HB 1629

CS

CHAMBER ACTION

1	The Committee on Insurance 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	providing a definition; providing for a fine for failure
11	to provide such information; amending s. 381.734, F.S.;
12	including participation by health care providers, small
13	businesses, and health insurers in the Healthy
14	Communities, Healthy People Program; requiring the
15	Department of Health to provide public Internet access to
16	certain public health programs; requiring the department
17	to monitor and assess the effectiveness of such programs;
18	requiring a report; requiring the Office of Program Policy
19	and Government Accountability to evaluate the
20	effectiveness of such programs; requiring a report;
21	amending s. 395.1041, F.S.; authorizing hospitals to
22	develop certain emergency room diversion programs;
23	amending s. 395.301, F.S.; requiring certain licensed
24	facilities to provide prospective patients certain
25	estimates of charges for services; requiring such
26	facilities to provide patients with certain bill
27	verification information; providing for a fine for failure
28	to provide such information; providing charge limitations;
29	requiring such facilities to establish a patient question
30	review and response methodology; providing requirements;
31	requiring certain licensed facilities to provide public
32	Internet access to certain financial information; amending
33	s. 408.061, F.S.; requiring the Agency for Health Care
34	Administration to require health care facilities, health
35	care providers, and health insurers to submit certain
36	information; providing requirements; requiring the agency
37	to adopt certain risk and severity adjustment
38	methodologies; requiring the agency to adopt certain
39	rules; requiring certain information to be certified;
40	amending s. 408.062, F.S.; requiring the agency to conduct
41	certain health care costs and access research, analyses,
42	and studies; expanding the scope of such studies to
43	include collection of pharmacy retail price data, use of
44	emergency departments, physician information, and Internet
45	patient charge information availability; requiring a
46	report; requiring the agency to conduct additional data-
47	based studies and make recommendations to the Legislature;
48	requiring the agency to develop and implement a strategy
49	to adopt and use electronic health records; authorizing
50	the agency to develop rules to protect electronic records
51	confidentiality; requiring a report to the Governor and
52	Legislature; amending s. 408.05, F.S.; requiring the
53	agency to develop a plan to make performance outcome and
54	financial data available to consumers for health care
55	services comparison purposes; requiring submittal of the
56	plan to the Governor and Legislature; requiring the agency
57	to update the plan; requiring the agency to make the plan
58	available electronically; providing plan requirements;
59	amending s. 409.9066, F.S.; requiring the agency to
60	provide certain information relating to the Medicare
61	prescription discount program; amending s. 408.7056, F.S.;
62	renaming the Statewide Provider and Subscriber Assistance
63	Program as the Subscriber Assistance Program; revising
64	provisions to conform; expanding certain records
65	availability provisions; revising membership provisions
66	relating to a subscriber grievance hearing panel; revising
67	a list of grievances the panel may consider; providing
68	hearing procedures; amending s. 641.3154, F.S., to conform
69	to the renaming of the Subscriber Assistance Program;
70	amending s. 641.511, F.S., to conform to the renaming of
71	the Subscriber Assistance Program; adopting and
72	incorporating by reference the Employee Retirement Income
73	Security Act of 1974, as implemented by federal
74	regulations; amending s. 641.58, F.S., to conform to the
75	renaming of the Subscriber Assistance Program; amending s.
76	408.909, F.S.; expanding a definition of "health flex plan
77	entity" to include public-private partnerships; making a
78	pilot health flex plan program apply permanently
79	statewide; providing additional program requirements;
80	creating s. 381.0271, F.S.; providing definitions;
81	creating the Florida Patient Safety Corporation;
82	authorizing the corporation to create additional not-for-
83	profit corporate subsidiaries for certain purposes;
84	specifying application of public records and public
85	meetings requirements; exempting the corporation and
86	subsidiaries from public procurement provisions; providing
87	purposes; providing for a board of directors; providing
88	for membership; authorizing the corporation to establish
89	certain advisory committees; providing for organization of
90	the corporation; providing for meetings; providing powers
91	and duties of the corporation; requiring the corporation
92	to collect, analyze, and evaluate patient safety data and
93	related information; requiring the corporation to
94	establish a pilot project to identify and report near
95	misses relating to patient safety; requiring the
96	corporation to work with state agencies to develop
97	electronic health records; providing for an active library
98	of evidence-based medicine and patient safety practices;
99	requiring the corporation to develop and recommend core
100	competencies in patient safety and public education
101	programs; requiring an annual report; providing report
102	requirements; authorizing the corporation to seek funding
103	and apply for grants; requiring the Office of Program
104	Policy Analysis and Government Accountability, the
105	Department of Health, and the Agency for Health Care
106	Administration to develop performance standards to
107	evaluate the corporation; amending s. 409.91255, F.S.;
108	expanding assistance to certain health centers to include
109	community emergency room diversion programs and urgent
110	care services; amending s. 627.410, F.S.; requiring
111	insurers to file certain rates with the Office of
112	Insurance Regulation; amending s. 627.6487, F.S.; revising
113	a definition; creating s. 627.64872, F.S.; providing
114	legislative intent; creating the Florida Health Insurance
115	Plan for certain purposes; providing definitions;
116	providing exclusions; providing requirements for operation
117	of the plan; providing for a board of directors; providing
118	for appointment of members; providing for terms;
119	specifying service without compensation; providing for
120	travel and per diem expenses; requiring a plan of
121	operation; providing requirements; providing for powers of
122	the plan; requiring reports to the Governor and
123	Legislature; providing for an actuarial study; providing
124	certain immunity from liability for plan obligations;
125	authorizing the board to provide for indemnification of
126	certain costs; requiring an annually audited financial
127	statement; providing for eligibility for coverage under
128	the plan; providing criteria, requirements, and
129	limitations; specifying certain activity as an unfair
130	trade practice; providing for a plan administrator;
131	providing criteria; providing requirements; providing term
132	limits for the plan administrator; providing duties;
133	providing for paying the administrator; providing for
134	premium rates for plan coverage; providing rate
135	limitations; providing for sources of additional revenue;
136	specifying benefits under the plan; providing criteria,
137	requirements, and limitations; providing for
138	nonduplication of benefits; providing for annual and
139	maximum lifetime benefits; providing for tax exempt
140	status; providing for abolition of the Florida
141	Comprehensive Health Association upon implementation of
142	the plan; providing for continued operation of the Florida
143	Comprehensive Health Association until adoption of a plan
144	of operation for the Florida Health Insurance Plan;
145	providing for enrollment in the plan of persons enrolled
146	in the association; requiring insurers to pay certain
147	assessments to the board for certain purposes; providing
148	criteria, requirements, and limitations for such
149	assessments; providing for repeal of ss. 627.6488,
150	627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
151	627.6498, F.S., relating to the Florida Comprehensive
152	Health Association, upon implementation of the plan;
153	amending s. 627.662, F.S.; providing for application of
154	certain claim payment methodologies to certain types of
155	insurance; providing for certain actions relating to
156	inappropriate utilization of emergency care; amending s.
157	627.6699, F.S.; revising provisions requiring small
158	employer carriers to offer certain health benefit plans;
159	preserving a right to open enrollment for certain small
160	groups; requiring small employer carriers to file and
161	provide coverage under certain high deductible plans;
162	including high deductible plans under certain required
163	plan provisions; creating the Small Employers Access
164	Program; providing legislative intent; providing
165	definitions; providing participation eligibility
166	requirements and criteria; requiring the Office of
167	Insurance Regulation to administer the program by
168	selecting an insurer through competitive bidding;
169	providing requirements; specifying insurer qualifications;
170	providing duties of the insurer; providing a contract
171	term; providing insurer reporting requirements; providing
172	application requirements; providing for benefits under the
173	program; requiring the office to annually report to the
174	Governor and Legislature; creating ss. 627.6405 and
175	641.31097, F.S.; providing for decreasing inappropriate
176	use of emergency care; providing legislative findings and
177	intent; requiring health insurers and health maintenance
178	organizations to provide certain information
179	electronically and develop community emergency department
180	diversion programs; authorizing health insurers to require
181	higher copayments for certain uses of emergency
182	departments; amending s. 627.9175, F.S.; requiring certain
183	health insurers to annually report certain coverage
184	information to the office; providing requirements;
185	deleting certain reporting requirements; retitling ch.
186	636, F.S.; designating ss. 636.002-636.067, F.S., as pt. I
187	of ch. 636, F.S.; providing a part title; amending s.
188	636.003, F.S.; revising the definition of "prepaid limited
189	health service organization" to exclude discount medical
190	plan organizations; creating pt. II of ch. 636, F.S.,
191	consisting of ss. 636.202-636.244, F.S.; providing a part
192	title; providing definitions; providing for regulation and
193	operation of discount medical plan organizations;
194	requiring corporate licensure before doing business as a
195	discount medical plan; specifying application
196	requirements; requiring license fees; providing for
197	expiration and renewal of licenses; requiring such
198	organizations to establish an Internet website; requiring
199	publication of certain information on the website;
200	specifying collection and deposit of the licensing fee;
201	authorizing the office to examine or investigate the
202	business affairs of such organizations; requiring
203	examinations and investigations; authorizing the office to
204	order production of documents and take statements;
205	requiring organizations to pay certain expenses;
206	specifying grounds for denial or revocation under certain
207	circumstances; specifying permitted activities of a
208	discount medical plan organization; prohibiting certain
209	activities; requiring certain disclosures to prospective
210	members; requiring provider agreements to provide services
211	under a medical discount plan; providing agreement
212	requirements; requiring forms and rates to be filed with
213	the office; requiring annual reports to be filed with the
214	office; providing requirements; providing for fines and
215	administrative sanctions for failing to file annual
216	reports; establishing minimum capital requirements;
217	providing for suspension or revocation of licenses under
218	certain circumstances; providing for suspension of
219	enrollment of new members under certain circumstances;
220	providing terms of suspensions; requiring notice of any
221	change of an organization's name; requiring discount
222	medical plan organizations to maintain provider names
223	listings; specifying marketing requirements of discount
224	medical plans; providing limitations; specifying fee
225	disclosure requirements for bundling discount medical
226	plans with other insurance products; authorizing the
227	commission to adopt rules; applying insurer service of
228	process requirements on discount medical plan
229	organizations; requiring a security deposit; prohibiting
230	levy on certain deposit assets or securities under certain
231	circumstances; providing criminal penalties; authorizing
232	the office to seek certain injunctive relief under certain
233	circumstances; providing limitations; providing for civil
234	actions for damages for certain violations; providing for
235	awards of court costs and attorney fees; specifying
236	application of unauthorized insurer provisions of law to
237	unlicensed discount medical plan organizations; creating
238	ss. 627.65626 and 627.6402, F.S.; providing for insurance
239	rebates for healthy lifestyles; providing for rebate of
240	certain premiums for participation in health wellness,
241	maintenance, or improvement programs under certain
242	circumstances; providing requirements; amending s. 641.31,
243	F.S.; authorizing health maintenance organizations
244	offering certain point-of-service riders to offer such
245	riders to certain employers for certain employees;
246	providing requirements and limitations; providing for
247	application of certain claim payment methodologies to
248	certain types of insurance; providing for rebate of
249	certain premiums for participation in health wellness,
250	maintenance, or improvement programs under certain
251	circumstances; providing requirements; amending s.
252	626.015, F.S.; defining "insurance advisor"; amending ss.
253	626.016, 626.342, 626.536, 626.561, 626.572, and 626.601,
254	F.S., to include application of such provisions to
255	insurance advisors; providing penalties; creating s.
256	626.593, F.S.; providing fee and commission limitations
257	for health insurance advisors; requiring a written
258	contract for compensation; providing contract
259	requirements; requiring a rebate of commission under
260	certain circumstances; creating s. 626.594, F.S.;
261	providing qualification requirements for an insurance
262	advisor license; providing an exemption; providing
263	limitations; amending ss. 626.171, 626.191, and 626.201,
264	F.S.; clarifying certain application requirements;
265	amending ss. 624.509 and 626.7845, F.S.; correcting cross
266	references; preserving certain rights to enrollment in
267	certain health benefit coverage programs for certain
268	groups under certain circumstances; creating s. 465.0244,
269	F.S.; requiring each pharmacy to make available on its
270	Internet website a link to certain performance outcome and
271	financial data of the Agency for Health Care
272	Administration and a notice of the availability of such
273	information; amending s. 627.6499, F.S.; requiring each
274	health insurer to make available on its Internet website a
275	link to certain performance outcome and financial data of
276	the Agency for Health Care Administration and a notice in
277	policies of the availability of such information; amending
278	s. 641.54, F.S.; requiring health maintenance
279	organizations to make certain insurance financial
280	information available to subscribers; requiring health
281	maintenance organizations to make available on its
282	Internet website a link to certain performance outcome and
283	financial data of the Agency for Health Care
284	Administration and a notice in policies of the
285	availability of such information; repealing s. 408.02,
286	F.S., relating to the development, endorsement,
287	implementation, and evaluation of patient management
288	practice parameters by the Agency for Health Care
289	Administration; providing appropriations; providing
290	effective dates.
291
292	WHEREAS, according to the Kaiser Family Foundation, eight
293	out of ten uninsured Americans are workers or dependents of
294	workers and nearly eight out of ten uninsured Americans have
295	family incomes above the poverty level, and
296	WHEREAS, fifty-five percent of those who do not have
297	insurance state the reason they don't have insurance is lack of
298	affordability, and
299	WHEREAS, average health insurance premium increases for the
300	last two years have been in the range of ten to twenty percent
301	for Florida's employers, and
302	WHEREAS, an increasing number of employers are opting to
303	cease providing insurance coverage to their employees due to the
304	high cost, and
305	WHEREAS, an increasing number of employers who continue
306	providing coverage are forced to shift more premium cost to
307	their employees, thus diminishing the value of employee wage
308	increases, and
309	WHEREAS, according to studies, the rate of avoidable
310	hospitalization is fifty to seventy percent lower for the
311	insured versus the uninsured, and
312	WHEREAS, according to Florida Cancer Registry data, the
313	uninsured have a seventy percent greater chance of a late
314	diagnosis, thus decreasing the chances of a positive health
315	outcome, and
316	WHEREAS, according to the Agency for Health Care
317	Administration's 2002 financial data, uncompensated care in
318	Florida's hospitals is growing at the rate of twelve to thirteen
319	percent per year, and, at $4.3 billion in 2001, this cost, when
320	shifted to Floridians who remain insured, is not sustainable,
321	and
322	WHEREAS, the Florida Legislature, through the creation of
323	Health Flex, has already identified the need for lower cost
324	alternatives, and
325	WHEREAS, it is of vital importance and in the best
326	interests of the people of the State of Florida that the issue
327	of available, affordable health care insurance be addressed in a
328	cohesive and meaningful manner, and
329	WHEREAS, there is general recognition that the issues
330	surrounding the problem of access to affordable health insurance
331	are complicated and multifaceted, and
332	WHEREAS, on August 14, 2003, Speaker Johnnie Byrd created
333	the Select Committee on Affordable Health Care for Floridians in
334	an effort to address the issue of affordable and accessible
335	employment-based insurance, and
336	WHEREAS, the Select Committee on Affordable Health Care for
337	Floridians held public hearings with predetermined themes around
338	the state, specifically, in Orlando, Miami, Jacksonville, Tampa,
339	Pensacola, Boca Raton, and Tallahassee, from October through
340	November 2003 to effectively probe the operation of the private
341	insurance marketplace, to understand the health insurance market
342	trends, to learn from past policy initiatives, and to identify,
343	explore, and debate new ideas for change, and
344	WHEREAS, recommendations from the Select Committee on
345	Affordable Health Care were adopted on February 4, 2004, to
346	address the multifaceted issues attributed to the increase in
347	health care cost, and
348	WHEREAS, these recommendations were presented to the
349	Speaker of the House of Representatives in a final report from
350	the committee on February 18, 2004, and subsequent legislation
351	was drafted creating the "The 2004 Affordable Health Care for
352	Floridians Act," NOW, THEREFORE,
353
354	Be It Enacted by the Legislature of the State of Florida:
355
356	Section 1.  This act may be referred to by the popular name
357	"The 2004 Affordable Health Care for Floridians Act."
358	Section 2.  The purpose of this act is to address the
359	underlying cause of the double-digit increases in health
360	insurance premiums by mitigating the overall growth in health
361	care costs.
362	Section 3.  Paragraph (c) of subsection (4) of section
363	381.026, Florida Statutes, is amended to read:
364	381.026  Florida Patient's Bill of Rights and
365	Responsibilities.--
366	(4)  RIGHTS OF PATIENTS.--Each health care facility or
367	provider shall observe the following standards:
368	(c)  Financial information and disclosure.--
369	1.  A patient has the right to be given, upon request, by
370	the responsible provider, his or her designee, or a
371	representative of the health care facility full information and
372	necessary counseling on the availability of known financial
373	resources for the patient's health care.
374	2.  A health care provider or a health care facility shall,
375	upon request, disclose to each patient who is eligible for
376	Medicare, in advance of treatment, whether the health care
377	provider or the health care facility in which the patient is
378	receiving medical services accepts assignment under Medicare
379	reimbursement as payment in full for medical services and
380	treatment rendered in the health care provider's office or
381	health care facility.
382	3.  A health care provider or a health care facility shall,
383	upon request, furnish a patient, prior to provision of medical
384	services, a reasonable estimate of charges for such services.
385	Such reasonable estimate shall not preclude the health care
386	provider or health care facility from exceeding the estimate or
387	making additional charges based on changes in the patient's
388	condition or treatment needs.
389	4.  Each licensed facility not operated by the state shall
390	make available to the public on its Internet website or by other
391	electronic means information regarding the package price of
392	service. The term "package price" means all facility-related
393	charges for all services typically associated with a procedure
394	or diagnosis related group. The facility shall maintain on its
395	website a description of and a link to the agency's website
396	which provides an average cost of the top 50 inpatient and top
397	50 outpatient services provided. The facility shall place a
398	notice in the reception areas that such information is available
399	electronically and the website address. The licensed facility
400	may indicate that the pricing information is based on a
401	compilation of charges for the average patient and that each
402	patient's bill may vary from the average depending upon the
403	severity of illness and individual resources consumed. The
404	licensed facility may also indicate that the price of service is
405	negotiable for eligible patients based upon the patient's
406	ability to pay.
407	5.4.  A patient has the right to receive a copy of an
408	itemized bill upon request. A patient has a right to be given an
409	explanation of charges upon request.
410	6.  Failure to provide data upon request shall result in a
411	fine of $500 for each instance of the facility's failure to
412	provide the requested information.
413	Section 4.  Subsection (1) and paragraph (g) of subsection
414	(3) of section 381.734, Florida Statutes, are amended, and
415	subsections (4), (5), and (6) are added to said section, to
416	read:
417	381.734  Healthy Communities, Healthy People Program.--
418	(1)  The department shall develop and implement the Healthy
419	Communities, Healthy People Program, a comprehensive and
420	community-based health promotion and wellness program. The
421	program shall be designed to reduce major behavioral risk
422	factors associated with chronic diseases, including those
423	chronic diseases identified in chapter 385, by enhancing the
424	knowledge, skills, motivation, and opportunities for
425	individuals, organizations, health care providers, small
426	businesses, health insurers, and communities to develop and
427	maintain healthy lifestyles.
428	(3)  The program shall include:
429	(g)  The establishment of a comprehensive program to inform
430	the public, health care professionals, health insurers, and
431	communities about the prevalence of chronic diseases in the
432	state; known and potential risks, including social and
433	behavioral risks; and behavior changes that would reduce risks.
434	(4)  The department shall make available on its Internet
435	website, no later than October 1, 2004, and in a hard-copy
436	format upon request, a listing of age-specific, disease-
437	specific, and community-specific health promotion, preventive
438	care, and wellness programs offered and established under the
439	Healthy Communities, Healthy People Program. The website shall
440	also provide residents with information to identify behavior
441	risk factors that lead to diseases that are preventable by
442	maintaining a healthy lifestyle. The website shall allow
443	consumers to select by county or region disease-specific
444	statistical information.
445	(5)  The department shall monitor and assess the
446	effectiveness of such programs. The department shall submit a
447	status report based on this monitoring and assessment to the
448	Governor, the Speaker of the House of Representatives, the
449	President of the Senate, and the substantive committees of each
450	house of the Legislature, with the first annual report due
451	January 31, 2005.
452	(6)  The Office of Program Policy and Government
453	Accountability shall evaluate and report to the Governor, the
454	President of the Senate, and the Speaker of the House of
455	Representatives, by March 1, 2005, on the effectiveness of the
456	department's monitoring and assessment of the program's
457	effectiveness.
458	Section 5.  Subsection (7) is added to section 395.1041,
459	Florida Statutes, to read:
460	395.1041  Access to emergency services and care.--
461	(7)  EMERGENCY ROOM DIVERSION PROGRAMS.--Hospitals may
462	develop emergency room diversion programs, including, but not
463	limited to, an "Emergency Hotline" which allows patients to help
464	determine if emergency department services are appropriate or if
465	other health care settings may be more appropriate for care, and
466	a "Fast Track" program allowing nonemergency patients to be
467	treated at an alternative site. Alternative sites may include
468	health care programs funded with local tax revenue and federally
469	funded community health centers, county health departments, or
470	other nonhospital providers of health care services. The program
471	may include provisions for followup care and case management.
472	Section 6.  Subsections (1), (2), and (3) of section
473	395.301, Florida Statutes, are amended, and subsections (7),
474	(8), (9), and (10) are added to said section, to read:
475	395.301  Itemized patient bill; form and content prescribed
476	by the agency.--
477	(1)  A licensed facility not operated by the state shall
478	notify each patient during admission and at discharge of his or
479	her right to receive an itemized bill upon request. Within 7
480	days following the patient's discharge or release from a
481	licensed facility not operated by the state, or within 7 days
482	after the earliest date at which the loss or expense from the
483	service may be determined, the licensed facility providing the
484	service shall, upon request, submit to the patient, or to the
485	patient's survivor or legal guardian as may be appropriate, an
486	itemized statement detailing in language comprehensible to an
487	ordinary layperson the specific nature of charges or expenses
488	incurred by the patient, which in the initial billing shall
489	contain a statement of specific services received and expenses
490	incurred for such items of service, enumerating in detail the
491	constituent components of the services received within each
492	department of the licensed facility and including unit price
493	data on rates charged by the licensed facility, as prescribed by
494	the agency.
495	(2)(a)  Each such statement submitted pursuant to this
496	section:
497	1.(a)  May not include charges of hospital-based physicians
498	if billed separately.
499	2.(b)  May not include any generalized category of expenses
500	such as "other" or "miscellaneous" or similar categories.
501	3.(c)  Shall list drugs by brand or generic name and not
502	refer to drug code numbers when referring to drugs of any sort.
503	4.(d)  Shall specifically identify therapy treatment as to
504	the date, type, and length of treatment when therapy treatment
505	is a part of the statement.
506	(b)  Any person receiving a statement pursuant to this
507	section shall be fully and accurately informed as to each charge
508	and service provided by the institution preparing the statement.
