Florida Senate - 2015 CS for SB 1190
By the Committee on Banking and Insurance; and Senator Lee
597-02405-15 20151190c1
1 A bill to be entitled
2 An act relating to insurer solvency; amending s.
3 624.407, F.S.; revising the amount of surplus which
4 must be possessed by insurers applying for an original
5 certificate of authority; defining the term “health
6 benefit plan”; amending s. 624.408, F.S.; revising the
7 amount of surplus which must be possessed by insurers
8 in order to retain a certificate of authority;
9 authorizing the Office of Insurance Regulation to
10 reduce certain surplus requirements under specified
11 circumstances; defining the term “health benefit
12 plan”; amending s. 624.4085, F.S.; revising the term
13 “life and health insurer” to include specified health
14 maintenance and prepaid limited health service
15 organizations; amending s. 636.043, F.S.; revising the
16 due date and required content for the mandatory annual
17 report of a prepaid limited health service
18 organization to the office; revising the time periods
19 to be covered by such organization’s required
20 quarterly reports to the office; amending s. 641.19,
21 F.S.; defining the term “management services
22 organization”; amending s. 641.201, F.S.; providing
23 that a health maintenance organization is considered
24 an insurer for purposes of specified provisions of law
25 relating to insolvent insurers, requirements for the
26 directors of domestic insurers, the payment of
27 dividends and distributions of other property by
28 domestic stock insurers, penalties for domestic and
29 mutual stock insurers that illegally pay dividends,
30 and certain restrictions on premiums written;
31 providing that health maintenance organizations are
32 considered life and health insurers for purposes of
33 specified provisions of law relating to insurer
34 surplus requirements; amending s. 641.225, F.S.;
35 conforming provisions to changes made by the act;
36 amending s. 641.26, F.S.; revising the due date and
37 required content for the mandatory annual report and
38 audited financial statement of a health maintenance
39 organization which must be submitted to the office;
40 amending s. 641.27, F.S.; revising the annual limit
41 applicable to health maintenance organizations for the
42 examination expenses incurred by the office; amending
43 s. 641.35, F.S.; excluding receivables from a
44 management services organization from being included
45 in the assets of a health maintenance organization for
46 purposes of determining the organization’s financial
47 condition; repealing s. 641.365, F.S., relating to the
48 payment of dividends and distributions of other
49 property by health maintenance organizations; amending
50 ss. 817.234 and 817.50, F.S.; conforming cross
51 references; providing a directive to the Division of
52 Law Revision and Information; providing an effective
53 date.
54
55 Be It Enacted by the Legislature of the State of Florida:
56
57 Section 1. Section 624.407, Florida Statutes, is amended to
58 read:
59 624.407 Surplus required of; new insurers applying for an
60 original certificate of authority.—
61 (1) To receive authority to transact any one kind or
62 combinations of kinds of insurance, as defined in part V of this
63 chapter, an insurer applying for its original certificate of
64 authority in this state must shall possess surplus as to
65 policyholders in at least the following amount greater of:
66 (a) For a property and casualty insurer, $5 million or 10
67 percent of the insurer’s total liabilities, whichever is
68 greater, except for a domestic insurer that transacts
69 residential property insurance and is:
70 1. Not a wholly owned subsidiary of an insurer domiciled in
71 any other state, which must have a surplus of $15 million.
72 2. A wholly owned subsidiary of an insurer domiciled in any
73 other state, which must have a surplus of $50 million., or $2.5
74 million for any other insurer;
75 (b) For a life insurer insurers, $2.5 million or 4 percent
76 of the insurer’s total liabilities, whichever is greater.;
77 (c) For a life and health insurer that will issue a health
78 benefit plan or a long-term care insurance policy on or after
79 the effective date of this act, the greater of:
80 1. The sum of $10 million plus the amount of startup
81 losses, excluding profits, projected to be incurred on the
82 insurer’s startup projection until the projection reflects
83 statutory net profits for 12 consecutive months; insurers,
84 2. Four 4 percent of the insurer’s total liabilities, plus
85 6 percent of the insurer’s liabilities relative to health
86 insurance, based on the insurer’s startup projection; or
87 3. Two percent of the insurer’s total projected premiums
88 relative to health insurance, based on the insurer’s startup
89 projection.
