CS for CS for CS for SB 892               Second Engrossed (ntc)
       
       
       
       
       
       
       
       
       2024892e2
       
    1                        A bill to be entitled                      
    2         An act relating to dental insurance claims; amending
    3         s. 627.6131, F.S.; prohibiting a contract between a
    4         health insurer and a dentist from containing certain
    5         restrictions on payment methods; requiring a health
    6         insurer to make certain notifications and obtain a
    7         dentist’s consent before paying a claim to the dentist
    8         through electronic funds transfer; providing that the
    9         dentist’s consent applies to the dentist’s entire
   10         practice; requiring the dentist’s consent to bear the
   11         signature of the dentist; specifying the form of such
   12         signature; prohibiting the insurer and dentist from
   13         requiring consent on a patient-by-patient basis;
   14         specifying the requirements of a certain notification;
   15         prohibiting a health insurer from charging a fee to
   16         transmit a payment to a dentist through Automated
   17         Clearing House (ACH) transfer unless the dentist has
   18         consented to such fee; providing applicability;
   19         authorizing the Office of Insurance Regulation of the
   20         Financial Services Commission to enforce certain
   21         provisions; authorizing the commission to adopt rules;
   22         prohibiting a health insurer from denying claims for
   23         procedures included in a prior authorization;
   24         providing exceptions; providing applicability;
   25         authorizing the office to enforce certain provisions;
   26         authorizing the commission to adopt rules; amending s.
   27         636.032, F.S.; prohibiting a contract between a
   28         prepaid limited health service organization and a
   29         dentist from containing certain restrictions on
   30         payment methods; requiring the prepaid limited health
   31         service organization to make certain notifications and
   32         obtain a dentist’s consent before paying a claim to
   33         the dentist through electronic funds transfer;
   34         providing that a dentist’s consent applies to the
   35         dentist’s entire practice; requiring the dentist’s
   36         consent to bear the signature of the dentist;
   37         specifying the form of such signature; prohibiting the
   38         limited health service organization and dentist from
   39         requiring consent on a patient-by-patient basis;
   40         specifying the requirements of a certain notification;
   41         prohibiting a prepaid limited health service
   42         organization from charging a fee to transmit a payment
   43         to a dentist through ACH transfer unless the dentist
   44         has consented to such fee; providing applicability;
   45         authorizing the office to enforce certain provisions;
   46         authorizing the commission to adopt rules; amending s.
   47         636.035, F.S.; prohibiting a prepaid limited health
   48         service organization from denying claims for
   49         procedures included in a prior authorization;
   50         providing exceptions; providing applicability;
   51         authorizing the office to enforce certain provisions;
   52         authorizing the commission to adopt rules; amending s.
   53         641.315, F.S.; prohibiting a contract between a health
   54         maintenance organization and a dentist from containing
   55         certain restrictions on payment methods; requiring the
   56         health maintenance organization to make certain
   57         notifications and obtain a dentist’s consent before
   58         paying a claim to the dentist through electronic funds
   59         transfer; providing that the dentist’s consent applies
   60         to the dentist’s entire practice; requiring the
   61         dentist’s consent to bear the signature of the
   62         dentist; specifying the form of such signature;
   63         prohibiting the health maintenance organization and
   64         dentist from requiring consent on a patient-by-patient
   65         basis; specifying the requirements of a certain
   66         notification; prohibiting a health maintenance
   67         organization from charging a fee to transmit a payment
   68         to a dentist through ACH transfer unless the dentist
   69         has consented to such fee; providing applicability;
   70         authorizing the office to enforce certain provisions;
   71         authorizing the commission to adopt rules; prohibiting
   72         a health maintenance organization from denying claims
   73         for procedures included in a prior authorization;
   74         providing exceptions; providing applicability;
   75         authorizing the office to enforce certain provisions;
   76         authorizing the commission to adopt rules; providing
   77         an effective date.
   78          
   79  Be It Enacted by the Legislature of the State of Florida:
   80  
   81         Section 1. Subsections (20) and (21) are added to section
   82  627.6131, Florida Statutes, to read:
   83         627.6131 Payment of claims.—
   84         (20)(a) A contract between a health insurer and a dentist
   85  licensed under chapter 466 for the provision of services to an
   86  insured may not specify credit card payment as the only
   87  acceptable method for payments from the health insurer to the
   88  dentist.
