Florida Senate - 2017                        COMMITTEE AMENDMENT
       Bill No. SB 102
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  04/19/2017           .                                

       The Committee on Rules (Flores) recommended the following:
    1         Senate Amendment to Amendment (321438) (with title
    2  amendment)
    4         Delete line 29
    5  and insert:
    6         Section 3. Subsection (1) of section 626.88, Florida
    7  Statutes, is amended to read:
    8         626.88 Definitions.—For the purposes of this part, the
    9  term:
   10         (1) “Administrator” is any person who directly or
   11  indirectly solicits or effects coverage of, collects charges or
   12  premiums from, or adjusts or settles claims on residents of this
   13  state in connection with authorized commercial self-insurance
   14  funds or with insured or self-insured programs which provide
   15  life or health insurance coverage or coverage of any other
   16  expenses described in s. 624.33(1); or any person who, through a
   17  health care risk contract as defined in s. 641.234 with an
   18  insurer or health maintenance organization, provides billing and
   19  collection services to health insurers and health maintenance
   20  organizations on behalf of health care providers; or a pharmacy
   21  benefits manager as defined in s. 465.1862(1). The term does not
   22  include the following persons, other than any of the following
   23  persons:
   24         (a) An employer or wholly owned direct or indirect
   25  subsidiary of an employer, on behalf of such employer’s
   26  employees or the employees of one or more subsidiary or
   27  affiliated corporations of such employer.
   28         (b) A union on behalf of its members.
   29         (c) An insurance company which is either authorized to
   30  transact insurance in this state or is acting as an insurer with
   31  respect to a policy lawfully issued and delivered by such
   32  company in and pursuant to the laws of a state in which the
   33  insurer was authorized to transact an insurance business.
   34         (d) A health care services plan, health maintenance
   35  organization, professional service plan corporation, or person
   36  in the business of providing continuing care, possessing a valid
   37  certificate of authority issued by the office, and the sales
   38  representatives thereof, if the activities of such entity are
   39  limited to the activities permitted under the certificate of
   40  authority.
   41         (e) An entity that is affiliated with an insurer and that
   42  only performs the contractual duties, between the administrator
   43  and the insurer, of an administrator for the direct and assumed
   44  insurance business of the affiliated insurer. The insurer is
   45  responsible for the acts of the administrator and is responsible
   46  for providing all of the administrator’s books and records to
   47  the insurance commissioner, upon a request from the insurance
   48  commissioner. For purposes of this paragraph, the term “insurer”
   49  means a licensed insurance company, health maintenance
   50  organization, prepaid limited health service organization, or
   51  prepaid health clinic.
   52         (f) A nonresident entity licensed in its state of domicile
   53  as an administrator if its duties in this state are limited to
   54  the administration of a group policy or plan of insurance and no
   55  more than a total of 100 lives for all plans reside in this
   56  state.
   57         (g) An insurance agent licensed in this state whose
   58  activities are limited exclusively to the sale of insurance.
   59         (h) A person licensed as a managing general agent in this
   60  state, whose activities are limited exclusively to the scope of
   61  activities conveyed under such license.
   62         (i) An adjuster licensed in this state whose activities are
   63  limited to the adjustment of claims.
   64         (j) A creditor on behalf of such creditor’s debtors with
   65  respect to insurance covering a debt between the creditor and
   66  its debtors.
   67         (k) A trust and its trustees, agents, and employees acting
   68  pursuant to such trust established in conformity with 29 U.S.C.
   69  s. 186.
   70         (l) A trust exempt from taxation under s. 501(a) of the
   71  Internal Revenue Code, a trust satisfying the requirements of
   72  ss. 624.438 and 624.439, or any governmental trust as defined in
   73  s. 624.33(3), and the trustees and employees acting pursuant to
   74  such trust, or a custodian and its agents and employees,
   75  including individuals representing the trustees in overseeing
   76  the activities of a service company or administrator, acting
   77  pursuant to a custodial account which meets the requirements of
   78  s. 401(f) of the Internal Revenue Code.
   79         (m) A financial institution which is subject to supervision
   80  or examination by federal or state authorities or a mortgage
   81  lender licensed under chapter 494 who collects and remits
   82  premiums to licensed insurance agents or authorized insurers
   83  concurrently or in connection with mortgage loan payments.
   84         (n) A credit card issuing company which advances for and
   85  collects premiums or charges from its credit card holders who
   86  have authorized such collection if such company does not adjust
   87  or settle claims.
   88         (o) A person who adjusts or settles claims in the normal
   89  course of such person’s practice or employment as an attorney at
   90  law and who does not collect charges or premiums in connection
   91  with life or health insurance coverage.
   92         (p) A person approved by the department who administers
   93  only self-insured workers’ compensation plans.
   94         (q) A service company or service agent and its employees,
   95  authorized in accordance with ss. 626.895-626.899, serving only
   96  a single employer plan, multiple-employer welfare arrangements,
   97  or a combination thereof.
   98         (r) Any provider or group practice, as defined in s.
   99  456.053, providing services under the scope of the license of
  100  the provider or the member of the group practice.
