, directly or through any representative,
3057	may not furnish to any agent any blank forms, applications,
3058	stationery, or other supplies to be used in soliciting,
3059	negotiating, or effecting contracts of insurance on its behalf
3060	unless such blank forms, applications, stationery, or other
3061	supplies relate to a class of business with respect to which the
3062	agent is licensed and appointed, whether for that insurer or
3063	another insurer.
3064	(2)  Any insurer, general agent, insurance advisor, or
3065	agent who furnishes any of the supplies specified in subsection
3066	(1) to any agent or prospective agent not appointed to represent
3067	the insurer and who accepts from or writes any insurance
3068	business for such agent or agency is subject to civil liability
3069	to any insured of such insurer to the same extent and in the
3070	same manner as if such agent or prospective agent had been
3071	appointed or authorized by the insurer or such agent to act in
3072	its or his or her behalf. The provisions of this subsection do
3073	not apply to insurance risk apportionment plans under s.
3074	627.351.
3075	Section 35.  Section 626.536, Florida Statutes, is amended
3076	to read:
3077	626.536  Reporting of actions.--An agent or insurance
3078	advisor shall submit to the department, within 30 days after the
3079	final disposition of any administrative action taken against the
3080	agent by a governmental agency in this or any other state or
3081	jurisdiction relating to the business of insurance, the sale of
3082	securities, or activity involving fraud, dishonesty,
3083	trustworthiness, or breach of a fiduciary duty, a copy of the
3084	order, consent to order, or other relevant legal documents. The
3085	department may adopt rules implementing the provisions of this
3086	section.
3087	Section 36.  Subsections (1) and (3) of section 626.561,
3088	Florida Statutes, are amended to read:
3089	626.561  Reporting and accounting for funds.--
3090	(1)  All premiums, return premiums, or other funds
3091	belonging to insurers or others received by an insurance
3092	advisor, agent, customer representative, or adjuster in
3093	transactions under a his or her license are trust funds received
3094	by the licensee in a fiduciary capacity. An agent or insurance
3095	advisor shall keep the funds belonging to each insurer for which
3096	an agent or insurance advisor he or she is not appointed, other
3097	than a surplus lines insurer, in a separate account so as to
3098	allow the department or office to properly audit such funds. The
3099	licensee in the applicable regular course of business shall
3100	account for and pay the same to the insurer, insured, or other
3101	person entitled thereto.
3102	(3)  Any insurance advisor, agent, customer representative,
3103	or adjuster who, not being lawfully entitled thereto, either
3104	temporarily or permanently diverts or misappropriates such funds
3105	or any portion thereof or deprives the other person of a benefit
3106	therefrom commits the offense specified below:
3107	(a)  If the funds diverted or misappropriated are $300 or
3108	less, a misdemeanor of the first degree, punishable as provided
3109	in s. 775.082 or s. 775.083.
3110	(b)  If the funds diverted or misappropriated are more than
3111	$300, but less than $20,000, a felony of the third degree,
3112	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
3113	(c)  If the funds diverted or misappropriated are $20,000
3114	or more, but less than $100,000, a felony of the second degree,
3115	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
3116	(d)  If the funds diverted or misappropriated are $100,000
3117	or more, a felony of the first degree, punishable as provided in
3118	s. 775.082, s. 775.083, or s. 775.084.
3119	Section 37.  Subsections (1) and (2) of section 626.572,
3120	Florida Statutes, are amended to read:
3121	626.572  Rebating; when allowed.--
3122	(1)  No insurance advisor or agent shall rebate any portion
3123	of a his or her commission except as follows:
3124	(a)  The rebate shall be available to all insureds in the
3125	same actuarial class.
3126	(b)  The rebate shall be in accordance with a rebating
3127	schedule filed by the agent with the insurer issuing the policy
3128	to which the rebate applies.
3129	(c)  The rebating schedule shall be uniformly applied in
3130	that all insureds who purchase the same policy through the agent
3131	for the same amount of insurance receive the same percentage
3132	rebate.
3133	(d)  Rebates shall not be given to an insured with respect
3134	to a policy purchased from an insurer that prohibits its agents
3135	from rebating commissions.
3136	(e)  The rebate schedule is prominently displayed in public
3137	view in the agent's place of doing business and a copy is
3138	available to insureds on request at no charge.
3139	(f)  The age, sex, place of residence, race, nationality,
3140	ethnic origin, marital status, or occupation of the insured or
3141	location of the risk is not utilized in determining the
3142	percentage of the rebate or whether a rebate is available.
3143	(2)  The insurance advisor or agent shall maintain a copy
3144	of all rebate schedules for the most recent 5 years and their
3145	effective dates.
