September 23, 2020
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HB 1629CS

CHAMBER ACTION




1The Committee on Health Care recommends the following:
2
3     Committee Substitute
4     Remove the entire bill and insert:
5
A bill to be entitled
6An act relating to affordable health care; providing a
7popular name; providing purpose; amending s. 381.026,
8F.S.; requiring certain licensed facilities to provide
9public Internet access to certain financial information;
10amending s. 381.734, F.S.; including participation by
11health care providers, small businesses, and health
12insurers in the Healthy Communities, Healthy People
13Program; requiring the Department of Health to provide
14public Internet access to certain public health programs;
15requiring the department to monitor and assess the
16effectiveness of such programs; requiring a report;
17requiring the Office of Program Policy and Government
18Accountability to evaluate the effectiveness of such
19programs; requiring a report; amending s. 395.1041, F.S.;
20authorizing hospitals to develop certain emergency room
21diversion programs; amending s. 395.301, F.S.; requiring
22certain licensed facilities to provide public Internet
23access to certain financial information; requiring certain
24licensed facilities to provide prospective patients
25certain estimates of charges for services; amending s.
26408.061, F.S.; requiring the Agency for Health Care
27Administration to require health care facilities, health
28care providers, and health insurers to submit certain
29information; requiring the agency to adopt certain rules;
30amending s. 408.062, F.S.; requiring the agency to conduct
31certain health care costs and access research, analyses,
32and studies; expanding the scope of such studies to
33include collection of pharmacy retail price data, use of
34emergency departments, and Internet patient charge
35information availability; requiring a report; requiring
36the agency to conduct additional data-based studies and
37make recommendations to the Legislature; amending s.
38408.05, F.S.; requiring the agency to develop a plan to
39make performance outcome and financial data available to
40consumers for health care services comparison purposes;
41requiring submittal of the plan to the Governor and
42Legislature; requiring the agency to update the plan;
43requiring the agency to make the plan available
44electronically; providing plan requirements; amending s.
45409.9066, F.S.; requiring the agency to provide certain
46information relating to the Medicare prescription discount
47program; amending s. 408.7056, F.S.; renaming the
48Statewide Provider and Subscriber Assistance Program as
49the Subscriber Assistance Program; revising provisions to
50conform; expanding certain records availability
51provisions; revising membership provisions relating to a
52subscriber grievance hearing panel; providing hearing
53procedures; amending s. 641.3154, F.S., to conform to the
54renaming of the Subscriber Assistance Program; amending s.
55641.511, F.S., to conform to the renaming of the
56Subscriber Assistance Program; adopting and incorporating
57by reference the Employee Retirement Income Security Act
58of 1974, as implemented by federal regulations; amending
59s. 641.58, F.S., to conform to the renaming of the
60Subscriber Assistance Program; amending s. 408.909, F.S.;
61expanding a definition of "health flex plan entity" to
62include public-private partnerships; making a pilot health
63flex plan program apply permanently statewide; providing
64additional program requirements; creating s. 381.0271,
65F.S.; providing definitions; creating the Florida Patient
66Safety Corporation; authorizing the corporation to create
67additional not-for-profit corporate subsidiaries for
68certain purposes; specifying application of public records
69and public meetings requirements; exempting the
70corporation and subsidiaries from public procurement
71provisions; providing purposes; providing for a board of
72directors; providing for membership; authorizing the
73corporation to establish certain advisory committees;
74providing for organization of the corporation; providing
75for meetings; providing powers and duties of the
76corporation; requiring the corporation to collect,
77analyze, and evaluate patient safety data and related
78information; requiring the corporation to establish a
79pilot project to identify and report near misses relating
80to patient safety; requiring the corporation to develop a
81statewide electronic medical record system; providing
82requirements; providing for an active library of evidence-
83based medicine and patient safety practices; requiring the
84corporation to develop and recommend core competencies in
85patient safety and public education programs; requiring an
86annual report; providing report requirements; authorizing
87the corporation to seek funding and apply for grants;
88requiring the Office of Program Policy Analysis and
89Government Accountability, the Department of Health, and
90the Agency for Health Care Administration to develop
91performance standards to evaluate the corporation;
92amending s. 409.91255, F.S.; expanding assistance to
93certain health centers to include community emergency room
94diversion programs and urgent care services; amending s.
95627.410, F.S.; requiring insurers to file certain rates
96with the Office of Insurance Regulation; amending s.
97627.6487, F.S.; revising a definition; creating s.
98627.64872, F.S.; providing legislative intent; creating
99the Florida Health Insurance Plan for certain purposes;
100providing definitions; providing requirements for
101operation of the plan; providing for a board of directors;
102providing for appointment of members; providing for terms;
103specifying service without compensation; providing for
104travel and per diem expenses; requiring a plan of
105operation; providing requirements; providing for powers of
106the plan; requiring reports to the Governor and
107Legislature; providing certain immunity from liability for
108plan obligations; authorizing the board to provide for
109indemnification of certain costs; requiring an annually
110audited financial statement; providing for eligibility for
111coverage under the plan; providing criteria; requirements,
112and limitations; specifying certain activity as an unfair
113trade practice; providing for a plan administrator;
114providing criteria; providing requirements; providing term
115limits for the plan administrator; providing duties;
116providing for paying the administrator; providing for
117funding mechanisms of the plan; providing for premium
118rates for plan coverage; providing rate limitations;
119providing for assessing certain insurers providing
120coverage for persons under the Health Insurance
121Portability and Accountability Act; specifying benefits
122under the plan; providing criteria, requirements, and
123limitations; providing for nonduplication of benefits;
124providing for annual and maximum lifetime benefits;
125providing for tax exempt status; providing for abolition
126of the Florida Comprehensive Health Association upon
127implementation of the plan; providing for enrollment in
128the plan of persons enrolled in the association; requiring
129insurers to pay certain assessments to the board for
130certain purposes; providing criteria, requirements, and
131limitations for such assessments; providing for repeal of
132ss. 627.6488, 627.6489, 627.649, 627.6492, 627.6494,
133627.6496, and 627.6498, F.S., relating to the Florida
134Comprehensive Health Association, upon implementation of
135the plan; amending s. 627.662, F.S.; providing for
136application of certain claim payment methodologies to
137certain types of insurance; amending s. 627.6699, F.S.;
138revising provisions requiring small employer carriers to
139offer certain health benefit plans; preserving a right to
140open enrollment for certain small groups; requiring small
141employer carriers to file and provide coverage under
142certain high deductible plans; including high deductible
143plans under certain required plan provisions; creating the
144Small Employers Access Program; providing legislative
145intent; providing definitions; providing participation
146eligibility requirements and criteria; requiring the
147Office of Insurance Regulation to administer the program
148by selecting an insurer through competitive bidding;
149providing requirements; specifying insurer qualifications;
150providing duties of the insurer; providing a contract
151term; providing insurer reporting requirements; providing
152application requirements; providing for benefits under the
153program; requiring the office to annually report to the
154Governor and Legislature; providing for decreases in
155inappropriate use of emergency care; providing legislative
156intent; requiring health insurers to provide certain
157information electronically and develop community emergency
158department diversion programs; authorizing health insurers
159to require higher copayments for certain uses of emergency
160departments; amending s. 627.9175, F.S.; requiring certain
161health insurers to annually report certain coverage
162information to the office; providing requirements;
163deleting certain reporting requirements; amending s.
164636.003, F.S.; revising the definition of "prepaid limited
165health service organization" to exclude provision of
166discounted medical service programs; creating ss.
167627.65626 and 627.6402, F.S.; providing for insurance
168rebates for healthy lifestyles; providing for rebate of
169certain premiums for participation in health wellness,
170maintenance, or improvement programs under certain
171circumstances; providing requirements; amending s. 641.31,
172F.S.; authorizing health maintenance organizations
173offering certain point-of-service riders to offer such
174riders to certain employers for certain employees;
175providing requirements and limitations; providing for
176application of certain claim payment methodologies to
177certain types of insurance; providing for rebate of
178certain premiums for participation in health wellness,
179maintenance, or improvement programs under certain
180circumstances; providing requirements; amending s.
181626.015, F.S.; defining insurance advisor; amending ss.
182626.016, 626.342, 626.536, 626.561, 626.572, and 626.601,
183F.S., to include application of such provisions to
184insurance advisors; providing penalties; creating s.
185626.593, F.S.; providing fee and commission limitations
186for health insurance advisors; requiring a written
187contract for compensation; providing contract
188requirements; amending ss. 626.171, 626.191, and 626.201,
189F.S.; clarifying certain application requirements;
190amending s. 626.6115, F.S.; providing additional grounds
191for adverse actions against insurance agency licensure;
192amending ss. 624.509, 626.7845, 626.292, and 626.321,
193F.S.; correcting cross references; preserving certain
194rights to enrollment in certain health benefit coverage
195for certain groups under certain circumstances; creating
196s. 465.0244, F.S.; requiring each pharmacy to make
197available on its Internet website a link to certain
198performance outcome and financial data of the Agency for
199Health Care Administration and a notice of the
200availability of such information; amending s. 627.6499,
201F.S.; requiring each health insurer to make available on
202its Internet website a link to certain performance outcome
203and financial data of the Agency for Health Care
204Administration and a notice in policies of the
205availability of such information; amending s. 641.54,
206F.S.; requiring health maintenance organizations to make
207certain insurance financial information available to
208subscribers; requiring health maintenance organizations to
209make available on its Internet website a link to certain
210performance outcome and financial data of the Agency for
211Health Care Administration and a notice in policies of the
212availability of such information; repealing s. 408.02,
213F.S., relating to the development, endorsement,
214implementation, and evaluation of patient management
215practice parameters by the Agency for Health Care
216Administration; providing appropriations; providing an
217effective date.
