HB 1629

CS

CHAMBER ACTION

1	The Committee on Appropriations 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; amending s. 381.734, F.S.;
11	including participation by health care providers, small
12	businesses, and health insurers in the Healthy
13	Communities, Healthy People Program; requiring the
14	Department of Health to provide public Internet access to
15	certain public health programs; requiring the department
16	to monitor and assess the effectiveness of such programs;
17	requiring a report; requiring the Office of Program Policy
18	and Government Accountability to evaluate the
19	effectiveness of such programs; requiring a report;
20	amending s. 395.1041, F.S.; authorizing hospitals to
21	develop certain emergency room diversion programs;
22	amending s. 395.1055, F.S.; requiring licensed facilities
23	to make certain patient charge and performance outcome
24	data available on Internet websites; amending s. 395.1065,
25	F.S.; authorizing the Agency for Health Care
26	Administration to charge a fine for failure to provide
27	such information; amending s. 395.301, F.S.; requiring
28	certain licensed facilities to provide prospective
29	patients certain estimates of charges for services;
30	requiring such facilities to provide patients with certain
31	bill verification information; providing for a fine for
32	failure to provide such information; providing charge
33	limitations; requiring such facilities to establish a
34	patient question review and response methodology;
35	providing requirements; requiring certain licensed
36	facilities to provide public Internet access to certain
37	financial information; requiring posting of a notice of
38	the availability of such information; amending s. 408.061,
39	F.S.; requiring the Agency for Health Care Administration
40	to require health care facilities, health care providers,
41	and health insurers to submit certain information;
42	providing requirements; requiring the agency to adopt
43	certain risk and severity adjustment methodologies;
44	requiring the agency to adopt certain rules; requiring
45	certain information to be certified; amending s. 408.062,
46	F.S.; requiring the agency to conduct certain health care
47	costs and access research, analyses, and studies;
48	expanding the scope of such studies to include collection
49	of pharmacy retail price data, use of emergency
50	departments, physician information, and Internet patient
51	charge information availability; requiring a report;
52	requiring the agency to conduct additional data-based
53	studies and make recommendations to the Legislature;
54	requiring the agency to develop and implement a strategy
55	to adopt and use electronic health records; authorizing
56	the agency to develop rules to protect electronic records
57	confidentiality; requiring a report to the Governor and
58	Legislature; amending s. 408.05, F.S.; requiring the
59	agency to develop a plan to make performance outcome and
60	financial data available to consumers for health care
61	services comparison purposes; requiring submittal of the
62	plan to the Governor and Legislature; requiring the agency
63	to update the plan; requiring the agency to make the plan
64	available electronically; providing plan requirements;
65	amending s. 409.9066, F.S.; requiring the agency to
66	provide certain information relating to the Medicare
67	prescription discount program; amending s. 408.7056, F.S.;
68	renaming the Statewide Provider and Subscriber Assistance
69	Program as the Subscriber Assistance Program; revising
70	provisions to conform; expanding certain records
71	availability provisions; revising membership provisions
72	relating to a subscriber grievance hearing panel; revising
73	a list of grievances the panel may consider; providing
74	hearing procedures; amending s. 641.3154, F.S., to conform
75	to the renaming of the Subscriber Assistance Program;
76	amending s. 641.511, F.S., to conform to the renaming of
77	the Subscriber Assistance Program; adopting and
78	incorporating by reference the Employee Retirement Income
79	Security Act of 1974, as implemented by federal
80	regulations; amending s. 641.58, F.S., to conform to the
81	renaming of the Subscriber Assistance Program; amending s.
82	408.909, F.S.; expanding a definition of "health flex plan
83	entity" to include public-private partnerships; making a
84	pilot health flex plan program apply permanently
85	statewide; providing additional program requirements;
86	creating s. 381.0271, F.S.; providing definitions;
87	creating the Florida Patient Safety Corporation;
88	authorizing the corporation to create additional not-for-
89	profit corporate subsidiaries for certain purposes;
90	specifying application of public records and public
91	meetings requirements; exempting the corporation and
92	subsidiaries from public procurement provisions; providing
93	purposes; providing for a board of directors; providing
94	for membership; authorizing the corporation to establish
95	certain advisory committees; providing for organization of
96	the corporation; providing for meetings; providing powers
97	and duties of the corporation; requiring the corporation
98	to collect, analyze, and evaluate patient safety data and
99	related information; requiring the corporation to
100	establish a reporting system to identify and report near
101	misses relating to patient safety; requiring the
102	corporation to work with state agencies to develop
103	electronic health records; providing for an active library
104	of evidence-based medicine and patient safety practices;
105	requiring the corporation to develop and recommend core
106	competencies in patient safety and public education
107	programs; requiring an annual report; providing report
108	requirements; authorizing the corporation to seek funding
109	and apply for grants; requiring the Office of Program
110	Policy Analysis and Government Accountability, the
111	Department of Health, and the Agency for Health Care
112	Administration to develop performance standards to
113	evaluate the corporation; amending s. 409.91255, F.S.;
114	expanding assistance to certain health centers to include
115	community emergency room diversion programs and urgent
116	care services; amending s. 627.410, F.S.; requiring
117	insurers to file certain rates with the Office of
118	Insurance Regulation; creating s. 627.64872, F.S.;
119	providing legislative intent; creating the Florida Health
120	Insurance Plan for certain purposes; providing
121	definitions; providing exclusions; providing requirements
122	for operation of the plan; providing for a board of
123	directors; providing for appointment of members; providing
124	for terms; specifying service without compensation;
125	providing for travel and per diem expenses; requiring a
126	plan of operation; providing requirements; providing for
127	powers of the plan; requiring reports to the Governor and
128	Legislature; providing for an actuarial study; providing
129	certain immunity from liability for plan obligations;
130	authorizing the board to provide for indemnification of
131	certain costs; requiring an annually audited financial
132	statement; providing for eligibility for coverage under
133	the plan; providing criteria, requirements, and
134	limitations; specifying certain activity as an unfair
135	trade practice; providing for a plan administrator;
136	providing criteria; providing requirements; providing term
137	limits for the plan administrator; providing duties;
138	providing for paying the administrator; providing for
139	premium rates for plan coverage; providing rate
140	limitations; providing for sources of additional revenue;
141	specifying benefits under the plan; providing criteria,
142	requirements, and limitations; providing for
143	nonduplication of benefits; providing for annual and
144	maximum lifetime benefits; providing for tax exempt
145	status; providing for abolition of the Florida
146	Comprehensive Health Association upon implementation of
147	the plan; providing for continued operation of the Florida
148	Comprehensive Health Association until adoption of a plan
149	of operation for the Florida Health Insurance Plan;
150	providing for enrollment in the plan of persons enrolled
151	in the association; requiring insurers to pay certain
152	assessments to the board for certain purposes; providing
153	criteria, requirements, and limitations for such
154	assessments; providing for repeal of ss. 627.6488,
155	627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
156	627.6498, F.S., relating to the Florida Comprehensive
157	Health Association, upon implementation of the plan;
158	amending s. 627.662, F.S.; providing for application of
159	certain claim payment methodologies to certain types of
160	insurance; providing for certain actions relating to
161	inappropriate utilization of emergency care; amending s.
162	627.6699, F.S.; revising provisions requiring small
163	employer carriers to offer certain health benefit plans;
164	preserving a right to open enrollment for certain small
165	groups; requiring small employer carriers to file and
166	provide coverage under certain high deductible plans;
167	including high deductible plans and health reimbursement
168	arrangements under certain required plan provisions;
169	creating the Small Employers Access Program; providing
170	legislative intent; providing definitions; providing
171	participation eligibility requirements and criteria;
172	requiring the Office of Insurance Regulation to administer
173	the program by selecting an insurer through competitive
174	bidding; providing requirements; specifying insurer
175	qualifications; providing duties of the insurer; providing
176	a contract term; providing insurer reporting requirements;
177	providing application requirements; providing for benefits
178	under the program; requiring the office to annually report
179	to the Governor and Legislature; creating ss. 627.6405 and
180	641.31097, F.S.; providing for decreasing inappropriate
181	use of emergency care; providing legislative findings and
182	intent; requiring health maintenance organizations and
183	providers to provide certain information electronically
184	and develop community emergency department diversion
185	programs; authorizing health maintenance organizations to
186	require higher copayments for certain uses of emergency
187	departments; amending s. 627.9175, F.S.; requiring certain
188	health insurers to annually report certain coverage
189	information to the office; providing requirements;
190	deleting certain reporting requirements; retitling ch.
191	636, F.S.; designating ss. 636.002-636.067, F.S., as pt. I
192	of ch. 636, F.S.; providing a part title; amending s.
193	636.003, F.S.; revising the definition of "prepaid limited
194	health service organization" to exclude discount medical
195	plan organizations; creating pt. II of ch. 636, F.S.,
196	consisting of ss. 636.202-636.244, F.S.; providing a part
197	title; providing definitions; providing for regulation and
198	operation of discount medical plan organizations;
199	requiring corporate licensure before doing business as a
200	discount medical plan; specifying application
201	requirements; requiring license fees; providing for
202	expiration and renewal of licenses; requiring such
203	organizations to establish an Internet website; requiring
204	publication of certain information on the website;
205	specifying collection and deposit of the licensing fee;
206	authorizing the office to examine or investigate the
207	business affairs of such organizations; requiring
208	examinations and investigations; authorizing the office to
209	order production of documents and take statements;
210	requiring organizations to pay certain expenses;
211	specifying grounds for denial or revocation under certain
212	circumstances; authorizing discount medical plan
213	organizations to charge certain fees under certain
214	circumstances; providing reimbursement requirements;
215	prohibiting certain activities; requiring certain
216	disclosures to prospective members; requiring provider
217	agreements to provide services under a medical discount
218	plan; providing agreement requirements; requiring forms
219	and rates to be filed with the office; requiring annual
220	reports to be filed with the office; providing
221	requirements; providing for fines and administrative
222	sanctions for failing to file annual reports; establishing
223	minimum capital requirements; providing for suspension or
224	revocation of licenses under certain circumstances;
225	providing for suspension of enrollment of new members
226	under certain circumstances; providing terms of
227	suspensions; requiring notice of any change of an
228	organization's name; requiring discount medical plan
229	organizations to maintain provider names listings;
230	specifying marketing requirements of discount medical
231	plans; providing limitations; specifying fee disclosure
232	requirements for bundling discount medical plans with
233	other insurance products; authorizing the commission to
234	adopt rules; applying insurer service of process
235	requirements on discount medical plan organizations;
236	requiring a security deposit; prohibiting levy on certain
237	deposit assets or securities under certain circumstances;
238	providing criminal penalties; authorizing the office to
239	seek certain injunctive relief under certain
240	circumstances; providing limitations; providing for civil
241	actions for damages for certain violations; providing for
242	awards of court costs and attorney fees; specifying
243	application of unauthorized insurer provisions of law to
244	unlicensed discount medical plan organizations; creating
245	ss. 627.65626 and 627.6402, F.S.; providing for insurance
246	rebates for healthy lifestyles; providing for rebate of
247	certain premiums for participation in health wellness,
248	maintenance, or improvement programs under certain
249	circumstances; providing requirements; amending s. 641.31,
250	F.S.; authorizing health maintenance organizations
251	offering certain point-of-service riders to offer such
252	riders to certain employers for certain employees;
253	providing requirements and limitations; providing for
254	application of certain claim payment methodologies to
255	certain types of insurance; providing for rebate of
256	certain premiums for participation in health wellness,
257	maintenance, or improvement programs under certain
258	circumstances; providing requirements; creating s.
259	626.593, F.S.; providing fee and commission limitations
260	for health insurance agents; requiring a written contract
261	for compensation; providing contract requirements;
262	requiring a rebate of commission under certain
263	circumstances; amending ss. 626.191 and 626.201, F.S.;
264	clarifying certain application requirements; preserving
265	certain rights to enrollment in certain health benefit
266	coverage programs for certain groups under certain
267	circumstances; creating s. 465.0244, F.S.; requiring each
268	pharmacy to make available on its Internet website a link
269	to certain performance outcome and financial data of the
270	Agency for Health Care Administration and a notice of the
271	availability of such information; amending s. 627.6499,
272	F.S.; requiring each health insurer to make available on
273	its Internet website a link to certain performance outcome
274	and financial data of the Agency for Health Care
275	Administration and a notice in policies of the
276	availability of such information; amending s. 641.54,
277	F.S.; requiring health maintenance organizations to make
278	certain insurance financial information available to
279	subscribers; requiring health maintenance organizations to
280	make available on its Internet website a link to certain
281	performance outcome and financial data of the Agency for
282	Health Care Administration and a notice in policies of the
283	availability of such information; repealing s. 408.02,
284	F.S., relating to the development, endorsement,
285	implementation, and evaluation of patient management
286	practice parameters by the Agency for Health Care
287	Administration; providing appropriations; providing
288	effective dates.
289
290	WHEREAS, according to the Kaiser Family Foundation, eight
291	out of ten uninsured Americans are workers or dependents of
292	workers and nearly eight out of ten uninsured Americans have
293	family incomes above the poverty level, and
294	WHEREAS, fifty-five percent of those who do not have
295	insurance state the reason they don't have insurance is lack of
296	affordability, and
297	WHEREAS, average health insurance premium increases for the
298	last two years have been in the range of ten to twenty percent
299	for Florida's employers, and
300	WHEREAS, an increasing number of employers are opting to
301	cease providing insurance coverage to their employees due to the
302	high cost, and
303	WHEREAS, an increasing number of employers who continue
304	providing coverage are forced to shift more premium cost to
305	their employees, thus diminishing the value of employee wage
306	increases, and
307	WHEREAS, according to studies, the rate of avoidable
308	hospitalization is fifty to seventy percent lower for the
309	insured versus the uninsured, and
310	WHEREAS, according to Florida Cancer Registry data, the
311	uninsured have a seventy percent greater chance of a late
312	diagnosis, thus decreasing the chances of a positive health
313	outcome, and
314	WHEREAS, according to the Agency for Health Care
315	Administration's 2002 financial data, uncompensated care in
316	Florida's hospitals is growing at the rate of twelve to thirteen
317	percent per year, and, at $4.3 billion in 2001, this cost, when
318	shifted to Floridians who remain insured, is not sustainable,
319	and
320	WHEREAS, the Florida Legislature, through the creation of
321	Health Flex, has already identified the need for lower cost
322	alternatives, and
323	WHEREAS, it is of vital importance and in the best
324	interests of the people of the State of Florida that the issue
325	of available, affordable health care insurance be addressed in a
326	cohesive and meaningful manner, and
327	WHEREAS, there is general recognition that the issues
328	surrounding the problem of access to affordable health insurance
329	are complicated and multifaceted, and
330	WHEREAS, on August 14, 2003, Speaker Johnnie Byrd created
331	the Select Committee on Affordable Health Care for Floridians in
332	an effort to address the issue of affordable and accessible
333	employment-based insurance, and
334	WHEREAS, the Select Committee on Affordable Health Care for
335	Floridians held public hearings with predetermined themes around
336	the state, specifically, in Orlando, Miami, Jacksonville, Tampa,
337	Pensacola, Boca Raton, and Tallahassee, from October through
338	November 2003 to effectively probe the operation of the private
339	insurance marketplace, to understand the health insurance market
340	trends, to learn from past policy initiatives, and to identify,
341	explore, and debate new ideas for change, and
342	WHEREAS, recommendations from the Select Committee on
343	Affordable Health Care were adopted on February 4, 2004, to
344	address the multifaceted issues attributed to the increase in
345	health care cost, and
346	WHEREAS, these recommendations were presented to the
347	Speaker of the House of Representatives in a final report from
348	the committee on February 18, 2004, and subsequent legislation
349	was drafted creating the "The 2004 Affordable Health Care for
350	Floridians Act," NOW, THEREFORE,
351
352	Be It Enacted by the Legislature of the State of Florida:
353
354	Section 1.  This act may be referred to by the popular name
355	"The 2004 Affordable Health Care for Floridians Act."
356	Section 2.  The purpose of this act is to address the
357	underlying cause of the double-digit increases in health
358	insurance premiums by mitigating the overall growth in health
359	care costs.
360	Section 3.  Paragraph (c) of subsection (4) of section
361	381.026, Florida Statutes, is amended to read:
362	381.026  Florida Patient's Bill of Rights and
363	Responsibilities.--
364	(4)  RIGHTS OF PATIENTS.--Each health care facility or
365	provider shall observe the following standards:
366	(c)  Financial information and disclosure.--
367	1.  A patient has the right to be given, upon request, by
368	the responsible provider, his or her designee, or a
369	representative of the health care facility full information and
370	necessary counseling on the availability of known financial
371	resources for the patient's health care.
372	2.  A health care provider or a health care facility shall,
373	upon request, disclose to each patient who is eligible for
374	Medicare, in advance of treatment, whether the health care
375	provider or the health care facility in which the patient is
376	receiving medical services accepts assignment under Medicare
377	reimbursement as payment in full for medical services and
378	treatment rendered in the health care provider's office or
379	health care facility.
380	3.  A health care provider or a health care facility shall,
381	upon request, furnish a person patient, prior to provision of
382	medical services, a reasonable estimate of charges for such
383	services. Such reasonable estimate shall not preclude the health
384	care provider or health care facility from exceeding the
385	estimate or making additional charges based on changes in the
386	patient's condition or treatment needs.
387	4.  Each licensed facility not operated by the state shall
388	make available to the public on its Internet website or by other
389	electronic means a description of and a link to the performance
390	outcome and financial data that is published by the agency
391	pursuant to s. 408.05(3)(l). The facility shall place a notice
392	in the reception area that such information is available
393	electronically and the website address. The licensed facility
394	may indicate that the pricing information is based on a
395	compilation of charges for the average patient and that each
396	patient's bill may vary from the average depending upon the
397	severity of illness and individual resources consumed. The
398	licensed facility may also indicate that the price of service is
399	negotiable for eligible patients based upon the patient's
400	ability to pay.
401	5.4.  A patient has the right to receive a copy of an
402	itemized bill upon request. A patient has a right to be given an
403	explanation of charges upon request.
404	Section 4.  Subsection (1) and paragraph (g) of subsection
405	(3) of section 381.734, Florida Statutes, are amended, and
406	subsections (4), (5), and (6) are added to said section, to
407	read:
408	381.734  Healthy Communities, Healthy People Program.--
409	(1)  The department shall develop and implement the Healthy
410	Communities, Healthy People Program, a comprehensive and
411	community-based health promotion and wellness program. The
412	program shall be designed to reduce major behavioral risk
413	factors associated with chronic diseases, including those
414	chronic diseases identified in chapter 385, by enhancing the
415	knowledge, skills, motivation, and opportunities for
416	individuals, organizations, health care providers, small
417	businesses, health insurers, and communities to develop and
418	maintain healthy lifestyles.
419	(3)  The program shall include:
420	(g)  The establishment of a comprehensive program to inform
421	the public, health care professionals, health insurers, and
422	communities about the prevalence of chronic diseases in the
423	state; known and potential risks, including social and
424	behavioral risks; and behavior changes that would reduce risks.
425	(4)  The department shall make available on its Internet
426	website, no later than October 1, 2004, and in a hard-copy
427	format upon request, a listing of age-specific, disease-
428	specific, and community-specific health promotion, preventive
429	care, and wellness programs offered and established under the
430	Healthy Communities, Healthy People Program. The website shall
431	also provide residents with information to identify behavior
432	risk factors that lead to diseases that are preventable by
433	maintaining a healthy lifestyle. The website shall allow
434	consumers to select by county or region disease-specific
435	statistical information.
436	(5)  The department shall monitor and assess the
437	effectiveness of such programs. The department shall submit a
438	status report based on this monitoring and assessment to the
439	Governor, the Speaker of the House of Representatives, the
440	President of the Senate, and the substantive committees of each
441	house of the Legislature, with the first annual report due
442	January 31, 2005.
443	(6)  The Office of Program Policy and Government
444	Accountability shall evaluate and report to the Governor, the
445	President of the Senate, and the Speaker of the House of
446	Representatives, by March 1, 2005, on the effectiveness of the
447	department's monitoring and assessment of the program's
448	effectiveness.
449	Section 5.  Subsection (7) is added to section 395.1041,
450	Florida Statutes, to read:
451	395.1041  Access to emergency services and care.--
452	(7)  EMERGENCY ROOM DIVERSION PROGRAMS.--Hospitals may
453	develop emergency room diversion programs, including, but not
454	limited to, an "Emergency Hotline" which allows patients to help
455	determine if emergency department services are appropriate or if
456	other health care settings may be more appropriate for care, and
457	a "Fast Track" program allowing nonemergency patients to be
458	treated at an alternative site. Alternative sites may include
459	health care programs funded with local tax revenue and federally
460	funded community health centers, county health departments, or
461	other nonhospital providers of health care services. The program
462	may include provisions for followup care and case management.
463	Section 6.  Paragraph (h) is added to subsection (1) of
464	section 395.1055, Florida Statutes, to read:
465	395.1055  Rules and enforcement.--
466	(1)  The agency shall adopt rules pursuant to ss.
467	120.536(1) and 120.54 to implement the provisions of this part,
468	which shall include reasonable and fair minimum standards for
469	ensuring that:
470	(h)  Licensed facilities make available on their Internet
471	websites, no later than October 1, 2004, and in a hard-copy
472	format upon request, a description of and a link to the patient
473	charge and performance outcome data collected from licensed
474	facilities pursuant to s. 408.061.
475	Section 7.  Subsection (7) is added to section 395.1065,
476	Florida Statutes, to read:
477	395.1065  Criminal and administrative penalties;
478	injunctions; emergency orders; moratorium.--
479	(7)  The agency shall impose a fine of $500 for each
480	instance of the facility's failure to provide the information
481	required by rules adopted pursuant to s. 395.1055(1)(h).
