Florida Senate - 2017 CS for CS for SB 240 By the Committees on Health Policy; and Banking and Insurance; and Senators Lee and Mayfield 588-01932-17 2017240c2 1 A bill to be entitled 2 An act relating to direct primary care; amending s. 3 409.977, F.S.; requiring the Agency for Health Care 4 Administration to provide specified financial 5 assistance to certain Medicaid recipients; requiring 6 the agency to resubmit, by a specified date, certain 7 federal waivers or waiver amendments to specified 8 federal entities to incorporate recipient elections of 9 certain direct primary care agreements; creating s. 10 456.0625, F.S.; defining terms; authorizing primary 11 care providers or their agents to enter into direct 12 primary care agreements for providing primary care 13 services; providing applicability; specifying 14 requirements for direct primary care agreements; 15 creating s. 624.27, F.S.; providing construction and 16 applicability of the Florida Insurance Code as to 17 direct primary care agreements; providing an exception 18 for primary care providers or their agents from 19 certain requirements under the code under certain 20 circumstances; providing an effective date. 21 22 Be It Enacted by the Legislature of the State of Florida: 23 24 Section 1. Subsection (4) of section 409.977, Florida 25 Statutes, is amended to read: 26 409.977 Enrollment.— 27 (4) The agency shall: 28 (a) Develop a process to enable a recipient with access to 29 employer-sponsored health care coverage to opt out of all 30 managed care plans and to use Medicaid financial assistance to 31 pay for the recipient’s share of the cost in such employer 32 sponsored coverage. 33 (b) Contingent upon federal approval,
the agency shall also34 enable recipients with access to other insurance or related 35 products providing access to health care services created 36 pursuant to state law, including any product available under the 37 Florida Health Choices Program, or any health exchange, to opt 38 out. 39 (c) Provide The amount offinancial assistance providedfor 40 each recipient in an amount maynot to exceed the amount of the 41 Medicaid premium which thatwould have been paid to a managed 42 care plan for that recipient opting to receive services under 43 this subsection. 44 (d) The agency shallSeek federal approval to require 45 Medicaid recipients with access to employer-sponsored health 46 care coverage to enroll in that coverage and use Medicaid 47 financial assistance to pay for the recipient’s share of the 48 cost for such coverage. The amount of financial assistance 49 provided for each recipient may not exceed the amount of the 50 Medicaid premium that would have been paid to a managed care 51 plan for that recipient. 52 (e) By January 1, 2018, resubmit an appropriate federal 53 waiver or waiver amendment to the Centers for Medicare and 54 Medicaid Services, the United States Department of Health and 55 Human Services, or any other designated federal entity to 56 incorporate the election by a recipient for a direct primary 57 care agreement, as defined in s. 456.0625, within the Statewide 58 Medicaid Managed Care program. 59 Section 2. Section 456.0625, Florida Statutes, is created 60 to read: 61 456.0625 Direct primary care agreements.— 62 (1) As used in this section, the term: 63 (a) “Direct primary care agreement” means a contract 64 between a primary care provider and a patient, the patient’s 65 legal representative, or an employer which meets the 66 requirements specified under subsection (3) and which does not 67 indemnify for services provided by a third party. 68 (b) “Primary care provider” means a health care 69 practitioner licensed under chapter 458, chapter 459, chapter 70 460, or chapter 464 or a primary care group practice that 71 provides medical services to patients which are commonly 72 provided without referral from another health care provider. 73 (c) “Primary care service” means the screening, assessment, 74 diagnosis, and treatment of a patient for the purpose of 75 promoting health or detecting and managing disease or injury 76 within the competency and training of the primary care provider. 77 (2) A primary care provider or an agent of the primary care 78 provider may enter into a direct primary care agreement for 79 providing primary care services. Section 624.27 applies to a 80 direct primary care agreement. 81 (3) A direct primary care agreement must: 82 (a) Be in writing. 83 (b) Be signed by the primary care provider or an agent of 84 the primary care provider and the patient, the patient’s legal 85 representative, or an employer. 86 (c) Allow a party to terminate the agreement by giving the 87 other party at least 30 days’ advance written notice. The 88 agreement may provide for immediate termination due to a 89 violation of the physician-patient relationship or a breach of 90 the terms of the agreement. 91 (d) Describe the scope of primary care services that are 92 covered by the monthly fee. 93 (e) Specify the monthly fee and any fees for primary care 94 services not covered by the monthly fee. 95 (f) Specify the duration of the agreement and any automatic 96 renewal provisions. 97 (g) Offer a refund to the patient of monthly fees paid in 98 advance if the primary care provider ceases to offer primary 99 care services for any reason. 100 (h) Contain, in contrasting color and in not less than 12 101 point type, the following statements on the same page as the 102 applicant’s signature: 103 1. This agreement is not health insurance, and the primary 104 care provider will not file any claims against the patient’s 105 health insurance policy or plan for reimbursement of any primary 106 care services covered by this agreement. 107 2. This agreement does not qualify as minimum essential 108 coverage to satisfy the individual shared responsibility 109 provision of the federal Patient Protection and Affordable Care 110 Act, Pub. L. No. 111-148. 111 3. This agreement is not workers’ compensation insurance 112 and may not replace the employer’s obligations under chapter 113 440, Florida Statutes. 114 Section 3. Section 624.27, Florida Statutes, is created to 115 read: 116 624.27 Application of code as to direct primary care 117 agreements.— 118 (1) A direct primary care agreement, as defined in s. 119 456.0625, does not constitute insurance and is not subject to 120 any chapter of the Florida Insurance Code. The act of entering 121 into a direct primary care agreement does not constitute the 122 business of insurance and is not subject to any chapter of the 123 Florida Insurance Code. 124 (2) A primary care provider or an agent of a primary care 125 provider is not required to obtain a certificate of authority or 126 license under any chapter of the Florida Insurance Code to 127 market, sell, or offer to sell a direct primary care agreement 128 pursuant to s. 456.0625. 129 Section 4. This act shall take effect July 1, 2017.