509	(3)  On each such itemized statement submitted pursuant to
510	subsection (1) there shall appear the words "A FOR-PROFIT (or
511	NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
512	CENTER) LICENSED BY THE STATE OF FLORIDA" or substantially
513	similar words sufficient to identify clearly and plainly the
514	ownership status of the licensed facility. Each itemized
515	statement must prominently display the phone number of the
516	medical facility's patient liaison who is responsible for
517	expediting the resolution of any billing dispute between the
518	patient, or his or her representative, and the billing
519	department.
520	(7)  Each licensed facility not operated by the state shall
521	provide, prior to provision of any medical services, a written
522	good-faith estimate of reasonably anticipated charges for the
523	facility to treat the patient's condition upon request of a
524	prospective patient who does not have insurance coverage or
525	whose insurer or health maintenance organization does not have a
526	contract with the hospital and an emergency medical condition
527	does not exist or the service is not a covered service. The
528	estimate may be the average charges for that diagnosis related
529	group or the average charges for that procedure. Upon request,
530	the facility shall notify the patient of any revision to the
531	good-faith estimate. Such estimate shall not preclude the actual
532	charges from exceeding the estimate. The facility shall place a
533	notice in reception areas that such information is available
534	electronically and the facility's website address. Failure to
535	provide data upon request shall result in a fine of $500 for
536	each instance of the facility's failure to provide the requested
537	information.
538	(8)  A licensed facility shall make available to a patient
539	all records necessary for verification of the accuracy of the
540	patient's bill within 30 business days after the request for
541	such records. The verification information must be made
542	available in the facility's offices. Such records shall be
543	available to the patient prior to and after payment of the bill
544	or claim. The facility may not charge the patient for making
545	such verification records available; however, the facility may
546	charge its usual fee for providing copies of records as
547	specified in s. 395.3025.
548	(9)  Each facility shall establish a method for reviewing
549	and responding to questions from patients concerning the
550	patient's itemized bill. Such response shall be provided within
551	30 days after the date a question is received. If the patient is
552	not satisfied with the response, the facility must provide the
553	patient with the address of the agency to which the issue may be
554	sent for review.
555	(10)  Each licensed facility shall make available on its
556	Internet website a link to the performance outcome and financial
557	data that is published by the Agency for Health Care
558	Administration pursuant to s. 408.05(3)(l).
559	Section 7.  Subsection (1) of section 408.061, Florida
560	Statutes, is amended to read:
561	408.061  Data collection; uniform systems of financial
562	reporting; information relating to physician charges;
563	confidential information; immunity.--
564	(1)  The agency shall may require the submission by health
565	care facilities, health care providers, and health insurers of
566	data necessary to carry out the agency's duties. Specifications
567	for data to be collected under this section shall be developed
568	by the agency with the assistance of technical advisory panels
569	including representatives of affected entities, consumers,
570	purchasers, and such other interested parties as may be
571	determined by the agency.
572	(a)  Data to be submitted by health care facilities,
573	including the facilities as defined in chapter 395, shall may
574	include, but are not limited to: case-mix data, patient
575	admission and or discharge data, outpatient data which shall
576	include the number of patients treated in the emergency
577	department of a licensed hospital reported by patient acuity
578	level, data on hospital-acquired infections as specified by
579	rule, data on complications as specified by rule, data on
580	readmissions as specified by rule, with patient and provider-
581	specific identifiers included, actual charge data by diagnostic
582	groups, financial data, accounting data, operating expenses,
583	expenses incurred for rendering services to patients who cannot
584	or do not pay, interest charges, depreciation expenses based on
585	the expected useful life of the property and equipment involved,
586	and demographic data. The agency shall adopt the 3M All Patient
587	Refined Diagnosis Related Group software risk and severity
588	adjustment methodology for all data submitted as required by
589	this section. Data may be obtained from documents such as, but
590	not limited to: leases, contracts, debt instruments, itemized
591	patient bills, medical record abstracts, and related diagnostic
592	information. Reported data elements shall be reported
593	electronically in accordance with Rule 59E-7.012, Florida
594	Administrative Code. Data submitted shall be certified by the
595	chief executive officer or an appropriate and duly authorized
596	representative or employee of the licensed facility that the
597	information submitted is true and accurate.
598	(b)  Data to be submitted by health care providers may
599	include, but are not limited to: Medicare and Medicaid
600	participation, types of services offered to patients, amount of
601	revenue and expenses of the health care provider, and such other
602	data which are reasonably necessary to study utilization
603	patterns.
604	(c)  Data to be submitted by health insurers may include
605	percentage of claims denied, percentage of claims meeting prompt
606	pay requirements, and medical and administrative loss ratios,
607	but are not limited to: claims, premium, administration, and
608	financial information. Data submitted shall be certified by the
609	appropriate and duly authorized representative or employee of
610	the insurer that the information submitted is true and accurate.
611	(d)  Data required to be submitted by health care
612	facilities, health care providers, or health insurers shall not
613	include specific provider contract reimbursement information.
614	However, such specific provider reimbursement data shall be
615	reasonably available for onsite inspection by the agency as is
616	necessary to carry out the agency's regulatory duties. Any such
617	data obtained by the agency as a result of onsite inspections
618	may not be used by the state for purposes of direct provider
619	contracting and are confidential and exempt from the provisions
620	of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
621	(e)  A requirement to submit data shall be adopted by rule
622	if the submission of data is being required of all members of
623	any type of health care facility, health care provider, or
624	health insurer. Rules are not required, however, for the
625	submission of data for a special study mandated by the
626	Legislature or when information is being requested for a single
627	health care facility, health care provider, or health insurer.
628	Section 8.  Subsections (1) and (4) of section 408.062,
629	Florida Statutes, are amended, and subsection (5) is added to
630	said section, to read:
631	408.062  Research, analyses, studies, and reports.--
632	(1)  The agency shall have the authority to conduct
633	research, analyses, and studies relating to health care costs
634	and access to and quality of health care services as access and
635	quality are affected by changes in health care costs. Such
636	research, analyses, and studies shall include, but not be
637	limited to, research and analysis relating to:
638	(a)  The financial status of any health care facility or
639	facilities subject to the provisions of this chapter.
640	(b)  The impact of uncompensated charity care on health
641	care facilities and health care providers.
642	(c)  The state's role in assisting to fund indigent care.
643	(d)  In conjunction with the Office of Insurance
644	Regulation, the availability and affordability of health
645	insurance for small businesses.
646	(e)  Total health care expenditures in the state according
647	to the sources of payment and the type of expenditure.
648	(f)  The quality of health services, using techniques such
649	as small area analysis, severity adjustments, and risk-adjusted
650	mortality rates.
651	(g)  The development of physician information payment
652	systems which are capable of providing data for health care
653	consumers taking into account the amount of resources consumed
654	at licensed facilities as defined in chapter 395 and the
655	outcomes produced in the delivery of care.
656	(h)  The collection of a statistically valid sample of data
657	on the retail prices charged by pharmacies for the 50 most
658	frequently prescribed medicines from any pharmacy licensed by
659	this state as a special study authorized by the Legislature to
660	be performed by the agency quarterly. If the drug is available
661	generically, price data shall be reported for the generic drug
662	and price data of a brand-named drug for which the generic drug
663	is the equivalent shall be reported. The agency shall make
664	available on its Internet website for each pharmacy, no later
665	than October 1, 2005, drug prices for a 30-day supply at a
666	standard dose. The data collected shall be reported for each
667	drug by pharmacy and by metropolitan statistical area or region
668	and updated quarterly The impact of subacute admissions on
669	hospital revenues and expenses for purposes of calculating
670	adjusted admissions as defined in s. 408.07.
671	(i)  The use of emergency department services by patient
672	acuity level and the implication of increasing hospital cost by
673	providing nonurgent care in emergency departments. The agency
674	shall submit an annual report based on this monitoring and
675	assessment to the Governor, the Speaker of the House of
676	Representatives, the President of the Senate, and the
677	substantive legislative committees with the first report due
678	January 1, 2006.
679	(j)  The making available on its Internet website no later
680	than October 1, 2004, and in a hard-copy format upon request, of
681	patient charge, volumes, length of stay, and performance outcome
682	indicators collected from health care facilities pursuant to s.
683	408.061(1)(a) for specific medical conditions, surgeries, and
684	procedures provided in inpatient and outpatient facilities as
685	determined by the agency. In making the determination of
686	specific medical conditions, surgeries, and procedures to
687	include, the agency shall consider such factors as volume,
688	severity of the illness, urgency of admission, individual and
689	societal costs, and whether the condition is acute or chronic.
690	Performance outcome indicators shall be risk adjusted or
691	severity adjusted, as applicable, using 3M All Patient Refined
692	Diagnosis Related Groups. The website shall also provide an
693	interactive search that allows consumers to view and compare the
694	information for specific facilities, a map that allows consumers
695	to select a county or region, definitions of all of the data,
696	descriptions of each procedure, and an explanation about why the
697	data may differ from facility to facility. Such public data
698	shall be updated quarterly. The agency shall submit an annual
699	status report on the collection of data and publication of
700	performance outcome indicators to the Governor, the Speaker of
701	the House of Representatives, the President of the Senate, and
702	the substantive legislative committees with the first status
703	report due January 1, 2005.
704	(4)(a)  The agency shall may conduct data-based studies and
705	evaluations and make recommendations to the Legislature and the
706	Governor concerning exemptions, the effectiveness of limitations
707	of referrals, restrictions on investment interests and
708	compensation arrangements, and the effectiveness of public
709	disclosure. Such analysis shall may include, but need not be
710	limited to, utilization of services, cost of care, quality of
711	care, and access to care. The agency may require the submission
712	of data necessary to carry out this duty, which may include, but
713	need not be limited to, data concerning ownership, Medicare and
714	Medicaid, charity care, types of services offered to patients,
715	revenues and expenses, patient-encounter data, and other data
716	reasonably necessary to study utilization patterns and the
717	impact of health care provider ownership interests in health-
718	care-related entities on the cost, quality, and accessibility of
719	health care.
720	(b)  The agency may collect such data from any health
721	facility or licensed health care provider as a special study.
722	(5)  The agency shall develop and implement a strategy for
723	the adoption and use of electronic health records. The agency
724	may develop rules to facilitate the functionality and protect
725	the confidentiality of electronic health records. The agency
726	shall report to the Governor, the Speaker of the House of
727	Representatives, and the President of the Senate on legislative
728	recommendations to protect the confidentiality of electronic
729	health records.
730	Section 9.  Paragraph (l) is added to subsection (3) of
731	section 408.05, Florida Statutes, to read:
732	408.05  State Center for Health Statistics.--
733	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
734	produce comparable and uniform health information and
735	statistics, the agency shall perform the following functions:
736	(l)  Develop, in conjunction with the State Comprehensive
737	Health Information System Advisory Council, and implement a
738	long-range plan for making available performance outcome and
739	financial data that will allow consumers to compare health care
740	services. The performance outcomes and financial data the agency
741	must make available shall include, but is not limited to,
742	pharmaceuticals, physicians, health care facilities, and health
743	plans and managed care entities. The agency shall submit the
744	initial plan to the Governor, the President of the Senate, and
745	the Speaker of the House of Representatives by March 1, 2005,
746	and shall update the plan and report on the status of its
747	implementation annually thereafter. The agency shall also make
748	the plan and status report available to the public on its
749	Internet website. As part of the plan, the agency shall identify
750	the process and timeframes for implementation, any barriers to
751	implementation, and recommendations of changes in the law that
752	may be enacted by the Legislature to eliminate the barriers. As
753	preliminary elements of the plan, the agency shall:
754	1.  Make available performance outcome and patient charge
755	data collected from health care facilities pursuant to s.
756	408.061(1)(a) and (2). The agency shall determine which
757	conditions and procedures, performance outcomes, and patient
758	charge data to disclose based upon input from the council. When
759	determining which conditions and procedures are to be disclosed,
760	the council and the agency shall consider variation in costs,
761	variation in outcomes, and magnitude of variations and other
762	relevant information. When determining which performance
763	outcomes to disclose, the agency:
764	a.  Shall consider such factors as volume of cases; average
765	patient charges; average length of stay; complication rates;
766	mortality rates; and infection rates, among others, which shall
767	be adjusted for case mix and severity, if applicable.
768	b.  May consider such additional measures that are adopted
769	by the Centers for Medicare and Medicaid Studies, National
770	Quality Forum, the Joint Commission on Accreditation of
771	Healthcare Organizations, the Agency for Healthcare Research and
772	Quality, or a similar national entity that establishes standards
773	to measure the performance of health care providers, or by other
774	states.
775
776	When determining which patient charge data to disclose, the
777	agency shall consider such measures as average charge, average
778	net revenue per adjusted patient day, average cost per adjusted
779	patient day, and average cost per admission, among others.
780	2.  Make available performance measures, benefit design,
781	and premium cost data from health plans licensed pursuant to
782	chapter 627 or chapter 641. The agency shall determine which
783	performance outcome and member and subscriber cost data to
784	disclose, based upon input from the council. When determining
785	which data to disclose, the agency shall consider information
786	that may be required by either individual or group purchasers to
787	assess the value of the product, which may include membership
788	satisfaction, quality of care, current enrollment or membership,
789	coverage areas, accreditation status, premium costs, plan costs,
790	premium increases, range of benefits, copayments and
791	deductibles, accuracy and speed of claims payment, credentials
792	of physicians, number of providers, names of network providers,
793	and hospitals in the network.
794	3.  Determine the method and format for public disclosure
795	of data reported pursuant to this paragraph. The agency shall
796	make its determination based upon input from the Comprehensive
797	Health Information System Advisory Council. At a minimum, the
798	data shall be made available on the agency's Internet website in
799	a manner that allows consumers to conduct an interactive search
800	that allows them to view and compare the information for
801	specific providers. The website must include such additional
802	information as is determined necessary to ensure that the
803	website enhances informed decision making among consumers and
804	health care purchasers, which shall include, at a minimum,
805	appropriate guidance on how to use the data and an explanation
806	of why the data may vary from provider to provider. The data
807	specified in subparagraph 1. shall be released no later than
808	March 1, 2005. The data specified in subparagraph 2. shall be
809	released no later than March 1, 2006.
810	Section 10.  Subsection (3) of section 409.9066, Florida
811	Statutes, is amended to read:
812	409.9066  Medicare prescription discount program.--
813	(3)  The Agency for Health Care Administration shall
814	publish, on a free website available to the public, the most
815	recent average wholesale prices for the 200 drugs most
816	frequently dispensed to the elderly and, to the extent possible,
817	shall provide a mechanism that consumers may use to calculate
818	the retail price and the price that should be paid after the
819	discount required in subsection (1) is applied. The agency shall
820	provide retail information by geographic area and retail
821	information by provider within geographical areas.
822	Section 11.  Section 408.7056, Florida Statutes, is amended
823	to read:
824	408.7056  Statewide Provider and Subscriber Assistance
825	Program.--
826	(1)  As used in this section, the term:
827	(a)  "Agency" means the Agency for Health Care
828	Administration.
829	(b)  "Department" means the Department of Financial
830	Services.
831	(c)  "Grievance procedure" means an established set of
832	rules that specify a process for appeal of an organizational
833	decision.
834	(d)  "Health care provider" or "provider" means a state-
835	licensed or state-authorized facility, a facility principally
836	supported by a local government or by funds from a charitable
837	organization that holds a current exemption from federal income
838	tax under s. 501(c)(3) of the Internal Revenue Code, a licensed
839	practitioner, a county health department established under part
840	I of chapter 154, a prescribed pediatric extended care center
841	defined in s. 400.902, a federally supported primary care
842	program such as a migrant health center or a community health
843	center authorized under s. 329 or s. 330 of the United States
844	Public Health Services Act that delivers health care services to
845	individuals, or a community facility that receives funds from
846	the state under the Community Alcohol, Drug Abuse, and Mental
847	Health Services Act and provides mental health services to
848	individuals.
849	(e)  "Managed care entity" means a health maintenance
850	organization or a prepaid health clinic certified under chapter
851	641, a prepaid health plan authorized under s. 409.912, or an
852	exclusive provider organization certified under s. 627.6472.
853	(f)  "Office" means the Office of Insurance Regulation of
854	the Financial Services Commission.
855	(g)  "Panel" means a statewide provider and subscriber
856	assistance panel selected as provided in subsection (11).
857	(2)  The agency shall adopt and implement a program to
858	provide assistance to subscribers and providers, including those
859	whose grievances are not resolved by the managed care entity to
860	the satisfaction of the subscriber or provider. The program
861	shall consist of one or more panels that meet as often as
862	necessary to timely review, consider, and hear grievances and
863	recommend to the agency or the office any actions that should be
864	taken concerning individual cases heard by the panel. The panel
865	shall hear every grievance filed by subscribers and providers on
866	behalf of subscribers, unless the grievance:
867	(a)  Relates to a managed care entity's refusal to accept a
868	provider into its network of providers;
869	(b)  Is part of an internal grievance in a Medicare managed
870	care entity or a reconsideration appeal through the Medicare
871	appeals process which does not involve a quality of care issue;
872	(c)  Is related to a health plan not regulated by the state
873	such as an administrative services organization, third-party
874	administrator, or federal employee health benefit program;
875	(d)  Is related to appeals by in-plan suppliers and
876	providers, unless related to quality of care provided by the
877	plan;
878	(e)  Is part of a Medicaid fair hearing pursued under 42
879	C.F.R. ss. 431.220 et seq.;
880	(f)  Is the basis for an action pending in state or federal
881	court;
882	(g)  Is related to an appeal by nonparticipating providers,
883	unless related to the quality of care provided to a subscriber
884	by the managed care entity and the provider is involved in the
885	care provided to the subscriber;
886	(h)  Was filed before the subscriber or provider completed
887	the entire internal grievance procedure of the managed care
888	entity, the managed care entity has complied with its timeframes
889	for completing the internal grievance procedure, and the
890	circumstances described in subsection (6) do not apply;
891	(i)  Has been resolved to the satisfaction of the
892	subscriber or provider who filed the grievance, unless the
893	managed care entity's initial action is egregious or may be
894	indicative of a pattern of inappropriate behavior;
895	(j)  Is limited to seeking damages for pain and suffering,
896	lost wages, or other incidental expenses, including accrued
897	interest on unpaid balances, court costs, and transportation
898	costs associated with a grievance procedure;
899	(k)  Is limited to issues involving conduct of a health
900	care provider or facility, staff member, or employee of a
901	managed care entity which constitute grounds for disciplinary
902	action by the appropriate professional licensing board and is
903	not indicative of a pattern of inappropriate behavior, and the
904	agency, office, or department has reported these grievances to
905	the appropriate professional licensing board or to the health
906	facility regulation section of the agency for possible
907	investigation; or
908	(l)  Is withdrawn by the subscriber or provider. Failure of
909	the subscriber or the provider to attend the hearing shall be
910	considered a withdrawal of the grievance; or
911	(m)  Is related to a specific exclusion, an express
912	limitation, or a benefit or service not covered by the
913	subscriber contract issued to the member.
914	(3)  The agency shall review all grievances within 60 days
915	after receipt and make a determination whether the grievance
916	shall be heard. Once the agency notifies the panel, the
917	subscriber or provider, and the managed care entity that a
918	grievance will be heard by the panel, the panel shall hear the
919	grievance either in the network area or by teleconference no
920	later than 120 days after the date the grievance was filed. The
921	agency shall notify the parties, in writing, by facsimile
922	transmission, or by phone, of the time and place of the hearing.
923	The panel may take testimony under oath, request certified
924	copies of documents, and take similar actions to collect
925	information and documentation that will assist the panel in
926	making findings of fact and a recommendation. The panel shall
927	issue a written recommendation, supported by findings of fact,
928	to the provider or subscriber, to the managed care entity, and
929	to the agency or the office no later than 15 working days after
930	hearing the grievance. If at the hearing the panel requests
931	additional documentation or additional records, the time for
932	issuing a recommendation is tolled until the information or
933	documentation requested has been provided to the panel. The
934	proceedings of the panel are not subject to chapter 120.
935	(4)  If, upon receiving a proper patient authorization
936	along with a properly filed grievance, the agency requests
937	medical records from a health care provider or managed care
938	entity, the health care provider or managed care entity that has
939	custody of the records has 10 days to provide the records to the
940	agency. Records include medical records, communication logs
941	associated with the grievance both to and from the subscriber,
942	contracts, and any other contents of the internal grievance file
943	associated with the complaint filed with the Subscriber
944	Assistance Program. Failure to provide requested medical records
945	may result in the imposition of a fine of up to $500. Each day
946	that records are not produced is considered a separate
947	violation.
948	(5)  Grievances that the agency determines pose an
949	immediate and serious threat to a subscriber's health must be
950	given priority over other grievances. The panel may meet at the
951	call of the chair to hear the grievances as quickly as possible
952	but no later than 45 days after the date the grievance is filed,
953	unless the panel receives a waiver of the time requirement from
954	the subscriber. The panel shall issue a written recommendation,
955	supported by findings of fact, to the office or the agency
956	within 10 days after hearing the expedited grievance.
957	(6)  When the agency determines that the life of a
958	subscriber is in imminent and emergent jeopardy, the chair of
959	the panel may convene an emergency hearing, within 24 hours
960	after notification to the managed care entity and to the
961	subscriber, to hear the grievance. The grievance must be heard
962	notwithstanding that the subscriber has not completed the
963	internal grievance procedure of the managed care entity. The
964	panel shall, upon hearing the grievance, issue a written
965	emergency recommendation, supported by findings of fact, to the
966	managed care entity, to the subscriber, and to the agency or the
967	office for the purpose of deferring the imminent and emergent
968	jeopardy to the subscriber's life. Within 24 hours after receipt
969	of the panel's emergency recommendation, the agency or office
970	may issue an emergency order to the managed care entity. An
971	emergency order remains in force until:
972	(a)  The grievance has been resolved by the managed care
973	entity;
974	(b)  Medical intervention is no longer necessary; or
975	(c)  The panel has conducted a full hearing under
976	subsection (3) and issued a recommendation to the agency or the
977	office, and the agency or office has issued a final order.
978	(7)  After hearing a grievance, the panel shall make a
979	recommendation to the agency or the office which may include
980	specific actions the managed care entity must take to comply
981	with state laws or rules regulating managed care entities.
982	(8)  A managed care entity, subscriber, or provider that is
983	affected by a panel recommendation may within 10 days after
984	receipt of the panel's recommendation, or 72 hours after receipt
985	of a recommendation in an expedited grievance, furnish to the
986	agency or office written evidence in opposition to the
987	recommendation or findings of fact of the panel.
988	(9)  No later than 30 days after the issuance of the
989	panel's recommendation and, for an expedited grievance, no later
990	than 10 days after the issuance of the panel's recommendation,
991	the agency or the office may adopt the panel's recommendation or
992	findings of fact in a proposed order or an emergency order, as
993	provided in chapter 120, which it shall issue to the managed
994	care entity. The agency or office may issue a proposed order or
995	an emergency order, as provided in chapter 120, imposing fines
996	or sanctions, including those contained in ss. 641.25 and
997	641.52. The agency or the office may reject all or part of the
998	panel's recommendation. All fines collected under this
999	subsection must be deposited into the Health Care Trust Fund.
