Florida Senate - 2019                              CS for SB 524
       By the Committee on Banking and Insurance; and Senators Diaz and
       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.
   24  Be It Enacted by the Legislature of the State of Florida:
   26         Section 1. Section 627.6387, Florida Statutes, is created
   27  to read:
   28         627.6387Shared 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.