482	Section 8.  Subsections (1), (2), and (3) of section
483	395.301, Florida Statutes, are amended, and subsections (7),
484	(8), (9), and (10) are added to said section, to read:
485	395.301  Itemized patient bill; form and content prescribed
486	by the agency.--
487	(1)  A licensed facility not operated by the state shall
488	notify each patient during admission and at discharge of his or
489	her right to receive an itemized bill upon request. Within 7
490	days following the patient's discharge or release from a
491	licensed facility not operated by the state, or within 7 days
492	after the earliest date at which the loss or expense from the
493	service may be determined, the licensed facility providing the
494	service shall, upon request, submit to the patient, or to the
495	patient's survivor or legal guardian as may be appropriate, an
496	itemized statement detailing in language comprehensible to an
497	ordinary layperson the specific nature of charges or expenses
498	incurred by the patient, which in the initial billing shall
499	contain a statement of specific services received and expenses
500	incurred for such items of service, enumerating in detail the
501	constituent components of the services received within each
502	department of the licensed facility and including unit price
503	data on rates charged by the licensed facility, as prescribed by
504	the agency.
505	(2)(a)  Each such statement submitted pursuant to this
506	section:
507	1.(a)  May not include charges of hospital-based physicians
508	if billed separately.
509	2.(b)  May not include any generalized category of expenses
510	such as "other" or "miscellaneous" or similar categories.
511	3.(c)  Shall list drugs by brand or generic name and not
512	refer to drug code numbers when referring to drugs of any sort.
513	4.(d)  Shall specifically identify therapy treatment as to
514	the date, type, and length of treatment when therapy treatment
515	is a part of the statement.
516	(b)  Any person receiving a statement pursuant to this
517	section shall be fully and accurately informed as to each charge
518	and service provided by the institution preparing the statement.
519	(3)  On each such itemized statement submitted pursuant to
520	subsection (1) there shall appear the words "A FOR-PROFIT (or
521	NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
522	CENTER) LICENSED BY THE STATE OF FLORIDA" or substantially
523	similar words sufficient to identify clearly and plainly the
524	ownership status of the licensed facility. Each itemized
525	statement must prominently display the phone number of the
526	medical facility's patient liaison who is responsible for
527	expediting the resolution of any billing dispute between the
528	patient, or his or her representative, and the billing
529	department.
530	(7)  Each licensed facility not operated by the state shall
531	provide, prior to provision of any nonemergency medical
532	services, a written good-faith estimate of reasonably
533	anticipated charges for the facility to treat the patient's
534	condition upon written request of a prospective patient. The
535	estimate shall be provided to the prospective patient within 7
536	business days after the receipt of the request. The estimate may
537	be the average charges for that diagnosis related group or the
538	average charges for that procedure. Upon request, the facility
539	shall notify the patient of any revision to the good-faith
540	estimate. Such estimate shall not preclude the actual charges
541	from exceeding the estimate. The facility shall place a notice
542	in the reception area that such information is available.
543	Failure to provide the estimate within the provisions
544	established pursuant to this section shall result in a fine of
545	$500 for each instance of the facility's failure to provide the
546	requested information.
547	(8)  A licensed facility shall make available to a patient
548	all records necessary for verification of the accuracy of the
549	patient's bill within 30 business days after the request for
550	such records. The verification information must be made
551	available in the facility's offices. Such records shall be
552	available to the patient prior to and after payment of the bill
553	or claim. The facility may not charge the patient for making
554	such verification records available; however, the facility may
555	charge its usual fee for providing copies of records as
556	specified in s. 395.3025.
557	(9)  Each facility shall establish a method for reviewing
558	and responding to questions from patients concerning the
559	patient's itemized bill. Such response shall be provided within
560	30 days after the date a question is received. If the patient is
561	not satisfied with the response, the facility must provide the
562	patient with the address of the agency to which the issue may be
563	sent for review.
564	(10)  Each licensed facility shall make available on its
565	Internet website a link to the performance outcome and financial
566	data that is published by the Agency for Health Care
567	Administration pursuant to s. 408.05(3)(l). The facility shall
568	place a notice in the reception area that the information is
569	available electronically and the facility's Internet website
570	address.
571	Section 9.  Subsection (1) of section 408.061, Florida
572	Statutes, is amended to read:
573	408.061  Data collection; uniform systems of financial
574	reporting; information relating to physician charges;
575	confidential information; immunity.--
576	(1)  The agency shall may require the submission by health
577	care facilities, health care providers, and health insurers of
578	data necessary to carry out the agency's duties. Specifications
579	for data to be collected under this section shall be developed
580	by the agency with the assistance of technical advisory panels
581	including representatives of affected entities, consumers,
582	purchasers, and such other interested parties as may be
583	determined by the agency.
584	(a)  Data to be submitted by health care facilities,
585	including the facilities as defined in chapter 395, shall may
586	include, but are not limited to: case-mix data, patient
587	admission and or discharge data, hospital emergency department
588	data which shall include the number of patients treated in the
589	emergency department of a licensed hospital reported by patient
590	acuity level, data on hospital-acquired infections as specified
591	by rule, data on complications as specified by rule, data on
592	readmissions as specified by rule, with patient and provider-
593	specific identifiers included, actual charge data by diagnostic
594	groups, financial data, accounting data, operating expenses,
595	expenses incurred for rendering services to patients who cannot
596	or do not pay, interest charges, depreciation expenses based on
597	the expected useful life of the property and equipment involved,
598	and demographic data. The agency shall adopt nationally
599	recognized risk adjustment methodologies or software consistent
600	with the standards of the Agency for Healthcare Research and
601	Quality and as selected by the agency for all data submitted as
602	required by this section. Data may be obtained from documents
603	such as, but not limited to: leases, contracts, debt
604	instruments, itemized patient bills, medical record abstracts,
605	and related diagnostic information. Reported data elements shall
606	be reported electronically in accordance with Rule 59E-7.012,
607	Florida Administrative Code. Data submitted shall be certified
608	by the chief executive officer or an appropriate and duly
609	authorized representative or employee of the licensed facility
610	that the information submitted is true and accurate.
611	(b)  Data to be submitted by health care providers may
612	include, but are not limited to: Medicare and Medicaid
613	participation, types of services offered to patients, amount of
614	revenue and expenses of the health care provider, and such other
615	data which are reasonably necessary to study utilization
616	patterns. Data submitted shall be certified by the appropriate
617	duly authorized representative or employee of the health care
618	provider that the information submitted is true and accurate.
619	(c)  Data to be submitted by health insurers may include,
620	but are not limited to: claims, premium, administration, and
621	financial information. Data submitted shall be certified by the
622	chief financial officer, an appropriate and duly authorized
623	representative, or an employee of the insurer that the
624	information submitted is true and accurate.
625	(d)  Data required to be submitted by health care
626	facilities, health care providers, or health insurers shall not
627	include specific provider contract reimbursement information.
628	However, such specific provider reimbursement data shall be
629	reasonably available for onsite inspection by the agency as is
630	necessary to carry out the agency's regulatory duties. Any such
631	data obtained by the agency as a result of onsite inspections
632	may not be used by the state for purposes of direct provider
633	contracting and are confidential and exempt from the provisions
634	of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
635	(e)  A requirement to submit data shall be adopted by rule
636	if the submission of data is being required of all members of
637	any type of health care facility, health care provider, or
638	health insurer. Rules are not required, however, for the
639	submission of data for a special study mandated by the
640	Legislature or when information is being requested for a single
641	health care facility, health care provider, or health insurer.
642	Section 10.  Subsections (1) and (4) of section 408.062,
643	Florida Statutes, are amended, and subsection (5) is added to
644	said section, to read:
645	408.062  Research, analyses, studies, and reports.--
646	(1)  The agency shall have the authority to conduct
647	research, analyses, and studies relating to health care costs
648	and access to and quality of health care services as access and
649	quality are affected by changes in health care costs. Such
650	research, analyses, and studies shall include, but not be
651	limited to, research and analysis relating to:
652	(a)  The financial status of any health care facility or
653	facilities subject to the provisions of this chapter.
654	(b)  The impact of uncompensated charity care on health
655	care facilities and health care providers.
656	(c)  The state's role in assisting to fund indigent care.
657	(d)  In conjunction with the Office of Insurance
658	Regulation, the availability and affordability of health
659	insurance for small businesses.
660	(e)  Total health care expenditures in the state according
661	to the sources of payment and the type of expenditure.
662	(f)  The quality of health services, using techniques such
663	as small area analysis, severity adjustments, and risk-adjusted
664	mortality rates.
665	(g)  The development of physician information payment
666	systems which are capable of providing data for health care
667	consumers taking into account the amount of resources consumed,
668	including such information at licensed facilities as defined in
669	chapter 395, and the outcomes produced in the delivery of care.
670	(h)  The collection of a statistically valid sample of data
671	on the retail prices charged by pharmacies for the 50 most
672	frequently prescribed medicines from any pharmacy licensed by
673	this state as a special study authorized by the Legislature to
674	be performed by the agency quarterly. If the drug is available
675	generically, price data shall be reported for the generic drug
676	and price data of a brand-named drug for which the generic drug
677	is the equivalent shall be reported. The agency shall make
678	available on its Internet website for each pharmacy, no later
679	than October 1, 2005, drug prices for a 30-day supply at a
680	standard dose. The data collected shall be reported for each
681	drug by pharmacy and by metropolitan statistical area or region
682	and updated quarterly The impact of subacute admissions on
683	hospital revenues and expenses for purposes of calculating
684	adjusted admissions as defined in s. 408.07.
685	(i)  The use of emergency department services by patient
686	acuity level and the implication of increasing hospital cost by
687	providing nonurgent care in emergency departments. The agency
688	shall submit an annual report based on this monitoring and
689	assessment to the Governor, the Speaker of the House of
690	Representatives, the President of the Senate, and the
691	substantive legislative committees with the first report due
692	January 1, 2006.
693	(j)  The making available on its Internet website no later
694	than October 1, 2004, and in a hard-copy format upon request, of
695	patient charge, volumes, length of stay, and performance outcome
696	indicators collected from health care facilities pursuant to s.
697	408.061(1)(a) for specific medical conditions, surgeries, and
698	procedures provided in inpatient and outpatient facilities as
699	determined by the agency. In making the determination of
700	specific medical conditions, surgeries, and procedures to
701	include, the agency shall consider such factors as volume,
702	severity of the illness, urgency of admission, individual and
703	societal costs, and whether the condition is acute or chronic.
704	Performance outcome indicators shall be risk adjusted or
705	severity adjusted, as applicable, using nationally recognized
706	risk adjustment methodologies or software consistent with the
707	standards of the Agency for Healthcare Research and Quality and
708	as selected by the agency. The website shall also provide an
709	interactive search that allows consumers to view and compare the
710	information for specific facilities, a map that allows consumers
711	to select a county or region, definitions of all of the data,
712	descriptions of each procedure, and an explanation about why the
713	data may differ from facility to facility. Such public data
714	shall be updated quarterly. The agency shall submit an annual
715	status report on the collection of data and publication of
716	performance outcome indicators to the Governor, the Speaker of
717	the House of Representatives, the President of the Senate, and
718	the substantive legislative committees with the first status
719	report due January 1, 2005.
720	(4)(a)  The agency shall may conduct data-based studies and
721	evaluations and make recommendations to the Legislature and the
722	Governor concerning exemptions, the effectiveness of limitations
723	of referrals, restrictions on investment interests and
724	compensation arrangements, and the effectiveness of public
725	disclosure. Such analysis shall may include, but need not be
726	limited to, utilization of services, cost of care, quality of
727	care, and access to care. The agency may require the submission
728	of data necessary to carry out this duty, which may include, but
729	need not be limited to, data concerning ownership, Medicare and
730	Medicaid, charity care, types of services offered to patients,
731	revenues and expenses, patient-encounter data, and other data
732	reasonably necessary to study utilization patterns and the
733	impact of health care provider ownership interests in health-
734	care-related entities on the cost, quality, and accessibility of
735	health care.
736	(b)  The agency may collect such data from any health
737	facility or licensed health care provider as a special study.
738	(5)  The agency shall develop and implement a strategy for
739	the adoption and use of electronic health records. The agency
740	may develop rules to facilitate the functionality and protect
741	the confidentiality of electronic health records. The agency
742	shall report to the Governor, the Speaker of the House of
743	Representatives, and the President of the Senate on legislative
744	recommendations to protect the confidentiality of electronic
745	health records.
746	Section 11.  Paragraph (l) is added to subsection (3) of
747	section 408.05, Florida Statutes, to read:
748	408.05  State Center for Health Statistics.--
749	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
750	produce comparable and uniform health information and
751	statistics, the agency shall perform the following functions:
752	(l)  Develop, in conjunction with the State Comprehensive
753	Health Information System Advisory Council, and implement a
754	long-range plan for making available performance outcome and
755	financial data that will allow consumers to compare health care
756	services. The performance outcomes and financial data the agency
757	must make available shall include, but is not limited to,
758	pharmaceuticals, physicians, health care facilities, and health
759	plans and managed care entities. The agency shall submit the
760	initial plan to the Governor, the President of the Senate, and
761	the Speaker of the House of Representatives by March 1, 2005,
762	and shall update the plan and report on the status of its
763	implementation annually thereafter. The agency shall also make
764	the plan and status report available to the public on its
765	Internet website. As part of the plan, the agency shall identify
766	the process and timeframes for implementation, any barriers to
767	implementation, and recommendations of changes in the law that
768	may be enacted by the Legislature to eliminate the barriers. As
769	preliminary elements of the plan, the agency shall:
770	1.  Make available performance outcome and patient charge
771	data collected from health care facilities pursuant to s.
772	408.061(1)(a) and (2). The agency shall determine which
773	conditions and procedures, performance outcomes, and patient
774	charge data to disclose based upon input from the council. When
775	determining which conditions and procedures are to be disclosed,
776	the council and the agency shall consider variation in costs,
777	variation in outcomes, and magnitude of variations and other
778	relevant information. When determining which performance
779	outcomes to disclose, the agency:
780	a.  Shall consider such factors as volume of cases; average
781	patient charges; average length of stay; complication rates;
782	mortality rates; and infection rates, among others, which shall
783	be adjusted for case mix and severity, if applicable.
784	b.  May consider such additional measures that are adopted
785	by the Centers for Medicare and Medicaid Studies, National
786	Quality Forum, the Joint Commission on Accreditation of
787	Healthcare Organizations, the Agency for Healthcare Research and
788	Quality, or a similar national entity that establishes standards
789	to measure the performance of health care providers, or by other
790	states.
791
792	When determining which patient charge data to disclose, the
793	agency shall consider such measures as average charge, average
794	net revenue per adjusted patient day, average cost per adjusted
795	patient day, and average cost per admission, among others.
796	2.  Make available performance measures, benefit design,
797	and premium cost data from health plans licensed pursuant to
798	chapter 627 or chapter 641. The agency shall determine which
799	performance outcome and member and subscriber cost data to
800	disclose, based upon input from the council. When determining
801	which data to disclose, the agency shall consider information
802	that may be required by either individual or group purchasers to
803	assess the value of the product, which may include membership
804	satisfaction, quality of care, current enrollment or membership,
805	coverage areas, accreditation status, premium costs, plan costs,
806	premium increases, range of benefits, copayments and
807	deductibles, accuracy and speed of claims payment, credentials
808	of physicians, number of providers, names of network providers,
809	and hospitals in the network. Health plans shall make available
810	to the agency any such data or information that is not currently
811	reported to the agency or the office.
812	3.  Determine the method and format for public disclosure
813	of data reported pursuant to this paragraph. The agency shall
814	make its determination based upon input from the Comprehensive
815	Health Information System Advisory Council. At a minimum, the
816	data shall be made available on the agency's Internet website in
817	a manner that allows consumers to conduct an interactive search
818	that allows them to view and compare the information for
819	specific providers. The website must include such additional
820	information as is determined necessary to ensure that the
821	website enhances informed decision making among consumers and
822	health care purchasers, which shall include, at a minimum,
823	appropriate guidance on how to use the data and an explanation
824	of why the data may vary from provider to provider. The data
825	specified in subparagraph 1. shall be released no later than
826	March 1, 2005. The data specified in subparagraph 2. shall be
827	released no later than March 1, 2006.
828	Section 12.  Subsection (3) of section 409.9066, Florida
829	Statutes, is amended to read:
830	409.9066  Medicare prescription discount program.--
831	(3)  The Agency for Health Care Administration shall
832	publish, on a free website available to the public, the most
833	recent average wholesale prices for the 200 drugs most
834	frequently dispensed to the elderly and, to the extent possible,
835	shall provide a mechanism that consumers may use to calculate
836	the retail price and the price that should be paid after the
837	discount required in subsection (1) is applied. The agency shall
838	provide retail information by geographic area and retail
839	information by provider within geographical areas.
840	Section 13.  Section 408.7056, Florida Statutes, is amended
841	to read:
842	408.7056  Statewide Provider and Subscriber Assistance
843	Program.--
844	(1)  As used in this section, the term:
845	(a)  "Agency" means the Agency for Health Care
846	Administration.
847	(b)  "Department" means the Department of Financial
848	Services.
849	(c)  "Grievance procedure" means an established set of
850	rules that specify a process for appeal of an organizational
851	decision.
852	(d)  "Health care provider" or "provider" means a state-
853	licensed or state-authorized facility, a facility principally
854	supported by a local government or by funds from a charitable
855	organization that holds a current exemption from federal income
856	tax under s. 501(c)(3) of the Internal Revenue Code, a licensed
857	practitioner, a county health department established under part
858	I of chapter 154, a prescribed pediatric extended care center
859	defined in s. 400.902, a federally supported primary care
860	program such as a migrant health center or a community health
861	center authorized under s. 329 or s. 330 of the United States
862	Public Health Services Act that delivers health care services to
863	individuals, or a community facility that receives funds from
864	the state under the Community Alcohol, Drug Abuse, and Mental
865	Health Services Act and provides mental health services to
866	individuals.
867	(e)  "Managed care entity" means a health maintenance
868	organization or a prepaid health clinic certified under chapter
869	641, a prepaid health plan authorized under s. 409.912, or an
870	exclusive provider organization certified under s. 627.6472.
871	(f)  "Office" means the Office of Insurance Regulation of
872	the Financial Services Commission.
873	(g)  "Panel" means a statewide provider and subscriber
874	assistance panel selected as provided in subsection (11).
875	(2)  The agency shall adopt and implement a program to
876	provide assistance to subscribers and providers, including those
877	whose grievances are not resolved by the managed care entity to
878	the satisfaction of the subscriber or provider. The program
879	shall consist of one or more panels that meet as often as
880	necessary to timely review, consider, and hear grievances and
881	recommend to the agency or the office any actions that should be
882	taken concerning individual cases heard by the panel. The panel
883	shall hear every grievance filed by subscribers and providers on
884	behalf of subscribers, unless the grievance:
885	(a)  Relates to a managed care entity's refusal to accept a
886	provider into its network of providers;
887	(b)  Is part of an internal grievance in a Medicare managed
888	care entity or a reconsideration appeal through the Medicare
889	appeals process which does not involve a quality of care issue;
890	(c)  Is related to a health plan not regulated by the state
891	such as an administrative services organization, third-party
892	administrator, or federal employee health benefit program;
893	(d)  Is related to appeals by in-plan suppliers and
894	providers, unless related to quality of care provided by the
895	plan;
896	(e)  Is part of a Medicaid fair hearing pursued under 42
897	C.F.R. ss. 431.220 et seq.;
898	(f)  Is the basis for an action pending in state or federal
899	court;
900	(g)  Is related to an appeal by nonparticipating providers,
901	unless related to the quality of care provided to a subscriber
902	by the managed care entity and the provider is involved in the
903	care provided to the subscriber;
904	(h)  Was filed before the subscriber or provider completed
905	the entire internal grievance procedure of the managed care
906	entity, the managed care entity has complied with its timeframes
907	for completing the internal grievance procedure, and the
908	circumstances described in subsection (6) do not apply;
909	(i)  Has been resolved to the satisfaction of the
910	subscriber or provider who filed the grievance, unless the
911	managed care entity's initial action is egregious or may be
912	indicative of a pattern of inappropriate behavior;
913	(j)  Is limited to seeking damages for pain and suffering,
914	lost wages, or other incidental expenses, including accrued
915	interest on unpaid balances, court costs, and transportation
916	costs associated with a grievance procedure;
917	(k)  Is limited to issues involving conduct of a health
918	care provider or facility, staff member, or employee of a
919	managed care entity which constitute grounds for disciplinary
920	action by the appropriate professional licensing board and is
921	not indicative of a pattern of inappropriate behavior, and the
922	agency, office, or department has reported these grievances to
923	the appropriate professional licensing board or to the health
924	facility regulation section of the agency for possible
925	investigation; or
926	(l)  Is withdrawn by the subscriber or provider. Failure of
927	the subscriber or the provider to attend the hearing shall be
928	considered a withdrawal of the grievance; or
929	(3)  The agency shall review all grievances within 60 days
930	after receipt and make a determination whether the grievance
931	shall be heard. Once the agency notifies the panel, the
932	subscriber or provider, and the managed care entity that a
933	grievance will be heard by the panel, the panel shall hear the
934	grievance either in the network area or by teleconference no
935	later than 120 days after the date the grievance was filed. The
936	agency shall notify the parties, in writing, by facsimile
937	transmission, or by phone, of the time and place of the hearing.
938	The panel may take testimony under oath, request certified
939	copies of documents, and take similar actions to collect
940	information and documentation that will assist the panel in
941	making findings of fact and a recommendation. The panel shall
942	issue a written recommendation, supported by findings of fact,
943	to the provider or subscriber, to the managed care entity, and
944	to the agency or the office no later than 15 working days after
945	hearing the grievance. If at the hearing the panel requests
946	additional documentation or additional records, the time for
947	issuing a recommendation is tolled until the information or
948	documentation requested has been provided to the panel. The
949	proceedings of the panel are not subject to chapter 120.
950	(4)  If, upon receiving a proper patient authorization
951	along with a properly filed grievance, the agency requests
952	medical records from a health care provider or managed care
953	entity, the health care provider or managed care entity that has
954	custody of the records has 10 days to provide the records to the
955	agency. Records include medical records, communication logs
956	associated with the grievance both to and from the subscriber,
957	and contracts. Failure to provide requested medical records may
958	result in the imposition of a fine of up to $500. Each day that
959	records are not produced is considered a separate violation.