1000	(10)  In determining any fine or sanction to be imposed,
1001	the agency and the office may consider the following factors:
1002	(a)  The severity of the noncompliance, including the
1003	probability that death or serious harm to the health or safety
1004	of the subscriber will result or has resulted, the severity of
1005	the actual or potential harm, and the extent to which provisions
1006	of chapter 641 were violated.
1007	(b)  Actions taken by the managed care entity to resolve or
1008	remedy any quality-of-care grievance.
1009	(c)  Any previous incidents of noncompliance by the managed
1010	care entity.
1011	(d)  Any other relevant factors the agency or office
1012	considers appropriate in a particular grievance.
1013	(11)(a)  The panel shall consist of the Insurance Consumer
1014	Advocate, or designee thereof, established by s. 627.0613; at
1015	least two members employed by the agency and at least two
1016	members employed by the department, chosen by their respective
1017	agencies; a consumer appointed by the Governor; a physician
1018	appointed by the Governor, as a standing member; and, if
1019	necessary, physicians who have expertise relevant to the case to
1020	be heard, on a rotating basis. The agency may contract with a
1021	medical director, and a primary care physician, or both, who
1022	shall provide additional technical expertise to the panel but
1023	shall not be voting members of the panel. The medical director
1024	shall be selected from a health maintenance organization with a
1025	current certificate of authority to operate in Florida.
1026	(b)  A majority of those panel members required under
1027	paragraph (a) shall constitute a quorum for any meeting or
1028	hearing of the panel. A grievance may not be heard or voted upon
1029	at any panel meeting or hearing unless a quorum is present,
1030	except that a minority of the panel may adjourn a meeting or
1031	hearing until a quorum is present. A panel convened for the
1032	purpose of hearing a subscriber's grievance in accordance with
1033	subsections (2) and (3) shall not consist of more than 11
1034	members.
1035	(12)  Every managed care entity shall submit a quarterly
1036	report to the agency, the office, and the department listing the
1037	number and the nature of all subscribers' and providers'
1038	grievances which have not been resolved to the satisfaction of
1039	the subscriber or provider after the subscriber or provider
1040	follows the entire internal grievance procedure of the managed
1041	care entity. The agency shall notify all subscribers and
1042	providers included in the quarterly reports of their right to
1043	file an unresolved grievance with the panel.
1044	(13)  A proposed order issued by the agency or office which
1045	only requires the managed care entity to take a specific action
1046	under subsection (7) is subject to a summary hearing in
1047	accordance with s. 120.574, unless all of the parties agree
1048	otherwise. If the managed care entity does not prevail at the
1049	hearing, the managed care entity must pay reasonable costs and
1050	attorney's fees of the agency or the office incurred in that
1051	proceeding.
1052	(14)(a)  Any information that identifies a subscriber which
1053	is held by the panel, agency, or department pursuant to this
1054	section is confidential and exempt from the provisions of s.
1055	119.07(1) and s. 24(a), Art. I of the State Constitution.
1056	However, at the request of a subscriber or managed care entity
1057	involved in a grievance procedure, the panel, agency, or
1058	department shall release information identifying the subscriber
1059	involved in the grievance procedure to the requesting subscriber
1060	or managed care entity.
1061	(b)  Meetings of the panel shall be open to the public
1062	unless the provider or subscriber whose grievance will be heard
1063	requests a closed meeting or the agency or the department
1064	determines that information which discloses the subscriber's
1065	medical treatment or history or information relating to internal
1066	risk management programs as defined in s. 641.55(5)(c), (6), and
1067	(8) may be revealed at the panel meeting, in which case that
1068	portion of the meeting during which a subscriber's medical
1069	treatment or history or internal risk management program
1070	information is discussed shall be exempt from the provisions of
1071	s. 286.011 and s. 24(b), Art. I of the State Constitution. All
1072	closed meetings shall be recorded by a certified court reporter.
1073	Section 12.  Paragraph (c) of subsection (4) of section
1074	641.3154, Florida Statutes, is amended to read:
1075	641.3154  Organization liability; provider billing
1076	prohibited.--
1077	(4)  A provider or any representative of a provider,
1078	regardless of whether the provider is under contract with the
1079	health maintenance organization, may not collect or attempt to
1080	collect money from, maintain any action at law against, or
1081	report to a credit agency a subscriber of an organization for
1082	payment of services for which the organization is liable, if the
1083	provider in good faith knows or should know that the
1084	organization is liable. This prohibition applies during the
1085	pendency of any claim for payment made by the provider to the
1086	organization for payment of the services and any legal
1087	proceedings or dispute resolution process to determine whether
1088	the organization is liable for the services if the provider is
1089	informed that such proceedings are taking place. It is presumed
1090	that a provider does not know and should not know that an
1091	organization is liable unless:
1092	(c)  The office or agency makes a final determination that
1093	the organization is required to pay for such services subsequent
1094	to a recommendation made by the Statewide Provider and
1095	Subscriber Assistance Panel pursuant to s. 408.7056; or
1096	Section 13.  Subsection (1), paragraphs (b) and (e) of
1097	subsection (3), paragraph (d) of subsection (4), subsection (5),
1098	paragraph (g) of subsection (6), and subsections (9), (10), and
1099	(11) of section 641.511, Florida Statutes, are amended to read:
1100	641.511  Subscriber grievance reporting and resolution
1101	requirements.--
1102	(1)  Every organization must have a grievance procedure
1103	available to its subscribers for the purpose of addressing
1104	complaints and grievances. Every organization must notify its
1105	subscribers that a subscriber must submit a grievance within 1
1106	year after the date of occurrence of the action that initiated
1107	the grievance, and may submit the grievance for review to the
1108	Statewide Provider and Subscriber Assistance Program panel as
1109	provided in s. 408.7056 after receiving a final disposition of
1110	the grievance through the organization's grievance process. An
1111	organization shall maintain records of all grievances and shall
1112	report annually to the agency the total number of grievances
1113	handled, a categorization of the cases underlying the
1114	grievances, and the final disposition of the grievances.
1115	(3)  Each organization's grievance procedure, as required
1116	under subsection (1), must include, at a minimum:
1117	(b)  The names of the appropriate employees or a list of
1118	grievance departments that are responsible for implementing the
1119	organization's grievance procedure. The list must include the
1120	address and the toll-free telephone number of each grievance
1121	department, the address of the agency and its toll-free
1122	telephone hotline number, and the address of the Statewide
1123	Provider and Subscriber Assistance Program and its toll-free
1124	telephone number.
1125	(e)  A notice that a subscriber may voluntarily pursue
1126	binding arbitration in accordance with the terms of the contract
1127	if offered by the organization, after completing the
1128	organization's grievance procedure and as an alternative to the
1129	Statewide Provider and Subscriber Assistance Program. Such
1130	notice shall include an explanation that the subscriber may
1131	incur some costs if the subscriber pursues binding arbitration,
1132	depending upon the terms of the subscriber's contract.
1133	(4)
1134	(d)  In any case when the review process does not resolve a
1135	difference of opinion between the organization and the
1136	subscriber or the provider acting on behalf of the subscriber,
1137	the subscriber or the provider acting on behalf of the
1138	subscriber may submit a written grievance to the Statewide
1139	Provider and Subscriber Assistance Program.
1140	(5)  Except as provided in subsection (6), the organization
1141	shall resolve a grievance within 60 days after receipt of the
1142	grievance, or within a maximum of 90 days if the grievance
1143	involves the collection of information outside the service area.
1144	These time limitations are tolled if the organization has
1145	notified the subscriber, in writing, that additional information
1146	is required for proper review of the grievance and that such
1147	time limitations are tolled until such information is provided.
1148	After the organization receives the requested information, the
1149	time allowed for completion of the grievance process resumes.
1150	The Employee Retirement Income Security Act of 1974, as
1151	implemented by 29 C.F.R. 2560.503-1, is adopted and incorporated
1152	by reference as applicable to all organizations that administer
1153	small and large group health plans that are subject to 29 C.F.R.
1154	2560.503-1. The claims procedures of the regulations of the
1155	Employee Retirement Income Security Act of 1974 as implemented
1156	by 29 C.F.R. 2560.503-1 shall be the minimum standards for
1157	grievance processes for claims for benefits for small and large
1158	group health plans that are subject to 29 C.F.R. 2560.503-1.
1159	(6)
1160	(g)  In any case when the expedited review process does not
1161	resolve a difference of opinion between the organization and the
1162	subscriber or the provider acting on behalf of the subscriber,
1163	the subscriber or the provider acting on behalf of the
1164	subscriber may submit a written grievance to the Statewide
1165	Provider and Subscriber Assistance Program.
1166	(9)(a)  The agency shall advise subscribers with grievances
1167	to follow their organization's formal grievance process for
1168	resolution prior to review by the Statewide Provider and
1169	Subscriber Assistance Program. The subscriber may, however,
1170	submit a copy of the grievance to the agency at any time during
1171	the process.
1172	(b)  Requiring completion of the organization's grievance
1173	process before the Statewide Provider and Subscriber Assistance
1174	Program panel's review does not preclude the agency from
1175	investigating any complaint or grievance before the organization
1176	makes its final determination.
1177	(10)  Each organization must notify the subscriber in a
1178	final decision letter that the subscriber may request review of
1179	the organization's decision concerning the grievance by the
1180	Statewide Provider and Subscriber Assistance Program, as
1181	provided in s. 408.7056, if the grievance is not resolved to the
1182	satisfaction of the subscriber. The final decision letter must
1183	inform the subscriber that the request for review must be made
1184	within 365 days after receipt of the final decision letter, must
1185	explain how to initiate such a review, and must include the
1186	addresses and toll-free telephone numbers of the agency and the
1187	Statewide Provider and Subscriber Assistance Program.
1188	(11)  Each organization, as part of its contract with any
1189	provider, must require the provider to post a consumer
1190	assistance notice prominently displayed in the reception area of
1191	the provider and clearly noticeable by all patients. The
1192	consumer assistance notice must state the addresses and toll-
1193	free telephone numbers of the Agency for Health Care
1194	Administration, the Statewide Provider and Subscriber Assistance
1195	Program, and the Department of Financial Services. The consumer
1196	assistance notice must also clearly state that the address and
1197	toll-free telephone number of the organization's grievance
1198	department shall be provided upon request. The agency may adopt
1199	rules to implement this section.
1200	Section 14.  Subsection (4) of section 641.58, Florida
1201	Statutes, is amended to read:
1202	641.58  Regulatory assessment; levy and amount; use of
1203	funds; tax returns; penalty for failure to pay.--
1204	(4)  The moneys received and deposited into the Health Care
1205	Trust Fund shall be used to defray the expenses of the agency in
1206	the discharge of its administrative and regulatory powers and
1207	duties under this part, including conducting an annual survey of
1208	the satisfaction of members of health maintenance organizations;
1209	contracting with physician consultants for the Statewide
1210	Provider and Subscriber Assistance Panel; maintaining offices
1211	and necessary supplies, essential equipment, and other
1212	materials, salaries and expenses of required personnel; and
1213	discharging the administrative and regulatory powers and duties
1214	imposed under this part.
1215	Section 15.  Paragraph (f) of subsection (2) and
1216	subsections (3) and (9) of section 408.909, Florida Statutes,
1217	are amended to read:
1218	408.909  Health flex plans.--
1219	(2)  DEFINITIONS.--As used in this section, the term:
1220	(f)  "Health flex plan entity" means a health insurer,
1221	health maintenance organization, health-care-provider-sponsored
1222	organization, local government, health care district, or other
1223	public or private community-based organization, or public-
1224	private partnership that develops and implements an approved
1225	health flex plan and is responsible for administering the health
1226	flex plan and paying all claims for health flex plan coverage by
1227	enrollees of the health flex plan.
1228	(3)  PILOT PROGRAM.--The agency and the office shall each
1229	approve or disapprove health flex plans that provide health care
1230	coverage for eligible participants who reside in the three areas
1231	of the state that have the highest number of uninsured persons,
1232	as identified in the Florida Health Insurance Study conducted by
1233	the agency and in Indian River County. A health flex plan may
1234	limit or exclude benefits otherwise required by law for insurers
1235	offering coverage in this state, may cap the total amount of
1236	claims paid per year per enrollee, may limit the number of
1237	enrollees, or may take any combination of those actions. A
1238	health flex plan offering may include the option of a
1239	catastrophic plan supplementing the health flex plan.
1240	(a)  The agency shall develop guidelines for the review of
1241	applications for health flex plans and shall disapprove or
1242	withdraw approval of plans that do not meet or no longer meet
1243	minimum standards for quality of care and access to care. The
1244	agency shall ensure that the health flex plans follow
1245	standardized grievance procedures similar to those required of
1246	health maintenance organizations.
1247	(b)  The office shall develop guidelines for the review of
1248	health flex plan applications and provide regulatory oversight
1249	of health flex plan advertisement and marketing procedures. The
1250	office shall disapprove or shall withdraw approval of plans
1251	that:
1252	1.  Contain any ambiguous, inconsistent, or misleading
1253	provisions or any exceptions or conditions that deceptively
1254	affect or limit the benefits purported to be assumed in the
1255	general coverage provided by the health flex plan;
1256	2.  Provide benefits that are unreasonable in relation to
1257	the premium charged or contain provisions that are unfair or
1258	inequitable or contrary to the public policy of this state, that
1259	encourage misrepresentation, or that result in unfair
1260	discrimination in sales practices; or
1261	3.  Cannot demonstrate that the health flex plan is
1262	financially sound and that the applicant is able to underwrite
1263	or finance the health care coverage provided.
1264	(c)  The agency and the Financial Services Commission may
1265	adopt rules as needed to administer this section.
1266	(9)  PROGRAM EVALUATION.--The agency and the office shall
1267	evaluate the pilot program and its effect on the entities that
1268	seek approval as health flex plans, on the number of enrollees,
1269	and on the scope of the health care coverage offered under a
1270	health flex plan; shall provide an assessment of the health flex
1271	plans and their potential applicability in other settings; shall
1272	use health flex plans to gather more information to evaluate
1273	low-income consumer driven benefit packages; and shall, by
1274	January 1, 2005, and annually thereafter 2004, jointly submit a
1275	report to the Governor, the President of the Senate, and the
1276	Speaker of the House of Representatives.
1277	Section 16.  Section 381.0271, Florida Statutes, is created
1278	to read:
1279	381.0271  Florida Patient Safety Corporation.--
1280	(1)  DEFINITIONS.--As used in this section, the term:
1281	(a)  "Adverse incident" has the same meanings provided in
1282	ss. 395.0197, 458.351, and 459.026.
1283	(b)  "Corporation" means the Florida Patient Safety
1284	Corporation.
1285	(c)  "Patient safety data" has the same meaning provided in
1286	s. 766.1016.
1287	(2)  CREATION.--
1288	(a)  The Florida Patient Safety Corporation is created as a
1289	not-for-profit corporation and shall be registered,
1290	incorporated, organized, and operated in compliance with chapter
1291	617. The corporation may create not-for-profit corporate
1292	subsidiaries that are organized under the provisions of chapter
1293	617, upon the prior approval of the board of directors, as
1294	necessary, to fulfill its mission.
1295	(b)  The corporation and any authorized and approved
1296	subsidiary are not an agency as defined in s. 20.03(11).
1297	(c)  The corporation and any authorized and approved
1298	subsidiary are subject to the public meetings and records
1299	requirements of s. 24, Art. I of the State Constitution, chapter
1300	119, and s. 286.011.
1301	(d)  The corporation and any authorized and approved
1302	subsidiary are not subject to the provisions of chapter 287.
1303	(e)  The corporation is a patient safety organization as
1304	defined in s. 766.1016.
1305	(3)  PURPOSE.--
1306	(a)  The purpose of the corporation is to serve as a
1307	learning organization dedicated to assisting health care
1308	providers in this state to improve the quality and safety of
1309	health care rendered and to reduce harm to patients. The
1310	corporation shall promote the development of a culture of
1311	patient safety in the health care system in this state. The
1312	corporation shall not regulate health care providers in this
1313	state.
1314	(b)  In fulfilling its purpose, the corporation shall work
1315	with a consortium of patient safety centers and other patient
1316	safety programs.
1317	(4)  BOARD OF DIRECTORS; MEMBERSHIP.--The corporation shall
1318	be governed by a board of directors. The board of directors
1319	shall consist of:
1320	(a)  The chair of the Florida Council of Medical School
1321	Deans.
1322	(b)  Two persons responsible for patient safety issues for
1323	the authorized health insurer and authorized health maintenance
1324	organization with the largest market shares, respectively, as
1325	measured by premiums written in the state for the most recent
1326	calendar year, appointed by such insurer.
1327	(c)  A representative of an authorized medical malpractice
1328	insurer appointed by the Florida Insurance Council.
1329	(d)  The president of the Central Florida Health Care
1330	Coalition.
1331	(e)  Two representatives of a hospital in this state that
1332	is implementing innovative patient safety initiatives, appointed
1333	by the Florida Hospital Association.
1334	(f)  A physician with expertise in patient safety,
1335	appointed by the Florida Medical Association.
1336	(g)  A physician with expertise in patient safety,
1337	appointed by the Florida Osteopathic Medical Association.
1338	(h)  A physician with expertise in patient safety,
1339	appointed by the Florida Podiatric Medical Association.
1340	(i)  A physician with expertise in patient safety,
1341	appointed by the Florida Chiropractic Association.
1342	(j)  A dentist with expertise in patient safety, appointed
1343	by the Florida Dental Association.
1344	(k)  A nurse with expertise in patient safety, appointed by
1345	the Florida Nurses Association.
1346	(l)  An institutional pharmacist, appointed by the Florida
1347	Society of Health-System Pharmacists.
1348	(m)  A representative of Florida AARP, appointed by the
1349	state director of Florida AARP.
1350	(5)  ADVISORY COMMITTEES.--In addition to any committees
1351	that the corporation may establish, the corporation shall
1352	establish the following advisory committees:
1353	(a)  A scientific research advisory committee that
1354	includes, at a minimum, a representative from each patient
1355	safety center or other patient safety program in the
1356	universities of the state who are physicians licensed pursuant
1357	to chapter 458 or chapter 459, with experience in patient safety
1358	and evidenced-based medicine. The duties of the advisory
1359	committee shall include, but not be limited to, the analysis of
1360	existing data and research to improve patient safety and
1361	encourage evidence-based medicine.
1362	(b)  A technology advisory committee that includes, at a
1363	minimum, a representative of a hospital that has implemented a
1364	computerized physician order entry system and a health care
1365	provider that has implemented an electronic medical records
1366	system. The duties of the advisory committee shall include, but
1367	not be limited to, implementation of new technologies, including
1368	electronic medical records.
1369	(c)  A health care provider advisory committee that
1370	includes, at a minimum, representatives of hospitals, ambulatory
1371	surgical centers, physicians, nurses, and pharmacists licensed
1372	in this state and a representative of the Veterans Integrated
1373	Service Network 8, Virginia Patient Safety Center. The duties of
1374	the advisory committee shall include, but not be limited to,
1375	promotion of a culture of patient safety that reduces errors.
1376	(d)  A health care consumer advisory committee that
1377	includes, at a minimum, representatives of businesses that
1378	provide health insurance coverage to their employees, consumer
1379	advocacy groups, and representatives of patient safety
1380	organizations. The duties of the advisory committee shall
1381	include, but not be limited to, incentives to encourage patient
1382	safety and the efficiency and quality of care.
1383	(e)  A state agency advisory committee that includes, at a
1384	minimum, a representative from each state agency that has
1385	regulatory responsibilities related to patient safety. The
1386	duties of the advisory committee shall include, but not be
1387	limited to, interagency coordination of patient safety efforts.
1388	(f)  A tort advisory committee that includes, at a minimum,
1389	representatives of medical malpractice attorneys for plaintiffs
1390	and defendants and a representative of each law school in the
1391	state. The duties of the advisory committee shall include, but
1392	not be limited to, alternatives systems to compensate for
1393	injuries.
1394	(6)  ORGANIZATION; MEETINGS.--
1395	(a)  The Agency for Health Care Administration shall assist
1396	the corporation in its organizational activities required under
1397	chapter 617, including, but not limited to:
1398	1.  Eliciting appointments for the initial board of
1399	directors.
1400	2.  Convening the first meeting of the board of directors
1401	and assisting with other meetings of the board of directors,
1402	upon request of the board of directors, during the first year of
1403	operation of the corporation.
1404	3.  Drafting articles of incorporation for the board of
1405	directors and, upon request of the board of directors,
1406	delivering articles of incorporation to the Department of State
1407	for filing.
1408	4.  Drafting proposed bylaws for the corporation.
1409	5.  Paying fees related to incorporation.
1410	6.  Providing office space and administrative support, at
1411	the request of the board of directors, but not beyond July 1,
1412	2005.
1413	(b)  The board of directors must conduct its first meeting
1414	no later than August 1, 2004, and shall meet thereafter as
1415	frequently as necessary to carry out the duties of the
1416	corporation.
1417	(7)  POWERS AND DUTIES.--
1418	(a)  In addition to the powers and duties prescribed in
1419	chapter 617, and the articles and bylaws adopted under that
1420	chapter, the corporation shall, directly or through contract:
1421	1.  Secure staff necessary to properly administer the
1422	corporation.
1423	2.  Collect, analyze, and evaluate patient safety data and
1424	quality and patient safety indicators, medical malpractice
1425	closed claims, and adverse incidents reported to the Agency for
1426	Health Care Administration and the Department of Health for the
1427	purpose of recommending changes in practices and procedures that
1428	may be implemented by health care practitioners and health care
1429	facilities to improve health care quality and to prevent future
1430	adverse incidents. Notwithstanding any other provision of law,
1431	the Agency for Health Care Administration and the Department of
1432	Health shall make available to the corporation any adverse
1433	incident report submitted under ss. 395.0197, 458.351, and
1434	459.026. To the extent that adverse incident reports submitted
1435	under s. 395.0197 are confidential and exempt, the confidential
1436	and exempt status of such reports shall be maintained by the
1437	corporation.
1438	3.  Establish a 3-year pilot project of a "near-miss,"
1439	patient safety reporting system. The purpose of the near-miss
1440	reporting system is to: identify potential systemic problems
1441	that could lead to adverse incidents; enable publication of
1442	systemwide alerts of potential harm; and facilitate development
1443	of both facility-specific and statewide options to avoid adverse
1444	incidents and improve patient safety. The reporting system shall
1445	record "near misses" submitted by hospitals, birthing centers,
1446	and ambulatory surgical facilities and other providers. For the
1447	purpose of the reporting system:
1448	a.  A "near miss" means any potentially harmful event that
1449	could have had an adverse result but, through chance or
1450	intervention in which, harm was prevented.
1451	b.  The near-miss reporting system shall be voluntary and
1452	anonymous and independent of mandatory reporting systems used
1453	for regulatory purposes.
1454	c.  Near-miss data submitted to the corporation is patient
1455	safety data as defined in s. 766.1016.
1456	d.  Reports of near-miss data shall be published on a
1457	regular basis and special alerts shall be published as needed
1458	regarding newly identified, significant risks.
