Florida Senate - 2019 CS for SB 524
By the Committee on Banking and Insurance; and Senators Diaz and
Farmer
597-02919-19 2019524c1
1 A bill to be entitled
2 An act relating to health insurance savings programs;
3 creating s. 627.6387, F.S.; providing a short title;
4 defining terms; authorizing health insurers, which
5 include health maintenance organizations, to offer
6 shared savings incentive programs to insureds;
7 providing that insureds are not required to
8 participate in such programs; specifying requirements
9 for health insurers offering such programs; requiring
10 the Office of Insurance Regulation to review filed
11 descriptions of programs and make a certain
12 determination; providing notification and account
13 credit or deposit requirements for insurers;
14 specifying the minimum shared savings incentive and
15 the basis for calculating savings; specifying
16 requirements for annual reports submitted by insurers
17 to the office; providing construction; providing that
18 certain shared saving incentive amounts reduce an
19 insurer’s direct written premium for purposes of the
20 insurance premium tax and the retaliatory tax;
21 authorizing the Financial Services Commission to adopt
22 rules; providing an effective date.
23
24 Be It Enacted by the Legislature of the State of Florida:
25
26 Section 1. Section 627.6387, Florida Statutes, is created
27 to read:
28 627.6387 Shared savings incentive program.—
29 (1) This section may be cited as the “Patient Savings Act.”
30 (2) As used in this section, the term:
31 (a) “Health care provider” means a hospital, a facility
32 licensed under chapter 395; an entity licensed under chapter
33 400; a health care practitioner as defined in s. 456.001; a
34 blood bank, plasma center, industrial clinic, and renal dialysis
35 facility; or a professional association, partnership,
36 corporation, joint venture, or other association for
37 professional activity by health care providers. The term
38 includes entities and professionals outside of this state with
39 an active, unencumbered license for an equivalent facility or
40 practitioner type issued by another state, the District of
41 Columbia, or a possession or territory of the United States.
42 (b) “Health insurer” means an authorized insurer offering
43 health insurance as defined in s. 624.603 or a health
44 maintenance organization as defined in s. 641.19. The term does
45 not include the state group health insurance program provided
46 under s. 110.123.
47 (c) “Shared savings incentive” means a voluntary and
48 optional financial incentive that a health insurer may provide
49 to an insured for choosing certain shoppable health care
50 services under a shared savings incentive program and may
51 include, but is not limited to, the incentives described in s.
52 626.9541(4)(a).
53 (d) “Shared savings incentive program” means a voluntary
54 and optional incentive program established by a health insurer
55 pursuant to this section.
56 (e) “Shoppable health care service” means a lower-cost,
57 high-quality nonemergency health care service for which a shared
58 savings incentive is available for insureds under a health
59 insurer’s shared savings incentive program. Shoppable health
60 care services may be provided within or outside of this state
61 and include, but are not limited to:
62 1. Clinical laboratory services.
63 2. Infusion therapy.
64 3. Inpatient and outpatient surgical procedures.
65 4. Obstetrical and gynecological services.
66 5. Inpatient and outpatient nonsurgical diagnostic tests
67 and procedures.
68 6. Physical and occupational therapy services.
69 7. Radiology and imaging services.
70 8. Prescription drugs.
71 9. Services provided through telehealth.
72 (3) A health insurer may offer a shared savings incentive
73 program to provide incentives to an insured when the insured
74 obtains a shoppable health care service from the health
75 insurer’s shared savings list. An insured may not be required to
76 participate in a shared savings incentive program. A health
77 insurer that offers a shared savings incentive program must:
78 (a) Establish the program as a component part of the
79 policy, contract, or certificate of insurance provided by the
80 health insurer and notify the insureds and the office at least
81 30 days before program termination.
82 (b) File a description of the program on a form prescribed
83 by commission rule. The office must review the filing and
84 determine whether the shared savings incentive program complies
85 with this section.
86 (c) Notify an insured annually and at the time of renewal,
87 and an applicant for insurance at the time of enrollment, of the
88 availability of the shared savings incentive program and the
89 procedure to participate in the program.
90 (d) Publish on a webpage easily accessible to insureds and
91 to applicants for insurance a list of shoppable health care
92 services and health care providers and the shared savings
93 incentive amount applicable for each service. A shared savings
94 incentive may not be less than 25 percent of the savings
95 generated by the insured’s participation in any shared savings
96 incentive offered by the health insurer. The baseline for the
97 savings calculation is the average in-network amount paid for
98 that service in the most recent 12-month period or some other
99 methodology established by the health insurer and approved by
100 the office.
101 (e) At least quarterly, credit or deposit the shared
102 savings incentive amount to the insured’s account as a return or
103 reduction in premium, or credit the shared savings incentive
104 amount to the insured’s flexible spending account, health
105 savings account, or health reimbursement account, such that the
106 amount does not constitute income to the insured.
107 (f) Submit an annual report to the office within 90
108 business days after the close of each plan year. At a minimum,
109 the report must include the following information:
110 1. The number of insureds who participated in the program
111 during the plan year and the number of instances of
112 participation.
113 2. The total cost of services provided as a part of the
114 program.
115 3. The total value of the shared savings incentive payments
116 made to insureds participating in the program and the values
117 distributed as premium reductions, credits to flexible spending
118 accounts, credits to health savings accounts, or credits to
119 health reimbursement accounts.
120 4. An inventory of the shoppable health care services
121 offered by the health insurer.
122 (4)(a) A shared savings incentive offered by a health
123 insurer in accordance with this section:
124 1. Is not an administrative expense for rate development or
125 rate filing purposes.
126 2. Does not constitute an unfair method of competition or
127 an unfair or deceptive act or practice under s. 626.9541 and is
128 presumed to be appropriate unless credible data clearly
129 demonstrates otherwise.
130 (b) A shared saving incentive amount provided as a return
131 or reduction in premium reduces the health insurer’s direct
132 written premium by the shared saving incentive dollar amount for
133 the purposes of the taxes in ss. 624.509 and 624.5091.
134 (5) The commission may adopt rules necessary to implement
135 and enforce this section.
136 Section 2. This act shall take effect January 1, 2020.