960	(5)  Grievances that the agency determines pose an
961	immediate and serious threat to a subscriber's health must be
962	given priority over other grievances. The panel may meet at the
963	call of the chair to hear the grievances as quickly as possible
964	but no later than 45 days after the date the grievance is filed,
965	unless the panel receives a waiver of the time requirement from
966	the subscriber. The panel shall issue a written recommendation,
967	supported by findings of fact, to the office or the agency
968	within 10 days after hearing the expedited grievance.
969	(6)  When the agency determines that the life of a
970	subscriber is in imminent and emergent jeopardy, the chair of
971	the panel may convene an emergency hearing, within 24 hours
972	after notification to the managed care entity and to the
973	subscriber, to hear the grievance. The grievance must be heard
974	notwithstanding that the subscriber has not completed the
975	internal grievance procedure of the managed care entity. The
976	panel shall, upon hearing the grievance, issue a written
977	emergency recommendation, supported by findings of fact, to the
978	managed care entity, to the subscriber, and to the agency or the
979	office for the purpose of deferring the imminent and emergent
980	jeopardy to the subscriber's life. Within 24 hours after receipt
981	of the panel's emergency recommendation, the agency or office
982	may issue an emergency order to the managed care entity. An
983	emergency order remains in force until:
984	(a)  The grievance has been resolved by the managed care
985	entity;
986	(b)  Medical intervention is no longer necessary; or
987	(c)  The panel has conducted a full hearing under
988	subsection (3) and issued a recommendation to the agency or the
989	office, and the agency or office has issued a final order.
990	(7)  After hearing a grievance, the panel shall make a
991	recommendation to the agency or the office which may include
992	specific actions the managed care entity must take to comply
993	with state laws or rules regulating managed care entities.
994	(8)  A managed care entity, subscriber, or provider that is
995	affected by a panel recommendation may within 10 days after
996	receipt of the panel's recommendation, or 72 hours after receipt
997	of a recommendation in an expedited grievance, furnish to the
998	agency or office written evidence in opposition to the
999	recommendation or findings of fact of the panel.
1000	(9)  No later than 30 days after the issuance of the
1001	panel's recommendation and, for an expedited grievance, no later
1002	than 10 days after the issuance of the panel's recommendation,
1003	the agency or the office may adopt the panel's recommendation or
1004	findings of fact in a proposed order or an emergency order, as
1005	provided in chapter 120, which it shall issue to the managed
1006	care entity. The agency or office may issue a proposed order or
1007	an emergency order, as provided in chapter 120, imposing fines
1008	or sanctions, including those contained in ss. 641.25 and
1009	641.52. The agency or the office may reject all or part of the
1010	panel's recommendation. All fines collected under this
1011	subsection must be deposited into the Health Care Trust Fund.
1012	(10)  In determining any fine or sanction to be imposed,
1013	the agency and the office may consider the following factors:
1014	(a)  The severity of the noncompliance, including the
1015	probability that death or serious harm to the health or safety
1016	of the subscriber will result or has resulted, the severity of
1017	the actual or potential harm, and the extent to which provisions
1018	of chapter 641 were violated.
1019	(b)  Actions taken by the managed care entity to resolve or
1020	remedy any quality-of-care grievance.
1021	(c)  Any previous incidents of noncompliance by the managed
1022	care entity.
1023	(d)  Any other relevant factors the agency or office
1024	considers appropriate in a particular grievance.
1025	(11)(a)  The panel shall consist of the Insurance Consumer
1026	Advocate, or designee thereof, established by s. 627.0613; at
1027	least two members employed by the agency and at least two
1028	members employed by the department, chosen by their respective
1029	agencies; a consumer appointed by the Governor; a physician
1030	appointed by the Governor, as a standing member; and, if
1031	necessary, physicians who have expertise relevant to the case to
1032	be heard, on a rotating basis. The agency may contract with a
1033	medical director, and a primary care physician, or both, who
1034	shall provide additional technical expertise to the panel but
1035	shall not be voting members of the panel. The medical director
1036	shall be selected from a health maintenance organization with a
1037	current certificate of authority to operate in Florida.
1038	(b)  A majority of those panel members required under
1039	paragraph (a) shall constitute a quorum for any meeting or
1040	hearing of the panel. A grievance may not be heard or voted upon
1041	at any panel meeting or hearing unless a quorum is present,
1042	except that a minority of the panel may adjourn a meeting or
1043	hearing until a quorum is present. A panel convened for the
1044	purpose of hearing a subscriber's grievance in accordance with
1045	subsections (2) and (3) shall not consist of more than 11
1046	members.
1047	(12)  Every managed care entity shall submit a quarterly
1048	report to the agency, the office, and the department listing the
1049	number and the nature of all subscribers' and providers'
1050	grievances which have not been resolved to the satisfaction of
1051	the subscriber or provider after the subscriber or provider
1052	follows the entire internal grievance procedure of the managed
1053	care entity. The agency shall notify all subscribers and
1054	providers included in the quarterly reports of their right to
1055	file an unresolved grievance with the panel.
1056	(13)  A proposed order issued by the agency or office which
1057	only requires the managed care entity to take a specific action
1058	under subsection (7) is subject to a summary hearing in
1059	accordance with s. 120.574, unless all of the parties agree
1060	otherwise. If the managed care entity does not prevail at the
1061	hearing, the managed care entity must pay reasonable costs and
1062	attorney's fees of the agency or the office incurred in that
1063	proceeding.
1064	(14)(a)  Any information that identifies a subscriber which
1065	is held by the panel, agency, or department pursuant to this
1066	section is confidential and exempt from the provisions of s.
1067	119.07(1) and s. 24(a), Art. I of the State Constitution.
1068	However, at the request of a subscriber or managed care entity
1069	involved in a grievance procedure, the panel, agency, or
1070	department shall release information identifying the subscriber
1071	involved in the grievance procedure to the requesting subscriber
1072	or managed care entity.
1073	(b)  Meetings of the panel shall be open to the public
1074	unless the provider or subscriber whose grievance will be heard
1075	requests a closed meeting or the agency or the department
1076	determines that information which discloses the subscriber's
1077	medical treatment or history or information relating to internal
1078	risk management programs as defined in s. 641.55(5)(c), (6), and
1079	(8) may be revealed at the panel meeting, in which case that
1080	portion of the meeting during which a subscriber's medical
1081	treatment or history or internal risk management program
1082	information is discussed shall be exempt from the provisions of
1083	s. 286.011 and s. 24(b), Art. I of the State Constitution. All
1084	closed meetings shall be recorded by a certified court reporter.
1085	Section 14.  Paragraph (c) of subsection (4) of section
1086	641.3154, Florida Statutes, is amended to read:
1087	641.3154  Organization liability; provider billing
1088	prohibited.--
1089	(4)  A provider or any representative of a provider,
1090	regardless of whether the provider is under contract with the
1091	health maintenance organization, may not collect or attempt to
1092	collect money from, maintain any action at law against, or
1093	report to a credit agency a subscriber of an organization for
1094	payment of services for which the organization is liable, if the
1095	provider in good faith knows or should know that the
1096	organization is liable. This prohibition applies during the
1097	pendency of any claim for payment made by the provider to the
1098	organization for payment of the services and any legal
1099	proceedings or dispute resolution process to determine whether
1100	the organization is liable for the services if the provider is
1101	informed that such proceedings are taking place. It is presumed
1102	that a provider does not know and should not know that an
1103	organization is liable unless:
1104	(c)  The office or agency makes a final determination that
1105	the organization is required to pay for such services subsequent
1106	to a recommendation made by the Statewide Provider and
1107	Subscriber Assistance Panel pursuant to s. 408.7056; or
1108	Section 15.  Subsection (1), paragraphs (b) and (e) of
1109	subsection (3), paragraph (d) of subsection (4), subsection (5),
1110	paragraph (g) of subsection (6), and subsections (9), (10), and
1111	(11) of section 641.511, Florida Statutes, are amended to read:
1112	641.511  Subscriber grievance reporting and resolution
1113	requirements.--
1114	(1)  Every organization must have a grievance procedure
1115	available to its subscribers for the purpose of addressing
1116	complaints and grievances. Every organization must notify its
1117	subscribers that a subscriber must submit a grievance within 1
1118	year after the date of occurrence of the action that initiated
1119	the grievance, and may submit the grievance for review to the
1120	Statewide Provider and Subscriber Assistance Program panel as
1121	provided in s. 408.7056 after receiving a final disposition of
1122	the grievance through the organization's grievance process. An
1123	organization shall maintain records of all grievances and shall
1124	report annually to the agency the total number of grievances
1125	handled, a categorization of the cases underlying the
1126	grievances, and the final disposition of the grievances.
1127	(3)  Each organization's grievance procedure, as required
1128	under subsection (1), must include, at a minimum:
1129	(b)  The names of the appropriate employees or a list of
1130	grievance departments that are responsible for implementing the
1131	organization's grievance procedure. The list must include the
1132	address and the toll-free telephone number of each grievance
1133	department, the address of the agency and its toll-free
1134	telephone hotline number, and the address of the Statewide
1135	Provider and Subscriber Assistance Program and its toll-free
1136	telephone number.
1137	(e)  A notice that a subscriber may voluntarily pursue
1138	binding arbitration in accordance with the terms of the contract
1139	if offered by the organization, after completing the
1140	organization's grievance procedure and as an alternative to the
1141	Statewide Provider and Subscriber Assistance Program. Such
1142	notice shall include an explanation that the subscriber may
1143	incur some costs if the subscriber pursues binding arbitration,
1144	depending upon the terms of the subscriber's contract.
1145	(4)
1146	(d)  In any case when the review process does not resolve a
1147	difference of opinion between the organization and the
1148	subscriber or the provider acting on behalf of the subscriber,
1149	the subscriber or the provider acting on behalf of the
1150	subscriber may submit a written grievance to the Statewide
1151	Provider and Subscriber Assistance Program.
1152	(5)  Except as provided in subsection (6), the organization
1153	shall resolve a grievance within 60 days after receipt of the
1154	grievance, or within a maximum of 90 days if the grievance
1155	involves the collection of information outside the service area.
1156	These time limitations are tolled if the organization has
1157	notified the subscriber, in writing, that additional information
1158	is required for proper review of the grievance and that such
1159	time limitations are tolled until such information is provided.
1160	After the organization receives the requested information, the
1161	time allowed for completion of the grievance process resumes.
1162	The Employee Retirement Income Security Act of 1974, as
1163	implemented by 29 C.F.R. 2560.503-1, is adopted and incorporated
1164	by reference as applicable to all organizations that administer
1165	small and large group health plans that are subject to 29 C.F.R.
1166	2560.503-1. The claims procedures of the regulations of the
1167	Employee Retirement Income Security Act of 1974 as implemented
1168	by 29 C.F.R. 2560.503-1 shall be the minimum standards for
1169	grievance processes for claims for benefits for small and large
1170	group health plans that are subject to 29 C.F.R. 2560.503-1.
1171	(6)
1172	(g)  In any case when the expedited review process does not
1173	resolve a difference of opinion between the organization and the
1174	subscriber or the provider acting on behalf of the subscriber,
1175	the subscriber or the provider acting on behalf of the
1176	subscriber may submit a written grievance to the Statewide
1177	Provider and Subscriber Assistance Program.
1178	(9)(a)  The agency shall advise subscribers with grievances
1179	to follow their organization's formal grievance process for
1180	resolution prior to review by the Statewide Provider and
1181	Subscriber Assistance Program. The subscriber may, however,
1182	submit a copy of the grievance to the agency at any time during
1183	the process.
1184	(b)  Requiring completion of the organization's grievance
1185	process before the Statewide Provider and Subscriber Assistance
1186	Program panel's review does not preclude the agency from
1187	investigating any complaint or grievance before the organization
1188	makes its final determination.
1189	(10)  Each organization must notify the subscriber in a
1190	final decision letter that the subscriber may request review of
1191	the organization's decision concerning the grievance by the
1192	Statewide Provider and Subscriber Assistance Program, as
1193	provided in s. 408.7056, if the grievance is not resolved to the
1194	satisfaction of the subscriber. The final decision letter must
1195	inform the subscriber that the request for review must be made
1196	within 365 days after receipt of the final decision letter, must
1197	explain how to initiate such a review, and must include the
1198	addresses and toll-free telephone numbers of the agency and the
1199	Statewide Provider and Subscriber Assistance Program.
1200	(11)  Each organization, as part of its contract with any
1201	provider, must require the provider to post a consumer
1202	assistance notice prominently displayed in the reception area of
1203	the provider and clearly noticeable by all patients. The
1204	consumer assistance notice must state the addresses and toll-
1205	free telephone numbers of the Agency for Health Care
1206	Administration, the Statewide Provider and Subscriber Assistance
1207	Program, and the Department of Financial Services. The consumer
1208	assistance notice must also clearly state that the address and
1209	toll-free telephone number of the organization's grievance
1210	department shall be provided upon request. The agency may adopt
1211	rules to implement this section.
1212	Section 16.  Subsection (4) of section 641.58, Florida
1213	Statutes, is amended to read:
1214	641.58  Regulatory assessment; levy and amount; use of
1215	funds; tax returns; penalty for failure to pay.--
1216	(4)  The moneys received and deposited into the Health Care
1217	Trust Fund shall be used to defray the expenses of the agency in
1218	the discharge of its administrative and regulatory powers and
1219	duties under this part, including conducting an annual survey of
1220	the satisfaction of members of health maintenance organizations;
1221	contracting with physician consultants for the Statewide
1222	Provider and Subscriber Assistance Panel; maintaining offices
1223	and necessary supplies, essential equipment, and other
1224	materials, salaries and expenses of required personnel; and
1225	discharging the administrative and regulatory powers and duties
1226	imposed under this part.
1227	Section 17.  Paragraph (f) of subsection (2) and
1228	subsections (3) and (9) of section 408.909, Florida Statutes,
1229	are amended to read:
1230	408.909  Health flex plans.--
1231	(2)  DEFINITIONS.--As used in this section, the term:
1232	(f)  "Health flex plan entity" means a health insurer,
1233	health maintenance organization, health-care-provider-sponsored
1234	organization, local government, health care district, or other
1235	public or private community-based organization, or public-
1236	private partnership that develops and implements an approved
1237	health flex plan and is responsible for administering the health
1238	flex plan and paying all claims for health flex plan coverage by
1239	enrollees of the health flex plan.
1240	(3)  PILOT PROGRAM.--The agency and the office shall each
1241	approve or disapprove health flex plans that provide health care
1242	coverage for eligible participants who reside in the three areas
1243	of the state that have the highest number of uninsured persons,
1244	as identified in the Florida Health Insurance Study conducted by
1245	the agency and in Indian River County. A health flex plan may
1246	limit or exclude benefits otherwise required by law for insurers
1247	offering coverage in this state, may cap the total amount of
1248	claims paid per year per enrollee, may limit the number of
1249	enrollees, or may take any combination of those actions. A
1250	health flex plan offering may include the option of a
1251	catastrophic plan supplementing the health flex plan.
1252	(a)  The agency shall develop guidelines for the review of
1253	applications for health flex plans and shall disapprove or
1254	withdraw approval of plans that do not meet or no longer meet
1255	minimum standards for quality of care and access to care. The
1256	agency shall ensure that the health flex plans follow
1257	standardized grievance procedures similar to those required of
1258	health maintenance organizations.
1259	(b)  The office shall develop guidelines for the review of
1260	health flex plan applications and provide regulatory oversight
1261	of health flex plan advertisement and marketing procedures. The
1262	office shall disapprove or shall withdraw approval of plans
1263	that:
1264	1.  Contain any ambiguous, inconsistent, or misleading
1265	provisions or any exceptions or conditions that deceptively
1266	affect or limit the benefits purported to be assumed in the
1267	general coverage provided by the health flex plan;
1268	2.  Provide benefits that are unreasonable in relation to
1269	the premium charged or contain provisions that are unfair or
1270	inequitable or contrary to the public policy of this state, that
1271	encourage misrepresentation, or that result in unfair
1272	discrimination in sales practices; or
1273	3.  Cannot demonstrate that the health flex plan is
1274	financially sound and that the applicant is able to underwrite
1275	or finance the health care coverage provided.
1276	(c)  The agency and the Financial Services Commission may
1277	adopt rules as needed to administer this section.
1278	(9)  PROGRAM EVALUATION.--The agency and the office shall
1279	evaluate the pilot program and its effect on the entities that
1280	seek approval as health flex plans, on the number of enrollees,
1281	and on the scope of the health care coverage offered under a
1282	health flex plan; shall provide an assessment of the health flex
1283	plans and their potential applicability in other settings; shall
1284	use health flex plans to gather more information to evaluate
1285	low-income consumer driven benefit packages; and shall, by
1286	January 1, 2005, and annually thereafter 2004, jointly submit a
1287	report to the Governor, the President of the Senate, and the
1288	Speaker of the House of Representatives.
1289	Section 18.  Section 381.0271, Florida Statutes, is created
1290	to read:
1291	381.0271  Florida Patient Safety Corporation.--
1292	(1)  DEFINITIONS.--As used in this section, the term:
1293	(a)  "Adverse incident" has the same meanings provided in
1294	ss. 395.0197, 458.351, and 459.026.
1295	(b)  "Corporation" means the Florida Patient Safety
1296	Corporation.
1297	(c)  "Patient safety data" has the same meaning provided in
1298	s. 766.1016.
1299	(2)  CREATION.--
1300	(a)  The Florida Patient Safety Corporation is created as a
1301	not-for-profit corporation and shall be registered,
1302	incorporated, organized, and operated in compliance with chapter
1303	617. The corporation may create not-for-profit corporate
1304	subsidiaries that are organized under the provisions of chapter
1305	617, upon the prior approval of the board of directors, as
1306	necessary, to fulfill its mission.
1307	(b)  The corporation and any authorized and approved
1308	subsidiary are not an agency as defined in s. 20.03(11).
1309	(c)  The corporation and any authorized and approved
1310	subsidiary are subject to the public meetings and records
1311	requirements of s. 24, Art. I of the State Constitution, chapter
1312	119, and s. 286.011.
1313	(d)  The corporation and any authorized and approved
1314	subsidiary are not subject to the provisions of chapter 287.
1315	(e)  The corporation is a patient safety organization as
1316	defined in s. 766.1016.
1317	(3)  PURPOSE.--
1318	(a)  The purpose of the corporation is to serve as a
1319	learning organization dedicated to assisting health care
1320	providers in this state to improve the quality and safety of
1321	health care rendered and to reduce harm to patients. The
1322	corporation shall promote the development of a culture of
1323	patient safety in the health care system in this state. The
1324	corporation shall not regulate health care providers in this
1325	state.
1326	(b)  In fulfilling its purpose, the corporation shall work
1327	with a consortium of patient safety centers and other patient
1328	safety programs.
1329	(4)  BOARD OF DIRECTORS; MEMBERSHIP.--The corporation shall
1330	be governed by a board of directors. The board of directors
1331	shall consist of:
1332	(a)  The chair of the Florida Council of Medical School
1333	Deans.
1334	(b)  Two representatives with expertise in patient safety
1335	issues for the authorized health insurer and authorized health
1336	maintenance organization with the largest market shares,
1337	respectively, as measured by premiums written in the state for
1338	the most recent calendar year, appointed by such insurer.
1339	(c)  A representative of an authorized medical malpractice
1340	insurer appointed by the Florida Insurance Council.
1341	(d)  The president of the Central Florida Health Care
1342	Coalition.
1343	(e)  Two representatives of a hospital in this state that
1344	is implementing innovative patient safety initiatives, appointed
1345	by the Florida Hospital Association.
1346	(f)  A physician with expertise in patient safety,
1347	appointed by the Florida Medical Association.
1348	(g)  A physician with expertise in patient safety,
1349	appointed by the Florida Osteopathic Medical Association.
1350	(h)  A physician with expertise in patient safety,
1351	appointed by the Florida Podiatric Medical Association.
1352	(i)  A physician with expertise in patient safety,
1353	appointed by the Florida Chiropractic Association.
1354	(j)  A dentist with expertise in patient safety, appointed
1355	by the Florida Dental Association.
1356	(k)  A nurse with expertise in patient safety, appointed by
1357	the Florida Nurses Association.
1358	(l)  An institutional pharmacist, appointed by the Florida
1359	Society of Health-System Pharmacists.
1360	(m)  A representative of Florida AARP, appointed by the
1361	state director of Florida AARP.
1362	(5)  ADVISORY COMMITTEES.--In addition to any committees
1363	that the corporation may establish, the corporation shall
1364	establish the following advisory committees:
1365	(a)  A scientific research advisory committee that
1366	includes, at a minimum, a representative from each patient
1367	safety center or other patient safety program in the
1368	universities of the state who are physicians licensed pursuant
1369	to chapter 458 or chapter 459, with experience in patient safety
1370	and evidenced-based medicine. The duties of the advisory
1371	committee shall include, but not be limited to, the analysis of
1372	existing data and research to improve patient safety and
1373	encourage evidence-based medicine.
1374	(b)  A technology advisory committee that includes, at a
1375	minimum, a representative of a hospital that has implemented a
1376	computerized physician order entry system and a health care
1377	provider that has implemented an electronic medical records
1378	system. The duties of the advisory committee shall include, but
1379	not be limited to, implementation of new technologies, including
1380	electronic medical records.
1381	(c)  A health care provider advisory committee that
1382	includes, at a minimum, representatives of hospitals, ambulatory
1383	surgical centers, physicians, nurses, and pharmacists licensed
1384	in this state and a representative of the Veterans Integrated
1385	Service Network 8, Virginia Patient Safety Center. The duties of
1386	the advisory committee shall include, but not be limited to,
1387	promotion of a culture of patient safety that reduces errors.
1388	(d)  A health care consumer advisory committee that
1389	includes, at a minimum, representatives of businesses that
1390	provide health insurance coverage to their employees, consumer
1391	advocacy groups, and representatives of patient safety
1392	organizations. The duties of the advisory committee shall
1393	include, but not be limited to, incentives to encourage patient
1394	safety and the efficiency and quality of care.