1459	e.  Aggregated data shall be made available publicly.
1460	f.  The corporation shall report the performance and
1461	results of the pilot project in its annual report.
1462	4.  Work collaboratively with the appropriate state
1463	agencies in the development of electronic health records.
1464	5.  Provide for access to an active library of evidence-
1465	based medicine and patient safety practices, together with the
1466	emerging evidence supporting their retention or modification,
1467	and make this information available to health care
1468	practitioners, health care facilities, and the public. Support
1469	for implementation of evidence-based medicine shall include:
1470	a.  A report to the Governor, the President of the Senate,
1471	the Speaker of the House of Representatives, and the Agency for
1472	Health Care Administration by January 1, 2005, on:
1473	(I)  The ability to join or support efforts for the use of
1474	evidence-based medicine already underway, such as those of the
1475	Leapfrog Group, the international group Bandolier, and the
1476	Healthy Florida Foundation.
1477	(II)  The means by which to promote research using Medicaid
1478	and other data collected by the Agency for Health Care
1479	Administration to identify and quantify the most cost-effective
1480	treatment and interventions, including disease management and
1481	prevention programs.
1482	(III)  The means by which to encourage development of
1483	systems to measure and reward providers who implement evidence-
1484	based medical practices.
1485	(IV)  The review of other state and private initiatives and
1486	published literature for promising approaches and the
1487	dissemination of information about them to providers.
1488	(V)  The encouragement of the Florida health care boards
1489	under the Department of Health to regularly publish findings
1490	related to the cost-effectiveness of disease-specific, evidence-
1491	based standards.
1492	(VI)  Public and private sector initiatives related to
1493	evidence-based medicine and communication systems for the
1494	sharing of clinical information among caregivers.
1495	(VII)  Regulatory barriers that interfere with the sharing
1496	of clinical information among caregivers.
1497	b.  An implementation plan reported to the Governor, the
1498	President of the Senate, the Speaker of the House of
1499	Representatives, and the Agency for Health Care Administration
1500	by September 1, 2005, that must include, but need not be limited
1501	to: estimated costs and savings, capital investment
1502	requirements, recommended investment incentives, initial
1503	committed provider participation by region, standards of
1504	functionality and features, a marketing plan, and implementation
1505	schedules for key components.
1506	6.  Develop and recommend core competencies in patient
1507	safety that can be incorporated into the curricula in schools of
1508	medicine, nursing, and allied health in the state.
1509	7.  Develop and recommend programs to educate the public
1510	about the role of health care consumers in promoting patient
1511	safety.
1512	8.  Provide recommendations for interagency coordination of
1513	patient safety efforts in the state.
1514	(b)  In carrying out its powers and duties, the corporation
1515	may also:
1516	1.  Assess the patient safety culture at volunteering
1517	hospitals and recommend methods to improve the working
1518	environment related to patient safety at these hospitals.
1519	2.  Inventory the information technology capabilities
1520	related to patient safety of health care facilities and health
1521	care practitioners and recommend a plan for expediting the
1522	implementation of patient safety technologies statewide.
1523	3.  Recommend continuing medical education regarding
1524	patient safety to practicing health care practitioners.
1525	4.  Study and facilitate the testing of alternative systems
1526	of compensating injured patients as a means of reducing and
1527	preventing medical errors and promoting patient safety.
1528	(8)  ANNUAL REPORT.--By December 1, 2004, the corporation
1529	shall prepare a report on the startup activities of the
1530	corporation and any proposals for legislative action that are
1531	needed for the corporation to fulfill its purposes under this
1532	section. By December 1 of each year thereafter, the corporation
1533	shall prepare a report for the preceding fiscal year. The
1534	report, at a minimum, must include:
1535	(a)  A description of the activities of the corporation
1536	under this section.
1537	(b)  Progress made in improving patient safety and reducing
1538	medical errors.
1539	(c)  Policies and programs that have been implemented and
1540	their outcomes.
1541	(d)  A compliance and financial audit of the accounts and
1542	records of the corporation at the end of the preceding fiscal
1543	year conducted by an independent certified public accountant.
1544	(e)  Recommendations for legislative action needed to
1545	improve patient safety in the state.
1546	(f)  An assessment of the ability of the corporation to
1547	fulfill the duties specified in this section.
1548
1549	The corporation shall submit the report to the Governor, the
1550	President of the Senate, and the Speaker of the House of
1551	Representatives.
1552	(9)  FUNDING.--The corporation is required to seek private
1553	sector funding and apply for grants to accomplish its goals and
1554	duties.
1555	(10)  PERFORMANCE EXPECTATIONS.--The Office of Program
1556	Policy Analysis and Government Accountability, the Agency for
1557	Health Care Administration, and the Department of Health shall
1558	develop performance standards by which to measure the success of
1559	the corporation in fulfilling the purposes established in this
1560	section. Using the performance standards, the Office of Program
1561	Policy Analysis and Government Accountability shall conduct a
1562	performance audit of the corporation during 2006 and shall
1563	submit a report to the Governor, the President of the Senate,
1564	and the Speaker of the House of Representatives by January 1,
1565	2007.
1566	Section 17.  Subsection (3) of section 409.91255, Florida
1567	Statutes, is amended to read:
1568	409.91255  Federally qualified health center access
1569	program.--
1570	(3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.--The
1571	Department of Health shall develop a program for the expansion
1572	of federally qualified health centers for the purpose of
1573	providing comprehensive primary and preventive health care and
1574	urgent care services, including services that may reduce the
1575	morbidity, mortality, and cost of care among the uninsured
1576	population of the state. The program shall provide for
1577	distribution of financial assistance to federally qualified
1578	health centers that apply and demonstrate a need for such
1579	assistance in order to sustain or expand the delivery of primary
1580	and preventive health care services. In selecting centers to
1581	receive this financial assistance, the program:
1582	(a)  Shall give preference to communities that have few or
1583	no community-based primary care services or in which the current
1584	services are unable to meet the community's needs.
1585	(b)  Shall require that primary care services be provided
1586	to the medically indigent using a sliding fee schedule based on
1587	income.
1588	(c)  Shall allow innovative and creative uses of federal,
1589	state, and local health care resources.
1590	(d)  Shall require that the funds provided be used to pay
1591	for operating costs of a projected expansion in patient
1592	caseloads or services or for capital improvement projects.
1593	Capital improvement projects may include renovations to existing
1594	facilities or construction of new facilities, provided that an
1595	expansion in patient caseloads or services to a new patient
1596	population will occur as a result of the capital expenditures.
1597	The department shall include in its standard contract document a
1598	requirement that any state funds provided for the purchase of or
1599	improvements to real property are contingent upon the contractor
1600	granting to the state a security interest in the property at
1601	least to the amount of the state funds provided for at least 5
1602	years from the date of purchase or the completion of the
1603	improvements or as further required by law. The contract must
1604	include a provision that, as a condition of receipt of state
1605	funding for this purpose, the contractor agrees that, if it
1606	disposes of the property before the department's interest is
1607	vacated, the contractor will refund the proportionate share of
1608	the state's initial investment, as adjusted by depreciation.
1609	(e)  May require in-kind support from other sources.
1610	(f)  May encourage coordination among federally qualified
1611	health centers, other private-sector providers, and publicly
1612	supported programs.
1613	(g)  Shall allow the development of community emergency
1614	room diversion programs in conjunction with local resources,
1615	providing extended hours of operation to urgent care patients.
1616	Diversion programs shall include case management for emergency
1617	room followup care.
1618	Section 18.  Paragraph (a) of subsection (6) of section
1619	627.410, Florida Statutes, is amended to read:
1620	627.410  Filing, approval of forms.--
1621	(6)(a)  An insurer shall not deliver or issue for delivery
1622	or renew in this state any health insurance policy form until it
1623	has filed with the office a copy of every applicable rating
1624	manual, rating schedule, change in rating manual, and change in
1625	rating schedule; if rating manuals and rating schedules are not
1626	applicable, the insurer must file with the office order
1627	applicable premium rates and any change in applicable premium
1628	rates. This paragraph does not apply to group health insurance
1629	policies, effectuated and delivered in this state, insuring
1630	groups of 51 or more persons, except for Medicare supplement
1631	insurance, long-term care insurance, and any coverage under
1632	which the increase in claim costs over the lifetime of the
1633	contract due to advancing age or duration is prefunded in the
1634	premium.
1635	Section 19.  Paragraph (b) of subsection (3) of section
1636	627.6487, Florida Statutes, is amended to read:
1637	627.6487  Guaranteed availability of individual health
1638	insurance coverage to eligible individuals.--
1639	(3)  For the purposes of this section, the term "eligible
1640	individual" means an individual:
1641	(b)  Who is not eligible for coverage under:
1642	1.  A group health plan, as defined in s. 2791 of the
1643	Public Health Service Act;
1644	2.  A conversion policy or contract issued by an authorized
1645	insurer or health maintenance organization under s. 627.6675 or
1646	s. 641.3921, respectively, offered to an individual who is no
1647	longer eligible for coverage under either an insured or self-
1648	insured employer plan;
1649	3.  Part A or part B of Title XVIII of the Social Security
1650	Act; or
1651	4.  A state plan under Title XIX of such act, or any
1652	successor program, and does not have other health insurance
1653	coverage; or
1654	5.  The Florida Health Insurance Plan as specified in s.
1655	627.64872 and such plan is accepting new enrollment;
1656	Section 20.  Section 627.64872, Florida Statutes, is
1657	created to read:
1658	627.64872  Uninsurable risk assumption plan.--
1659	(1)  LEGISLATIVE INTENT; FLORIDA HEALTH INSURANCE PLAN.--
1660	(a)  The Legislature recognizes that to secure a more
1661	stable and orderly health insurance market, the establishment of
1662	a plan to assume risks deemed uninsurable by the private
1663	marketplace is required.
1664	(b)  The Florida Health Insurance Plan is to make coverage
1665	available to individuals who have no other option for similar
1666	coverage, at a premium that is commensurate with the risk and
1667	benefits provided, and with benefit designs that are reasonable
1668	in relation to the general market. While plan operations may
1669	include supplementary funding, the plan shall fundamentally
1670	operate on sound actuarial principles, using basic insurance
1671	management techniques to ensure that the plan is run in an
1672	economical, cost-efficient, and sound manner, conserving plan
1673	resources to serve the maximum number of people possible in a
1674	sustainable fashion.
1675	(2)  DEFINITIONS.--As used in this section:
1676	(a)  "Board" means the board of directors of the plan.
1677	(b)  "Dependent" means a resident spouse or resident
1678	unmarried child under the age of 19 years, a child who is a
1679	student under the age of 25 years and who is financially
1680	dependent upon the parent, or a child of any age who is disabled
1681	and dependent upon the parent.
1682	(c)  "Director" means the director of the Office of
1683	Insurance Regulation.
1684	(d)  "Health insurance" means any hospital or medical
1685	expense incurred policy, health maintenance organization
1686	subscriber contract pursuant to chapter 641. The term does not
1687	include short term, accident, dental-only, vision-only, fixed
1688	indemnity, limited benefit, or credit insurance; disability
1689	income insurance; coverage for onsite medical clinics; insurance
1690	coverage specified in federal regulations issued pursuant to
1691	Pub. L. No. 104-191, under which benefits for medical care are
1692	secondary or incidental to other insurance benefits; benefits
1693	for long-term care, nursing home care, home health care,
1694	community-based care, or any combination thereof, or other
1695	similar, limited benefits specified in federal regulations
1696	issued pursuant to Pub. L. No. 104-191; benefits provided under
1697	a separate policy, certificate, or contract of insurance, under
1698	which there is no coordination between the provision of the
1699	benefits and any exclusion of benefits under any group health
1700	plan maintained by the same plan sponsor and the benefits are
1701	paid with respect to an event without regard to whether benefits
1702	are provided with respect to such an event under any group
1703	health plan maintained by the same plan sponsor, such as for
1704	coverage only for a specified disease or illness; hospital
1705	indemnity or other fixed indemnity insurance; coverage offered
1706	as a separate policy, certificate, or contract of insurance,
1707	such as Medicare supplemental health insurance as defined under
1708	s. 1882(g)(1) of the Social Security Act; coverage supplemental
1709	to the coverage provided under Chapter 55 of Title 10, United
1710	States Code, the Civilian Health and Medical Program of the
1711	Uniformed Services (CHAMPUS); similar supplemental coverage
1712	provided to coverage under a group health plan; coverage issued
1713	as a supplement to liability insurance; insurance arising out of
1714	a workers' compensation or similar law; automobile medical
1715	payment insurance; or insurance under which benefits are payable
1716	with or without regard to fault and which is statutorily
1717	required to be contained in any liability insurance policy or
1718	equivalent selfinsurance.
1719	(e)  "Implementation" means the effective date of the
1720	establishment of the board.
1721	(f)  "Insurer" means any entity that provides health
1722	insurance in this state. For purposes of this section, insurer
1723	includes an insurance company with a valid certificate in
1724	accordance with chapter 624, a health maintenance organization
1725	with a valid certificate of authority in accordance with part I
1726	or part III of chapter 641, a prepaid health clinic authorized
1727	to transact business in this state pursuant to part II of
1728	chapter 641, multiple employer welfare arrangements authorized
1729	to transact business in this state pursuant to ss. 624.436-
1730	624.45, or a fraternal benefit society providing health benefits
1731	to its members as authorized pursuant to chapter 632.
1732	(g)  "Medicare" means coverage under both Parts A and B of
1733	Title XVIII of the Social Security Act, 42 USC 1395 et seq., as
1734	amended.
1735	(h)  "Medicaid" means coverage under Title XIX of the
1736	Social Security Act.
1737	(i)  "Office" means the Office of Insurance Regulation of
1738	the Financial Services Commission.
1739	(j)  "Participating insurer" means any insurer providing
1740	health insurance to citizens of this state.
1741	(k)  "Provider" means any physician, hospital, or other
1742	institution, organization, or person that furnishes health care
1743	services and is licensed or otherwise authorized to practice in
1744	the state.
1745	(l)  "Plan" means the Florida Health Insurance Plan created
1746	in subsection (1).
1747	(m)  "Plan of operation" means the articles, bylaws, and
1748	operating rules and procedures adopted by the board pursuant to
1749	this section.
1750	(n)  "Resident" means an individual who has been legally
1751	domiciled in this state for a period of at least 12 months with
1752	exception of residents deemed eligible under the federal Health
1753	Insurance Portability and Accountability Act of 1996.
1754	(3)  BOARD OF DIRECTORS.--
1755	(a)  The plan shall operate subject to the supervision and
1756	control of the board. The board shall consist of the director or
1757	his or her designated representative, who shall serve as a
1758	member of the board and shall be its chair, and an additional
1759	eight members, five of whom shall be appointed by the Governor,
1760	at least two of whom shall be individuals not representative of
1761	insurers or health care providers, one of whom shall be
1762	appointed by the President of the Senate, one of whom shall be
1763	appointed by the Speaker of the House of Representatives, and
1764	one of whom shall be appointed by the Chief Financial Officer.
1765	(b)  The initial board members shall be appointed as
1766	follows: one-third of the members to serve a term of 2 years;
1767	one-third of the members to serve a term of 4 years; and one-
1768	third of the members to serve a term of 6 years. Subsequent
1769	board members shall serve for a term of 3 years. A board
1770	member's term shall continue until his or her successor is
1771	appointed.
1772	(c)  Vacancies in the board shall be filled by the
1773	appointing authority, such authority being the Governor, the
1774	President of the Senate, the Speaker of the House of
1775	Representatives, or the Chief Financial Officer. Board members
1776	may be removed by the appointing authority for cause.
1777	(d)  The board shall conduct its first meeting by September
1778	1, 2004.
1779	(e)  Members shall not be compensated in their capacity as
1780	board members but shall be reimbursed for reasonable expenses
1781	incurred in the necessary performance of their duties in
1782	accordance with s. 112.061.
1783	(f)  The board shall submit to the Financial Services
1784	Commission a plan of operation for the plan and any amendments
1785	thereto necessary or suitable to ensure the fair, reasonable,
1786	and equitable administration of the plan. The plan of operation
1787	shall ensure that the plan qualifies to apply for any available
1788	funding from the Federal Government that adds to the financial
1789	viability of the plan. The plan of operation shall become
1790	effective upon approval in writing by the Financial Services
1791	Commission consistent with the date on which the coverage under
1792	this section must be made available. If the board fails to
1793	submit a suitable plan of operation within one year after the
1794	appointment of the board of directors, or at any time thereafter
1795	fails to submit suitable amendments to the plan of operation,
1796	the Financial Services Commission shall adopt such rules as are
1797	necessary or advisable to effectuate the provisions of this
1798	section. Such rules shall continue in force until modified by
1799	the office or superseded by a plan of operation submitted by the
1800	board and approved by the Financial Services Commission.
1801	(4)  PLAN OF OPERATION.--The plan of operation shall:
1802	(a)  Establish procedures for operation of the plan.
1803	(b)  Establish procedures for selecting an administrator in
1804	accordance with subsection (11).
1805	(c)  Establish procedures to create a fund, under
1806	management of the board, for administrative expenses.
1807	(d)  Establish procedures for the handling, accounting, and
1808	auditing of assets, moneys, and claims of the plan and the plan
1809	administrator.
1810	(e)  Develop and implement a program to publicize the
1811	existence of the plan, plan eligibility requirements, and
1812	procedures for enrollment and maintain public awareness of the
1813	plan.
1814	(f)  Establish procedures under which applicants and
1815	participants may have grievances reviewed by a grievance
1816	committee appointed by the board. The grievances shall be
1817	reported to the board after completion of the review, with the
1818	committee's recommendation for grievance resolution. The board
1819	shall retain all written grievances regarding the plan for at
1820	least 3 years.
1821	(g)  Provide for other matters as may be necessary and
1822	proper for the execution of the board's powers, duties, and
1823	obligations under this section.
1824	(5)  POWERS OF THE PLAN.--The plan shall have the general
1825	powers and authority granted under the laws of this state to
1826	health insurers and, in addition thereto, the specific authority
1827	to:
1828	(a)  Enter into such contracts as are necessary or proper
1829	to carry out the provisions and purposes of this section,
1830	including the authority, with the approval of the Chief
1831	Financial Officer, to enter into contracts with similar plans of
1832	other states for the joint performance of common administrative
1833	functions, or with persons or other organizations for the
1834	performance of administrative functions.
1835	(b)  Take any legal actions necessary or proper to recover
1836	or collect assessments due the plan.
1837	(c)  Take such legal action as is necessary to:
1838	1.  Avoid payment of improper claims against the plan or
1839	the coverage provided by or through the plan;
1840	2.  Recover any amounts erroneously or improperly paid by
1841	the plan;
1842	3.  Recover any amounts paid by the plan as a result of
1843	mistake of fact or law; or
1844	4.  Recover other amounts due the plan.
1845	(d)  Establish, and modify as appropriate, rates, rate
1846	schedules, rate adjustments, expense allowances, agents'
1847	commissions, claims reserve formulas, and any other actuarial
1848	functions appropriate to the operation of the plan. Rates and
1849	rate schedules may be adjusted for appropriate factors such as
1850	age, sex, and geographic variation in claim cost and shall take
1851	into consideration appropriate factors in accordance with
1852	established actuarial and underwriting practices. For purposes
1853	of this paragraph, usual and customary agent's commissions shall
1854	be paid for the initial placement of coverage with the plan and
1855	for one renewal only.
1856	(e)  Issue policies of insurance in accordance with the
1857	requirements of this section.
1858	(f)  Appoint appropriate legal, actuarial, investment, and
1859	other committees as necessary to provide technical assistance in
1860	the operation of the plan and develop and educate its
1861	policyholders regarding health savings accounts, policy and
1862	contract design, and any other function within the authority of
1863	the plan.
1864	(g)  Borrow money to effectuate the purposes of the plan.
1865	Any notes or other evidence of indebtedness of the plan not in
1866	default shall be legal investments for insurers and may be
1867	carried as admitted assets.
1868	(h)  Employ and fix the compensation of employees.
1869	(i)  Prepare and distribute certificate of eligibility
1870	forms and enrollment instruction forms to insurance producers
1871	and to the general public.
1872	(j)  Provide for reinsurance of risks incurred by the plan.
1873	(k)  Provide for and employ cost-containment measures and
1874	requirements, including, but not limited to, preadmission
1875	screening, second surgical opinion, concurrent utilization
1876	review, and individual case management for the purpose of making
1877	the plan more cost-effective.
1878	(l)  Design, use, contract, or otherwise arrange for the
1879	delivery of cost-effective health care services, including, but
1880	not limited to, establishing or contracting with preferred
1881	provider organizations, health maintenance organizations, and
1882	other limited network provider arrangements.
1883	(m)  Adopt such bylaws, policies, and procedures as may be
1884	necessary or convenient for the implementation of this section
1885	and the operation of the plan.
1886	(6)  INTERIM REPORT; ANNUAL REPORT.--
1887	(a)  By no later than December 1, 2004, the board shall
1888	report to the Governor, the President of the Senate, and the
1889	Speaker of the House of Representatives the results of an
1890	actuarial study conducted by the board to determine, including,
1891	but not being limited to:
1892	1.  The impact the creation of the plan will have on the
1893	small group insurance market and the individual market on
1894	premiums paid by insureds. This shall include an estimate of the
1895	total anticipated aggregate savings for all small employers in
1896	the state.
1897	2.  The number of individuals the pool could reasonably
1898	cover at various funding levels, specifically, the number of
1899	people the pool may cover at each of those funding levels.
1900	3.  A recommendation as to the best source of funding for
1901	the anticipated deficits of the pool.
1902
1903	The board shall take no action to implement the Florid Health
1904	Insurance Plan, other than the completion of the actuarial study
1905	authorized in this paragraph, until funds are appropriated for
1906	startup cost and any projected deficits.
1907	(b)  No later than December 1, 2005, and annually
1908	thereafter, the board shall submit to the Governor, the
1909	President of the Senate, the Speaker of the House of
1910	Representatives, and the substantive legislative committees of
1911	the Legislature a report which includes an independent actuarial
1912	study to determine, including, but not be limited to:
1913	1.  The impact the creation of the plan has on the small
1914	group and individual insurance market, specifically on the
1915	premiums paid by insureds. This shall include an estimate of the
1916	total anticipated aggregate savings for all small employers in
1917	the state.
1918	2.  The actual number of individuals covered at the current
1919	funding and benefit level, the projected number of individuals
1920	that may seek coverage in the forthcoming fiscal year, and the
1921	projected funding needed to cover anticipated increase or
1922	decrease in plan participation.
1923	3.  A recommendation as to the best source of funding for
1924	the anticipated deficits of the pool.
1925	4.  A summarization of the activities of the plan in the
1926	preceding calendar year, including the net written and earned
1927	premiums, plan enrollment, the expense of administration, and
1928	the paid and incurred losses.
1929	5.  A review of the operation of the plan as to whether the
1930	plan has met the intent of this section.
