HB 0805

CS

CHAMBER ACTION

1	The Commerce Council recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to plans, policies, contracts, and
7	programs for the provision of health care services;
8	amending s. 408.909, F.S.; revising eligibility
9	requirements for participation in health flex plans;
10	amending s. 627.642, F.S.; requiring an identification
11	card containing specified information to be given to
12	insureds who have health and accident insurance; amending
13	s. 627.657, F.S.; requiring an identification card
14	containing specified information to be given to insureds
15	under group health insurance policies; amending s. 641.31,
16	F.S.; requiring an identification card to be given to
17	persons having health care services through a health
18	maintenance contract; amending ss. 383.145, 641.185,
19	641.2018, 641.3107, 641.3922, and 641.513, F.S.;
20	conforming cross-references to changes made by the act;
21	providing application; providing an effective date.
22
23	Be It Enacted by the Legislature of the State of Florida:
24
25	Section 1.  Subsection (5) of section 408.909, Florida
26	Statutes, is amended to read:
27	408.909  Health flex plans.--
28	(5)  ELIGIBILITY.--Eligibility to enroll in an approved
29	health flex plan is limited to residents of this state who:
30	(a)  Are 64 years of age or younger;
31	(b)  Have a family income equal to or less than 250 200
32	percent of the federal poverty level;
33	(c)  Are eligible under a federally approved Medicaid
34	demonstration waiver and reside in Palm Beach County or Miami-
35	Dade County;
36	(d)  Are not covered by a private insurance policy and are
37	not eligible for coverage through a public health insurance
38	program, such as Medicare or Medicaid, unless specifically
39	authorized under paragraph (c), or another public health care
40	program, such as KidCare, and have not been covered at any time
41	during the past 6 months; and
42	(e)  Have applied for health care coverage through an
43	approved health flex plan and have agreed to make any payments
44	required for participation, including periodic payments or
45	payments due at the time health care services are provided; or.
46	(f)  Have met the requirements of paragraphs (a)-(e) and
47	are part of an employer group where at least 75 percent of the
48	employees have a family income equal to or less than 250 percent
49	of the federal poverty level.
50	Section 2.  Subsection (3) is added to section 627.642,
51	Florida Statutes, to read:
52	627.642  Outline of coverage.--
53	(3)  In addition to the outline of coverage, a policy as
54	specified in s. 627.6699(3)(k) must be accompanied by an
55	identification card that contains, at a minimum:
56	(a)  The name of the organization issuing the policy or
57	name of the organization administering the policy, whichever
58	applies.
59	(b)  The name of the contract holder.
60	(c)  The type of plan only if the health plan is filed with
61	the state, an indication that the plan is self-funded, or the
62	name of the network.
63	(d)  The member identification number, contract number, and
64	policy or group number, if applicable.
65	(e)  A contact phone number or electronic address for
66	authorizations.
67	(f)  A phone number or electronic address whereby the
68	covered person or hospital, physician, or other person rendering
69	services covered by the policy may determine if the plan is
70	insured and may obtain a benefits verification in order to
71	estimate patient financial responsibility, in compliance with
72	privacy rules under the Health Insurance Portability and
73	Accountability Act.
74	(g)  The national plan identifier, in accordance with the
75	compliance date set forth by the federal Department of Health
76	and Human Services.
77
78	The identification card must present the information in a
79	readily identifiable manner or, alternatively, the information
80	may be embedded on the card and available through magnetic
81	stripe or smart card. The information may also be provided
82	through other electronic technology.
83	Section 3.  Present subsection (2) of section 627.657,
84	Florida Statutes, is renumbered as subsection (3), and a new
85	subsection (2) is added to that section, to read:
86	627.657  Provisions of group health insurance policies.--
87	(2)  The medical policy as specified in s. 627.6699(3)(k)
88	must be accompanied by an identification card that contains, at
89	a minimum:
90	(a)  The name of the organization issuing the policy or
91	name of the organization administering the policy, whichever
92	applies.