1395	(e)  A state agency advisory committee that includes, at a
1396	minimum, a representative from each state agency that has
1397	regulatory responsibilities related to patient safety. The
1398	duties of the advisory committee shall include, but not be
1399	limited to, interagency coordination of patient safety efforts.
1400	(f)  A litigation alternatives advisory committee that
1401	includes, at a minimum, representatives of medical malpractice
1402	attorneys for plaintiffs and defendants and a representative of
1403	each law school in the state. The duties of the advisory
1404	committee shall include, but not be limited to, alternatives
1405	systems to compensate for injuries.
1406	(g)  An education advisory committee that includes, at a
1407	minimum, the associate dean for education, or the equivalent
1408	position, as a representative from each medicine, nursing,
1409	public health, or allied health service to provide advice on the
1410	development, implementation, and measurement of core
1411	competencies for patient safety to be considered for
1412	incorporation in the educational programs of the universities
1413	and colleges of this state.
1414	(6)  ORGANIZATION; MEETINGS.--
1415	(a)  The Agency for Health Care Administration shall assist
1416	the corporation in its organizational activities required under
1417	chapter 617, including, but not limited to:
1418	1.  Eliciting appointments for the initial board of
1419	directors.
1420	2.  Convening the first meeting of the board of directors
1421	and assisting with other meetings of the board of directors,
1422	upon request of the board of directors, during the first year of
1423	operation of the corporation.
1424	3.  Drafting articles of incorporation for the board of
1425	directors and, upon request of the board of directors,
1426	delivering articles of incorporation to the Department of State
1427	for filing.
1428	4.  Drafting proposed bylaws for the corporation.
1429	5.  Paying fees related to incorporation.
1430	6.  Providing office space and administrative support, at
1431	the request of the board of directors, but not beyond July 1,
1432	2005.
1433	(b)  The board of directors must conduct its first meeting
1434	no later than August 1, 2004, and shall meet thereafter as
1435	frequently as necessary to carry out the duties of the
1436	corporation.
1437	(7)  POWERS AND DUTIES.--
1438	(a)  In addition to the powers and duties prescribed in
1439	chapter 617, and the articles and bylaws adopted under that
1440	chapter, the corporation shall, directly or through contract:
1441	1.  Secure staff necessary to properly administer the
1442	corporation.
1443	2.  Collect, analyze, and evaluate patient safety data and
1444	quality and patient safety indicators, medical malpractice
1445	closed claims, and adverse incidents reported to the Agency for
1446	Health Care Administration and the Department of Health for the
1447	purpose of recommending changes in practices and procedures that
1448	may be implemented by health care practitioners and health care
1449	facilities to improve health care quality and to prevent future
1450	adverse incidents. Notwithstanding any other provision of law,
1451	the Agency for Health Care Administration and the Department of
1452	Health shall make available to the corporation any adverse
1453	incident report submitted under ss. 395.0197, 458.351, and
1454	459.026. To the extent that adverse incident reports submitted
1455	under s. 395.0197 are confidential and exempt, the confidential
1456	and exempt status of such reports shall be maintained by the
1457	corporation.
1458	3.  Establish a "near-miss" patient safety reporting
1459	system. The purpose of the near-miss reporting system is to:
1460	identify potential systemic problems that could lead to adverse
1461	incidents; enable publication of systemwide alerts of potential
1462	harm; and facilitate development of both facility-specific and
1463	statewide options to avoid adverse incidents and improve patient
1464	safety. The reporting system shall record "near misses"
1465	submitted by hospitals, birthing centers, and ambulatory
1466	surgical centers and other providers. For the purpose of the
1467	reporting system:
1468	a.  The term "near miss" means any potentially harmful
1469	event that could have had an adverse result but, through chance
1470	or intervention in which, harm was prevented.
1471	b.  The near-miss reporting system shall be voluntary and
1472	anonymous and independent of mandatory reporting systems used
1473	for regulatory purposes.
1474	c.  Near-miss data submitted to the corporation is patient
1475	safety data as defined in s. 766.1016.
1476	d.  Reports of near-miss data shall be published on a
1477	regular basis and special alerts shall be published as needed
1478	regarding newly identified, significant risks.
1479	e.  Aggregated data shall be made available publicly.
1480	f.  The corporation shall report the performance and
1481	results of the near-miss project in its annual report.
1482	4.  Work collaboratively with the appropriate state
1483	agencies in the development of electronic health records.
1484	5.  Provide for access to an active library of evidence-
1485	based medicine and patient safety practices, together with the
1486	emerging evidence supporting their retention or modification,
1487	and make this information available to health care
1488	practitioners, health care facilities, and the public. Support
1489	for implementation of evidence-based medicine shall include:
1490	a.  A report to the Governor, the President of the Senate,
1491	the Speaker of the House of Representatives, and the Agency for
1492	Health Care Administration by January 1, 2005, on:
1493	(I)  The ability to join or support efforts for the use of
1494	evidence-based medicine already underway, such as those of the
1495	Leapfrog Group, the international group Bandolier, and the
1496	Healthy Florida Foundation.
1497	(II)  The means by which to promote research using Medicaid
1498	and other data collected by the Agency for Health Care
1499	Administration to identify and quantify the most cost-effective
1500	treatment and interventions, including disease management and
1501	prevention programs.
1502	(III)  The means by which to encourage development of
1503	systems to measure and reward providers who implement evidence-
1504	based medical practices.
1505	(IV)  The review of other state and private initiatives and
1506	published literature for promising approaches and the
1507	dissemination of information about them to providers.
1508	(V)  The encouragement of the Florida health care boards
1509	under the Department of Health to regularly publish findings
1510	related to the cost-effectiveness of disease-specific, evidence-
1511	based standards.
1512	(VI)  Public and private sector initiatives related to
1513	evidence-based medicine and communication systems for the
1514	sharing of clinical information among caregivers.
1515	(VII)  Regulatory barriers that interfere with the sharing
1516	of clinical information among caregivers.
1517	b.  An implementation plan reported to the Governor, the
1518	President of the Senate, the Speaker of the House of
1519	Representatives, and the Agency for Health Care Administration
1520	by September 1, 2005, that must include, but need not be limited
1521	to: estimated costs and savings, capital investment
1522	requirements, recommended investment incentives, initial
1523	committed provider participation by region, standards of
1524	functionality and features, a marketing plan, and implementation
1525	schedules for key components.
1526	6.  Develop and recommend core competencies in patient
1527	safety that can be incorporated into the undergraduate and
1528	graduate curricula in schools of medicine, nursing, and allied
1529	health in the state.
1530	7.  Develop and recommend programs to educate the public
1531	about the role of health care consumers in promoting patient
1532	safety.
1533	8.  Provide recommendations for interagency coordination of
1534	patient safety efforts in the state.
1535	(b)  In carrying out its powers and duties, the corporation
1536	may also:
1537	1.  Assess the patient safety culture at volunteering
1538	hospitals and recommend methods to improve the working
1539	environment related to patient safety at these hospitals.
1540	2.  Inventory the information technology capabilities
1541	related to patient safety of health care facilities and health
1542	care practitioners and recommend a plan for expediting the
1543	implementation of patient safety technologies statewide.
1544	3.  Recommend continuing medical education regarding
1545	patient safety to practicing health care practitioners.
1546	4.  Study and facilitate the testing of alternative systems
1547	of compensating injured patients as a means of reducing and
1548	preventing medical errors and promoting patient safety.
1549	5.  Conduct other activities identified by the board of
1550	directors to promote patient safety in this state.
1551	(8)  ANNUAL REPORT.--By December 1, 2004, the corporation
1552	shall prepare a report on the startup activities of the
1553	corporation and any proposals for legislative action that are
1554	needed for the corporation to fulfill its purposes under this
1555	section. By December 1 of each year thereafter, the corporation
1556	shall prepare a report for the preceding fiscal year. The
1557	report, at a minimum, must include:
1558	(a)  A description of the activities of the corporation
1559	under this section.
1560	(b)  Progress made in improving patient safety and reducing
1561	medical errors.
1562	(c)  Policies and programs that have been implemented and
1563	their outcomes.
1564	(d)  A compliance and financial audit of the accounts and
1565	records of the corporation at the end of the preceding fiscal
1566	year conducted by an independent certified public accountant.
1567	(e)  Recommendations for legislative action needed to
1568	improve patient safety in the state.
1569	(f)  An assessment of the ability of the corporation to
1570	fulfill the duties specified in this section and the
1571	appropriateness of those duties for the corporation.
1572
1573	The corporation shall submit the report to the Governor, the
1574	President of the Senate, and the Speaker of the House of
1575	Representatives.
1576	(9)  FUNDING.--The corporation is required to seek private
1577	sector funding and apply for grants to accomplish its goals and
1578	duties.
1579	(10)  PERFORMANCE EXPECTATIONS.--The Office of Program
1580	Policy Analysis and Government Accountability, the Agency for
1581	Health Care Administration, and the Department of Health shall
1582	develop performance standards by which to measure the success of
1583	the corporation in fulfilling the purposes established in this
1584	section. Using the performance standards, the Office of Program
1585	Policy Analysis and Government Accountability shall conduct a
1586	performance audit of the corporation during 2006 and shall
1587	submit a report to the Governor, the President of the Senate,
1588	and the Speaker of the House of Representatives by January 1,
1589	2007.
1590	Section 19.  Subsection (3) of section 409.91255, Florida
1591	Statutes, is amended to read:
1592	409.91255  Federally qualified health center access
1593	program.--
1594	(3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.--The
1595	Department of Health shall develop a program for the expansion
1596	of federally qualified health centers for the purpose of
1597	providing comprehensive primary and preventive health care and
1598	urgent care services, including services that may reduce the
1599	morbidity, mortality, and cost of care among the uninsured
1600	population of the state. The program shall provide for
1601	distribution of financial assistance to federally qualified
1602	health centers that apply and demonstrate a need for such
1603	assistance in order to sustain or expand the delivery of primary
1604	and preventive health care services. In selecting centers to
1605	receive this financial assistance, the program:
1606	(a)  Shall give preference to communities that have few or
1607	no community-based primary care services or in which the current
1608	services are unable to meet the community's needs.
1609	(b)  Shall require that primary care services be provided
1610	to the medically indigent using a sliding fee schedule based on
1611	income.
1612	(c)  Shall allow innovative and creative uses of federal,
1613	state, and local health care resources.
1614	(d)  Shall require that the funds provided be used to pay
1615	for operating costs of a projected expansion in patient
1616	caseloads or services or for capital improvement projects.
1617	Capital improvement projects may include renovations to existing
1618	facilities or construction of new facilities, provided that an
1619	expansion in patient caseloads or services to a new patient
1620	population will occur as a result of the capital expenditures.
1621	The department shall include in its standard contract document a
1622	requirement that any state funds provided for the purchase of or
1623	improvements to real property are contingent upon the contractor
1624	granting to the state a security interest in the property at
1625	least to the amount of the state funds provided for at least 5
1626	years from the date of purchase or the completion of the
1627	improvements or as further required by law. The contract must
1628	include a provision that, as a condition of receipt of state
1629	funding for this purpose, the contractor agrees that, if it
1630	disposes of the property before the department's interest is
1631	vacated, the contractor will refund the proportionate share of
1632	the state's initial investment, as adjusted by depreciation.
1633	(e)  May require in-kind support from other sources.
1634	(f)  May encourage coordination among federally qualified
1635	health centers, other private-sector providers, and publicly
1636	supported programs.
1637	(g)  Shall allow the development of community emergency
1638	room diversion programs in conjunction with local resources,
1639	providing extended hours of operation to urgent care patients.
1640	Diversion programs shall include case management for emergency
1641	room followup care.
1642	Section 20.  Paragraph (a) of subsection (6) of section
1643	627.410, Florida Statutes, is amended to read:
1644	627.410  Filing, approval of forms.--
1645	(6)(a)  An insurer shall not deliver or issue for delivery
1646	or renew in this state any health insurance policy form until it
1647	has filed with the office a copy of every applicable rating
1648	manual, rating schedule, change in rating manual, and change in
1649	rating schedule; if rating manuals and rating schedules are not
1650	applicable, the insurer must file with the office order
1651	applicable premium rates and any change in applicable premium
1652	rates. This paragraph does not apply to group health insurance
1653	policies, effectuated and delivered in this state, insuring
1654	groups of 51 or more persons, except for Medicare supplement
1655	insurance, long-term care insurance, and any coverage under
1656	which the increase in claim costs over the lifetime of the
1657	contract due to advancing age or duration is prefunded in the
1658	premium.
1659	Section 21.  Section 627.64872, Florida Statutes, is
1660	created to read:
1661	627.64872  Florida Health Insurance Plan.--
1662	(1)  LEGISLATIVE INTENT.--
1663	(a)  The Legislature recognizes that to secure a more
1664	stable and orderly health insurance market, the establishment of
1665	a plan to assume risks deemed uninsurable by the private
1666	marketplace is required.
1667	(b)  The Florida Health Insurance Plan is to make coverage
1668	available to individuals who have no other option for similar
1669	coverage, at a premium that is commensurate with the risk and
1670	benefits provided, and with benefit designs that are reasonable
1671	in relation to the general market. While plan operations may
1672	include supplementary funding, the plan shall fundamentally
1673	operate on sound actuarial principles, using basic insurance
1674	management techniques to ensure that the plan is run in an
1675	economical, cost-efficient, and sound manner, conserving plan
1676	resources to serve the maximum number of people possible in a
1677	sustainable fashion.
1678	(2)  DEFINITIONS.--As used in this section:
1679	(a)  "Board" means the board of directors of the plan.
1680	(b)  "Dependent" means a resident spouse or resident
1681	unmarried child under the age of 19 years, a child who is a
1682	student under the age of 25 years and who is financially
1683	dependent upon the parent, or a child of any age who is disabled
1684	and dependent upon the parent.
1685	(c)  "Director" means the director of the Office of
1686	Insurance Regulation.
1687	(d)  "Health insurance" means any hospital or medical
1688	expense incurred policy or health maintenance organization
1689	subscriber contract pursuant to chapter 641. The term does not
1690	include short-term, accident, dental-only, vision-only, fixed-
1691	indemnity, limited-benefit, or credit insurance; disability
1692	income insurance; coverage for onsite medical clinics; insurance
1693	coverage specified in federal regulations issued pursuant to
1694	Pub. L. No. 104-191, under which benefits for medical care are
1695	secondary or incidental to other insurance benefits; benefits
1696	for long-term care, nursing home care, home health care,
1697	community-based care, or any combination thereof, or other
1698	similar, limited benefits specified in federal regulations
1699	issued pursuant to Pub. L. No. 104-191; benefits provided under
1700	a separate policy, certificate, or contract of insurance, under
1701	which there is no coordination between the provision of the
1702	benefits and any exclusion of benefits under any group health
1703	plan maintained by the same plan sponsor and the benefits are
1704	paid with respect to an event without regard to whether benefits
1705	are provided with respect to such an event under any group
1706	health plan maintained by the same plan sponsor, such as for
1707	coverage only for a specified disease or illness; hospital
1708	indemnity or other fixed indemnity insurance; coverage offered
1709	as a separate policy, certificate, or contract of insurance,
1710	such as Medicare supplemental health insurance as defined under
1711	s. 1882(g)(1) of the Social Security Act; coverage supplemental
1712	to the coverage provided under chapter 55 of Title 10, United
1713	States Code, the Civilian Health and Medical Program of the
1714	Uniformed Services (CHAMPUS); similar supplemental coverage
1715	provided to coverage under a group health plan; coverage issued
1716	as a supplement to liability insurance; insurance arising out of
1717	a workers' compensation or similar law; automobile medical
1718	payment insurance; or insurance under which benefits are payable
1719	with or without regard to fault and which is statutorily
1720	required to be contained in any liability insurance policy or
1721	equivalent selfinsurance.
1722	(e)  "Implementation" means the effective date after the
1723	first meeting of the board when legal authority and
1724	administrative ability exists for the board to subsume the
1725	transfer of all statutory powers, duties, functions, assets,
1726	records, personnel, and property of the Florida Comprehensive
1727	Health Association as specified in s. 627.6488.
1728	(f)  "Insurer" means any entity that provides health
1729	insurance in this state. For purposes of this section, insurer
1730	includes an insurance company with a valid certificate in
1731	accordance with chapter 624, a health maintenance organization
1732	with a valid certificate of authority in accordance with part I
1733	or part III of chapter 641, a prepaid health clinic authorized
1734	to transact business in this state pursuant to part II of
1735	chapter 641, multiple employer welfare arrangements authorized
1736	to transact business in this state pursuant to ss. 624.436-
1737	624.45, or a fraternal benefit society providing health benefits
1738	to its members as authorized pursuant to chapter 632.
1739	(g)  "Medicare" means coverage under both Parts A and B of
1740	Title XVIII of the Social Security Act, 42 USC 1395 et seq., as
1741	amended.
1742	(h)  "Medicaid" means coverage under Title XIX of the
1743	Social Security Act.
1744	(i)  "Office" means the Office of Insurance Regulation of
1745	the Financial Services Commission.
1746	(j)  "Participating insurer" means any insurer providing
1747	health insurance to citizens of this state.
1748	(k)  "Provider" means any physician, hospital, or other
1749	institution, organization, or person that furnishes health care
1750	services and is licensed or otherwise authorized to practice in
1751	the state.
1752	(l)  "Plan" means the Florida Health Insurance Plan created
1753	in subsection (1).
1754	(m)  "Plan of operation" means the articles, bylaws, and
1755	operating rules and procedures adopted by the board pursuant to
1756	this section.
1757	(n)  "Resident" means an individual who has been legally
1758	domiciled in this state for a period of at least 6 months.
1759	(3)  BOARD OF DIRECTORS.--
1760	(a)  The plan shall operate subject to the supervision and
1761	control of the board. The board shall consist of the director or
1762	his or her designated representative, who shall serve as a
1763	member of the board and shall be its chair, and an additional
1764	eight members, five of whom shall be appointed by the Governor,
1765	at least two of whom shall be individuals not representative of
1766	insurers or health care providers, one of whom shall be
1767	appointed by the President of the Senate, one of whom shall be
1768	appointed by the Speaker of the House of Representatives, and
1769	one of whom shall be appointed by the Chief Financial Officer.
1770	(b)  The term to be served on the board by the director of
1771	the Office of Insurance Regulation shall be determined by
1772	continued employment in such position. The remaining initial
1773	board members shall serve for a period of time as follows: two
1774	members appointed by the Governor and the members appointed by
1775	the President of the Senate and the Speaker of the House of
1776	Representatives shall serve a term of 2 years; and three members
1777	appointed by the Governor and the Chief Financial Officer shall
1778	serve a term of 4 years. Subsequent board members shall serve
1779	for a term of 3 years. A board member's term shall continue
1780	until his or her successor is appointed.
1781	(c)  Vacancies on the board shall be filled by the
1782	appointing authority, such authority being the Governor, the
1783	President of the Senate, the Speaker of the House of
1784	Representatives, or the Chief Financial Officer. The appointing
1785	authority may remove board members for cause.
1786	(d)  The director, or his or her recognized representative,
1787	shall be responsible for any organizational requirements
1788	necessary for the initial meeting of the board which shall take
1789	place no later than September 1, 2004.
1790	(e)  Members shall not be compensated in their capacity as
1791	board members but shall be reimbursed for reasonable expenses
1792	incurred in the necessary performance of their duties in
1793	accordance with s. 112.061.
1794	(f)  The board shall submit to the Financial Services
1795	Commission a plan of operation for the plan and any amendments
1796	thereto necessary or suitable to ensure the fair, reasonable,
1797	and equitable administration of the plan. The plan of operation
1798	shall ensure that the plan qualifies to apply for any available
1799	funding from the Federal Government that adds to the financial
1800	viability of the plan. The plan of operation shall become
1801	effective upon approval in writing by the Financial Services
1802	Commission consistent with the date on which the coverage under
1803	this section must be made available. If the board fails to
1804	submit a suitable plan of operation within 1 year after the
1805	appointment of the board of directors, or at any time thereafter
1806	fails to submit suitable amendments to the plan of operation,
1807	the Financial Services Commission shall adopt such rules as are
1808	necessary or advisable to effectuate the provisions of this
1809	section. Such rules shall continue in force until modified by
1810	the office or superseded by a plan of operation submitted by the
1811	board and approved by the Financial Services Commission.
1812	(4)  PLAN OF OPERATION.--The plan of operation shall:
1813	(a)  Establish procedures for operation of the plan.
1814	(b)  Establish procedures for selecting an administrator in
1815	accordance with subsection (11).
1816	(c)  Establish procedures to create a fund, under
1817	management of the board, for administrative expenses.
1818	(d)  Establish procedures for the handling, accounting, and
1819	auditing of assets, moneys, and claims of the plan and the plan
1820	administrator.
1821	(e)  Develop and implement a program to publicize the
1822	existence of the plan, plan eligibility requirements, and
1823	procedures for enrollment and maintain public awareness of the
1824	plan.
1825	(f)  Establish procedures under which applicants and
1826	participants may have grievances reviewed by a grievance
1827	committee appointed by the board. The grievances shall be
1828	reported to the board after completion of the review, with the
1829	committee's recommendation for grievance resolution. The board
1830	shall retain all written grievances regarding the plan for at
1831	least 3 years.
1832	(g)  Provide for other matters as may be necessary and
1833	proper for the execution of the board's powers, duties, and
1834	obligations under this section.
1835	(5)  POWERS OF THE PLAN.--The plan shall have the general
1836	powers and authority granted under the laws of this state to
1837	health insurers and, in addition thereto, the specific authority
1838	to:
1839	(a)  Enter into such contracts as are necessary or proper
1840	to carry out the provisions and purposes of this section,
1841	including the authority, with the approval of the Chief
1842	Financial Officer, to enter into contracts with similar plans of
1843	other states for the joint performance of common administrative
1844	functions, or with persons or other organizations for the
1845	performance of administrative functions.
1846	(b)  Take any legal actions necessary or proper to recover
1847	or collect assessments due the plan.
