September 24, 2020
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HB 1629

1
A bill to be entitled
2An act relating to affordable health care; providing a
3popular name; providing purposes; amending s. 381.026,
4F.S.; requiring certain licensed facilities to provide
5public Internet access to certain financial information;
6expanding the Florida Patient's Bill of Rights and
7Responsibilities to include a right to certain price and
8procedure comparison information; amending s. 381.734,
9F.S.; including participation by health care providers,
10small businesses, and health insurers in the Healthy
11Communities, Healthy People Program; requiring the
12Department of Health to provide public Internet access to
13certain public health programs; requiring the department
14to monitor and assess the effectiveness of such programs;
15requiring a report; requiring the Auditor General to
16investigate the effectiveness of such programs; requiring
17a report; requiring the department to develop certain
18community emergency room diversion programs; authorizing
19the department to provide certain private sector
20incentives for certain purposes; amending s. 395.1041,
21F.S.; authorizing hospitals to develop certain emergency
22room diversion programs; amending s. 395.301, F.S.;
23requiring certain licensed facilities to provide public
24Internet access to certain financial information;
25requiring certain licensed facilities to provide
26prospective patients certain estimates of charges for
27services; amending s. 408.061, F.S.; requiring the Agency
28for Health Care Administration to require health care
29facilities, health care providers, and health insurers to
30submit certain information; requiring health care
31facilities and health insurers to provide certain
32information quarterly; deleting an onsite inspection
33authorization requirement; amending s. 408.062, F.S.;
34requiring the agency to conduct certain health care costs
35and access research, analyses, and studies; expanding the
36scope of such studies to include use of emergency
37departments and Internet patient charge information
38availability; requiring a report; requiring the agency to
39conduct additional data-based studies and make
40recommendations to the Legislature; amending s. 408.7056,
41F.S.; renaming the Statewide Provider and Subscriber
42Assistance Program as the Subscriber Assistance Program;
43revising provisions to conform; expanding certain records
44availability provisions; revising membership provisions
45relating to a subscriber grievance hearing panel;
46providing hearing procedures; amending s. 641.3154, F.S.,
47to conform to the renaming of the Subscriber Assistance
48Program; amending s. 641.511, F.S., to conform to the
49renaming of the Subscriber Assistance Program; adopting
50and incorporating by reference the Employee Retirement
51Income Security Act of 1974, as implemented by federal
52regulations; amending s. 641.58, F.S., to conform to the
53renaming of the Subscriber Assistance Program; amending s.
54408.909, F.S.; expanding a definition of "health flex plan
55entity" to include public-private partnerships; making a
56pilot health flex plan program apply permanently
57statewide; providing additional program requirements;
58creating s. 408.919, F.S.; creating the Statewide
59Electronic Medical Records Advisory Council for certain
60purposes; requiring the agency to provide staff support;
61authorizing the agency to contract to assist the council
62in creating an electronic medical records system;
63providing for appointment of council members and meetings;
64providing responsibilities of the council; requiring an
65annual status report to the Governor and Legislature;
66specifying service without compensation; providing for per
67diem and travel expenses; providing for future repeal;
68creating the Statewide Evidenced-based Medicine Panel for
69certain purposes; requiring the Agency for Health Care
70Administration to provide staff support; authorizing the
71agency to contract to assist the panel in creating a
72statewide evidence-based medicine program; providing for
73appointment of panel members and meetings; providing
74responsibilities of the panel; requiring an annual status
75report to the Governor and Legislature; specifying service
76without compensation; providing for per diem and travel
77expenses; providing for future abolition of the panel;
78amending s. 409.91255, F.S.; expanding assistance to
79certain health centers to include urgent care services;
80amending s. 627.410, F.S.; requiring insurers to file
81certain rates with the Office of Insurance Regulation;
82amending s. 627.6487, F.S.; revising a definition;
83creating s. 627.64872, F.S.; providing legislative intent;
84creating the Florida Health Insurance Plan for certain
85purposes; providing definitions; providing requirements
86for operation of the plan; providing for a board of
87directors; providing for appointment of members; providing
88for terms; specifying service without compensation;
89providing for travel and per diem expenses; requiring a
90plan of operation; providing requirements; providing for
91powers of the plan; requiring reports to the Governor and
92Legislature; providing certain immunity from liability for
93plan obligations; authorizing the board to provide for
94indemnification of certain costs; requiring an annually
95audited financial statement; providing for eligibility for
96coverage under the plan; providing criteria; requirements,
97and limitations; specifying certain activity as an unfair
98trade practice; providing for a plan administrator;
99providing criteria; providing requirements; providing term
100limits for the plan administrator; providing duties;
101providing for paying the administrator; providing for
102funding mechanisms of the plan; specifying benefits under
103the plan; providing criteria, requirements, and
104limitations; providing for nonduplication of benefits;
105providing for annual and maximum lifetime benefits;
106providing for tax exempt status; providing for abolition
107of the Florida Comprehensive Health Association upon
108implementation of the plan; providing for enrollment in
109the plan of persons enrolled in the association; requiring
110insurers to pay certain assessments to the board for
111certain purposes; providing criteria, requirements, and
112limitations for such assessments; providing for repeal of
113ss. 627.6488, 627.6489, 627.649, 627.6492, 627.6494,
114627.6496, 627.6498, and 627.6499, F.S., relating to the
115Florida Comprehensive Health Association, upon
116implementation of the plan; amending s. 627.662, F.S.;
117providing for application of certain claim payment
118methodologies to certain types of insurance; amending s.
119627.6699, F.S.; revising provisions requiring small
120employer carriers to offer certain health benefit plans;
121requiring small employer carriers to file and provide
122coverage under certain high deductible plans; including
123high deductible plans under certain required plan
124provisions; creating the Small Employers Access Program;
125providing legislative intent; providing definitions;
126providing participation eligibility requirements and
127criteria; requiring the Office of Insurance Regulation to
128administer the program by selecting an insurer through
129competitive bidding; providing requirements; specifying
130insurer qualifications; providing duties of the insurer;
131providing a contract term; providing insurer reporting
132requirements; providing application requirements;
133providing for benefits under the program; requiring the
134office to annually report to the Governor and Legislature;
135authorizing health insurers to require higher copayments
136for certain uses of emergency departments; amending s.
137627.9175, F.S.; requiring certain health insurers to
138annually report certain coverage information to the
139office; providing requirements; deleting certain reporting
140requirements; amending s. 636.003, F.S.; revising the
141definition of "prepaid limited health service
142organization" to exclude provision of discounted medical
143service programs; creating ss. 627.6410 and 627.66912,
144F.S.; requiring certain insurers to provide for additional
145coverage for certain additional disorders; providing for
146additional premiums; providing limitations and exceptions;
147amending s. 641.31, F.S.; providing for application of
148certain claim payment methodologies to certain types of
149insurance; requiring health maintenance contracts to
150provide for additional coverage for certain additional
151disorders; providing for additional premiums; providing
152limitations and exceptions; amending s. 626.015, F.S.;
153defining insurance advisor; amending ss. 626.016, 626.342,
154626.536, 626.561, 626.572, and 626.601, F.S., to include
155application of such provisions to insurance advisors;
156providing penalties; amending ss. 626.171, 626.191, and
157626.201, F.S.; clarifying certain application
158requirements; amending s. 626.6115, F.S.; providing
159additional grounds for adverse actions against insurance
160agency licensure; amending ss. 624.509, 626.7845, 626.292,
161and 626.321, F.S.; correcting cross references; preserving
162certain rights to enrollment in certain health benefit
163coverage for certain groups under certain circumstances;
164repealing s. 408.02, F.S., relating to the development,
165endorsement, implementation, and evaluation of patient
166management practice parameters by the Agency for Health
167Care Administration; providing appropriations; providing
168an effective date.
169
170     WHEREAS, according to the Kaiser Family Foundation, eight
171out of ten uninsured Americans are workers or dependents of
172workers and nearly eight out of ten uninsured Americans have
173family incomes above the poverty level, and
174     WHEREAS, fifty-five percent of those who do not have
175insurance state the reason they don't have insurance is lack of
176affordability, and
177     WHEREAS, average health insurance premium increases for the
178last two years have been in the range of ten to twenty percent
179for Florida's employers, and
180     WHEREAS, an increasing number of employers are opting to
181cease providing insurance coverage to their employees due to the
182high cost, and
183     WHEREAS, an increasing number of employers who continue
184providing coverage are forced to shift more premium cost to
185their employees, thus diminishing the value of employee wage
186increases, and
187     WHEREAS, according to studies, the rate of avoidable
188hospitalization is fifty to seventy percent lower for the
189insured versus the uninsured, and
190     WHEREAS, according to Florida Cancer Registry data, the
191uninsured have a seventy percent greater chance of a late
192diagnosis, thus decreasing the chances of a positive health
193outcome, and
194     WHEREAS, according to the Agency for Health Care
195Administration's 2002 financial data, uncompensated care in
196Florida's hospitals is growing at the rate of twelve to thirteen
197percent per year, and, at $4.3 billion in 2001, this cost, when
198shifted to Floridians who remain insured, is not sustainable,
199and
200     WHEREAS, the Florida Legislature, through the creation of
201Health Flex, has already identified the need for lower cost
202alternatives, and
203     WHEREAS, it is of vital importance and in the best
204interests of the people of the State of Florida that the issue
205of available, affordable health care insurance be addressed in a
206cohesive and meaningful manner, and  
207     WHEREAS, there is general recognition that the issues
208surrounding the problem of access to affordable health insurance
209are complicated and multifaceted, and
210     WHEREAS, on August 14, 2003, Speaker Johnnie Byrd created
211the Select Committee on Affordable Health Care for Floridians
212effort to address the issue of affordable and accessible
213employment-based insurance, and
214     WHEREAS, the Select Committee on Affordable Health Care for
215Floridians held public hearings with predetermined themes around
216the state, specifically, in Orlando, Miami, Jacksonville, Tampa,
217Pensacola, Boca Raton, and Tallahassee, from October through
218November 2003 to effectively probe the operation of the private
219insurance marketplace, to understand the health insurance market
220trends, to learn from past policy initiatives, and to identify,
221explore, and debate new ideas for change, and
222     WHEREAS, recommendations from the Select Committee on
223Affordable Health Care were adopted on February 4, 2004, to
224address the multifaceted issues attributed to the increase in
225health care cost, and
226     WHEREAS, these recommendations were presented to the
227Speaker of the House of Representatives in a final report from
228the committee on February 18, 2004, and subsequent legislation
229was drafted creating the "The 2004 Affordable Health Care for
230Floridians Act," NOW, THEREFORE,
231
232Be It Enacted by the Legislature of the State of Florida:
233
234     Section 1.  This act may be referred to by the popular name
235"The 2004 Affordable Health Care for Floridians Act."
236     Section 2.  The purpose of this act is to address the
237underlying cause of the double-digit increases in health
238insurance premiums by mitigating the overall growth in health
239care costs.
240     Section 3.  Paragraph (c) of subsection (4) and subsection
241(6) of section 381.026, Florida Statutes, are amended to read:
242     381.026  Florida Patient's Bill of Rights and
243Responsibilities.--
244     (4)  RIGHTS OF PATIENTS.--Each health care facility or
245provider shall observe the following standards:
246     (c)  Financial information and disclosure.--
247     1.  A patient has the right to be given, upon request, by
248the responsible provider, his or her designee, or a
249representative of the health care facility full information and
250necessary counseling on the availability of known financial
251resources for the patient's health care.
252     2.  A health care provider or a health care facility shall,
253upon request, disclose to each patient who is eligible for
254Medicare, in advance of treatment, whether the health care
255provider or the health care facility in which the patient is
256receiving medical services accepts assignment under Medicare
257reimbursement as payment in full for medical services and
258treatment rendered in the health care provider's office or
259health care facility.
260     3.  A health care provider or a health care facility shall,
261upon request, furnish a patient, prior to provision of medical
262services, a reasonable estimate of charges for such services.
263Such reasonable estimate shall not preclude the health care
264provider or health care facility from exceeding the estimate or
265making additional charges based on changes in the patient's
266condition or treatment needs.
267     4.  Each licensed facility not operated by the state shall
268make available to the public on its Internet website or by other
269electronic means package prices for each of the top 50 most
270utilized elective inpatient and outpatient procedures. The
271package pricing shall include all hospital-related services, and
272shall include separate estimates of costs for professional fees
273charged by independent contractor physicians or physician
274groups. The licensed facilities shall also make available to the
275public on its Internet website or by other electronic means each
276of the top 50 most utilized inpatient and outpatient procedures.
277Such list shall be updated quarterly. The facility shall place a
278notice in the reception areas that such information is available
279electronically and the website address. The licensed facility
280may indicate that the package pricing is based on a compilation
281of charges for the average patient and that each patient's bill
282may vary from the average depending upon the severity of illness
283and individual resources consumed. The licensed facility may
284also indicate that the package pricing is negotiable based upon
285the patient's health plan and the ability to pay. The agency
286shall develop rules for implementation of a uniform mechanism
287for reporting this information on the facility's website.
288     5.4.  A patient has the right to receive a copy of an
289itemized bill upon request. A patient has a right to be given an
290explanation of charges upon request.
291     (6)  SUMMARY OF RIGHTS AND RESPONSIBILITIES.--Any health
292care provider who treats a patient in an office or any health
293care facility licensed under chapter 395 that provides emergency
294services and care or outpatient services and care to a patient,
295or admits and treats a patient, shall adopt and make available
296to the patient, in writing, a statement of the rights and
297responsibilities of patients, including the following:
298
299
SUMMARY OF THE FLORIDA PATIENT'S BILL
300OF RIGHTS AND RESPONSIBILITIES
301
302     Florida law requires that your health care provider or
303health care facility recognize your rights while you are
304receiving medical care and that you respect the health care
305provider's or health care facility's right to expect certain
306behavior on the part of patients. You may request a copy of the
307full text of this law from your health care provider or health
308care facility. A summary of your rights and responsibilities
309follows:
310     A patient has the right to be treated with courtesy and
311respect, with appreciation of his or her individual dignity, and
312with protection of his or her need for privacy.
313     A patient has the right to a prompt and reasonable response
314to questions and requests.
315     A patient has the right to know who is providing medical
316services and who is responsible for his or her care.
317     A patient has the right to know what patient support
318services are available, including whether an interpreter is
319available if he or she does not speak English.
320     A patient has the right to know what rules and regulations
321apply to his or her conduct.
322     A patient has the right to be given by the health care
323provider information concerning diagnosis, planned course of
324treatment, alternatives, risks, and prognosis.
325     A patient has the right to refuse any treatment, except as
326otherwise provided by law.
327     A patient has the right to be given, upon request, full
328information and necessary counseling on the availability of
329known financial resources for his or her care.
330     A patient who is eligible for Medicare has the right to
331know, upon request and in advance of treatment, whether the
332health care provider or health care facility accepts the
333Medicare assignment rate.
334     A patient has the right to receive, upon request, prior to
335treatment, a reasonable estimate of charges for medical care.
336     A patient has the right to receive, upon request, prior to
337treatment, a reasonable estimate of charges for proposed
338service.
339     A patient has the right to receive a copy of a reasonably
340clear and understandable, itemized bill and, upon request, to
341have the charges explained.
342     A patient has the right to impartial access to medical
343treatment or accommodations, regardless of race, national
344origin, religion, handicap, or source of payment.
345     A patient has the right to treatment for any emergency
346medical condition that will deteriorate from failure to provide
347treatment.
348     A patient has the right to know if medical treatment is for
349purposes of experimental research and to give his or her consent
350or refusal to participate in such experimental research.
351     A patient has the right to express grievances regarding any
352violation of his or her rights, as stated in Florida law,
353through the grievance procedure of the health care provider or
354health care facility which served him or her and to the
355appropriate state licensing agency.
356     A patient is responsible for providing to the health care
357provider, to the best of his or her knowledge, accurate and
358complete information about present complaints, past illnesses,
359hospitalizations, medications, and other matters relating to his
360or her health.
361     A patient is responsible for reporting unexpected changes
362in his or her condition to the health care provider.
363     A patient is responsible for reporting to the health care
364provider whether he or she comprehends a contemplated course of
365action and what is expected of him or her.
366     A patient is responsible for following the treatment plan
367recommended by the health care provider.
368     A patient is responsible for keeping appointments and, when
369he or she is unable to do so for any reason, for notifying the
370health care provider or health care facility.
371     A patient is responsible for his or her actions if he or
372she refuses treatment or does not follow the health care
373provider's instructions.
374     A patient is responsible for assuring that the financial
375obligations of his or her health care are fulfilled as promptly
376as possible.
377     A patient is responsible for following health care facility
378rules and regulations affecting patient care and conduct.
