HB 291

1	A bill to be entitled
2	An act relating to provider contracts; amending ss.
3	627.6474, 636.035, and 641.315, F.S.; proscribing certain
4	fee setting provisions in certain contracts between health
5	care practitioners and certain health insurance entities
6	under certain circumstances; providing a definition;
7	providing application; providing an effective date.
8
9	Be It Enacted by the Legislature of the State of Florida:
10
11	Section 1.  Section 627.6474, Florida Statutes, is amended
12	to read:
13	627.6474  Provider contracts.--
14	(1)  A health insurer shall not require a contracted health
15	care practitioner as defined in s. 456.001(4) to accept the
16	terms of other health care practitioner contracts with the
17	insurer or any other insurer, or health maintenance
18	organization, under common management and control with the
19	insurer, including Medicare and Medicaid practitioner contracts
20	and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
21	s. 641.315, except for a practitioner in a group practice as
22	defined in s. 456.053 who must accept the terms of a contract
23	negotiated for the practitioner by the group, as a condition of
24	continuation or renewal of the contract. Any contract provision
25	that violates this section is void. A violation of this section
26	is not subject to the criminal penalty specified in s. 624.15.
27	(2)  A contract between a health insurer and a health care
28	practitioner as defined in s. 456.001 for the provision of
29	services to patients may not contain any provision that requires
30	the practitioner to provide services to the policyholders of the
31	health insurer at a fee set by the health insurer unless such
32	services are covered services under the applicable health
33	insurance policy. For purposes of this subsection, the term
34	"covered services" means services reimbursable under the
35	applicable health insurance policy, subject to any contractual
36	limitations on an insured's benefits that may apply. This
37	subsection applies to all contracts entered into or renewed on
38	or after July 1, 2010.
39	Section 2.  Subsection (13) is added to section 636.035,
40	Florida Statutes, to read:
41	636.035  Provider contracts arrangements.--
42	(13)  A contract between a prepaid limited health service
43	organization and a health care practitioner as defined in s.
44	456.001 for the provision of services to patients may not
45	contain any provision that requires the practitioner to provide
46	services to the organization's subscribers at a fee set by the
47	organization unless such services are covered services under the
48	applicable subscriber agreement. For purposes of this
49	subsection, the term "covered services" means services
50	reimbursable under the applicable subscriber agreement, subject
51	to any contractual limitations on subscriber benefits that may
52	apply. This subsection applies to all contracts entered into or
53	renewed on or after July 1, 2010.
54	Section 3.  Subsection (11) is added to section 641.315,
55	Florida Statutes, read:
56	641.315  Provider contracts.--
57	(11)  A contract between a health maintenance organization
58	and a health care practitioner as defined in s. 456.001 for the
59	provision of services to patients may not contain any provision
60	that requires the practitioner to provide services to the
61	organization's subscribers at a fee set by the organization
62	unless such services are covered services under the applicable
63	subscriber agreement. For purposes of this subsection, the term
64	"covered services" means services reimbursable under the
65	applicable subscriber agreement, subject to any contractual
66	limitations on subscriber benefits that may apply. This
67	subsection applies to all contracts entered into or renewed on
68	or after July 1, 2010.
69	Section 4.  This act shall take effect July 1, 2010.

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