1931	(7)  LIABILITY OF THE PLAN.--Neither the board nor its
1932	employees shall be liable for any obligations of the plan. No
1933	member or employee of the board shall be liable, and no cause of
1934	action of any nature may arise against a member or employee of
1935	the board, for any act or omission related to the performance of
1936	any powers and duties under this section, unless such act or
1937	omission constitutes willful or wanton misconduct. The board may
1938	provide in its bylaws or rules for indemnification of, and legal
1939	representation for, its members and employees.
1940	(8)  AUDITED FINANCIAL STATEMENT.--No later than June 1
1941	following the close of each calendar year, the plan shall submit
1942	to the Financial Services Commission an audited financial
1943	statement prepared in accordance with statutory accounting
1944	principles as adopted by the National Association of Insurance
1945	Commissioners.
1946	(9)  ELIGIBILITY.--
1947	(a)  Any individual person who is and continues to be a
1948	resident of this state shall be eligible for coverage under the
1949	plan if:
1950	1.  Evidence is provided that the person received at least
1951	two notices of rejection or refusal to issue substantially
1952	similar insurance for health reasons by one insurer. A rejection
1953	or refusal by an insurer offering only stoploss, excess of loss,
1954	or reinsurance coverage with respect to the applicant shall not
1955	be sufficient evidence under this paragraph.
1956	2.  The person is enrolled in the Florida Comprehensive
1957	Health Association as of the date the plan is implemented.
1958	(b)  Each resident dependent of a person who is eligible
1959	for coverage under the plan shall also be eligible for such
1960	coverage.
1961	(c)  A person shall not be eligible for coverage under the
1962	plan if:
1963	1.  The person has or obtains health insurance coverage
1964	substantially similar to or more comprehensive than a plan
1965	policy, or would be eligible to obtain such coverage, unless a
1966	person may maintain other coverage for the period of time the
1967	person is satisfying any preexisting condition waiting period
1968	under a plan policy or may maintain plan coverage for the period
1969	of time the person is satisfying a preexisting condition waiting
1970	period under another health insurance policy intended to replace
1971	the plan policy.
1972	2.  The person is determined to be eligible for health care
1973	benefits under Medicaid, Medicare, the state's children's health
1974	insurance program, or any other federal, state, or local
1975	government program that provides health benefits;
1976	3.  The person voluntarily terminated plan coverage unless
1977	12 months have elapsed since such termination;
1978	4.  The person is an inmate or resident of a public
1979	institution; or
1980	5.  The person's premiums are paid for or reimbursed under
1981	any government-sponsored program or by any government agency or
1982	health care provider.
1983	(d)  Coverage shall cease:
1984	1.  On the date a person is no longer a resident of this
1985	state;
1986	2.  On the date a person requests coverage to end;
1987	3.  Upon the death of the covered person;
1988	4.  On the date state law requires cancellation or
1989	nonrenewal of the policy; or
1990	5.  At the option of the plan, 30 days after the plan makes
1991	any inquiry concerning the person's eligibility or place of
1992	residence to which the person does not reply.
1993	6.  Upon failure of the insured to pay for continued
1994	coverage.
1995	(e)  Except under the circumstances described in this
1996	subsection, coverage of a person who ceases to meet the
1997	eligibility requirements of this subsection shall be terminated
1998	at the end of the policy period for which the necessary premiums
1999	have been paid.
2000	(10)  UNFAIR REFERRAL TO PLAN.--It is an unfair trade
2001	practice for the purposes of part IX of chapter 626 or s.
2002	641.3901 for an insurer, health maintenance organization
2003	insurance agent, insurance broker, or third-party administrator
2004	to refer an individual employee to the plan, or arrange for an
2005	individual employee to apply to the plan, for the purpose of
2006	separating that employee from group health insurance coverage
2007	provided in connection with the employee's employment.
2008	(11)  PLAN ADMINISTRATOR.--The board shall select through a
2009	competitive bidding process a plan administrator to administer
2010	the plan. The board shall evaluate bids submitted based on
2011	criteria established by the board, which shall include:
2012	(a)  The plan administrator's proven ability to handle
2013	health insurance coverage to individuals.
2014	(b)  The efficiency and timeliness of the plan
2015	administrator's claim processing procedures.
2016	(c)  An estimate of total charges for administering the
2017	plan.
2018	(d)  The plan administrator's ability to apply effective
2019	cost-containment programs and procedures and to administer the
2020	plan in a cost-efficient manner.
2021	(e)  The financial condition and stability of the plan
2022	administrator.
2023
2024	The administrator shall be an insurer, a health maintenance
2025	organization, or a third-party administrator, or another
2026	organization duly authorized to provide insurance pursuant to
2027	the Florida Insurance Code.
2028	(12)  ADMINISTRATOR TERM LIMITS.--The plan administrator
2029	shall serve for a period specified in the contract between the
2030	plan and the plan administrator subject to removal for cause and
2031	subject to any terms, conditions, and limitations of the
2032	contract between the plan and the plan administrator. At least 1
2033	year prior to the expiration of each period of service by a plan
2034	administrator, the board shall invite eligible entities,
2035	including the current plan administrator, to submit bids to
2036	serve as the plan administrator. Selection of the plan
2037	administrator for each succeeding period shall be made at least
2038	6 months prior to the end of the current period.
2039	(13)  DUTIES OF THE PLAN ADMINISTRATOR.--
2040	(a)  The plan administrator shall perform such functions
2041	relating to the plan as may be assigned to it, including, but
2042	not limited to:
2043	1.  Determination of eligibility.
2044	2.  Payment of claims.
2045	3.  Establishment of a premium billing procedure for
2046	collection of premiums from persons covered under the plan.
2047	4.  Other necessary functions to ensure timely payment of
2048	benefits to covered persons under the plan.
2049	(b)  The plan administrator shall submit regular reports to
2050	the board regarding the operation of the plan. The frequency,
2051	content, and form of the reports shall be specified in the
2052	contract between the board and the plan administrator.
2053	(c)  On March 1 following the close of each calendar year,
2054	the plan administrator shall determine net written and earned
2055	premiums, the expense of administration, and the paid and
2056	incurred losses for the year and report this information to the
2057	board and the Governor on a form prescribed by the Governor.
2058	(14)  PAYMENT OF THE PLAN ADMINISTRATOR.--The plan
2059	administrator shall be paid as provided in the contract between
2060	the plan and the plan administrator.
2061	(15)  FUNDING OF THE PLAN.--
2062	(a)  Premiums.--
2063	1.  The plan shall establish premium rates for plan
2064	coverage as provided in this section. Separate schedules of
2065	premium rates based on age, sex, and geographical location may
2066	apply for individual risks. Premium rates and schedules shall be
2067	submitted to the office for approval prior to use.
2068	2.  Initial rates for plan coverage shall be limited to 200
2069	percent of rates established as applicable for individual
2070	standard risks as specified in s. 627.6675(3)(c). Subject to the
2071	limits provided in this paragraph, subsequent rates shall be
2072	established to provide fully for the expected costs of claims,
2073	including recovery of prior losses, expenses of operation,
2074	investment income of claim reserves, and any other cost factors
2075	subject to the limitations described herein, but in no event
2076	shall premiums exceed the 200-percent rate limitation provided
2077	in this section. Notwithstanding the 200-percent rate
2078	limitation, sliding scale premium surcharges based upon the
2079	insured's income may apply to all enrollees except those
2080	obtaining coverage in accordance with s. 627.6487.
2081	(b)  Sources of additional revenue.--Any deficit incurred
2082	by the plan shall be primarily funded through amounts
2083	appropriated by the Legislature from general revenue sources,
2084	including, but not limited to, a portion of the annual growth in
2085	existing net insurance premium taxes. The board shall operate
2086	the plan in such a manner that the estimated cost of providing
2087	health insurance during any fiscal year will not exceed total
2088	income the plan expects to receive from policy premiums and
2089	funds appropriated by the Legislature, including any interest on
2090	investments. After determining the amount of funds appropriated
2091	to the board for a fiscal year, the board shall estimate the
2092	number of new policies it believes the plan has the financial
2093	capacity to insure during that year so that costs do not exceed
2094	income. The board shall take steps necessary to ensure that plan
2095	enrollment does not exceed the number of residents it has
2096	estimated it has the financial capacity to insure.
2097	(16)  BENEFITS.--
2098	(a)  The benefits provided shall be the same as the
2099	standard and basic plans for small employers as outlined in s.
2100	627.6699. The board shall also establish an option of
2101	alternative coverage such as catastrophic coverage that includes
2102	a minimum level of primary care coverage and a high deductible
2103	plan that meets the federal requirements of a health savings
2104	account.
2105	(b)  In establishing the plan coverage, the board shall
2106	take into consideration the levels of health insurance provided
2107	in the state and such medical economic factors as may be deemed
2108	appropriate and adopt benefit levels, deductibles, copayments,
2109	coinsurance factors, exclusions, and limitations determined to
2110	be generally reflective of and commensurate with health
2111	insurance provided through a representative number of large
2112	employers in the state.
2113	(c)  The board may adjust any deductibles and coinsurance
2114	factors annually according to the medical component of the
2115	Consumer Price Index.
2116	(d)1.  Plan coverage shall exclude charges or expenses
2117	incurred during the first 6 months following the effective date
2118	of coverage for any condition for which medical advice, care, or
2119	treatment was recommended or received for such condition during
2120	the 6-month period immediately preceding the effective date of
2121	coverage.
2122	2.  Such preexisting condition exclusions shall be waived
2123	to the extent that similar exclusions, if any, have been
2124	satisfied under any prior health insurance coverage which was
2125	involuntarily terminated, provided application for pool coverage
2126	is made not later than 63 days following such involuntary
2127	termination. In such case, coverage under the plan shall be
2128	effective from the date on which such prior coverage was
2129	terminated and the applicant is not eligible for continuation or
2130	conversion rights that would provide coverage substantially
2131	similar to plan coverage.
2132	(17)  NONDUPLICATION OF BENEFITS.--
2133	(a)  The plan shall be payor of last resort of benefits
2134	whenever any other benefit or source of third-party payment is
2135	available. Benefits otherwise payable under plan coverage shall
2136	be reduced by all amounts paid or payable through any other
2137	health insurance, by all hospital and medical expense benefits
2138	paid or payable under any workers' compensation coverage,
2139	automobile medical payment, or liability insurance, whether
2140	provided on the basis of fault or nonfault, and by any hospital
2141	or medical benefits paid or payable under or provided pursuant
2142	to any state or federal law or program.
2143	(b)  The plan shall have a cause of action against an
2144	eligible person for the recovery of the amount of benefits paid
2145	that are not for covered expenses. Benefits due from the plan
2146	may be reduced or refused as a setoff against any amount
2147	recoverable under this paragraph.
2148	(18)  ANNUAL AND MAXIMUM BENEFITS.--Maximum benefits under
2149	the plan shall be determined by the board.
2150	(19)  TAXATION.--The plan is exempt from any tax imposed by
2151	this state. The plan shall apply for federal tax exemption
2152	status.
2153	(20)  COMBINING MEMBERSHIP OF THE FLORIDA COMPREHENSIVE
2154	HEALTH ASSOCIATION.--
2155	(a)1. Upon implementation of the plan, the Florida
2156	Comprehensive Health Association is abolished and all high-risk
2157	individuals actively enrolled in the Florida Comprehensive
2158	Health Association shall be enrolled in the plan subject to its
2159	rules and requirements. Maximum lifetime benefits paid to an
2160	individual in the plan shall not exceed the amount established
2161	under subsection (18), and benefits previously paid for any
2162	individual by the Florida Comprehensive Health Association shall
2163	be used in the determination of total lifetime benefits paid
2164	under the plan.
2165	2.  Persons formerly enrolled in the Florida Comprehensive
2166	Health Association are only eligible for the benefits authorized
2167	under subsection (18).
2168	3.  Except as otherwise provided in this paragraph, the
2169	Florida Comprehensive Health Association shall operate under the
2170	existing plan of operation without modification until the
2171	adoption of the new plan of operation for the Florida Health
2172	Insurance Plan.
2173	(b)1.  As a condition of doing business in this state, an
2174	insurer shall pay an assessment to the board in the amount
2175	prescribed by this paragraph. For operating losses incurred on
2176	or after July 1, 2004, by persons previously enrolled in the
2177	Florida Comprehensive Health Association, each insurer shall
2178	annually be assessed by the board in the following calendar year
2179	a portion of such incurred operating losses of the plan. Such
2180	portion shall be determined by multiplying such operating losses
2181	by a fraction, the numerator of which equals the insurer's
2182	earned premium pertaining to direct writings of health insurance
2183	in the state during the calendar year preceding that for which
2184	the assessment is levied, and the denominator of which equals
2185	the total of all such premiums earned by participating insurers
2186	in the state during such calendar year.
2187	2.  The total of all assessments under this paragraph upon
2188	a participating insurer shall not exceed 1 percent of such
2189	insurer's health insurance premium earned in this state during
2190	the calendar year preceding the year for which the assessments
2191	were levied.
2192	3.  All rights, title, and interest in the assessment funds
2193	collected under this paragraph shall vest in this state.
2194	However, all of such funds and interest earned shall be used by
2195	the plan to pay claims and administrative expenses.
2196	(c)  If assessments and other receipts by the plan, board,
2197	or plan administrator exceed the actual losses and
2198	administrative expenses of the plan, the excess shall be held in
2199	interest and used by the board to offset future losses. As used
2200	in this subsection, the term "future losses" includes reserves
2201	for claims incurred but not reported.
2202	(d)  Each insurer's assessment shall be determined annually
2203	by the board or plan administrator based on annual statements
2204	and other reports deemed necessary by the board or plan
2205	administrator and filed with the board or plan administrator by
2206	the insurer. Any deficit incurred under the plan by persons
2207	previously enrolled in the Florida Comprehensive Health
2208	Association shall be recouped by the assessments against
2209	participating insurers by the board or plan administrator in the
2210	manner provided in paragraph (b), and the insurers may recover
2211	the assessment in the normal course of their respective
2212	businesses without time limitation.
2213	(e)  If a person enrolled in the Florida Comprehensive
2214	Health Association as of July 1, 2004, loses eligibility for
2215	participation in the plan, such person shall not be included in
2216	the calculation of incurred operational losses as described in
2217	paragraph (b) if the person later regains eligibility for
2218	participation in the plan.
2219	(f)  After all persons enrolled in the Florida
2220	Comprehensive Health Association as of July 1, 2004, are no
2221	longer eligible for participation in the plan, the plan, board,
2222	or plan administrator shall no longer be allowed to assess
2223	insurers in this state for incurred losses as described in
2224	paragraph (b).
2225	Section 21.  Upon implementation, as defined in s.
2226	627.64872(2), Florida Statutes, and as provided in s.
2227	627.64872(20), Florida Statutes, of the Florida Health Benefit
2228	Plan created under s. 627.64872, Florida Statutes, sections
2229	627.6488, 627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
2230	627.6498, Florida Statutes, are repealed.
2231	Section 22.  Subsections (12) and (13) are added to section
2232	627.662, Florida Statutes, to read:
2233	627.662  Other provisions applicable.--The following
2234	provisions apply to group health insurance, blanket health
2235	insurance, and franchise health insurance:
2236	(12)  Section 627.6044, relating to the use of specific
2237	methodology for payment of claims.
2238	(13)  Section 627.6405, relating to the inappropriate
2239	utilization of emergency care.
2240	Section 23.  Paragraphs (c) and (d) of subsection (5),
2241	paragraph (b) of subsection (6), and subsection (12) of section
2242	627.6699, Florida Statutes, are amended, subsections (15) and
2243	(16) of said section are renumbered as subsections (16) and
2244	(17), respectively, present subsection (15) of said section is
2245	amended, and new subsections (15) and (18) are added to said
2246	section, to read:
2247	627.6699  Employee Health Care Access Act.--
2248	(5)  AVAILABILITY OF COVERAGE.--
2249	(c)  Every small employer carrier must, as a condition of
2250	transacting business in this state:
2251	1.  Offer and issue all small employer health benefit plans
2252	on a guaranteed-issue basis to every eligible small employer,
2253	with 2 to 50 eligible employees, that elects to be covered under
2254	such plan, agrees to make the required premium payments, and
2255	satisfies the other provisions of the plan. A rider for
2256	additional or increased benefits may be medically underwritten
2257	and may only be added to the standard health benefit plan. The
2258	increased rate charged for the additional or increased benefit
2259	must be rated in accordance with this section.
2260	2.  In the absence of enrollment availability in the
2261	Florida Health Insurance Plan, offer and issue basic and
2262	standard small employer health benefit plans on a guaranteed-
2263	issue basis, during a 31-day open enrollment period of August 1
2264	through August 31 of each year, to every eligible small
2265	employer, with fewer than two eligible employees, which small
2266	employer is not formed primarily for the purpose of buying
2267	health insurance and which elects to be covered under such plan,
2268	agrees to make the required premium payments, and satisfies the
2269	other provisions of the plan. Coverage provided under this
2270	subparagraph shall begin on October 1 of the same year as the
2271	date of enrollment, unless the small employer carrier and the
2272	small employer agree to a different date. A rider for additional
2273	or increased benefits may be medically underwritten and may only
2274	be added to the standard health benefit plan. The increased rate
2275	charged for the additional or increased benefit must be rated in
2276	accordance with this section. For purposes of this subparagraph,
2277	a person, his or her spouse, and his or her dependent children
2278	constitute a single eligible employee if that person and spouse
2279	are employed by the same small employer and either that person
2280	or his or her spouse has a normal work week of less than 25
2281	hours. Any right to an open enrollment of health benefit
2282	coverage for groups of fewer than two employees, pursuant to
2283	this section, shall remain in full force and effect in the
2284	absence of the availability of new enrollment into the Florida
2285	Health Insurance Plan.
2286	3.  This paragraph does not limit a carrier's ability to
2287	offer other health benefit plans to small employers if the
2288	standard and basic health benefit plans are offered and
2289	rejected.
2290	(d)  A small employer carrier must file with the office, in
2291	a format and manner prescribed by the committee, a standard
2292	health care plan, a high deductible plan that meets the federal
2293	requirements of a health savings account plan, and a basic
2294	health care plan to be used by the carrier.
2295	(6)  RESTRICTIONS RELATING TO PREMIUM RATES.--
2296	(b)  For all small employer health benefit plans that are
2297	subject to this section and are issued by small employer
2298	carriers on or after January 1, 1994, premium rates for health
2299	benefit plans subject to this section are subject to the
2300	following:
2301	1.  Small employer carriers must use a modified community
2302	rating methodology in which the premium for each small employer
2303	must be determined solely on the basis of the eligible
2304	employee's and eligible dependent's gender, age, family
2305	composition, tobacco use, or geographic area as determined under
2306	paragraph (5)(j) and in which the premium may be adjusted as
2307	permitted by this paragraph.
2308	2.  Rating factors related to age, gender, family
2309	composition, tobacco use, or geographic location may be
2310	developed by each carrier to reflect the carrier's experience.
2311	The factors used by carriers are subject to office review and
2312	approval.
2313	3.  Small employer carriers may not modify the rate for a
2314	small employer for 12 months from the initial issue date or
2315	renewal date, unless the composition of the group changes or
2316	benefits are changed. However, a small employer carrier may
2317	modify the rate one time prior to 12 months after the initial
2318	issue date for a small employer who enrolls under a previously
2319	issued group policy that has a common anniversary date for all
2320	employers covered under the policy if:
2321	a.  The carrier discloses to the employer in a clear and
2322	conspicuous manner the date of the first renewal and the fact
2323	that the premium may increase on or after that date.
2324	b.  The insurer demonstrates to the office that
2325	efficiencies in administration are achieved and reflected in the
2326	rates charged to small employers covered under the policy.
2327	4.  A carrier may issue a group health insurance policy to
2328	a small employer health alliance or other group association with
2329	rates that reflect a premium credit for expense savings
2330	attributable to administrative activities being performed by the
2331	alliance or group association if such expense savings are
2332	specifically documented in the insurer's rate filing and are
2333	approved by the office. Any such credit may not be based on
2334	different morbidity assumptions or on any other factor related
2335	to the health status or claims experience of any person covered
2336	under the policy. Nothing in this subparagraph exempts an
2337	alliance or group association from licensure for any activities
2338	that require licensure under the insurance code. A carrier
2339	issuing a group health insurance policy to a small employer
2340	health alliance or other group association shall allow any
2341	properly licensed and appointed agent of that carrier to market
2342	and sell the small employer health alliance or other group
2343	association policy. Such agent shall be paid the usual and
2344	customary commission paid to any agent selling the policy.
2345	5.  Any adjustments in rates for claims experience, health
2346	status, or duration of coverage may not be charged to individual
2347	employees or dependents. For a small employer's policy, such
2348	adjustments may not result in a rate for the small employer
2349	which deviates more than 15 percent from the carrier's approved
2350	rate. Any such adjustment must be applied uniformly to the rates
2351	charged for all employees and dependents of the small employer.
2352	A small employer carrier may make an adjustment to a small
2353	employer's renewal premium, not to exceed 10 percent annually,
2354	due to the claims experience, health status, or duration of
2355	coverage of the employees or dependents of the small employer.
2356	Semiannually, small group carriers shall report information on
2357	forms adopted by rule by the commission, to enable the office to
2358	monitor the relationship of aggregate adjusted premiums actually
2359	charged policyholders by each carrier to the premiums that would
2360	have been charged by application of the carrier's approved
2361	modified community rates. If the aggregate resulting from the
2362	application of such adjustment exceeds the premium that would
2363	have been charged by application of the approved modified
2364	community rate by 5 percent for the current reporting period,
2365	the carrier shall limit the application of such adjustments only
2366	to minus adjustments beginning not more than 60 days after the
2367	report is sent to the office. For any subsequent reporting
2368	period, if the total aggregate adjusted premium actually charged
2369	does not exceed the premium that would have been charged by
2370	application of the approved modified community rate by 4 5
2371	percent, the carrier may apply both plus and minus adjustments.
2372	A small employer carrier may provide a credit to a small
2373	employer's premium based on administrative and acquisition
2374	expense differences resulting from the size of the group. Group
2375	size administrative and acquisition expense factors may be
2376	developed by each carrier to reflect the carrier's experience
2377	and are subject to office review and approval.
2378	6.  A small employer carrier rating methodology may include
2379	separate rating categories for one dependent child, for two
2380	dependent children, and for three or more dependent children for
2381	family coverage of employees having a spouse and dependent
2382	children or employees having dependent children only. A small
2383	employer carrier may have fewer, but not greater, numbers of
2384	categories for dependent children than those specified in this
2385	subparagraph.
2386	7.  Small employer carriers may not use a composite rating
2387	methodology to rate a small employer with fewer than 10
2388	employees. For the purposes of this subparagraph, a "composite
2389	rating methodology" means a rating methodology that averages the
2390	impact of the rating factors for age and gender in the premiums
2391	charged to all of the employees of a small employer.
2392	8.a.  A carrier may separate the experience of small
2393	employer groups with less than 2 eligible employees from the
2394	experience of small employer groups with 2-50 eligible employees
2395	for purposes of determining an alternative modified community
2396	rating.