1848	(c)  Take such legal action as is necessary to:
1849	1.  Avoid payment of improper claims against the plan or
1850	the coverage provided by or through the plan;
1851	2.  Recover any amounts erroneously or improperly paid by
1852	the plan;
1853	3.  Recover any amounts paid by the plan as a result of
1854	mistake of fact or law; or
1855	4.  Recover other amounts due the plan.
1856	(d)  Establish, and modify as appropriate, rates, rate
1857	schedules, rate adjustments, expense allowances, agents'
1858	commissions, claims reserve formulas, and any other actuarial
1859	functions appropriate to the operation of the plan. Rates and
1860	rate schedules may be adjusted for appropriate factors such as
1861	age, sex, and geographic variation in claim cost and shall take
1862	into consideration appropriate factors in accordance with
1863	established actuarial and underwriting practices. For purposes
1864	of this paragraph, usual and customary agent's commissions shall
1865	be paid for the initial placement of coverage with the plan and
1866	for one renewal only.
1867	(e)  Issue policies of insurance in accordance with the
1868	requirements of this section.
1869	(f)  Appoint appropriate legal, actuarial, investment, and
1870	other committees as necessary to provide technical assistance in
1871	the operation of the plan and develop and educate its
1872	policyholders regarding health savings accounts, policy and
1873	contract design, and any other function within the authority of
1874	the plan.
1875	(g)  Borrow money to effectuate the purposes of the plan.
1876	Any notes or other evidence of indebtedness of the plan not in
1877	default shall be legal investments for insurers and may be
1878	carried as admitted assets.
1879	(h)  Employ and fix the compensation of employees.
1880	(i)  Prepare and distribute certificate of eligibility
1881	forms and enrollment instruction forms to insurance producers
1882	and to the general public.
1883	(j)  Provide for reinsurance of risks incurred by the plan.
1884	(k)  Provide for and employ cost-containment measures and
1885	requirements, including, but not limited to, preadmission
1886	screening, second surgical opinion, concurrent utilization
1887	review, and individual case management for the purpose of making
1888	the plan more cost-effective.
1889	(l)  Design, use, contract, or otherwise arrange for the
1890	delivery of cost-effective health care services, including, but
1891	not limited to, establishing or contracting with preferred
1892	provider organizations, health maintenance organizations, and
1893	other limited network provider arrangements.
1894	(m)  Adopt such bylaws, policies, and procedures as may be
1895	necessary or convenient for the implementation of this section
1896	and the operation of the plan.
1897	(n)  Subsume the transfer of statutory powers, duties,
1898	functions, assets, records, personnel, and property of the
1899	Florida Comprehensive Health Association as specified in ss.
1900	627.6488, 627.6489, 627.649, 627.6492, 627.6496, 627.6498, and
1901	627.6499, unless otherwise specified by law.
1902	(6)  INTERIM REPORT; ANNUAL REPORT.--
1903	(a)  By no later than December 1, 2004, the board shall
1904	report to the Governor, the President of the Senate, and the
1905	Speaker of the House of Representatives the results of an
1906	actuarial study conducted by the board to determine, including,
1907	but not limited to:
1908	1.  The impact the creation of the plan will have on the
1909	small group insurance market and the individual market on
1910	premiums paid by insureds. This shall include an estimate of the
1911	total anticipated aggregate savings for all small employers in
1912	the state.
1913	2.  The number of individuals the pool could reasonably
1914	cover at various funding levels, specifically, the number of
1915	people the pool may cover at each of those funding levels.
1916	3.  A recommendation as to the best source of funding for
1917	the anticipated deficits of the pool.
1918	4.  The effect on the individual and small group market by
1919	including in the Florida Health Insurance Plan persons eligible
1920	for coverage under s. 627.6487, as well as the cost of including
1921	these individuals.
1922
1923	The board shall take no action to implement the Florida Health
1924	Insurance Plan, other than the completion of the actuarial study
1925	authorized in this paragraph, until funds are appropriated for
1926	startup cost and any projected deficits.
1927	(b)  No later than December 1, 2005, and annually
1928	thereafter, the board shall submit to the Governor, the
1929	President of the Senate, the Speaker of the House of
1930	Representatives, and the substantive legislative committees of
1931	the Legislature a report which includes an independent actuarial
1932	study to determine, including, but not be limited to:
1933	1.  The impact the creation of the plan has on the small
1934	group and individual insurance market, specifically on the
1935	premiums paid by insureds. This shall include an estimate of the
1936	total anticipated aggregate savings for all small employers in
1937	the state.
1938	2.  The actual number of individuals covered at the current
1939	funding and benefit level, the projected number of individuals
1940	that may seek coverage in the forthcoming fiscal year, and the
1941	projected funding needed to cover anticipated increase or
1942	decrease in plan participation.
1943	3.  A recommendation as to the best source of funding for
1944	the anticipated deficits of the pool.
1945	4.  A summarization of the activities of the plan in the
1946	preceding calendar year, including the net written and earned
1947	premiums, plan enrollment, the expense of administration, and
1948	the paid and incurred losses.
1949	5.  A review of the operation of the plan as to whether the
1950	plan has met the intent of this section.
1951	(7)  LIABILITY OF THE PLAN.--Neither the board nor its
1952	employees shall be liable for any obligations of the plan. No
1953	member or employee of the board shall be liable, and no cause of
1954	action of any nature may arise against a member or employee of
1955	the board, for any act or omission related to the performance of
1956	any powers and duties under this section, unless such act or
1957	omission constitutes willful or wanton misconduct. The board may
1958	provide in its bylaws or rules for indemnification of, and legal
1959	representation for, its members and employees.
1960	(8)  AUDITED FINANCIAL STATEMENT.--No later than June 1
1961	following the close of each calendar year, the plan shall submit
1962	to the Financial Services Commission an audited financial
1963	statement prepared in accordance with statutory accounting
1964	principles as adopted by the National Association of Insurance
1965	Commissioners.
1966	(9)  ELIGIBILITY.--
1967	(a)  Any individual person who is and continues to be a
1968	resident of this state shall be eligible for coverage under the
1969	plan if:
1970	1.  Evidence is provided that the person received notices
1971	of rejection or refusal to issue substantially similar coverage
1972	for health reasons from at least two health insurers or health
1973	maintenance organizations. A rejection or refusal by an insurer
1974	offering only stoploss, excess of loss, or reinsurance coverage
1975	with respect to the applicant shall not be sufficient evidence
1976	under this paragraph.
1977	2.  The person is enrolled in the Florida Comprehensive
1978	Health Association as of the date the plan is implemented.
1979	(b)  Each resident dependent of a person who is eligible
1980	for coverage under the plan shall also be eligible for such
1981	coverage.
1982	(c)  A person shall not be eligible for coverage under the
1983	plan if:
1984	1.  The person has or obtains health insurance coverage
1985	substantially similar to or more comprehensive than a plan
1986	policy, or would be eligible to obtain such coverage, unless a
1987	person may maintain other coverage for the period of time the
1988	person is satisfying any preexisting condition waiting period
1989	under a plan policy or may maintain plan coverage for the period
1990	of time the person is satisfying a preexisting condition waiting
1991	period under another health insurance policy intended to replace
1992	the plan policy.
1993	2.  The person is determined to be eligible for health care
1994	benefits under Medicaid, Medicare, the state's children's health
1995	insurance program, or any other federal, state, or local
1996	government program that provides health benefits;
1997	3.  The person voluntarily terminated plan coverage unless
1998	12 months have elapsed since such termination;
1999	4.  The person is an inmate or resident of a public
2000	institution; or
2001	5.  The person's premiums are paid for or reimbursed under
2002	any government-sponsored program or by any government agency or
2003	health care provider.
2004	(d)  Coverage shall cease:
2005	1.  On the date a person is no longer a resident of this
2006	state;
2007	2.  On the date a person requests coverage to end;
2008	3.  Upon the death of the covered person;
2009	4.  On the date state law requires cancellation or
2010	nonrenewal of the policy; or
2011	5.  At the option of the plan, 30 days after the plan makes
2012	any inquiry concerning the person's eligibility or place of
2013	residence to which the person does not reply.
2014	6.  Upon failure of the insured to pay for continued
2015	coverage.
2016	(e)  Except under the circumstances described in this
2017	subsection, coverage of a person who ceases to meet the
2018	eligibility requirements of this subsection shall be terminated
2019	at the end of the policy period for which the necessary premiums
2020	have been paid.
2021	(10)  UNFAIR REFERRAL TO PLAN.--It is an unfair trade
2022	practice for the purposes of part IX of chapter 626 or s.
2023	641.3901 for an insurer, health maintenance organization
2024	insurance agent, insurance broker, or third-party administrator
2025	to refer an individual employee to the plan, or arrange for an
2026	individual employee to apply to the plan, for the purpose of
2027	separating that employee from group health insurance coverage
2028	provided in connection with the employee's employment.
2029	(11)  PLAN ADMINISTRATOR.--The board shall select through a
2030	competitive bidding process a plan administrator to administer
2031	the plan. The board shall evaluate bids submitted based on
2032	criteria established by the board, which shall include:
2033	(a)  The plan administrator's proven ability to handle
2034	health insurance coverage to individuals.
2035	(b)  The efficiency and timeliness of the plan
2036	administrator's claim processing procedures.
2037	(c)  An estimate of total charges for administering the
2038	plan.
2039	(d)  The plan administrator's ability to apply effective
2040	cost-containment programs and procedures and to administer the
2041	plan in a cost-efficient manner.
2042	(e)  The financial condition and stability of the plan
2043	administrator.
2044
2045	The administrator shall be an insurer, a health maintenance
2046	organization, or a third-party administrator, or another
2047	organization duly authorized to provide insurance pursuant to
2048	the Florida Insurance Code.
2049	(12)  ADMINISTRATOR TERM LIMITS.--The plan administrator
2050	shall serve for a period specified in the contract between the
2051	plan and the plan administrator subject to removal for cause and
2052	subject to any terms, conditions, and limitations of the
2053	contract between the plan and the plan administrator. At least 1
2054	year prior to the expiration of each period of service by a plan
2055	administrator, the board shall invite eligible entities,
2056	including the current plan administrator, to submit bids to
2057	serve as the plan administrator. Selection of the plan
2058	administrator for each succeeding period shall be made at least
2059	6 months prior to the end of the current period.
2060	(13)  DUTIES OF THE PLAN ADMINISTRATOR.--
2061	(a)  The plan administrator shall perform such functions
2062	relating to the plan as may be assigned to it, including, but
2063	not limited to:
2064	1.  Determination of eligibility.
2065	2.  Payment of claims.
2066	3.  Establishment of a premium billing procedure for
2067	collection of premiums from persons covered under the plan.
2068	4.  Other necessary functions to ensure timely payment of
2069	benefits to covered persons under the plan.
2070	(b)  The plan administrator shall submit regular reports to
2071	the board regarding the operation of the plan. The frequency,
2072	content, and form of the reports shall be specified in the
2073	contract between the board and the plan administrator.
2074	(c)  On March 1 following the close of each calendar year,
2075	the plan administrator shall determine net written and earned
2076	premiums, the expense of administration, and the paid and
2077	incurred losses for the year and report this information to the
2078	board and the Governor on a form prescribed by the Governor.
2079	(14)  PAYMENT OF THE PLAN ADMINISTRATOR.--The plan
2080	administrator shall be paid as provided in the contract between
2081	the plan and the plan administrator.
2082	(15)  FUNDING OF THE PLAN.--
2083	(a)  Premiums.--
2084	1.  The plan shall establish premium rates for plan
2085	coverage as provided in this section. Separate schedules of
2086	premium rates based on age, sex, and geographical location may
2087	apply for individual risks. Premium rates and schedules shall be
2088	submitted to the office for approval prior to use.
2089	2.  Initial rates for plan coverage shall be limited to no
2090	more than 300 percent of rates established for individual
2091	standard risks as specified in s. 627.6675(3)(c). Subject to the
2092	limits provided in this paragraph, subsequent rates shall be
2093	established to provide fully for the expected costs of claims,
2094	including recovery of prior losses, expenses of operation,
2095	investment income of claim reserves, and any other cost factors
2096	subject to the limitations described herein, but in no event
2097	shall premiums exceed the 300-percent rate limitation provided
2098	in this section. Notwithstanding the 300-percent rate
2099	limitation, sliding scale premium surcharges based upon the
2100	insured's income may apply to all enrollees.
2101	(b)  Sources of additional revenue.--Any deficit incurred
2102	by the plan shall be primarily funded through amounts
2103	appropriated by the Legislature from general revenue sources,
2104	including, but not limited to, a portion of the annual growth in
2105	existing net insurance premium taxes. The board shall operate
2106	the plan in such a manner that the estimated cost of providing
2107	health insurance during any fiscal year will not exceed total
2108	income the plan expects to receive from policy premiums and
2109	funds appropriated by the Legislature, including any interest on
2110	investments. After determining the amount of funds appropriated
2111	to the board for a fiscal year, the board shall estimate the
2112	number of new policies it believes the plan has the financial
2113	capacity to insure during that year so that costs do not exceed
2114	income. The board shall take steps necessary to ensure that plan
2115	enrollment does not exceed the number of residents it has
2116	estimated it has the financial capacity to insure.
2117	(16)  BENEFITS.--
2118	(a)  The benefits provided shall be the same as the
2119	standard and basic plans for small employers as outlined in s.
2120	627.6699. The board shall also establish an option of
2121	alternative coverage such as catastrophic coverage that includes
2122	a minimum level of primary care coverage and a high deductible
2123	plan that meets the federal requirements of a health savings
2124	account.
2125	(b)  In establishing the plan coverage, the board shall
2126	take into consideration the levels of health insurance provided
2127	in the state and such medical economic factors as may be deemed
2128	appropriate and adopt benefit levels, deductibles, copayments,
2129	coinsurance factors, exclusions, and limitations determined to
2130	be generally reflective of and commensurate with health
2131	insurance provided through a representative number of large
2132	employers in the state.
2133	(c)  The board may adjust any deductibles and coinsurance
2134	factors annually according to the medical component of the
2135	Consumer Price Index.
2136	(d)1.  Plan coverage shall exclude charges or expenses
2137	incurred during the first 6 months following the effective date
2138	of coverage for any condition for which medical advice, care, or
2139	treatment was recommended or received for such condition during
2140	the 6-month period immediately preceding the effective date of
2141	coverage.
2142	2.  Such preexisting condition exclusions shall be waived
2143	to the extent that similar exclusions, if any, have been
2144	satisfied under any prior health insurance coverage which was
2145	involuntarily terminated, provided application for pool coverage
2146	is made not later than 63 days following such involuntary
2147	termination. In such case, coverage under the plan shall be
2148	effective from the date on which such prior coverage was
2149	terminated and the applicant is not eligible for continuation or
2150	conversion rights that would provide coverage substantially
2151	similar to plan coverage.
2152	(17)  NONDUPLICATION OF BENEFITS.--
2153	(a)  The plan shall be payor of last resort of benefits
2154	whenever any other benefit or source of third-party payment is
2155	available. Benefits otherwise payable under plan coverage shall
2156	be reduced by all amounts paid or payable through any other
2157	health insurance, by all hospital and medical expense benefits
2158	paid or payable under any workers' compensation coverage,
2159	automobile medical payment, or liability insurance, whether
2160	provided on the basis of fault or nonfault, and by any hospital
2161	or medical benefits paid or payable under or provided pursuant
2162	to any state or federal law or program.
2163	(b)  The plan shall have a cause of action against an
2164	eligible person for the recovery of the amount of benefits paid
2165	that are not for covered expenses. Benefits due from the plan
2166	may be reduced or refused as a setoff against any amount
2167	recoverable under this paragraph.
2168	(18)  ANNUAL AND MAXIMUM BENEFITS.--Maximum benefits under
2169	the plan shall be determined by the board.
2170	(19)  TAXATION.--The plan is exempt from any tax imposed by
2171	this state. The plan shall apply for federal tax exemption
2172	status.
2173	(20)  COMBINING MEMBERSHIP OF THE FLORIDA COMPREHENSIVE
2174	HEALTH ASSOCIATION; ASSESSMENT.--
2175	(a)1. Upon implementation of the Florida Health Insurance
2176	Plan, the Florida Comprehensive Health Association, as specified
2177	in s. 627.6488, is abolished as a separate nonprofit entity and
2178	shall be subsumed under the board of directors of the Florida
2179	Health Insurance Plan. All individuals actively enrolled in the
2180	Florida Comprehensive Health Association shall be enrolled in
2181	the plan subject to its rules and requirements, except as
2182	otherwise specified in this section. Maximum lifetime benefits
2183	paid to an individual in the plan shall not exceed the amount
2184	established under subsection (16), and benefits previously paid
2185	for any individual by the Florida Comprehensive Health
2186	Association shall be used in the determination of total lifetime
2187	benefits paid under the plan.
2188	2.  All persons enrolled in the Florida Comprehensive
2189	Health Association upon implementation of the Florida Health
2190	Insurance Plan are only eligible for the benefits authorized
2191	under subsection (16). Persons identified by this section shall
2192	convert to the benefits authorized under subsection (16) no
2193	later than January 1, 2005.
2194	3.  Except as otherwise provided in this section, the
2195	administration of the coverage of persons actively enrolled in
2196	the Florida Comprehensive Health Association shall operate under
2197	the existing plan of operation without modification until the
2198	adoption of the new plan of operation for the Florida Health
2199	Insurance Plan.
2200	(b)1.  As a condition of doing business in this state, an
2201	insurer shall pay an assessment to the board in the amount
2202	prescribed by this section. For operating losses incurred on or
2203	after July 1, 2004, by persons enrolled in the Florida
2204	Comprehensive Health Association, each insurer shall annually be
2205	assessed by the board in the following calendar year a portion
2206	of such incurred operating losses of the plan. Such portion
2207	shall be determined by multiplying such operating losses by a
2208	fraction, the numerator of which equals the insurer's earned
2209	premium pertaining to direct writings of health insurance in the
2210	state during the calendar year preceding that for which the
2211	assessment is levied, and the denominator of which equals the
2212	total of all such premiums earned by insurers in the state
2213	during such calendar year.
2214	2.  The total of all assessments under this paragraph upon
2215	an insurer shall not exceed 1 percent of such insurer's health
2216	insurance premium earned in this state during the calendar year
2217	preceding the year for which the assessments were levied.
2218	3.  All rights, title, and interest in the assessment funds
2219	collected under this paragraph shall vest in this state.
2220	However, all of such funds and interest earned shall be used by
2221	the plan to pay claims and administrative expenses.
2222	(c)  If assessments and other receipts by the plan, board,
2223	or plan administrator exceed the actual losses and
2224	administrative expenses of the plan, the excess shall be held in
2225	interest and used by the board to offset future losses. As used
2226	in this subsection, the term "future losses" includes reserves
2227	for claims incurred but not reported.
2228	(d)  Each insurer's assessment shall be determined annually
2229	by the board or plan administrator based on annual statements
2230	and other reports deemed necessary by the board or plan
2231	administrator and filed with the board or plan administrator by
2232	the insurer. Any deficit incurred under the plan by persons
2233	previously enrolled in the Florida Comprehensive Health
2234	Association shall be recouped by the assessments against
2235	insurers by the board or plan administrator in the manner
2236	provided in paragraph (b), and the insurers may recover the
2237	assessment in the normal course of their respective businesses
2238	without time limitation.
2239	(e)  If a person actively enrolled in the Florida
2240	Comprehensive Health Association after implementation of the
2241	plan loses eligibility for participation in the Florida
2242	Comprehensive Health Association, such person shall not be
2243	included in the calculation of the assessment if the person
2244	later regains eligibility for participation in the plan.
2245	(f)  When all persons actively enrolled in the Florida
2246	Comprehensive Health Association as of the date of
2247	implementation of the plan are no longer eligible for
2248	participation in the Florida Comprehensive Health Association,
2249	the board of directors and plan administrator shall no longer be
2250	allowed to assess insurers in this state for incurred losses in
2251	the Florida Comprehensive Health Association.
2252	Section 22.  Upon implementation, as defined in s.
2253	627.64872(2), Florida Statutes, and as provided in s.
2254	627.64872(20), Florida Statutes, of the Florida Health Insurance
2255	Plan created under s. 627.64872, Florida Statutes, sections
2256	627.6488, 627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
2257	627.6498, Florida Statutes, are repealed.
2258	Section 23.  Subsections (12) and (13) are added to section
2259	627.662, Florida Statutes, to read:
2260	627.662  Other provisions applicable.--The following
2261	provisions apply to group health insurance, blanket health
2262	insurance, and franchise health insurance:
2263	(12)  Section 627.6044, relating to the use of specific
2264	methodology for payment of claims.
2265	(13)  Section 627.6405, relating to the inappropriate
2266	utilization of emergency care.
2267	Section 24.  Paragraphs (c) and (d) of subsection (5),
2268	paragraph (b) of subsection (6), and subsection (12) of section
2269	627.6699, Florida Statutes, are amended, subsections (15) and
2270	(16) of said section are renumbered as subsections (16) and
2271	(17), respectively, present subsection (15) of said section is
2272	amended, and new subsections (15) and (18) are added to said
2273	section, to read:
2274	627.6699  Employee Health Care Access Act.--
2275	(5)  AVAILABILITY OF COVERAGE.--
2276	(c)  Every small employer carrier must, as a condition of
2277	transacting business in this state:
2278	1.  Offer and issue all small employer health benefit plans
2279	on a guaranteed-issue basis to every eligible small employer,
2280	with 2 to 50 eligible employees, that elects to be covered under
2281	such plan, agrees to make the required premium payments, and
2282	satisfies the other provisions of the plan. A rider for
2283	additional or increased benefits may be medically underwritten
2284	and may only be added to the standard health benefit plan. The
2285	increased rate charged for the additional or increased benefit
2286	must be rated in accordance with this section.
