HB 1883

1	A bill to be entitled
2	An act relating to health maintenance organizations;
3	amending s. 641.234, F.S.; deleting a definition;
4	expanding the requirement that a health maintenance
5	organization remains responsible for violations of certain
6	statutory requirements if the organization transfers to
7	any entity the obligations to pay any provider for claims
8	arising from services to subscribers of the organization;
9	amending s. 641.316, F.S.; redefining the term "fiscal
10	intermediary services organization"; amending s. 626.88,
11	F.S., to conform; providing an effective date.
12
13	Be It Enacted by the Legislature of the State of Florida:
14
15	Section 1.  Subsection (4) of section 641.234, Florida
16	Statutes, is amended to read:
17	641.234  Administrative, provider, and management
18	contracts.--
19	(4)(a)  If a health maintenance organization, through a
20	health care risk contract, transfers to any entity the
21	obligations to pay any provider for any claims arising from
22	services provided to or for the benefit of any subscriber of the
23	organization, the health maintenance organization shall remain
24	responsible for any violations of ss. 641.3155, 641.3156, and
25	641.51(4). The provisions of ss. 624.418-624.4211 and 641.52
26	shall apply to any such violations.
27	(b)  As used in this subsection,:
28	1.  The term "health care risk contract" means a contract
29	under which an entity receives compensation in exchange for
30	providing to the health maintenance organization a provider
31	network or other services, which may include administrative
32	services.
33	2.  the term "entity" means a person licensed as an
34	administrator under s. 626.88 and does not include any provider
35	or group practice, as defined in s. 456.053, providing services
36	under the scope of the license of the provider or the members of
37	the group practice. The term does not include a hospital
38	providing billing, claims, and collection services solely on its
39	own and its physicians' behalf and providing services under the
40	scope of its license.
41	Section 2.  Paragraph (b) of subsection (2) of section
42	641.316, Florida Statutes, is amended to read:
43	641.316  Fiscal intermediary services.--
44	(2)
45	(b)  The term "fiscal intermediary services organization"
46	means a person or entity that which performs fiduciary or fiscal
47	intermediary services to health care professionals who contract
48	with health maintenance organizations other than a fiscal
49	intermediary services organization owned, operated, or
50	controlled by a hospital licensed under chapter 395, an insurer
51	licensed under chapter 624, a third-party administrator licensed
52	under chapter 626, a prepaid limited health service organization
53	licensed under chapter 636, a health maintenance organization
54	licensed under this chapter, or physician group practices as
55	defined in s. 456.053(3)(h) and providing services under the
56	scope of licenses of the members of the group practice.
57	Section 3.  Subsection (1) of section 626.88, Florida
58	Statutes, is amended to read:
59	626.88  Definitions of "administrator" and "insurer".--
60	(1)  For the purposes of this part, an "administrator" is
61	any person who directly or indirectly solicits or effects
62	coverage of, collects charges or premiums from, or adjusts or
63	settles claims on residents of this state in connection with
64	authorized commercial self-insurance funds or with insured or
65	self-insured programs which provide life or health insurance
66	coverage or coverage of any other expenses described in s.
67	624.33(1) or any person who, through a health care risk contract
68	as defined in s. 641.234 with an insurer or health maintenance
69	organization, provides billing and collection services to health
70	insurers and health maintenance organizations on behalf of
71	health care providers, other than any of the following persons:
72	(a)  An employer on behalf of such employer's employees or
73	the employees of one or more subsidiary or affiliated
74	corporations of such employer.
75	(b)  A union on behalf of its members.
76	(c)  An insurance company which is either authorized to
77	transact insurance in this state or is acting as an insurer with
78	respect to a policy lawfully issued and delivered by such
79	company in and pursuant to the laws of a state in which the
80	insurer was authorized to transact an insurance business.
81	(d)  A health care services plan, health maintenance
82	organization, professional service plan corporation, or person
83	in the business of providing continuing care, possessing a valid
84	certificate of authority issued by the office, and the sales
85	representatives thereof, if the activities of such entity are
86	limited to the activities permitted under the certificate of
87	authority.
88	(e)  An insurance agent licensed in this state whose
89	activities are limited exclusively to the sale of insurance.
90	(f)  An adjuster licensed in this state whose activities
91	are limited to the adjustment of claims.
92	(g)  A creditor on behalf of such creditor's debtors with
93	respect to insurance covering a debt between the creditor and
94	its debtors.
95	(h)  A trust and its trustees, agents, and employees acting
96	pursuant to such trust established in conformity with 29 U.S.C.
97	s. 186.
98	(i)  A trust exempt from taxation under s. 501(a) of the
99	Internal Revenue Code, a trust satisfying the requirements of
100	ss. 624.438 and 624.439, or any governmental trust as defined in
101	s. 624.33(3), and the trustees and employees acting pursuant to
102	such trust, or a custodian and its agents and employees,
103	including individuals representing the trustees in overseeing
104	the activities of a service company or administrator, acting
105	pursuant to a custodial account which meets the requirements of
106	s. 401(f) of the Internal Revenue Code.
107	(j)  A financial institution which is subject to
108	supervision or examination by federal or state authorities or a
109	mortgage lender licensed under chapter 494 who collects and
110	remits premiums to licensed insurance agents or authorized
111	insurers concurrently or in connection with mortgage loan
112	payments.
113	(k)  A credit card issuing company which advances for and
114	collects premiums or charges from its credit card holders who
115	have authorized such collection if such company does not adjust
116	or settle claims.
117	(l)  A person who adjusts or settles claims in the normal
118	course of such person's practice or employment as an attorney at
119	law and who does not collect charges or premiums in connection
120	with life or health insurance coverage.
121	(m)  A person approved by the department who administers
122	only self-insured workers' compensation plans.
123	(n)  A service company or service agent and its employees,
124	authorized in accordance with ss. 626.895-626.899, serving only
125	a single employer plan, multiple-employer welfare arrangements,
126	or a combination thereof.
127	(o)  Any provider or group practice, as defined in s.
128	456.053, providing services under the scope of the license of
129	the provider or the member of the group practice.
130	(p)  Any hospital providing billing, claims, and collection
131	services solely on its own and its physicians' behalf and
132	providing services under the scope of its license.
133
134	A person who provides billing and collection services to health
135	insurers and health maintenance organizations on behalf of
136	health care providers shall comply with the provisions of ss.
137	627.6131, 641.3155, and 641.51(4).
138	Section 4.  This act shall take effect October 1, 2005.

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