379     Section 4.  Subsection (1) and paragraph (g) of subsection
380(3) of section 381.734, Florida Statutes, are amended, and
381subsections (4), (5), and (6) are added to said section, to
382read:
383     381.734  Healthy Communities, Healthy People Program.--
384     (1)  The department shall develop and implement the Healthy
385Communities, Healthy People Program, a comprehensive and
386community-based health promotion and wellness program. The
387program shall be designed to reduce major behavioral risk
388factors associated with chronic diseases, including those
389chronic diseases identified in chapter 385, by enhancing the
390knowledge, skills, motivation, and opportunities for
391individuals, organizations, health care providers, small
392businesses, health insurers, and communities to develop and
393maintain healthy lifestyles.
394     (3)  The program shall include:
395     (g)  The establishment of a comprehensive program to inform
396the public, health care professionals, health insurers, and
397communities about the prevalence of chronic diseases in the
398state; known and potential risks, including social and
399behavioral risks; and behavior changes that would reduce risks.
400     (4)  The department shall make available on its Internet
401website, no later than October 1, 2004, and in a hard-copy
402format upon request, a listing of age-specific, disease-
403specific, and community-specific health promotion, preventive
404care, and wellness programs offered and established under the
405Healthy Communities, Health People Program. The website shall
406also provide residents with information to identify behavior
407risk factors that lead to preventable diseases by maintaining a
408healthy lifestyle. The website shall allow consumers to select
409by county or region disease-specific statistical information.
410     (5)  The department shall monitor and assess the
411effectiveness of such programs. The department shall submit a
412status report based on this monitoring and assessment to the
413Governor, the Speaker of the House of Representatives, the
414President of the Senate, and the substantive legislative
415committees of each house of the Legislature, with the first
416annual report due January 31, 2005.
417     (6)  The Auditor General's office shall investigate and
418report to the President of the Senate and the Speaker of the
419House of Representatives, by February 15, 2005, on the
420effectiveness of such programs.
421     Section 5.  Subsection (7) is added to section 395.1041,
422Florida Statutes, to read:
423     395.1041  Access to emergency services and care.--
424     (7)  Hospitals may develop emergency room diversion
425programs, including, but not limited to, an "Emergency Hotline"
426which allows patients to help determine if emergency department
427services are appropriate or if other health care settings may be
428more appropriate for care, and a "Fast Track" program allowing
429nonemergency patients to be treated at an alternative site.
430Alternative sites may include health care programs funded with
431local tax revenue and federally funded community health centers,
432county health departments, or other nonhospital providers of
433health care services.
434     Section 6.  Subsections (7) and (8) are added to section
435395.301, Florida Statutes, to read:
436     395.301  Itemized patient bill; form and content prescribed
437by the agency.--
438     (7)  Each licensed facility not operated by the state shall
439make available to the public on its Internet website or by other
440electronic means package prices and the Medicare reimbursement
441rate for each of the top 50 most used elective inpatient and
442outpatient procedures. The package pricing shall include all
443hospital-related services and shall include separate estimates
444of costs for professional fees charged by independent contractor
445physicians or physician groups. The licensed facilities shall
446also make available to the public on its Internet website or by
447other electronic means the top 50 most used procedures in both
448inpatient and outpatient settings. The list shall be updated
449quarterly. The facility shall place a notice in reception areas
450that such information is available electronically and the
451website address. The licensed facility may indicate that the
452package pricing is based on a compilation of charges for the
453average patient and that each patient's bill may vary from the
454average depending upon the severity of illness and individual
455resources consumed. The licensed facility may also indicate that
456the package pricing is negotiable based upon the patient's
457health plan and the ability to pay. The agency shall develop
458rules for implementation of a uniform mechanism for reporting
459this information on the facility's website.
460     (8)  Each licensed facility not operated by the state
461shall, upon request of a prospective patient prior to the
462provision of medical services, provide a reasonable estimate of
463charges for the proposed service. Such estimate shall not
464preclude the actual charges from exceeding the estimate based on
465changes in the patient's medical condition or the treatment
466needs of the patient as determined by the attending and
467consulting physicians.
468     Section 7.  Subsection (1) of section 408.061, Florida
469Statutes, is amended to read:
470     408.061  Data collection; uniform systems of financial
471reporting; information relating to physician charges;
472confidential information; immunity.--
473     (1)  The agency shall may require the submission by health
474care facilities, health care providers, and health insurers of
475data necessary to carry out the agency's duties. Specifications
476for data to be collected under this section shall be developed
477by the agency with the assistance of technical advisory panels
478including representatives of affected entities, consumers,
479purchasers, and such other interested parties as may be
480determined by the agency.
481     (a)  Data shall to be submitted by health care facilities
482quarterly for each preceding calendar quarter no later than
483February 1, May 1, August 1, and November 1 of each year
484commencing August 1, 2004. Such data shall may include, but are
485not limited to: case-mix data, patient admission and or
486discharge data, outpatient data which shall include the number
487of patients treated in the emergency department of a licensed
488hospital reported by  patient acuity level, morbidity rates, and
489mortality rates for the top 50 diagnoses which are risk
490adjusted, with patient and provider-specific identifiers
491included, actual charge data by diagnostic groups, financial
492data, accounting data, operating expenses, expenses incurred for
493rendering services to patients who cannot or do not pay,
494interest charges, depreciation expenses based on the expected
495useful life of the property and equipment involved, and
496demographic data. Data may be obtained from documents such as,
497but not limited to: leases, contracts, debt instruments,
498itemized patient bills, medical record abstracts, and related
499diagnostic information.
500     (b)  Data to be submitted by health care providers may
501include, but are not limited to: Medicare and Medicaid
502participation, types of services offered to patients, amount of
503revenue and expenses of the health care provider, and such other
504data which are reasonably necessary to study utilization
505patterns.
506     (c)  Data shall to be electronically submitted by health
507insurers quarterly for each preceding calendar quarter no later
508than February 1, May 1, August 1, and November 1 of each year
509commencing August 1, 2004. Such data shall may include, but are
510not limited to: claims paid data aggregated by current
511procedural terminology (CPT) code or service and provider,
512premium, administration, and financial information.
513     (d)  Data submission requirements of required to be
514submitted by health care facilities, health care providers, or
515health insurers shall not include specific provider contract
516reimbursement information. However, such specific provider
517reimbursement data shall be reasonably available for onsite
518inspection by the agency as is necessary to carry out the
519agency's regulatory duties. Any such data obtained by the agency
520as a result of specified reporting requirements onsite
521inspections may not be used by the state for purposes of direct
522provider contracting and are confidential and exempt from the
523provisions of s. 119.07(1) and s. 24(a), Art. I of the State
524Constitution.
525     (e)  A requirement to submit data shall be adopted by rule
526if the submission of data is being required of all members of
527any type of health care facility, health care provider, or
528health insurer. Rules are not required, however, for the
529submission of data for a special study mandated by the
530Legislature or when information is being requested for a single
531health care facility, health care provider, or health insurer.
532     Section 8.  Subsections (1) and (4) of section 408.062,
533Florida Statutes, are amended to read:
534     408.062  Research, analyses, studies, and reports.--
535     (1)  The agency shall have the authority to conduct
536research, analyses, and studies relating to health care costs
537and access to and quality of health care services as access and
538quality are affected by changes in health care costs. Such
539research, analyses, and studies shall include, but not be
540limited to, research and analysis relating to:
541     (a)  The financial status of any health care facility or
542facilities subject to the provisions of this chapter.
543     (b)  The impact of uncompensated charity care on health
544care facilities and health care providers.
545     (c)  The state's role in assisting to fund indigent care.
546     (d)  In conjunction with the Office of Insurance
547Regulation, the availability and affordability of health
548insurance for small businesses.
549     (e)  Total health care expenditures in the state according
550to the sources of payment and the type of expenditure.
551     (f)  The quality of health services, using techniques such
552as small area analysis, severity adjustments, and risk-adjusted
553mortality rates.
554     (g)  The development of physician payment systems which are
555capable of taking into account the amount of resources consumed
556and the outcomes produced in the delivery of care.
557     (h)  The impact of subacute admissions on hospital revenues
558and expenses for purposes of calculating adjusted admissions as
559defined in s. 408.07.
560     (i)  The utilization of emergency department services by
561patient acuity level and the implication of increasing hospital
562cost by providing nonurgent care in emergency departments. The
563agency shall submit an annual report based on this monitoring
564and assessment to the Governor, the Speaker of the House of
565Representatives, the President of the Senate, and the
566substantive legislative committees with the first annual report
567due January 1, 2005.
568     (j)  The making available on its Internet website no later
569than October 1, 2004, and in a hard-copy format upon request, of
570patient charge information by provider aggregated by claims data
571submitted by insurers and performance outcome data collected
572from health care facilities pursuant to s. 408.061(1)(a) and (d)
573for not less than 100 inpatient and outpatient diagnostic and
574therapeutic conditions and procedures and the volume of
575inpatient and outpatient procedures by Medicare discharge
576referral experience. The website shall also provide an
577interactive search that allows consumers to view and compare the
578information for specific facilities, a map that allows consumers
579to select a county or region, definitions of all of the data,
580descriptions of each procedure, and an explanation about why the
581data may differ from facility to facility. Such public data
582shall be updated quarterly. The agency shall submit an annual
583report based on this monitoring and assessment to the Governor,
584the Speaker of the House of Representatives, the President of
585the Senate, and the substantive legislative committees with the
586first annual report due January 1, 2005.
587     (4)(a)  The agency shall may conduct data-based studies and
588evaluations and make recommendations to the Legislature and the
589Governor concerning exemptions, the effectiveness of limitations
590of referrals, restrictions on investment interests and
591compensation arrangements, and the effectiveness of public
592disclosure. Such analysis shall may include, but need not be
593limited to, utilization of services, cost of care, quality of
594care, and access to care. The agency may require the submission
595of data necessary to carry out this duty, which may include, but
596need not be limited to, data concerning ownership, Medicare and
597Medicaid, charity care, types of services offered to patients,
598revenues and expenses, patient-encounter data, and other data
599reasonably necessary to study utilization patterns and the
600impact of health care provider ownership interests in health-
601care-related entities on the cost, quality, and accessibility of
602health care.
603     (b)  The agency may collect such data from any health
604facility or licensed health care provider as a special study.
605     Section 9.  Section 408.7056, Florida Statutes, is amended
606to read:
607     408.7056  Statewide Provider and Subscriber Assistance
608Program.--
609     (1)  As used in this section, the term:
610     (a)  "Agency" means the Agency for Health Care
611Administration.
612     (b)  "Department" means the Department of Financial
613Services.
614     (c)  "Grievance procedure" means an established set of
615rules that specify a process for appeal of an organizational
616decision.
617     (d)  "Health care provider" or "provider" means a state-
618licensed or state-authorized facility, a facility principally
619supported by a local government or by funds from a charitable
620organization that holds a current exemption from federal income
621tax under s. 501(c)(3) of the Internal Revenue Code, a licensed
622practitioner, a county health department established under part
623I of chapter 154, a prescribed pediatric extended care center
624defined in s. 400.902, a federally supported primary care
625program such as a migrant health center or a community health
626center authorized under s. 329 or s. 330 of the United States
627Public Health Services Act that delivers health care services to
628individuals, or a community facility that receives funds from
629the state under the Community Alcohol, Drug Abuse, and Mental
630Health Services Act and provides mental health services to
631individuals.
632     (e)  "Managed care entity" means a health maintenance
633organization or a prepaid health clinic certified under chapter
634641, a prepaid health plan authorized under s. 409.912, or an
635exclusive provider organization certified under s. 627.6472.
636     (f)  "Office" means the Office of Insurance Regulation of
637the Financial Services Commission.
638     (g)  "Panel" means a statewide provider and subscriber
639assistance panel selected as provided in subsection (11).
640     (2)  The agency shall adopt and implement a program to
641provide assistance to subscribers and providers, including those
642whose grievances are not resolved by the managed care entity to
643the satisfaction of the subscriber or provider. The program
644shall consist of one or more panels that meet as often as
645necessary to timely review, consider, and hear grievances and
646recommend to the agency or the office any actions that should be
647taken concerning individual cases heard by the panel. The panel
648shall hear every grievance filed by subscribers and providers on
649behalf of subscribers, unless the grievance:
650     (a)  Relates to a managed care entity's refusal to accept a
651provider into its network of providers;
652     (b)  Is part of an internal grievance in a Medicare managed
653care entity or a reconsideration appeal through the Medicare
654appeals process which does not involve a quality of care issue;
655     (c)  Is related to a health plan not regulated by the state
656such as an administrative services organization, third-party
657administrator, or federal employee health benefit program;
658     (d)  Is related to appeals by in-plan suppliers and
659providers, unless related to quality of care provided by the
660plan;
661     (e)  Is part of a Medicaid fair hearing pursued under 42
662C.F.R. ss. 431.220 et seq.;
663     (f)  Is the basis for an action pending in state or federal
664court;
665     (g)  Is related to an appeal by nonparticipating providers,
666unless related to the quality of care provided to a subscriber
667by the managed care entity and the provider is involved in the
668care provided to the subscriber;
669     (h)  Was filed before the subscriber or provider completed
670the entire internal grievance procedure of the managed care
671entity, the managed care entity has complied with its timeframes
672for completing the internal grievance procedure, and the
673circumstances described in subsection (6) do not apply;
674     (i)  Has been resolved to the satisfaction of the
675subscriber or provider who filed the grievance, unless the
676managed care entity's initial action is egregious or may be
677indicative of a pattern of inappropriate behavior;
678     (j)  Is limited to seeking damages for pain and suffering,
679lost wages, or other incidental expenses, including accrued
680interest on unpaid balances, court costs, and transportation
681costs associated with a grievance procedure;
682     (k)  Is limited to issues involving conduct of a health
683care provider or facility, staff member, or employee of a
684managed care entity which constitute grounds for disciplinary
685action by the appropriate professional licensing board and is
686not indicative of a pattern of inappropriate behavior, and the
687agency, office, or department has reported these grievances to
688the appropriate professional licensing board or to the health
689facility regulation section of the agency for possible
690investigation; or
691     (l)  Is withdrawn by the subscriber or provider. Failure of
692the subscriber or the provider to attend the hearing shall be
693considered a withdrawal of the grievance.
694     (3)  The agency shall review all grievances within 60 days
695after receipt and make a determination whether the grievance
696shall be heard. Once the agency notifies the panel, the
697subscriber or provider, and the managed care entity that a
698grievance will be heard by the panel, the panel shall hear the
699grievance either in the network area or by teleconference no
700later than 120 days after the date the grievance was filed. The
701agency shall notify the parties, in writing, by facsimile
702transmission, or by phone, of the time and place of the hearing.
703The panel may take testimony under oath, request certified
704copies of documents, and take similar actions to collect
705information and documentation that will assist the panel in
706making findings of fact and a recommendation. The panel shall
707issue a written recommendation, supported by findings of fact,
708to the provider or subscriber, to the managed care entity, and
709to the agency or the office no later than 15 working days after
710hearing the grievance. If at the hearing the panel requests
711additional documentation or additional records, the time for
712issuing a recommendation is tolled until the information or
713documentation requested has been provided to the panel. The
714proceedings of the panel are not subject to chapter 120.
715     (4)  If, upon receiving a proper patient authorization
716along with a properly filed grievance, the agency requests
717medical records from a health care provider or managed care
718entity, the health care provider or managed care entity that has
719custody of the records has 10 days to provide the records to the
720agency. Records include medical records, communication logs
721associated with the grievance both to and from the subscriber,
722contracts, and any other contents of the internal grievance file
723associated with the complaint filed with the Subscriber
724Assistance Program. Failure to provide requested medical records
725may result in the imposition of a fine of up to $500. Each day
726that records are not produced is considered a separate
727violation.
728     (5)  Grievances that the agency determines pose an
729immediate and serious threat to a subscriber's health must be
730given priority over other grievances. The panel may meet at the
731call of the chair to hear the grievances as quickly as possible
732but no later than 45 days after the date the grievance is filed,
733unless the panel receives a waiver of the time requirement from
734the subscriber. The panel shall issue a written recommendation,
735supported by findings of fact, to the office or the agency
736within 10 days after hearing the expedited grievance.
737     (6)  When the agency determines that the life of a
738subscriber is in imminent and emergent jeopardy, the chair of
739the panel may convene an emergency hearing, within 24 hours
740after notification to the managed care entity and to the
741subscriber, to hear the grievance. The grievance must be heard
742notwithstanding that the subscriber has not completed the
743internal grievance procedure of the managed care entity. The
744panel shall, upon hearing the grievance, issue a written
745emergency recommendation, supported by findings of fact, to the
746managed care entity, to the subscriber, and to the agency or the
747office for the purpose of deferring the imminent and emergent
748jeopardy to the subscriber's life. Within 24 hours after receipt
749of the panel's emergency recommendation, the agency or office
750may issue an emergency order to the managed care entity. An
751emergency order remains in force until:
752     (a)  The grievance has been resolved by the managed care
753entity;
754     (b)  Medical intervention is no longer necessary; or
755     (c)  The panel has conducted a full hearing under
756subsection (3) and issued a recommendation to the agency or the
757office, and the agency or office has issued a final order.