93	(b)  The name of the certificateholder.
94	(c)  The type of plan only if the health plan is filed with
95	the state, an indication that the plan is self-funded, or the
96	name of the network.
97	(d)  The member identification number, contract number, and
98	policy or group number, if applicable.
99	(e)  A contact phone number or electronic address for
100	authorizations.
101	(f)  A phone number or electronic address whereby the
102	covered person or hospital, physician, or other person rendering
103	services covered by the policy may determine if the plan is
104	insured and may obtain a benefits verification in order to
105	estimate patient financial responsibility, in compliance with
106	privacy rules under the Health Insurance Portability and
107	Accountability Act.
108	(g)  The national plan identifier, in accordance with the
109	compliance date set forth by the federal Department of Health
110	and Human Services.
111
112	The identification card must present the information in a
113	readily identifiable manner or, alternatively, the information
114	may be embedded on the card and available through magnetic
115	stripe or smart card. The information may also be provided
116	through other electronic technology.
117	Section 4.  Present subsections (5) through (40) of section
118	641.31, Florida Statutes, are renumbered as subsections (6)
119	through (41), respectively, and a new subsection (5) is added to
120	that section, to read:
121	641.31  Health maintenance contracts.--
122	(5)  The contract, certificate, or member handbook must be
123	accompanied by an identification card that contains, at a
124	minimum:
125	(a)  The name of the organization offering the contract or
126	name of the organization administering the contract, whichever
127	applies.
128	(b)  The name of the subscriber.
129	(c)  A statement that the health plan is a health
130	maintenance organization. Only a health plan with a certificate
131	of authority issued under this chapter may be identified as a
132	health maintenance organization.
133	(d)  The member identification number, contract number, and
134	group number, if applicable.
135	(e)  A contact phone number or electronic address for
136	authorizations.
137	(f)  A phone number or electronic address whereby the
138	covered person or hospital, physician, or other person rendering
139	services covered by the contract may determine if the plan is
140	insured and may obtain a benefits verification in order to
141	estimate patient financial responsibility, in compliance with
142	privacy rules under the Health Insurance Portability and
143	Accountability Act.
144	(g)  The national plan identifier, in accordance with the
145	compliance date set forth by the federal Department of Health
146	and Human Services.
147
148	The identification card must present the information in a
149	readily identifiable manner or, alternatively, the information
150	may be embedded on the card and available through magnetic
151	stripe or smart card. The information may also be provided
152	through other electronic technology.
153	Section 5.  Paragraph (j) of subsection (3) of section
154	383.145, Florida Statutes, is amended to read:
155	383.145  Newborn and infant hearing screening.--
156	(3)  REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE
157	COVERAGE; REFERRAL FOR ONGOING SERVICES.--
158	(j)  The initial procedure for screening the hearing of the
159	newborn or infant and any medically necessary followup
160	reevaluations leading to diagnosis shall be a covered benefit,
161	reimbursable under Medicaid as an expense compensated
162	supplemental to the per diem rate for Medicaid patients enrolled
163	in MediPass or Medicaid patients covered by a fee for service
164	program. For Medicaid patients enrolled in HMOs, providers shall
165	be reimbursed directly by the Medicaid Program Office at the
166	Medicaid rate. This service may not be considered a covered
167	service for the purposes of establishing the payment rate for
168	Medicaid HMOs. All health insurance policies and health
169	maintenance organizations as provided under ss. 627.6416,
170	627.6579, and 641.31(31)(30), except for supplemental policies
171	that only provide coverage for specific diseases, hospital
172	indemnity, or Medicare supplement, or to the supplemental
173	polices, shall compensate providers for the covered benefit at
174	the contracted rate. Nonhospital-based providers shall be
175	eligible to bill Medicaid for the professional and technical
176	component of each procedure code.
