HB 621

1	A bill to be entitled
2	An act relating to health maintenance organizations;
3	amending s. 641.316, F.S.; redefining the term "fiscal
4	intermediary services organization"; amending s. 641.234,
5	F.S.; expanding the requirement that a health maintenance
6	organization remains responsible for violations of certain
7	statutory requirements if the organization transfers to
8	any entity the obligations to pay any provider for claims
9	arising from services to subscribers of the organization;
10	amending s. 626.88, F.S., relating to the regulation of
11	insurance administrators; conforming provisions to changes
12	made by the act; providing an effective date.
13
14	Be It Enacted by the Legislature of the State of Florida:
15
16	Section 1.  Paragraph (b) of subsection (2) of section
17	641.316, Florida Statutes, is amended to read:
18	641.316  Fiscal intermediary services.--
19	(2)
20	(b)  The term "fiscal intermediary services organization"
21	means a person or entity that which performs fiduciary or fiscal
22	intermediary services to health care professionals who contract
23	with health maintenance organizations other than a fiscal
24	intermediary services organization owned, operated, or
25	controlled by a hospital licensed under chapter 395, an insurer
26	licensed under chapter 624, a third-party administrator licensed
27	under chapter 626, a prepaid limited health service organization
28	licensed under chapter 636, a health maintenance organization
29	licensed under this chapter, or physician group practices as
30	defined in s. 456.053(3)(h) and providing services under the
31	scope of licenses of the members of the group practice.
32	Section 2.  Subsection (4) of section 641.234, Florida
33	Statutes, is amended to read:
34	641.234  Administrative, provider, and management
35	contracts.--
36	(4)(a)  If a health maintenance organization, through a
37	health care risk contract, transfers to any entity the
38	obligations to pay any provider for any claims arising from
39	services provided to or for the benefit of any subscriber of the
40	organization, the health maintenance organization remains shall
41	remain responsible for any violations of ss. 641.3155, 641.3156,
42	and 641.51(4). The provisions of ss. 624.418-624.4211 and 641.52
43	shall apply to any such violations.
44	(b)  As used in this subsection,:
45	1.  The term "health care risk contract" means a contract
46	under which an entity receives compensation in exchange for
47	providing to the health maintenance organization a provider
48	network or other services, which may include administrative
49	services.
50	2.  the term "entity" means a person licensed as an
51	administrator under s. 626.88 and does not include any provider
52	or group practice, as defined in s. 456.053, providing services
53	under the scope of the license of the provider or the members of
54	the group practice. The term does not include a hospital
55	providing billing, claims, and collection services solely on its
56	own and its physicians' behalf and providing services under the
57	scope of its license.
58	Section 3.  Subsection (1) of section 626.88, Florida
59	Statutes, is amended to read:
60	626.88  Definitions.--For the purposes of this part, the
61	term:
62	(1)  "Administrator" is any person who directly or
63	indirectly solicits or effects coverage of, collects charges or
64	premiums from, or adjusts or settles claims on residents of this
65	state in connection with authorized commercial self-insurance
66	funds or with insured or self-insured programs which provide
67	life or health insurance coverage or coverage of any other
68	expenses described in s. 624.33(1) or any person who, through a
69	health care risk contract as defined in s. 641.234 with an
70	insurer or health maintenance organization, provides billing and
71	collection services to health insurers and health maintenance
72	organizations on behalf of health care providers, other than any
73	of the following persons:
74	(a)  An employer or wholly owned direct or indirect
75	subsidiary of an employer, on behalf of such employer's
76	employees or the employees of one or more subsidiary or
77	affiliated corporations of such employer.
78	(b)  A union on behalf of its members.
79	(c)  An insurance company which is either authorized to
80	transact insurance in this state or is acting as an insurer with
81	respect to a policy lawfully issued and delivered by such
82	company in and pursuant to the laws of a state in which the
83	insurer was authorized to transact an insurance business.
84	(d)  A health care services plan, health maintenance
85	organization, professional service plan corporation, or person
86	in the business of providing continuing care, possessing a valid
87	certificate of authority issued by the office, and the sales
88	representatives thereof, if the activities of such entity are
89	limited to the activities permitted under the certificate of
90	authority.
91	(e)  An entity that is affiliated with an insurer and that
92	only performs the contractual duties, between the administrator
93	and the insurer, of an administrator for the direct and assumed
94	insurance business of the affiliated insurer. The insurer is
95	responsible for the acts of the administrator and is responsible
96	for providing all of the administrator's books and records to
97	the insurance commissioner, upon a request from the insurance
98	commissioner. For purposes of this paragraph, the term "insurer"
99	means a licensed insurance company, health maintenance
100	organization, prepaid limited health service organization, or
101	prepaid health clinic.
102	(f)  A nonresident entity licensed in its state of domicile
103	as an administrator if its duties in this state are limited to
104	the administration of a group policy or plan of insurance and no
105	more than a total of 100 lives for all plans reside in this
106	state.
107	(g)  An insurance agent licensed in this state whose
108	activities are limited exclusively to the sale of insurance.
109	(h)  A person licensed as a managing general agent in this
110	state, whose activities are limited exclusively to the scope of
111	activities conveyed under such license.
112	(i)  An adjuster licensed in this state whose activities
113	are limited to the adjustment of claims.
114	(j)  A creditor on behalf of such creditor's debtors with
115	respect to insurance covering a debt between the creditor and
116	its debtors.
117	(k)  A trust and its trustees, agents, and employees acting
118	pursuant to such trust established in conformity with 29 U.S.C.
119	s. 186.
120	(l)  A trust exempt from taxation under s. 501(a) of the
121	Internal Revenue Code, a trust satisfying the requirements of
122	ss. 624.438 and 624.439, or any governmental trust as defined in
123	s. 624.33(3), and the trustees and employees acting pursuant to
124	such trust, or a custodian and its agents and employees,
125	including individuals representing the trustees in overseeing
126	the activities of a service company or administrator, acting
127	pursuant to a custodial account which meets the requirements of
128	s. 401(f) of the Internal Revenue Code.
129	(m)  A financial institution which is subject to
130	supervision or examination by federal or state authorities or a
131	mortgage lender licensed under chapter 494 who collects and
132	remits premiums to licensed insurance agents or authorized
133	insurers concurrently or in connection with mortgage loan
134	payments.
135	(n)  A credit card issuing company which advances for and
136	collects premiums or charges from its credit card holders who
137	have authorized such collection if such company does not adjust
138	or settle claims.
139	(o)  A person who adjusts or settles claims in the normal
140	course of such person's practice or employment as an attorney at
141	law and who does not collect charges or premiums in connection
142	with life or health insurance coverage.
143	(p)  A person approved by the department who administers
144	only self-insured workers' compensation plans.
145	(q)  A service company or service agent and its employees,
146	authorized in accordance with ss. 626.895-626.899, serving only
147	a single employer plan, multiple-employer welfare arrangements,
148	or a combination thereof.
149	(r)  Any provider or group practice, as defined in s.
150	456.053, providing services under the scope of the license of
151	the provider or the member of the group practice.
152	(s)  Any hospital providing billing, claims, and collection
153	services solely on its own and its physicians' behalf and
154	providing services under the scope of its license.
155
156	A person who provides billing and collection services to health
157	insurers and health maintenance organizations on behalf of
158	health care providers shall comply with the provisions of ss.
159	627.6131, 641.3155, and 641.51(4).
160	Section 4.  This act shall take effect October 1, 2006.

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