758     (7)  After hearing a grievance, the panel shall make a
759recommendation to the agency or the office which may include
760specific actions the managed care entity must take to comply
761with state laws or rules regulating managed care entities.
762     (8)  A managed care entity, subscriber, or provider that is
763affected by a panel recommendation may within 10 days after
764receipt of the panel's recommendation, or 72 hours after receipt
765of a recommendation in an expedited grievance, furnish to the
766agency or office written evidence in opposition to the
767recommendation or findings of fact of the panel.
768     (9)  No later than 30 days after the issuance of the
769panel's recommendation and, for an expedited grievance, no later
770than 10 days after the issuance of the panel's recommendation,
771the agency or the office may adopt the panel's recommendation or
772findings of fact in a proposed order or an emergency order, as
773provided in chapter 120, which it shall issue to the managed
774care entity. The agency or office may issue a proposed order or
775an emergency order, as provided in chapter 120, imposing fines
776or sanctions, including those contained in ss. 641.25 and
777641.52. The agency or the office may reject all or part of the
778panel's recommendation. All fines collected under this
779subsection must be deposited into the Health Care Trust Fund.
780     (10)  In determining any fine or sanction to be imposed,
781the agency and the office may consider the following factors:
782     (a)  The severity of the noncompliance, including the
783probability that death or serious harm to the health or safety
784of the subscriber will result or has resulted, the severity of
785the actual or potential harm, and the extent to which provisions
786of chapter 641 were violated.
787     (b)  Actions taken by the managed care entity to resolve or
788remedy any quality-of-care grievance.
789     (c)  Any previous incidents of noncompliance by the managed
790care entity.
791     (d)  Any other relevant factors the agency or office
792considers appropriate in a particular grievance.
793     (11)(a)  The panel shall consist of the Insurance Consumer
794Advocate, or designee thereof, established by s. 627.0613; at
795least two members employed by the agency and at least two
796members employed by the department, chosen by their respective
797agencies; a consumer appointed by the Governor; a physician
798appointed by the Governor, as a standing member; and, if
799necessary, physicians who have expertise relevant to the case to
800be heard, on a rotating basis. The agency may contract with a
801medical director, and a primary care physician, or both, who
802shall provide additional technical expertise to the panel but
803shall not be voting members of the panel. The medical director
804shall be selected from a health maintenance organization with a
805current certificate of authority to operate in Florida.
806     (b)  A majority of those panel members required under
807paragraph (a) shall constitute a quorum for any meeting or
808hearing of the panel. A grievance may not be heard or voted upon
809at any panel meeting or hearing unless a quorum is present,
810except that a minority of the panel may adjourn a meeting or
811hearing until a quorum is present. A panel convened for the
812purpose of hearing a subscriber's grievance in accordance with
813subsections (2) and (3) shall not consist of more than 11
814members.
815     (12)  Every managed care entity shall submit a quarterly
816report to the agency, the office, and the department listing the
817number and the nature of all subscribers' and providers'
818grievances which have not been resolved to the satisfaction of
819the subscriber or provider after the subscriber or provider
820follows the entire internal grievance procedure of the managed
821care entity. The agency shall notify all subscribers and
822providers included in the quarterly reports of their right to
823file an unresolved grievance with the panel.
824     (13)  A proposed order issued by the agency or office which
825only requires the managed care entity to take a specific action
826under subsection (7) is subject to a summary hearing in
827accordance with s. 120.574, unless all of the parties agree
828otherwise. If the managed care entity does not prevail at the
829hearing, the managed care entity must pay reasonable costs and
830attorney's fees of the agency or the office incurred in that
831proceeding.
832     (14)(a)  Any information that identifies a subscriber which
833is held by the panel, agency, or department pursuant to this
834section is confidential and exempt from the provisions of s.
835119.07(1) and s. 24(a), Art. I of the State Constitution.
836However, at the request of a subscriber or managed care entity
837involved in a grievance procedure, the panel, agency, or
838department shall release information identifying the subscriber
839involved in the grievance procedure to the requesting subscriber
840or managed care entity.
841     (b)  Meetings of the panel shall be open to the public
842unless the provider or subscriber whose grievance will be heard
843requests a closed meeting or the agency or the department
844determines that information which discloses the subscriber's
845medical treatment or history or information relating to internal
846risk management programs as defined in s. 641.55(5)(c), (6), and
847(8) may be revealed at the panel meeting, in which case that
848portion of the meeting during which a subscriber's medical
849treatment or history or internal risk management program
850information is discussed shall be exempt from the provisions of
851s. 286.011 and s. 24(b), Art. I of the State Constitution. All
852closed meetings shall be recorded by a certified court reporter.
853     Section 10.  Paragraph (c) of subsection (4) of section
854641.3154, Florida Statutes, is amended to read:
855     641.3154  Organization liability; provider billing
856prohibited.--
857     (4)  A provider or any representative of a provider,
858regardless of whether the provider is under contract with the
859health maintenance organization, may not collect or attempt to
860collect money from, maintain any action at law against, or
861report to a credit agency a subscriber of an organization for
862payment of services for which the organization is liable, if the
863provider in good faith knows or should know that the
864organization is liable. This prohibition applies during the
865pendency of any claim for payment made by the provider to the
866organization for payment of the services and any legal
867proceedings or dispute resolution process to determine whether
868the organization is liable for the services if the provider is
869informed that the such proceedings are taking place. It is
870presumed that a provider does not know and should not know that
871an organization is liable unless:
872     (c)  The office or agency makes a final determination that
873the organization is required to pay for such services subsequent
874to a recommendation made by the Statewide Provider and
875Subscriber Assistance Panel pursuant to s. 408.7056; or
876     Section 11.  Subsection (1), paragraphs (b) and (e) of
877subsection (3), paragraph (d) of subsection (4), subsection (5),
878paragraph (g) of subsection (6), and subsections  (9), (10), and
879(11) of section 641.511, Florida Statutes, are amended to read:
880     641.511  Subscriber grievance reporting and resolution
881requirements.--
882     (1)  Every organization must have a grievance procedure
883available to its subscribers for the purpose of addressing
884complaints and grievances. Every organization must notify its
885subscribers that a subscriber must submit a grievance within 1
886year after the date of occurrence of the action that initiated
887the grievance, and may submit the grievance for review to the
888Statewide Provider and Subscriber Assistance Program panel as
889provided in s. 408.7056 after receiving a final disposition of
890the grievance through the organization's grievance process. An
891organization shall maintain records of all grievances and shall
892report annually to the agency the total number of grievances
893handled, a categorization of the cases underlying the
894grievances, and the final disposition of the grievances.
895     (3)  Each organization's grievance procedure, as required
896under subsection (1), must include, at a minimum:
897     (b)  The names of the appropriate employees or a list of
898grievance departments that are responsible for implementing the
899organization's grievance procedure. The list must include the
900address and the toll-free telephone number of each grievance
901department, the address of the agency and its toll-free
902telephone hotline number, and the address of the Statewide
903Provider and Subscriber Assistance Program and its toll-free
904telephone number.
905     (e)  A notice that a subscriber may voluntarily pursue
906binding arbitration in accordance with the terms of the contract
907if offered by the organization, after completing the
908organization's grievance procedure and as an alternative to the
909Statewide Provider and Subscriber Assistance Program. Such
910notice shall include an explanation that the subscriber may
911incur some costs if the subscriber pursues binding arbitration,
912depending upon the terms of the subscriber's contract.
913     (4)
914     (d)  In any case when the review process does not resolve a
915difference of opinion between the organization and the
916subscriber or the provider acting on behalf of the subscriber,
917the subscriber or the provider acting on behalf of the
918subscriber may submit a written grievance to the Statewide
919Provider and Subscriber Assistance Program.
920     (5)  Except as provided in subsection (6), the organization
921shall resolve a grievance within 60 days after receipt of the
922grievance, or within a maximum of 90 days if the grievance
923involves the collection of information outside the service area.
924These time limitations are tolled if the organization has
925notified the subscriber, in writing, that additional information
926is required for proper review of the grievance and that such
927time limitations are tolled until such information is provided.
928After the organization receives the requested information, the
929time allowed for completion of the grievance process resumes.
930The Employee Retirement Income Security Act of 1974, as
931implemented by 29 C.F.R. 2560.503-1, is adopted and incorporated
932by reference as applicable to all organizations that administer
933small and large group health plans that are subject to 29 C.F.R.
9342560.503-1. The claims procedures of the regulations of the
935Employee Retirement Income Security Act of 1974 as implemented
936by 29 C.F.R. 2560.503-1 shall be the minimum standards for
937grievance processes for claims for benefits for small and large
938group health plans that are subject to 29 C.F.R. 2560.503-1.
939     (6)
940     (g)  In any case when the expedited review process does not
941resolve a difference of opinion between the organization and the
942subscriber or the provider acting on behalf of the subscriber,
943the subscriber or the provider acting on behalf of the
944subscriber may submit a written grievance to the Statewide
945Provider and Subscriber Assistance Program.
946     (9)(a)  The agency shall advise subscribers with grievances
947to follow their organization's formal grievance process for
948resolution prior to review by the Statewide Provider and
949Subscriber Assistance Program. The subscriber may, however,
950submit a copy of the grievance to the agency at any time during
951the process.
952     (b)  Requiring completion of the organization's grievance
953process before the Statewide Provider and Subscriber Assistance
954Program panel's review does not preclude the agency from
955investigating any complaint or grievance before the organization
956makes its final determination.
957     (10)  Each organization must notify the subscriber in a
958final decision letter that the subscriber may request review of
959the organization's decision concerning the grievance by the
960Statewide Provider and Subscriber Assistance Program, as
961provided in s. 408.7056, if the grievance is not resolved to the
962satisfaction of the subscriber. The final decision letter must
963inform the subscriber that the request for review must be made
964within 365 days after receipt of the final decision letter, must
965explain how to initiate such a review, and must include the
966addresses and toll-free telephone numbers of the agency and the
967Statewide Provider and Subscriber Assistance Program.
968     (11)  Each organization, as part of its contract with any
969provider, must require the provider to post a consumer
970assistance notice prominently displayed in the reception area of
971the provider and clearly noticeable by all patients. The
972consumer assistance notice must state the addresses and toll-
973free telephone numbers of the Agency for Health Care
974Administration, the Statewide Provider and Subscriber Assistance
975Program, and the Department of Financial Services. The consumer
976assistance notice must also clearly state that the address and
977toll-free telephone number of the organization's grievance
978department shall be provided upon request. The agency may adopt
979rules to implement this section.
980     Section 12.  Subsection (4) of section 641.58, Florida
981Statutes, is amended to read:
982     641.58  Regulatory assessment; levy and amount; use of
983funds; tax returns; penalty for failure to pay.--
984     (4)  The moneys received and deposited into the Health Care
985Trust Fund shall be used to defray the expenses of the agency in
986the discharge of its administrative and regulatory powers and
987duties under this part, including conducting an annual survey of
988the satisfaction of members of health maintenance organizations;
989contracting with physician consultants for the Statewide
990Provider and Subscriber Assistance Panel; maintaining offices
991and necessary supplies, essential equipment, and other
992materials, salaries and expenses of required personnel; and
993discharging the administrative and regulatory powers and duties
994imposed under this part.
995     Section 13.  Paragraph (f) of subsection (2) and
996subsections (3) and (9) of section 408.909, Florida Statutes,
997are amended to read:
998     408.909  Health flex plans.--
999     (2)  DEFINITIONS.--As used in this section, the term:
1000     (f)  "Health flex plan entity" means a health insurer,
1001health maintenance organization, health-care-provider-sponsored
1002organization, local government, health care district, or other
1003public or private community-based organization, or public-
1004private partnership that develops and implements an approved
1005health flex plan and is responsible for administering the health
1006flex plan and paying all claims for health flex plan coverage by
1007enrollees of the health flex plan.
1008     (3)  PILOT PROGRAM.--The agency and the office shall each
1009approve or disapprove health flex plans that provide health care
1010coverage for eligible participants who reside in the three areas
1011of the state that have the highest number of uninsured persons,
1012as identified in the Florida Health Insurance Study conducted by
1013the agency and in Indian River County. A health flex plan may
1014limit or exclude benefits otherwise required by law for insurers
1015offering coverage in this state, may cap the total amount of
1016claims paid per year per enrollee, may limit the number of
1017enrollees, or may take any combination of those actions. A
1018health flex plan offering may include the option of a
1019catastrophic plan supplementing the health flex plan.
1020     (a)  The agency shall develop guidelines for the review of
1021applications for health flex plans and shall disapprove or
1022withdraw approval of plans that do not meet or no longer meet
1023minimum standards for quality of care and access to care. The
1024agency shall ensure that the health flex plans follow
1025standardized grievance procedures similar to those required of
1026health maintenance organizations.
1027     (b)  The office shall develop guidelines for the review of
1028health flex plan applications and provide regulatory oversight
1029of health flex plan advertisement and marketing procedures. The
1030office shall disapprove or shall withdraw approval of plans
1031that:
1032     1.  Contain any ambiguous, inconsistent, or misleading
1033provisions or any exceptions or conditions that deceptively
1034affect or limit the benefits purported to be assumed in the
1035general coverage provided by the health flex plan;
1036     2.  Provide benefits that are unreasonable in relation to
1037the premium charged or contain provisions that are unfair or
1038inequitable or contrary to the public policy of this state, that
1039encourage misrepresentation, or that result in unfair
1040discrimination in sales practices; or
1041     3.  Cannot demonstrate that the health flex plan is
1042financially sound and that the applicant is able to underwrite
1043or finance the health care coverage provided.
1044     (c)  The agency and the Financial Services Commission may
1045adopt rules as needed to administer this section.
1046     (9)  PROGRAM EVALUATION.--The agency and the office shall
1047evaluate the pilot program and its effect on the entities that
1048seek approval as health flex plans, on the number of enrollees,
1049and on the scope of the health care coverage offered under a
1050health flex plan; shall provide an assessment of the health flex
1051plans and their potential applicability in other settings; shall
1052use health flex plans to gather more information to evaluate
1053low-income consumer driven benefit packages; and shall, by
1054January 1, 2005 2004, jointly submit a report to the Governor,
1055the President of the Senate, and the Speaker of the House of
1056Representatives.
1057     Section 14.  Section 408.919, Florida Statutes, is created
1058to read:
1059     408.919  Statewide Electronic Medical Records Advisory
1060Council.--
1061     (1)  There is hereby created a Statewide Electronic Medical
1062Records Advisory Council to serve as a body of experts to guide
1063the Agency for Health Care Administration in the development of
1064policy related to electronic medical records and the technology
1065required for sharing clinical information among caregivers.
1066     (2)  The agency shall provide staff support to the council
1067and may enter into contracts as are necessary or proper to carry
1068out the provisions and purposes of this act in assisting the
1069advisory council in creating an electronic medical records
1070system.
1071     (3)  The advisory council shall be appointed by the
1072Governor, the President of the Senate, and the Speaker of the
1073House of Representatives. The advisory council shall consist of
1074nine members, with three members appointed by the Governor,
1075three members appointed by the President of the Senate, and
1076three members appointed by the Speaker of the House of
1077Representatives.
1078     (4)  The council shall meet at least quarterly and advise
1079the Governor, the Legislature, and the agency regarding:
1080     (a)  Public and private sector initiatives related to
1081electronic medical records and communication systems for the
1082sharing of clinical information among caregivers.
1083     (b)  Regulatory barriers that interfere with the sharing of
1084clinical information among caregivers.
1085     (c)  Investment incentives to promote the use of
1086recommended technologies by health care providers.
1087     (d)  Educational strategies to promote the use of
1088recommended technologies by health care providers.
1089     (e)  Standards for public access to facilitate transparency
1090in pricing, costs, and quality.
1091     (5)  By November 30, 2004, and annually thereafter, the
1092advisory council shall provide to the Executive Office of the
1093Governor, the Speaker of the House of Representatives, and the
1094President of the Senate a status report to include any
1095recommendations and an implementation plan to include, but not
1096be limited to, estimated costs, capital investment requirements,
1097recommended investment incentives, initial committed provider
1098participation by region, standards of functionality and
1099features, a marketing plan, and implementation schedules for key
1100components.
1101     (6)  Members of the advisory council shall serve without
1102compensation but shall be entitled to receive reimbursement for
1103per diem and travel expenses as provided in s. 112.061.