177	Section 6.  Paragraphs (b) and (i) of subsection (1) of
178	section 641.185, Florida Statutes, are amended to read:
179	641.185  Health maintenance organization subscriber
180	protections.--
181	(1)  With respect to the provisions of this part and part
182	III, the principles expressed in the following statements shall
183	serve as standards to be followed by the commission, the office,
184	the department, and the Agency for Health Care Administration in
185	exercising their powers and duties, in exercising administrative
186	discretion, in administrative interpretations of the law, in
187	enforcing its provisions, and in adopting rules:
188	(b)  A health maintenance organization subscriber should
189	receive quality health care from a broad panel of providers,
190	including referrals, preventive care pursuant to s. 641.402(1),
191	emergency screening and services pursuant to ss. 641.31(13)(12)
192	and 641.513, and second opinions pursuant to s. 641.51.
193	(i)  A health maintenance organization subscriber should
194	receive timely and, if necessary, urgent grievances and appeals
195	within the health maintenance organization pursuant to ss.
196	641.228, 641.31(6)(5), 641.47, and 641.511.
197	Section 7.  Subsection (1) of section 641.2018, Florida
198	Statutes, is amended to read:
199	641.2018  Limited coverage for home health care
200	authorized.--
201	(1)  Notwithstanding other provisions of this chapter, a
202	health maintenance organization may issue a contract that limits
203	coverage to home health care services only. The organization and
204	the contract shall be subject to all of the requirements of this
205	part that do not require or otherwise apply to specific benefits
206	other than home care services. To this extent, all of the
207	requirements of this part apply to any organization or contract
208	that limits coverage to home care services, except the
209	requirements for providing comprehensive health care services as
210	provided in ss. 641.19(4), (11), and (12), and 641.31(1), except
211	ss. 641.31(10)(9), (13)(12), (17), (18), (19), (20), (21), (22),
212	and (25)(24) and 641.31095.
213	Section 8.  Section 641.3107, Florida Statutes, is amended
214	to read:
215	641.3107  Delivery of contract.--Unless delivered upon
216	execution or issuance, a health maintenance contract,
217	certificate of coverage, or member handbook shall be mailed or
218	delivered to the subscriber or, in the case of a group health
219	maintenance contract, to the employer or other person who will
220	hold the contract on behalf of the subscriber group within 10
221	working days from approval of the enrollment form by the health
222	maintenance organization or by the effective date of coverage,
223	whichever occurs first. However, if the employer or other person
224	who will hold the contract on behalf of the subscriber group
225	requires retroactive enrollment of a subscriber, the
226	organization shall deliver the contract, certificate, or member
227	handbook to the subscriber within 10 days after receiving notice
228	from the employer of the retroactive enrollment. This section
229	does not apply to the delivery of those contracts specified in
230	s. 641.31(14)(13).
231	Section 9.  Paragraph (a) of subsection (7) of section
232	641.3922, Florida Statutes, is amended to read:
233	641.3922  Conversion contracts; conditions.--Issuance of a
234	converted contract shall be subject to the following conditions:
235	(7)  REASONS FOR CANCELLATION; TERMINATION.--The converted
236	health maintenance contract must contain a cancellation or
237	nonrenewability clause providing that the health maintenance
238	organization may refuse to renew the contract of any person
239	covered thereunder, but cancellation or nonrenewal must be
240	limited to one or more of the following reasons:
241	(a)  Fraud or intentional misrepresentation, subject to the
242	limitations of s. 641.31(24)(23), in applying for any benefits
243	under the converted health maintenance contract.;
244	Section 10.  Subsection (4) of section 641.513, Florida
245	Statutes, is amended to read:
246	641.513  Requirements for providing emergency services and
247	care.--
248	(4)  A subscriber may be charged a reasonable copayment, as
249	provided in s. 641.31(13)(12), for the use of an emergency room.
250	Section 11.  This act shall take effect January 1, 2007,
251	and shall apply to identification cards issued for policies or
252	certificates issued or renewed on or after that date.

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