218
219     WHEREAS, according to the Kaiser Family Foundation, eight
220out of ten uninsured Americans are workers or dependents of
221workers and nearly eight out of ten uninsured Americans have
222family incomes above the poverty level, and
223     WHEREAS, fifty-five percent of those who do not have
224insurance state the reason they don't have insurance is lack of
225affordability, and
226     WHEREAS, average health insurance premium increases for the
227last two years have been in the range of ten to twenty percent
228for Florida's employers, and
229     WHEREAS, an increasing number of employers are opting to
230cease providing insurance coverage to their employees due to the
231high cost, and
232     WHEREAS, an increasing number of employers who continue
233providing coverage are forced to shift more premium cost to
234their employees, thus diminishing the value of employee wage
235increases, and
236     WHEREAS, according to studies, the rate of avoidable
237hospitalization is fifty to seventy percent lower for the
238insured versus the uninsured, and
239     WHEREAS, according to Florida Cancer Registry data, the
240uninsured have a seventy percent greater chance of a late
241diagnosis, thus decreasing the chances of a positive health
242outcome, and
243     WHEREAS, according to the Agency for Health Care
244Administration's 2002 financial data, uncompensated care in
245Florida's hospitals is growing at the rate of twelve to thirteen
246percent per year, and, at $4.3 billion in 2001, this cost, when
247shifted to Floridians who remain insured, is not sustainable,
248and
249     WHEREAS, the Florida Legislature, through the creation of
250Health Flex, has already identified the need for lower cost
251alternatives, and
252     WHEREAS, it is of vital importance and in the best
253interests of the people of the State of Florida that the issue
254of available, affordable health care insurance be addressed in a
255cohesive and meaningful manner, and  
256     WHEREAS, there is general recognition that the issues
257surrounding the problem of access to affordable health insurance
258are complicated and multifaceted, and
259     WHEREAS, on August 14, 2003, Speaker Johnnie Byrd created
260the Select Committee on Affordable Health Care for Floridians in
261an effort to address the issue of affordable and accessible
262employment-based insurance, and
263     WHEREAS, the Select Committee on Affordable Health Care for
264Floridians held public hearings with predetermined themes around
265the state, specifically, in Orlando, Miami, Jacksonville, Tampa,
266Pensacola, Boca Raton, and Tallahassee, from October through
267November 2003 to effectively probe the operation of the private
268insurance marketplace, to understand the health insurance market
269trends, to learn from past policy initiatives, and to identify,
270explore, and debate new ideas for change, and
271     WHEREAS, recommendations from the Select Committee on
272Affordable Health Care were adopted on February 4, 2004, to
273address the multifaceted issues attributed to the increase in
274health care cost, and
275     WHEREAS, these recommendations were presented to the
276Speaker of the House of Representatives in a final report from
277the committee on February 18, 2004, and subsequent legislation
278was drafted creating the "The 2004 Affordable Health Care for
279Floridians Act," NOW, THEREFORE,
280
281Be It Enacted by the Legislature of the State of Florida:
282
283     Section 1.  This act may be referred to by the popular name
284"The 2004 Affordable Health Care for Floridians Act."
285     Section 2.  The purpose of this act is to address the
286underlying cause of the double-digit increases in health
287insurance premiums by mitigating the overall growth in health
288care costs.
289     Section 3.  Paragraph (c) of subsection (4) of section
290381.026, Florida Statutes, is amended to read:
291     381.026  Florida Patient's Bill of Rights and
292Responsibilities.--
293     (4)  RIGHTS OF PATIENTS.--Each health care facility or
294provider shall observe the following standards:
295     (c)  Financial information and disclosure.--
296     1.  A patient has the right to be given, upon request, by
297the responsible provider, his or her designee, or a
298representative of the health care facility full information and
299necessary counseling on the availability of known financial
300resources for the patient's health care.
301     2.  A health care provider or a health care facility shall,
302upon request, disclose to each patient who is eligible for
303Medicare, in advance of treatment, whether the health care
304provider or the health care facility in which the patient is
305receiving medical services accepts assignment under Medicare
306reimbursement as payment in full for medical services and
307treatment rendered in the health care provider's office or
308health care facility.
309     3.  A health care provider or a health care facility shall,
310upon request, furnish a patient, prior to provision of medical
311services, a reasonable estimate of charges for such services.
312Such reasonable estimate shall not preclude the health care
313provider or health care facility from exceeding the estimate or
314making additional charges based on changes in the patient's
315condition or treatment needs.
316     4.  Each licensed facility not operated by the state shall
317make available to the public on its Internet website or by other
318electronic means information regarding cost of service. The
319facility shall maintain on its website a description of and a
320link to the agency's website which provides an average cost of
321the top 50 inpatient and outpatient services provided. The
322facility shall place a notice in the reception areas that such
323information is available electronically and the website address.
324The licensed facility may indicate that the pricing information
325is based on a compilation of charges for the average patient and
326that each patient's bill may vary from the average depending
327upon the severity of illness and individual resources consumed.
328The licensed facility may also indicate that the price of
329service is negotiable for eligible patients based upon the
330patient's ability to pay.
331     5.4.  A patient has the right to receive a copy of an
332itemized bill upon request. A patient has a right to be given an
333explanation of charges upon request.
334     Section 4.  Subsection (1) and paragraph (g) of subsection
335(3) of section 381.734, Florida Statutes, are amended, and
336subsections (4), (5), and (6) are added to said section, to
337read:
338     381.734  Healthy Communities, Healthy People Program.--
339     (1)  The department shall develop and implement the Healthy
340Communities, Healthy People Program, a comprehensive and
341community-based health promotion and wellness program. The
342program shall be designed to reduce major behavioral risk
343factors associated with chronic diseases, including those
344chronic diseases identified in chapter 385, by enhancing the
345knowledge, skills, motivation, and opportunities for
346individuals, organizations, health care providers, small
347businesses, health insurers, and communities to develop and
348maintain healthy lifestyles.
349     (3)  The program shall include:
350     (g)  The establishment of a comprehensive program to inform
351the public, health care professionals, health insurers, and
352communities about the prevalence of chronic diseases in the
353state; known and potential risks, including social and
354behavioral risks; and behavior changes that would reduce risks.
355     (4)  The department shall make available on its Internet
356website, no later than October 1, 2004, and in a hard-copy
357format upon request, a listing of age-specific, disease-
358specific, and community-specific health promotion, preventive
359care, and wellness programs offered and established under the
360Healthy Communities, Healthy People Program. The website shall
361also provide residents with information to identify behavior
362risk factors that lead to diseases that are preventable by
363maintaining a healthy lifestyle. The website shall allow
364consumers to select by county or region disease-specific
365statistical information.
366     (5)  The department shall monitor and assess the
367effectiveness of such programs. The department shall submit a
368status report based on this monitoring and assessment to the
369Governor, the Speaker of the House of Representatives, the
370President of the Senate, and the substantive committees of each
371house of the Legislature, with the first annual report due
372January 31, 2005.
373     (6)  The Office of Program Policy and Government
374Accountability shall evaluate and report to the Governor, the
375President of the Senate, and the Speaker of the House of
376Representatives, by March 1, 2005, on the effectiveness of the
377department's monitoring and assessment of the program's
378effectiveness.
379     Section 5.  Subsection (7) is added to section 395.1041,
380Florida Statutes, to read:
381     395.1041  Access to emergency services and care.--
382     (7)  EMERGENCY ROOM DIVERSION PROGRAMS.--Hospitals may
383develop emergency room diversion programs, including, but not
384limited to, an "Emergency Hotline" which allows patients to help
385determine if emergency department services are appropriate or if
386other health care settings may be more appropriate for care, and
387a "Fast Track" program allowing nonemergency patients to be
388treated at an alternative site. Alternative sites may include
389health care programs funded with local tax revenue and federally
390funded community health centers, county health departments, or
391other nonhospital providers of health care services. The program
392may include provisions for followup care and case management.
393     Section 6.  Subsections (7) and (8) are added to section
394395.301, Florida Statutes, to read:
395     395.301  Itemized patient bill; form and content prescribed
396by the agency.--
397     (7)  Each licensed facility not operated by the state shall
398provide, prior to provision of any medical services, an estimate
399of charges for the proposed service upon request of a
400prospective patient who does not have insurance coverage or
401whose insurer or health maintenance organization does not have a
402contract with the hospital and an emergency medical condition
403does not exist or the service is not a covered service. The
404estimate may be the average charges for that diagnosis-related
405group or the average charges for that procedure. Such estimate
406shall not preclude the actual charges from exceeding the
407estimate. The facility shall place a notice in reception areas
408that such information is available electronically and the
409website address.
410     (8)  Each licensed facility shall make available on its
411Internet website a link to the performance outcome and financial
412data that is published by the Agency for Health Care
413Administration pursuant to s. 408.05(3)(l).
414     Section 7.  Subsection (1) of section 408.061, Florida
415Statutes, is amended to read:
416     408.061  Data collection; uniform systems of financial
417reporting; information relating to physician charges;
418confidential information; immunity.--
419     (1)  The agency shall may require the submission by health
420care facilities, health care providers, and health insurers of
421data necessary to carry out the agency's duties. Specifications
422for data to be collected under this section shall be developed
423by the agency with the assistance of technical advisory panels
424including representatives of affected entities, consumers,
425purchasers, and such other interested parties as may be
426determined by the agency.
427     (a)  Data to be submitted by health care facilities,
428including the facilities as defined in chapter 395, shall may
429include, but are not limited to: case-mix data, patient
430admission and or discharge data, outpatient data which shall
431include the number of patients treated in the emergency
432department of a licensed hospital reported by patient acuity
433level, data on hospital-acquired infections including date of
434diagnosis as specified by rule, data on complications including
435date of diagnosis as specified by rule, data on readmissions as
436specified by rule, with patient and provider-specific
437identifiers included, actual charge data by diagnostic groups,
438financial data, accounting data, operating expenses, expenses
439incurred for rendering services to patients who cannot or do not
440pay, interest charges, depreciation expenses based on the
441expected useful life of the property and equipment involved, and
442demographic data. The agency shall adopt rules for a risk and
443morbidity adjustment methodology for all data submitted as
444required by this section. Such methodology may be a nationally
445recognized formula published by the Agency for Healthcare
446Research and Quality of the United States Department of Health
447and Human Services or any other nationally recognized
448organization. Data may be obtained from documents such as, but
449not limited to: leases, contracts, debt instruments, itemized
450patient bills, medical record abstracts, and related diagnostic
451information. Reported data elements shall be reported
452electronically in accordance with Rule 59E-7.012, Florida
453Administrative Code.
454     (b)  Data to be submitted by health care providers may
455include, but are not limited to: Medicare and Medicaid
456participation, types of services offered to patients, amount of
457revenue and expenses of the health care provider, and such other
458data which are reasonably necessary to study utilization
459patterns.
460     (c)  Data to be submitted by health insurers may include
461percentage of claims denied, percentage of claims meeting prompt
462pay requirements, and medical and administrative loss ratios,
463but are not limited to: claims, premium, administration, and
464financial information.