90 (d) For a life and health insurer that is not subject to
91 paragraph (c), the greater of:
92 1. The sum of $2.5 million; or
93 2. Four percent of the insurer’s total liabilities, plus 6
94 percent of the insurer’s liabilities relative to health
95 insurance.
96 (e) For all other insurers, the greater of $2.5 million or
97 other than life insurers and life and health insurers, 10
98 percent of the insurer’s total liabilities.; or
99 (e) Notwithstanding paragraph (a) or paragraph (d), for a
100 domestic insurer that transacts residential property insurance
101 and is:
102 1. Not a wholly owned subsidiary of an insurer domiciled in
103 any other state, $15 million.
104 2. A wholly owned subsidiary of an insurer domiciled in any
105 other state, $50 million.
106 (2) Notwithstanding subsection (1), a new insurer may not
107 be required to have surplus as to policyholders greater than
108 $100 million.
109 (3) The requirements of this section shall be based upon
110 all the kinds of insurance actually transacted or to be
111 transacted by the insurer in any and all areas in which it
112 operates, regardless of whether or not only a portion of such
113 kinds of insurance are transacted in this state.
114 (4) As to surplus as to policyholders required for
115 qualification to transact one or more kinds of insurance,
116 domestic mutual insurers are governed by chapter 628, and
117 domestic reciprocal insurers are governed by chapter 629.
118 (5) For the purposes of this section, liabilities do not
119 include liabilities required under s. 625.041(5). For purposes
120 of computing minimum surplus as to policyholders pursuant to s.
121 625.305(1), liabilities include liabilities required under s.
122 625.041(5).
123 (6) As used in this section, the term “health benefit plan”
124 has the same meaning as in s. 627.6699.
125 Section 2. Section 624.408, Florida Statutes, is amended to
126 read:
127 624.408 Surplus required for; current insurers to maintain
128 a certificate of authority.—
129 (1) To maintain a certificate of authority to transact any
130 one kind or combinations of kinds of insurance, as defined in
131 part V of this chapter, an insurer in this state must at all
132 times maintain surplus as to policyholders in at least the
133 following amount greater of:
134 (a) Except as provided in paragraphs (e), (f), and (g),
135 $1.5 million.
136 (b) For a life insurer insurers, $1.5 million or 4 percent
137 of the insurer’s total liabilities, whichever is greater.
138 (b) For a life and health insurer that is authorized to
139 issue a health benefit plan or long-term care insurance policy,
140 the greater of:
141 1. Four percent of the insurer’s total liabilities, plus 6
142 percent of the insurer’s liabilities relative to health
143 insurance;
144 2. Two percent of the insurer’s total annualized premium
145 relative to health insurance; or
146 3. If the insurer:
147 a. Does not hold a certificate of authority before the
148 effective date of this act, $10 million; or
149 b. Holds a certificate of authority before the effective
150 date of this act, $1.5 million until June 30, 2017; $3 million
151 on or after July 1, 2017, and until June 30, 2021; $6 million on
152 or after July 1, 2021, and until June 30, 2025; and $10 million
153 on or after July 1, 2025.
154
155 The office may reduce the surplus requirement imposed under sub
156 subparagraph 3.a. or sub-subparagraph 3.b. if the office finds
157 the reduction to be in the public interest because the insurer
158 is not writing new business in this state, the insurer is
159 writing business only within a limited geographic service area,
160 the insurer has premiums in force of less than $1 million
161 annually, or the insurer has a policy count of fewer than 6,000,
162 or because of any other factor relevant to making such a
163 finding.
164 (c) For a life and health insurer that is not subject to
165 paragraph (b) insurers, the greater of:
166 1. The sum of $1.5 million; or
167 2. Four 4 percent of the insurer’s total liabilities, plus
168 6 percent of the insurer’s liabilities relative to health
169 insurance.
