| 1 | A bill to be entitled |
| 2 | An act relating to policies, contracts, and programs for |
| 3 | the provision of health care services; amending s. |
| 4 | 627.642, F.S.; requiring an identification card containing |
| 5 | specified information to be given to insureds who have |
| 6 | health and accident insurance; amending s. 627.657, F.S.; |
| 7 | requiring an identification card containing specified |
| 8 | information to be given to insureds under group health |
| 9 | insurance policies; amending s. 641.31, F.S.; requiring an |
| 10 | identification card to be given to persons having health |
| 11 | care services through a health maintenance contract; |
| 12 | amending ss. 383.145, 641.185, 641.2018, 641.3107, |
| 13 | 641.3922, and 641.513, F.S.; conforming cross-references |
| 14 | to changes made by the act; providing an effective date. |
| 15 |
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| 16 | Be It Enacted by the Legislature of the State of Florida: |
| 17 |
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| 18 | Section 1. Subsection (3) is added to section 627.642, |
| 19 | Florida Statutes, to read: |
| 20 | 627.642 Outline of coverage.-- |
| 21 | (3) In addition to the outline of coverage, the policy |
| 22 | must be accompanied by an identification card that contains, at |
| 23 | a minimum: |
| 24 | (a) The name of the organization issuing the policy or |
| 25 | name of the organization administering the policy, whichever |
| 26 | applies. |
| 27 | (b) The name of the covered person or covered family, |
| 28 | whichever applies. |
| 29 | (c) The chapter under which the policy was issued, or |
| 30 | self-insured plan, as indicated by SIP. |
| 31 | (d) The member identification number, contract number, and |
| 32 | group number, if applicable. |
| 33 | (e) A contact phone number or electronic address for |
| 34 | authorizations. |
| 35 | (f) A phone number or electronic address whereby the |
| 36 | covered person or hospital, physician, or other person rendering |
| 37 | services covered by the policy may determine estimated |
| 38 | copayments, deductibles, and coinsurance for which the covered |
| 39 | person may be liable, as well as the percentage of the covered |
| 40 | person's or covered family's maximum annual out-of-pocket |
| 41 | payments that has been paid. |
| 42 | (g) The national plan identifier, when available. |
| 43 | Section 2. Present subsection (2) of section 627.657, |
| 44 | Florida Statutes, is renumbered as subsection (3), and a new |
| 45 | subsection (2) is added to that section, to read: |
| 46 | 627.657 Provisions of group health insurance policies.-- |
| 47 | (2) The policy must be accompanied by an identification |
| 48 | card that contains, at a minimum: |
| 49 | (a) The name of the organization issuing the policy or |
| 50 | name of the organization administering the policy, whichever |
| 51 | applies. |
| 52 | (b) The name of the covered person or covered family, |
| 53 | whichever applies. |
| 54 | (c) The chapter under which the policy was issued, of |
| 55 | self-insured plan, as indicated by SIP. |
| 56 | (d) The member identification number, contract number, and |
| 57 | group number, if applicable. |
| 58 | (e) A contact phone number or electronic address for |
| 59 | authorizations. |
| 60 | (f) A phone number or electronic address whereby the |
| 61 | covered person or hospital, physician, or other person rendering |
| 62 | services covered by the policy may determine estimated |
| 63 | copayments, deductibles, and coinsurance for which the covered |
| 64 | person may be liable, as well as the percentage of the covered |
| 65 | person's or covered family's maximum annual out-of-pocket |
| 66 | payments that has been paid. |
| 67 | (g) The national plan identifier, when available. |
| 68 | Section 3. Present subsections (5) through (40) of section |
| 69 | 641.31, Florida Statutes, are renumbered as subsections (6) |
| 70 | through (41), respectively, and a new subsection (5) is added to |
| 71 | that section, to read: |
| 72 | 641.31 Health maintenance contracts.-- |
| 73 | (5) The contract, certificate, or member handbook must be |
| 74 | accompanied by an identification card that contains, at a |
| 75 | minimum: |
| 76 | (a) The name of the organization offering the contract or |
| 77 | name of the organization administering the contract, whichever |
| 78 | applies. |
| 79 | (b) The name of the covered person or covered family, |
| 80 | whichever applies. |
| 81 | (c) The chapter under which the contract was issued, or |
| 82 | self-insured plan, as indicated by SIP. |
| 83 | (d) The member identification number, contract number, and |
| 84 | group number, if applicable. |
| 85 | (e) A contact phone number or electronic address for |
| 86 | authorizations. |
| 87 | (f) A phone number or electronic address whereby the |
| 88 | covered person or hospital, physician, or other person rendering |
| 89 | services covered by the contract may determine estimated |
| 90 | copayments, deductibles, and coinsurance for which the covered |
| 91 | person may be liable, as well as the percentage of the covered |
| 92 | person's or covered family's maximum annual out-of-pocket |
| 93 | payments that have been paid. |
| 94 | (g) The national plan identifier, when available. |
| 95 | Section 4. Paragraph (j) of subsection (3) of section |
| 96 | 383.145, Florida Statutes, is amended to read: |
| 97 | 383.145 Newborn and infant hearing screening.-- |
| 98 | (3) REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE |
| 99 | COVERAGE; REFERRAL FOR ONGOING SERVICES.-- |
| 100 | (j) The initial procedure for screening the hearing of the |
| 101 | newborn or infant and any medically necessary followup |
| 102 | reevaluations leading to diagnosis shall be a covered benefit, |