   89         (b) When a health insurer employs the method of claims
   90  payment to a dentist through electronic funds transfer,
   91  including, but not limited to, virtual credit card payment, the
   92  health insurer shall notify the dentist as provided in this
   93  paragraph and obtain the dentist’s consent before employing the
   94  electronic funds transfer. The dentist’s consent described in
   95  this paragraph applies to the dentist’s entire practice. For the
   96  purpose of this paragraph, the dentist’s consent, which may be
   97  given through e-mail, must bear the signature of the dentist.
   98  Such signature includes an electronic or digital signature if
   99  the form of signature is recognized as a valid signature under
  100  applicable federal law or state contract law or an act that
  101  demonstrates express consent, including, but not limited to,
  102  checking a box indicating consent. The insurer or dentist may
  103  not require that a dentist’s consent as described in this
  104  paragraph be made on a patient-by-patient basis. The
  105  notification provided by the health insurer to the dentist must
  106  include all of the following:
  107         1. The fees, if any, associated with the electronic funds
  108  transfer.
  109         2. The available methods of payment of claims by the health
  110  insurer, with clear instructions to the dentist on how to select
  111  an alternative payment method.
  112         (c) A health insurer that pays a claim to a dentist through
  113  Automated Clearing House transfer may not charge a fee solely to
  114  transmit the payment to the dentist unless the dentist has
  115  consented to the fee.
  116         (d) This subsection applies to contracts delivered, issued,
  117  or renewed on or after January 1, 2025.
  118         (e) The office has all rights and powers to enforce this
  119  subsection as provided by s. 624.307.
  120         (f) The commission may adopt rules to implement this
  121  subsection.
  122         (21)(a) A health insurer may not deny any claim
  123  subsequently submitted by a dentist licensed under chapter 466
  124  for procedures specifically included in a prior authorization
  125  unless at least one of the following circumstances applies for
  126  each procedure denied:
  127         1. Benefit limitations, such as annual maximums and
  128  frequency limitations not applicable at the time of the prior
  129  authorization, are reached subsequent to issuance of the prior
  130  authorization.
  131         2. The documentation provided by the person submitting the
  132  claim fails to support the claim as originally authorized.
  133         3. Subsequent to the issuance of the prior authorization,
  134  new procedures are provided to the patient or a change in the
  135  condition of the patient occurs such that the prior authorized
  136  procedure would no longer be considered medically necessary,
  137  based on the prevailing standard of care.
  138         4. Subsequent to the issuance of the prior authorization,
  139  new procedures are provided to the patient or a change in the
  140  patient’s condition occurs such that the prior authorized
  141  procedure would at that time have required disapproval pursuant
  142  to the terms and conditions for coverage under the patient’s
  143  plan in effect at the time the prior authorization was issued.
  144         5. The denial of the claim was due to one of the following:
  145         a. Another payor is responsible for payment.
  146         b. The dentist has already been paid for the procedures
  147  identified in the claim.
  148         c. The claim was submitted fraudulently, or the prior
  149  authorization was based in whole or material part on erroneous
  150  information provided to the health insurer by the dentist,
  151  patient, or other person not related to the insurer.
  152         d. The person receiving the procedure was not eligible to
  153  receive the procedure on the date of service.
  154         e. The services were provided during the grace period
  155  established under s. 627.608 or applicable federal regulations,
  156  and the dental insurer notified the provider that the patient
  157  was in the grace period when the provider requested eligibility
  158  or enrollment verification from the dental insurer, if such
  159  request was made.
  160         (b) This subsection applies to all contracts delivered,
  161  issued, or renewed on or after January 1, 2025.
  162         (c) The office has all rights and powers to enforce this
  163  subsection as provided by s. 624.307.
  164         (d) The commission may adopt rules to implement this
  165  subsection.
  166         Section 2. Section 636.032, Florida Statutes, is amended to
  167  read:
  168         636.032 Acceptable payments.—
  169         (1) Each prepaid limited health service organization may
  170  accept from government agencies, corporations, groups, or
  171  individuals payments covering all or part of the cost of
  172  contracts entered into between the prepaid limited health
  173  service organization and its subscribers.