465     (d)  Data required to be submitted by health care
466facilities, health care providers, or health insurers shall not
467include specific provider contract reimbursement information.
468However, such specific provider reimbursement data shall be
469reasonably available for onsite inspection by the agency as is
470necessary to carry out the agency's regulatory duties. Any such
471data obtained by the agency as a result of onsite inspections
472may not be used by the state for purposes of direct provider
473contracting and are confidential and exempt from the provisions
474of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
475     (e)  A requirement to submit data shall be adopted by rule
476if the submission of data is being required of all members of
477any type of health care facility, health care provider, or
478health insurer. Rules are not required, however, for the
479submission of data for a special study mandated by the
480Legislature or when information is being requested for a single
481health care facility, health care provider, or health insurer.
482     Section 8.  Subsections (1) and (4) of section 408.062,
483Florida Statutes, are amended to read:
484     408.062  Research, analyses, studies, and reports.--
485     (1)  The agency shall have the authority to conduct
486research, analyses, and studies relating to health care costs
487and access to and quality of health care services as access and
488quality are affected by changes in health care costs. Such
489research, analyses, and studies shall include, but not be
490limited to, research and analysis relating to:
491     (a)  The financial status of any health care facility or
492facilities subject to the provisions of this chapter.
493     (b)  The impact of uncompensated charity care on health
494care facilities and health care providers.
495     (c)  The state's role in assisting to fund indigent care.
496     (d)  In conjunction with the Office of Insurance
497Regulation, the availability and affordability of health
498insurance for small businesses.
499     (e)  Total health care expenditures in the state according
500to the sources of payment and the type of expenditure.
501     (f)  The quality of health services, using techniques such
502as small area analysis, severity adjustments, and risk-adjusted
503mortality rates.
504     (g)  The development of physician payment systems which are
505capable of taking into account the amount of resources consumed
506and the outcomes produced in the delivery of care.
507     (h)  The collection of a statistically valid sample of data
508on the retail prices charged by pharmacies for the 50 most
509frequently prescribed medicines from any pharmacy licensed by
510this state as a special study authorized by the Legislature to
511be performed by the agency quarterly. If the drug is available
512generically, price data shall be reported for the generic drug
513and price data of a brand-named drug for which the generic drug
514is the equivalent shall be reported. The data collected shall be
515reported for each drug by pharmacy and by metropolitan
516statistical area or region and updated quarterly The impact of
517subacute admissions on hospital revenues and expenses for
518purposes of calculating adjusted admissions as defined in s.
519408.07.
520     (i)  The use of emergency department services by patient
521acuity level and the implication of increasing hospital cost by
522providing nonurgent care in emergency departments. The agency
523shall submit an annual report based on this monitoring and
524assessment to the Governor, the Speaker of the House of
525Representatives, the President of the Senate, and the
526substantive legislative committees with the first report due
527January 1, 2006.
528     (j)  The making available on its Internet website no later
529than October 1, 2004, and in a hard-copy format upon request, of
530patient charge, volumes, length of stay, and performance outcome
531indicators collected from health care facilities pursuant to s.
532408.061(1)(a) for specific medical conditions, surgeries, and
533procedures provided in inpatient and outpatient facilities as
534determined by the agency. In making the determination of
535specific medical conditions, surgeries, and procedures to
536include, the agency shall consider such factors as volume,
537severity of the illness, urgency of admission, individual and
538societal costs, and whether the condition is acute or chronic.
539Performance outcome indicators shall be risk adjusted. The
540website shall also provide an interactive search that allows
541consumers to view and compare the information for specific
542facilities, a map that allows consumers to select a county or
543region, definitions of all of the data, descriptions of each
544procedure, and an explanation about why the data may differ from
545facility to facility. Such public data shall be updated
546quarterly. The agency shall submit an annual status report on
547the collection of data and publication of performance outcome
548indicators to the Governor, the Speaker of the House of
549Representatives, the President of the Senate, and the
550substantive legislative committees with the first status report
551due January 1, 2005.
552     (4)(a)  The agency shall may conduct data-based studies and
553evaluations and make recommendations to the Legislature and the
554Governor concerning exemptions, the effectiveness of limitations
555of referrals, restrictions on investment interests and
556compensation arrangements, and the effectiveness of public
557disclosure. Such analysis shall may include, but need not be
558limited to, utilization of services, cost of care, quality of
559care, and access to care. The agency may require the submission
560of data necessary to carry out this duty, which may include, but
561need not be limited to, data concerning ownership, Medicare and
562Medicaid, charity care, types of services offered to patients,
563revenues and expenses, patient-encounter data, and other data
564reasonably necessary to study utilization patterns and the
565impact of health care provider ownership interests in health-
566care-related entities on the cost, quality, and accessibility of
567health care.
568     (b)  The agency may collect such data from any health
569facility or licensed health care provider as a special study.
570     Section 9.  Paragraph (l) is added to subsection (3) of
571section 408.05, Florida Statutes, to read:
572     408.05  State Center for Health Statistics.--
573     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
574produce comparable and uniform health information and
575statistics, the agency shall perform the following functions:
576     (l)  Develop, in conjunction with the State Comprehensive
577Health Information System Advisory Council, and implement a
578long-range plan for making available performance, including, at
579a minimum, pharmaceuticals, physicians, health care facilities,
580and health plans and managed care entities. The agency shall
581submit the initial plan to the Governor, the President of the
582Senate, and the Speaker of the House of Representatives by March
5831, 2005, and shall update the plan and report on the status of
584its implementation annually thereafter. The agency shall also
585make the plan and status report available to the public on its
586Internet website. As part of the plan, the agency shall identify
587the process and timeframes for implementation, any barriers to
588implementation, and recommendations of changes in the law that
589may be enacted by the Legislature to eliminate the barriers. As
590preliminary elements of the plan, the agency shall:
591     1.  Make available performance outcome and patient charge
592data collected from health care facilities pursuant to s.
593408.061(1)(a) and (2). The agency shall determine which
594conditions and procedures, performance outcomes, and patient
595charge data to disclose based upon input from the council. When
596determining which conditions and procedures are to be disclosed,
597the council and the agency shall consider variation in costs,
598variation in outcomes, and magnitude of variations and other
599relevant information. When determining which performance
600outcomes to disclose, the agency:
601     a.  Shall consider such factors as volume of cases; average
602patient charges; average length of stay; complication rates;
603mortality rates; and infection rates, among others, which shall
604be adjusted for case mix and severity, if applicable.
605     b.  May consider such additional measures that are adopted
606by the Centers for Medicare and Medicaid Studies, National
607Quality Forum, the Joint Commission on Accreditation of
608Healthcare Organizations, the Agency for Healthcare Research and
609Quality, or a similar national entity that establishes standards
610to measure the performance of health care providers, or by other
611states.
612
613When determining which patient charge data to disclose, the
614agency shall consider such measures as average charge, average
615net revenue per adjusted patient day, average cost per adjusted
616patient day, and average cost per admission, among others.
617     2.  Make available performance measures, benefit design,
618and premium cost data from health plans licensed pursuant to
619chapter 627 or chapter 641. The agency shall determine which
620performance outcome and member and subscriber cost data to
621disclose, based upon input from the council. When determining
622which data to disclose, the agency shall consider information
623that may be required by either individual or group purchasers to
624assess the value of the product, which may include membership
625satisfaction, quality of care, current enrollment or membership,
626coverage areas, accreditation status, premium costs, plan costs,
627premium increases, range of benefits, copayments and
628deductibles, accuracy and speed of claims payment, credentials
629of physicians, number of providers, names of network providers,
630and hospitals in the network.
631     3.  Determine the method and format for public disclosure
632of data reported pursuant to this paragraph. The agency shall
633make its determination based upon input from the Comprehensive
634Health Information System Advisory Council. At a minimum, the
635data shall be made available on the agency's Internet website in
636a manner that allows consumers to conduct an interactive search
637that allows them to view and compare the information for
638specific providers. The website must include such additional
639information as is determined necessary to ensure that the
640website enhances informed decision making among consumers and
641health care purchasers, which shall include, at a minimum,
642appropriate guidance on how to use the data and an explanation
643of why the data may vary from provider to provider. The data
644specified in subparagraphs 1. and 2. shall be released no later
645than March 1, 2005.
646     Section 10.  Subsection (3) of section 409.9066, Florida
647Statutes, is amended to read:
648     409.9066  Medicare prescription discount program.--
649     (3)  The Agency for Health Care Administration shall
650publish, on a free website available to the public, the most
651recent average wholesale prices for the 200 drugs most
652frequently dispensed to the elderly and, to the extent possible,
653shall provide a mechanism that consumers may use to calculate
654the retail price and the price that should be paid after the
655discount required in subsection (1) is applied. The agency shall
656provide retail information by geographic area and retail
657information by provider within geographical areas.
658     Section 11.  Section 408.7056, Florida Statutes, is amended
659to read:
660     408.7056  Statewide Provider and Subscriber Assistance
661Program.--
662     (1)  As used in this section, the term:
663     (a)  "Agency" means the Agency for Health Care
664Administration.
665     (b)  "Department" means the Department of Financial
666Services.
667     (c)  "Grievance procedure" means an established set of
668rules that specify a process for appeal of an organizational
669decision.
670     (d)  "Health care provider" or "provider" means a state-
671licensed or state-authorized facility, a facility principally
672supported by a local government or by funds from a charitable
673organization that holds a current exemption from federal income
674tax under s. 501(c)(3) of the Internal Revenue Code, a licensed
675practitioner, a county health department established under part
676I of chapter 154, a prescribed pediatric extended care center
677defined in s. 400.902, a federally supported primary care
678program such as a migrant health center or a community health
679center authorized under s. 329 or s. 330 of the United States
680Public Health Services Act that delivers health care services to
681individuals, or a community facility that receives funds from
682the state under the Community Alcohol, Drug Abuse, and Mental
683Health Services Act and provides mental health services to
684individuals.
685     (e)  "Managed care entity" means a health maintenance
686organization or a prepaid health clinic certified under chapter
687641, a prepaid health plan authorized under s. 409.912, or an
688exclusive provider organization certified under s. 627.6472.
689     (f)  "Office" means the Office of Insurance Regulation of
690the Financial Services Commission.
691     (g)  "Panel" means a statewide provider and subscriber
692assistance panel selected as provided in subsection (11).
