Florida Senate - 2010                                     SB 302
       
       
       
       By Senator Jones
       
       
       
       
       13-00416-10                                            2010302__
    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.; prohibiting
    4         certain provider contracts from containing a provision
    5         that requires health care practitioners to provide
    6         services to subscribers at a fee set by the health
    7         insurer, prepaid limited health service organization,
    8         or health maintenance organization unless the services
    9         are covered under an applicable subscriber agreement;
   10         defining the term “covered services”; providing for
   11         application; providing an effective date.
   12  
   13  Be It Enacted by the Legislature of the State of Florida:
   14  
   15         Section 1. Section 627.6474, Florida Statutes, is amended
   16  to read:
   17         627.6474 Provider contracts.—
   18         (1) A health insurer may shall not require a contracted
   19  health care practitioner as defined in s. 456.001(4) to accept
   20  the terms of other health care practitioner contracts with the
   21  insurer or any other insurer, or health maintenance
   22  organization, under common management and control with the
   23  insurer, including Medicare and Medicaid practitioner contracts
   24  and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
   25  s. 641.315, except for a practitioner in a group practice as
   26  defined in s. 456.053 who must accept the terms of a contract
   27  negotiated for the practitioner by the group, as a condition of
   28  continuation or renewal of the contract. Any contract provision
   29  that violates this section is void. A violation of this section
   30  is not subject to the criminal penalty specified in s. 624.15.
   31         (2) A contract between a health insurer and a health care
   32  practitioner as defined in s. 456.001(4) governing the provision
   33  of services to patients may not contain any provision that
   34  requires the practitioner to provide services to the health
   35  insurance subscribers at a fee set by the health insurer unless
   36  the services are covered services under the applicable
   37  subscriber agreement. As used in this subsection, the term
   38  “covered services” means services reimbursable under the
   39  applicable subscriber agreement, subject to such contractual
   40  limitations on subscriber benefits as may apply. This subsection
   41  applies to all contracts entered into or renewed on or after
   42  July 1, 2010.
   43         Section 2. Subsection (13) is added to section 636.035,
   44  Florida Statutes, to read:
   45         636.035 Provider arrangements.—
   46         (13) A contract between a prepaid limited health service
   47  organization and a health care practitioner as defined in s.
   48  456.001(4) governing the provision of services to patients may
   49  not contain any provision that requires the practitioner to
   50  provide services to subscribers at a fee set by the prepaid
   51  limited health service organization unless the services are
   52  covered services under the applicable subscriber agreement. As
   53  used in this subsection, the term “covered services” means
   54  services reimbursable under the applicable subscriber agreement,
   55  subject to such contractual limitations on subscriber benefits
   56  as may apply. This subsection applies to all contracts entered
   57  into or renewed on or after July 1, 2010.
   58         Section 3. Subsection (11) is added to section 641.315,
   59  Florida Statutes, to read:
   60         641.315 Provider contracts.—
   61         (11) A contract between a health maintenance organization
   62  and a health care practitioner as defined in s. 456.001(4)
   63  governing the provision of services to patients may not contain
   64  any provision that requires the practitioner to provide services
   65  to the subscribers of the health maintenance organization at a
   66  fee set by the health maintenance organization unless the
   67  services are covered services under the applicable subscriber
   68  agreement. As used in this subsection, the term “covered
   69  services” means services reimbursable under the applicable
   70  subscriber agreement, subject to such contractual limitations on
   71  subscriber benefits as may apply. This subsection applies to all
   72  contracts entered into or renewed on or after July 1, 2010.
   73         Section 4. This act shall take effect July 1, 2010.