Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. CS for CS for SB 1972
                                Barcode 364932                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/15/2011           .                                

       The Committee on Budget (Flores) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Between lines 5720 and 5721
    4  insert:
    5         Section 75. Present subsections (15) through (21) of
    6  section 641.19, Florida Statutes, are renumbered as subsections
    7  (16) through (22), respectively, and a new subsection (15) is
    8  added to that section, to read:
    9         641.19 Definitions.—As used in this part, the term:
   10         (15) “Provider service network” means a network established
   11  or organized and operated by a health care provider or group of
   12  affiliated health care providers, including minority physician
   13  networks and emergency room diversion programs that meet the
   14  requirements of s. 409.91211, which directly provides a
   15  substantial proportion of the health care items and services
   16  under a contract and may make arrangements with physicians,
   17  other health care practitioners, health care institutions, or
   18  any combination of such practitioners or institutions to assume
   19  all or part of the financial risk on a prospective basis for the
   20  provision of basic health services by such physicians,
   21  practitioners, or institutions. The health care providers
   22  operating the provider service network must have a controlling
   23  interest in the governing body of the network.
   24         Section 76. Section 641.2019, Florida Statutes, is created
   25  to read:
   26         641.2019Provider service network certificate of
   27  authority.—Notwithstanding any other provisions of this chapter,
   28  a provider service network, including a prepaid provider service
   29  network described under s. 409.912(4)(d), which meets all of the
   30  applicable requirements of this part may apply for and obtain a
   31  health care provider certificate pursuant to part III of this
   32  chapter and a certificate of authority pursuant to this part
   33  which states that the network is authorized to operate a
   34  certified provider service network under this chapter. A
   35  certified provider service network has the same rights and
   36  responsibilities as a health maintenance organization certified
   37  under this part.
   38         Section 77. Subsection (13) of section 641.47, Florida
   39  Statutes, is amended to read:
   40         641.47 Definitions.—As used in this part, the term:
   41         (13) “Organization” means a any health maintenance
   42  organization as defined in s. 641.19, a and any prepaid health
   43  clinic as defined in s. 641.402, and a provider service network
   44  as defined in s. 641.19.
   45         Section 78. Section 641.49, Florida Statutes, is amended to
   46  read:
   47         641.49 Health care provider certificate certification of
   48  health maintenance organization and prepaid health clinic as
   49  health care providers; application procedure.—
   50         (1) No person or governmental unit shall establish,
   51  conduct, or maintain a health maintenance organization, or a
   52  prepaid health clinic, or provider service network in this state
   53  without first obtaining a health care provider certificate under
   54  this part.
   55         (2) The office may shall not issue a certificate of
   56  authority under part I or part II of this chapter to any
   57  applicant which does not possess a valid health care provider
   58  certificate issued by the agency under this part.
   59         (3) Each application for a health care provider certificate
   60  shall be on a form prescribed by the agency. The following
   61  information and documents shall be submitted by an applicant and
   62  maintained, after certification under this part, by each
   63  organization and shall be available for inspection or
   64  examination by the agency at the offices of an organization at
   65  any time during regular business hours. The agency shall give
   66  reasonable notice to an organization before prior to any onsite
   67  inspection or examination of its records or premises conducted
   68  under this section. The agency may require that the following
   69  information or documents be submitted with the application:
   70         (a) A copy of the articles of incorporation and all
   71  amendments to the articles.
   72         (b) A copy of the bylaws, rules and regulations, or similar
   73  form of document, if any, regulating the conduct of the affairs
   74  of the applicant or organization.
   75         (c) A list of the names, addresses, and official capacities
   76  with the applicant or organization of the persons who are to be
   77  responsible for the conduct of the affairs of the applicant or
   78  organization, including all officers and directors of the
   79  corporation. Such persons must shall fully disclose to the
   80  agency and the directors of the applicant or organization the
   81  extent and nature of any contracts or arrangements between them
   82  and the applicant or organization, including any possible
   83  conflicts of interest.
   84         (d) The name and address of the applicant and the name by
   85  which the applicant or organization is to be known.
   86         (e) A statement generally describing the applicant or
   87  organization and its operations.
   88         (f) A copy of the form for each group and individual
   89  contract, certificate, subscriber handbook, and any other
   90  similar documents issued to subscribers.
   91         (g) A statement describing the manner in which health care
   92  services shall be regularly available.
   93         (h) A statement that the applicant has an established
   94  network of health care providers which is capable of providing
   95  the health care services that are to be offered by the
   96  organization.
   97         (i) The locations at which health care services shall be
   98  regularly available to subscribers.