693     (2)  The agency shall adopt and implement a program to
694provide assistance to subscribers and providers, including those
695whose grievances are not resolved by the managed care entity to
696the satisfaction of the subscriber or provider. The program
697shall consist of one or more panels that meet as often as
698necessary to timely review, consider, and hear grievances and
699recommend to the agency or the office any actions that should be
700taken concerning individual cases heard by the panel. The panel
701shall hear every grievance filed by subscribers and providers on
702behalf of subscribers, unless the grievance:
703     (a)  Relates to a managed care entity's refusal to accept a
704provider into its network of providers;
705     (b)  Is part of an internal grievance in a Medicare managed
706care entity or a reconsideration appeal through the Medicare
707appeals process which does not involve a quality of care issue;
708     (c)  Is related to a health plan not regulated by the state
709such as an administrative services organization, third-party
710administrator, or federal employee health benefit program;
711     (d)  Is related to appeals by in-plan suppliers and
712providers, unless related to quality of care provided by the
713plan;
714     (e)  Is part of a Medicaid fair hearing pursued under 42
715C.F.R. ss. 431.220 et seq.;
716     (f)  Is the basis for an action pending in state or federal
717court;
718     (g)  Is related to an appeal by nonparticipating providers,
719unless related to the quality of care provided to a subscriber
720by the managed care entity and the provider is involved in the
721care provided to the subscriber;
722     (h)  Was filed before the subscriber or provider completed
723the entire internal grievance procedure of the managed care
724entity, the managed care entity has complied with its timeframes
725for completing the internal grievance procedure, and the
726circumstances described in subsection (6) do not apply;
727     (i)  Has been resolved to the satisfaction of the
728subscriber or provider who filed the grievance, unless the
729managed care entity's initial action is egregious or may be
730indicative of a pattern of inappropriate behavior;
731     (j)  Is limited to seeking damages for pain and suffering,
732lost wages, or other incidental expenses, including accrued
733interest on unpaid balances, court costs, and transportation
734costs associated with a grievance procedure;
735     (k)  Is limited to issues involving conduct of a health
736care provider or facility, staff member, or employee of a
737managed care entity which constitute grounds for disciplinary
738action by the appropriate professional licensing board and is
739not indicative of a pattern of inappropriate behavior, and the
740agency, office, or department has reported these grievances to
741the appropriate professional licensing board or to the health
742facility regulation section of the agency for possible
743investigation; or
744     (l)  Is withdrawn by the subscriber or provider. Failure of
745the subscriber or the provider to attend the hearing shall be
746considered a withdrawal of the grievance.
747     (3)  The agency shall review all grievances within 60 days
748after receipt and make a determination whether the grievance
749shall be heard. Once the agency notifies the panel, the
750subscriber or provider, and the managed care entity that a
751grievance will be heard by the panel, the panel shall hear the
752grievance either in the network area or by teleconference no
753later than 120 days after the date the grievance was filed. The
754agency shall notify the parties, in writing, by facsimile
755transmission, or by phone, of the time and place of the hearing.
756The panel may take testimony under oath, request certified
757copies of documents, and take similar actions to collect
758information and documentation that will assist the panel in
759making findings of fact and a recommendation. The panel shall
760issue a written recommendation, supported by findings of fact,
761to the provider or subscriber, to the managed care entity, and
762to the agency or the office no later than 15 working days after
763hearing the grievance. If at the hearing the panel requests
764additional documentation or additional records, the time for
765issuing a recommendation is tolled until the information or
766documentation requested has been provided to the panel. The
767proceedings of the panel are not subject to chapter 120.
768     (4)  If, upon receiving a proper patient authorization
769along with a properly filed grievance, the agency requests
770medical records from a health care provider or managed care
771entity, the health care provider or managed care entity that has
772custody of the records has 10 days to provide the records to the
773agency. Records include medical records, communication logs
774associated with the grievance both to and from the subscriber,
775contracts, and any other contents of the internal grievance file
776associated with the complaint filed with the Subscriber
777Assistance Program. Failure to provide requested medical records
778may result in the imposition of a fine of up to $500. Each day
779that records are not produced is considered a separate
780violation.
781     (5)  Grievances that the agency determines pose an
782immediate and serious threat to a subscriber's health must be
783given priority over other grievances. The panel may meet at the
784call of the chair to hear the grievances as quickly as possible
785but no later than 45 days after the date the grievance is filed,
786unless the panel receives a waiver of the time requirement from
787the subscriber. The panel shall issue a written recommendation,
788supported by findings of fact, to the office or the agency
789within 10 days after hearing the expedited grievance.
790     (6)  When the agency determines that the life of a
791subscriber is in imminent and emergent jeopardy, the chair of
792the panel may convene an emergency hearing, within 24 hours
793after notification to the managed care entity and to the
794subscriber, to hear the grievance. The grievance must be heard
795notwithstanding that the subscriber has not completed the
796internal grievance procedure of the managed care entity. The
797panel shall, upon hearing the grievance, issue a written
798emergency recommendation, supported by findings of fact, to the
799managed care entity, to the subscriber, and to the agency or the
800office for the purpose of deferring the imminent and emergent
801jeopardy to the subscriber's life. Within 24 hours after receipt
802of the panel's emergency recommendation, the agency or office
803may issue an emergency order to the managed care entity. An
804emergency order remains in force until:
805     (a)  The grievance has been resolved by the managed care
806entity;
807     (b)  Medical intervention is no longer necessary; or
808     (c)  The panel has conducted a full hearing under
809subsection (3) and issued a recommendation to the agency or the
810office, and the agency or office has issued a final order.
811     (7)  After hearing a grievance, the panel shall make a
812recommendation to the agency or the office which may include
813specific actions the managed care entity must take to comply
814with state laws or rules regulating managed care entities.
815     (8)  A managed care entity, subscriber, or provider that is
816affected by a panel recommendation may within 10 days after
817receipt of the panel's recommendation, or 72 hours after receipt
818of a recommendation in an expedited grievance, furnish to the
819agency or office written evidence in opposition to the
820recommendation or findings of fact of the panel.
821     (9)  No later than 30 days after the issuance of the
822panel's recommendation and, for an expedited grievance, no later
823than 10 days after the issuance of the panel's recommendation,
824the agency or the office may adopt the panel's recommendation or
825findings of fact in a proposed order or an emergency order, as
826provided in chapter 120, which it shall issue to the managed
827care entity. The agency or office may issue a proposed order or
828an emergency order, as provided in chapter 120, imposing fines
829or sanctions, including those contained in ss. 641.25 and
830641.52. The agency or the office may reject all or part of the
831panel's recommendation. All fines collected under this
832subsection must be deposited into the Health Care Trust Fund.
833     (10)  In determining any fine or sanction to be imposed,
834the agency and the office may consider the following factors:
835     (a)  The severity of the noncompliance, including the
836probability that death or serious harm to the health or safety
837of the subscriber will result or has resulted, the severity of
838the actual or potential harm, and the extent to which provisions
839of chapter 641 were violated.
840     (b)  Actions taken by the managed care entity to resolve or
841remedy any quality-of-care grievance.
842     (c)  Any previous incidents of noncompliance by the managed
843care entity.
844     (d)  Any other relevant factors the agency or office
845considers appropriate in a particular grievance.
846     (11)(a)  The panel shall consist of the Insurance Consumer
847Advocate, or designee thereof, established by s. 627.0613; at
848least two members employed by the agency and at least two
849members employed by the department, chosen by their respective
850agencies; a consumer appointed by the Governor; a physician
851appointed by the Governor, as a standing member; and, if
852necessary, physicians who have expertise relevant to the case to
853be heard, on a rotating basis. The agency may contract with a
854medical director, and a primary care physician, or both, who
855shall provide additional technical expertise to the panel but
856shall not be voting members of the panel. The medical director
857shall be selected from a health maintenance organization with a
858current certificate of authority to operate in Florida.
859     (b)  A majority of those panel members required under
860paragraph (a) shall constitute a quorum for any meeting or
861hearing of the panel. A grievance may not be heard or voted upon
862at any panel meeting or hearing unless a quorum is present,
863except that a minority of the panel may adjourn a meeting or
864hearing until a quorum is present. A panel convened for the
865purpose of hearing a subscriber's grievance in accordance with
866subsections (2) and (3) shall not consist of more than 11
867members.
868     (12)  Every managed care entity shall submit a quarterly
869report to the agency, the office, and the department listing the
870number and the nature of all subscribers' and providers'
871grievances which have not been resolved to the satisfaction of
872the subscriber or provider after the subscriber or provider
873follows the entire internal grievance procedure of the managed
874care entity. The agency shall notify all subscribers and
875providers included in the quarterly reports of their right to
876file an unresolved grievance with the panel.
877     (13)  A proposed order issued by the agency or office which
878only requires the managed care entity to take a specific action
879under subsection (7) is subject to a summary hearing in
880accordance with s. 120.574, unless all of the parties agree
881otherwise. If the managed care entity does not prevail at the
882hearing, the managed care entity must pay reasonable costs and
883attorney's fees of the agency or the office incurred in that
884proceeding.
885     (14)(a)  Any information that identifies a subscriber which
886is held by the panel, agency, or department pursuant to this
887section is confidential and exempt from the provisions of s.
888119.07(1) and s. 24(a), Art. I of the State Constitution.
889However, at the request of a subscriber or managed care entity
890involved in a grievance procedure, the panel, agency, or
891department shall release information identifying the subscriber
892involved in the grievance procedure to the requesting subscriber
893or managed care entity.
894     (b)  Meetings of the panel shall be open to the public
895unless the provider or subscriber whose grievance will be heard
896requests a closed meeting or the agency or the department
897determines that information which discloses the subscriber's
898medical treatment or history or information relating to internal
899risk management programs as defined in s. 641.55(5)(c), (6), and
900(8) may be revealed at the panel meeting, in which case that
901portion of the meeting during which a subscriber's medical
902treatment or history or internal risk management program
903information is discussed shall be exempt from the provisions of
904s. 286.011 and s. 24(b), Art. I of the State Constitution. All
905closed meetings shall be recorded by a certified court reporter.