  101         (s) Any hospital providing billing, claims, and collection
  102  services solely on its own and its physicians’ behalf and
  103  providing services under the scope of its license.
  104         (t) A corporation not for profit whose membership consists
  105  entirely of local governmental units authorized to enter into
  106  risk management consortiums under s. 112.08.
  108  A person who provides billing and collection services to health
  109  insurers and health maintenance organizations on behalf of
  110  health care providers shall comply with the provisions of ss.
  111  627.6131, 641.3155, and 641.51(4).
  112         Section 4. Present subsection (6) of section 626.8805,
  113  Florida Statutes, is redesignated as subsection (7), and a new
  114  subsection (6) is added to that section, to read:
  115         626.8805 Certificate of authority to act as administrator.—
  116         (6) The office shall conduct quarterly audits of each
  117  pharmacy benefits manager who holds a certificate of authority
  118  to act as an administrator under this part for the purpose of
  119  determining whether the pharmacy benefits manager violated any
  120  provision of s. 465.1862 or failed to perform as required under
  121  that section.
  122         Section 5. Subsection (2) of section 626.891, Florida
  123  Statutes, is amended to read:
  124         626.891 Grounds for suspension or revocation of certificate
  125  of authority.—
  126         (2) The office may, in its discretion, suspend or revoke
  127  the certificate of authority of an administrator if it finds
  128  that the administrator:
  129         (a) Has violated any lawful rule or order of the commission
  130  or office, or any provision of this chapter, s. 465.1862, or s.
  131  465.1885;
  132         (b) Has refused to be examined or to produce its accounts,
  133  records, and files for examination, or if any of its officers
  134  has refused to give information with respect to its affairs or
  135  has refused to perform any other legal obligation as to such
  136  examination, when required by the office;
  137         (c) Has, without just cause, refused to pay proper claims
  138  or perform services arising under its contracts or has, without
  139  just cause, compelled insured persons to accept less than the
  140  amount due them or to employ attorneys or bring suit against the
  141  administrator to secure full payment or settlement of such
  142  claims;
  143         (d) Is or was affiliated with and under the same general
  144  management or interlocking directorate or ownership as another
  145  administrator which transacts business in this state without
  146  having a certificate of authority;
  147         (e) At any time fails to meet any qualification for which
  148  issuance of the certificate could have been refused had such
  149  failure then existed and been known to the office;
  150         (f) Has been convicted of, or has entered a plea of guilty
  151  or nolo contendere to, a felony relating to the business of
  152  insurance or insurance administration in this state or in any
  153  other state without regard to whether adjudication was withheld;
  154  or
  155         (g) Is under suspension or revocation in another state.
  156         Section 6. Subsection (3) of section 626.894, Florida
  157  Statutes, is amended to read:
  158         626.894 Administrative fine in lieu of suspension or
  159  revocation.—
  160         (3) With respect to any knowing and willful violation of a
  161  lawful order or rule of the office or commission, or a provision
  162  of this part, s. 465.1862, or s. 465.1885, the office may impose
  163  a fine upon the administrator in an amount not to exceed $5,000
  164  for each such violation. In no event may such fine exceed an
  165  aggregate amount of $25,000 for all knowing and willful
  166  violations arising out of the same action. In addition to such
  167  fine, the administrator shall make restitution when due in
  168  accordance with the provisions of subsection (2).
  169         Section 7. Until December 31, 2017, the Office of Insurance
  170  Regulation may not penalize a pharmacy benefits manager, as
  171  defined in s. 465.1862(1), Florida Statutes, for operating as an
  172  administrator if the pharmacy benefits manager applies for a
  173  certificate of authority by October 1, 2017, and is issued such
  174  certificate of authority by December 31, 2017.
  175         Section 8. This act shall take effect July 1, 2017.
  177  ================= T I T L E  A M E N D M E N T ================
  178  And the title is amended as follows:
  179         Delete lines 36 - 44
  180  and insert:
  181         An act relating to health care; amending s. 627.6131,
  182         F.S.; prohibiting a health insurer from retroactively
  183         denying a claim under specified circumstances;
  184         providing applicability; amending s. 641.3155, F.S.;
  185         prohibiting a health maintenance organization from
  186         retroactively denying a claim under specified
  187         circumstances; providing applicability; exempting
  188         certain Medicaid managed care plans; amending s.
  189         626.88, F.S.; redefining the term “administrator” to
  190         include a pharmacy benefits manager; amending s.
  191         626.8805, F.S.; requiring the Office of Insurance
  192         Regulation to conduct quarterly audits, for a certain
  193         purpose, of pharmacy benefits managers that hold
  194         certificates of authority to act as administrators;
  195         amending ss. 626.891 and 626.894, F.S.; adding
  196         violations of certain provisions of the Florida
  197         Pharmacy Act as grounds for the office’s suspension or
  198         revocation of an administrator’s certificate of
  199         authority or imposition of a fine, respectively;
  200         prohibiting the office, until a specified date, from
  201         penalizing a pharmacy benefits manager for operating
  202         as an administrator if the pharmacy benefits manager
  203         meets certain conditions; providing an effective date.