  174         (2)(a) A contract between a prepaid limited health service
  175  organization and a dentist licensed under chapter 466 for the
  176  provision of services to a subscriber may not specify credit
  177  card payment as the only acceptable method for payments from the
  178  prepaid limited health service organization to the dentist.
  179         (b) When a prepaid limited health service organization
  180  employs the method of claims payment to a dentist through
  181  electronic funds transfer, including, but not limited to,
  182  virtual credit card payment, the prepaid limited health service
  183  organization shall notify the dentist as provided in this
  184  paragraph and obtain the dentist’s consent before employing the
  185  electronic funds transfer. The dentist’s consent described in
  186  this paragraph applies to the dentist’s entire practice. For the
  187  purpose of this paragraph, the dentist’s consent, which may be
  188  given through e-mail, must bear the signature of the dentist.
  189  Such signature includes an electronic or digital signature if
  190  the form of signature is recognized as a valid signature under
  191  applicable federal law or state contract law or an act that
  192  demonstrates express consent, including, but not limited to,
  193  checking a box indicating consent. The prepaid limited health
  194  service organization or dentist may not require that a dentist’s
  195  consent as described in this paragraph be made on a patient-by
  196  patient basis. The notification provided by the prepaid limited
  197  health service organization to the dentist must include all of
  198  the following:
  199         1. The fees, if any, that are associated with the
  200  electronic funds transfer.
  201         2. The available methods of payment of claims by the
  202  prepaid limited health service organization, with clear
  203  instructions to the dentist on how to select an alternative
  204  payment method.
  205         (c) A prepaid limited health service organization that pays
  206  a claim to a dentist through Automatic Clearing House transfer
  207  may not charge a fee solely to transmit the payment to the
  208  dentist unless the dentist has consented to the fee.
  209         (d) This subsection applies to contracts delivered, issued,
  210  or renewed on or after January 1, 2025.
  211         (e) The office has all rights and powers to enforce this
  212  subsection as provided by s. 624.307.
  213         (f) The commission may adopt rules to implement this
  214  subsection.
  215         Section 3. Subsection (15) is added to section 636.035,
  216  Florida Statutes, to read:
  217         636.035 Provider arrangements.—
  218         (15)(a) A prepaid limited health service organization may
  219  not deny any claim subsequently submitted by a dentist licensed
  220  under chapter 466 for procedures specifically included in a
  221  prior authorization unless at least one of the following
  222  circumstances applies for each procedure denied:
  223         1. Benefit limitations, such as annual maximums and
  224  frequency limitations not applicable at the time of the prior
  225  authorization, are reached subsequent to issuance of the prior
  226  authorization.
  227         2. The documentation provided by the person submitting the
  228  claim fails to support the claim as originally authorized.
  229         3. Subsequent to the issuance of the prior authorization,
  230  new procedures are provided to the patient or a change in the
  231  condition of the patient occurs such that the prior authorized
  232  procedure would no longer be considered medically necessary,
  233  based on the prevailing standard of care.
  234         4. Subsequent to the issuance of the prior authorization,
  235  new procedures are provided to the patient or a change in the
  236  patient’s condition occurs such that the prior authorized
  237  procedure would at that time have required disapproval pursuant
  238  to the terms and conditions for coverage under the patient’s
  239  plan in effect at the time the prior authorization was issued.
  240         5. The denial of the dental service claim was due to one of
  241  the following:
  242         a. Another payor is responsible for payment.
  243         b. The dentist has already been paid for the procedures
  244  identified in the claim.
  245         c. The claim was submitted fraudulently, or the prior
  246  authorization was based in whole or material part on erroneous
  247  information provided to the prepaid limited health service
  248  organization by the dentist, patient, or other person not
  249  related to the organization.
  250         d. The person receiving the procedure was not eligible to
  251  receive the procedure on the date of service.
  252         e. The services were provided during the grace period
  253  established under s. 627.608 or applicable federal regulations,
  254  and the dental insurer notified the provider that the patient
  255  was in the grace period when the provider requested eligibility
  256  or enrollment verification from the dental insurer, if such
  257  request was made.
  258         (b) This subsection applies to all contracts delivered,
  259  issued, or renewed on or after January 1, 2025.
  260         (c) The office has all rights and powers to enforce this
  261  subsection as provided by s. 624.307.
  262         (d) The commission may adopt rules to implement this
  263  subsection.