906     Section 12.  Paragraph (c) of subsection (4) of section
907641.3154, Florida Statutes, is amended to read:
908     641.3154  Organization liability; provider billing
909prohibited.--
910     (4)  A provider or any representative of a provider,
911regardless of whether the provider is under contract with the
912health maintenance organization, may not collect or attempt to
913collect money from, maintain any action at law against, or
914report to a credit agency a subscriber of an organization for
915payment of services for which the organization is liable, if the
916provider in good faith knows or should know that the
917organization is liable. This prohibition applies during the
918pendency of any claim for payment made by the provider to the
919organization for payment of the services and any legal
920proceedings or dispute resolution process to determine whether
921the organization is liable for the services if the provider is
922informed that such proceedings are taking place. It is presumed
923that a provider does not know and should not know that an
924organization is liable unless:
925     (c)  The office or agency makes a final determination that
926the organization is required to pay for such services subsequent
927to a recommendation made by the Statewide Provider and
928Subscriber Assistance Panel pursuant to s. 408.7056; or
929     Section 13.  Subsection (1), paragraphs (b) and (e) of
930subsection (3), paragraph (d) of subsection (4), subsection (5),
931paragraph (g) of subsection (6), and subsections  (9), (10), and
932(11) of section 641.511, Florida Statutes, are amended to read:
933     641.511  Subscriber grievance reporting and resolution
934requirements.--
935     (1)  Every organization must have a grievance procedure
936available to its subscribers for the purpose of addressing
937complaints and grievances. Every organization must notify its
938subscribers that a subscriber must submit a grievance within 1
939year after the date of occurrence of the action that initiated
940the grievance, and may submit the grievance for review to the
941Statewide Provider and Subscriber Assistance Program panel as
942provided in s. 408.7056 after receiving a final disposition of
943the grievance through the organization's grievance process. An
944organization shall maintain records of all grievances and shall
945report annually to the agency the total number of grievances
946handled, a categorization of the cases underlying the
947grievances, and the final disposition of the grievances.
948     (3)  Each organization's grievance procedure, as required
949under subsection (1), must include, at a minimum:
950     (b)  The names of the appropriate employees or a list of
951grievance departments that are responsible for implementing the
952organization's grievance procedure. The list must include the
953address and the toll-free telephone number of each grievance
954department, the address of the agency and its toll-free
955telephone hotline number, and the address of the Statewide
956Provider and Subscriber Assistance Program and its toll-free
957telephone number.
958     (e)  A notice that a subscriber may voluntarily pursue
959binding arbitration in accordance with the terms of the contract
960if offered by the organization, after completing the
961organization's grievance procedure and as an alternative to the
962Statewide Provider and Subscriber Assistance Program. Such
963notice shall include an explanation that the subscriber may
964incur some costs if the subscriber pursues binding arbitration,
965depending upon the terms of the subscriber's contract.
966     (4)
967     (d)  In any case when the review process does not resolve a
968difference of opinion between the organization and the
969subscriber or the provider acting on behalf of the subscriber,
970the subscriber or the provider acting on behalf of the
971subscriber may submit a written grievance to the Statewide
972Provider and Subscriber Assistance Program.
973     (5)  Except as provided in subsection (6), the organization
974shall resolve a grievance within 60 days after receipt of the
975grievance, or within a maximum of 90 days if the grievance
976involves the collection of information outside the service area.
977These time limitations are tolled if the organization has
978notified the subscriber, in writing, that additional information
979is required for proper review of the grievance and that such
980time limitations are tolled until such information is provided.
981After the organization receives the requested information, the
982time allowed for completion of the grievance process resumes.
983The Employee Retirement Income Security Act of 1974, as
984implemented by 29 C.F.R. 2560.503-1, is adopted and incorporated
985by reference as applicable to all organizations that administer
986small and large group health plans that are subject to 29 C.F.R.
9872560.503-1. The claims procedures of the regulations of the
988Employee Retirement Income Security Act of 1974 as implemented
989by 29 C.F.R. 2560.503-1 shall be the minimum standards for
990grievance processes for claims for benefits for small and large
991group health plans that are subject to 29 C.F.R. 2560.503-1.
992     (6)
993     (g)  In any case when the expedited review process does not
994resolve a difference of opinion between the organization and the
995subscriber or the provider acting on behalf of the subscriber,
996the subscriber or the provider acting on behalf of the
997subscriber may submit a written grievance to the Statewide
998Provider and Subscriber Assistance Program.
999     (9)(a)  The agency shall advise subscribers with grievances
1000to follow their organization's formal grievance process for
1001resolution prior to review by the Statewide Provider and
1002Subscriber Assistance Program. The subscriber may, however,
1003submit a copy of the grievance to the agency at any time during
1004the process.
1005     (b)  Requiring completion of the organization's grievance
1006process before the Statewide Provider and Subscriber Assistance
1007Program panel's review does not preclude the agency from
1008investigating any complaint or grievance before the organization
1009makes its final determination.
1010     (10)  Each organization must notify the subscriber in a
1011final decision letter that the subscriber may request review of
1012the organization's decision concerning the grievance by the
1013Statewide Provider and Subscriber Assistance Program, as
1014provided in s. 408.7056, if the grievance is not resolved to the
1015satisfaction of the subscriber. The final decision letter must
1016inform the subscriber that the request for review must be made
1017within 365 days after receipt of the final decision letter, must
1018explain how to initiate such a review, and must include the
1019addresses and toll-free telephone numbers of the agency and the
1020Statewide Provider and Subscriber Assistance Program.
1021     (11)  Each organization, as part of its contract with any
1022provider, must require the provider to post a consumer
1023assistance notice prominently displayed in the reception area of
1024the provider and clearly noticeable by all patients. The
1025consumer assistance notice must state the addresses and toll-
1026free telephone numbers of the Agency for Health Care
1027Administration, the Statewide Provider and Subscriber Assistance
1028Program, and the Department of Financial Services. The consumer
1029assistance notice must also clearly state that the address and
1030toll-free telephone number of the organization's grievance
1031department shall be provided upon request. The agency may adopt
1032rules to implement this section.
1033     Section 14.  Subsection (4) of section 641.58, Florida
1034Statutes, is amended to read:
1035     641.58  Regulatory assessment; levy and amount; use of
1036funds; tax returns; penalty for failure to pay.--
1037     (4)  The moneys received and deposited into the Health Care
1038Trust Fund shall be used to defray the expenses of the agency in
1039the discharge of its administrative and regulatory powers and
1040duties under this part, including conducting an annual survey of
1041the satisfaction of members of health maintenance organizations;
1042contracting with physician consultants for the Statewide
1043Provider and Subscriber Assistance Panel; maintaining offices
1044and necessary supplies, essential equipment, and other
1045materials, salaries and expenses of required personnel; and
1046discharging the administrative and regulatory powers and duties
1047imposed under this part.
1048     Section 15.  Paragraph (f) of subsection (2) and
1049subsections (3) and (9) of section 408.909, Florida Statutes,
1050are amended to read:
1051     408.909  Health flex plans.--
1052     (2)  DEFINITIONS.--As used in this section, the term:
1053     (f)  "Health flex plan entity" means a health insurer,
1054health maintenance organization, health-care-provider-sponsored
1055organization, local government, health care district, or other
1056public or private community-based organization, or public-
1057private partnership that develops and implements an approved
1058health flex plan and is responsible for administering the health
1059flex plan and paying all claims for health flex plan coverage by
1060enrollees of the health flex plan.
1061     (3)  PILOT PROGRAM.--The agency and the office shall each
1062approve or disapprove health flex plans that provide health care
1063coverage for eligible participants who reside in the three areas
1064of the state that have the highest number of uninsured persons,
1065as identified in the Florida Health Insurance Study conducted by
1066the agency and in Indian River County. A health flex plan may
1067limit or exclude benefits otherwise required by law for insurers
1068offering coverage in this state, may cap the total amount of
1069claims paid per year per enrollee, may limit the number of
1070enrollees, or may take any combination of those actions. A
1071health flex plan offering may include the option of a
1072catastrophic plan supplementing the health flex plan.
1073     (a)  The agency shall develop guidelines for the review of
1074applications for health flex plans and shall disapprove or
1075withdraw approval of plans that do not meet or no longer meet
1076minimum standards for quality of care and access to care. The
1077agency shall ensure that the health flex plans follow
1078standardized grievance procedures similar to those required of
1079health maintenance organizations.
1080     (b)  The office shall develop guidelines for the review of
1081health flex plan applications and provide regulatory oversight
1082of health flex plan advertisement and marketing procedures. The
1083office shall disapprove or shall withdraw approval of plans
1084that:
1085     1.  Contain any ambiguous, inconsistent, or misleading
1086provisions or any exceptions or conditions that deceptively
1087affect or limit the benefits purported to be assumed in the
1088general coverage provided by the health flex plan;
1089     2.  Provide benefits that are unreasonable in relation to
1090the premium charged or contain provisions that are unfair or
1091inequitable or contrary to the public policy of this state, that
1092encourage misrepresentation, or that result in unfair
1093discrimination in sales practices; or
1094     3.  Cannot demonstrate that the health flex plan is
1095financially sound and that the applicant is able to underwrite
1096or finance the health care coverage provided.
1097     (c)  The agency and the Financial Services Commission may
1098adopt rules as needed to administer this section.
1099     (9)  PROGRAM EVALUATION.--The agency and the office shall
1100evaluate the pilot program and its effect on the entities that
1101seek approval as health flex plans, on the number of enrollees,
1102and on the scope of the health care coverage offered under a
1103health flex plan; shall provide an assessment of the health flex
1104plans and their potential applicability in other settings; shall
1105use health flex plans to gather more information to evaluate
1106low-income consumer driven benefit packages; and shall, by
1107January 1, 2005 2004, jointly submit a report to the Governor,
1108the President of the Senate, and the Speaker of the House of
1109Representatives.
1110     Section 16.  Section 381.0271, Florida Statutes, is created
1111to read:
1112     381.0271  Florida Patient Safety Corporation.--
1113     (1)  DEFINITIONS.--As used in this section, the term:
1114     (a)  "Adverse incident" has the same meanings provided in
1115ss. 395.0197, 458.351, and 459.026.
1116     (b)  "Corporation" means the Florida Patient Safety
1117Corporation.
1118     (c)  "Patient safety data" has the same meaning provided in
1119s. 766.1016.
1120     (2)  CREATION.--
1121     (a)  The Florida Patient Safety Corporation is created as a
1122not-for-profit corporation and shall be registered,
1123incorporated, organized, and operated in compliance with chapter
1124617. The corporation may create not-for-profit corporate
1125subsidiaries that are organized under the provisions of chapter
1126617, upon the prior approval of the board of directors, as
1127necessary, to fulfill its mission.