170 (d) For all insurers other than mortgage guaranty insurers,
171 life insurers, and life and health insurers, 10 percent of the
172 insurer’s total liabilities.
173 (e) For a property and casualty insurer insurers, $4
174 million, except for a property and casualty insurer insurers
175 authorized to underwrite any line of residential property
176 insurance.
177 (e)(f) For a residential property insurer:
178 1. insurers Not holding a certificate of authority before
179 July 1, 2011, $15 million.
180 2.(g) For residential property insurers Holding a
181 certificate of authority before July 1, 2011, $5 million and
182 until June 30, 2016, $5 million; $10 million on or after July 1,
183 2016, and until June 30, 2021, $10 million; and $15 million on
184 or after July 1, 2021, $15 million.
185
186 The office may reduce the surplus requirement under this
187 paragraph in paragraphs (f) and (g) if the insurer is not
188 writing new business, has premiums in force of less than $1
189 million per year in residential property insurance, or is a
190 mutual insurance company.
191 (f) For all other insurers, the greater of $1.5 million or
192 10 percent of the insurer’s total liabilities.
193 (2) For purposes of this section, liabilities do not
194 include liabilities required under s. 625.041(5). For purposes
195 of computing minimum surplus as to policyholders pursuant to s.
196 625.305(1), liabilities include liabilities required under s.
197 625.041(5).
198 (3) This section does not require an insurer to have
199 surplus as to policyholders greater than $100 million.
200 (4) A mortgage guaranty insurer shall maintain a minimum
201 surplus as required by s. 635.042.
202 (5) As used in this section, the term “health benefit plan”
203 has the same meaning as in s. 627.6699.
204 Section 3. Effective July 1, 2015, paragraph (g) of
205 subsection (1) of section 624.4085, Florida Statutes, is amended
206 to read:
207 624.4085 Risk-based capital requirements for insurers.—
208 (1) As used in this section, the term:
209 (g) “Life and health insurer” means an insurer authorized
210 or eligible under the Florida Insurance Code to underwrite life
211 or health insurance. The term also includes:
212 1. A property and casualty insurer that writes accident and
213 health insurance only.
214 2. Effective January 1, 2015, the term also includes a
215 health maintenance organization that is authorized in this state
216 and one or more other states, jurisdictions, or countries and a
217 prepaid limited health service organization that is authorized
218 in this state and one or more other states, jurisdictions, or
219 countries.
220 3. A health maintenance organization and a prepaid limited
221 health service organization initially authorized in this state
222 on or after July 1, 2015, and not authorized in any other state,
223 jurisdiction, or country.
224
225 As used in this paragraph, the term “health maintenance
226 organization” has the same meaning as in s. 641.19 and the term
227 “prepaid limited health service organization” has the same
228 meaning as in s. 636.003.
229 Section 4. Effective July 1, 2015, subsection (1),
230 paragraph (a) of subsection (2), and subsections (4) and (6) of
231 section 636.043, Florida Statutes, are amended to read:
232 636.043 Annual, quarterly, and miscellaneous reports.—
233 (1) Each prepaid limited health service organization must
234 file an annual report with the office on or before March 1 of
235 each year showing its condition on the last day of the
236 immediately preceding calendar year. The annually, within 3
237 months after the end of its fiscal year, a report must be
238 verified by the notarized oath of at least two officers covering
239 the preceding calendar year. Any organization licensed prior to
240 October 1, 1993, shall not be required to file a financial
241 statement, as required by paragraph (2)(a), based on statutory
242 accounting principles until the first annual report for fiscal
243 years ending after December 31, 1994.