3146	Section 38.  Section 626.593, Florida Statutes, is created
3147	to read:
3148	626.593  Insurance advisor; written contract for
3149	compensation.--
3150	(1)  A person licensed as a health insurance advisor may
3151	not receive any fee or commission or any other thing of value in
3152	addition to the rates filed pursuant to chapter 627 for
3153	examining any life, accident, or health insurance or any health
3154	benefit plan for the purpose of giving or offering advice,
3155	counsel, recommendation, or information in respect to terms,
3156	conditions, benefits coverage, or premium of any such policy or
3157	contract unless such compensation is based upon a written
3158	contract signed by the party to be charged and specifying or
3159	clearly defining the amount or extent of such compensation and
3160	informing the party to be charged whether the health advisor is
3161	also receiving a commission from an insurer in addition to any
3162	other compensation disclosed in the contract.
3163	(2)  A copy of every such contract shall be retained by the
3164	licensee for not less than 3 years after such services have been
3165	fully performed.
3166	(3)  This section shall not prohibit the payment of a
3167	commission by an insurer pursuant to any lawful contract between
3168	an insurer and a licensed insurance advisor.
3169	(4)  An insurance advisor must be appointed by any insurer
3170	with which coverage is placed on behalf of an insured.
3171	Section 39.  Subsection (1) of section 626.601, Florida
3172	Statutes, is amended to read:
3173	626.601  Improper conduct; inquiry; fingerprinting.--
3174	(1)  The department or office may, upon its own motion or
3175	upon a written complaint signed by any interested person and
3176	filed with the department or office, inquire into any alleged
3177	improper conduct of any licensed insurance advisor, agent,
3178	adjuster, service representative, managing general agent,
3179	customer representative, title insurance agent, title insurance
3180	agency, continuing education course provider, instructor, school
3181	official, or monitor group under this code. The department or
3182	office may thereafter initiate an investigation of any such
3183	licensee if it has reasonable cause to believe that the licensee
3184	has violated any provision of the insurance code. During the
3185	course of its investigation, the department or office shall
3186	contact the licensee being investigated unless it determines
3187	that contacting such person could jeopardize the successful
3188	completion of the investigation or cause injury to the public.
3189	Section 40.  Section 626.6115, Florida Statutes, is amended
3190	to read:
3191	626.6115  Grounds for compulsory refusal, suspension, or
3192	revocation of insurance agency license.--The department shall
3193	deny, suspend, revoke, or refuse to continue the license of any
3194	insurance agency if it finds, as to any insurance agency or as
3195	to any majority owner, partner, manager, director, officer, or
3196	other person who manages or controls such agency, that any
3197	either one or both of the following applicable grounds exist:
3198	(1)  Lack by the agency of one or more of the
3199	qualifications for the license as specified in this code;.
3200	(2)  Material misstatement, misrepresentation, or fraud in
3201	obtaining the license or in attempting to obtain the license; or
3202	(3)  Denial, suspension, or revocation of a license to
3203	practice or conduct any regulated profession, business, or
3204	vocation relating to the business of insurance by this state,
3205	any other state, any nation, any possession or district of the
3206	United States, any court, or any lawful agency thereof.
3207	Section 41.  Paragraph (b) of subsection (5) of section
3208	624.509, Florida Statutes, is amended to read:
3209	624.509  Premium tax; rate and computation.--
3210	(5)  There shall be allowed a credit against the net tax
3211	imposed by this section equal to 15 percent of the amount paid
3212	by the insurer in salaries to employees located or based within
3213	this state and who are covered by the provisions of chapter 443.
3214	For purposes of this subsection:
3215	(b)  The term "employees" does not include independent
3216	contractors or any person whose duties require that the person
3217	hold a valid license under the Florida Insurance Code, except
3218	persons defined in s. 626.015(1), (16)(15), and (18)(17).
3219	Section 42.  Subsection (2) of section 626.7845, Florida
3220	Statutes, is amended to read:
3221	626.7845  Prohibition against unlicensed transaction of
3222	life insurance.--
3223	(2)  Except as provided in s. 626.112(6), with respect to
3224	any line of authority specified in s. 626.015(12)(11), no
3225	individual shall, unless licensed as a life agent:
3226	(a)  Solicit insurance or annuities or procure
3227	applications; or
3228	(b)  In this state, engage or hold himself or herself out
3229	as engaging in the business of analyzing or abstracting
3230	insurance policies or of counseling or advising or giving
3231	opinions to persons relative to insurance or insurance contracts
3232	other than:
3233	1.  As a consulting actuary advising an insurer; or
3234	2.  As to the counseling and advising of labor unions,
3235	associations, trustees, employers, or other business entities,
3236	the subsidiaries and affiliates of each, relative to their
3237	interests and those of their members or employees under
3238	insurance benefit plans.