  264         Section 4. Subsections (13) and (14) are added to section
  265  641.315, Florida Statutes, to read:
  266         641.315 Provider contracts.—
  267         (13)(a) A contract between a health maintenance
  268  organization and a dentist licensed under chapter 466 for the
  269  provision of services to a subscriber of the health maintenance
  270  organization may not specify credit card payment as the only
  271  acceptable method for payments from the health maintenance
  272  organization to the dentist.
  273         (b) When a health maintenance organization employs the
  274  method of claims payment to a dentist through electronic funds
  275  transfer, including, but not limited to, virtual credit card
  276  payment, the health maintenance organization shall notify the
  277  dentist as provided in this paragraph and obtain the dentist’s
  278  consent before employing the electronic funds transfer. The
  279  dentist’s consent described in this paragraph applies to the
  280  dentist’s entire practice. For the purpose of this paragraph,
  281  the dentist’s consent, which may be given through e-mail, must
  282  bear the signature of the dentist. Such signature includes an
  283  electronic or digital signature if the form of signature is
  284  recognized as a valid signature under applicable federal law or
  285  state contract law or an act that demonstrates express consent,
  286  including, but not limited to, checking a box indicating
  287  consent. The health maintenance organization or dentist may not
  288  require that a dentist’s consent as described in this paragraph
  289  be made on a patient-by-patient basis. The notification provided
  290  by the health maintenance organization to the dentist must
  291  include all of the following:
  292         1. The fees, if any, that are associated with the
  293  electronic funds transfer.
  294         2. The available methods of payment of claims by the health
  295  maintenance organization, with clear instructions to the dentist
  296  on how to select an alternative payment method.
  297         (c) A health maintenance organization that pays a claim to
  298  a dentist through Automated Clearing House transfer may not
  299  charge a fee solely to transmit the payment to the dentist
  300  unless the dentist has consented to the fee.
  301         (d) This subsection applies to contracts delivered, issued,
  302  or renewed on or after January 1, 2025.
  303         (e) The office has all rights and powers to enforce this
  304  subsection as provided by s. 624.307.
  305         (f) The commission may adopt rules to implement this
  306  subsection.
  307         (14)(a) A health maintenance organization may not deny any
  308  claim subsequently submitted by a dentist licensed under chapter
  309  466 for procedures specifically included in a prior
  310  authorization unless at least one of the following circumstances
  311  applies for each procedure denied:
  312         1. Benefit limitations, such as annual maximums and
  313  frequency limitations not applicable at the time of the prior
  314  authorization, are reached subsequent to issuance of the prior
  315  authorization.
  316         2. The documentation provided by the person submitting the
  317  claim fails to support the claim as originally authorized.
  318         3. Subsequent to the issuance of the prior authorization,
  319  new procedures are provided to the patient or a change in the
  320  condition of the patient occurs such that the prior authorized
  321  procedure would no longer be considered medically necessary,
  322  based on the prevailing standard of care.
  323         4. Subsequent to the issuance of the prior authorization,
  324  new procedures are provided to the patient or a change in the
  325  patient’s condition occurs such that the prior authorized
  326  procedure would at that time have required disapproval pursuant
  327  to the terms and conditions for coverage under the patient’s
  328  plan in effect at the time the prior authorization was issued.
  329         5. The denial of the claim was due to one of the following:
  330         a. Another payor is responsible for payment.
  331         b. The dentist has already been paid for the procedures
  332  identified in the claim.
  333         c. The claim was submitted fraudulently, or the prior
  334  authorization was based in whole or material part on erroneous
  335  information provided to the health maintenance organization by
  336  the dentist, patient, or other person not related to the
  337  organization.
  338         d. The person receiving the procedure was not eligible to
  339  receive the procedure on the date of service.
  340         e. The services were provided during the grace period
  341  established under s. 627.608 or applicable federal regulations,
  342  and the dental insurer notified the provider that the patient
  343  was in the grace period when the provider requested eligibility
  344  or enrollment verification from the dental insurer, if such
  345  request was made.
  346         (b) This subsection applies to all contracts delivered,
  347  issued, or renewed on or after January 1, 2025.
  348         (c)The office has all rights and powers to enforce this
  349  subsection as provided by s. 624.307.
  350         (d)The commission may adopt rules to implement this
  351  subsection.
  352         Section 5. This act shall take effect January 1, 2025.