244 (2) The Such report must be on forms prescribed by the
245 commission and must include:
246 (a)1. A statutory financial statement of the organization
247 prepared in accordance with statutory accounting principles and
248 filed by electronic means in a computer-readable format
249 acceptable to the office, including its balance sheet, income
250 statement, and statement of changes in cash flow for the
251 preceding year, certified by an independent certified public
252 accountant, or a consolidated audited financial statement of its
253 parent company prepared on the basis of statutory accounting
254 principles, certified by an independent certified public
255 accountant, attached to which must be consolidating financial
256 statements of the parent company, including the prepaid limited
257 health service organization.
258 2. Any entity subject to this chapter may make written
259 application to the office for approval to file audited financial
260 statements prepared in accordance with generally accepted
261 accounting principles in lieu of statutory financial statements.
262 The office shall approve the application if it finds it to be in
263 the best interest of the subscribers. An application for
264 exemption is required each year and must be filed with the
265 office at least 2 months prior to the end of the fiscal year for
266 which the exemption is being requested.
267 (4)(a) Each authorized prepaid limited health service
268 organization must file a quarterly report for each calendar
269 quarter. The report for the quarter ending March 31 shall be
270 filed with the office on or before May 15, the report for the
271 quarter ending June 30 shall be filed on or before August 15,
272 and the report for the quarter ending September 30 shall be
273 filed on or before November 15. The quarterly report must be
274 verified by the notarized oath of two officers of the
275 organization within 45 days after the end of the quarter. The
276 report must shall contain:
277 1.(a) A financial statement prepared in accordance with
278 statutory accounting principles. Any entity licensed before
279 October 1, 1993, is shall not be required to file a financial
280 statement based on statutory accounting principles until the
281 first quarterly filing after the entity files its annual
282 financial statement based on statutory accounting principles as
283 required by subsection (1).
284 2.(b) A listing of providers.
285 3.(c) Such other information relating to the performance of
286 the prepaid limited health service organization as is reasonably
287 required by the commission or office.
288 (b) On or before June 1, each authorized prepaid limited
289 health service organization shall annually file with the office
290 an audited financial statement of the organization for the
291 preceding year ending December 31. The office may require the
292 organization to file an audited financial report earlier than
293 June 1 upon notifying the organization at least 90 days in
294 advance. The audited financial statement must include:
295 1. A balance sheet, income statement, and statement of
296 changes in cash flow for the preceding year, all of which must
297 be certified by an independent certified public accountant; or
298 2. A consolidated audited financial statement of the
299 organization’s parent company, prepared on the basis of
300 statutory accounting principles, which must be certified by an
301 independent certified public accountant and to which are
302 attached the consolidated financial statements of the parent
303 company, including those of the prepaid limited health service
304 organization.
305
306 Beginning with the financial statement filed for the year ending
307 December 31, 2015, the audited financial statement or
308 consolidated audited financial statement required by this
309 paragraph is subject to commission rules applicable to insurer
310 audits.
311 (6) Each authorized prepaid limited health service
312 organization shall retain an independent certified public
313 accountant, hereinafter referred to as “CPA,” who agrees by
314 written contract with the prepaid limited health service
315 organization to comply with the provisions of this act. The
316 contract must state that:
317 (a) The independent certified public accountant must CPA
318 will provide to the prepaid limited health service organization
319 audited statutory financial statements consistent with this act.
320 (b) Any determination by the independent certified public
321 accountant CPA that the prepaid limited health service
322 organization does not meet minimum surplus requirements as set
323 forth in this act must will be stated by the independent
324 certified public accountant CPA, in writing, in the audited
325 financial statement.
326 (c) The completed workpapers and any written communications
327 between the independent certified public accountant CPA and the
328 prepaid limited health service organization relating to the
329 audit of the prepaid limited health service organization must
330 will be made available for review on a visual-inspection-only
331 basis by the office at the offices of the prepaid limited health
332 service organization, at the office, or at any other reasonable
333 place as mutually agreed between the office and the prepaid
334 limited health service organization. The independent certified
335 public accountant CPA must retain for review the workpapers and
336 written communications for a period of not less than 6 years.