1104     (7)  Unless otherwise reenacted by the Legislature, the
1105advisory council is abolished effective July 1, 2007.
1106     Section 15.  (1)  The Statewide Evidence-based Medicine
1107Panel is created to serve as a body of experts to guide the
1108Agency for Health Care Administration and the Department of
1109Health in the development of policy related to evidence-based
1110medicine and the technology required for sharing information
1111among caregivers.
1112     (2)  The agency shall provide staff support to the panel
1113and may enter into contracts as are necessary or proper to carry
1114out the provisions and purposes of this section in assisting the
1115panel in creating a statewide evidence-based medicine program.
1116     (3)  The panel shall consist of nine members, with three
1117members appointed by the Governor, three members appointed by
1118the President of the Senate, and three members appointed by the
1119Speaker of the House of Representatives.
1120     (4)  The panel shall meet at least quarterly and advise the
1121Governor, the President of the Senate, the Speaker of the House
1122of Representatives, and the agency regarding:
1123     (a)  The ability to join or support efforts for the use of
1124evidence-based medicine already underway, such as those of the
1125Leapfrog Group, the international group Bandolier, and the
1126Healthy Florida Foundation.
1127     (b)  The means by which to promote university-based or
1128medical-school-based research using Medicaid and other data
1129collected by the Agency for Health Care Administration to
1130identify and quantify the most cost-effective treatment and
1131interventions, including disease management programs.
1132     (c)  The means by which to encourage development of systems
1133to measure and reward providers who implement evidence-based
1134medical practices.
1135     (d)  The evaluation and identification of ways to tie a
1136health care provider's use of evidence-based medical practice to
1137medical malpractice liability.
1138     (e)  The review of other state and private initiatives and
1139published literature for promising approaches and the
1140dissemination of information about them to providers.
1141     (f)  The encouragement of the Florida Medical Association
1142and other health care associations to regularly publish findings
1143related to the cost-effectiveness of disease-specific evidence-
1144based standards.
1145     (g)  Public and private sector initiatives related to
1146evidence-based medicine and communication systems for the
1147sharing of clinical information among caregivers.
1148     (h)  Regulatory barriers that interfere with the sharing of
1149clinical information among caregivers.
1150     (5)  By November 30, 2004, and annually thereafter, the
1151panel shall provide to the Office of the Governor, the Speaker
1152of the House of Representatives, and the President of the Senate
1153a status report including any recommendations and an
1154implementation plan to include, but not be limited to, estimated
1155costs, capital investment requirements, recommended investment
1156incentives, initial committed provider participation by region,
1157standards of functionality and features, a marketing plan, and
1158implementation schedules for key components.
1159     (6)  Members of the panel shall serve without compensation
1160but shall be entitled to receive reimbursement for per diem and
1161travel expenses as provided in s. 112.061, Florida Statutes.
1162     (7)  Unless otherwise reestablished by the Legislature, the
1163panel is abolished effective July 1, 2007.
1164     Section 16.  Subsection (3) of section 409.91255, Florida
1165Statutes, is amended to read:
1166     409.91255  Federally qualified health center access
1167program.--
1168     (3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.--The
1169Department of Health shall develop a program for the expansion
1170of federally qualified health centers for the purpose of
1171providing comprehensive primary and preventive health care and
1172urgent care services, including services that may reduce the
1173morbidity, mortality, and cost of care among the uninsured
1174population of the state. The program shall provide for
1175distribution of financial assistance to federally qualified
1176health centers that apply and demonstrate a need for such
1177assistance in order to sustain or expand the delivery of primary
1178and preventive health care services. In selecting centers to
1179receive this financial assistance, the program:
1180     (a)  Shall give preference to communities that have few or
1181no community-based primary care services or in which the current
1182services are unable to meet the community's needs.
1183     (b)  Shall require that primary care services be provided
1184to the medically indigent using a sliding fee schedule based on
1185income.
1186     (c)  Shall allow innovative and creative uses of federal,
1187state, and local health care resources.
1188     (d)  Shall require that the funds provided be used to pay
1189for operating costs of a projected expansion in patient
1190caseloads or services or for capital improvement projects.
1191Capital improvement projects may include renovations to existing
1192facilities or construction of new facilities, provided that an
1193expansion in patient caseloads or services to a new patient
1194population will occur as a result of the capital expenditures.
1195The department shall include in its standard contract document a
1196requirement that any state funds provided for the purchase of or
1197improvements to real property are contingent upon the contractor
1198granting to the state a security interest in the property at
1199least to the amount of the state funds provided for at least 5
1200years from the date of purchase or the completion of the
1201improvements or as further required by law. The contract must
1202include a provision that, as a condition of receipt of state
1203funding for this purpose, the contractor agrees that, if it
1204disposes of the property before the department's interest is
1205vacated, the contractor will refund the proportionate share of
1206the state's initial investment, as adjusted by depreciation.
1207     (e)  May require in-kind support from other sources.
1208     (f)  May encourage coordination among federally qualified
1209health centers, other private-sector providers, and publicly
1210supported programs.
1211     (g)  Shall allow the development of community diversion
1212programs in conjunction with local resources, providing extended
1213hours of operation to urgent care patients.
1214     Section 17.  Paragraph (a) of subsection (6) of section
1215627.410, Florida Statutes, is amended to read:
1216     627.410  Filing, approval of forms.--
1217     (6)(a)  An insurer shall not deliver or issue for delivery
1218or renew in this state any health insurance policy form until it
1219has filed with the office a copy of every applicable rating
1220manual, rating schedule, change in rating manual, and change in
1221rating schedule; if rating manuals and rating schedules are not
1222applicable, the insurer must file with the office order
1223applicable premium rates and any change in applicable premium
1224rates. This paragraph does not apply to group health insurance
1225policies, effectuated and delivered in this state, insuring
1226groups of 51 or more persons, except for Medicare supplement
1227insurance, long-term care insurance, and any coverage under
1228which the increase in claim costs over the lifetime of the
1229contract due to advancing age or duration is prefunded in the
1230premium.
1231     Section 18.  Paragraph (b) of subsection (3) of section
1232627.6487, Florida Statutes, is amended to read:
1233     627.6487  Guaranteed availability of individual health
1234insurance coverage to eligible individuals.--
1235     (3)  For the purposes of this section, the term "eligible
1236individual" means an individual:
1237     (b)  Who is not eligible for coverage under:
1238     1.  A group health plan, as defined in s. 2791 of the
1239Public Health Service Act;
1240     2.  A conversion policy or contract issued by an authorized
1241insurer or health maintenance organization under s. 627.6675 or
1242s. 641.3921, respectively, offered to an individual who is no
1243longer eligible for coverage under either an insured or self-
1244insured employer plan;
1245     3.  Part A or part B of Title XVIII of the Social Security
1246Act; or
1247     4.  A state plan under Title XIX of such act, or any
1248successor program, and does not have other health insurance
1249coverage; or
1250     5.  The Florida Health Insurance Plan as specified in s.
1251627.64872 and such plan is accepting new enrollment;
1252     Section 19.  Section 627.64872, Florida Statutes, is
1253created to read:
1254     627.64872  Uninsurable risk assumption plan.--
1255     (1)  LEGISLATIVE INTENT; FLORIDA HEALTH INSURANCE PLAN.--
1256     (a)  The Legislature recognizes that to secure a more
1257stable and orderly health insurance market, the establishment of
1258a plan to assume risks deemed uninsurable by the private
1259marketplace is required.
1260     (b)  The Florida Health Insurance Plan is created. The plan
1261shall make coverage available to individuals who have no other
1262option for similar coverage, at a premium that is commensurate
1263with the risk and benefits provided, and with benefit designs
1264that are reasonable in relation to the general market. While
1265plan operations may include supplementary funding, the plan
1266shall fundamentally operate on sound actuarial principles, using
1267basic insurance management techniques to ensure that the plan is
1268run in an economical, cost-efficient, and sound manner,
1269conserving plan resources to serve the maximum number of people
1270possible in a sustainable fashion.
1271     (2)  DEFINITIONS.--As used in this section:
1272     (a)  "Board" means the board of directors of the plan.
1273     (b)  "Governor" means the Governor of this state.
1274     (c)  "Office" means the Office of Insurance Regulation of
1275the Financial Services Commission.
1276     (d)  "Dependent" means a resident spouse or resident
1277unmarried child under the age of 19 years, a child who is a
1278student under the age of 25 years and who is financially
1279dependent upon the parent, or a child of any age who is disabled
1280and dependent upon the parent.
1281     (e)  "Director" means the director of the Office of
1282Insurance Regulation.
1283     (f)  "Health insurance" means any hospital or medical
1284expense incurred policy, health maintenance organization
1285subscriber contract pursuant to chapter 627 or chapter 641, or
1286any other health care plan or arrangement that pays for or
1287furnishes medical or health care services, whether by insurance
1288or otherwise. The term does not include short term, accident,
1289dental-only, vision-only, fixed indemnity, limited benefit, or
1290credit insurance, coverage issued as a supplement to liability
1291insurance, insurance arising out of a workers' compensation or
1292similar law, automobile medical payment insurance, or insurance
1293under which benefits are payable with or without regard to fault
1294and which is statutorily required to be contained in any
1295liability insurance policy or equivalent selfinsurance.
1296     (g)  "Implementation" means the enrollment of eligible
1297individuals in the plan and provision of the benefits described
1298in this section.
1299     (h)  "Insurer" means any entity that provides health
1300insurance in this state. For purposes of this section, insurer
1301includes an insurance company with a valid certificate in
1302accordance with chapter 624, a health maintenance organization
1303with a valid certificate of authority in accordance with part I
1304or part III of chapter 641, a prepaid health clinic authorized
1305to transact business in this state pursuant to part II of
1306chapter 641, multiple employer welfare arrangements authorized
1307to transact business in this state pursuant to ss. 624.436-
1308624.45, or a fraternal benefit society providing health benefits
1309to its members as authorized pursuant to chapter 632.
1310     (i)  "Medicare" means coverage under both Parts A and B of
1311Title XVIII of the Social Security Act, 42 USC 1395 et seq., as
1312amended.
1313     (j)  "Medicaid" means coverage under Title XIX of the
1314Social Security Act.
1315     (k)  "Participating insurer" means any insurer providing
1316health insurance to citizens of this state.
1317     (l)  "Provider" means any physician, hospital, or other
1318institution, organization, or person that furnishes health care
1319services and is licensed or otherwise authorized to practice in
1320the state.
1321     (m)  "Plan" means the Florida Health Insurance Plan created
1322in subsection (1).
1323     (n)  "Plan of operation" means the articles, bylaws, and
1324operating rules and procedures adopted by the board pursuant to
1325this section.
1326     (o)  "Resident" means an individual who has been legally
1327domiciled in this state for a period of at least 30 days.
1328     (3)  BOARD OF DIRECTORS.--
1329     (a)  The plan shall operate subject to the supervision and
1330control of the board. The board shall consist of the director or
1331his or her designated representative, who shall serve as a
1332member of the board and shall be its chair, and an additional
1333eight members, four of whom shall be appointed by the Governor,
1334two of whom shall be appointed by the President of the Senate,
1335and two of whom shall be appointed by the Speaker of the House
1336of Representatives. A majority of the board shall be composed of
1337individuals who are not representatives of insurers or health
1338care providers.
1339     (b)  The initial board members shall be appointed as
1340follows: one-third of the members to serve a term of 2 years;
1341one-third of the members to serve a term of 4 years; and one-
1342third of the members to serve a term of 6 years. Subsequent
1343board members shall serve for a term of 3 years. A board
1344member's term shall continue until his or her successor is
1345appointed.
1346     (c)  Vacancies in the board shall be filled by the
1347appointing authority, such authority being the Governor, the
1348President of the Senate, or the Speaker of the House of
1349Representatives. Board members may be removed by the appointing
1350authority for cause.
1351     (d)  The board shall conduct its first meeting by December
13521, 2004.
1353     (e)  Members shall not be compensated in their capacity as
1354board members but shall be reimbursed for reasonable expenses
1355incurred in the necessary performance of their duties in
1356accordance with s. 112.061.
1357     (f)  The board shall submit to the Governor a plan of
1358operation for the plan and any amendments thereto necessary or
1359suitable to ensure the fair, reasonable, and equitable
1360administration of the plan. The plan of operation shall ensure
1361that the plan qualifies to apply for any available funding from
1362the Federal Government that adds to the financial viability of
1363the plan. The plan of operation shall become effective upon
1364approval in writing by the Governor consistent with the date on
1365which the coverage under this section must be made available. If
1366the board fails to submit a suitable plan of operation within
1367180 days after the appointment of the board of directors, or at
1368any time thereafter fails to submit suitable amendments to the
1369plan of operation, the office shall adopt such rules as are
1370necessary or advisable to effectuate the provisions of this
1371section. Such rules shall continue in force until modified by
1372the office or superseded by a plan of operation submitted by the
1373board and approved by the Governor.
1374     (4)  PLAN OF OPERATION.--The plan of operation shall:
1375     (a)  Establish procedures for operation of the plan.
1376     (b)  Establish procedures for selecting an administrator in
1377accordance with subsection (11).
1378     (c)  Establish procedures to create a fund, under
1379management of the board, for administrative expenses.
1380     (d)  Establish procedures for the handling, accounting, and
1381auditing of assets, moneys, and claims of the plan and the plan
1382administrator.
1383     (e)  Develop and implement a program to publicize the
1384existence of the plan, plan eligibility requirements, and
1385procedures for enrollment and maintain public awareness of the
1386plan.
1387     (f)  Establish procedures under which applicants and
1388participants may have grievances reviewed by a grievance
1389committee appointed by the board. The grievances shall be
1390reported to the board after completion of the review, with the
1391committee's recommendation for grievance resolution. The board
1392shall retain all written grievances regarding the plan for at
1393least 3 years.
1394     (g)  Provide for other matters as may be necessary and
1395proper for the execution of the board's powers, duties, and
1396obligations under this section.
1397     (5)  POWERS OF THE PLAN.--The plan shall have the general
1398powers and authority granted under the laws of this state to
1399health insurers and, in addition thereto, the specific authority
1400to:
1401     (a)  Enter into such contracts as are necessary or proper
1402to carry out the provisions and purposes of this section,
1403including the authority, with the approval of the Governor, to
1404enter into contracts with similar plans of other states for the
1405joint performance of common administrative functions, or with
1406persons or other organizations for the performance of
1407administrative functions.
1408     (b)  Take any legal actions necessary or proper to recover
1409or collect assessments due the plan.
1410     (c)  Take such legal action as is necessary to:
1411     1.  Avoid payment of improper claims against the plan or
1412the coverage provided by or through the plan;
1413     2.  Recover any amounts erroneously or improperly paid by
1414the plan;
1415     3.  Recover any amounts paid by the plan as a result of
1416mistake of fact or law; or
1417     4.  Recover other amounts due the plan.
1418     (d)  Establish, and modify as appropriate, rates, rate
1419schedules, rate adjustments, expense allowances, agents'
1420referral fees, claim reserve formulas, and any other actuarial
1421functions appropriate to the operation of the plan. Rates and
1422rate schedules may be adjusted for appropriate factors such as
1423age, sex, and geographic variation in claim cost and shall take
1424into consideration appropriate factors in accordance with
1425established actuarial and underwriting practices.
1426     (e)  Issue policies of insurance in accordance with the
1427requirements of this section.
1428     (f)  Appoint appropriate legal, actuarial, investment, and
1429other committees as necessary to provide technical assistance in
1430the operation of the plan and develop and educate its
1431policyholders regarding health savings accounts, policy and
1432contract design, and any other function within the authority of
1433the plan.
1434     (g)  Borrow money to effectuate the purposes of the plan.
1435Any notes or other evidence of indebtedness of the plan not in
1436default shall be legal investments for insurers and may be
1437carried as admitted assets.
1438     (h)  Employ and fix the compensation of employees.
1439     (i)  Prepare and distribute certificate of eligibility
1440forms and enrollment instruction forms to insurance producers
1441and to the general public.
1442     (j)  Provide for reinsurance of risks incurred by the plan.
1443     (k)  Provide for and employ cost-containment measures and
1444requirements, including, but not limited to, preadmission
1445screening, second surgical opinion, concurrent utilization
1446review, and individual case management for the purpose of making
1447the plan more cost-effective.
1448     (l)  Design, use, contract, or otherwise arrange for the
1449delivery of cost-effective health care services, including, but
1450not limited to, establishing or contracting with preferred
1451provider organizations, health maintenance organizations, and
1452other limited network provider arrangements.
1453     (m)  Adopt such bylaws, policies, and procedures as may be
1454necessary or convenient for the implementation of this section
1455and the operation of the plan.
