Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 524
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Banking and Insurance (Diaz) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 627.6387, Florida Statutes, is created
    6  to read:
    7         627.6387Shared savings incentive program.—
    8         (1)This section may be cited as the “Patient Savings Act.”
    9         (2)As used in this section, the term:
   10         (a)“Health care provider” means a hospital, a facility
   11  licensed under chapter 395; an entity licensed under chapter
   12  400; a health care practitioner as defined in s. 456.001; a
   13  blood bank, plasma center, industrial clinic, and renal dialysis
   14  facility; or a professional association, partnership,
   15  corporation, joint venture, or other association for
   16  professional activity by health care providers. The term
   17  includes entities and professionals outside of this state with
   18  an active, unencumbered license for an equivalent facility or
   19  practitioner type issued by another state, the District of
   20  Columbia, or a possession or territory of the United States.
   21         (b)“Health insurer” means an authorized insurer offering
   22  health insurance as defined in s. 624.603 or a health
   23  maintenance organization as defined in s. 641.19. The term does
   24  not include the state group health insurance program provided
   25  under s. 110.123.
   26         (c)“Shared savings incentive” means a voluntary and
   27  optional financial incentive that a health insurer may provide
   28  to an insured for choosing certain shoppable health care
   29  services under a shared savings incentive program and may
   30  include, but is not limited to, the incentives described in s.
   31  626.9541(4)(a).
   32         (d)“Shared savings incentive program” means a voluntary
   33  and optional incentive program established by a health insurer
   34  pursuant to this section.
   35         (e)“Shoppable health care service” means a lower-cost,
   36  high-quality nonemergency health care service for which a shared
   37  savings incentive is available for insureds under a health
   38  insurer’s shared savings incentive program. Shoppable health
   39  care services may be provided within or outside of this state
   40  and include, but are not limited to:
   41         1.Clinical laboratory services.
   42         2.Infusion therapy.
   43         3.Inpatient and outpatient surgical procedures.
   44         4.Obstetrical and gynecological services.
   45         5.Inpatient and outpatient nonsurgical diagnostic tests
   46  and procedures.
   47         6.Physical and occupational therapy services.
   48         7.Radiology and imaging services.
   49         8.Prescription drugs.
   50         9.Services provided through telehealth.
   51         (3)A health insurer may offer a shared savings incentive
   52  program to provide incentives to an insured when the insured
   53  obtains a shoppable health care service from the health
   54  insurer’s shared savings list. An insured may not be required to
   55  participate in a shared savings incentive program. A health
   56  insurer that offers a shared savings incentive program must:
   57         (a)Establish the program as a component part of the
   58  policy, contract, or certificate of insurance provided by the
   59  health insurer and notify the insureds and the office at least
   60  30 days before program termination.
   61         (b)File a description of the program on a form prescribed
   62  by commission rule. The office must review the filing and
   63  determine whether the shared savings incentive program complies
   64  with this section.
   65         (c)Notify an insured annually and at the time of renewal,
   66  and an applicant for insurance at the time of enrollment, of the
   67  availability of the shared savings incentive program and the
   68  procedure to participate in the program.
   69         (d)Publish on a webpage easily accessible to insureds and
   70  to applicants for insurance a list of shoppable health care
   71  services and health care providers and the shared savings
   72  incentive amount applicable for each service. A shared savings
   73  incentive may not be less than 25 percent of the savings
   74  generated by the insured’s participation in any shared savings
   75  incentive offered by the health insurer. The baseline for the
   76  savings calculation is the average in-network amount paid for
   77  that service in the most recent 12-month period or some other
   78  methodology established by the health insurer and approved by
   79  the Commissioner of Insurance Regulation.
   80         (e)At least quarterly, credit or deposit the shared
   81  savings incentive amount to the insured’s account as a return or
   82  reduction in premium, or credit the shared savings incentive
   83  amount to the insured’s flexible spending account, health
   84  savings account, or health reimbursement account, such that the
   85  amount does not constitute income to the insured.
   86         (f)Submit an annual report to the office within 90
   87  business days after the close of each plan year. At a minimum,
   88  the report must include the following information:
   89         1.The number of insureds who participated in the program
   90  during the plan year and the number of instances of
   91  participation.
   92         2.The total cost of services provided as a part of the
   93  program.
   94         3.The total value of the shared savings incentive payments
   95  made to insureds participating in the program and the values
   96  distributed as premium reductions, credits to flexible spending
   97  accounts, credits to health savings accounts, or credits to
   98  health reimbursement accounts.
   99         4.An inventory of the shoppable health care services
  100  offered by the health insurer.
  101         (4)(a)A shared savings incentive offered by a health
  102  insurer in accordance with this section:
  103         1.Is not an administrative expense for rate development or
  104  rate filing purposes.
  105         2.Does not constitute an unfair method of competition or
  106  an unfair or deceptive act or practice under s. 626.9541 and is
  107  presumed to be appropriate unless credible data clearly
  108  demonstrates otherwise.
  109         (b)A shared saving incentive amount provided as a return
  110  or reduction in premium reduces the health insurer’s direct
  111  written premium by the shared saving incentive dollar amount for
  112  the purposes of the taxes in ss. 624.509 and 624.5091.
  113         (5)The commission may adopt rules necessary to implement
  114  and enforce this section.
  115         Section 2. This act shall take effect January 1, 2020.
  117  ================= T I T L E  A M E N D M E N T ================
  118  And the title is amended as follows:
  119         Delete everything before the enacting clause
  120  and insert:
  121                        A bill to be entitled                      
  122         An act relating to health insurance savings programs;
  123         creating s. 627.6387, F.S.; providing a short title;
  124         defining terms; authorizing health insurers, which
  125         include health maintenance organizations, to offer
  126         shared savings incentive programs to insureds;
  127         providing that insureds are not required to
  128         participate in such programs; specifying requirements
  129         for health insurers offering such programs; requiring
  130         the Office of Insurance Regulation to review filed
  131         descriptions of programs and make a certain
  132         determination; providing notification and account
  133         credit or deposit requirements for insurers;
  134         specifying the minimum shared savings incentive and
  135         the basis for calculating savings; specifying
  136         requirements for annual reports submitted by insurers
  137         to the office; providing construction; providing that
  138         certain shared saving incentive amounts reduce an
  139         insurer’s direct written premium for purposes of the
  140         insurance premium tax and the retaliatory tax;
  141         authorizing the Financial Services Commission to adopt
  142         rules; providing an effective date.