2287	2.  In the absence of enrollment availability in the
2288	Florida Health Insurance Plan, offer and issue basic and
2289	standard small employer health benefit plans on a guaranteed-
2290	issue basis, during a 31-day open enrollment period of August 1
2291	through August 31 of each year, to every eligible small
2292	employer, with fewer than two eligible employees, which small
2293	employer is not formed primarily for the purpose of buying
2294	health insurance and which elects to be covered under such plan,
2295	agrees to make the required premium payments, and satisfies the
2296	other provisions of the plan. Coverage provided under this
2297	subparagraph shall begin on October 1 of the same year as the
2298	date of enrollment, unless the small employer carrier and the
2299	small employer agree to a different date. A rider for additional
2300	or increased benefits may be medically underwritten and may only
2301	be added to the standard health benefit plan. The increased rate
2302	charged for the additional or increased benefit must be rated in
2303	accordance with this section. For purposes of this subparagraph,
2304	a person, his or her spouse, and his or her dependent children
2305	constitute a single eligible employee if that person and spouse
2306	are employed by the same small employer and either that person
2307	or his or her spouse has a normal work week of less than 25
2308	hours. Any right to an open enrollment of health benefit
2309	coverage for groups of fewer than two employees, pursuant to
2310	this section, shall remain in full force and effect in the
2311	absence of the availability of new enrollment into the Florida
2312	Health Insurance Plan.
2313	3.  This paragraph does not limit a carrier's ability to
2314	offer other health benefit plans to small employers if the
2315	standard and basic health benefit plans are offered and
2316	rejected.
2317	(d)  A small employer carrier must file with the office, in
2318	a format and manner prescribed by the committee, a standard
2319	health care plan, a high deductible plan that meets the federal
2320	requirements of a health savings account plan or a health
2321	reimbursement arrangement, and a basic health care plan to be
2322	used by the carrier. The provisions of this section requiring
2323	the filing of a high deductible plan are effective September 1,
2324	2004.
2325	(6)  RESTRICTIONS RELATING TO PREMIUM RATES.--
2326	(b)  For all small employer health benefit plans that are
2327	subject to this section and are issued by small employer
2328	carriers on or after January 1, 1994, premium rates for health
2329	benefit plans subject to this section are subject to the
2330	following:
2331	1.  Small employer carriers must use a modified community
2332	rating methodology in which the premium for each small employer
2333	must be determined solely on the basis of the eligible
2334	employee's and eligible dependent's gender, age, family
2335	composition, tobacco use, or geographic area as determined under
2336	paragraph (5)(j) and in which the premium may be adjusted as
2337	permitted by this paragraph.
2338	2.  Rating factors related to age, gender, family
2339	composition, tobacco use, or geographic location may be
2340	developed by each carrier to reflect the carrier's experience.
2341	The factors used by carriers are subject to office review and
2342	approval.
2343	3.  Small employer carriers may not modify the rate for a
2344	small employer for 12 months from the initial issue date or
2345	renewal date, unless the composition of the group changes or
2346	benefits are changed. However, a small employer carrier may
2347	modify the rate one time prior to 12 months after the initial
2348	issue date for a small employer who enrolls under a previously
2349	issued group policy that has a common anniversary date for all
2350	employers covered under the policy if:
2351	a.  The carrier discloses to the employer in a clear and
2352	conspicuous manner the date of the first renewal and the fact
2353	that the premium may increase on or after that date.
2354	b.  The insurer demonstrates to the office that
2355	efficiencies in administration are achieved and reflected in the
2356	rates charged to small employers covered under the policy.
2357	4.  A carrier may issue a group health insurance policy to
2358	a small employer health alliance or other group association with
2359	rates that reflect a premium credit for expense savings
2360	attributable to administrative activities being performed by the
2361	alliance or group association if such expense savings are
2362	specifically documented in the insurer's rate filing and are
2363	approved by the office. Any such credit may not be based on
2364	different morbidity assumptions or on any other factor related
2365	to the health status or claims experience of any person covered
2366	under the policy. Nothing in this subparagraph exempts an
2367	alliance or group association from licensure for any activities
2368	that require licensure under the insurance code. A carrier
2369	issuing a group health insurance policy to a small employer
2370	health alliance or other group association shall allow any
2371	properly licensed and appointed agent of that carrier to market
2372	and sell the small employer health alliance or other group
2373	association policy. Such agent shall be paid the usual and
2374	customary commission paid to any agent selling the policy.
2375	5.  Any adjustments in rates for claims experience, health
2376	status, or duration of coverage may not be charged to individual
2377	employees or dependents. For a small employer's policy, such
2378	adjustments may not result in a rate for the small employer
2379	which deviates more than 15 percent from the carrier's approved
2380	rate. Any such adjustment must be applied uniformly to the rates
2381	charged for all employees and dependents of the small employer.
2382	A small employer carrier may make an adjustment to a small
2383	employer's renewal premium, not to exceed 10 percent annually,
2384	due to the claims experience, health status, or duration of
2385	coverage of the employees or dependents of the small employer.
2386	Semiannually, small group carriers shall report information on
2387	forms adopted by rule by the commission, to enable the office to
2388	monitor the relationship of aggregate adjusted premiums actually
2389	charged policyholders by each carrier to the premiums that would
2390	have been charged by application of the carrier's approved
2391	modified community rates. If the aggregate resulting from the
2392	application of such adjustment exceeds the premium that would
2393	have been charged by application of the approved modified
2394	community rate by 4 5 percent for the current reporting period,
2395	the carrier shall limit the application of such adjustments only
2396	to minus adjustments beginning not more than 60 days after the
2397	report is sent to the office. For any subsequent reporting
2398	period, if the total aggregate adjusted premium actually charged
2399	does not exceed the premium that would have been charged by
2400	application of the approved modified community rate by 4 5
2401	percent, the carrier may apply both plus and minus adjustments.
2402	A small employer carrier may provide a credit to a small
2403	employer's premium based on administrative and acquisition
2404	expense differences resulting from the size of the group. Group
2405	size administrative and acquisition expense factors may be
2406	developed by each carrier to reflect the carrier's experience
2407	and are subject to office review and approval.
2408	6.  A small employer carrier rating methodology may include
2409	separate rating categories for one dependent child, for two
2410	dependent children, and for three or more dependent children for
2411	family coverage of employees having a spouse and dependent
2412	children or employees having dependent children only. A small
2413	employer carrier may have fewer, but not greater, numbers of
2414	categories for dependent children than those specified in this
2415	subparagraph.
2416	7.  Small employer carriers may not use a composite rating
2417	methodology to rate a small employer with fewer than 10
2418	employees. For the purposes of this subparagraph, a "composite
2419	rating methodology" means a rating methodology that averages the
2420	impact of the rating factors for age and gender in the premiums
2421	charged to all of the employees of a small employer.
2422	8.a.  A carrier may separate the experience of small
2423	employer groups with less than 2 eligible employees from the
2424	experience of small employer groups with 2-50 eligible employees
2425	for purposes of determining an alternative modified community
2426	rating.
2427	b.  If a carrier separates the experience of small employer
2428	groups as provided in sub-subparagraph a., the rate to be
2429	charged to small employer groups of less than 2 eligible
2430	employees may not exceed 150 percent of the rate determined for
2431	small employer groups of 2-50 eligible employees. However, the
2432	carrier may charge excess losses of the experience pool
2433	consisting of small employer groups with less than 2 eligible
2434	employees to the experience pool consisting of small employer
2435	groups with 2-50 eligible employees so that all losses are
2436	allocated and the 150-percent rate limit on the experience pool
2437	consisting of small employer groups with less than 2 eligible
2438	employees is maintained. Notwithstanding s. 627.411(1), the rate
2439	to be charged to a small employer group of fewer than 2 eligible
2440	employees, insured as of July 1, 2002, may be up to 125 percent
2441	of the rate determined for small employer groups of 2-50
2442	eligible employees for the first annual renewal and 150 percent
2443	for subsequent annual renewals.
2444	(12)  STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH
2445	BENEFIT PLANS.--
2446	(a)1.  The Chief Financial Officer shall appoint a health
2447	benefit plan committee composed of four representatives of
2448	carriers which shall include at least two representatives of
2449	HMOs, at least one of which is a staff model HMO, two
2450	representatives of agents, four representatives of small
2451	employers, and one employee of a small employer. The carrier
2452	members shall be selected from a list of individuals recommended
2453	by the board. The Chief Financial Officer may require the board
2454	to submit additional recommendations of individuals for
2455	appointment.
2456	2.  The plans shall comply with all of the requirements of
2457	this subsection.
2458	3.  The plans must be filed with and approved by the office
2459	prior to issuance or delivery by any small employer carrier.
2460	4.  After approval of the revised health benefit plans, if
2461	the office determines that modifications to a plan might be
2462	appropriate, the Chief Financial Officer shall appoint a new
2463	health benefit plan committee in the manner provided in
2464	subparagraph 1. to submit recommended modifications to the
2465	office for approval.
2466	(b)1.  Each small employer carrier issuing new health
2467	benefit plans shall offer to any small employer, upon request, a
2468	standard health benefit plan, and a basic health benefit plan,
2469	and a high deductible plan that meets the requirements of a
2470	health savings account plan as defined by federal law or a
2471	health reimbursement arrangement as authorized by the Internal
2472	Revenue Service, that meet meets the criteria set forth in this
2473	section.
2474	2.  For purposes of this subsection, the terms "standard
2475	health benefit plan," and "basic health benefit plan," and "high
2476	deductible plan" mean policies or contracts that a small
2477	employer carrier offers to eligible small employers that
2478	contain:
2479	a.  An exclusion for services that are not medically
2480	necessary or that are not covered preventive health services;
2481	and
2482	b.  A procedure for preauthorization by the small employer
2483	carrier, or its designees.
2484	3.  A small employer carrier may include the following
2485	managed care provisions in the policy or contract to control
2486	costs:
2487	a.  A preferred provider arrangement or exclusive provider
2488	organization or any combination thereof, in which a small
2489	employer carrier enters into a written agreement with the
2490	provider to provide services at specified levels of
2491	reimbursement or to provide reimbursement to specified
2492	providers. Any such written agreement between a provider and a
2493	small employer carrier must contain a provision under which the
2494	parties agree that the insured individual or covered member has
2495	no obligation to make payment for any medical service rendered
2496	by the provider which is determined not to be medically
2497	necessary. A carrier may use preferred provider arrangements or
2498	exclusive provider arrangements to the same extent as allowed in
2499	group products that are not issued to small employers.
2500	b.  A procedure for utilization review by the small
2501	employer carrier or its designees.
2502
2503	This subparagraph does not prohibit a small employer carrier
2504	from including in its policy or contract additional managed care
2505	and cost containment provisions, subject to the approval of the
2506	office, which have potential for controlling costs in a manner
2507	that does not result in inequitable treatment of insureds or
2508	subscribers. The carrier may use such provisions to the same
2509	extent as authorized for group products that are not issued to
2510	small employers.
2511	4.  The standard health benefit plan shall include:
2512	a.  Coverage for inpatient hospitalization;
2513	b.  Coverage for outpatient services;
2514	c.  Coverage for newborn children pursuant to s. 627.6575;
2515	d.  Coverage for child care supervision services pursuant
2516	to s. 627.6579;
2517	e.  Coverage for adopted children upon placement in the
2518	residence pursuant to s. 627.6578;
2519	f.  Coverage for mammograms pursuant to s. 627.6613;
2520	g.  Coverage for handicapped children pursuant to s.
2521	627.6615;
2522	h.  Emergency or urgent care out of the geographic service
2523	area; and
2524	i.  Coverage for services provided by a hospice licensed
2525	under s. 400.602 in cases where such coverage would be the most
2526	appropriate and the most cost-effective method for treating a
2527	covered illness.
2528	5.  The standard health benefit plan and the basic health
2529	benefit plan may include a schedule of benefit limitations for
2530	specified services and procedures. If the committee develops
2531	such a schedule of benefits limitation for the standard health
2532	benefit plan or the basic health benefit plan, a small employer
2533	carrier offering the plan must offer the employer an option for
2534	increasing the benefit schedule amounts by 4 percent annually.
2535	6.  The basic health benefit plan shall include all of the
2536	benefits specified in subparagraph 4.; however, the basic health
2537	benefit plan shall place additional restrictions on the benefits
2538	and utilization and may also impose additional cost containment
2539	measures.
2540	7.  Sections 627.419(2), (3), and (4), 627.6574, 627.6612,
2541	627.66121, 627.66122, 627.6616, 627.6618, 627.668, and 627.66911
2542	apply to the standard health benefit plan and to the basic
2543	health benefit plan. However, notwithstanding said provisions,
2544	the plans may specify limits on the number of authorized
2545	treatments, if such limits are reasonable and do not
2546	discriminate against any type of provider.
2547	8.  The high deductible plan associated with a health
2548	savings account or a health reimbursement arrangement shall
2549	include all the benefits specified in subparagraph 4.
2550	9.8.  Each small employer carrier that provides for
2551	inpatient and outpatient services by allopathic hospitals may
2552	provide as an option of the insured similar inpatient and
2553	outpatient services by hospitals accredited by the American
2554	Osteopathic Association when such services are available and the
2555	osteopathic hospital agrees to provide the service.
2556	(c)  If a small employer rejects, in writing, the standard
2557	health benefit plan, and the basic health benefit plan, and the
2558	high deductible health savings account plan or a health
2559	reimbursement arrangement, the small employer carrier may offer
2560	the small employer a limited benefit policy or contract.
2561	(d)1.  Upon offering coverage under a standard health
2562	benefit plan, a basic health benefit plan, or a limited benefit
2563	policy or contract for any small employer, the small employer
2564	carrier shall provide such employer group with a written
2565	statement that contains, at a minimum:
2566	a.  An explanation of those mandated benefits and providers
2567	that are not covered by the policy or contract;
2568	b.  An explanation of the managed care and cost control
2569	features of the policy or contract, along with all appropriate
2570	mailing addresses and telephone numbers to be used by insureds
2571	in seeking information or authorization; and
2572	c.  An explanation of the primary and preventive care
2573	features of the policy or contract.
2574
2575	Such disclosure statement must be presented in a clear and
2576	understandable form and format and must be separate from the
2577	policy or certificate or evidence of coverage provided to the
2578	employer group.
2579	2.  Before a small employer carrier issues a standard
2580	health benefit plan, a basic health benefit plan, or a limited
2581	benefit policy or contract, it must obtain from the prospective
2582	policyholder a signed written statement in which the prospective
2583	policyholder:
2584	a.  Certifies as to eligibility for coverage under the
2585	standard health benefit plan, basic health benefit plan, or
2586	limited benefit policy or contract;
2587	b.  Acknowledges the limited nature of the coverage and an
2588	understanding of the managed care and cost control features of
2589	the policy or contract;
2590	c.  Acknowledges that if misrepresentations are made
2591	regarding eligibility for coverage under a standard health
2592	benefit plan, a basic health benefit plan, or a limited benefit
2593	policy or contract, the person making such misrepresentations
2594	forfeits coverage provided by the policy or contract; and
2595	d.  If a limited plan is requested, acknowledges that the
2596	prospective policyholder had been offered, at the time of
2597	application for the insurance policy or contract, the
2598	opportunity to purchase any health benefit plan offered by the
2599	carrier and that the prospective policyholder had rejected that
2600	coverage.
2601
2602	A copy of such written statement shall be provided to the
2603	prospective policyholder no later than at the time of delivery
2604	of the policy or contract, and the original of such written
2605	statement shall be retained in the files of the small employer
2606	carrier for the period of time that the policy or contract
2607	remains in effect or for 5 years, whichever period is longer.
2608	3.  Any material statement made by an applicant for
2609	coverage under a health benefit plan which falsely certifies as
2610	to the applicant's eligibility for coverage serves as the basis
2611	for terminating coverage under the policy or contract.
2612	4.  Each marketing communication that is intended to be
2613	used in the marketing of a health benefit plan in this state
2614	must be submitted for review by the office prior to use and must
2615	contain the disclosures stated in this subsection.
2616	(e)  A small employer carrier may not use any policy,
2617	contract, form, or rate under this section, including
2618	applications, enrollment forms, policies, contracts,
2619	certificates, evidences of coverage, riders, amendments,
2620	endorsements, and disclosure forms, until the insurer has filed
2621	it with the office and the office has approved it under ss.
2622	627.410 and 627.411 and this section.
2623	(15)  SMALL EMPLOYERS ACCESS PROGRAM.--
2624	(a)  Popular name.--This subsection may be referred to by
2625	the popular name "The Small Employers Access Program."
2626	(b)  Intent.--The Legislature finds that increased access
2627	to health care coverage for small employers with up to 25
2628	employees could improve employees' health and reduce the
2629	incidence and costs of illness and disabilities among residents
2630	in this state. Many employers do not offer health care benefits
2631	to their employees citing the increased cost of this benefit. It
2632	is the intent of the Legislature to create the Small Business
2633	Health Plan to provide small employers the option and ability to
2634	provide health care benefits to their employees at an affordable
2635	cost through the creation of purchasing pools for employers with
2636	up to 25 employees, and rural hospital employers and nursing
2637	home employers regardless of the number of employees.
2638	(c)  Definitions.--For purposes of this subsection:
2639	1.  "Fair commission" means a commission structure
2640	determined by the insurers and reflected in the insurers' rate
2641	filings made pursuant to this subsection.
2642	2.  "Insurer" means any entity that provides health
2643	insurance in this state. For purposes of this subsection,
2644	insurer includes an insurance company holding a certificate of
2645	authority pursuant to chapter 624 or a health maintenance
2646	organization holding a certificate of authority pursuant to
2647	chapter 641, which qualifies to provide coverage to small
2648	employer groups pursuant to this section.
2649	3.  "Mutually supported benefit plan" means an optional
2650	alternative coverage plan developed within a defined geographic
2651	region which may include, but is not limited to, a minimum level
2652	of primary care coverage in which the percentage of the premium
2653	is distributed among the employer, the employee, and community-
2654	generated revenue either alone or in conjunction with federal
2655	matching funds.
2656	4.  "Office" means the Office of Insurance Regulation of
2657	the Department of Financial Services.
2658	5.  "Participating insurer" means any insurer providing
2659	health insurance to small employers that has been selected by
2660	the office in accordance with this subsection for its designated
2661	region.
2662	6.  "Program" means the Small Employer Access Program as
2663	created by this subsection.
2664	(d)  Eligibility.--
2665	1.  Any small employer that is actively engaged in
2666	business, has its principal place of business in this state,
2667	employs up to 25 eligible employees on business days during the
2668	preceding calendar year, employs at least 2 employees on the
2669	first day of the plan year, and has had no prior coverage for
2670	the last 6 months may participate.
2671	2.  Any municipality, county, school district, or hospital
2672	employer located in a rural community as defined in s.
2673	288.0656(2)(b), may participate.
2674	3.  Nursing home employers may participate.
2675	4.  Each dependent of a person eligible for coverage is
2676	also eligible to participate.
2677
2678	Any employer participating in the program must do so until the
2679	end of the term for which the carrier providing the coverage is
2680	obligated to provide such coverage to the program. Coverage for
2681	a small employer group that ceases to meet the eligibility
2682	requirements of this section may be terminated at the end of the
2683	policy period for which the necessary premiums have been paid.
2684	(e)  Administration.--
2685	1.  The office shall by competitive bid, in accordance with
2686	current state law, select an insurer to provide coverage through
2687	the program to eligible small employers within an established
2688	geographical area of this state. The office may develop
2689	exclusive regions for the program similar to those used by the
2690	Healthy Kids Corporation. However the office is not precluded
2691	from developing, in conjunction with insurers, regions different
2692	from those used by the Healthy Kids Corporation if the office
2693	deems that such a region will carry out the intentions of this
2694	subsection.
2695	2.  The office shall evaluate bids submitted based upon
2696	criteria established by the office, which shall include, but not
2697	be limited to:
2698	a.  The insurer's proven ability to handle health insurance
2699	coverage to small employer groups.
2700	b.  The efficiency and timeliness of the insurer's claim
2701	processing procedures.
2702	c.  The insurer's ability to apply effective cost-
2703	containment programs and procedures and to administer the
2704	program in a cost-efficient manner.
2705	d.  The financial condition and stability of the insurer.
2706	e.  The insurer's ability to develop an optional mutually
2707	supported benefit plan.
2708
2709	The office may use any financial information available to it
2710	through its regulatory duties to make this evaluation.
2711	(f)  Insurer qualifications.--The insurer shall be a duly
2712	authorized insurer or health maintenance organization.
2713	(g)  Duties of the insurer.--The insurer shall:
2714	1.  Develop and implement a program to publicize the
2715	existence of the program, program eligibility requirements, and
2716	procedures for enrollment and maintain public awareness of the
2717	program.
2718	2.  Maintain employer awareness of the program.
2719	3.  Demonstrate the ability to use delivery of cost-
2720	effective health care services.
2721	4.  Encourage, educate, advise, and administer the
2722	effective use of health savings accounts by covered employees
2723	and dependents.
2724	5.  Serve for a period specified in the contract between
2725	the office and the insurer, subject to removal for cause and
2726	subject to any terms, conditions, and limitations of the
2727	contract between the office and the insurer as may be specified
2728	in the request for proposal.
2729	(h)  Contract term.--The contract term shall not exceed 3
2730	years. At least 6 months prior to the expiration of each
2731	contract period, the office shall invite eligible entities,
2732	including the current insurer, to submit bids to serve as the
2733	insurer for a designated geographic area. Selection of the
2734	insurer for the succeeding period shall be made at least 3
2735	months prior to the end of the current period. If a protest is
2736	filed and not resolved by the end of the contract period, the
2737	contract with the existing administrator may be extended for a
2738	period not to exceed 6 months. During the contract extension
2739	period, the administrator shall be paid at a rate to be
2740	negotiated by the office.
2741	(i)  Insurer reporting requirements.--On March 1 following
2742	the close of each calendar year, the insurer shall determine net
2743	written and earned premiums, the expense of administration, and
2744	the paid and incurred losses for the year and report this
2745	information to the office on a form prescribed by the office.
2746	(j)  Application requirements.--The insurer shall permit or
2747	allow any licensed and duly appointed health insurance agent
2748	residing in the designated region to submit applications for
2749	coverage, and such agent shall be paid a fair commission if
2750	coverage is written. The agent must be appointed to at least one
2751	insurer.