2397	b.  If a carrier separates the experience of small employer
2398	groups as provided in sub-subparagraph a., the rate to be
2399	charged to small employer groups of less than 2 eligible
2400	employees may not exceed 150 percent of the rate determined for
2401	small employer groups of 2-50 eligible employees. However, the
2402	carrier may charge excess losses of the experience pool
2403	consisting of small employer groups with less than 2 eligible
2404	employees to the experience pool consisting of small employer
2405	groups with 2-50 eligible employees so that all losses are
2406	allocated and the 150-percent rate limit on the experience pool
2407	consisting of small employer groups with less than 2 eligible
2408	employees is maintained. Notwithstanding s. 627.411(1), the rate
2409	to be charged to a small employer group of fewer than 2 eligible
2410	employees, insured as of July 1, 2002, may be up to 125 percent
2411	of the rate determined for small employer groups of 2-50
2412	eligible employees for the first annual renewal and 150 percent
2413	for subsequent annual renewals.
2414	(12)  STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH
2415	BENEFIT PLANS.--
2416	(a)1.  The Chief Financial Officer shall appoint a health
2417	benefit plan committee composed of four representatives of
2418	carriers which shall include at least two representatives of
2419	HMOs, at least one of which is a staff model HMO, two
2420	representatives of agents, four representatives of small
2421	employers, and one employee of a small employer. The carrier
2422	members shall be selected from a list of individuals recommended
2423	by the board. The Chief Financial Officer may require the board
2424	to submit additional recommendations of individuals for
2425	appointment.
2426	2.  The plans shall comply with all of the requirements of
2427	this subsection.
2428	3.  The plans must be filed with and approved by the office
2429	prior to issuance or delivery by any small employer carrier.
2430	4.  After approval of the revised health benefit plans, if
2431	the office determines that modifications to a plan might be
2432	appropriate, the Chief Financial Officer shall appoint a new
2433	health benefit plan committee in the manner provided in
2434	subparagraph 1. to submit recommended modifications to the
2435	office for approval.
2436	(b)1.  Each small employer carrier issuing new health
2437	benefit plans shall offer to any small employer, upon request, a
2438	standard health benefit plan, and a basic health benefit plan,
2439	and a high deductible plan that meets the requirements of a
2440	health savings account plan as defined by federal law, that meet
2441	meets the criteria set forth in this section.
2442	2.  For purposes of this subsection, the terms "standard
2443	health benefit plan," and "basic health benefit plan," and "high
2444	deductible plan" mean policies or contracts that a small
2445	employer carrier offers to eligible small employers that
2446	contain:
2447	a.  An exclusion for services that are not medically
2448	necessary or that are not covered preventive health services;
2449	and
2450	b.  A procedure for preauthorization by the small employer
2451	carrier, or its designees.
2452	3.  A small employer carrier may include the following
2453	managed care provisions in the policy or contract to control
2454	costs:
2455	a.  A preferred provider arrangement or exclusive provider
2456	organization or any combination thereof, in which a small
2457	employer carrier enters into a written agreement with the
2458	provider to provide services at specified levels of
2459	reimbursement or to provide reimbursement to specified
2460	providers. Any such written agreement between a provider and a
2461	small employer carrier must contain a provision under which the
2462	parties agree that the insured individual or covered member has
2463	no obligation to make payment for any medical service rendered
2464	by the provider which is determined not to be medically
2465	necessary. A carrier may use preferred provider arrangements or
2466	exclusive provider arrangements to the same extent as allowed in
2467	group products that are not issued to small employers.
2468	b.  A procedure for utilization review by the small
2469	employer carrier or its designees.
2470
2471	This subparagraph does not prohibit a small employer carrier
2472	from including in its policy or contract additional managed care
2473	and cost containment provisions, subject to the approval of the
2474	office, which have potential for controlling costs in a manner
2475	that does not result in inequitable treatment of insureds or
2476	subscribers. The carrier may use such provisions to the same
2477	extent as authorized for group products that are not issued to
2478	small employers.
2479	4.  The standard health benefit plan shall include:
2480	a.  Coverage for inpatient hospitalization;
2481	b.  Coverage for outpatient services;
2482	c.  Coverage for newborn children pursuant to s. 627.6575;
2483	d.  Coverage for child care supervision services pursuant
2484	to s. 627.6579;
2485	e.  Coverage for adopted children upon placement in the
2486	residence pursuant to s. 627.6578;
2487	f.  Coverage for mammograms pursuant to s. 627.6613;
2488	g.  Coverage for handicapped children pursuant to s.
2489	627.6615;
2490	h.  Emergency or urgent care out of the geographic service
2491	area; and
2492	i.  Coverage for services provided by a hospice licensed
2493	under s. 400.602 in cases where such coverage would be the most
2494	appropriate and the most cost-effective method for treating a
2495	covered illness.
2496	5.  The standard health benefit plan and the basic health
2497	benefit plan may include a schedule of benefit limitations for
2498	specified services and procedures. If the committee develops
2499	such a schedule of benefits limitation for the standard health
2500	benefit plan or the basic health benefit plan, a small employer
2501	carrier offering the plan must offer the employer an option for
2502	increasing the benefit schedule amounts by 4 percent annually.
2503	6.  The basic health benefit plan shall include all of the
2504	benefits specified in subparagraph 4.; however, the basic health
2505	benefit plan shall place additional restrictions on the benefits
2506	and utilization and may also impose additional cost containment
2507	measures.
2508	7.  Sections 627.419(2), (3), and (4), 627.6574, 627.6612,
2509	627.66121, 627.66122, 627.6616, 627.6618, 627.668, and 627.66911
2510	apply to the standard health benefit plan and to the basic
2511	health benefit plan. However, notwithstanding said provisions,
2512	the plans may specify limits on the number of authorized
2513	treatments, if such limits are reasonable and do not
2514	discriminate against any type of provider.
2515	8.  The plan associated with a health savings account shall
2516	include all the benefits specified in subparagraph 4.
2517	9.8.  Each small employer carrier that provides for
2518	inpatient and outpatient services by allopathic hospitals may
2519	provide as an option of the insured similar inpatient and
2520	outpatient services by hospitals accredited by the American
2521	Osteopathic Association when such services are available and the
2522	osteopathic hospital agrees to provide the service.
2523	(c)  If a small employer rejects, in writing, the standard
2524	health benefit plan, and the basic health benefit plan, and the
2525	high deductible health savings account plan, the small employer
2526	carrier may offer the small employer a limited benefit policy or
2527	contract.
2528	(d)1.  Upon offering coverage under a standard health
2529	benefit plan, a basic health benefit plan, or a limited benefit
2530	policy or contract for any small employer, the small employer
2531	carrier shall provide such employer group with a written
2532	statement that contains, at a minimum:
2533	a.  An explanation of those mandated benefits and providers
2534	that are not covered by the policy or contract;
2535	b.  An explanation of the managed care and cost control
2536	features of the policy or contract, along with all appropriate
2537	mailing addresses and telephone numbers to be used by insureds
2538	in seeking information or authorization; and
2539	c.  An explanation of the primary and preventive care
2540	features of the policy or contract.
2541
2542	Such disclosure statement must be presented in a clear and
2543	understandable form and format and must be separate from the
2544	policy or certificate or evidence of coverage provided to the
2545	employer group.
2546	2.  Before a small employer carrier issues a standard
2547	health benefit plan, a basic health benefit plan, or a limited
2548	benefit policy or contract, it must obtain from the prospective
2549	policyholder a signed written statement in which the prospective
2550	policyholder:
2551	a.  Certifies as to eligibility for coverage under the
2552	standard health benefit plan, basic health benefit plan, or
2553	limited benefit policy or contract;
2554	b.  Acknowledges the limited nature of the coverage and an
2555	understanding of the managed care and cost control features of
2556	the policy or contract;
2557	c.  Acknowledges that if misrepresentations are made
2558	regarding eligibility for coverage under a standard health
2559	benefit plan, a basic health benefit plan, or a limited benefit
2560	policy or contract, the person making such misrepresentations
2561	forfeits coverage provided by the policy or contract; and
2562	d.  If a limited plan is requested, acknowledges that the
2563	prospective policyholder had been offered, at the time of
2564	application for the insurance policy or contract, the
2565	opportunity to purchase any health benefit plan offered by the
2566	carrier and that the prospective policyholder had rejected that
2567	coverage.
2568
2569	A copy of such written statement shall be provided to the
2570	prospective policyholder no later than at the time of delivery
2571	of the policy or contract, and the original of such written
2572	statement shall be retained in the files of the small employer
2573	carrier for the period of time that the policy or contract
2574	remains in effect or for 5 years, whichever period is longer.
2575	3.  Any material statement made by an applicant for
2576	coverage under a health benefit plan which falsely certifies as
2577	to the applicant's eligibility for coverage serves as the basis
2578	for terminating coverage under the policy or contract.
2579	4.  Each marketing communication that is intended to be
2580	used in the marketing of a health benefit plan in this state
2581	must be submitted for review by the office prior to use and must
2582	contain the disclosures stated in this subsection.
2583	(e)  A small employer carrier may not use any policy,
2584	contract, form, or rate under this section, including
2585	applications, enrollment forms, policies, contracts,
2586	certificates, evidences of coverage, riders, amendments,
2587	endorsements, and disclosure forms, until the insurer has filed
2588	it with the office and the office has approved it under ss.
2589	627.410 and 627.411 and this section.
2590	(15)  SMALL EMPLOYERS ACCESS PROGRAM.--
2591	(a)  Popular name.--This subsection may be referred to by
2592	the popular name "The Small Employers Access Program."
2593	(b)  Intent.--The Legislature finds that increased access
2594	to health care coverage for small employers with up to 25
2595	employees could improve employees' health and reduce the
2596	incidence and costs of illness and disabilities among residents
2597	in this state. Many employers do not offer health care benefits
2598	to their employees citing the increased cost of this benefit. It
2599	is the intent of the Legislature to create the Small Business
2600	Health Plan to provide small employers the option and ability to
2601	provide health care benefits to their employees at an affordable
2602	cost through the creation of purchasing pools for employers with
2603	up to 25 employees, and rural hospital employers and nursing
2604	home employers regardless of the number of employees.
2605	(c)  Definitions.--For purposes of this subsection:
2606	1.  "Fair commission" means a commission structure
2607	determined by the insurers and reflected in the insurers' rate
2608	filings made pursuant to this subsection.
2609	2.  "Insurer" means any entity that provides health
2610	insurance in this state. For purposes of this subsection,
2611	insurer includes an insurance company holding a certificate of
2612	authority pursuant to chapter 624 or a health maintenance
2613	organization holding a certificate of authority pursuant to
2614	chapter 641, which qualifies to provide coverage to small
2615	employer groups pursuant to this section.
2616	3.  "Mutually supported benefit plan" means an optional
2617	alternative coverage plan developed within a defined geographic
2618	region which may include, but is not limited to, a minimum level
2619	of primary care coverage in which the percentage of the premium
2620	is distributed among the employer, the employee, and community-
2621	generated revenue either alone or in conjunction with federal
2622	matching funds.
2623	4.  "Office" means the Office of Insurance Regulation of
2624	the Department of Financial Services.
2625	5.  "Participating insurer" means any insurer providing
2626	health insurance to small employers that has been selected by
2627	the office in accordance with this subsection for its designated
2628	region.
2629	6.  "Program" means the Small Employer Access Program as
2630	created by this subsection.
2631	(d)  Eligibility.--
2632	1.  Any small employer group of up to 25 employees that has
2633	had no prior coverage for the last 6 months may participate.
2634	2.  Any municipality, county, school district, or hospital
2635	located in a rural community as defined in s. 288.0656(2)(b),
2636	may participate.
2637	3.  Rural hospital employers as defined by law may
2638	participate.
2639	4.  Nursing home employers may participate.
2640	5.  Each dependent of a person eligible for coverage is
2641	also eligible to participate.
2642	6.  Any small employer that is actively engaged in
2643	business, has its principal place of business in this state,
2644	employed up to 25 eligible employees on business days during the
2645	preceding calendar year, and employs at least 2 employees on the
2646	first day of the plan year may participate.
2647
2648	Any employer participating in the program must do so until the
2649	end of the term for which the carrier providing the coverage is
2650	obligated to provide such coverage to the program. Coverage for
2651	a small employer group that ceases to meet the eligibility
2652	requirements of this section may be terminated at the end of the
2653	policy period for which the necessary premiums have been paid.
2654	(e)  Administration.--
2655	1.  The office shall by competitive bid, in accordance with
2656	current state law, select an insurer to provide coverage through
2657	the program to eligible small employers within an established
2658	geographical area of this state. The office may develop
2659	exclusive regions for the program similar to those used by the
2660	Healthy Kids Corporation. However the office is not precluded
2661	from developing, in conjunction with insurers, regions different
2662	from those used by the Healthy Kids Corporation if the office
2663	deems that such a region will carry out the intentions of this
2664	subsection.
2665	2.  The office shall evaluate bids submitted based upon
2666	criteria established by the office, which shall include, but not
2667	be limited to:
2668	a.  The insurer's proven ability to handle health insurance
2669	coverage to small employer groups.
2670	b.  The efficiency and timeliness of the insurer's claim
2671	processing procedures.
2672	c.  The insurer's ability to apply effective cost-
2673	containment programs and procedures and to administer the
2674	program in a cost-efficient manner.
2675	d.  The financial condition and stability of the insurer.
2676	e.  The insurer's ability to develop an optional mutually
2677	supported benefit plan.
2678
2679	The office may use any financial information available to it
2680	through its regulatory duties to make this evaluation.
2681	(f)  Insurer qualifications.--The insurer shall be a duly
2682	authorized insurer or health maintenance organization.
2683	(g)  Duties of the insurer.--The insurer shall:
2684	1.  Develop and implement a program to publicize the
2685	existence of the program, program eligibility requirements, and
2686	procedures for enrollment and maintain public awareness of the
2687	program.
2688	2.  Maintain employer awareness of the program.
2689	3.  Demonstrate the ability to use delivery of cost-
2690	effective health care services.
2691	4.  Encourage, educate, advise, and administer the
2692	effective use of health savings accounts by covered employees
2693	and dependents.
2694	5.  Serve for a period specified in the contract between
2695	the office and the insurer, subject to removal for cause and
2696	subject to any terms, conditions, and limitations of the
2697	contract between the office and the insurer as may be specified
2698	in the request for proposal.
2699	(h)  Contract term.--The contract term shall not exceed 3
2700	years. At least 6 months prior to the expiration of each
2701	contract period, the office shall invite eligible entities,
2702	including the current insurer, to submit bids to serve as the
2703	insurer for a designated geographic area. Selection of the
2704	insurer for the succeeding period shall be made at least 3
2705	months prior to the end of the current period. If a protest is
2706	filed and not resolved by the end of the contract period, the
2707	contract with the existing administrator may be extended for a
2708	period not to exceed 6 months. During the contract extension
2709	period, the administrator shall be paid at a rate to be
2710	negotiated by the office.
2711	(i)  Insurer reporting requirements.--On March 1 following
2712	the close of each calendar year, the insurer shall determine net
2713	written and earned premiums, the expense of administration, and
2714	the paid and incurred losses for the year and report this
2715	information to the office on a form prescribed by the office.
2716	(j)  Application requirements.--The insurer shall permit or
2717	allow any licensed and duly appointed health insurance agent
2718	residing in the designated region to submit applications for
2719	coverage, and such agent shall be paid a fair commission if
2720	coverage is written. The agent must be appointed to at least one
2721	insurer.
2722	(k)  Benefits.--The benefits provided by the plan shall be
2723	the same as the coverage required for small employers under
2724	subsection (12). Upon the approval of the office, the insurer
2725	may also establish an optional mutually supported benefit plan
2726	which is an alternative plan developed within a defined
2727	geographic region of this state or any other such alternative
2728	plan which will carry out the intent of this subsection. Any
2729	small employer carrier issuing new health benefit plans may
2730	offer a benefit plan with coverages similar to, but not less
2731	than, any alternative coverage plan developed pursuant to this
2732	subsection.
2733	(l)  Annual reporting.--The office shall make an annual
2734	report to the Governor, the President of the Senate, and the
2735	Speaker of the House of Representatives. The report shall
2736	summarize the activities of the program in the preceding
2737	calendar year, including the net written and earned premiums,
2738	program enrollment, the expense of administration, and the paid
2739	and incurred losses. The report shall be submitted no later than
2740	March 15 following the close of the prior calendar year.
2741	(16)(15)  APPLICABILITY OF OTHER STATE LAWS.--
2742	(a)  Except as expressly provided in this section, a law
2743	requiring coverage for a specific health care service or
2744	benefit, or a law requiring reimbursement, utilization, or
2745	consideration of a specific category of licensed health care
2746	practitioner, does not apply to a standard or basic health
2747	benefit plan policy or contract or a limited benefit policy or
2748	contract offered or delivered to a small employer unless that
2749	law is made expressly applicable to such policies or contracts.
2750	A law restricting or limiting deductibles, coinsurance,
2751	copayments, or annual or lifetime maximum payments does not
2752	apply to any health plan policy, including a standard or basic
2753	health benefit plan policy or contract, offered or delivered to
2754	a small employer unless such law is made expressly applicable to
2755	such policy or contract. However, every small employer carrier
2756	must offer to eligible small employers the standard benefit plan
2757	and the basic benefit plan, as required by subsection (5), as
2758	such plans have been approved by the office pursuant to
2759	subsection (12).
2760	(b)  Except as provided in this section, a standard or
2761	basic health benefit plan policy or contract or limited benefit
2762	policy or contract offered to a small employer is not subject to
2763	any provision of this code which:
2764	1.  Inhibits a small employer carrier from contracting with
2765	providers or groups of providers with respect to health care
2766	services or benefits;
2767	2.  Imposes any restriction on a small employer carrier's
2768	ability to negotiate with providers regarding the level or
2769	method of reimbursing care or services provided under a health
2770	benefit plan; or
2771	3.  Requires a small employer carrier to either include a
2772	specific provider or class of providers when contracting for
2773	health care services or benefits or to exclude any class of
2774	providers that is generally authorized by statute to provide
2775	such care.
2776	(c)  Any second tier assessment paid by a carrier pursuant
2777	to paragraph (11)(j) may be credited against assessments levied
2778	against the carrier pursuant to s. 627.6494.
2779	(d)  Notwithstanding chapter 641, a health maintenance
2780	organization is authorized to issue contracts providing benefits
2781	equal to the standard health benefit plan, the basic health
2782	benefit plan, and the limited benefit policy authorized by this
2783	section.
2784	(17)(16)  RULEMAKING AUTHORITY.--The commission may adopt
2785	rules to administer this section, including rules governing
2786	compliance by small employer carriers and small employers.
2787	Section 24.  Section 627.6405, Florida Statutes, is created
2788	to read:
2789	627.6405  Decreasing inappropriate utilization of emergency
2790	care.--
2791	(1)  The Legislature finds and declares it to be of vital
2792	importance that emergency services and care be provided by
2793	hospitals and physicians to every person in need of such care,
2794	but with the double-digit increases in health insurance
2795	premiums, health care providers and insurers should encourage
2796	patients and the insured to assume responsibility for their
2797	treatment, including emergency care. The Legislature finds that
2798	inappropriate utilization of emergency department services
2799	increases the overall cost of providing health care and these
2800	costs are ultimately borne by the hospital, the insured
2801	patients, and, many times, by the taxpayers of this state.
2802	Finally, the Legislature declares that the providers and
2803	insurers must share the responsibility of providing alternative
2804	treatment options to urgent care patients outside of the
2805	emergency department. Therefore, it is the intent of the
2806	Legislature to place the obligation for educating consumers and
2807	creating mechanisms for delivery of care that will decrease the
2808	overutilization of emergency service on health insurers and
2809	providers.
2810	(2)  Health insurers shall provide on their websites
2811	information regarding appropriate utilization of emergency care
2812	services which shall include, but not be limited to, a list of
2813	alternative urgent care contracted providers, the types of
2814	services offered by these providers, and what to do in the event
2815	of a true emergency.
2816	(3)  Health insurers shall develop community emergency
2817	department diversion programs. Such programs may include, but
2818	not be limited to, enlisting providers to be on call to insurers
2819	after hours, coordinating care through local community
2820	resources, and providing incentives to providers for case
2821	management.
2822	(4)  As a disincentive for insureds to inappropriately use
2823	emergency department services for nonemergency care, health
2824	insurers may require higher copayments for urgent care or
2825	primary care provided in an emergency department and higher
2826	copayments for use of out-of-network emergency departments.
2827	Higher copayments may not be charged for the utilization of the
2828	emergency department for emergency care. For the purposes of
2829	this section, the term "emergency care" has the same meaning as
2830	provided in s. 395.002, and shall include services provided to
2831	rule out an emergency medical condition.
2832	Section 25.  Section 641.31097, Florida Statutes, is
2833	created to read:
2834	641.31097  Decreasing inappropriate utilization of
2835	emergency care.--
2836	(1)  The Legislature finds and declares it to be of vital
2837	importance that emergency services and care be provided by
2838	hospitals and physicians to every person in need of such care,
2839	but with the double-digit increases in health insurance
2840	premiums, health care providers and insurers should encourage
2841	patients and the insured to assume responsibility for their
2842	treatment, including emergency care. The Legislature finds that
2843	inappropriate utilization of emergency department services
2844	increases the overall cost of providing health care and these
2845	costs are ultimately borne by the hospital, by the insured
2846	patients, and, many times, by the taxpayers of this state.
2847	Finally, the Legislature declares that the providers and
2848	insurers must share the responsibility of providing alternative
2849	treatment options to urgent care patients outside of the
2850	emergency department. Therefore, it is the intent of the
2851	Legislature to place the obligation for educating consumers and
2852	creating mechanisms for delivery of care that will decrease the
2853	overutilization of emergency service on health insurers and
2854	providers.
2855	(2)  Health insurers shall provide on their Internet
2856	websites information regarding appropriate utilization of
2857	emergency care services, which shall include, but not be limited
2858	to, a list of alternative urgent care contracted providers, the
2859	types of services offered by these providers, and what to do in
2860	the event of a true emergency.
2861	(3)  Health insurers shall develop community emergency
2862	department diversion programs. Such programs may include, but
2863	not be limited to, enlisting providers to be on call to insurers
2864	after hours, coordinating care through local community
2865	resources, and providing incentives to providers for case
2866	management.
2867	(4)  As a disincentive for insureds to inappropriately use
2868	emergency department services for nonemergency care, health
2869	insurers may require higher copayments for urgent care or
2870	primary care provided in an emergency department and higher
2871	copayments for use of out-of-network emergency departments.
2872	Higher copayments may not be charged for the utilization of the
2873	emergency department for emergency care. For the purposes of
2874	this section, the term "emergency care" has the same meaning as
2875	provided in s. 395.002 and shall include services provided to
2876	rule out an emergency medical condition.
2877	Section 26.  Subsection (1) of section 627.9175, Florida
2878	Statutes, is amended to read:
2879	627.9175  Reports of information on health and accident
2880	insurance.--
2881	(1)  Each health insurer, prepaid limited health services
2882	organization, and health maintenance organization shall submit,
2883	no later than April 1 of each year, annually to the office
2884	information concerning health and accident insurance coverage
2885	and medical plans being marketed and currently in force in this
2886	state. The required information shall be described by market
2887	segment, to include, but not be limited to:
2888	(a)  Issuing, servicing company, and entity contact
2889	information.
