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