2752	(k)  Benefits.--The benefits provided by the plan shall be
2753	the same as the coverage required for small employers under
2754	subsection (12). Upon the approval of the office, the insurer
2755	may also establish an optional mutually supported benefit plan
2756	which is an alternative plan developed within a defined
2757	geographic region of this state or any other such alternative
2758	plan which will carry out the intent of this subsection. Any
2759	small employer carrier issuing new health benefit plans may
2760	offer a benefit plan with coverages similar to, but not less
2761	than, any alternative coverage plan developed pursuant to this
2762	subsection.
2763	(l)  Annual reporting.--The office shall make an annual
2764	report to the Governor, the President of the Senate, and the
2765	Speaker of the House of Representatives. The report shall
2766	summarize the activities of the program in the preceding
2767	calendar year, including the net written and earned premiums,
2768	program enrollment, the expense of administration, and the paid
2769	and incurred losses. The report shall be submitted no later than
2770	March 15 following the close of the prior calendar year.
2771	(16)(15)  APPLICABILITY OF OTHER STATE LAWS.--
2772	(a)  Except as expressly provided in this section, a law
2773	requiring coverage for a specific health care service or
2774	benefit, or a law requiring reimbursement, utilization, or
2775	consideration of a specific category of licensed health care
2776	practitioner, does not apply to a standard or basic health
2777	benefit plan policy or contract or a limited benefit policy or
2778	contract offered or delivered to a small employer unless that
2779	law is made expressly applicable to such policies or contracts.
2780	A law restricting or limiting deductibles, coinsurance,
2781	copayments, or annual or lifetime maximum payments does not
2782	apply to any health plan policy, including a standard or basic
2783	health benefit plan policy or contract, offered or delivered to
2784	a small employer unless such law is made expressly applicable to
2785	such policy or contract. However, every small employer carrier
2786	must offer to eligible small employers the standard benefit plan
2787	and the basic benefit plan, as required by subsection (5), as
2788	such plans have been approved by the office pursuant to
2789	subsection (12).
2790	(b)  Except as provided in this section, a standard or
2791	basic health benefit plan policy or contract or limited benefit
2792	policy or contract offered to a small employer is not subject to
2793	any provision of this code which:
2794	1.  Inhibits a small employer carrier from contracting with
2795	providers or groups of providers with respect to health care
2796	services or benefits;
2797	2.  Imposes any restriction on a small employer carrier's
2798	ability to negotiate with providers regarding the level or
2799	method of reimbursing care or services provided under a health
2800	benefit plan; or
2801	3.  Requires a small employer carrier to either include a
2802	specific provider or class of providers when contracting for
2803	health care services or benefits or to exclude any class of
2804	providers that is generally authorized by statute to provide
2805	such care.
2806	(c)  Any second tier assessment paid by a carrier pursuant
2807	to paragraph (11)(j) may be credited against assessments levied
2808	against the carrier pursuant to s. 627.6494.
2809	(d)  Notwithstanding chapter 641, a health maintenance
2810	organization is authorized to issue contracts providing benefits
2811	equal to the standard health benefit plan, the basic health
2812	benefit plan, and the limited benefit policy authorized by this
2813	section.
2814	(17)(16)  RULEMAKING AUTHORITY.--The commission may adopt
2815	rules to administer this section, including rules governing
2816	compliance by small employer carriers and small employers.
2817	Section 25.  Section 627.6405, Florida Statutes, is created
2818	to read:
2819	627.6405  Decreasing inappropriate utilization of emergency
2820	care.--
2821	(1)  The Legislature finds and declares it to be of vital
2822	importance that emergency services and care be provided by
2823	hospitals and physicians to every person in need of such care,
2824	but with the double-digit increases in health insurance
2825	premiums, health care providers and insurers should encourage
2826	patients and the insured to assume responsibility for their
2827	treatment, including emergency care. The Legislature finds that
2828	inappropriate utilization of emergency department services
2829	increases the overall cost of providing health care and these
2830	costs are ultimately borne by the hospital, the insured
2831	patients, and, many times, by the taxpayers of this state.
2832	Finally, the Legislature declares that the providers and
2833	insurers must share the responsibility of providing alternative
2834	treatment options to urgent care patients outside of the
2835	emergency department. Therefore, it is the intent of the
2836	Legislature to place the obligation for educating consumers and
2837	creating mechanisms for delivery of care that will decrease the
2838	overutilization of emergency service on health insurers and
2839	providers.
2840	(2)  Health insurers shall provide on their websites
2841	information regarding appropriate utilization of emergency care
2842	services which shall include, but not be limited to, a list of
2843	alternative urgent care contracted providers, the types of
2844	services offered by these providers, and what to do in the event
2845	of a true emergency.
2846	(3)  Health insurers shall develop community emergency
2847	department diversion programs. Such programs may include, at the
2848	discretion of the insurer, but not be limited to, enlisting
2849	providers to be on call to insurers after hours, coordinating
2850	care through local community resources, and providing incentives
2851	to providers for case management.
2852	(4)  As a disincentive for insureds to inappropriately use
2853	emergency department services for nonemergency care, health
2854	insurers may require higher copayments for urgent care or
2855	primary care provided in an emergency department and higher
2856	copayments for use of out-of-network emergency departments.
2857	Higher copayments may not be charged for the utilization of the
2858	emergency department for emergency care. For the purposes of
2859	this section, the term "emergency care" has the same meaning as
2860	provided in s. 395.002, and shall include services provided to
2861	rule out an emergency medical condition.
2862	Section 26.  Section 641.31097, Florida Statutes, is
2863	created to read:
2864	641.31097  Decreasing inappropriate utilization of
2865	emergency care.--
2866	(1)  The Legislature finds and declares it to be of vital
2867	importance that emergency services and care be provided by
2868	hospitals and physicians to every person in need of such care,
2869	but with the double-digit increases in health insurance
2870	premiums, health care providers and insurers should encourage
2871	patients and the insured to assume responsibility for their
2872	treatment, including emergency care. The Legislature finds that
2873	inappropriate utilization of emergency department services
2874	increases the overall cost of providing health care and these
2875	costs are ultimately borne by the hospital, by the insured
2876	patients, and, many times, by the taxpayers of this state.
2877	Finally, the Legislature declares that the providers and
2878	insurers must share the responsibility of providing alternative
2879	treatment options to urgent care patients outside of the
2880	emergency department. Therefore, it is the intent of the
2881	Legislature to place the obligation for educating consumers and
2882	creating mechanisms for delivery of care that will decrease the
2883	overutilization of emergency service on health maintenance
2884	organizations and providers.
2885	(2)  Health maintenance organizations shall provide on
2886	their Internet websites information regarding appropriate
2887	utilization of emergency care services, which shall include, but
2888	not be limited to, a list of alternative urgent care contracted
2889	providers, the types of services offered by these providers, and
2890	what to do in the event of a true emergency.
2891	(3)  Health maintenance organizations shall develop
2892	community emergency department diversion programs. Such programs
2893	may include at the discretion of the health maintenance
2894	organization, but not be limited to, enlisting providers to be
2895	on call to subscribers after hours, coordinating care through
2896	local community resources, and providing incentives to providers
2897	for case management.
2898	(4)  As a disincentive for subscribers to inappropriately
2899	use emergency department services for nonemergency care, health
2900	maintenance organizations may require higher copayments for
2901	urgent care or primary care provided in an emergency department
2902	and higher copayments for use of out-of-network emergency
2903	departments. Higher copayments may not be charged for the
2904	utilization of the emergency department for emergency care. For
2905	the purposes of this section, the term "emergency care" has the
2906	same meaning as provided in s. 395.002 and shall include
2907	services provided to rule out an emergency medical condition.
2908	Section 27.  Subsection (1) of section 627.9175, Florida
2909	Statutes, is amended to read:
2910	627.9175  Reports of information on health and accident
2911	insurance.--
2912	(1)  Each health insurer, prepaid limited health services
2913	organization, and health maintenance organization shall submit,
2914	no later than April 1 of each year, annually to the office
2915	information concerning health and accident insurance coverage
2916	and medical plans being marketed and currently in force in this
2917	state. The required information shall be described by market
2918	segment, to include, but not be limited to:
2919	(a)  Issuing, servicing company, and entity contact
2920	information.
2921	(b)  Information on all health and accident insurance
2922	policies and prepaid limited health service organizations and
2923	health maintenance organization contracts in force and issued in
2924	the previous year. Such information shall include, but not be
2925	limited to, direct premiums earned, direct losses incurred,
2926	number of policies, number of certificates, number of covered
2927	lives, and the average number of days taken to pay claims. as to
2928	policies of individual health insurance:
2929	(a)  A summary of typical benefits, exclusions, and
2930	limitations for each type of individual policy form currently
2931	being issued in the state. The summary shall include, as
2932	appropriate:
2933	1.  The deductible amount;
2934	2.  The coinsurance percentage;
2935	3.  The out-of-pocket maximum;
2936	4.  Outpatient benefits;
2937	5.  Inpatient benefits; and
2938	6.  Any exclusions for preexisting conditions.
2939
2940	The commission shall determine other appropriate benefits,
2941	exclusions, and limitations to be reported for inclusion in the
2942	consumer's guide published pursuant to this section.
2943	(b)  A schedule of rates for each type of individual policy
2944	form reflecting typical variations by age, sex, region of the
2945	state, or any other applicable factor which is in use and is
2946	determined to be appropriate for inclusion by the commission.
2947
2948	The commission may establish rules governing shall provide by
2949	rule a uniform format for the submission of this information
2950	described in this section, including the use of uniform formats
2951	and electronic data transmission order to allow for meaningful
2952	comparisons of premiums charged for comparable benefits. The
2953	office shall provide this information to the department, which
2954	shall publish annually a consumer's guide which summarizes and
2955	compares the information required to be reported under this
2956	subsection.
2957	Section 28.  Chapter 636, Florida Statutes, entitled
2958	"Prepaid Limited Health Service Organizations," is retitled as
2959	"Prepaid Limited Health Service Organizations and Discount
2960	Medical Plan Organizations."
2961	Section 29.  Sections 636.002 through 636.067, Florida
2962	Statutes, are designated as part I of chapter 636, Florida
2963	Statutes, and entitled "Prepaid Limited Health Service
2964	Organizations."
2965	Section 30.  Paragraph (c) of subsection (7) of section
2966	636.003, Florida Statutes, is amended to read:
2967	636.003  Definitions.--As used in this act, the term:
2968	(7)  "Prepaid limited health service organization" means
2969	any person, corporation, partnership, or any other entity which,
2970	in return for a prepayment, undertakes to provide or arrange
2971	for, or provide access to, the provision of a limited health
2972	service to enrollees through an exclusive panel of providers.
2973	Prepaid limited health service organization does not include:
2974	(c)  Any person who is licensed pursuant to part II as a
2975	discount medical plan organization, in exchange for fees, dues,
2976	charges or other consideration, provides access to a limited
2977	health service provider without assuming any responsibility for
2978	payment for the limited health service or any portion thereof.
2979	Section 31.  Effective January 1, 2005, part II of chapter
2980	636, Florida Statutes, consisting of sections 636.202, 636.204,
2981	636.206, 636.208, 636.210, 636.212, 636.214, 636.216, 636.218,
2982	636.220, 636.222, 636.224, 636.226, 636.228, 636.230, 636.232,
2983	636.234, 636.236, 636.238, 636.240, 636.242, and 636.244, is
2984	created to read:
2985	PART II
2986	DISCOUNT MEDICAL PLAN ORGANIZATIONS
2987	636.202  Definitions.--As used in this part, the term:
2988	(1)  "Discount medical plan" means a business arrangement
2989	or contract in which a person, in exchange for fees, dues,
2990	charges, or other consideration, provides access for plan
2991	members to providers of medical services and the right to
2992	receive medical services from those providers at a discount. The
2993	term "discount medical plan" does not include any product
2994	regulated under chapter 627, chapter 641, or part I of chapter
2995	636.
2996	(2)  "Discount medical plan organization" means an entity
2997	which, in exchange for fees, dues, charges, or other
2998	consideration, provides access for plan members to providers of
2999	medical services and the right to receive medical services from
3000	those providers at a discount. The term "discount medical plan"
3001	does not include any product regulated under chapter 627,
3002	chapter 641, or part I of chapter 636.
3003	(3)  "Marketer" means a person or entity which markets,
3004	promotes, sells, or distributes a discount medical plan,
3005	including a private label entity which places its name on and
3006	markets or distributes a discount medical plan but does not
3007	operate a discount medical plan.
3008	(4)  "Medical services" means any care, service, or
3009	treatment of illness or dysfunction of, or injury to, the human
3010	body, including, but not limited to, physician care, inpatient
3011	care, hospital surgical services, emergency services, ambulance
3012	services, dental care services, vision care services, mental
3013	health services, substance abuse services, chiropractic
3014	services, podiatric care services, laboratory services, and
3015	medical equipment and supplies. The term does not include
3016	pharmaceutical supplies or prescriptions.
3017	(5)  "Member" means any person who pays fees, dues,
3018	charges, or other consideration for the right to receive the
3019	purported benefits of a discount medical plan.
3020	(6)  "Provider" means any person or institution which is
3021	contracted, directly or indirectly, with a discount medical plan
3022	organization to provide medical services to members.
3023	(7)  "Provider network" means an entity which negotiates on
3024	behalf of more than one provider with a discount medical plan
3025	organization to provide medical services to members.
3026	636.204  License required.--
3027	(1)  Before doing business in this state as a discount
3028	medical plan organization, an entity must be a corporation,
3029	incorporated under the laws of this state or, if a foreign
3030	corporation, authorized to transact business in this state, and
3031	must possess a license as a discount medical plan organization
3032	from the office.
3033	(2)  An application for a license to operate as a discount
3034	medical plan organization must be filed with the office on a
3035	form prescribed by the commission. Such application must be
3036	sworn to by an officer or authorized representative of the
3037	applicant and be accompanied by the following:
3038	(a)  A copy of the applicant's articles of incorporation,
3039	including all amendments.
3040	(b)  A copy of the corporation's bylaws.
3041	(c)  A list of the names, addresses, official positions,
3042	and biographical information of the individuals who are
3043	responsible for conducting the applicant's affairs, including,
3044	but not limited to, all members of the board of directors, board
3045	of trustees, executive committee, or other governing board or
3046	committee, the officers, contracted management company
3047	personnel, and any person or entity owning or having the right
3048	to acquire 10 percent or more of the voting securities of the
3049	applicant. Such listing must fully disclose the extent and
3050	nature of any contracts or arrangements between any individual
3051	who is responsible for conducting the applicant's affairs and
3052	the discount medical plan organization, including any possible
3053	conflicts of interest.
3054	(d)  A complete biographical statement, on forms prescribed
3055	by the commission, an independent investigation report, and a
3056	set of fingerprints, as provided in chapter 624, with respect to
3057	each individual identified under paragraph (c).
3058	(e)  A statement generally describing the applicant, its
3059	facilities and personnel, and the medical services to be
3060	offered.
3061	(f)  A copy of the form of all contracts made or to be made
3062	between the applicant and any providers or provider networks
3063	regarding the provision of medical services to members.
3064	(g)  A copy of the form of any contract made or arrangement
3065	to be made between the applicant and any person listed in
3066	paragraph (c).
3067	(h)  A copy of the form of any contract made or to be made
3068	between the applicant and any person, corporation, partnership,
3069	or other entity for the performance on the applicant's behalf of
3070	any function, including, but not limited to, marketing,
3071	administration, enrollment, investment management, and
3072	subcontracting for the provision of health services to members.
3073	(i)  A copy of the applicant's most recent financial
3074	statements audited by an independent certified public
3075	accountant.
3076	(j)  A description of the proposed method of marketing.
3077	(k)  A description of the subscriber complaint procedures
3078	to be established and maintained.
3079	(l)  The fee for issuance of a license.
3080	(m)  Such other information as the commission or office may
3081	reasonably require to make the determinations required by this
3082	part.
3083	(3)  The office shall issue a license which shall expire 1
3084	year later, and each year on that date thereafter, and which the
3085	office shall renew if the licensee pays the annual license fee
3086	of $50 and if the office is satisfied that the licensee is in
3087	compliance with this part.
3088	(4)  Prior to licensure by the office, each discount
3089	medical plan organization must establish an Internet website so
3090	as to conform to the requirements of s. 636.226.
3091	(5)  The license fee under subsection (2) is $50 per year
3092	per licensee. All amounts collected shall be deposited into the
3093	General Revenue Fund.
3094	(6)  Nothing in this part requires a provider who provides
3095	discounts to his or her own patients to obtain and maintain a
3096	license as a discount medical plan organization.
3097	636.206  Examinations and investigations.--
3098	(1)  The office may examine or investigate the business and
3099	affairs of any discount medical plan organization. The office
3100	may order any discount medical plan organization or applicant to
3101	produce any records, books, files, advertising and solicitation
3102	materials, or other information and may take statements under
3103	oath to determine whether the discount medical plan organization
3104	or applicant is in violation of the law or is acting contrary to
3105	the public interest. The expenses incurred in conducting any
3106	examination or investigation must be paid by the discount
3107	medical plan organization or applicant. Examinations and
3108	investigations must be conducted as provided in chapter 624, and
3109	discount medical plan organizations are subject to all
3110	applicable provisions of the insurance code.
3111	(2)  Failure by the discount medical plan organization to
3112	pay the expenses incurred under subsection (1) is grounds for
3113	denial or revocation.
3114	636.208  Fees.--A discount medical plan organization may
3115	charge a reasonable one-time processing fee and a periodic
3116	charge. If a discount medical plan charges for a time period in
3117	excess of one month, the plan must, in the event of cancellation
3118	of the membership by either party, make a pro rata reimbursement
3119	of the fees to the member.
3120	636.210  Prohibited activities of a discount medical plan
3121	organization.--
3122	(1)  A discount medical plan organization may not:
3123	(a)  Use in its advertisements, marketing material,
3124	brochures, and discount cards the term "insurance" except as
3125	otherwise provided in this part;
3126	(b)  Use in its advertisements, marketing material,
3127	brochures, and discount cards the terms "health plan,"
3128	"coverage," "copay," "copayments," "preexisting conditions,"
3129	"guaranteed issue," "premium," "enrollment," "PPO," "preferred
3130	provider organization," or other terms that could reasonably
3131	mislead a person into believing the discount medical plan was
3132	health insurance;
3133	(c)  Have restrictions on free access to plan providers,
3134	including, but not limited to, waiting periods and notification
3135	periods; or
3136	(d)  Pay providers any fees for medical services.
3137	(2)  A discount medical plan organization may not collect
3138	or accept money from a member for payment to a provider for
3139	specific medical services furnished or to be furnished to the
3140	member unless the organization has an active certificate of
3141	authority from the office to act as an administrator.
3142	636.212  Disclosures.--The following disclosures must be
3143	made in writing to any prospective member and must be on the
3144	first page of any advertisements, marketing materials, or
3145	brochures relating to a discount medical plan. The disclosures
3146	must be printed in not less than 12-point type or no smaller
3147	than the largest type on the page if larger than 12-point type:
3148	(1)  That the plan is not a health insurance policy.
3149	(2)  That the plan provides discounts at certain health
3150	care providers for medical services.
3151	(3)  That the plan does not make payments directly to the
3152	providers of medical services.
3153	(4)  That the plan member is obligated to pay for all
3154	health care services but will receive a discount from those
3155	health care providers who have contracted with the discount plan
3156	organization.
3157	(5)  The corporate name and the locations of the licensed
3158	discount medical plan organization.
3159	636.214  Provider agreements.--
3160	(1)  All providers offering medical services to members
3161	under a discount medical plan must provide such services
3162	pursuant to a written agreement. The agreement may be entered
3163	into directly by the provider or by a provider network to which
3164	the provider belongs.
3165	(2)  A provider agreement must provide the following:
3166	(a)  A list of the services and products to be provided at
3167	a discount.
3168	(b)  The amount or amounts of the discounts or,
3169	alternatively, a fee schedule which reflects the provider's
3170	discounted rates.
3171	(c)  That the provider will not charge members more than
3172	the discounted rates.
3173	(3)  A provider agreement between a discount medical plan
3174	organization and a provider network shall require that the
3175	provider network have written agreements with its providers
3176	which:
3177	(a)  Contain the terms described in subsection (2).
3178	(b)  Authorize the provider network to contract with the
3179	discount medical plan organization on behalf of the provider.
3180	(c)  Require the network to maintain an up-to-date list of
3181	its contracted providers and to provide that list on a monthly
3182	basis to the discount medical plan organization.
3183	(4)  The discount medical plan organization shall maintain
3184	a copy of each active provider agreement.
3185	636.216  Form filings.--
3186	(1)  All charges to members must be filed with the office
3187	and any charge to members greater than $30 per month or $360 per
3188	year must be approved by the office before the charges can be
3189	used. The discount medical plan organization has the burden of
3190	proof that the charges bear a reasonable relation to the
3191	benefits received by the member.
3192	(2)  There must be a written agreement between the discount
3193	medical plan organization and the member specifying the benefits
3194	under the discount medical plan and complying with the
3195	disclosure requirements of this part.
3196	(3)  All forms used, including the written agreement
3197	pursuant to subsection (2), must first be filed with and
3198	approved by the office. Every form filed shall be identified by
3199	a unique form number placed in the lower left corner of each
3200	form.
3201	(4)  If such filings are disapproved, the office shall
3202	notify the discount medical plan organization and shall specify
3203	in the notice the reasons for disapproval. The discount medical
3204	plan organization has 21 days from the date of receipt of notice
3205	to request a hearing before the office pursuant to chapter 120.
3206	636.218  Annual reports.--
3207	(1)  Each discount medical plan organization must file with
3208	the office, within 3 months after the end of each fiscal year,
3209	an annual report.
3210	(2)  Such reports must be on forms prescribed by the
3211	commission and must include:
3212	(a)  Audited financial statements prepared in accordance
3213	with generally accepted accounting principles certified by an
3214	independent certified public accountant, including the
3215	organization's balance sheet, income statement, and statement of
3216	changes in cash flow for the preceding year.