2890	(b)  Information on all health and accident insurance
2891	policies and prepaid limited health service organizations and
2892	health maintenance organization contracts in force and issued in
2893	the previous year. Such information shall include, but not be
2894	limited to, direct premiums earned, direct losses incurred,
2895	number of policies, number of certificates, number of covered
2896	lives, number or the percentage of claims denied and claims
2897	meeting prompt pay requirements, and the average number of days
2898	taken to pay claims. as to policies of individual health
2899	insurance:
2900	(a)  A summary of typical benefits, exclusions, and
2901	limitations for each type of individual policy form currently
2902	being issued in the state. The summary shall include, as
2903	appropriate:
2904	1.  The deductible amount;
2905	2.  The coinsurance percentage;
2906	3.  The out-of-pocket maximum;
2907	4.  Outpatient benefits;
2908	5.  Inpatient benefits; and
2909	6.  Any exclusions for preexisting conditions.
2910
2911	The commission shall determine other appropriate benefits,
2912	exclusions, and limitations to be reported for inclusion in the
2913	consumer's guide published pursuant to this section.
2914	(b)  A schedule of rates for each type of individual policy
2915	form reflecting typical variations by age, sex, region of the
2916	state, or any other applicable factor which is in use and is
2917	determined to be appropriate for inclusion by the commission.
2918
2919	The commission may establish rules governing shall provide by
2920	rule a uniform format for the submission of this information
2921	described in this section, including the use of uniform formats
2922	and electronic data transmission order to allow for meaningful
2923	comparisons of premiums charged for comparable benefits. The
2924	office shall provide this information to the department, which
2925	shall publish annually a consumer's guide which summarizes and
2926	compares the information required to be reported under this
2927	subsection.
2928	Section 27.  Chapter 636, Florida Statutes, entitled
2929	"Prepaid Limited Health Service Organizations," is retitled as
2930	"Prepaid Limited Health Service Organizations and Discount
2931	Medical Plan Organizations."
2932	Section 28.  Sections 636.002 through 636.067, Florida
2933	Statutes, are designated as part I of chapter 636, Florida
2934	Statutes, and entitled "Prepaid Limited Health Service
2935	Organizations."
2936	Section 29.  Paragraph (c) of subsection (7) of section
2937	636.003, Florida Statutes, is amended to read:
2938	636.003  Definitions.--As used in this act, the term:
2939	(7)  "Prepaid limited health service organization" means
2940	any person, corporation, partnership, or any other entity which,
2941	in return for a prepayment, undertakes to provide or arrange
2942	for, or provide access to, the provision of a limited health
2943	service to enrollees through an exclusive panel of providers.
2944	Prepaid limited health service organization does not include:
2945	(c)  Any person who is licensed pursuant to part II as a
2946	discount medical plan organization, in exchange for fees, dues,
2947	charges or other consideration, provides access to a limited
2948	health service provider without assuming any responsibility for
2949	payment for the limited health service or any portion thereof.
2950	Section 30.  Effective January 1, 2005, part II of chapter
2951	636, Florida Statutes, consisting of sections 636.202, 636.204,
2952	636.206, 636.208, 636.210, 636.212, 636.214, 636.216, 636.218,
2953	636.220, 636.222, 636.224, 636.226, 636.228, 636.230, 636.232,
2954	636.234, 636.236, 636.238, 636.240, 636.242, and 636.244, is
2955	created to read:
2956	PART II
2957	DISCOUNT MEDICAL PLAN ORGANIZATIONS
2958	636.202  Definitions.--As used in this part, the term:
2959	(1)  "Discount medical plan" means a business arrangement
2960	or contract in which a person, in exchange for fees, dues,
2961	charges, or other consideration, provides access for plan
2962	members to providers of medical services and the right to
2963	receive medical services from those providers at a discount.
2964	(2)  "Discount medical plan organization" means an entity
2965	which, in exchange for fees, dues, charges, or other
2966	consideration, provides access for plan members to providers of
2967	medical services and the right to receive medical services from
2968	those providers at a discount.
2969	(3)  "Marketer" means a person or entity which markets,
2970	promotes, sells, or distributes a discount medical plan,
2971	including a private label entity which places its name on and
2972	markets or distributes a discount medical plan but does not
2973	operate a discount medical plan.
2974	(4)  "Medical services" means any care, service, or
2975	treatment of illness or dysfunction of, or injury to, the human
2976	body, including, but not limited to, physician care, inpatient
2977	care, hospital surgical services, emergency services, ambulance
2978	services, dental care services, vision care services, mental
2979	health services, substance abuse services, chiropractic
2980	services, podiatric care services, laboratory services, and
2981	medical equipment and supplies. The term does not include
2982	pharmaceutical supplies or prescriptions.
2983	(5)  "Member" means any person who pays fees, dues,
2984	charges, or other consideration for the right to receive the
2985	purported benefits of a discount medical plan.
2986	(6)  "Provider" means any person or institution which is
2987	contracted, directly or indirectly, with a discount medical plan
2988	organization to provide medical services to members.
2989	(7)  "Provider network" means an entity which negotiates on
2990	behalf of more than one provider with a discount medical plan
2991	organization to provide medical services to members.
2992	636.204  License required.--
2993	(1)  Before doing business in this state as a discount
2994	medical plan organization, an entity must be a corporation,
2995	incorporated under the laws of this state or, if a foreign
2996	corporation, authorized to transact business in this state, and
2997	must possess a license as a discount medical plan organization
2998	from the office.
2999	(2)  An application for a license to operate as a discount
3000	medical plan organization must be filed with the office on a
3001	form prescribed by the commission. Such application must be
3002	sworn to by an officer or authorized representative of the
3003	applicant and be accompanied by the following:
3004	(a)  A copy of the applicant's articles of incorporation,
3005	including all amendments.
3006	(b)  A copy of the corporation's bylaws.
3007	(c)  A list of the names, addresses, official positions,
3008	and biographical information of the individuals who are
3009	responsible for conducting the applicant's affairs, including,
3010	but not limited to, all members of the board of directors, board
3011	of trustees, executive committee, or other governing board or
3012	committee, the officers, contracted management company
3013	personnel, and any person or entity owning or having the right
3014	to acquire 10 percent or more of the voting securities of the
3015	applicant. Such listing must fully disclose the extent and
3016	nature of any contracts or arrangements between any individual
3017	who is responsible for conducting the applicant's affairs and
3018	the discount medical plan organization, including any possible
3019	conflicts of interest.
3020	(d)  A complete biographical statement, on forms prescribed
3021	by the commission, an independent investigation report, and a
3022	set of fingerprints, as provided in chapter 624, with respect to
3023	each individual identified under paragraph (c).
3024	(e)  A statement generally describing the applicant, its
3025	facilities and personnel, and the medical services to be
3026	offered.
3027	(f)  A copy of the form of all contracts made or to be made
3028	between the applicant and any providers or provider networks
3029	regarding the provision of medical services to members.
3030	(g)  A copy of the form of any contract made or arrangement
3031	to be made between the applicant and any person listed in
3032	paragraph (c).
3033	(h)  A copy of the form of any contract made or to be made
3034	between the applicant and any person, corporation, partnership,
3035	or other entity for the performance on the applicant's behalf of
3036	any function, including, but not limited to, marketing,
3037	administration, enrollment, investment management, and
3038	subcontracting for the provision of health services to members.
3039	(i)  A copy of the applicant's most recent financial
3040	statements audited by an independent certified public
3041	accountant.
3042	(j)  A description of the proposed method of marketing.
3043	(k)  A description of the subscriber complaint procedures
3044	to be established and maintained.
3045	(l)  The fee for issuance of a license.
3046	(m)  Such other information as the commission or office may
3047	reasonably require to make the determinations required by this
3048	part.
3049	(3)  The office shall issue a license which shall expire
3050	one year later, and each year on that date thereafter, and which
3051	the office shall renew if the licensee pays the annual license
3052	fee of $50 and if the office is satisfied that the licensee is
3053	in compliance with this part.
3054	(4)  Prior to licensure by the office, each discount
3055	medical plan organization must establish an Internet website so
3056	as to conform to the requirements of s. 636.226.
3057	(5)  The license fee under subsection (2) is $50 per year
3058	per licensee. All amounts collected shall be deposited into the
3059	General Revenue Fund.
3060	(6)  Nothing in this part requires a provider who provides
3061	discounts to his or her own patients to obtain and maintain a
3062	license as a discount medical plan organization.
3063	636.206  Examinations and investigations.--
3064	(1)  The office may examine or investigate the business and
3065	affairs of any discount medical plan organization. The office
3066	may order any discount medical plan organization or applicant to
3067	produce any records, books, files, advertising and solicitation
3068	materials, or other information and may take statements under
3069	oath to determine whether the discount medical plan organization
3070	or applicant is in violation of the law or is acting contrary to
3071	the public interest. The expenses incurred in conducting any
3072	examination or investigation must be paid by the discount
3073	medical plan organization or applicant. Examinations and
3074	investigations must be conducted as provided in chapter 624, and
3075	discount medical plan organizations are subject to all
3076	applicable provisions of the insurance code.
3077	(2)  Failure by the discount medical plan organization to
3078	pay the expenses incurred under subsection (1) is grounds for
3079	denial or revocation.
3080	636.208  Permitted activities of a discount medical plan
3081	organization.--A discount medical plan organization may engage
3082	in the following activities:
3083	(1)  Charge a monthly fee to its members, provided, if a
3084	discount medical plan charges for a time period in excess of one
3085	month, the plan must, in the event of cancellation of the
3086	membership by either party, make a pro rata reimbursement of the
3087	fees to the member.
3088	(2)  Enter into contracts with providers and provider
3089	networks in which the providers or provider networks agree to
3090	provide medical services at a discount to plan members.
3091	636.210  Prohibited activities of a discount medical plan
3092	organization.--
3093	(1)  A discount medical plan organization may not:
3094	(a)  Use in its advertisements, marketing material,
3095	brochures, and discount cards the term "insurance" except as
3096	otherwise provided in this part;
3097	(b)  Use in its advertisements, marketing material,
3098	brochures, and discount cards the terms "affordable healthcare,"
3099	"health plan," "coverage," "copay," "copayments," "preexisting
3100	conditions," "guaranteed issue," or "premium" or other terms
3101	which could reasonably mislead a person into believing the
3102	discount medical plan was health insurance;
3103	(c)  Have restrictions on free access to plan providers,
3104	including, but not limited to, waiting periods and notification
3105	periods; or
3106	(d)  Pay to providers any fees for medical services.
3107	(2)  A discount medical plan organization may not collect
3108	or accept money from a member for payment to a provider for
3109	specific medical services furnished or to be furnished to the
3110	member unless the organization has an active certificate of
3111	authority from the office to act as an administrator.
3112	636.212  Disclosures.--The following disclosures must be
3113	made in writing to any prospective member and must be on the
3114	first page of any advertisements, marketing materials, and
3115	brochures relating to a discount medical plan, in not less than
3116	10-point type or no smaller than the largest type on the page if
3117	larger than 10-point type:
3118	(1)  That the plan is not insurance.
3119	(2)  That the plan does not make payments directly to the
3120	providers of medical services.
3121	(3)  That the plan member is obligated to pay to the
3122	provider the full amount of the discounted fees.
3123	(4)  The corporate name and the locations of the licensed
3124	discount medical plan organization.
3125	636.214  Provider agreements.--
3126	(1)  All providers offering medical services to members
3127	under a discount medical plan must provide such services
3128	pursuant to a written agreement. The agreement may be entered
3129	into directly by the provider or by a provider network to which
3130	the provider belongs.
3131	(2)  A provider agreement must provide the following:
3132	(a)  A list of the services and products to be provided at
3133	a discount.
3134	(b)  The amount or amounts of the discounts or,
3135	alternatively, a fee schedule which reflects the provider's
3136	discounted rates.
3137	(c)  That the provider will not charge members more than
3138	the discounted rates.
3139	(3)  A provider agreement between a discount medical plan
3140	organization and a provider network shall require that the
3141	provider network have written agreements with its providers
3142	which:
3143	(a)  Contain the terms described in subsection (2).
3144	(b)  Authorize the provider network to contract with the
3145	discount medical plan organization on behalf of the provider.
3146	(c)  Require the network to maintain an up-to-date list of
3147	its contracted providers and to provide that list on a monthly
3148	basis to the discount medical plan organization.
3149	(4)  The discount medical plan organization shall maintain
3150	a copy of each active provider agreement.
3151	636.216  Form and rate filings.--
3152	(1)  All charges to members must be filed with the office
3153	and must be approved by the office before the charges can be
3154	used. The discount medical plan organization has the burden of
3155	proof that the charges bear a reasonable relation to the
3156	benefits received by the member.
3157	(2)  There must be a written agreement between the discount
3158	medical plan organization and the member specifying the benefits
3159	under the discount medical plan and complying with the
3160	disclosure requirements of this part.
3161	(3)  All forms used, including the written agreement
3162	pursuant to subsection (2), must first be filed with and
3163	approved by the office. Every form filed shall be identified by
3164	a unique form number placed in the lower left corner of each
3165	form.
3166	(4)  If such filings are disapproved, the office shall
3167	notify the discount medical plan organization and shall specify
3168	in the notice the reasons for disapproval. The discount medical
3169	plan organization has 21 days from the date of receipt of notice
3170	to request a hearing before the office pursuant to chapter 120.
3171	636.218  Annual reports.--
3172	(1)  Each discount medical plan organization must file with
3173	the office, within 3 months after the end of each fiscal year,
3174	an annual report.
3175	(2)  Such reports must be on forms prescribed by the
3176	commission and must include:
3177	(a)  Audited financial statements prepared in accordance
3178	with generally accepted accounting principles certified by an
3179	independent certified public accountant, including the
3180	organization's balance sheet, income statement, and statement of
3181	changes in cash flow for the preceding year.
3182	(b)  A list of the names and residence addresses of all
3183	persons responsible for the conduct of the organization's
3184	affairs, together with a disclosure of the extent and nature of
3185	any contracts or arrangements between such persons and the
3186	discount medical plan organization, including any possible
3187	conflicts of interest.
3188	(c)  The number of discount medical plan members.
3189	(d)  Such other information relating to the performance of
3190	the discount medical plan organization as is reasonably required
3191	by the commission or office.
3192	(3)  Every discount medical plan organization which fails
3193	to file an annual report in the form and within the time
3194	required by this section shall forfeit up to $500 for each day
3195	for the first 10 days during which the neglect continues and
3196	shall forfeit up to $1,000 for each day after the first 10 days
3197	during which the neglect continues; and, upon notice by the
3198	office to that effect, the organization's authority to enroll
3199	new members or to do business in this state ceases while such
3200	default continues. The office shall deposit all sums collected
3201	by the office under this section to the credit of the Insurance
3202	Regulatory Trust Fund. The office may not collect more than
3203	$50,000 for each report.
3204	636.220  Minimum capital requirements.?-
3205	(1)  Each discount medical plan organization must at all
3206	times maintain a net worth of at least $150,000.
3207	(2)  The office may not issue a license unless the discount
3208	medical plan organization has a net worth of at least $150,000.
3209	636.222  Suspension or revocation of license; suspension of
3210	enrollment of new members; terms of suspension.--
3211	(1)  The office may suspend the authority of a discount
3212	medical plan organization to enroll new members, revoke any
3213	license issued to a discount medical plan organization, or order
3214	compliance if the office finds that any of the following
3215	conditions exist:
3216	(a)  The organization is not operating in compliance with
3217	this part.
3218	(b)  The organization does not have the minimum net worth
3219	as required by this part.
3220	(c)  The organization has advertised, merchandised, or
3221	attempted to merchandise its services in such a manner as to
3222	misrepresent its services or capacity for service or has engaged
3223	in deceptive, misleading, or unfair practices with respect to
3224	advertising or merchandising.
3225	(d)  The organization is not fulfilling its obligations as
3226	a medical discount medical plan organization.
3227	(e)  The continued operation of the organization would be
3228	hazardous to its members.
3229	(2)  If the office has cause to believe that grounds for
3230	the suspension or revocation of a license exist, the office
3231	shall notify the discount medical plan organization in writing
3232	specifically stating the grounds for suspension or revocation
3233	and shall pursue a hearing on the matter in accordance with the
3234	provisions of chapter 120.
3235	(3)  When the license of a discount medical plan
3236	organization is surrendered or revoked, such organization must
3237	proceed, immediately following the effective date of the order
3238	of revocation, to wind up its affairs transacted under the
3239	license. The organization may not engage in any further
3240	advertising, solicitation, collecting of fees, or renewal of
3241	contracts.
3242	(4)  The office shall, in its order suspending the
3243	authority of a discount medical plan organization to enroll new
3244	members, specify the period during which the suspension is to be
3245	in effect and the conditions, if any, which must be met by the
3246	discount medical plan organization prior to reinstatement of its
3247	license to enroll new members. The order of suspension is
3248	subject to rescission or modification by further order of the
3249	office prior to the expiration of the suspension period.
3250	Reinstatement may not be made unless requested by the discount
3251	medical plan organization; however, the office may not grant
3252	reinstatement if it finds that the circumstances for which the
3253	suspension occurred still exist or are likely to recur.
3254	636.224  Notice of change of name or address of discount
3255	medical plan organization.--Each discount medical plan
3256	organization must provide the office at least 30 days' advance
3257	notice of any change in the discount medical plan organization's
3258	name, address, principal business address, or mailing address.
3259	636.226  Provider name listing.?-Each discount medical plan
3260	organization must maintain an up-to-date list of the names and
3261	addresses of the providers with which it has contracted, on an
3262	Internet website page, the address of which shall be prominently
3263	displayed on all its advertisements, marketing materials,
3264	brochures, and discount cards. This section applies to those
3265	providers with whom the discount medical plan organization has
3266	contracted directly, as well as those who are members of a
3267	provider network with which the discount medical plan
3268	organization has contracted.
3269	636.228  Marketing of discount medical plans.--
3270	(1)  All advertisements, marketing materials, brochures,
3271	and discount cards used by marketers must be approved in writing
3272	for such use by the discount medical plan organization.
3273	(2)  The discount medical plan organization shall have an
3274	executed written agreement with a marketer prior to the
3275	marketer's marketing, promoting, selling, or distributing the
3276	discount medical plan.
3277	(3)  No person may act in the capacity of a marketer unless
3278	licensed as an agent as defined in s. 626.015(2).
3279	(4)  No person may act in the capacity of a marketer for a
3280	discount medical plan organization unless appointed by the
3281	discount medical plan organization on a form prescribed by the
3282	commission.
3283	636.230  Bundling discount medical plans with other
3284	insurance products.?-When a marketer or discount medical plan
3285	organization sells a discount medical plan together with any
3286	other product, the fees for each individual product must be
3287	provided in writing to the member and itemized.
3288	636.232  Rules.--The commission may adopt rules to
3289	administer this part, including rules for the licensing of
3290	discount medical plan organizations; establishing standards for
3291	evaluating forms, advertisements, marketing materials,
3292	brochures, and discount cards; providing for the collection of
3293	data; relating to disclosures to plan members; and defining
3294	terms used in this part.
3295	636.234  Service of process on a discount medical plan
3296	organization.-?Sections 624.422 and 624.423 apply to a discount
3297	medical plan organization as if the discount medical plan
3298	organization were an insurer.
3299	636.236  Security deposit.--
3300	(1)  A licensed discount medical plan organization must
3301	deposit and maintain deposited in trust with the department
3302	securities eligible for deposit under s. 625.52, having at all
3303	times a value of not less than $35,000, for use by the office in
3304	protecting plan members.
3305	(2)  No judgment creditor or other claimant of a discount
3306	medical plan organization, other than the office or department,
3307	shall have the right to levy upon any of the assets or
3308	securities held in this state as a deposit under subsection (1).
3309	636.238  Penalties for violation of this part.--
3310	(1)  Except as provided in subsection (2), a person who
3311	violates any provision of this part commits a misdemeanor of the
3312	second degree, punishable as provided in s. 775.082 or s.
3313	775.083.
3314	(2)  A person who operates as or aids and abets another
3315	operating as a discount medical plan organization in violation
3316	of s. 636.204(1) commits a felony punishable as provided for in
3317	s. 624.401(4)(b), as if the unlicensed discount medical plan
3318	organization were an unauthorized insurer, and the fees, dues,
3319	charges, or other consideration collected from the members by
3320	the unlicensed discount medical plan organization or marketer
3321	were insurance premium.
3322	(3)  A person who collects fees for purported membership in
3323	a discount medical plan but fails to provide the promised
3324	benefits commits a theft, punishable as provided in s. 812.014.
3325	636.240  Injunctions.--
3326	(1)  In addition to the penalties and other enforcement
3327	provisions of this part, the office may seek both temporary and
3328	permanent injunctive relief when:
3329	(a)  A discount medical plan is being operated by any
3330	person or entity that is not licensed pursuant to this part.
3331	(b)  Any person, entity, or discount medical plan
3332	organization has engaged in any activity prohibited by this part
3333	or any rule adopted pursuant to this part.
3334	(2)  The venue for any proceeding bought pursuant to this
3335	section shall be in the Circuit Court of Leon County.
3336	(3)  The office's authority to seek injunctive relief is
3337	not conditioned on having conducted any proceeding pursuant to
3338	chapter 120.
3339	636.242  Civil remedies.--Any person damaged by the acts of
3340	a person in violation of this part may bring a civil action
3341	against the person committing the violation in the circuit court
3342	of the county in which the alleged violator resides or has a
3343	principal place of business or in the county in which the
3344	alleged violation occurred. Upon an adverse adjudication, the
3345	defendant is liable for damages, together with court costs and
3346	reasonable attorney's fees incurred by the plaintiff. When so
3347	awarded, court costs and attorney's fees must be included in the
3348	judgment or decree rendered in the case. If it appears to the
3349	court that the suit brought by the plaintiff is frivolous or
3350	brought for purposes of harassment, the court may apply
3351	sanctions in accordance with chapter 57.
3352	636.244  Unlicensed discount medical plan
3353	organizations.--The provisions of ss. 626.901-626.912 apply to
3354	The provisions of ss. 626.901-626.912 apply to the activities of
3355	an unlicensed discount medical plan organization as if the
3356	unlicensed discount medical plan organization were an
3357	unauthorized insurer.
3358	Section 31.  Section 627.65626, Florida Statutes, is
3359	created to read:
3360	627.65626  Insurance rebates for healthy lifestyles.--
3361	(1)  Any rate, rating schedule, or rating manual for a
3362	health insurance policy filed with the office shall provide for
3363	an appropriate rebate of premiums paid in the last calendar year
3364	when the majority of members of a health plan have enrolled and
3365	maintained participation in any health wellness, maintenance, or
3366	improvement program offered by the employer. The employer must
3367	provide evidence of demonstrative maintenance or improvement of
3368	the enrollees' health status as determined by assessments of
3369	agreed-upon health status indicators between the employer and
3370	the health insurer, including, but not limited to, reduction in
3371	weight, body mass index, and smoking cessation. Any rebate
3372	provided by the health insurer is presumed to be appropriate
3373	unless credible data demonstrates otherwise, but shall not
3374	exceed 10 percent of paid premiums.