337 Section 5. Present subsections (14) through (22) of section
338 641.19, Florida Statutes, are redesignated as subsections (15)
339 through (23), respectively, and a new subsection (14) is added
340 to that section, to read:
341 641.19 Definitions.—As used in this part, the term:
342 (14) “Management services organization” means an entity
343 that provides one or more medical practice management services
344 to health care providers, including, but not limited to,
345 administrative, financial, operational, personnel, records
346 management, educational, compliance, and managed care services.
347 Section 6. Section 641.201, Florida Statutes, is amended to
348 read:
349 641.201 Applicability of other laws.—
350 (1) Except as provided in this part, health maintenance
351 organizations are shall be governed by the provisions of this
352 part and part III of this chapter and are shall be exempt from
353 all other provisions of the Florida Insurance Code except those
354 provisions of the Florida Insurance Code that are explicitly
355 made applicable to health maintenance organizations.
356 (2) Health maintenance organizations are considered
357 insurers for purposes of:
358 (a) Sections 624.4073, 628.231, 628.371, and 628.391.
359 (b) Section 624.4095, except that:
360 1. The ratio of actual or projected annual gross written
361 premiums to current or projected surplus as to policyholders for
362 a health maintenance organization holding a certificate of
363 authority before the effective date of this act, may not exceed
364 30 to 1 on or after July 1, 2017, until June 30, 2021; 20 to 1
365 on or after July 1, 2021, until June 30, 2025; and 10 to 1 on or
366 after July 1, 2025.
367 2. In calculating the premium-to-surplus ratio of a health
368 maintenance organization pursuant to s. 624.4095(1), actual or
369 projected risk revenue must be added to actual or projected
370 written premiums.
371 (3) Health maintenance organizations are considered life
372 and health insurers for purposes of ss. 624.407 and 624.408.
373 Section 7. Subsections (1) and (2) of section 641.225,
374 Florida Statutes, are amended to read:
375 641.225 Surplus requirements.—
376 (1) Each health maintenance organization shall at all times
377 maintain a minimum surplus as provided in s. 624.408 in an
378 amount that is the greater of $1,500,000, or 10 percent of total
379 liabilities, or 2 percent of total annualized premium.
380 (2) The office may shall not issue a certificate of
381 authority, except as provided in subsection (3), unless the
382 health maintenance organization has at least the a minimum
383 surplus required in s. 624.407 in an amount which is the greater
384 of:
385 (a) Ten percent of their total liabilities based on their
386 startup projection as set forth in this part;
387 (b) Two percent of their total projected premiums based on
388 their startup projection as set forth in this part; or
389 (c) $1,500,000, plus all startup losses, excluding profits,
390 projected to be incurred on their startup projection until the
391 projection reflects statutory net profits for 12 consecutive
392 months.
393 Section 8. Effective July 1, 2015, subsections (1), (3),
394 and (5) of section 641.26, Florida Statutes, are amended to
395 read:
396 641.26 Annual and quarterly reports.—
397 (1) Each Every health maintenance organization must file an
398 annual report with the office on or before March 1 of each year
399 showing its condition on the last day of the immediately
400 preceding calendar year. The report must be shall, annually
401 within 3 months after the end of its fiscal year, or within an
402 extension of time therefor as the office, for good cause, may
403 grant, in a form prescribed by the commission, file a report
404 with the office, verified by the notarized oath of two officers
405 of the organization or, if not a corporation, of two persons who
406 are principal managing directors of the affairs of the
407 organization, on a form prescribed by the commission. For good
408 cause, the office may grant the organization an extension of
409 time to file the report. The report must properly notarized,
410 showing its condition on the last day of the immediately
411 preceding reporting period. Such report shall include:
412 (a) A financial statement of the health maintenance
413 organization filed by electronic means in a computer-readable
414 form using a format acceptable to the office.
415 (b) A financial statement of the health maintenance
416 organization filed on forms acceptable to the office.
417 (c) An audited financial statement of the health
418 maintenance organization, including its balance sheet and a
419 statement of operations for the preceding year certified by an
420 independent certified public accountant, prepared in accordance
421 with statutory accounting principles.