3217	(b)  A list of the names and residence addresses of all
3218	persons responsible for the conduct of the organization's
3219	affairs, together with a disclosure of the extent and nature of
3220	any contracts or arrangements between such persons and the
3221	discount medical plan organization, including any possible
3222	conflicts of interest.
3223	(c)  The number of discount medical plan members.
3224	(d)  Such other information relating to the performance of
3225	the discount medical plan organization as is reasonably required
3226	by the commission or office.
3227	(3)  Every discount medical plan organization which fails
3228	to file an annual report in the form and within the time
3229	required by this section shall forfeit up to $500 for each day
3230	for the first 10 days during which the neglect continues and
3231	shall forfeit up to $1,000 for each day after the first 10 days
3232	during which the neglect continues; and, upon notice by the
3233	office to that effect, the organization's authority to enroll
3234	new members or to do business in this state ceases while such
3235	default continues. The office shall deposit all sums collected
3236	by the office under this section to the credit of the Insurance
3237	Regulatory Trust Fund. The office may not collect more than
3238	$50,000 for each report.
3239	636.220  Minimum capital requirements.?-
3240	(1)  Each discount medical plan organization must at all
3241	times maintain a net worth of at least $150,000.
3242	(2)  The office may not issue a license unless the discount
3243	medical plan organization has a net worth of at least $150,000.
3244	636.222  Suspension or revocation of license; suspension of
3245	enrollment of new members; terms of suspension.--
3246	(1)  The office may suspend the authority of a discount
3247	medical plan organization to enroll new members, revoke any
3248	license issued to a discount medical plan organization, or order
3249	compliance if the office finds that any of the following
3250	conditions exist:
3251	(a)  The organization is not operating in compliance with
3252	this part.
3253	(b)  The organization does not have the minimum net worth
3254	as required by this part.
3255	(c)  The organization has advertised, merchandised, or
3256	attempted to merchandise its services in such a manner as to
3257	misrepresent its services or capacity for service or has engaged
3258	in deceptive, misleading, or unfair practices with respect to
3259	advertising or merchandising.
3260	(d)  The organization is not fulfilling its obligations as
3261	a medical discount medical plan organization.
3262	(e)  The continued operation of the organization would be
3263	hazardous to its members.
3264	(2)  If the office has cause to believe that grounds for
3265	the suspension or revocation of a license exist, the office
3266	shall notify the discount medical plan organization in writing
3267	specifically stating the grounds for suspension or revocation
3268	and shall pursue a hearing on the matter in accordance with the
3269	provisions of chapter 120.
3270	(3)  When the license of a discount medical plan
3271	organization is surrendered or revoked, such organization must
3272	proceed, immediately following the effective date of the order
3273	of revocation, to wind up its affairs transacted under the
3274	license. The organization may not engage in any further
3275	advertising, solicitation, collecting of fees, or renewal of
3276	contracts.
3277	(4)  The office shall, in its order suspending the
3278	authority of a discount medical plan organization to enroll new
3279	members, specify the period during which the suspension is to be
3280	in effect and the conditions, if any, which must be met by the
3281	discount medical plan organization prior to reinstatement of its
3282	license to enroll new members. The order of suspension is
3283	subject to rescission or modification by further order of the
3284	office prior to the expiration of the suspension period.
3285	Reinstatement may not be made unless requested by the discount
3286	medical plan organization; however, the office may not grant
3287	reinstatement if it finds that the circumstances for which the
3288	suspension occurred still exist or are likely to recur.
3289	636.224  Notice of change of name or address of discount
3290	medical plan organization.--Each discount medical plan
3291	organization must provide the office at least 30 days' advance
3292	notice of any change in the discount medical plan organization's
3293	name, address, principal business address, or mailing address.
3294	636.226  Provider name listing.?-Each discount medical plan
3295	organization must maintain an up-to-date list of the names and
3296	addresses of the providers with which it has contracted, on an
3297	Internet website page, the address of which shall be prominently
3298	displayed on all its advertisements, marketing materials,
3299	brochures, and discount cards. This section applies to those
3300	providers with whom the discount medical plan organization has
3301	contracted directly, as well as those who are members of a
3302	provider network with which the discount medical plan
3303	organization has contracted.
3304	636.228  Marketing of discount medical plans.--
3305	(1)  All advertisements, marketing materials, brochures,
3306	and discount cards used by marketers must be approved in writing
3307	for such use by the discount medical plan organization.
3308	(2)  The discount medical plan organization shall have an
3309	executed written agreement with a marketer prior to the
3310	marketer's marketing, promoting, selling, or distributing the
3311	discount medical plan and shall be responsible and financially
3312	liable for any acts of its marketers that do not comply with the
3313	provisions of this part.
3314	636.230  Bundling discount medical plans with other
3315	insurance products.?-When a marketer or discount medical plan
3316	organization sells a discount medical plan together with any
3317	other product, the fees for each individual product must be
3318	provided in writing to the member and itemized.
3319	636.232  Rules.--The commission may adopt rules to
3320	administer this part, including rules for the licensing of
3321	discount medical plan organizations; establishing standards for
3322	evaluating forms, advertisements, marketing materials,
3323	brochures, and discount cards; providing for the collection of
3324	data; relating to disclosures to plan members; and defining
3325	terms used in this part.
3326	636.234  Service of process on a discount medical plan
3327	organization.-?Sections 624.422 and 624.423 apply to a discount
3328	medical plan organization as if the discount medical plan
3329	organization were an insurer.
3330	636.236  Security deposit.--
3331	(1)  A licensed discount medical plan organization must
3332	deposit and maintain deposited in trust with the department
3333	securities eligible for deposit under s. 625.52, having at all
3334	times a value of not less than $35,000, for use by the office in
3335	protecting plan members.
3336	(2)  No judgment creditor or other claimant of a discount
3337	medical plan organization, other than the office or department,
3338	shall have the right to levy upon any of the assets or
3339	securities held in this state as a deposit under subsection (1).
3340	636.238  Penalties for violation of this part.--
3341	(1)  Except as provided in subsection (2), a person who
3342	violates any provision of this part commits a misdemeanor of the
3343	second degree, punishable as provided in s. 775.082 or s.
3344	775.083.
3345	(2)  A person who operates as or aids and abets another
3346	operating as a discount medical plan organization in violation
3347	of s. 636.204(1) commits a felony punishable as provided for in
3348	s. 624.401(4)(b), as if the unlicensed discount medical plan
3349	organization were an unauthorized insurer, and the fees, dues,
3350	charges, or other consideration collected from the members by
3351	the unlicensed discount medical plan organization or marketer
3352	were insurance premium.
3353	(3)  A person who collects fees for purported membership in
3354	a discount medical plan but fails to provide the promised
3355	benefits commits a theft, punishable as provided in s. 812.014.
3356	636.240  Injunctions.--
3357	(1)  In addition to the penalties and other enforcement
3358	provisions of this part, the office may seek both temporary and
3359	permanent injunctive relief when:
3360	(a)  A discount medical plan is being operated by any
3361	person or entity that is not licensed pursuant to this part.
3362	(b)  Any person, entity, or discount medical plan
3363	organization has engaged in any activity prohibited by this part
3364	or any rule adopted pursuant to this part.
3365	(2)  The venue for any proceeding bought pursuant to this
3366	section shall be in the Circuit Court of Leon County.
3367	(3)  The office's authority to seek injunctive relief is
3368	not conditioned on having conducted any proceeding pursuant to
3369	chapter 120.
3370	636.242  Civil remedies.--Any person damaged by the acts of
3371	a person in violation of this part may bring a civil action
3372	against the person committing the violation in the circuit court
3373	of the county in which the alleged violator resides or has a
3374	principal place of business or in the county in which the
3375	alleged violation occurred. Upon an adverse adjudication, the
3376	defendant is liable for damages, together with court costs and
3377	reasonable attorney's fees incurred by the plaintiff. When so
3378	awarded, court costs and attorney's fees must be included in the
3379	judgment or decree rendered in the case. If it appears to the
3380	court that the suit brought by the plaintiff is frivolous or
3381	brought for purposes of harassment, the court may apply
3382	sanctions in accordance with chapter 57.
3383	636.244  Unlicensed discount medical plan
3384	organizations.--The provisions of ss. 626.901-626.912 apply to
3385	The provisions of ss. 626.901-626.912 apply to the activities of
3386	an unlicensed discount medical plan organization as if the
3387	unlicensed discount medical plan organization were an
3388	unauthorized insurer.
3389	Section 32.  Section 627.65626, Florida Statutes, is
3390	created to read:
3391	627.65626  Insurance rebates for healthy lifestyles.--
3392	(1)  Any rate, rating schedule, or rating manual for a
3393	health insurance policy filed with the office shall provide for
3394	an appropriate rebate of premiums paid in the last calendar year
3395	when the majority of members of a health plan have enrolled and
3396	maintained participation in any health wellness, maintenance, or
3397	improvement program offered by the employer. The employer must
3398	provide evidence of demonstrative maintenance or improvement of
3399	the enrollees' health status as determined by assessments of
3400	agreed-upon health status indicators between the employer and
3401	the health insurer, including, but not limited to, reduction in
3402	weight, body mass index, and smoking cessation. Any rebate
3403	provided by the health insurer is presumed to be appropriate
3404	unless credible data demonstrates otherwise, but shall not
3405	exceed 10 percent of paid premiums.
3406	(2)  The premium rebate authorized by this section shall be
3407	effective for an insured on an annual basis, unless the number
3408	of participating employees becomes less than the majority of the
3409	employees eligible for participation in the wellness program.
3410	Section 33.  Section 627.6402, Florida Statutes, is created
3411	to read:
3412	627.6402  Insurance rebates for healthy lifestyles.--
3413	(1)  Any rate, rating schedule, or rating manual for an
3414	individual health insurance policy filed with the office shall
3415	provide for an appropriate rebate of premiums paid in the last
3416	calendar year when the individual covered by such plan is
3417	enrolled in and maintains participation in any health wellness,
3418	maintenance, or improvement program approved by the health plan.
3419	The individual must provide evidence of demonstrative
3420	maintenance or improvement of the individual's health status as
3421	determined by assessments of agreed-upon health status
3422	indicators between the individual and the health insurer,
3423	including, but not limited to, reduction in weight, body mass
3424	index, and smoking cessation. Any rebate provided by the health
3425	insurer is presumed to be appropriate unless credible data
3426	demonstrates otherwise, but shall not exceed 10 percent of paid
3427	premiums.
3428	(2)  The premium rebate authorized by this section shall be
3429	effective for an insured on an annual basis, unless the
3430	individual fails to maintain or improve his or her health status
3431	while participating in an approved wellness program, or credible
3432	evidence demonstrates that the individual is not participating
3433	in the approved wellness program.
3434	Section 34.  Subsection (38) of section 641.31, Florida
3435	Statutes, is amended, and subsection (40) is added to said
3436	section, to read:
3437	641.31  Health maintenance contracts.--
3438	(38)(a)  Notwithstanding any other provision of this part,
3439	a health maintenance organization that meets the requirements of
3440	paragraph (b) may, through a point-of-service rider to its
3441	contract providing comprehensive health care services, include a
3442	point-of-service benefit. Under such a rider, a subscriber or
3443	other covered person of the health maintenance organization may
3444	choose, at the time of covered service, a provider with whom the
3445	health maintenance organization does not have a health
3446	maintenance organization provider contract. The rider may not
3447	require a referral from the health maintenance organization for
3448	the point-of-service benefits.
3449	(b)  A health maintenance organization offering a point-of-
3450	service rider under this subsection must have a valid
3451	certificate of authority issued under the provisions of the
3452	chapter, must have been licensed under this chapter for a
3453	minimum of 3 years, and must at all times that it has riders in
3454	effect maintain a minimum surplus of $5 million. A health
3455	maintenance organization offering a point-of-service rider to
3456	its contract providing comprehensive health care services may
3457	offer the rider to employers who have employees living and
3458	working outside the health maintenance organization's approved
3459	geographic service area without having to obtain a health care
3460	provider certificate, as long as the master group contract is
3461	issued to an employer that maintains its primary place of
3462	business within the health maintenance organization's approved
3463	service area. Any member or subscriber that lives and works
3464	outside the health maintenance organization's service area and
3465	elects coverage under the health maintenance organization's
3466	point-of-service rider must provide a statement to the health
3467	maintenance organization that indicates the member or subscriber
3468	understands the limitations of his or her policy and that only
3469	those benefits under the point-of-service rider will be covered
3470	when services are provided outside the service area.
3471	(c)  Premiums paid in for the point-of-service riders may
3472	not exceed 15 percent of total premiums for all health plan
3473	products sold by the health maintenance organization offering
3474	the rider. If the premiums paid for point-of-service riders
3475	exceed 15 percent, the health maintenance organization must
3476	notify the office and, once this fact is known, must immediately
3477	cease offering such a rider until it is in compliance with the
3478	rider premium cap.
3479	(d)  Notwithstanding the limitations of deductibles and
3480	copayment provisions in this part, a point-of-service rider may
3481	require the subscriber to pay a reasonable copayment for each
3482	visit for services provided by a noncontracted provider chosen
3483	at the time of the service. The copayment by the subscriber may
3484	either be a specific dollar amount or a percentage of the
3485	reimbursable provider charges covered by the contract and must
3486	be paid by the subscriber to the noncontracted provider upon
3487	receipt of covered services. The point-of-service rider may
3488	require that a reasonable annual deductible for the expenses
3489	associated with the point-of-service rider be met and may
3490	include a lifetime maximum benefit amount. The rider must
3491	include the language required by s. 627.6044 and must comply
3492	with copayment limits described in s. 627.6471. Section 641.3154
3493	does not apply to a point-of-service rider authorized under this
3494	subsection.
3495	(e)  The point-of-service rider must contain provisions
3496	that comply with s. 627.6044.
3497	(f)(e)  The term "point of service" may not be used by a
3498	health maintenance organization except with riders permitted
3499	under this section or with forms approved by the office in which
3500	a point-of-service product is offered with an indemnity carrier.
3501	(g)(f)  A point-of-service rider must be filed and approved
3502	under ss. 627.410 and 627.411.
3503	(40)(a)  Any rate, rating schedule, or rating manual for a
3504	health maintenance organization policy filed with the office
3505	shall provide for an appropriate rebate of premiums paid in the
3506	last calendar year when the individual covered by such plan is
3507	enrolled in and maintains participation in any health wellness,
3508	maintenance, or improvement program approved by the health plan.
3509	The individual must provide evidence of demonstrative
3510	maintenance or improvement of his or her health status as
3511	determined by assessments of agreed-upon health status
3512	indicators between the individual and the health insurer,
3513	including, but not limited to, reduction in weight, body mass
3514	index, and smoking cessation. Any rebate provided by the health
3515	insurer is presumed to be appropriate unless credible data
3516	demonstrates otherwise, but shall not exceed 10 percent of paid
3517	premiums.
3518	(b)  The premium rebate authorized by this section shall be
3519	effective for an insured on an annual basis, unless the
3520	individual fails to maintain or improve his or her health status
3521	while participating in an approved wellness program, or credible
3522	evidence demonstrates that the individual is not participating
3523	in the approved wellness program.
3524	Section 35.  Section 626.191, Florida Statutes, is amended
3525	to read:
3526	626.191  Repeated applications.--The failure of an
3527	applicant to secure a license upon an application shall not
3528	preclude the applicant him or her from applying again as many
3529	times as desired, but the department or office shall not give
3530	consideration to or accept any further application by the same
3531	individual for a similar license dated or filed within 30 days
3532	subsequent to the date the department or office denied the last
3533	application, except as provided in s. 626.281.
3534	Section 36.  Subsection (1) of section 626.201, Florida
3535	Statutes, is amended to read:
3536	626.201  Investigation.--
3537	(1)  The department or office may propound any reasonable
3538	interrogatories in addition to those contained in the
3539	application, to any applicant for license or appointment, or on
3540	any renewal, reinstatement, or continuation thereof, relating to
3541	the applicant's his or her qualifications, residence,
3542	prospective place of business, and any other matter which, in
3543	the opinion of the department or office, is deemed necessary or
3544	advisable for the protection of the public and to ascertain the
3545	applicant's qualifications.
3546	Section 37.  Section 626.593, Florida Statutes, is created
3547	to read:
3548	626.593  Insurance agent; written contract for
3549	compensation.--
3550	(1)  No person licensed as an insurance agent may receive
3551	any fee or commission or any other thing of value in addition to
3552	the rates filed pursuant to chapter 627 for examining any group
3553	health insurance or any group health benefit plan for the
3554	purpose of giving or offering advice, counsel, recommendation,
3555	or information in respect to terms, conditions, benefits,
3556	coverage, or premium of any such policy or contract unless such
3557	compensation is based upon a written contract signed by the
3558	party to be charged and specifying or clearly defining the
3559	amount or extent of such compensation and informing the party to
3560	be charged that any commission received from an insurer will be
3561	rebated to the party in accordance with subsection (3). In
3562	addition, all compensation to be paid to the insurance agent
3563	must be disclosed in the contract.
3564	(2)  A copy of every such contract shall be retained by the
3565	licensee for not less than 3 years after such services have been
3566	fully performed.
3567	(3)  Notwithstanding the provisions of s. 626.572, all
3568	commissions received by an insurance agent from an insurer in
3569	connection with the issuance of a policy, when a separate fee or
3570	other consideration has been paid to the insurance agent by an
3571	insured, shall be rebated to the insured or other party being
3572	charged within 30 days after receipt of such commission by the
3573	insurance agent.
3574	(4)  This section is subject to the unfair insurance trade
3575	practices provisions of s. 626.9541(1)(g).
3576	Section 38.  Notwithstanding the amendment to s.
3577	627.6699(5)(c), Florida Statutes, by this act, any right to an
3578	open enrollment offer of health benefit coverage for groups of
3579	fewer than two employees, pursuant to s. 627.6699(5)(c), Florida
3580	Statutes, as it existed immediately before the effective date of
3581	this act, shall remain in full force and effect until the
3582	enactment of s. 627.64872, Florida Statutes, and the subsequent
3583	date upon which such plan begins to accept new risks or members.
3584	Section 39.  Section 465.0244, Florida Statutes, is created
3585	to read:
3586	465.0244  Information disclosure.--Every pharmacy shall
3587	make available on its Internet website a link to the performance
3588	outcome and financial data that is published by the Agency for
3589	Health Care Administration pursuant to s. 408.05(3)(l) and shall
3590	place in the area where customers receive filled prescriptions
3591	notice that such information is available electronically and the
3592	address of its Internet website.
3593	Section 40.  Section 627.6499, Florida Statutes, is amended
3594	to read:
3595	627.6499  Reporting by insurers and third-party
3596	administrators.--
3597	(1)  The office may require any insurer, third-party
3598	administrator, or service company to report any information
3599	reasonably required to assist the board in assessing insurers as
3600	required by this act.
3601	(2)  Each health insurance issuer shall make available on
3602	its Internet website a link to the performance outcome and
3603	financial data that is published by the Agency for Health Care
3604	Administration pursuant to s. 408.05(3)(l) and shall include in
3605	every policy delivered or issued for delivery to any person in
3606	the state or any materials provided as required by s. 627.64725
3607	notice that such information is available electronically and the
3608	address of its Internet website.
3609	Section 41.  Subsections (6) and (7) are added to section
3610	641.54, Florida Statutes, to read:
3611	641.54  Information disclosure.--
3612	(6)  Each health maintenance organization shall make
3613	available to its subscribers the estimated copay, coinsurance
3614	percentage, or deductible, whichever is applicable, for any
3615	covered services, the status of the subscriber's maximum annual
3616	out-of-pocket payments for a covered individual or family, and
3617	the status of the subscriber's maximum lifetime benefit. Such
3618	estimate shall not preclude the actual copay, coinsurance
3619	percentage, or deductible, whichever is applicable, from
3620	exceeding the estimate.
3621	(7)  Each health maintenance organization shall make
3622	available on its Internet website a link to the performance
3623	outcome and financial data that is published by the Agency for
3624	Health Care Administration pursuant to s. 408.05(3)(l) and shall
3625	include in every policy delivered or issued for delivery to any
3626	person in the state or any materials provided as required by s.
3627	627.64725 notice that such information is available
3628	electronically and the address of its Internet website.
3629	Section 42.  Section 408.02, Florida Statutes, is repealed.
3630	Section 43.  The sum of $250,000 is appropriated from the
3631	Insurance Regulatory Trust Fund in the Department of Financial
3632	Services to the Office of Insurance Regulation for the purpose
3633	of implementing the provisions in this act relating to the Small
3634	Employers Access Program.
3635	Section 44.  The sum of $250,000 is appropriated from the
3636	Insurance Regulatory Trust Fund to enable the board of the
3637	Florida Health Insurance Plan to conduct an actuarial study
3638	required under s. 627.64872, Florida Statutes.
3639	Section 45.  The sum of $169,069 is appropriated from the
3640	Insurance Regulatory Trust Fund in the Department of Financial
3641	Services to the Office of Insurance Regulation, and three full-
3642	time equivalent positions are authorized, for the purpose of
3643	implementing the provisions in this act relating to the
3644	regulation of Discount Medical Plan Organizations.
3645	Section 46.  The sum of $650,000 is appropriated from the
3646	General Revenue Fund to the Agency for Health Care
3647	Administration for the purposes of implementing the Florida
3648	Patient Safety Corporation. The sum of $350,000 shall be used as
3649	startup funds for the Florida Patient Safety Corporation and
3650	$300,000 shall be used for the "near miss" project within the
3651	Florida Patient Safety Corporation.
3652	Section 47.  The sum of $1,136,171 is appropriated from the
3653	General Revenue Fund to the Agency for Health Care
3654	Administration, and 11 full-time equivalent positions are
3655	authorized, for the purposes of implementing the provisions of
3656	this act relating to the reporting of performance and cost data
3657	for hospitals, physicians, and pharmacies.
3658	Section 48.  Except as otherwise provided herein, this act
3659	shall take effect July 1, 2004.

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