1128     (b)  The corporation and any authorized and approved
1129subsidiary are not an agency as defined in s. 20.03(11).
1130     (c)  The corporation and any authorized and approved
1131subsidiary are subject to the public meetings and records
1132requirements of s. 24, Art. I of the State Constitution, chapter
1133119, and s. 286.011.
1134     (d)  The corporation and any authorized and approved
1135subsidiary are not subject to the provisions of chapter 287.
1136     (e)  The corporation is a patient safety organization as
1137defined in s. 766.1016.
1138     (3)  PURPOSE.--
1139     (a)  The purpose of the corporation is to serve as a
1140learning organization dedicated to assisting health care
1141providers in this state to improve the quality and safety of
1142health care rendered and to reduce harm to patients. The
1143corporation shall promote the development of a culture of
1144patient safety in the health care system in this state. The
1145corporation shall not regulate health care providers in this
1146state.
1147     (b)  In fulfilling its purpose, the corporation shall work
1148with a consortium of patient safety centers and other patient
1149safety programs.
1150     (4)  BOARD OF DIRECTORS; MEMBERSHIP.--The corporation shall
1151be governed by a board of directors. The board of directors
1152shall consist of:
1153     (a)  The chair of the Florida Council of Medical School
1154Deans.
1155     (b)  The person responsible for patient safety issues for
1156the authorized health insurer with the largest market share as
1157measured by premiums written in the state for the most recent
1158calendar year, appointed by such insurer.
1159     (c)  A representative of an authorized medical malpractice
1160insurer appointed by the insurers.
1161     (d)  The president of the Central Florida Health Care
1162Coalition.
1163     (e)  A representative of a hospital in this state that is
1164implementing innovative patient safety initiatives, appointed by
1165the Florida Hospital Association.
1166     (f)  A physician with expertise in patient safety,
1167appointed by the Florida Medical Association.
1168     (g)  A physician with expertise in patient safety,
1169appointed by the Florida Osteopathic Medical Association.
1170     (h)  A physician with expertise in patient safety,
1171appointed by the Florida Podiatric Medical Association.
1172     (i)  A physician with expertise in patient safety,
1173appointed by the Florida Chiropractic Association.
1174     (j)  A dentist with expertise in patient safety, appointed
1175by the Florida Dental Association.
1176     (k)  A nurse with expertise in patient safety, appointed by
1177the Florida Nurses Association.
1178     (l)  An institutional pharmacist, appointed by the Florida
1179Society of Health-System Pharmacists.
1180     (m)  A representative of Florida AARP, appointed by the
1181state director of Florida AARP.
1182     (5)  ADVISORY COMMITTEES.--In addition to any committees
1183that the corporation may establish, the corporation shall
1184establish the following advisory committees:
1185     (a)  A scientific research advisory committee that
1186includes, at a minimum, a representative from each patient
1187safety center or other patient safety program in the
1188universities of the state. The duties of the advisory committee
1189shall include, but not be limited to, the analysis of existing
1190data and research to improve patient safety and encourage
1191evidence-based medicine.
1192     (b)  A technology advisory committee that includes, at a
1193minimum, a representative of a hospital that has implemented a
1194computerized physician order entry system and a health care
1195provider that has implemented an electronic medical records
1196system. The duties of the advisory committee shall include, but
1197not be limited to, implementation of new technologies, including
1198electronic medical records.
1199     (c)  A health care provider advisory committee that
1200includes, at a minimum, representatives of hospitals, ambulatory
1201surgical centers, physicians, nurses, and pharmacists licensed
1202in this state and a representative of the Veterans Integrated
1203Service Network 8, Virginia Patient Safety Center. The duties of
1204the advisory committee shall include, but not be limited to,
1205promotion of a culture of patient safety that reduces errors.
1206     (d)  A health care consumer advisory committee that
1207includes, at a minimum, representatives of businesses that
1208provide health insurance coverage to their employees, consumer
1209advocacy groups, and representatives of patient safety
1210organizations. The duties of the advisory committee shall
1211include, but not be limited to, incentives to encourage patient
1212safety and the efficiency and quality of care.
1213     (e)  A state agency advisory committee that includes, at a
1214minimum, a representative from each state agency that has
1215regulatory responsibilities related to patient safety. The
1216duties of the advisory committee shall include, but not be
1217limited to, interagency coordination of patient safety efforts.
1218     (f)  A tort advisory committee that includes, at a minimum,
1219representatives of medical malpractice attorneys for plaintiffs
1220and defendants and a representative of each law school in the
1221state. The duties of the advisory committee shall include, but
1222not be limited to, alternatives systems to compensate for
1223injuries.
1224     (6)  ORGANIZATION; MEETINGS.--
1225     (a)  The Agency for Health Care Administration shall assist
1226the corporation in its organizational activities required under
1227chapter 617, including, but not limited to:
1228     1.  Eliciting appointments for the initial board of
1229directors.
1230     2.  Convening the first meeting of the board of directors
1231and assisting with other meetings of the board of directors,
1232upon request of the board of directors, during the first year of
1233operation of the corporation.
1234     3.  Drafting articles of incorporation for the board of
1235directors and, upon request of the board of directors,
1236delivering articles of incorporation to the Department of State
1237for filing.
1238     4.  Drafting proposed bylaws for the corporation.
1239     5.  Paying fees related to incorporation.
1240     6.  Providing office space and administrative support, at
1241the request of the board of directors, but not beyond July 1,
12422005.
1243     (b)  The board of directors must conduct its first meeting
1244no later than August 1, 2004, and shall meet thereafter as
1245frequently as necessary to carry out the duties of the
1246corporation.
1247     (7)  POWERS AND DUTIES.--
1248     (a)  In addition to the powers and duties prescribed in
1249chapter 617, and the articles and bylaws adopted under that
1250chapter, the corporation shall, directly or through contract:
1251     1.  Secure staff necessary to properly administer the
1252corporation.
1253     2.  Collect, analyze, and evaluate patient safety data and
1254quality and patient safety indicators, medical malpractice
1255closed claims, and adverse incidents reported to the Agency for
1256Health Care Administration and the Department of Health for the
1257purpose of recommending changes in practices and procedures that
1258may be implemented by health care practitioners and health care
1259facilities to improve health care quality and to prevent future
1260adverse incidents. Notwithstanding any other provision of law,
1261the Agency for Health Care Administration and the Department of
1262Health shall make available to the corporation any adverse
1263incident report submitted under ss. 395.0197, 458.351, and
1264459.026. To the extent that adverse incident reports submitted
1265under s. 395.0197 are confidential and exempt, the confidential
1266and exempt status of such reports shall be maintained by the
1267corporation.
1268     3.  Establish a 3-year pilot project of a "near-miss,"
1269patient safety reporting system. The purpose of the near-miss
1270reporting system is to: identify potential systemic problems
1271that could lead to adverse incidents; enable publication of
1272systemwide alerts of potential harm; and facilitate development
1273of both facility-specific and statewide options to avoid adverse
1274incidents and improve patient safety. The reporting system shall
1275record "near misses" submitted by hospitals, birthing centers,
1276and ambulatory surgical facilities and other providers. For the
1277purpose of the reporting system:
1278     a.  A "near miss" means any potentially harmful event that
1279could have had an adverse result but, through chance or
1280intervention in which, harm was prevented.
1281     b.  The near-miss reporting system shall be voluntary and
1282anonymous and independent of mandatory reporting systems used
1283for regulatory purposes.
1284     c.  Information in data submitted to the authority shall be
1285redacted and shall not be discoverable or admissible in any
1286civil or administrative action.
1287     d.  Reports of near-miss data shall be published on a
1288regular basis and special alerts shall be published as needed
1289regarding newly identified, significant risks.
1290     e.  Aggregated data shall be made available publicly.
1291     f.  The corporation shall report the performance and
1292results of the pilot project in its annual report.
1293     4.  Foster the development of a statewide electronic
1294infrastructure, including implementation of statewide electronic
1295medical records systems, that may be implemented in phases over
1296a multiyear period and that is designed to improve patient care
1297and the delivery and quality of health care services by health
1298care facilities and health care practitioners. Support for
1299implementation of electronic medical records systems shall
1300include:
1301     a.  A report to the Governor, the President of the Senate,
1302the Speaker of the House of Representatives, and the Agency for
1303Health Care Administration by January 1, 2005, on:
1304     (I)  Public and private sector initiatives relating to
1305electronic medical records and the communication systems used to
1306share clinical information among caregivers.
1307     (II)  Regulatory barriers that interfere with the sharing
1308of clinical information among caregivers.
1309     (III)  Investment incentives that might be used to promote
1310the use of recommended technologies by health care providers.
1311     (IV)  Educational strategies that could be implemented to
1312educate health care providers about the recommended technologies
1313for sharing clinical information.
1314     b.  An implementation plan reported to the Governor, the
1315President of the Senate, the Speaker of the House of
1316Representatives, and the Agency for Health Care Administration
1317by September 1, 2005, that must include, but need not be limited
1318to, the capital investment required to begin implementing the
1319system; the costs to operate the system; the financial
1320incentives recommended to increase capital investment; data
1321concerning the providers initially committed to participate in
1322the system, by region; the standards for systemic functionality
1323and features; any marketing plan to increase participation; and
1324implementation schedules for key components.
1325     5.  Provide for access to an active library of evidence-
1326based medicine and patient safety practices, together with the
1327emerging evidence supporting their retention or modification,
1328and make this information available to health care
1329practitioners, health care facilities, and the public. Support
1330for implementation of evidence-based medicine shall include:
1331     a.  A report to the Governor, the President of the Senate,
1332the Speaker of the House of Representatives, and the Agency for
1333Health Care Administration by January 1, 2005, on:
1334     (I)  The ability to join or support efforts for the use of
1335evidence-based medicine already underway, such as those of the
1336Leapfrog Group, the international group Bandolier, and the
1337Healthy Florida Foundation.
1338     (II)  The means by which to promote research using Medicaid
1339and other data collected by the Agency for Health Care
1340Administration to identify and quantify the most cost-effective
1341treatment and interventions, including disease management and
1342prevention programs.
1343     (III)  The means by which to encourage development of
1344systems to measure and reward providers who implement evidence-
1345based medical practices.
1346     (IV)  The review of other state and private initiatives and
1347published literature for promising approaches and the
1348dissemination of information about them to providers.