422 (c)(d) The number of health maintenance contracts issued
423 and outstanding and the number of health maintenance contracts
424 terminated.
425 (d)(e) The number and amount of damage claims for medical
426 injury initiated against the health maintenance organization and
427 any of the providers engaged by it during the reporting year,
428 broken down into claims with and without formal legal process,
429 and the disposition, if any, of each such claim.
430 (e)(f) An actuarial certification that:
431 1. The health maintenance organization is actuarially
432 sound, which certification must shall consider the rates,
433 benefits, and expenses of, and any other funds available for the
434 payment of obligations of, the organization.
435 2. The rates being charged or to be charged are actuarially
436 adequate to the end of the period for which rates have been
437 guaranteed.
438 3. Incurred but not reported claims and claims reported but
439 not fully paid have been adequately provided for.
440 4. The health maintenance organization has adequately
441 provided for all obligations required by s. 641.35(3)(a).
442 (g) A report prepared by the certified public accountant
443 and filed with the office describing material weaknesses in the
444 health maintenance organization’s internal control structure as
445 noted by the certified public accountant during the audit. The
446 report must be filed with the annual audited financial report as
447 required in paragraph (c). The health maintenance organization
448 shall provide a description of remedial actions taken or
449 proposed to correct material weaknesses, if the actions are not
450 described in the independent certified public accountant’s
451 report.
452 (f)(h) Such other information relating to the performance
453 of health maintenance organizations as is required by the
454 commission or office.
455 (3)(a) Each Every health maintenance organization shall
456 file quarterly, for the first three calendar quarters of each
457 year, an unaudited financial statement of the organization as
458 described in paragraphs (1)(a) and (b). The statement for the
459 quarter ending March 31 shall be filed with the office on or
460 before May 15, the statement for the quarter ending June 30
461 shall be filed on or before August 15, and the statement for the
462 quarter ending September 30 shall be filed on or before November
463 15. The quarterly report must shall be verified by the notarized
464 oath of two officers of the organization, properly notarized.
465 (b) Each health maintenance organization shall file
466 annually, for the preceding year ending December 31, an audited
467 financial statement of the organization. The statement for the
468 year ending December 31 must be filed with the office on or
469 before the following June 1. The office may require a health
470 maintenance organization to file an audited financial report
471 earlier than June 1 upon notifying the organization at least 90
472 days in advance. The audited financial statement must include a
473 balance sheet and statement of operations for the preceding year
474 certified by an independent certified public accountant and must
475 be prepared in accordance with statutory accounting principles.
476 The audited financial statement filed for the year ending
477 December 31, 2015, is subject to commission rules applicable to
478 insurer audits.
479 (5) Each authorized health maintenance organization shall
480 retain an independent certified public accountant, referred to
481 in this section as “CPA,” who agrees by written contract with
482 the health maintenance organization to comply with the
483 provisions of this part.
484 (a) The independent certified public accountant CPA shall
485 provide to the health maintenance organization HMO audited
486 financial statements consistent with this part.
487 (b) Any determination by the independent certified public
488 accountant CPA that the health maintenance organization does not
489 meet minimum surplus requirements as set forth in this part must
490 shall be stated by the independent certified public accountant
491 CPA, in writing, in the audited financial statement.
492 (c) The completed work papers and any written
493 communications between the independent certified public
494 accountant CPA firm and the health maintenance organization
495 relating to the audit of the health maintenance organization
496 shall be made available for review on a visual-inspection-only
497 basis by the office at the offices of the health maintenance
498 organization, at the office, or at any other reasonable place as
499 mutually agreed between the office and the health maintenance
500 organization. The independent certified public accountant CPA
501 must retain for review the work papers and written
502 communications for a period of not less than 6 years.