1456     (6)  ANNUAL REPORT.--No later than December 1, 2005, and
1457annually thereafter, the board shall submit to the Governor, the
1458President of the Senate, and the Speaker of the House of
1459Representatives a report which includes an independent actuarial
1460study to determine, including, but not be limited to:
1461     (a)  The impact the creation of the plan has on the small
1462group insurance market, specifically on the premiums paid by
1463insureds. This shall include an estimate of the total
1464anticipated aggregate savings for all small employers in the
1465state.
1466     (b)  The actual number of individuals covered at the
1467current funding and benefit level, the projected number of
1468individuals that may seek coverage in the forthcoming fiscal
1469year, and the projected funding needed to cover anticipated
1470increase or decrease in plan participation.
1471     (c)  A recommendation as to the best source of funding for
1472the anticipated deficits of the pool.
1473     (d)  A summarization of the activities of the plan in the
1474preceding calendar year, including the net written and earned
1475premiums, plan enrollment, the expense of administration, and
1476the paid and incurred losses.
1477     (e)  A review of the operation of the plan as to whether
1478the plan has met the intent of this section.
1479     (7)  LIABILITY OF THE PLAN.--Neither the board nor its
1480employees shall be liable for any obligations of the plan. No
1481member or employee of the board shall be liable, and no cause of
1482action of any nature may arise against a member or employee of
1483the board, for any act or omission related to the performance of
1484any powers and duties under this section, unless such act or
1485omission constitutes willful or wanton misconduct. The board may
1486provide in its bylaws or rules for indemnification of, and legal
1487representation for, its members and employees.
1488     (8)  AUDITED FINANCIAL STATEMENT.--No later than June 1
1489following the close of each calendar year, the plan shall submit
1490to the Governor an audited financial statement prepared in
1491accordance with statutory accounting principles as adopted by
1492the National Association of Insurance Commissioners.
1493     (9)  ELIGIBILITY.--
1494     (a)  Any individual person who is and continues to be a
1495resident of this state shall be eligible for coverage under the
1496plan if:
1497     1.  Evidence is provided that the person received:
1498     a.  A notice of rejection or refusal to issue substantially
1499similar insurance for health reasons by one insurer; or
1500     b.  A refusal by an insurer to issue insurance except at a
1501rate exceeding the plan rate.
1502
1503A rejection or refusal by an insurer offering only stoploss,
1504excess of loss, or reinsurance coverage with respect to the
1505applicant shall not be sufficient evidence under this paragraph.
1506     2.  The person is eligible for individual coverage in
1507accordance with s. 627.6487.
1508     3.  The person is enrolled in the Florida Comprehensive
1509Health Association as of the date the plan is implemented.
1510     (b)  The board may provide a list of medical or health
1511conditions for which a person shall be eligible for coverage
1512under the plan without applying for health insurance pursuant to
1513paragraph (a). A person who can demonstrate the existence or
1514history of any medical or health conditions on the list provided
1515by the board shall not be required to provide the evidence
1516specified in paragraph (a). The list shall be effective on the
1517first day of the operation of the plan and may be amended as
1518appropriate.
1519     (c)  Each resident dependent of a person who is eligible
1520for coverage under the plan shall also be eligible for such
1521coverage.
1522     (d)  A person shall not be eligible for coverage under the
1523plan if:
1524     1.  The person has or obtains health insurance coverage
1525substantially similar to or more comprehensive than a plan
1526policy, or would be eligible to obtain such coverage, unless a
1527person may maintain other coverage for the period of time the
1528person is satisfying any preexisting condition waiting period
1529under a plan policy or may maintain plan coverage for the period
1530of time the person is satisfying a preexisting condition waiting
1531period under another health insurance policy intended to replace
1532the plan policy.
1533     2.  The person is determined to be eligible for health care
1534benefits under Medicaid, the state's children's health insurance
1535program, or any other federal, state, or local government
1536program that provides health benefits;
1537     3.  The person has previously terminated plan coverage
1538unless 12 months have elapsed since such termination;
1539     4.  The person is an inmate or resident of a public
1540institution; or
1541     5.  The person's premiums are paid for or reimbursed under
1542any government-sponsored program or by any government agency or
1543health care provider, except as an otherwise qualifying fulltime
1544employee, or dependent thereof, of a government agency or health
1545care provider.
1546     (e)  Coverage shall cease:
1547     1.  On the date a person is no longer a resident of this
1548state;
1549     2.  On the date a person requests coverage to end;
1550     3.  Upon the death of the covered person;
1551     4.  On the date state law requires cancellation of the
1552policy; or
1553     5.  At the option of the plan, 30 days after the plan makes
1554any inquiry concerning the person's eligibility or place of
1555residence to which the person does not reply.
1556     (f)  Except under the circumstances described in this
1557subsection, coverage of a person who ceases to meet the
1558eligibility requirements of this subsection may be terminated at
1559the end of the policy period for which the necessary premiums
1560have been paid.
1561     (10)  UNFAIR REFERRAL TO PLAN.--It is an unfair trade
1562practice for the purposes of part IX of chapter 626, Florida
1563Statutes, or s. 641.3901 for an insurer, health maintenance
1564organization insurance agent, insurance broker, or third-party
1565administrator to refer an individual employee to the plan, or
1566arrange for an individual employee to apply to the plan, for the
1567purpose of separating that employee from group health insurance
1568coverage provided in connection with the employee's employment.
1569     (11)  PLAN ADMINISTRATOR.--The board shall select through a
1570competitive bidding process a plan administrator to administer
1571the plan. The board shall evaluate bids submitted based on
1572criteria established by the board, which shall include:
1573     (a)  The plan administrator's proven ability to handle
1574health insurance coverage to individuals.
1575     (b)  The efficiency and timeliness of the plan
1576administrator's claim processing procedures.
1577     (c)  An estimate of total charges for administering the
1578plan.
1579     (d)  The plan administrator's ability to apply effective
1580cost-containment programs and procedures and to administer the
1581plan in a cost-efficient manner.
1582     (e)  The financial condition and stability of the plan
1583administrator.
1584
1585The administrator shall be an insurer, a health maintenance
1586organization, or a third-party administrator, or another
1587organization duly authorized to provide insurance pursuant to
1588the Florida Insurance Code.
1589     (12)  ADMINISTRATOR TERM LIMITS.--The plan administrator
1590shall serve for a period specified in the contract between the
1591plan and the plan administrator subject to removal for cause and
1592subject to any terms, conditions, and limitations of the
1593contract between the plan and the plan administrator. At least 1
1594year prior to the expiration of each period of service by a plan
1595administrator, the board shall invite eligible entities,
1596including the current plan administrator, to submit bids to
1597serve as the plan administrator. Selection of the plan
1598administrator for each succeeding period shall be made at least
15996 months prior to the end of the current period.
1600     (13)  DUTIES OF THE PLAN ADMINISTRATOR.--
1601     (a)  The plan administrator shall perform such functions
1602relating to the plan as may be assigned to it, including, but
1603not limited to:
1604     1.  Determination of eligibility.
1605     2.  Payment of claims.
1606     3.  Establishment of a premium billing procedure for
1607collection of premiums from persons covered under the plan.
1608     4.  Other necessary functions to ensure timely payment of
1609benefits to covered persons under the plan.
1610     (b)  The plan administrator shall submit regular reports to
1611the board regarding the operation of the plan. The frequency,
1612content, and form of the reports shall be specified in the
1613contract between the board and the plan administrator.
1614     (c)  On March 1 following the close of each calendar year,
1615the plan administrator shall determine net written and earned
1616premiums, the expense of administration, and the paid and
1617incurred losses for the year and report this information to the
1618board and the Governor on a form prescribed by the Governor.
1619     (14)  PAYMENT OF THE PLAN ADMINISTRATOR.--The plan
1620administrator shall be paid as provided in the contract between
1621the plan and the plan administrator.
1622     (15)  FUNDING OF THE PLAN.--
1623     (a)  Premiums.--
1624     1.  The plan shall establish premium rates for plan
1625coverage as provided in subparagraph (5)(a)4. Separate schedules
1626of premium rates based on age, sex, and geographical location
1627may apply for individual risks. Premium rates and schedules
1628shall be submitted to the office for approval prior to use.
1629     2.  Initial rates for plan coverage shall be capped at 200
1630percent of rates established as applicable for individual
1631standard risks as specified in s. 627.6653. The plan shall also
1632develop a sliding scale premium surcharge based upon the
1633insured's income. Subject to the limits provided in this
1634paragraph, subsequent rates shall be established to provide
1635fully for the expected costs of claims, including recovery of
1636prior losses, expenses of operation, investment income of claim
1637reserves, and any other cost factors subject to the limitations
1638described herein.
1639     (b)  Sources of additional revenue.--Any deficit incurred
1640by the plan shall be funded through amounts appropriated by the
1641Legislature from general revenue sources, including, but not
1642limited to, a portion of the annual growth in existing net
1643insurance premium taxes. The board shall operate the plan in
1644such a manner that the estimated cost of providing health
1645insurance during any fiscal year will not exceed total income
1646the plan expects to receive from policy premiums and funds
1647appropriated by the Legislature, including any interest on
1648investments. After determining the amount of funds appropriated
1649to the board for a fiscal year, the board shall estimate the
1650number of new policies it believes the plan has the financial
1651capacity to insure during that year so that costs do not exceed
1652income. The board shall take steps necessary to ensure that plan
1653enrollment does not exceed the number of residents it has
1654estimated it has the financial capacity to insure.
1655     (16)  BENEFITS.--
1656     (a)  The benefits provided shall be the same as the
1657standard and basic plans for small employers as outlined in s.
1658627.6699. The board may also establish an option of alternative
1659coverage such as catastrophic coverage that includes a minimum
1660level of primary care coverage.
1661     (b)  In establishing the plan coverage, the board shall
1662take into consideration the levels of health insurance provided
1663in the state and such medical economic factors as may be deemed
1664appropriate and adopt benefit levels, deductibles, copayments,
1665coinsurance factors, exclusions, and limitations determined to
1666be generally reflective of and commensurate with health
1667insurance provided through a representative number of large
1668employers in the state.
1669     (c)  The board may adjust any deductibles and coinsurance
1670factors annually according to the medical component of the
1671Consumer Price Index.
1672     (d)1.  Plan coverage shall exclude charges or expenses
1673incurred during the first 6 months following the effective date
1674of coverage for any condition for which medical advice, care, or
1675treatment was recommended or received for such condition during
1676the 6-month period immediately preceding the effective date of
1677coverage.
1678     2.  Such preexisting condition exclusions shall be waived
1679to the extent that similar exclusions, if any, have been
1680satisfied under any prior health insurance coverage which was
1681involuntarily terminated, provided application for pool coverage
1682is made not later than 63 days following such involuntary
1683termination. In such case, coverage under the plan shall be
1684effective from the date on which such prior coverage was
1685terminated and the applicant is not eligible for continuation or
1686conversion rights that would provide coverage substantially
1687similar to plan coverage.
1688     (17)  NONDUPLICATION OF BENEFITS.--
1689     (a)  The plan shall be payor of last resort of benefits
1690whenever any other benefit or source of third-party payment is
1691available. Benefits otherwise payable under plan coverage shall
1692be reduced by all amounts paid or payable through any other
1693health insurance, by all hospital and medical expense benefits
1694paid or payable under any workers' compensation coverage,
1695automobile medical payment, or liability insurance, whether
1696provided on the basis of fault or nonfault, and by any hospital
1697or medical benefits paid or payable under or provided pursuant
1698to any state or federal law or program.
1699     (b)  The plan shall have a cause of action against an
1700eligible person for the recovery of the amount of benefits paid
1701that are not for covered expenses. Benefits due from the plan
1702may be reduced or refused as a setoff against any amount
1703recoverable under this paragraph.
1704     (18)  ANNUAL AND MAXIMUM BENEFITS.--Maximum benefits under
1705the plan shall be determined by the board.
1706     (19)  TAXATION.--The plan is exempt from any tax imposed by
1707this state. The plan shall apply for federal tax exemption
1708status.
1709     (20)  COMBINING MEMBERSHIP OF THE FLORIDA COMPREHENSIVE
1710HEALTH ASSOCIATION.--
1711     (a)1. Upon implementation of the plan, the Florida
1712Comprehensive Health Association is abolished and all high-risk
1713individuals actively enrolled in the Florida Comprehensive
1714Health Association shall be enrolled in the plan subject to its
1715rules and requirements.
1716     2.  Persons formerly enrolled in the Florida Comprehensive
1717Health Association are only eligible for the benefits authorized
1718under subsection (18).
1719     (b)1.  As a condition of doing business in this state, an
1720insurer shall pay an assessment to the board in the amount
1721prescribed by this paragraph. For operating losses incurred on
1722or after July 1, 2004, by persons previously enrolled in the
1723Florida Comprehensive Health Association, each insurer shall
1724annually be assessed by the board in the following calendar year
1725a portion of such incurred operating losses of the plan. Such
1726portion shall be determined by multiplying such operating losses
1727by a fraction, the numerator of which equals the insurer's
1728earned premium pertaining to direct writings of health insurance
1729in the state during the calendar year proceeding that for which
1730the assessment is levied, and the denominator of which equals
1731the total of all such premiums earned by participating insurers
1732in the state during such calendar year.
1733     2.  The total of all assessments under this paragraph upon
1734a participating insurer shall not exceed 1 percent of such
1735insurer's health insurance premium earned in this state during
1736the calendar year preceeding the year for which the assessments
1737were levied.
1738     3.  All rights, title, and interest in the assessment funds
1739collected under this paragraph shall vest in this state.
1740However, all of such funds and interest earned shall be used by
1741the plan to pay claims and administrative expenses.
1742     (c)  If assessments and other receipts by the plan, board,
1743or plan administrator exceed the actual losses and
1744administrative expenses of the plan, the excess shall be held in
1745interest and used by the board to offset future losses. As used
1746in this subsection, the term "future losses" includes reserves
1747for claims incurred but not reported.
1748     (d)  Each insurer's assessment shall be determined annually
1749by the board or plan administrator based on annual statements
1750and other reports deemed necessary by the board or plan
1751administrator and filed with the board or plan administrator by
1752the insurer. Any deficit incurred under the plan by persons
1753previously enrolled in the Florida Comprehensive Health
1754Association shall be recouped by the assessments against
1755participating insurers by the board or plan administrator in the
1756manner provided in paragraph (b), and the insurers may recover
1757the assessment in the normal course of their respective
1758businesses without time limitation.
1759     (e)  If a person enrolled in the Florida Comprehensive
1760Health Association as of July 1, 2004, loses eligibility for
1761participation in the plan, such person shall not be included in
1762the calculation of incurred operational losses as described in
1763paragraph (b) if the person later regains eligibility for
1764participation in the plan.
1765     (f)  After all persons enrolled in the Florida
1766Comprehensive Health Association as of July 1, 2004, are no
1767longer eligible for participation in the plan, the plan, board,
1768or plan administrator shall no longer be allowed to assess
1769insurers in this state for incurred losses as described in
1770paragraph (b).
1771     Section 20.  Upon implementation, as defined in s.
1772627.64872(2), Florida Statutes, and provided in s.
1773627.64872(22), Florida Statutes, of the Florida Health Benefit
1774Plan created under s. 627.64872, Florida Statutes, sections
1775627.6488, 627.6489, 627.649, 627.6492, 627.6494, 627.6496,
1776627.6498, and 627.6499, Florida Statutes, are repealed.
1777     Section 21.  Subsection (12) is added to section 627.662,
1778Florida Statutes, to read:
1779     627.662  Other provisions applicable.--The following
1780provisions apply to group health insurance, blanket health
1781insurance, and franchise health insurance:
1782     (12)  Section 627.6044, relating to the use of specific
1783methodology for payment of claims.
1784     Section 22.  Paragraphs (c) and (d) of subsection (5),
1785paragraph (b) of subsection (6), and subsection (12) of section
1786627.6699, Florida Statutes, are amended, subsections (15) and
1787(16) of said section are renumbered as subsections (16) and
1788(17), respectively, present subsection (15) of said section is
1789amended, and new subsections (15) and (18) are added to said
1790section, to read:
1791     627.6699  Employee Health Care Access Act.--
1792     (5)  AVAILABILITY OF COVERAGE.--
1793     (c)  Every small employer carrier must, as a condition of
1794transacting business in this state:
1795     1.  Offer and issue all small employer health benefit plans
1796on a guaranteed-issue basis to every eligible small employer,
1797with 2 to 50 eligible employees, that elects to be covered under
1798such plan, agrees to make the required premium payments, and
1799satisfies the other provisions of the plan. A rider for
1800additional or increased benefits may be medically underwritten
1801and may only be added to the standard health benefit plan. The
1802increased rate charged for the additional or increased benefit
1803must be rated in accordance with this section.