1349     (V)  The encouragement of the Florida health care boards
1350under the Department of Health to regularly publish findings
1351related to the cost-effectiveness of disease-specific, evidence-
1352based standards.
1353     (VI)  Public and private sector initiatives related to
1354evidence-based medicine and communication systems for the
1355sharing of clinical information among caregivers.
1356     (VII)  Regulatory barriers that interfere with the sharing
1357of clinical information among caregivers.
1358     b.  An implementation plan reported to the Governor, the
1359President of the Senate, the Speaker of the House of
1360Representatives, and the Agency for Health Care Administration
1361by September 1, 2005, that must include, but need not be limited
1362to: estimated costs and savings, capital investment
1363requirements, recommended investment incentives, initial
1364committed provider participation by region, standards of
1365functionality and features, a marketing plan, and implementation
1366schedules for key components.
1367     6.  Develop and recommend core competencies in patient
1368safety that can be incorporated into the curricula in schools of
1369medicine, nursing, and allied health in the state.
1370     7.  Develop and recommend programs to educate the public
1371about the role of health care consumers in promoting patient
1372safety.
1373     8.  Provide recommendations for interagency coordination of
1374patient safety efforts in the state.
1375     (b)  In carrying out its powers and duties, the corporation
1376may also:
1377     1.  Assess the patient safety culture at volunteering
1378hospitals and recommend methods to improve the working
1379environment related to patient safety at these hospitals.
1380     2.  Inventory the information technology capabilities
1381related to patient safety of health care facilities and health
1382care practitioners and recommend a plan for expediting the
1383implementation of patient safety technologies statewide.
1384     3.  Recommend continuing medical education regarding
1385patient safety to practicing health care practitioners.
1386     4.  Study and facilitate the testing of alternative systems
1387of compensating injured patients as a means of reducing and
1388preventing medical errors and promoting patient safety.
1389     (8)  ANNUAL REPORT.--By December 1, 2004, the corporation
1390shall prepare a report on the startup activities of the
1391corporation and any proposals for legislative action that are
1392needed for the corporation to fulfill its purposes under this
1393section. By December 1 of each year thereafter, the corporation
1394shall prepare a report for the preceding fiscal year. The
1395report, at a minimum, must include:
1396     (a)  A description of the activities of the corporation
1397under this section.
1398     (b)  Progress made in improving patient safety and reducing
1399medical errors.
1400     (c)  Policies and programs that have been implemented and
1401their outcomes.
1402     (d)  A compliance and financial audit of the accounts and
1403records of the corporation at the end of the preceding fiscal
1404year conducted by an independent certified public accountant.
1405     (e)  Recommendations for legislative action needed to
1406improve patient safety in the state.
1407
1408The corporation shall submit the report to the Governor, the
1409President of the Senate, and the Speaker of the House of
1410Representatives.
1411     (9)  FUNDING.--The corporation is required to seek private
1412sector funding and apply for grants to accomplish its goals and
1413duties.
1414     (10)  PERFORMANCE EXPECTATIONS.--The Office of Program
1415Policy Analysis and Government Accountability, the Agency for
1416Health Care Administration, and the Department of Health shall
1417develop performance standards by which to measure the success of
1418the corporation in fulfilling the purposes established in this
1419section. Using the performance standards, the Office of Program
1420Policy Analysis and Government Accountability shall conduct a
1421performance audit of the corporation during 2006 and shall
1422submit a report to the Governor, the President of the Senate,
1423and the Speaker of the House of Representatives by January 1,
14242007.
1425     Section 17.  Subsection (3) of section 409.91255, Florida
1426Statutes, is amended to read:
1427     409.91255  Federally qualified health center access
1428program.--
1429     (3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.--The
1430Department of Health shall develop a program for the expansion
1431of federally qualified health centers for the purpose of
1432providing comprehensive primary and preventive health care and
1433urgent care services, including services that may reduce the
1434morbidity, mortality, and cost of care among the uninsured
1435population of the state. The program shall provide for
1436distribution of financial assistance to federally qualified
1437health centers that apply and demonstrate a need for such
1438assistance in order to sustain or expand the delivery of primary
1439and preventive health care services. In selecting centers to
1440receive this financial assistance, the program:
1441     (a)  Shall give preference to communities that have few or
1442no community-based primary care services or in which the current
1443services are unable to meet the community's needs.
1444     (b)  Shall require that primary care services be provided
1445to the medically indigent using a sliding fee schedule based on
1446income.
1447     (c)  Shall allow innovative and creative uses of federal,
1448state, and local health care resources.
1449     (d)  Shall require that the funds provided be used to pay
1450for operating costs of a projected expansion in patient
1451caseloads or services or for capital improvement projects.
1452Capital improvement projects may include renovations to existing
1453facilities or construction of new facilities, provided that an
1454expansion in patient caseloads or services to a new patient
1455population will occur as a result of the capital expenditures.
1456The department shall include in its standard contract document a
1457requirement that any state funds provided for the purchase of or
1458improvements to real property are contingent upon the contractor
1459granting to the state a security interest in the property at
1460least to the amount of the state funds provided for at least 5
1461years from the date of purchase or the completion of the
1462improvements or as further required by law. The contract must
1463include a provision that, as a condition of receipt of state
1464funding for this purpose, the contractor agrees that, if it
1465disposes of the property before the department's interest is
1466vacated, the contractor will refund the proportionate share of
1467the state's initial investment, as adjusted by depreciation.
1468     (e)  May require in-kind support from other sources.
1469     (f)  May encourage coordination among federally qualified
1470health centers, other private-sector providers, and publicly
1471supported programs.
1472     (g)  Shall allow the development of community emergency
1473room diversion programs in conjunction with local resources,
1474providing extended hours of operation to urgent care patients.
1475Diversion programs shall include case management for emergency
1476room followup care.
1477     Section 18.  Paragraph (a) of subsection (6) of section
1478627.410, Florida Statutes, is amended to read:
1479     627.410  Filing, approval of forms.--
1480     (6)(a)  An insurer shall not deliver or issue for delivery
1481or renew in this state any health insurance policy form until it
1482has filed with the office a copy of every applicable rating
1483manual, rating schedule, change in rating manual, and change in
1484rating schedule; if rating manuals and rating schedules are not
1485applicable, the insurer must file with the office order
1486applicable premium rates and any change in applicable premium
1487rates. This paragraph does not apply to group health insurance
1488policies, effectuated and delivered in this state, insuring
1489groups of 51 or more persons, except for Medicare supplement
1490insurance, long-term care insurance, and any coverage under
1491which the increase in claim costs over the lifetime of the
1492contract due to advancing age or duration is prefunded in the
1493premium.
1494     Section 19.  Paragraph (b) of subsection (3) of section
1495627.6487, Florida Statutes, is amended to read:
1496     627.6487  Guaranteed availability of individual health
1497insurance coverage to eligible individuals.--
1498     (3)  For the purposes of this section, the term "eligible
1499individual" means an individual:
1500     (b)  Who is not eligible for coverage under:
1501     1.  A group health plan, as defined in s. 2791 of the
1502Public Health Service Act;
1503     2.  A conversion policy or contract issued by an authorized
1504insurer or health maintenance organization under s. 627.6675 or
1505s. 641.3921, respectively, offered to an individual who is no
1506longer eligible for coverage under either an insured or self-
1507insured employer plan;
1508     3.  Part A or part B of Title XVIII of the Social Security
1509Act; or
1510     4.  A state plan under Title XIX of such act, or any
1511successor program, and does not have other health insurance
1512coverage; or
1513     5.  The Florida Health Insurance Plan as specified in s.
1514627.64872 and such plan is accepting new enrollment;
1515     Section 20.  Section 627.64872, Florida Statutes, is
1516created to read:
1517     627.64872  Uninsurable risk assumption plan.--
1518     (1)  LEGISLATIVE INTENT; FLORIDA HEALTH INSURANCE PLAN.--
1519     (a)  The Legislature recognizes that to secure a more
1520stable and orderly health insurance market, the establishment of
1521a plan to assume risks deemed uninsurable by the private
1522marketplace is required.
1523     (b)  The Florida Health Insurance Plan is created within
1524the Office of Insurance Regulation. The plan shall make coverage
1525available to individuals who have no other option for similar
1526coverage, at a premium that is commensurate with the risk and
1527benefits provided, and with benefit designs that are reasonable
1528in relation to the general market. While plan operations may
1529include supplementary funding, the plan shall fundamentally
1530operate on sound actuarial principles, using basic insurance
1531management techniques to ensure that the plan is run in an
1532economical, cost-efficient, and sound manner, conserving plan
1533resources to serve the maximum number of people possible in a
1534sustainable fashion.
1535     (2)  DEFINITIONS.--As used in this section:
1536     (a)  "Board" means the board of directors of the plan.
1537     (b)  "Chief Financial Officer" means the Chief Financial
1538Officer of this state.
1539     (c)  "Dependent" means a resident spouse or resident
1540unmarried child under the age of 19 years, a child who is a
1541student under the age of 25 years and who is financially
1542dependent upon the parent, or a child of any age who is disabled
1543and dependent upon the parent.
1544     (d)  "Director" means the director of the Office of
1545Insurance Regulation.
1546     (e)  "Governor" means the Governor of this state.
1547     (f)  "Health insurance" means any hospital or medical
1548expense incurred policy, health maintenance organization
1549subscriber contract pursuant to chapter 627 or chapter 641, or
1550any other health care plan or arrangement that pays for or
1551furnishes medical or health care services, whether by insurance
1552or otherwise. The term does not include short term, accident,
1553dental-only, vision-only, fixed indemnity, limited benefit, or
1554credit insurance, coverage issued as a supplement to liability
1555insurance, insurance arising out of a workers' compensation or
1556similar law, automobile medical payment insurance, or insurance
1557under which benefits are payable with or without regard to fault
1558and which is statutorily required to be contained in any
1559liability insurance policy or equivalent selfinsurance.
1560     (g)  "Implementation" means the enrollment of eligible
1561individuals in the plan and provision of the benefits described
1562in this section.
1563     (h)  "Insurer" means any entity that provides health
1564insurance in this state. For purposes of this section, insurer
1565includes an insurance company with a valid certificate in
1566accordance with chapter 624, a health maintenance organization
1567with a valid certificate of authority in accordance with part I
1568or part III of chapter 641, a prepaid health clinic authorized
1569to transact business in this state pursuant to part II of
1570chapter 641, multiple employer welfare arrangements authorized
1571to transact business in this state pursuant to ss. 624.436-
1572624.45, or a fraternal benefit society providing health benefits
1573to its members as authorized pursuant to chapter 632.