503 (d) The independent certified public accountant CPA shall
504 provide to the office a written report describing material
505 weaknesses in the health maintenance organization’s internal
506 control structure as noted during the audit. The report must be
507 filed with the annual audited financial statement required under
508 paragraph (3)(b). The health maintenance organization must
509 provide a description of remedial actions taken or proposed to
510 be taken to correct material weaknesses, if the actions are not
511 described in the written report provided to the office by the
512 independent certified public accountant.
513 Section 9. Effective July 1, 2015, section 641.27, Florida
514 Statutes, is amended to read:
515 641.27 Examination by the office department.—
516 (1) The office shall examine the affairs, transactions,
517 accounts, business records, and assets of any health maintenance
518 organization as often as it deems it expedient for the
519 protection of the people of this state, but not less frequently
520 than once every 5 years. However, except when the medical
521 records are requested and copies furnished pursuant to s.
522 456.057, medical records of individuals and records of
523 physicians providing service under contract to the health
524 maintenance organization are shall not be subject to audit,
525 although they may be subject to subpoena by court order upon a
526 showing of good cause. For the purpose of examinations, the
527 office may administer oaths to and examine the officers and
528 agents of a health maintenance organization concerning its
529 business and affairs. The examination of each health maintenance
530 organization by the office shall be subject to the same terms
531 and conditions as apply to insurers under chapter 624. In no
532 event shall expenses of all examinations exceed a maximum of
533 $100,000 $50,000 for any 1-year period. Any rehabilitation,
534 liquidation, conservation, or dissolution of a health
535 maintenance organization shall be conducted under the
536 supervision of the department, which shall have all power with
537 respect thereto granted to it under the laws governing the
538 rehabilitation, liquidation, reorganization, conservation, or
539 dissolution of life insurance companies.
540 (2) The office may contract, at reasonable fees for work
541 performed, with qualified, impartial outside sources to perform
542 audits or examinations or portions thereof pertaining to the
543 qualification of an entity for issuance of a certificate of
544 authority or to determine continued compliance with the
545 requirements of this part, in which case the payment must be
546 made directly to the contracted examiner by the health
547 maintenance organization examined, in accordance with the rates
548 and terms agreed to by the office and the examiner. Any
549 contracted assistance shall be under the direct supervision of
550 the office. The results of any contracted assistance are shall
551 be subject to the review of, and approval, disapproval, or
552 modification by, the office.
553 Section 10. Paragraph (j) is added to subsection (2) of
554 section 641.35, Florida Statutes, to read:
555 641.35 Assets, liabilities, and investments.—
556 (2) ASSETS NOT ALLOWED.—In addition to assets impliedly
557 excluded by the provisions of subsection (1), the following
558 assets are expressly shall not be allowed as assets in any
559 determination of the financial condition of a health maintenance
560 organization:
561 (j) Beginning on or after January 1, 2016, any receivables
562 from a management services organization pursuant to contract
563 with the health maintenance organization.
564 Section 11. Section 641.365, Florida Statutes, is repealed.
565 Section 12. Paragraph (b) of subsection (2) of section
566 817.234, Florida Statutes, is amended to read:
567 817.234 False and fraudulent insurance claims.—
568 (2)
569 (b) In addition to any other provision of law, systematic
570 upcoding by a provider, as defined in s. 641.19(14), with the
571 intent to obtain reimbursement otherwise not due from an insurer
572 is punishable as provided in s. 641.52(5).
573 Section 13. Subsection (1) of section 817.50, Florida
574 Statutes, is amended to read:
575 817.50 Fraudulently obtaining goods, services, etc., from a
576 health care provider.—
577 (1) Whoever shall, willfully and with intent to defraud,
578 obtain or attempt to obtain goods, products, merchandise, or
579 services from any health care provider in this state, as defined
580 in s. 641.19(14), commits a misdemeanor of the second degree,
581 punishable as provided in s. 775.082 or s. 775.083.
582 Section 14. The Division of Law Revision and Information is
583 directed to replace the phrase “the effective date of this act”
584 where it occurs in this act with the date the act becomes a law.
585 Section 15. Except as otherwise provided, this act shall
586 take effect upon becoming a law.