3239	Section 43.  Paragraph (c) of subsection (2) of section
3240	626.292, Florida Statutes, is amended to read:
3241	626.292  Transfer of license from another state.--
3242	(2)  To qualify for a license transfer, an individual
3243	applicant must meet the following requirements:
3244	(c)  The individual shall submit a completed application
3245	for this state which is received by the department within 90
3246	days after the date the individual became a resident of this
3247	state, along with payment of the applicable fees set forth in s.
3248	624.501 and submission of the following documents:
3249	1.  A certification issued by the appropriate official of
3250	the applicant's home state identifying the type of license and
3251	lines of authority under the license and stating that, at the
3252	time the license from the home state was canceled, the applicant
3253	was in good standing in that state or that the state's Producer
3254	Database records, maintained by the National Association of
3255	Insurance Commissioners, its affiliates, or subsidiaries,
3256	indicate that the agent is or was licensed in good standing for
3257	the line of authority requested.
3258	2.  A set of the individual applicant's fingerprints in
3259	accordance with s. 626.171(4)(5).
3260	Section 44.  Paragraph (a) of subsection (2) of section
3261	626.321, Florida Statutes, is amended to read:
3262	626.321  Limited licenses.--
3263	(2)  An entity applying for a license under this section is
3264	required to:
3265	(a)  Submit only one application for a license under s.
3266	626.171. The requirements of s. 626.171(4)(5) shall only apply
3267	to the officers and directors of the entity submitting the
3268	application.
3269	Section 45.  Notwithstanding the amendment to s.
3270	627.6699(5)(c), Florida Statutes, by this act, any right to an
3271	open enrollment offer of health benefit coverage for groups of
3272	fewer than two employees, pursuant to s. 627.6699(5)(c), Florida
3273	Statutes, as it existed immediately before the effective date of
3274	this act, shall remain in full force and effect until the
3275	enactment of s. 627.64872, Florida Statutes, and the subsequent
3276	date upon which such plan begins to accept new risks or members.
3277	Section 46.  Section 465.0244, Florida Statutes, is created
3278	to read:
3279	465.0244  Information disclosure.--Every pharmacy shall
3280	make available on its Internet website a link to the performance
3281	outcome and financial data that is published by the Agency for
3282	Health Care Administration pursuant to s. 408.05(3)(l) and shall
3283	place in the area where customers receive filled prescriptions
3284	notice that such information is available electronically and the
3285	address of its Internet website.
3286	Section 47.  Section 627.6499, Florida Statutes, is amended
3287	to read:
3288	627.6499  Reporting by insurers and third-party
3289	administrators.--
3290	(1)  The office may require any insurer, third-party
3291	administrator, or service company to report any information
3292	reasonably required to assist the board in assessing insurers as
3293	required by this act.
3294	(2)  Each health insurance issuer shall make available on
3295	its Internet website a link to the performance outcome and
3296	financial data that is published by the Agency for Health Care
3297	Administration pursuant to s. 408.05(3)(l) and shall include in
3298	every policy delivered or issued for delivery to any person in
3299	the state or any materials provided as required by s. 627.64725
3300	notice that such information is available electronically and the
3301	address of its Internet website.
3302	Section 48.  Subsections (6) and (7) are added to section
3303	641.54, Florida Statutes, to read:
3304	641.54  Information disclosure.--
3305	(6)  Each health maintenance organization shall make
3306	available to its subscribers the estimated co-pay, coinsurance,
3307	or deductible, whichever is applicable, for any covered
3308	services, the status of the subscriber's maximum annual out-of-
3309	pocket payments for a covered individual or family, and the
3310	status of the subscriber's maximum lifetime benefit. Such
3311	estimate shall not preclude the actual co-pay, coinsurance, or
3312	deductible, whichever is applicable, from exceeding the
3313	estimate.
3314	(7)  Each health maintenance organization shall make
3315	available on its Internet website a link to the performance
3316	outcome and financial data that is published by the Agency for
3317	Health Care Administration pursuant to s. 408.05(3)(l) and shall
3318	include in every policy delivered or issued for delivery to any
3319	person in the state or any materials provided as required by s.
3320	627.64725 notice that such information is available
3321	electronically and the address of its Internet website.
3322	Section 49.  Section 408.02, Florida Statutes, is repealed.
3323	Section 50.  The sum of $250,000 is appropriated from the
3324	Insurance Regulatory Trust Fund in the Department of Financial
3325	Services to the Office of Insurance Regulation for the purpose
3326	of implementing the provisions in this act relating to the Small
3327	Business Health Plan.
3328	Section 51.  The sum of $2 million is appropriated from
3329	General Revenue to the Agency for Health Care Administration for
3330	funding activities relating to the Patient Safety Corporation as
3331	created in this act.
3332	Section 52.  This act shall take effect October 1, 2004.

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