Florida Senate - 2019                                     SB 524
       By Senator Diaz
       36-00918-19                                            2019524__
    1                        A bill to be entitled                      
    2         An act relating to health insurance savings programs;
    3         creating 627.6387, F.S.; providing a short title;
    4         providing definitions; authorizing health insurers and
    5         health maintenance organizations to implement shared
    6         savings incentive programs; providing procedures and
    7         requirements for such programs; providing
    8         construction; providing that a direct written premium
    9         must be reduced by the dollar amount of certain
   10         incentives, for the purpose of certain taxes;
   11         providing website requirements; providing notification
   12         requirements; requiring the Office of Insurance
   13         Regulation to review insurers’ filings of their
   14         program descriptions; limiting the amount of annual
   15         savings incentives; authorizing the office to make
   16         rules; providing an effective date.
   18  Be It Enacted by the Legislature of the State of Florida:
   20         Section 1. Section 627.6387, Florida Statutes, is created
   21  to read:
   22         627.6387 Shared savings incentive program.—
   23         (1) This section may be cited as the “Patient Savings Act.”
   24         (2) As used in this section, the term:
   25         (a) “Contracted amount” means the amount agreed to be paid
   26  by the health insurer pursuant to a policy, contract, or
   27  certificate of insurance to a health care provider for shoppable
   28  health care services covered by the policy, contract, or
   29  certificate of insurance.
   30         (b) “Health care provider” means a hospital, an ambulatory
   31  surgical center, and any other medical facility licensed under
   32  chapter 395; a home health agency licensed under chapter 400; a
   33  physician licensed under chapter 458; a physician assistant
   34  licensed under chapter 458 or chapter 459; an osteopathic
   35  physician licensed under chapter 459; a chiropractic physician
   36  licensed under chapter 460; a podiatric physician licensed under
   37  chapter 461; a naturopath licensed under chapter 462; a nurse
   38  licensed under part I of chapter 464; a dentist licensed under
   39  chapter 466; a midwife licensed under chapter 467; an
   40  occupational therapist licensed under chapter 468; radiological
   41  personnel certified under chapter 468; clinical laboratory
   42  personnel licensed under chapter 483; a physical therapist and a
   43  physical therapist assistant licensed under chapter 486; a blood
   44  bank, plasma center, industrial clinic, and renal dialysis
   45  facility; or a professional association, partnership,
   46  corporation, joint venture, or other association for
   47  professional activity by health care providers.
   48         (c) “Health insurer” means an authorized insurer offering
   49  health insurance as defined in s. 624.603 or a health
   50  maintenance organization as defined in s. 641.19. The term does
   51  not include the state group health insurance program provided
   52  under s. 110.123.
   53         (d) “Shared savings incentive” means a voluntary and
   54  optional cash incentive that a health insurer may provide to an
   55  insured for choosing certain shoppable health care services
   56  under a shared savings incentive program and may include, but is
   57  not limited to, the incentives described in s. 626.9541(4)(a).
   58         (e) “Shared savings incentive program” means a voluntary
   59  and optional incentive program established by a health insurer
   60  pursuant to this section.
   61         (f) “Shoppable health care services” means a nonemergency
   62  health care service for which an insured may receive a shared
   63  savings incentive under a health insurer’s shared savings
   64  incentive program. Shoppable health care services include:
   65         1. Clinical laboratory services.
   66         2. Infusion therapy.
   67         3. Inpatient and outpatient surgical procedures.
   68         4. Obstetrical and gynecological services.
   69         5. Inpatient and outpatient nonsurgical diagnostic tests
   70  and procedures.
   71         6. Physical and occupational therapy services.
   72         7. Radiology and imaging services.
   73         8. Prescription drugs.
   74         9. Telehealth services.
   75         (3) Notwithstanding any other provision of law, a health
   76  insurer may implement a shared savings incentive program to
   77  provide incentives to an insured when the insured obtains a
   78  shoppable health care service from the health insurer’s shared
   79  savings list. The insurer’s shared savings incentive list may
   80  include shoppable health care services in and out of this state.
   81         (a) An insured is not required to participate in a health
   82  insurer’s shared savings incentive program.
   83         (b) A health insurer is not required to establish a shared
   84  savings incentive program. A health insurer may terminate a
   85  shared savings incentive program with a 30 days’ notice to the
   86  office before termination.
   87         (c) If an insured elects to receive a shoppable health care
   88  service from the health insurer’s shared savings incentive list,
   89  the health insurer shall deposit into, or shall credit, the
   90  insured’s account with the shared savings incentive amount.
   91         (d) A shared savings incentive made by a health insurer in
   92  accordance with this section is not an administrative expense
   93  for rate development or rate filing purposes.
   94         (e) A shared savings incentive provided to the insured
   95  under this section is deemed a return of premium or a reduction
   96  in premium based on expected claims experience and does not
   97  constitute income to the insured.
   98         (f) A health insurer’s direct written premium must be
   99  reduced by the dollar amount of the shared savings incentives
  100  provided to the insured under this section for the purposes of
  101  the premium tax in s. 624.509 and the retaliatory tax in s.
  102  624.5091.
  103         (4) If a health insurer establishes a shared savings
  104  incentive program, the shared savings incentive program must be
  105  a component part of the policy, contract, or certificate of
  106  insurance provided by the health insurer. Annually and at the
  107  time of enrollment or renewal, a health insurer must notify each
  108  insured of the shared savings incentive program.
  109         (5) If a health insurer establishes a shared savings
  110  incentive program, the health insurer must:
  111         (a) Provide on its website a method for an insured to
  112  request and obtain information on the contracted amount for
  113  shoppable health care services from a health care provider and
  114  indicate whether a shared savings incentive applies to a
  115  particular shoppable health care service.
  116         (b) Notify insureds and applicants for insurance of the
  117  availability of the shared savings incentive program and the
  118  procedure to participate in the program at the time of
  119  enrollment. Thereafter, annually and at the time of renewal, the
  120  health insurer must notify each insured of the shared savings
  121  incentive program.
  122         (6) A health insurer must file a description of the shared
  123  savings incentive program on a form prescribed by the office.
  124  The office must review the filing to determine if the shared
  125  savings incentive program complies with this section.
  126         (7) A shared savings incentive provided under this section
  127  is presumed to be appropriate unless credible data clearly
  128  demonstrates otherwise; however, shared savings incentives
  129  provided to an insured each year may not exceed 30 percent of
  130  the insured’s annual paid premium.
  131         (8) The office may adopt rules necessary to implement and
  132  enforce this section.
  133         Section 2. This act shall take effect January 1, 2020.