Florida Senate - 2013                              CS for SB 422
       
       
       
       By the Committee on Appropriations; and Senators Benacquisto,
       Hays, Bradley, Simpson, Bullard, Soto, Gibson, Detert, Ring,
       Clemens, Negron, Evers, Margolis, Abruzzo, Stargel, Thompson,
       Flores, Sobel, Hukill, Altman, Smith, Diaz de la Portilla,
       Braynon, Garcia, and Montford
       576-02872-13                                           2013422c1
    1                        A bill to be entitled                      
    2         An act relating to cancer treatment; providing a short
    3         title; creating ss. 627.42391 and 641.313, F.S.;
    4         providing definitions; requiring that an individual or
    5         group insurance policy or contract or a health
    6         maintenance contract that provides coverage for cancer
    7         treatment medications provide coverage for orally
    8         administered cancer treatment medications on a basis
    9         no less favorable than that required by the policy or
   10         contract for intravenously administered or injected
   11         cancer treatment medications; prohibiting insurers,
   12         health maintenance organizations, and certain other
   13         entities from engaging in specified actions to avoid
   14         compliance with this act; amending s. 627.6515, F.S.;
   15         adding a cross-reference to conform to changes made by
   16         the act; providing a directive to the Division of Law
   17         Revision and Information; providing an effective date.
   18  
   19  Be It Enacted by the Legislature of the State of Florida:
   20  
   21         Section 1. This act may be cited as the “Cancer Treatment
   22  Fairness Act.”
   23         Section 2. Section 627.42391, Florida Statutes, is created
   24  to read:
   25         627.42391 Insurance policies; cancer treatment parity;
   26  orally administered cancer treatment medications.—
   27         (1) As used in this section, the term:
   28         (a) “Cancer treatment medication” means medication
   29  prescribed by a treating physician who determines that the
   30  medication is medically necessary to kill or slow the growth of
   31  cancerous cells in a manner consistent with nationally accepted
   32  standards of practice.
   33         (b) “Cost sharing” includes copayments, coinsurance, dollar
   34  limits, and deductibles imposed on the covered person.
   35         (2) An individual or group insurance policy delivered,
   36  issued for delivery, renewed, amended, or continued in this
   37  state that provides medical, major medical, or similar
   38  comprehensive coverage and includes coverage for cancer
   39  treatment medications must also cover prescribed, orally
   40  administered cancer treatment medications and may not apply
   41  cost-sharing requirements for orally administered cancer
   42  treatment medications that are less favorable to the covered
   43  person than cost-sharing requirements for intravenous or
   44  injected cancer treatment medications covered under the policy
   45  or contract.
   46         (3) An insurer providing a policy or contract described in
   47  subsection (2) and any participating entity through which the
   48  insurer offers health services may not:
   49         (a) Vary the terms of the policy in effect on the effective
   50  date of this act to avoid compliance with this section.
   51         (b) Provide any incentive, including, but not limited to, a
   52  monetary incentive, or impose treatment limitations to encourage
   53  a covered person to accept less than the minimum protections
   54  available under this section.
   55         (c) Penalize a health care practitioner or reduce or limit
   56  the compensation of a health care practitioner for recommending
   57  or providing services or care to a covered person as required
   58  under this section.
   59         (d) Provide any incentive, including, but not limited to, a
   60  monetary incentive, to induce a health care practitioner to
   61  provide care or services that do not comply with this section.
   62         (e) Change the classification of any intravenous or
   63  injected cancer treatment medication or increase the amount of
   64  cost sharing applicable to any intravenous or injected cancer
   65  treatment medication in effect on the effective date of this act
   66  in order to achieve compliance with this section.
   67         Section 3. Section 641.313, Florida Statutes, is created to
   68  read:
   69         641.313 Health maintenance contracts; cancer treatment
   70  parity; orally administered cancer treatment medications.—
   71         (1) As used in this section, the term:
   72         (a) “Cancer treatment medication” means medication
   73  prescribed by a treating physician who determines that the
   74  medication is medically necessary to kill or slow the growth of
   75  cancerous cells in a manner consistent with nationally accepted
   76  standards of practice.
   77         (b) “Cost sharing” includes copayments, coinsurance, dollar
   78  limits, and deductibles imposed on the covered person.
   79         (2) A health maintenance contract delivered, issued for
   80  delivery, renewed, amended, or continued in this state that
   81  provides medical, major medical, or similar comprehensive
   82  coverage and includes coverage for cancer treatment medications
   83  must also cover prescribed, orally administered cancer treatment
   84  medications and may not apply cost-sharing requirements for
   85  orally administered cancer treatment medications that are less
   86  favorable to the covered person than cost-sharing requirements
   87  for intravenous or injected cancer treatment medications covered
   88  under the contract.
   89         (3) A health maintenance organization providing a contract
   90  described in subsection (2) and any participating entity through
   91  which the health maintenance organization offers health services
   92  may not:
   93         (a) Vary the terms of the policy in effect on the effective
   94  date of this act to avoid compliance with this section.