1804     2.  Depending upon the absence of the availability of new
1805enrollment into the Florida Health Insurance Plan, offer and
1806issue basic and standard small employer health benefit plans on
1807a guaranteed-issue basis, during a 31-day open enrollment period
1808of August 1 through August 31 of each year, to every eligible
1809small employer, with fewer than two eligible employees, which
1810small employer is not formed primarily for the purpose of buying
1811health insurance and which elects to be covered under such plan,
1812agrees to make the required premium payments, and satisfies the
1813other provisions of the plan. Coverage provided under this
1814subparagraph shall begin on October 1 of the same year as the
1815date of enrollment, unless the small employer carrier and the
1816small employer agree to a different date. A rider for additional
1817or increased benefits may be medically underwritten and may only
1818be added to the standard health benefit plan. The increased rate
1819charged for the additional or increased benefit must be rated in
1820accordance with this section. For purposes of this subparagraph,
1821a person, his or her spouse, and his or her dependent children
1822constitute a single eligible employee if that person and spouse
1823are employed by the same small employer and either that person
1824or his or her spouse has a normal work week of less than 25
1825hours.
1826     3.  This paragraph does not limit a carrier's ability to
1827offer other health benefit plans to small employers if the
1828standard and basic health benefit plans are offered and
1829rejected.
1830     (d)  A small employer carrier must file with the office, in
1831a format and manner prescribed by the committee, a standard
1832health care plan, a high deductible plan that meets the federal
1833requirements of a health savings account plan, and a basic
1834health care plan to be used by the carrier.
1835     (6)  RESTRICTIONS RELATING TO PREMIUM RATES.--
1836     (b)  For all small employer health benefit plans that are
1837subject to this section and are issued by small employer
1838carriers on or after January 1, 1994, premium rates for health
1839benefit plans subject to this section are subject to the
1840following:
1841     1.  Small employer carriers must use a modified community
1842rating methodology in which the premium for each small employer
1843must be determined solely on the basis of the eligible
1844employee's and eligible dependent's gender, age, family
1845composition, tobacco use, or geographic area as determined under
1846paragraph (5)(j) and in which the premium may be adjusted as
1847permitted by this paragraph.
1848     2.  Rating factors related to age, gender, family
1849composition, tobacco use, or geographic location may be
1850developed by each carrier to reflect the carrier's experience.
1851The factors used by carriers are subject to office review and
1852approval.
1853     3.  Small employer carriers may not modify the rate for a
1854small employer for 12 months from the initial issue date or
1855renewal date, unless the composition of the group changes or
1856benefits are changed. However, a small employer carrier may
1857modify the rate one time prior to 12 months after the initial
1858issue date for a small employer who enrolls under a previously
1859issued group policy that has a common anniversary date for all
1860employers covered under the policy if:
1861     a.  The carrier discloses to the employer in a clear and
1862conspicuous manner the date of the first renewal and the fact
1863that the premium may increase on or after that date.
1864     b.  The insurer demonstrates to the office that
1865efficiencies in administration are achieved and reflected in the
1866rates charged to small employers covered under the policy.
1867     4.  A carrier may issue a group health insurance policy to
1868a small employer health alliance or other group association with
1869rates that reflect a premium credit for expense savings
1870attributable to administrative activities being performed by the
1871alliance or group association if such expense savings are
1872specifically documented in the insurer's rate filing and are
1873approved by the office. Any such credit may not be based on
1874different morbidity assumptions or on any other factor related
1875to the health status or claims experience of any person covered
1876under the policy. Nothing in this subparagraph exempts an
1877alliance or group association from licensure for any activities
1878that require licensure under the insurance code. A carrier
1879issuing a group health insurance policy to a small employer
1880health alliance or other group association shall allow any
1881properly licensed and appointed agent of that carrier to market
1882and sell the small employer health alliance or other group
1883association policy. Such agent shall be paid the usual and
1884customary commission paid to any agent selling the policy.
1885     5.  Any adjustments in rates for claims experience, health
1886status, or duration of coverage may not be charged to individual
1887employees or dependents. For a small employer's policy, such
1888adjustments may not result in a rate for the small employer
1889which deviates more than 15 percent from the carrier's approved
1890rate. Any such adjustment must be applied uniformly to the rates
1891charged for all employees and dependents of the small employer.
1892A small employer carrier may make an adjustment to a small
1893employer's renewal premium, not to exceed 10 percent annually,
1894due to the claims experience, health status, or duration of
1895coverage of the employees or dependents of the small employer.
1896Semiannually, small group carriers shall report information on
1897forms adopted by rule by the commission, to enable the office to
1898monitor the relationship of aggregate adjusted premiums actually
1899charged policyholders by each carrier to the premiums that would
1900have been charged by application of the carrier's approved
1901modified community rates. If the aggregate resulting from the
1902application of such adjustment exceeds the premium that would
1903have been charged by application of the approved modified
1904community rate by 5 percent for the current reporting period,
1905the carrier shall limit the application of such adjustments only
1906to minus adjustments beginning not more than 60 days after the
1907report is sent to the office. For any subsequent reporting
1908period, if the total aggregate adjusted premium actually charged
1909does not exceed the premium that would have been charged by
1910application of the approved modified community rate by 2 5
1911percent, the carrier may apply both plus and minus adjustments.
1912A small employer carrier may provide a credit to a small
1913employer's premium based on administrative and acquisition
1914expense differences resulting from the size of the group. Group
1915size administrative and acquisition expense factors may be
1916developed by each carrier to reflect the carrier's experience
1917and are subject to office review and approval.
1918     6.  A small employer carrier rating methodology may include
1919separate rating categories for one dependent child, for two
1920dependent children, and for three or more dependent children for
1921family coverage of employees having a spouse and dependent
1922children or employees having dependent children only. A small
1923employer carrier may have fewer, but not greater, numbers of
1924categories for dependent children than those specified in this
1925subparagraph.
1926     7.  Small employer carriers may not use a composite rating
1927methodology to rate a small employer with fewer than 10
1928employees. For the purposes of this subparagraph, a "composite
1929rating methodology" means a rating methodology that averages the
1930impact of the rating factors for age and gender in the premiums
1931charged to all of the employees of a small employer.
1932     8.a.  A carrier may separate the experience of small
1933employer groups with less than 2 eligible employees from the
1934experience of small employer groups with 2-50 eligible employees
1935for purposes of determining an alternative modified community
1936rating.
1937     b.  If a carrier separates the experience of small employer
1938groups as provided in sub-subparagraph a., the rate to be
1939charged to small employer groups of less than 2 eligible
1940employees may not exceed 150 percent of the rate determined for
1941small employer groups of 2-50 eligible employees. However, the
1942carrier may charge excess losses of the experience pool
1943consisting of small employer groups with less than 2 eligible
1944employees to the experience pool consisting of small employer
1945groups with 2-50 eligible employees so that all losses are
1946allocated and the 150-percent rate limit on the experience pool
1947consisting of small employer groups with less than 2 eligible
1948employees is maintained. Notwithstanding s. 627.411(1), the rate
1949to be charged to a small employer group of fewer than 2 eligible
1950employees, insured as of July 1, 2002, may be up to 125 percent
1951of the rate determined for small employer groups of 2-50
1952eligible employees for the first annual renewal and 150 percent
1953for subsequent annual renewals.
1954     (12)  STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH
1955BENEFIT PLANS.--
1956     (a)1.  The Chief Financial Officer shall appoint a health
1957benefit plan committee composed of four representatives of
1958carriers which shall include at least two representatives of
1959HMOs, at least one of which is a staff model HMO, two
1960representatives of agents, four representatives of small
1961employers, and one employee of a small employer. The carrier
1962members shall be selected from a list of individuals recommended
1963by the board. The Chief Financial Officer may require the board
1964to submit additional recommendations of individuals for
1965appointment.
1966     2.  The plans shall comply with all of the requirements of
1967this subsection.
1968     3.  The plans must be filed with and approved by the office
1969prior to issuance or delivery by any small employer carrier.
1970     4.  After approval of the revised health benefit plans, if
1971the office determines that modifications to a plan might be
1972appropriate, the Chief Financial Officer shall appoint a new
1973health benefit plan committee in the manner provided in
1974subparagraph 1. to submit recommended modifications to the
1975office for approval.
1976     (b)1.  Each small employer carrier issuing new health
1977benefit plans shall offer to any small employer, upon request, a
1978standard health benefit plan, and a basic health benefit plan,
1979and a high deductible plan that meets the requirements of a
1980health savings account plan as defined by federal law, that meet
1981meets the criteria set forth in this section.
1982     2.  For purposes of this subsection, the terms "standard
1983health benefit plan," and "basic health benefit plan," and "high
1984deductible plan" mean policies or contracts that a small
1985employer carrier offers to eligible small employers that
1986contain:
1987     a.  An exclusion for services that are not medically
1988necessary or that are not covered preventive health services;
1989and
1990     b.  A procedure for preauthorization by the small employer
1991carrier, or its designees.
1992     3.  A small employer carrier may include the following
1993managed care provisions in the policy or contract to control
1994costs:
1995     a.  A preferred provider arrangement or exclusive provider
1996organization or any combination thereof, in which a small
1997employer carrier enters into a written agreement with the
1998provider to provide services at specified levels of
1999reimbursement or to provide reimbursement to specified
2000providers. Any such written agreement between a provider and a
2001small employer carrier must contain a provision under which the
2002parties agree that the insured individual or covered member has
2003no obligation to make payment for any medical service rendered
2004by the provider which is determined not to be medically
2005necessary. A carrier may use preferred provider arrangements or
2006exclusive provider arrangements to the same extent as allowed in
2007group products that are not issued to small employers.
2008     b.  A procedure for utilization review by the small
2009employer carrier or its designees.
2010
2011This subparagraph does not prohibit a small employer carrier
2012from including in its policy or contract additional managed care
2013and cost containment provisions, subject to the approval of the
2014office, which have potential for controlling costs in a manner
2015that does not result in inequitable treatment of insureds or
2016subscribers. The carrier may use such provisions to the same
2017extent as authorized for group products that are not issued to
2018small employers.
2019     4.  The standard health benefit plan shall include:
2020     a.  Coverage for inpatient hospitalization;
2021     b.  Coverage for outpatient services;
2022     c.  Coverage for newborn children pursuant to s. 627.6575;
2023     d.  Coverage for child care supervision services pursuant
2024to s. 627.6579;
2025     e.  Coverage for adopted children upon placement in the
2026residence pursuant to s. 627.6578;
2027     f.  Coverage for mammograms pursuant to s. 627.6613;
2028     g.  Coverage for handicapped children pursuant to s.
2029627.6615;
2030     h.  Emergency or urgent care out of the geographic service
2031area; and
2032     i.  Coverage for services provided by a hospice licensed
2033under s. 400.602 in cases where such coverage would be the most
2034appropriate and the most cost-effective method for treating a
2035covered illness.
2036     5.  The standard health benefit plan and the basic health
2037benefit plan may include a schedule of benefit limitations for
2038specified services and procedures. If the committee develops
2039such a schedule of benefits limitation for the standard health
2040benefit plan or the basic health benefit plan, a small employer
2041carrier offering the plan must offer the employer an option for
2042increasing the benefit schedule amounts by 4 percent annually.
2043     6.  The basic health benefit plan shall include all of the
2044benefits specified in subparagraph 4.; however, the basic health
2045benefit plan shall place additional restrictions on the benefits
2046and utilization and may also impose additional cost containment
2047measures.
2048     7.  Sections 627.419(2), (3), and (4), 627.6574, 627.6612,
2049627.66121, 627.66122, 627.6616, 627.6618, 627.668, and 627.66911
2050apply to the standard health benefit plan and to the basic
2051health benefit plan. However, notwithstanding said provisions,
2052the plans may specify limits on the number of authorized
2053treatments, if such limits are reasonable and do not
2054discriminate against any type of provider.
2055     8.  The plan associated with a health savings account shall
2056include all the benefits specified in subparagraph 4.
2057     9.8.  Each small employer carrier that provides for
2058inpatient and outpatient services by allopathic hospitals may
2059provide as an option of the insured similar inpatient and
2060outpatient services by hospitals accredited by the American
2061Osteopathic Association when such services are available and the
2062osteopathic hospital agrees to provide the service.
2063     (c)  If a small employer rejects, in writing, the standard
2064health benefit plan, and the basic health benefit plan, and the
2065high-deductible health savings account plan, the small employer
2066carrier may offer the small employer a limited benefit policy or
2067contract.
2068     (d)1.  Upon offering coverage under a standard health
2069benefit plan, a basic health benefit plan, or a limited benefit
2070policy or contract for any small employer, the small employer
2071carrier shall provide such employer group with a written
2072statement that contains, at a minimum:
2073     a.  An explanation of those mandated benefits and providers
2074that are not covered by the policy or contract;
2075     b.  An explanation of the managed care and cost control
2076features of the policy or contract, along with all appropriate
2077mailing addresses and telephone numbers to be used by insureds
2078in seeking information or authorization; and
2079     c.  An explanation of the primary and preventive care
2080features of the policy or contract.
2081
2082Such disclosure statement must be presented in a clear and
2083understandable form and format and must be separate from the
2084policy or certificate or evidence of coverage provided to the
2085employer group.
2086     2.  Before a small employer carrier issues a standard
2087health benefit plan, a basic health benefit plan, or a limited
2088benefit policy or contract, it must obtain from the prospective
2089policyholder a signed written statement in which the prospective
2090policyholder:
2091     a.  Certifies as to eligibility for coverage under the
2092standard health benefit plan, basic health benefit plan, or
2093limited benefit policy or contract;
2094     b.  Acknowledges the limited nature of the coverage and an
2095understanding of the managed care and cost control features of
2096the policy or contract;
2097     c.  Acknowledges that if misrepresentations are made
2098regarding eligibility for coverage under a standard health
2099benefit plan, a basic health benefit plan, or a limited benefit
2100policy or contract, the person making such misrepresentations
2101forfeits coverage provided by the policy or contract; and
2102     d.  If a limited plan is requested, acknowledges that the
2103prospective policyholder had been offered, at the time of
2104application for the insurance policy or contract, the
2105opportunity to purchase any health benefit plan offered by the
2106carrier and that the prospective policyholder had rejected that
2107coverage.
2108
2109A copy of such written statement shall be provided to the
2110prospective policyholder no later than at the time of delivery
2111of the policy or contract, and the original of such written
2112statement shall be retained in the files of the small employer
2113carrier for the period of time that the policy or contract
2114remains in effect or for 5 years, whichever period is longer.
2115     3.  Any material statement made by an applicant for
2116coverage under a health benefit plan which falsely certifies as
2117to the applicant's eligibility for coverage serves as the basis
2118for terminating coverage under the policy or contract.
2119     4.  Each marketing communication that is intended to be
2120used in the marketing of a health benefit plan in this state
2121must be submitted for review by the office prior to use and must
2122contain the disclosures stated in this subsection.
2123     (e)  A small employer carrier may not use any policy,
2124contract, form, or rate under this section, including
2125applications, enrollment forms, policies, contracts,
2126certificates, evidences of coverage, riders, amendments,
2127endorsements, and disclosure forms, until the insurer has filed
2128it with the office and the office has approved it under ss.
2129627.410 and 627.411 and this section.
2130     (15)  SMALL EMPLOYERS ACCESS PROGRAM.--
2131     (a)  Popular name.--This subsection may be referred to by
2132the popular name "The Small Employers Access Program."
2133     (b)  Intent.--The Legislature finds that increased access
2134to health care coverage for small employers with up to 25
2135employees could improve employees' health and reduce the
2136incidence and costs of illness and disabilities among residents
2137in this state. Many employers do not offer health care benefits
2138to their employees citing the increased cost of this benefit. It
2139is the intent of the Legislature to create the Small Business
2140Health Plan to provide small employers the option and ability to
2141provide health care benefits to their employees at an affordable
2142cost through the creation of purchasing pools for employers with
2143up to 25 employees, and rural hospital employers and nursing
2144home employers regardless of the number of employees.
2145     (c)  Definitions.--For purposes of this subsection:
2146     1.  "Fair commission" means a commission structure
2147determined by the office and the insurers, which will carry out
2148the intent of this subsection.
2149     2.  "Insurer" means any entity that provides health
2150insurance in this state. For purposes of this subsection,
2151insurer includes an insurance company holding a certificate of
2152authority pursuant to chapter 624 or a health maintenance
2153organization holding a certificate of authority pursuant to
2154chapter 641, which qualifies to provide coverage to small
2155employer groups pursuant to this section.
2156     3.  "Mutually supported benefit plan" means an optional
2157alternative coverage plan developed within a defined geographic
2158region which may include, but is not limited to, a minimum level
2159of primary care coverage in which the percentage of the premium
2160is distributed among the employer, the employee, and community-
2161generated revenue either alone or in conjunction with federal
2162matching funds.
2163     4.  "Office" means the Office of Insurance Regulation of
2164the Department of Financial Services.