3375	(2)  The premium rebate authorized by this section shall be
3376	effective for an insured on an annual basis, unless the number
3377	of participating employees becomes less than the majority of the
3378	employees eligible for participation in the wellness program.
3379	Section 32.  Section 627.6402, Florida Statutes, is created
3380	to read:
3381	627.6402  Insurance rebates for healthy lifestyles.--
3382	(1)  Any rate, rating schedule, or rating manual for an
3383	individual health insurance policy filed with the office shall
3384	provide for an appropriate rebate of premiums paid in the last
3385	calendar year when the individual covered by such plan is
3386	enrolled in and maintains participation in any health wellness,
3387	maintenance, or improvement program approved by the health plan.
3388	The individual must provide evidence of demonstrative
3389	maintenance or improvement of the individual's health status as
3390	determined by assessments of agreed-upon health status
3391	indicators between the individual and the health insurer,
3392	including, but not limited to, reduction in weight, body mass
3393	index, and smoking cessation. Any rebate provided by the health
3394	insurer is presumed to be appropriate unless credible data
3395	demonstrates otherwise, but shall not exceed 10 percent of paid
3396	premiums.
3397	(2)  The premium rebate authorized by this section shall be
3398	effective for an insured on an annual basis, unless the
3399	individual fails to maintain or improve his or her health status
3400	while participating in an approved wellness program, or credible
3401	evidence demonstrates that the individual is not participating
3402	in the approved wellness program.
3403	Section 33.  Subsection (38) of section 641.31, Florida
3404	Statutes, is amended, and subsection (40) is added to said
3405	section, to read:
3406	641.31  Health maintenance contracts.--
3407	(38)(a)  Notwithstanding any other provision of this part,
3408	a health maintenance organization that meets the requirements of
3409	paragraph (b) may, through a point-of-service rider to its
3410	contract providing comprehensive health care services, include a
3411	point-of-service benefit. Under such a rider, a subscriber or
3412	other covered person of the health maintenance organization may
3413	choose, at the time of covered service, a provider with whom the
3414	health maintenance organization does not have a health
3415	maintenance organization provider contract. The rider may not
3416	require a referral from the health maintenance organization for
3417	the point-of-service benefits.
3418	(b)  A health maintenance organization offering a point-of-
3419	service rider under this subsection must have a valid
3420	certificate of authority issued under the provisions of the
3421	chapter, must have been licensed under this chapter for a
3422	minimum of 3 years, and must at all times that it has riders in
3423	effect maintain a minimum surplus of $5 million. A health
3424	maintenance organization offering a point-of-service rider to
3425	its contract providing comprehensive health care services may
3426	offer the rider to employers who have employees living and
3427	working outside the health maintenance organization's approved
3428	geographic service area without having to obtain a health care
3429	provider certificate, as long as the master group contract is
3430	issued to an employer that maintains its primary place of
3431	business within the health maintenance organization's approved
3432	service area. Any member or subscriber that lives and works
3433	outside the health maintenance organization's service area and
3434	elects coverage under the health maintenance organization's
3435	point-of-service rider must provide a statement to the health
3436	maintenance organization that indicates the member or subscriber
3437	understands the limitations of his or her policy and that only
3438	those benefits under the point-of-service rider will be covered
3439	when services are provided outside the service area.
3440	(c)  Premiums paid in for the point-of-service riders may
3441	not exceed 15 percent of total premiums for all health plan
3442	products sold by the health maintenance organization offering
3443	the rider. If the premiums paid for point-of-service riders
3444	exceed 15 percent, the health maintenance organization must
3445	notify the office and, once this fact is known, must immediately
3446	cease offering such a rider until it is in compliance with the
3447	rider premium cap.
3448	(d)  Notwithstanding the limitations of deductibles and
3449	copayment provisions in this part, a point-of-service rider may
3450	require the subscriber to pay a reasonable copayment for each
3451	visit for services provided by a noncontracted provider chosen
3452	at the time of the service. The copayment by the subscriber may
3453	either be a specific dollar amount or a percentage of the
3454	reimbursable provider charges covered by the contract and must
3455	be paid by the subscriber to the noncontracted provider upon
3456	receipt of covered services. The point-of-service rider may
3457	require that a reasonable annual deductible for the expenses
3458	associated with the point-of-service rider be met and may
3459	include a lifetime maximum benefit amount. The rider must
3460	include the language required by s. 627.6044 and must comply
3461	with copayment limits described in s. 627.6471. Section 641.3154
3462	does not apply to a point-of-service rider authorized under this
3463	subsection.
3464	(e)  The point-of-service rider must contain provisions
3465	that comply with s. 627.6044.
3466	(f)(e)  The term "point of service" may not be used by a
3467	health maintenance organization except with riders permitted
3468	under this section or with forms approved by the office in which
3469	a point-of-service product is offered with an indemnity carrier.
3470	(g)(f)  A point-of-service rider must be filed and approved
3471	under ss. 627.410 and 627.411.
3472	(40)(a)  Any rate, rating schedule, or rating manual for a
3473	health maintenance organization policy filed with the office
3474	shall provide for an appropriate rebate of premiums paid in the
3475	last calendar year when the individual covered by such plan is
3476	enrolled in and maintains participation in any health wellness,
3477	maintenance, or improvement program approved by the health plan.
3478	The individual must provide evidence of demonstrative
3479	maintenance or improvement of his or her health status as
3480	determined by assessments of agreed-upon health status
3481	indicators between the individual and the health insurer,
3482	including, but not limited to, reduction in weight, body mass
3483	index, and smoking cessation. Any rebate provided by the health
3484	insurer is presumed to be appropriate unless credible data
3485	demonstrates otherwise, but shall not exceed 10 percent of paid
3486	premiums.
3487	(b)  The premium rebate authorized by this section shall be
3488	effective for an insured on an annual basis, unless the
3489	individual fails to maintain or improve his or her health status
3490	while participating in an approved wellness program, or credible
3491	evidence demonstrates that the individual is not participating
3492	in the approved wellness program.
3493	Section 34.  Subsection (2) of section 626.015, Florida
3494	Statutes, is amended, subsections (8) through (17) of said
3495	section are renumbered as subsections (9) through (18),
3496	respectively, and a new subsection (8) is added to said section,
3497	to read:
3498	626.015  Definitions.--As used in this part:
3499	(2)  "Agent" means a general lines agent, life agent,
3500	health agent, or title agent, or all such agents, as indicated
3501	by context. The term "agent" includes an insurance producer or
3502	producer, but does not include a customer representative,
3503	limited customer representative, or service representative but
3504	does include an insurance advisor.
3505	(8)  "Insurance advisor" means any person who, for money,
3506	fee, commission, or any other thing of value offers to examine
3507	or examines any policy of health insurance or any health benefit
3508	plan for the purpose of giving, or gives, or offers to give, any
3509	advice, counsel, recommendation, or information in respect to
3510	the terms, conditions, benefits, coverage, or premium of any
3511	such policy or contract, or in respect to the expediency or
3512	advisability of altering, changing, exchanging, converting,
3513	replacing, surrendering, continuing, or rejecting any such
3514	policy, plan, or contract, or of accepting or procuring any such
3515	policy, plan, or contract from any insurer or issuer of a health
3516	benefit plan, or who in or on advertisements, cards, signs,
3517	circulars, or letterheads, or elsewhere, or in any other way or
3518	manner by which public announcements are made, uses the title
3519	"insurance advisor," "insurance specialist," "insurance
3520	counselor," "insurance analyst," "policyholders' adviser,"
3521	"policyholders' counselor," or any other similar title, or any
3522	title indicating that the person gives, or is engaged in the
3523	business of giving advice, counsel, recommendation, or
3524	information to an insured, or a beneficiary, or any person
3525	having any interest in a health insurance contract or health
3526	benefit plan contract. This definition is not intended to
3527	prevent a person who has obtained the professional designation
3528	of life underwriter, chartered financial consultant, or
3529	certified financial planner by completing a course of
3530	instruction recognized within the business of insurance from
3531	using that designation to indicate professional achievement.
3532	Section 35.  Subsection (1) of section 626.016, Florida
3533	Statutes, is amended to read:
3534	626.016  Powers and duties of department, commission, and
3535	office.--
3536	(1)  The powers and duties of the Chief Financial Officer
3537	and the department specified in this part apply only with
3538	respect to insurance agents, insurance advisors, managing
3539	general agents, reinsurance intermediaries, viatical settlement
3540	brokers, customer representatives, service representatives, and
3541	agencies.
3542	Section 36.  Subsection (1) of section 626.171, Florida
3543	Statutes, is amended to read:
3544	626.171  Application for license.--
3545	(1)  The department or office shall not issue a license as
3546	agent, insurance advisor, customer representative, adjuster,
3547	insurance agency, service representative, managing general
3548	agent, or reinsurance intermediary to any person except upon
3549	written application therefor filed with it, qualification
3550	therefor, and payment in advance of all applicable fees. Any
3551	such application shall be made under the oath of the applicant
3552	and be signed by the applicant. Beginning November 1, 2002, The
3553	department shall accept the uniform application for nonresident
3554	agent licensing. The department may adopt revised versions of
3555	the uniform application by rule.
3556	Section 37.  Section 626.191, Florida Statutes, is amended
3557	to read:
3558	626.191  Repeated applications.--The failure of an
3559	applicant to secure a license upon an application shall not
3560	preclude the applicant him or her from applying again as many
3561	times as desired, but the department or office shall not give
3562	consideration to or accept any further application by the same
3563	individual for a similar license dated or filed within 30 days
3564	subsequent to the date the department or office denied the last
3565	application, except as provided in s. 626.281.
3566	Section 38.  Subsection (1) of section 626.201, Florida
3567	Statutes, is amended to read:
3568	626.201  Investigation.--
3569	(1)  The department or office may propound any reasonable
3570	interrogatories in addition to those contained in the
3571	application, to any applicant for license or appointment, or on
3572	any renewal, reinstatement, or continuation thereof, relating to
3573	the applicant's his or her qualifications, residence,
3574	prospective place of business, and any other matter which, in
3575	the opinion of the department or office, is deemed necessary or
3576	advisable for the protection of the public and to ascertain the
3577	applicant's qualifications.
3578	Section 39.  Subsections (1) and (2) of section 626.342,
3579	Florida Statutes, are amended to read:
3580	626.342  Furnishing supplies to unlicensed life, health, or
3581	general lines agent prohibited; civil liability.--
3582	(1)  An insurer, a managing general agent, an insurance
3583	advisor, or an agent, directly or through any representative,
3584	may not furnish to any agent any blank forms, applications,
3585	stationery, or other supplies to be used in soliciting,
3586	negotiating, or effecting contracts of insurance on its behalf
3587	unless such blank forms, applications, stationery, or other
3588	supplies relate to a class of business with respect to which the
3589	agent is licensed and appointed, whether for that insurer or
3590	another insurer.
3591	(2)  Any insurer, general agent, insurance advisor, or
3592	agent who furnishes any of the supplies specified in subsection
3593	(1) to any agent or prospective agent not appointed to represent
3594	the insurer and who accepts from or writes any insurance
3595	business for such agent or agency is subject to civil liability
3596	to any insured of such insurer to the same extent and in the
3597	same manner as if such agent or prospective agent had been
3598	appointed or authorized by the insurer or such agent to act in
3599	its or his or her behalf. The provisions of this subsection do
3600	not apply to insurance risk apportionment plans under s.
3601	627.351.
3602	Section 40.  Section 626.536, Florida Statutes, is amended
3603	to read:
3604	626.536  Reporting of actions.--An agent or insurance
3605	advisor shall submit to the department, within 30 days after the
3606	final disposition of any administrative action taken against the
3607	agent by a governmental agency in this or any other state or
3608	jurisdiction relating to the business of insurance, the sale of
3609	securities, or activity involving fraud, dishonesty,
3610	trustworthiness, or breach of a fiduciary duty, a copy of the
3611	order, consent to order, or other relevant legal documents. The
3612	department may adopt rules implementing the provisions of this
3613	section.
3614	Section 41.  Subsections (1) and (3) of section 626.561,
3615	Florida Statutes, are amended to read:
3616	626.561  Reporting and accounting for funds.--
3617	(1)  All premiums, return premiums, or other funds
3618	belonging to insurers or others received by an insurance
3619	advisor, agent, customer representative, or adjuster in
3620	transactions under a his or her license are trust funds received
3621	by the licensee in a fiduciary capacity. An agent or insurance
3622	advisor shall keep the funds belonging to each insurer for which
3623	an agent or insurance advisor he or she is not appointed, other
3624	than a surplus lines insurer, in a separate account so as to
3625	allow the department or office to properly audit such funds. The
3626	licensee in the applicable regular course of business shall
3627	account for and pay the same to the insurer, insured, or other
3628	person entitled thereto.
3629	(3)  Any insurance advisor, agent, customer representative,
3630	or adjuster who, not being lawfully entitled thereto, either
3631	temporarily or permanently diverts or misappropriates such funds
3632	or any portion thereof or deprives the other person of a benefit
3633	therefrom commits the offense specified below:
3634	(a)  If the funds diverted or misappropriated are $300 or
3635	less, a misdemeanor of the first degree, punishable as provided
3636	in s. 775.082 or s. 775.083.
3637	(b)  If the funds diverted or misappropriated are more than
3638	$300, but less than $20,000, a felony of the third degree,
3639	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
3640	(c)  If the funds diverted or misappropriated are $20,000
3641	or more, but less than $100,000, a felony of the second degree,
3642	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
3643	(d)  If the funds diverted or misappropriated are $100,000
3644	or more, a felony of the first degree, punishable as provided in
3645	s. 775.082, s. 775.083, or s. 775.084.
3646	Section 42.  Subsections (1) and (2) of section 626.572,
3647	Florida Statutes, are amended to read:
3648	626.572  Rebating; when allowed.--
3649	(1)  No insurance advisor or agent shall rebate any portion
3650	of a his or her commission except as follows:
3651	(a)  The rebate shall be available to all insureds in the
3652	same actuarial class.
3653	(b)  The rebate shall be in accordance with a rebating
3654	schedule filed by the agent with the insurer issuing the policy
3655	to which the rebate applies.
3656	(c)  The rebating schedule shall be uniformly applied in
3657	that all insureds who purchase the same policy through the agent
3658	for the same amount of insurance receive the same percentage
3659	rebate.
3660	(d)  Rebates shall not be given to an insured with respect
3661	to a policy purchased from an insurer that prohibits its agents
3662	from rebating commissions.
3663	(e)  The rebate schedule is prominently displayed in public
3664	view in the agent's place of doing business and a copy is
3665	available to insureds on request at no charge.
3666	(f)  The age, sex, place of residence, race, nationality,
3667	ethnic origin, marital status, or occupation of the insured or
3668	location of the risk is not utilized in determining the
3669	percentage of the rebate or whether a rebate is available.
3670	(2)  The insurance advisor or agent shall maintain a copy
3671	of all rebate schedules for the most recent 5 years and their
3672	effective dates.
3673	Section 43.  Section 626.593, Florida Statutes, is created
3674	to read:
3675	626.593  Insurance advisor; written contract for
3676	compensation.--
3677	(1)  No person licensed as an insurance advisor may receive
3678	any fee or commission or any other thing of value in addition to
3679	the rates filed pursuant to chapter 627 for examining any health
3680	insurance or any health benefit plan for the purpose of giving
3681	or offering advice, counsel, recommendation, or information in
3682	respect to terms, conditions, benefits, coverage, or premium of
3683	any such policy or contract unless such compensation is based
3684	upon a written contract signed by the party to be charged and
3685	specifying or clearly defining the amount or extent of such
3686	compensation and informing the party to be charged that any
3687	commission received from an insurer will be rebated to the party
3688	in accordance with subsection (3). In addition, all compensation
3689	to be paid to the insurance advisor must be disclosed in the
3690	contract.
3691	(2)  A copy of every such contract shall be retained by the
3692	licensee for not less than 3 years after such services have been
3693	fully performed.
3694	(3)  Notwithstanding the provisions of s. 626.572, all
3695	commissions received by an insurance advisor from an insurer in
3696	connection with the issuance of a policy, when a separate fee or
3697	other consideration has been paid to the insurance advisor by an
3698	insured, shall be rebated to the insured or other party being
3699	charged within 30 days after receipt of such commission by the
3700	insurance advisor.
3701	Section 44.  Section 626.594, Florida Statutes, is created
3702	to read:
3703	626.594  Qualifications for license; insurance advisor.-?An
3704	applicant for license as an insurance advisor shall qualify as
3705	such in the same manner as a health insurance agent pursuant to
3706	this chapter. However, any such applicant who is otherwise
3707	qualified and licensed as a health insurance agent in this state
3708	shall be exempt from examination, as required by s. 626.211 and
3709	the knowledge, experience, or instruction requirements of s.
3710	626.8311. The authority of the insurance advisor is limited to
3711	the specific lines of authority granted under the agent's
3712	subsisting health insurance agent license.
3713	Section 45.  Subsection (1) of section 626.601, Florida
3714	Statutes, is amended to read:
3715	626.601  Improper conduct; inquiry; fingerprinting.--
3716	(1)  The department or office may, upon its own motion or
3717	upon a written complaint signed by any interested person and
3718	filed with the department or office, inquire into any alleged
3719	improper conduct of any licensed insurance advisor, agent,
3720	adjuster, service representative, managing general agent,
3721	customer representative, title insurance agent, title insurance
3722	agency, continuing education course provider, instructor, school
3723	official, or monitor group under this code. The department or
3724	office may thereafter initiate an investigation of any such
3725	licensee if it has reasonable cause to believe that the licensee
3726	has violated any provision of the insurance code. During the
3727	course of its investigation, the department or office shall
3728	contact the licensee being investigated unless it determines
3729	that contacting such person could jeopardize the successful
3730	completion of the investigation or cause injury to the public.
3731	Section 46.  Paragraph (b) of subsection (5) of section
3732	624.509, Florida Statutes, is amended to read:
3733	624.509  Premium tax; rate and computation.--
3734	(5)  There shall be allowed a credit against the net tax
3735	imposed by this section equal to 15 percent of the amount paid
3736	by the insurer in salaries to employees located or based within
3737	this state and who are covered by the provisions of chapter 443.
3738	For purposes of this subsection:
3739	(b)  The term "employees" does not include independent
3740	contractors or any person whose duties require that the person
3741	hold a valid license under the Florida Insurance Code, except
3742	persons defined in s. 626.015(1), (16)(15), and (18)(17).
3743	Section 47.  Subsection (2) of section 626.7845, Florida
3744	Statutes, is amended to read:
3745	626.7845  Prohibition against unlicensed transaction of
3746	life insurance.--
3747	(2)  Except as provided in s. 626.112(6), with respect to
3748	any line of authority specified in s. 626.015(12)(11), no
3749	individual shall, unless licensed as a life agent:
3750	(a)  Solicit insurance or annuities or procure
3751	applications; or
3752	(b)  In this state, engage or hold himself or herself out
3753	as engaging in the business of analyzing or abstracting
3754	insurance policies or of counseling or advising or giving
3755	opinions to persons relative to insurance or insurance contracts
3756	other than:
3757	1.  As a consulting actuary advising an insurer; or
3758	2.  As to the counseling and advising of labor unions,
3759	associations, trustees, employers, or other business entities,
3760	the subsidiaries and affiliates of each, relative to their
3761	interests and those of their members or employees under
3762	insurance benefit plans.
3763	Section 48.  Notwithstanding the amendment to s.
3764	627.6699(5)(c), Florida Statutes, by this act, any right to an
3765	open enrollment offer of health benefit coverage for groups of
3766	fewer than two employees, pursuant to s. 627.6699(5)(c), Florida
3767	Statutes, as it existed immediately before the effective date of
3768	this act, shall remain in full force and effect until the
3769	enactment of s. 627.64872, Florida Statutes, and the subsequent
3770	date upon which such plan begins to accept new risks or members.
3771	Section 49.  Section 465.0244, Florida Statutes, is created
3772	to read:
3773	465.0244  Information disclosure.--Every pharmacy shall
3774	make available on its Internet website a link to the performance
3775	outcome and financial data that is published by the Agency for
3776	Health Care Administration pursuant to s. 408.05(3)(l) and shall
3777	place in the area where customers receive filled prescriptions
3778	notice that such information is available electronically and the
3779	address of its Internet website.
3780	Section 50.  Section 627.6499, Florida Statutes, is amended
3781	to read:
3782	627.6499  Reporting by insurers and third-party
3783	administrators.--
3784	(1)  The office may require any insurer, third-party
3785	administrator, or service company to report any information
3786	reasonably required to assist the board in assessing insurers as
3787	required by this act.
3788	(2)  Each health insurance issuer shall make available on
3789	its Internet website a link to the performance outcome and
3790	financial data that is published by the Agency for Health Care
3791	Administration pursuant to s. 408.05(3)(l) and shall include in
3792	every policy delivered or issued for delivery to any person in
3793	the state or any materials provided as required by s. 627.64725
3794	notice that such information is available electronically and the
3795	address of its Internet website.
3796	Section 51.  Subsections (6) and (7) are added to section
3797	641.54, Florida Statutes, to read:
3798	641.54  Information disclosure.--
3799	(6)  Each health maintenance organization shall make
3800	available to its subscribers the estimated co-pay, coinsurance,
3801	or deductible, whichever is applicable, for any covered
3802	services, the status of the subscriber's maximum annual out-of-
3803	pocket payments for a covered individual or family, and the
3804	status of the subscriber's maximum lifetime benefit. Such
3805	estimate shall not preclude the actual co-pay, coinsurance, or
3806	deductible, whichever is applicable, from exceeding the
3807	estimate.
3808	(7)  Each health maintenance organization shall make
3809	available on its Internet website a link to the performance
3810	outcome and financial data that is published by the Agency for
3811	Health Care Administration pursuant to s. 408.05(3)(l) and shall
3812	include in every policy delivered or issued for delivery to any
3813	person in the state or any materials provided as required by s.
3814	627.64725 notice that such information is available
3815	electronically and the address of its Internet website.
3816	Section 52.  Section 408.02, Florida Statutes, is repealed.
3817	Section 53.  The sum of $250,000 is appropriated from the
3818	Insurance Regulatory Trust Fund in the Department of Financial
3819	Services to the Office of Insurance Regulation for the purpose
3820	of implementing the provisions in this act relating to the Small
3821	Employers Access Program.
3822	Section 54.  The sum of $2 million is appropriated from the
3823	General Revenue Fund to the Agency for Health Care
3824	Administration for the purpose of implementing the provisions of
3825	this act relating to electronic medical records.
3826	Section 55.  The sum of $250,000 is appropriated from the
3827	Insurance Regulatory Trust Fund to enable the board of the
3828	Florida Health Insurance Plan to conduct an actuarial study
3829	required under s. 627.64872, Florida Statutes.
3830	Section 56.  Except as otherwise provided herein, this act
3831	shall take effect July 1, 2004.

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