   99         (j) The type of health care personnel engaged to provide
  100  the health care services and the quantity of the personnel of
  101  each type.
  102         (k) A statement giving the present and projected number of
  103  subscribers to be enrolled annually yearly for the next 3 years.
  104         (l) A statement indicating the source of emergency services
  105  and care on a 24-hour basis.
  106         (m) A statement that the physicians employed by the
  107  applicant have been formally organized as a medical staff and
  108  that the applicant’s governing body has designated a chief of
  109  medical staff.
  110         (n) A statement describing the manner in which the
  111  applicant or organization assures the maintenance of a medical
  112  records system in accordance with accepted medical records’
  113  standards and practices.
  114         (o) If general anesthesia is to be administered in a
  115  facility not licensed by the agency, a copy of architectural
  116  plans that meet the requirements for institutional occupancy
  117  (NFPA 101 Life Safety Code, current edition as adopted by the
  118  State Fire Marshal).
  119         (p) A description of the applicant’s or organization’s
  120  internal quality assurance program, including committee
  121  structure, as required under s. 641.51.
  122         (q) A description and supporting documentation concerning
  123  how the applicant or health maintenance organization will comply
  124  with internal risk management program requirements under s.
  125  641.55.
  126         (r) An explanation of how coverage for emergency services
  127  and care is to be effected outside the applicant’s or health
  128  maintenance organization’s stated geographic area.
  129         (s) A statement and map describing with reasonable accuracy
  130  the specific geographic area to be served.
  131         (t) A nonrefundable application fee of $1,000.
  132         (u) Such additional information as the agency may
  133  reasonably require.
  134         Section 79. Paragraph (b) of subsection (2) of section
  135  430.705, Florida Statutes, is amended to read:
  136         430.705 Implementation of the long-term care community
  137  diversion pilot projects.—
  138         (2)
  139         (b) The department shall select providers that meet all of
  140  the following criteria. Providers shall:
  141         1. Have a plan administrator who is dedicated to the
  142  diversion pilot project and project staff who perform the
  143  necessary project administrative functions, including data
  144  collection, reporting, and analysis.
  145         2. Demonstrate the ability to provide program enrollees
  146  with a choice of care provider by contracting with multiple
  147  providers that provide the same type of service.
  148         3. Demonstrate through performance or other documented
  149  means the capacity for prompt payment of claims as specified
  150  under s. 641.3155.
  151         4. Maintain an insolvency protection account in a bank or
  152  savings and loan association located in the state with a balance
  153  of at least $100,000 into which monthly deposits equal to at
  154  least 5 percent of premiums received under the project are made
  155  until the balance equals 2 percent of the total contract amount.
  156  The account shall be established with such terms as to ensure
  157  that funds are may only be withdrawn only with the signature
  158  approval of designated department representatives.
  159         5. Maintain a surplus of at least $1.5 million as
  160  determined by the department. Each applicant and each provider
  161  shall furnish to the department initial and annual unqualified
  162  audited financial statements prepared by a certified public
  163  accountant that expressly confirm that the applicant or provider
  164  satisfies this surplus requirement. The department may approve a
  165  waiver of compliance with the surplus requirement for an
  166  existing diversion provider. The department’s approval of the
  167  this waiver is must be contingent on the provider demonstrating
  168  proof to the department that the entity has posted and maintains
  169  a $1.5 million performance bond, which is written by an insurer
  170  licensed to transact insurance in this state, in lieu of meeting
  171  the surplus requirement. The department may not approve a waiver
  172  of compliance with the surplus requirement that extends beyond
  173  June 30, 2006. As used in this subparagraph, the term:
  174         a. “Existing diversion provider” means an entity that is
  175  approved by the department on or before June 30, 2005, to
  176  provide services to consumers through any long-term care
  177  community diversion pilot project authorized under ss. 430.701
  178  430.709.
  179         b. “Surplus” has the same meaning as in s. 641.19(19).
  181  ================= T I T L E  A M E N D M E N T ================
  182         And the title is amended as follows:
  183         Delete line 374
  184  and insert:
  185         without the insured’s permission; amending s. 641.19,
  186         F.S.; defining the term “provider service network”;
  187         creating s. 641.2019, F.S.; providing that a provider
  188         service network that meets the requirements of ch.
  189         641, F.S., may obtain a certificate of authority under
  190         that chapter; amending s. 641.47, F.S.; redefining the
  191         term “organization” to include a provider service
  192         network; amending s. 641.49, F.S.; providing that a
  193         provider service network may apply for a health care
  194         provider certificate; amending s. 430.705, F.S.;
  195         conforming a cross-reference; amending s. 766.102,