2165     5.  "Participating insurer" means any insurer providing
2166health insurance to small employers that has been selected by
2167the office in accordance with this subsection for its designated
2168region.
2169     6.  "Program" means the Small Employer Access Program as
2170created by this subsection.
2171     (d)  Eligibility.--
2172     1.  Any small employer group of up to 25 employees that has
2173had no prior coverage for the last 6 months may participate.
2174     2.  Rural hospital employers may participate.
2175     3.  Nursing home employers may participate.
2176     4.  Each dependent of a person eligible for coverage is
2177also eligible to participate.
2178     5.  Any small employer that is actively engaged in
2179business, has its principal place of business in this state,
2180employed up to 25 eligible employees on business days during the
2181preceding calendar year, and employs at least 2 employees on the
2182first day of the plan year may participate.
2183
2184Coverage for a small employer group that ceases to meet the
2185eligibility requirements of this section may be terminated at
2186the end of the policy period for which the necessary premiums
2187have been paid.
2188     (e)  Administration.--
2189     1.  The office shall by competitive bid, in accordance with
2190current state law, select an insurer to provide coverage through
2191the program to eligible small employers within an established
2192geographical area of this state. The office may develop
2193exclusive regions for the program similar to those used by the
2194Healthy Kids Corporation. However the office is not precluded
2195from developing, in conjunction with insurers, regions different
2196from those used by the Healthy Kids Corporation if the office
2197deems that such a region will carry out the intentions of this
2198subsection.
2199     2.  The office shall evaluate bids submitted based upon
2200criteria established by the office, which shall include, but not
2201be limited to:
2202     a.  The insurer's proven ability to handle health insurance
2203coverage to small employer groups.
2204     b.  The efficiency and timeliness of the insurer's claim
2205processing procedures.
2206     c.  The insurer's ability to apply effective cost-
2207containment programs and procedures and to administer the
2208program in a cost-efficient manner.
2209     d.  The financial condition and stability of the insurer.
2210e.  The insurer's ability to develop an optional mutually
2211supported benefit plan.
2212
2213The office may use any financial information available to it
2214through its regulatory duties to make this evaluation.
2215     (f)  Insurer qualifications.--The insurer shall be a duly
2216authorized insurer or health maintenance organization.
2217     (g)  Duties of the insurer.--The insurer shall:
2218     1.  Develop and implement a program to publicize the
2219existence of the program, program eligibility requirements, and
2220procedures for enrollment and maintain public awareness of the
2221program.
2222     2.  Maintain employer awareness of the program.
2223     3.  Demonstrate the ability to use delivery of cost-
2224effective health care services.
2225     4.  Encourage, educate, advise, and administer the
2226effective use of health savings accounts by covered employees
2227and dependents.
2228     5.  Serve for a period specified in the contract between
2229the office and the insurer, subject to removal for cause and
2230subject to any terms, conditions, and limitations of the
2231contract between the office and the insurer as may be specified
2232in the request for proposal.
2233     (h)  Contract term.--The contract term shall not exceed 3
2234years. At least 6 months prior to the expiration of each
2235contract period, the office shall invite eligible entities,
2236including the current insurer, to submit bids to serve as the
2237insurer for a designated geographic area. Selection of the
2238insurer for the succeeding period shall be made at least 3
2239months prior to the end of the current period.
2240     (i)  Insurer reporting requirements.--On March 1 following
2241the close of each calendar year, the insurer shall determine net
2242written and earned premiums, the expense of administration, and
2243the paid and incurred losses for the year and report this
2244information to the office on a form prescribed by the office.
2245     (j)  Application requirements.--The insurer shall permit or
2246allow any licensed and duly appointed health insurance agent
2247residing in the designated region to submit applications for
2248coverage, and such agent shall be paid a fair commission if
2249coverage is written. The agent must be appointed to at least one
2250insurer.
2251     (k)  Benefits.--The benefits provided by the plan shall be
2252the same as the coverage required for small employers under
2253subsection (12). Upon the approval of the office, the insurer
2254may also establish an optional mutually supported benefit plan
2255which is an alternative coverage plan developed within a defined
2256geographic region of this state or any other such alternative
2257coverage benefit plan which will carry out the intent of this
2258subsection.
2259     (l)  Annual reporting.--The office shall make an annual
2260report to the Governor, the President of the Senate, and the
2261Speaker of the House of Representatives. The report shall
2262summarize the activities of the program in the preceding
2263calendar year, including the net written and earned premiums,
2264program enrollment, the expense of administration, and the paid
2265and incurred losses. The report shall be submitted no later than
2266March 15 following the close of the prior calendar year.
2267     (16)(15)  APPLICABILITY OF OTHER STATE LAWS.--
2268     (a)  Except as expressly provided in this section, a law
2269requiring coverage for a specific health care service or
2270benefit, or a law requiring reimbursement, utilization, or
2271consideration of a specific category of licensed health care
2272practitioner, does not apply to a standard or basic health
2273benefit plan policy or contract, a small employer access
2274program, or a limited benefit policy or contract offered or
2275delivered to a small employer unless that law is made expressly
2276applicable to such policies or contracts. A law restricting or
2277limiting deductibles, coinsurance, copayments, or annual or
2278lifetime maximum payments does not apply to any health plan
2279policy, including a standard or basic health benefit plan policy
2280or contract, offered or delivered to a small employer unless
2281such law is made expressly applicable to such policy or
2282contract. However, every small employer carrier must offer to
2283eligible small employers the standard benefit plan and the basic
2284benefit plan, as required by subsection (5), as such plans have
2285been approved by the office pursuant to subsection (12).
2286     (b)  Except as provided in this section, a standard or
2287basic health benefit plan policy or contract or limited benefit
2288policy or contract offered to a small employer is not subject to
2289any provision of this code which:
2290     1.  Inhibits a small employer carrier from contracting with
2291providers or groups of providers with respect to health care
2292services or benefits;
2293     2.  Imposes any restriction on a small employer carrier's
2294ability to negotiate with providers regarding the level or
2295method of reimbursing care or services provided under a health
2296benefit plan; or
2297     3.  Requires a small employer carrier to either include a
2298specific provider or class of providers when contracting for
2299health care services or benefits or to exclude any class of
2300providers that is generally authorized by statute to provide
2301such care.
2302     (c)  Any second tier assessment paid by a carrier pursuant
2303to paragraph (11)(j) may be credited against assessments levied
2304against the carrier pursuant to s. 627.6494.
2305     (d)  Notwithstanding chapter 641, a health maintenance
2306organization is authorized to issue contracts providing benefits
2307equal to the standard health benefit plan, the basic health
2308benefit plan, and the limited benefit policy authorized by this
2309section.
2310     (17)(16)  RULEMAKING AUTHORITY.--The commission may adopt
2311rules to administer this section, including rules governing
2312compliance by small employer carriers and small employers.
2313     (18)  DECREASE IN INAPPROPRIATE UTILIZATION OF EMERGENCY
2314CARE.--Health insurers may require higher copayments for
2315nonemergency use of emergency departments and higher copayments
2316for out-of-network emergency department use and are encouraged
2317to create the development of emergency room diversion programs.
2318     Section 23.  Subsection (1) of section 627.9175, Florida
2319Statutes, is amended to read:
2320     627.9175  Reports of information on health and accident
2321insurance.--
2322     (1)  Each health insurer, prepaid limited health services
2323organization, and health maintenance organization shall submit,
2324no later than April 1 of each year, annually to the office
2325information concerning health and accident insurance coverage
2326and medical plans being marketed and currently in force in this
2327state. The required information shall be described by market
2328segment, to include, but not be limited to:
2329     (a)  Issuing, servicing company, and entity contact
2330information.
2331     (b)  Information on all health and accident insurance
2332policies and prepaid limited health service organizations and
2333health maintenance organization contracts in force and issued in
2334the previous year. Such information shall include, but not be
2335limited to, direct premiums earned, direct losses incurred,
2336number of policies, number of certificates, and number of
2337covered lives. as to policies of individual health insurance:
2338     (a)  A summary of typical benefits, exclusions, and
2339limitations for each type of individual policy form currently
2340being issued in the state. The summary shall include, as
2341appropriate:
2342     1.  The deductible amount;
2343     2.  The coinsurance percentage;
2344     3.  The out-of-pocket maximum;
2345     4.  Outpatient benefits;
2346     5.  Inpatient benefits; and
2347     6.  Any exclusions for preexisting conditions.
2348
2349The commission shall determine other appropriate benefits,
2350exclusions, and limitations to be reported for inclusion in the
2351consumer's guide published pursuant to this section.
2352     (b)  A schedule of rates for each type of individual policy
2353form reflecting typical variations by age, sex, region of the
2354state, or any other applicable factor which is in use and is
2355determined to be appropriate for inclusion by the commission.
2356
2357The commission may establish rules governing shall provide by
2358rule a uniform format for the submission of this information
2359described in this section, including the use of uniform formats
2360and electronic data transmission order to allow for meaningful
2361comparisons of premiums charged for comparable benefits. The
2362office shall provide this information to the department, which
2363shall publish annually a consumer's guide which summarizes and
2364compares the information required to be reported under this
2365subsection.
2366     Section 24.  Subsection (7) of section 636.003, Florida
2367Statutes, is amended to read:
2368     636.003  Definitions.--As used in this act, the term:
2369     (7)  "Prepaid limited health service organization" means
2370any person, corporation, partnership, or any other entity which,
2371in return for a prepayment, undertakes to provide or arrange
2372for, or provide access to, the provision of a limited health
2373service to enrollees through an exclusive panel of providers or
2374undertakes to provide access to any discounted medical services.
2375Prepaid limited health service organization does not include:
2376     (a)  An entity otherwise authorized pursuant to the laws of
2377this state to indemnify for any limited health service;
2378     (b)  A provider or entity when providing limited health
2379services pursuant to a contract with a prepaid limited health
2380service organization, a health maintenance organization, a
2381health insurer, or a self-insurance plan; or
2382     (c)  Any person who, in exchange for fees, dues, charges or
2383other consideration, provides access to a limited health service
2384provider without assuming any responsibility for payment for the
2385limited health service or any portion thereof; or
2386     (d)  Any plan or program of discounted medical services for
2387which fees, dues, charges, or other consideration paid to the
2388plan by consumers do not exceed $15 per month or $180 per year
2389and which, in its advertising and contracts:
2390     1.  Clearly indicates that the plan is not insurance, that
2391the plan is not obligated to pay any portion of the discounted
2392medical fees, and that the consumer is responsible for paying
2393the full amount of the discounted fees.
2394     2.  Does not use the terms "affordable health care" or
2395"coverage" or other terms which misrepresent the nature of the
2396program.
2397     3.  Requires a statement, together with the provider
2398network, on the discount card alerting the network providers and
2399facilities that the cardholder does not have insurance and is
2400merely entitled to the network discount rate for services
2401provided.
2402     Section 25.  Section 627.6410, Florida Statutes, is created
2403to read:
2404     627.6410  Optional coverage for speech, language,
2405swallowing, and hearing disorders.--
2406     (1)  Insurers issuing individual health insurance policies
2407in this state shall make available to the policyholder as part
2408of the application for any such policy of insurance, for an
2409appropriate additional premium, the benefits or levels of
2410benefits specified in the December 1999 Florida Medicaid Therapy
2411Services Handbook for genetic or congenital disorders or
2412conditions involving speech, language, swallowing, and hearing
2413and a hearing aid and earmolds benefit at the level of benefits
2414specified in the January 2001 Florida Medicaid Hearing Services
2415Handbook.
2416     (2)  This section does not apply to specified accident,
2417specified disease, hospital indemnity, limited benefit,
2418disability income, or long-term care insurance policies.
2419     (3)  Such optional coverage is not required to be offered
2420when substantially similar benefits are included in the policy
2421of insurance issued to the policyholder.
2422     (4)  This section does not require or prohibit the use of a
2423provider network.
2424     (5)  This section does not prohibit an insurer from
2425requiring prior authorization for the benefits under this
2426section.
2427     Section 26.  Section 627.66912, Florida Statutes, is
2428created to read:
2429     627.66912  Optional coverage for speech, language,
2430swallowing, and hearing disorders.--
2431     (1)  Insurers issuing group health insurance policies in
2432this state shall make available to the policyholder as part of
2433the application for any such policy of insurance, for an
2434appropriate additional premium, the benefits or levels of
2435benefits specified in the December 1999 Florida Medicaid Therapy
2436Services Handbook for genetic or congenital disorders or
2437conditions involving speech, language, swallowing, and hearing
2438and a hearing aid and earmolds benefit at the level of benefits
2439specified in the January 2001 Florida Medicaid Hearing Services
2440Handbook.
2441     (2)  This section does not apply to specified accident,
2442specified disease, hospital indemnity, limited benefit,
2443disability income, or long-term care insurance policies.
2444     (3)  Such optional coverage is not required to be offered
2445when substantially similar benefits are included in the policy
2446of insurance issued to the policyholder.
2447     (4)  This section does not require or prohibit the use of a
2448provider network.
2449     (5)  This section does not prohibit an insurer from
2450requiring prior authorization for the benefits under this
2451section.
2452     Section 27.  Subsection (38) of section 641.31, Florida
2453Statutes, is amended, and subsection (40) is added to said
2454section, to read:
2455     641.31  Health maintenance contracts.--
2456     (38)(a)  Notwithstanding any other provision of this part,
2457a health maintenance organization that meets the requirements of
2458paragraph (b) may, through a point-of-service rider to its
2459contract providing comprehensive health care services, include a
2460point-of-service benefit. Under such a rider, a subscriber or
2461other covered person of the health maintenance organization may
2462choose, at the time of covered service, a provider with whom the
2463health maintenance organization does not have a health
2464maintenance organization provider contract. The rider may not
2465require a referral from the health maintenance organization for
2466the point-of-service benefits.
2467     (b)  A health maintenance organization offering a point-of-
2468service rider under this subsection must have a valid
2469certificate of authority issued under the provisions of the
2470chapter, must have been licensed under this chapter for a
2471minimum of 3 years, and must at all times that it has riders in
2472effect maintain a minimum surplus of $5 million.
2473     (c)  Premiums paid in for the point-of-service riders may
2474not exceed 15 percent of total premiums for all health plan
2475products sold by the health maintenance organization offering
2476the rider. If the premiums paid for point-of-service riders
2477exceed 15 percent, the health maintenance organization must
2478notify the office and, once this fact is known, must immediately
2479cease offering such a rider until it is in compliance with the
2480rider premium cap.
2481     (d)  Notwithstanding the limitations of deductibles and
2482copayment provisions in this part, a point-of-service rider may
2483require the subscriber to pay a reasonable copayment for each
2484visit for services provided by a noncontracted provider chosen
2485at the time of the service. The copayment by the subscriber may
2486either be a specific dollar amount or a percentage of the
2487reimbursable provider charges covered by the contract and must
2488be paid by the subscriber to the noncontracted provider upon
2489receipt of covered services. The point-of-service rider may
2490require that a reasonable annual deductible for the expenses
2491associated with the point-of-service rider be met and may
2492include a lifetime maximum benefit amount. The rider must
2493include the language required by s. 627.6044 and must comply
2494with copayment limits described in s. 627.6471. Section 641.3154
2495does not apply to a point-of-service rider authorized under this
2496subsection.
2497     (e)  The point-of-service rider must contain provisions
2498that comply with s. 627.6044.
2499     (f)(e)  The term "point of service" may not be used by a
2500health maintenance organization except with riders permitted
2501under this section or with forms approved by the office in which
2502a point-of-service product is offered with an indemnity carrier.
2503     (g)(f)  A point-of-service rider must be filed and approved
2504under ss. 627.410 and 627.411.
2505     (40)  Health maintenance organizations shall make available
2506to the contract holder as part of the application for any such
2507contract, for an appropriate additional premium, the benefits or
2508levels of benefits specified in the December 1999 Florida
2509Medicaid Therapy Services Handbook for genetic or congenital
2510disorders or conditions involving speech, language, swallowing,
2511and hearing and a hearing aid and earmolds benefit at the level
2512of benefits specified in the January 2001 Florida Medicaid
2513Hearing Services Handbook.
2514     (a)  Such optional coverage is not required to be offered
2515when substantially similar benefits are included in
2516the contract issued to the subscriber.
2517     (b)  This section does not require or prohibit the use of a
2518provider network.
2519     (c)  This section does not prohibit an organization from
2520requiring prior authorization for the benefits under this
2521subsection.
2522     (d)  This subsection does not apply to health maintenance
2523organizations issuing individual coverage to fewer than 50,000
2524members.