   95         (b) Provide any incentive, including, but not limited to, a
   96  monetary incentive, or impose treatment limitations to encourage
   97  a covered person to accept less than the minimum protections
   98  available under this section.
   99         (c) Penalize a health care practitioner or reduce or limit
  100  the compensation of a health care practitioner for recommending
  101  or providing services or care to a covered person as required
  102  under this section.
  103         (d) Provide any incentive, including, but not limited to, a
  104  monetary incentive, to induce a health care practitioner to
  105  provide care or services that do not comply with this section.
  106         (e) Change the classification of any intravenous or
  107  injected cancer treatment medication or increase the amount of
  108  cost sharing applicable to any intravenous or injected cancer
  109  treatment medication in effect on the effective date of this act
  110  in order to achieve compliance with this section.
  111         Section 4. Subsection (2) of section 627.6515, Florida
  112  Statutes, is amended to read:
  113         627.6515 Out-of-state groups.—
  114         (2) Except as otherwise provided in this part, this part
  115  does not apply to a group health insurance policy issued or
  116  delivered outside this state under which a resident of this
  117  state is provided coverage if:
  118         (a) The policy is issued to an employee group the
  119  composition of which is substantially as described in s.
  120  627.653; a labor union group or association group the
  121  composition of which is substantially as described in s.
  122  627.654; an additional group the composition of which is
  123  substantially as described in s. 627.656; a group insured under
  124  a blanket health policy when the composition of the group is
  125  substantially in compliance with s. 627.659; a group insured
  126  under a franchise health policy when the composition of the
  127  group is substantially in compliance with s. 627.663; an
  128  association group to cover persons associated in any other
  129  common group, which common group is formed primarily for
  130  purposes other than providing insurance; a group that is
  131  established primarily for the purpose of providing group
  132  insurance, provided the benefits are reasonable in relation to
  133  the premiums charged thereunder and the issuance of the group
  134  policy has resulted, or will result, in economies of
  135  administration; or a group of insurance agents of an insurer,
  136  which insurer is the policyholder;
  137         (b) Certificates evidencing coverage under the policy are
  138  issued to residents of this state and contain in contrasting
  139  color and not less than 10-point type the following statement:
  140  “The benefits of the policy providing your coverage are governed
  141  primarily by the law of a state other than Florida”; and
  142         (c) The policy provides the benefits specified in ss.
  143  627.419, 627.42391, 627.6574, 627.6575, 627.6579, 627.6612,
  144  627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and
  145  627.66911, and complies with the requirements of s. 627.66996.
  146         (d) Applications for certificates of coverage offered to
  147  residents of this state must contain, in contrasting color and
  148  not less than 12-point type, the following statement on the same
  149  page as the applicant’s signature:
  150  
  151         “This policy is primarily governed by the laws of
  152         ...insert state where the master policy if filed....
  153         As a result, all of the rating laws applicable to
  154         policies filed in this state do not apply to this
  155         coverage, which may result in increases in your
  156         premium at renewal that would not be permissible under
  157         a Florida-approved policy. Any purchase of individual
  158         health insurance should be considered carefully, as
  159         future medical conditions may make it impossible to
  160         qualify for another individual health policy. For
  161         information concerning individual health coverage
  162         under a Florida-approved policy, consult your agent or
  163         the Florida Department of Financial Services.”
  164  
  165  This paragraph applies only to group certificates providing
  166  health insurance coverage which require individualized
  167  underwriting to determine coverage eligibility for an individual
  168  or premium rates to be charged to an individual except for the
  169  following:
  170         1. Policies issued to provide coverage to groups of persons
  171  all of whom are in the same or functionally related licensed
  172  professions, and providing coverage only to such licensed
  173  professionals, their employees, or their dependents;
  174         2. Policies providing coverage to small employers as
  175  defined by s. 627.6699. Such policies shall be subject to, and
  176  governed by, the provisions of s. 627.6699;
  177         3. Policies issued to a bona fide association, as defined
  178  by s. 627.6571(5), provided that there is a person or board
  179  acting as a fiduciary for the benefit of the members, and such
  180  association is not owned, controlled by, or otherwise associated
  181  with the insurance company; or
  182         4. Any accidental death, accidental death and
  183  dismemberment, accident-only, vision-only, dental-only, hospital
  184  indemnity-only, hospital accident-only, cancer, specified
  185  disease, Medicare supplement, products that supplement Medicare,
  186  long-term care, or disability income insurance, or similar
  187  supplemental plans provided under a separate policy,
  188  certificate, or contract of insurance, which cannot duplicate
  189  coverage under an underlying health plan, coinsurance, or
  190  deductibles or coverage issued as a supplement to workers’
  191  compensation or similar insurance, or automobile medical-payment
  192  insurance.
  193         Section 5. The Division of Law Revision and Information is
  194  directed to replace the phrase “the effective date of this act”
  195  wherever it occurs in this act with the date this act takes
  196  effect.
  197         Section 6. This act shall take effect July 1, 2013.