| 103 | reimbursable under Medicaid as an expense compensated |
| 104 | supplemental to the per diem rate for Medicaid patients enrolled |
| 105 | in MediPass or Medicaid patients covered by a fee for service |
| 106 | program. For Medicaid patients enrolled in HMOs, providers shall |
| 107 | be reimbursed directly by the Medicaid Program Office at the |
| 108 | Medicaid rate. This service may not be considered a covered |
| 109 | service for the purposes of establishing the payment rate for |
| 110 | Medicaid HMOs. All health insurance policies and health |
| 111 | maintenance organizations as provided under ss. 627.6416, |
| 112 | 627.6579, and 641.31(31)(30), except for supplemental policies |
| 113 | that only provide coverage for specific diseases, hospital |
| 114 | indemnity, or Medicare supplement, or to the supplemental |
| 115 | polices, shall compensate providers for the covered benefit at |
| 116 | the contracted rate. Nonhospital-based providers shall be |
| 117 | eligible to bill Medicaid for the professional and technical |
| 118 | component of each procedure code. |
| 119 | Section 5. Paragraphs (b) and (i) of subsection (1) of |
| 120 | section 641.185, Florida Statutes, are amended to read: |
| 121 | 641.185 Health maintenance organization subscriber |
| 122 | protections.-- |
| 123 | (1) With respect to the provisions of this part and part |
| 124 | III, the principles expressed in the following statements shall |
| 125 | serve as standards to be followed by the commission, the office, |
| 126 | the department, and the Agency for Health Care Administration in |
| 127 | exercising their powers and duties, in exercising administrative |
| 128 | discretion, in administrative interpretations of the law, in |
| 129 | enforcing its provisions, and in adopting rules: |
| 130 | (b) A health maintenance organization subscriber should |
| 131 | receive quality health care from a broad panel of providers, |
| 132 | including referrals, preventive care pursuant to s. 641.402(1), |
| 133 | emergency screening and services pursuant to ss. 641.31(13)(12) |
| 134 | and 641.513, and second opinions pursuant to s. 641.51. |
| 135 | (i) A health maintenance organization subscriber should |
| 136 | receive timely and, if necessary, urgent grievances and appeals |
| 137 | within the health maintenance organization pursuant to ss. |
| 138 | 641.228, 641.31(6)(5), 641.47, and 641.511. |
| 139 | Section 6. Subsection (1) of section 641.2018, Florida |
| 140 | Statutes, is amended to read: |
| 141 | 641.2018 Limited coverage for home health care |
| 142 | authorized.-- |
| 143 | (1) Notwithstanding other provisions of this chapter, a |
| 144 | health maintenance organization may issue a contract that limits |
| 145 | coverage to home health care services only. The organization and |
| 146 | the contract shall be subject to all of the requirements of this |
| 147 | part that do not require or otherwise apply to specific benefits |
| 148 | other than home care services. To this extent, all of the |
| 149 | requirements of this part apply to any organization or contract |
| 150 | that limits coverage to home care services, except the |
| 151 | requirements for providing comprehensive health care services as |
| 152 | provided in ss. 641.19(4), (11), and (12), and 641.31(1), except |
| 153 | ss. 641.31(10)(9), (13)(12), (17), (18), (19), (20), (21), (22), |
| 154 | and (25)(24) and 641.31095. |
| 155 | Section 7. Section 641.3107, Florida Statutes, is amended |
| 156 | to read: |
| 157 | 641.3107 Delivery of contract.--Unless delivered upon |
| 158 | execution or issuance, a health maintenance contract, |
| 159 | certificate of coverage, or member handbook shall be mailed or |
| 160 | delivered to the subscriber or, in the case of a group health |
| 161 | maintenance contract, to the employer or other person who will |
| 162 | hold the contract on behalf of the subscriber group within 10 |
| 163 | working days from approval of the enrollment form by the health |
| 164 | maintenance organization or by the effective date of coverage, |
| 165 | whichever occurs first. However, if the employer or other person |
| 166 | who will hold the contract on behalf of the subscriber group |
| 167 | requires retroactive enrollment of a subscriber, the |
| 168 | organization shall deliver the contract, certificate, or member |
| 169 | handbook to the subscriber within 10 days after receiving notice |
| 170 | from the employer of the retroactive enrollment. This section |
| 171 | does not apply to the delivery of those contracts specified in |
| 172 | s. 641.31(14)(13). |
| 173 | Section 8. Paragraph (a) of subsection (7) of section |
| 174 | 641.3922, Florida Statutes, is amended to read: |
| 175 | 641.3922 Conversion contracts; conditions.--Issuance of a |
| 176 | converted contract shall be subject to the following conditions: |
| 177 | (7) REASONS FOR CANCELLATION; TERMINATION.--The converted |
| 178 | health maintenance contract must contain a cancellation or |
| 179 | nonrenewability clause providing that the health maintenance |
| 180 | organization may refuse to renew the contract of any person |
| 181 | covered thereunder, but cancellation or nonrenewal must be |
| 182 | limited to one or more of the following reasons: |
| 183 | (a) Fraud or intentional misrepresentation, subject to the |
| 184 | limitations of s. 641.31(24)(23), in applying for any benefits |
| 185 | under the converted health maintenance contract.; |
| 186 | Section 9. Subsection (4) of section 641.513, Florida |
| 187 | Statutes, is amended to read: |
| 188 | 641.513 Requirements for providing emergency services and |
| 189 | care.-- |
| 190 | (4) A subscriber may be charged a reasonable copayment, as |
| 191 | provided in s. 641.31(13)(12), for the use of an emergency room. |
| 192 | Section 10. This act shall take effect July 1, 2006. |