2525     Section 28.  Subsection (2) of section 626.015, Florida
2526Statutes, is amended, subsections (8) through (17) of said
2527section are renumbered as subsections (9) through (18),
2528respectively, and a new subsection (8) is added to said section,
2529to read:
2530     626.015  Definitions.--As used in this part:
2531     (2)  "Agent" means a general lines agent, life agent,
2532health agent, or title agent, or all such agents, as indicated
2533by context. The term "agent" includes an insurance producer or
2534producer, but does not include a customer representative,
2535limited customer representative, or service representative but
2536does include an insurance advisor.
2537     (8)  "Insurance advisor" means any person who, for money,
2538fee, commission, or any other thing of value offers to examine
2539or examines any policy of life, accident, or health insurance,
2540any health benefit plan, or any annuity or pure endowment
2541contract for the purpose of giving, or gives, or offers to give,
2542any advice, counsel, recommendation, or information in respect
2543to the terms, conditions, benefits, coverage, or premium of any
2544such policy or contract, or in respect to the expediency or
2545advisability of altering, changing, exchanging, converting,
2546replacing, surrendering, continuing, or rejecting any such
2547policy, plan, or contract, or of accepting or procuring any such
2548policy, plan, or contract from any insurer or issuer of a health
2549benefit plan, or who in or on advertisements, cards, signs,
2550circulars, or letterheads, or elsewhere, or in any other way or
2551manner by which public announcements are made, uses the title
2552"insurance advisor," "insurance specialist," "insurance
2553counselor," "insurance analyst," "policyholders' adviser,"
2554"policyholders' counselor," or any other similar title, or any
2555title indicating that the person gives, or is engaged in the
2556business of giving advice, counsel, recommendation, or
2557information to an insured, or a beneficiary, or any person
2558having any interest in a life, accident, or health insurance
2559contract, health benefit plan contract, annuity, or pure
2560endowment contract. This definition is not intended to prevent a
2561person who has obtained the professional designation of life
2562underwriter, chartered financial consultant, or certified
2563financial planner by completing a course of instruction
2564recognized within the business of insurance from using that
2565designation to indicate professional achievement.
2566     Section 29.  Subsection (1) of section 626.016, Florida
2567Statutes, is amended to read:
2568     626.016  Powers and duties of department, commission, and
2569office.--
2570     (1)  The powers and duties of the Chief Financial Officer
2571and the department specified in this part apply only with
2572respect to insurance agents, insurance advisors, managing
2573general agents, reinsurance intermediaries, viatical settlement
2574brokers, customer representatives, service representatives, and
2575agencies.
2576     Section 30.  Section 626.171, Florida Statutes, is amended
2577to read:
2578     626.171  Application for license.--
2579     (1)  The department or office shall not issue a license as
2580agent, insurance advisor, customer representative, adjuster,
2581insurance agency, service representative, managing general
2582agent, or reinsurance intermediary to any person except upon
2583written application therefor filed with it, qualification
2584therefor, and payment in advance of all applicable fees. Any
2585such application shall be made under the oath of the applicant
2586and be signed by the applicant. Beginning November 1, 2002, The
2587department shall accept the uniform application for nonresident
2588agent licensing. The department may adopt revised versions of
2589the uniform application by rule.
2590     (2)  In the application, the applicant shall set forth:
2591     (a)  His or her full name, age, social security number,
2592residence address, business address, and mailing address.
2593     (b)  Proof that he or she has completed or is in the
2594process of completing any required prelicensing course.
2595     (c)  Whether he or she has been refused or has voluntarily
2596surrendered or has had suspended or revoked a license to solicit
2597insurance by the department or by the supervising officials of
2598any state.
2599     (d)  Whether any insurer or any managing general agent
2600claims the applicant is indebted under any agency contract or
2601otherwise and, if so, the name of the claimant, the nature of
2602the claim, and the applicant's defense thereto, if any.
2603     (e)  Proof that the applicant meets the requirements for
2604the type of license for which he or she is applying.
2605     (f)  Such other or additional information as the department
2606or office may deem proper to enable it to determine the
2607character, experience, ability, and other qualifications of the
2608applicant to hold himself or herself out to the public as an
2609insurance representative.
2610     (3)  An application for an insurance agency license shall
2611be signed by the owner or owners of the agency. If the agency is
2612incorporated, the application shall be signed by the president
2613and secretary of the corporation.
2614     (3)(4)  Each application shall be accompanied by payment of
2615any applicable fee.
2616     (4)(5)  An application for a license as an agent, customer
2617representative, adjuster, insurance agency, service
2618representative, managing general agent, or reinsurance
2619intermediary must be accompanied by a set of the individual
2620applicant's fingerprints, or, if the applicant is not an
2621individual, by a set of the fingerprints of the sole proprietor,
2622majority owner, partners, officers, and directors, on a form
2623adopted by rule of the department or commission and accompanied
2624by the fingerprint processing fee set forth in s. 624.501.
2625Fingerprints shall be used to investigate the applicant's
2626qualifications pursuant to s. 626.201. The fingerprints shall be
2627taken by a law enforcement agency or other department-approved
2628entity.
2629     (5)(6)  The application for license filing fee prescribed
2630in s. 624.501 is not subject to refund.
2631     (6)(7)  Pursuant to the federal Personal Responsibility and
2632Work Opportunity Reconciliation Act of 1996, each party is
2633required to provide his or her social security number in
2634accordance with this section. Disclosure of social security
2635numbers obtained through this requirement shall be limited to
2636the purpose of administration of the Title IV-D program for
2637child support enforcement.
2638     Section 31.  Section 626.191, Florida Statutes, is amended
2639to read:
2640     626.191  Repeated applications.--The failure of an
2641applicant to secure a license upon an application shall not
2642preclude the applicant him or her from applying again as many
2643times as desired, but the department or office shall not give
2644consideration to or accept any further application by the same
2645individual for a similar license dated or filed within 30 days
2646subsequent to the date the department or office denied the last
2647application, except as provided in s. 626.281.
2648     Section 32.  Subsection (1) of section 626.201, Florida
2649Statutes, is amended to read:
2650     626.201  Investigation.--
2651     (1)  The department or office may propound any reasonable
2652interrogatories in addition to those contained in the
2653application, to any applicant for license or appointment, or on
2654any renewal, reinstatement, or continuation thereof, relating to
2655the applicant's his or her qualifications, residence,
2656prospective place of business, and any other matter which, in
2657the opinion of the department or office, is deemed necessary or
2658advisable for the protection of the public and to ascertain the
2659applicant's qualifications.
2660     Section 33.  Subsections (1) and (2) of section 626.342,
2661Florida Statutes, are amended to read:
2662     626.342  Furnishing supplies to unlicensed life, health, or
2663general lines agent prohibited; civil liability.--
2664     (1)  An insurer, a managing general agent, an insurance
2665advisor, or an agent, directly or through any representative,
2666may not furnish to any agent any blank forms, applications,
2667stationery, or other supplies to be used in soliciting,
2668negotiating, or effecting contracts of insurance on its behalf
2669unless such blank forms, applications, stationery, or other
2670supplies relate to a class of business with respect to which the
2671agent is licensed and appointed, whether for that insurer or
2672another insurer.
2673     (2)  Any insurer, general agent, insurance advisor, or
2674agent who furnishes any of the supplies specified in subsection
2675(1) to any agent or prospective agent not appointed to represent
2676the insurer and who accepts from or writes any insurance
2677business for such agent or agency is subject to civil liability
2678to any insured of such insurer to the same extent and in the
2679same manner as if such agent or prospective agent had been
2680appointed or authorized by the insurer or such agent to act in
2681its or his or her behalf. The provisions of this subsection do
2682not apply to insurance risk apportionment plans under s.
2683627.351.
2684     Section 34.  Section 626.536, Florida Statutes, is amended
2685to read:
2686     626.536  Reporting of actions.--An agent and insurance
2687broker shall submit to the department, within 30 days after the
2688final disposition of any administrative action taken against the
2689agent by a governmental agency in this or any other state or
2690jurisdiction relating to the business of insurance, the sale of
2691securities, or activity involving fraud, dishonesty,
2692trustworthiness, or breach of a fiduciary duty, a copy of the
2693order, consent to order, or other relevant legal documents. The
2694department may adopt rules implementing the provisions of this
2695section.
2696     Section 35.  Subsections (1) and (3) of section 626.561,
2697Florida Statutes, are amended to read:
2698     626.561  Reporting and accounting for funds.--
2699     (1)  All premiums, return premiums, or other funds
2700belonging to insurers or others received by an insurance broker,
2701agent, customer representative, or adjuster in transactions
2702under a his or her license are trust funds received by the
2703licensee in a fiduciary capacity. An agent or insurance advisor
2704shall keep the funds belonging to each insurer for which an
2705agent or insurance advisor he or she is not appointed, other
2706than a surplus lines insurer, in a separate account so as to
2707allow the department or office to properly audit such funds. The
2708licensee in the applicable regular course of business shall
2709account for and pay the same to the insurer, insured, or other
2710person entitled thereto.
2711     (3)  Any insurance advisor, agent, customer representative,
2712or adjuster who, not being lawfully entitled thereto, either
2713temporarily or permanently diverts or misappropriates such funds
2714or any portion thereof or deprives the other person of a benefit
2715therefrom commits the offense specified below:
2716     (a)  If the funds diverted or misappropriated are $300 or
2717less, a misdemeanor of the first degree, punishable as provided
2718in s. 775.082 or s. 775.083.
2719     (b)  If the funds diverted or misappropriated are more than
2720$300, but less than $20,000, a felony of the third degree,
2721punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
2722     (c)  If the funds diverted or misappropriated are $20,000
2723or more, but less than $100,000, a felony of the second degree,
2724punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
2725     (d)  If the funds diverted or misappropriated are $100,000
2726or more, a felony of the first degree, punishable as provided in
2727s. 775.082, s. 775.083, or s. 775.084.
2728     Section 36.  Subsections (1) and (2) of section 626.572,
2729Florida Statutes, are amended to read:
2730     626.572  Rebating; when allowed.--
2731     (1)  No insurance advisor or agent shall rebate any portion
2732of a his or her commission except as follows:
2733     (a)  The rebate shall be available to all insureds in the
2734same actuarial class.
2735     (b)  The rebate shall be in accordance with a rebating
2736schedule filed by the agent with the insurer issuing the policy
2737to which the rebate applies.
2738     (c)  The rebating schedule shall be uniformly applied in
2739that all insureds who purchase the same policy through the agent
2740for the same amount of insurance receive the same percentage
2741rebate.
2742     (d)  Rebates shall not be given to an insured with respect
2743to a policy purchased from an insurer that prohibits its agents
2744from rebating commissions.
2745     (e)  The rebate schedule is prominently displayed in public
2746view in the agent's place of doing business and a copy is
2747available to insureds on request at no charge.
2748     (f)  The age, sex, place of residence, race, nationality,
2749ethnic origin, marital status, or occupation of the insured or
2750location of the risk is not utilized in determining the
2751percentage of the rebate or whether a rebate is available.
2752     (2)  The insurance advisor or agent shall maintain a copy
2753of all rebate schedules for the most recent 5 years and their
2754effective dates.
2755     Section 37.  Subsection (1) of section 626.601, Florida
2756Statutes, is amended to read:
2757     626.601  Improper conduct; inquiry; fingerprinting.--
2758     (1)  The department or office may, upon its own motion or
2759upon a written complaint signed by any interested person and
2760filed with the department or office, inquire into any alleged
2761improper conduct of any licensed insurance advisor, agent,
2762adjuster, service representative, managing general agent,
2763customer representative, title insurance agent, title insurance
2764agency, continuing education course provider, instructor, school
2765official, or monitor group under this code. The department or
2766office may thereafter initiate an investigation of any such
2767licensee if it has reasonable cause to believe that the licensee
2768has violated any provision of the insurance code. During the
2769course of its investigation, the department or office shall
2770contact the licensee being investigated unless it determines
2771that contacting such person could jeopardize the successful
2772completion of the investigation or cause injury to the public.
2773     Section 38.  Section 626.6115, Florida Statutes, is amended
2774to read:
2775     626.6115  Grounds for compulsory refusal, suspension, or
2776revocation of insurance agency license.--The department shall
2777deny, suspend, revoke, or refuse to continue the license of any
2778insurance agency if it finds, as to any insurance agency or as
2779to any majority owner, partner, manager, director, officer, or
2780other person who manages or controls such agency, that any
2781either one or both of the following applicable grounds exist:
2782     (1)  Lack by the agency of one or more of the
2783qualifications for the license as specified in this code;.
2784     (2)  Material misstatement, misrepresentation, or fraud in
2785obtaining the license or in attempting to obtain the license;
2786or.
2787     (3)  Denial, suspension, or revocation of a license to
2788practice or conduct any regulated profession, business, or
2789vocation relating to the business of insurance by this state,
2790any other state, any nation, any possession or district of the
2791United States, any court, or any lawful agency thereof.
2792     Section 39.  Paragraph (b) of subsection (5) of section
2793624.509, Florida Statutes, is amended to read:
2794     624.509  Premium tax; rate and computation.--
2795     (5)  There shall be allowed a credit against the net tax
2796imposed by this section equal to 15 percent of the amount paid
2797by the insurer in salaries to employees located or based within
2798this state and who are covered by the provisions of chapter 443.
2799For purposes of this subsection:
2800     (b)  The term "employees" does not include independent
2801contractors or any person whose duties require that the person
2802hold a valid license under the Florida Insurance Code, except
2803persons defined in s. 626.015(1), (16)(15), and (18)(17).
2804     Section 40.  Subsection (2) of section 626.7845, Florida
2805Statutes, is amended to read:
2806     626.7845  Prohibition against unlicensed transaction of
2807life insurance.--
2808     (2)  Except as provided in s. 626.112(6), with respect to
2809any line of authority specified in s. 626.015(12)(11), no
2810individual shall, unless licensed as a life agent:
2811     (a)  Solicit insurance or annuities or procure
2812applications; or
2813     (b)  In this state, engage or hold himself or herself out
2814as engaging in the business of analyzing or abstracting
2815insurance policies or of counseling or advising or giving
2816opinions to persons relative to insurance or insurance contracts
2817other than:
2818     1.  As a consulting actuary advising an insurer; or
2819     2.  As to the counseling and advising of labor unions,
2820associations, trustees, employers, or other business entities,
2821the subsidiaries and affiliates of each, relative to their
2822interests and those of their members or employees under
2823insurance benefit plans.
2824     Section 41.  Paragraph (c) of subsection (2) of section
2825626.292, Florida Statutes, is amended to read:
2826     626.292  Transfer of license from another state.--
2827     (2)  To qualify for a license transfer, an individual
2828applicant must meet the following requirements:
2829     (c)  The individual shall submit a completed application
2830for this state which is received by the department within 90
2831days after the date the individual became a resident of this
2832state, along with payment of the applicable fees set forth in s.
2833624.501 and submission of the following documents:
2834     1.  A certification issued by the appropriate official of
2835the applicant's home state identifying the type of license and
2836lines of authority under the license and stating that, at the
2837time the license from the home state was canceled, the applicant
2838was in good standing in that state or that the state's Producer
2839Database records, maintained by the National Association of
2840Insurance Commissioners, its affiliates, or subsidiaries,
2841indicate that the agent is or was licensed in good standing for
2842the line of authority requested.
2843     2.  A set of the individual applicant's fingerprints in
2844accordance with s. 626.171(4)(5).
2845     Section 42.  Paragraph (a) of subsection (2) of section
2846626.321, Florida Statutes, is amended to read:
2847     626.321  Limited licenses.--
2848     (2)  An entity applying for a license under this section is
2849required to:
2850     (a)  Submit only one application for a license under s.
2851626.171. The requirements of s. 626.171(4)(5) shall only apply
2852to the officers and directors of the entity submitting the
2853application.
2854     Section 43.  Notwithstanding the amendment to s.
2855627.6699(5)(c), Florida Statutes, by this act, any right to an
2856open enrollment offer of health benefit coverage for groups of
2857fewer than two employees, pursuant to s. 627.6699(5)(c), Florida
2858Statutes, as it existed immediately before the effective date of
2859this act, shall remain in full force and effect until the
2860enactment of s. 627.64872, Florida Statutes, and the subsequent
2861date upon which such plan begins to accept new risks or members.
2862     Section 44.  Section 408.02, Florida Statutes, is repealed.
2863     Section 45.  The sum of $250,000 is appropriated from the
2864Insurance Regulatory Trust Fund in the Department of Financial
2865Services to the Office of Insurance Regulation for the purpose
2866of implementing the provisions in this act related to the Small
2867Business Health Plan.
2868     Section 46.  There is hereby appropriated a sum of $2
2869million from General Revenue to the Agency for Health Care
2870Administration for funding activities relative to the Statewide
2871Electronic Medical Records Advisory Council provided under s.
2872408.919, Florida Statutes.
2873     Section 47.  This act shall take effect October 1, 2004.


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