1574     (i)  "Medicare" means coverage under both Parts A and B of
1575Title XVIII of the Social Security Act, 42 USC 1395 et seq., as
1576amended.
1577     (j)  "Medicaid" means coverage under Title XIX of the
1578Social Security Act.
1579     (k)  "Office" means the Office of Insurance Regulation of
1580the Financial Services Commission.
1581     (l)  "Participating insurer" means any insurer providing
1582health insurance to citizens of this state.
1583     (m)  "Provider" means any physician, hospital, or other
1584institution, organization, or person that furnishes health care
1585services and is licensed or otherwise authorized to practice in
1586the state.
1587     (n)  "Plan" means the Florida Health Insurance Plan created
1588in subsection (1).
1589     (o)  "Plan of operation" means the articles, bylaws, and
1590operating rules and procedures adopted by the board pursuant to
1591this section.
1592     (p)  "Resident" means an individual who has been legally
1593domiciled in this state for a period of at least 12 months with
1594exception of residents deemed eligible under the federal Health
1595Insurance Portability and Accountability Act of 1996.
1596     (3)  BOARD OF DIRECTORS.--
1597     (a)  The plan shall operate subject to the supervision and
1598control of the board. The board shall consist of the director or
1599his or her designated representative, who shall serve as a
1600member of the board and shall be its chair, and an additional
1601eight members, four of whom shall be appointed by the Governor,
1602at least two of whom shall be individuals not representative of
1603insurers or health care providers, two of whom shall be
1604appointed by the President of the Senate, at least one of whom
1605shall not be a representative of an insurer or health care
1606provider, and two of whom shall be appointed by the Speaker of
1607the House of Representatives, at least one of whom shall not be
1608a representative of an insurer or health care provider.
1609     (b)  The initial board members shall be appointed as
1610follows: one-third of the members to serve a term of 2 years;
1611one-third of the members to serve a term of 4 years; and one-
1612third of the members to serve a term of 6 years. Subsequent
1613board members shall serve for a term of 3 years. A board
1614member's term shall continue until his or her successor is
1615appointed.
1616     (c)  Vacancies in the board shall be filled by the
1617appointing authority, such authority being the Governor, the
1618President of the Senate, or the Speaker of the House of
1619Representatives. Board members may be removed by the appointing
1620authority for cause.
1621     (d)  The board shall conduct its first meeting by December
16221, 2004.
1623     (e)  Members shall not be compensated in their capacity as
1624board members but shall be reimbursed for reasonable expenses
1625incurred in the necessary performance of their duties in
1626accordance with s. 112.061.
1627     (f)  The board shall submit to the Chief Financial Officer
1628a plan of operation for the plan and any amendments thereto
1629necessary or suitable to ensure the fair, reasonable, and
1630equitable administration of the plan. The plan of operation
1631shall ensure that the plan qualifies to apply for any available
1632funding from the Federal Government that adds to the financial
1633viability of the plan. The plan of operation shall become
1634effective upon approval in writing by the Chief Financial
1635Officer consistent with the date on which the coverage under
1636this section must be made available. If the board fails to
1637submit a suitable plan of operation within 180 days after the
1638appointment of the board of directors, or at any time thereafter
1639fails to submit suitable amendments to the plan of operation,
1640the office shall adopt such rules as are necessary or advisable
1641to effectuate the provisions of this section. Such rules shall
1642continue in force until modified by the office or superseded by
1643a plan of operation submitted by the board and approved by the
1644Chief Financial Officer.
1645     (4)  PLAN OF OPERATION.--The plan of operation shall:
1646     (a)  Establish procedures for operation of the plan.
1647     (b)  Establish procedures for selecting an administrator in
1648accordance with subsection (11).
1649     (c)  Establish procedures to create a fund, under
1650management of the board, for administrative expenses.
1651     (d)  Establish procedures for the handling, accounting, and
1652auditing of assets, moneys, and claims of the plan and the plan
1653administrator.
1654     (e)  Develop and implement a program to publicize the
1655existence of the plan, plan eligibility requirements, and
1656procedures for enrollment and maintain public awareness of the
1657plan.
1658     (f)  Establish procedures under which applicants and
1659participants may have grievances reviewed by a grievance
1660committee appointed by the board. The grievances shall be
1661reported to the board after completion of the review, with the
1662committee's recommendation for grievance resolution. The board
1663shall retain all written grievances regarding the plan for at
1664least 3 years.
1665     (g)  Provide for other matters as may be necessary and
1666proper for the execution of the board's powers, duties, and
1667obligations under this section.
1668     (5)  POWERS OF THE PLAN.--The plan shall have the general
1669powers and authority granted under the laws of this state to
1670health insurers and, in addition thereto, the specific authority
1671to:
1672     (a)  Enter into such contracts as are necessary or proper
1673to carry out the provisions and purposes of this section,
1674including the authority, with the approval of the Chief
1675Financial Officer, to enter into contracts with similar plans of
1676other states for the joint performance of common administrative
1677functions, or with persons or other organizations for the
1678performance of administrative functions.
1679     (b)  Take any legal actions necessary or proper to recover
1680or collect assessments due the plan.
1681     (c)  Take such legal action as is necessary to:
1682     1.  Avoid payment of improper claims against the plan or
1683the coverage provided by or through the plan;
1684     2.  Recover any amounts erroneously or improperly paid by
1685the plan;
1686     3.  Recover any amounts paid by the plan as a result of
1687mistake of fact or law; or
1688     4.  Recover other amounts due the plan.
1689     (d)  Establish, and modify as appropriate, rates, rate
1690schedules, rate adjustments, expense allowances, agents'
1691commissions, claims reserve formulas, and any other actuarial
1692functions appropriate to the operation of the plan. Rates and
1693rate schedules may be adjusted for appropriate factors such as
1694age, sex, and geographic variation in claim cost and shall take
1695into consideration appropriate factors in accordance with
1696established actuarial and underwriting practices. For purposes
1697of this paragraph, usual and customary agent's commissions shall
1698be paid for the initial placement of coverage with the plan and
1699for one renewal only.
1700     (e)  Issue policies of insurance in accordance with the
1701requirements of this section.
1702     (f)  Appoint appropriate legal, actuarial, investment, and
1703other committees as necessary to provide technical assistance in
1704the operation of the plan and develop and educate its
1705policyholders regarding health savings accounts, policy and
1706contract design, and any other function within the authority of
1707the plan.
1708     (g)  Borrow money to effectuate the purposes of the plan.
1709Any notes or other evidence of indebtedness of the plan not in
1710default shall be legal investments for insurers and may be
1711carried as admitted assets.
1712     (h)  Employ and fix the compensation of employees.
1713     (i)  Prepare and distribute certificate of eligibility
1714forms and enrollment instruction forms to insurance producers
1715and to the general public.
1716     (j)  Provide for reinsurance of risks incurred by the plan.
1717     (k)  Provide for and employ cost-containment measures and
1718requirements, including, but not limited to, preadmission
1719screening, second surgical opinion, concurrent utilization
1720review, and individual case management for the purpose of making
1721the plan more cost-effective.
1722     (l)  Design, use, contract, or otherwise arrange for the
1723delivery of cost-effective health care services, including, but
1724not limited to, establishing or contracting with preferred
1725provider organizations, health maintenance organizations, and
1726other limited network provider arrangements.
1727     (m)  Adopt such bylaws, policies, and procedures as may be
1728necessary or convenient for the implementation of this section
1729and the operation of the plan.
1730     (6)  ANNUAL REPORT.--No later than December 1, 2005, and
1731annually thereafter, the board shall submit to the Governor, the
1732President of the Senate, the Speaker of the House of
1733Representatives, and the substantive legislative committees of
1734the Legislature a report which includes an independent actuarial
1735study to determine, including, but not be limited to:
1736     (a)  The impact the creation of the plan has on the small
1737group and individual insurance market, specifically on the
1738premiums paid by insureds. This shall include an estimate of the
1739total anticipated aggregate savings for all small employers in
1740the state.
1741     (b)  The actual number of individuals covered at the
1742current funding and benefit level, the projected number of
1743individuals that may seek coverage in the forthcoming fiscal
1744year, and the projected funding needed to cover anticipated
1745increase or decrease in plan participation.
1746     (c)  A recommendation as to the best source of funding for
1747the anticipated deficits of the pool.
1748     (d)  A summarization of the activities of the plan in the
1749preceding calendar year, including the net written and earned
1750premiums, plan enrollment, the expense of administration, and
1751the paid and incurred losses.
1752     (e)  A review of the operation of the plan as to whether
1753the plan has met the intent of this section.
1754     (7)  LIABILITY OF THE PLAN.--Neither the board nor its
1755employees shall be liable for any obligations of the plan. No
1756member or employee of the board shall be liable, and no cause of
1757action of any nature may arise against a member or employee of
1758the board, for any act or omission related to the performance of
1759any powers and duties under this section, unless such act or
1760omission constitutes willful or wanton misconduct. The board may
1761provide in its bylaws or rules for indemnification of, and legal
1762representation for, its members and employees.
1763     (8)  AUDITED FINANCIAL STATEMENT.--No later than June 1
1764following the close of each calendar year, the plan shall submit
1765to the Governor an audited financial statement prepared in
1766accordance with statutory accounting principles as adopted by
1767the National Association of Insurance Commissioners.
1768     (9)  ELIGIBILITY.--
1769     (a)  Any individual person who is and continues to be a
1770resident of this state shall be eligible for coverage under the
1771plan if:
1772     1.  Evidence is provided that the person received:
1773     a.  A notice of rejection or refusal to issue substantially
1774similar insurance for health reasons by one insurer; or
1775     b.  A refusal by an insurer to issue insurance.
1776
1777A rejection or refusal by an insurer offering only stoploss,
1778excess of loss, or reinsurance coverage with respect to the
1779applicant shall not be sufficient evidence under this paragraph.
1780     2.  The person is eligible for individual coverage in
1781accordance with s. 627.6487. The Office of Insurance Regulation
1782shall submit to the Federal Government a request for the
1783required waiver under the Health Insurance Portability and
1784Accountability Act of 1996.
1785     3.  The person is enrolled in the Florida Comprehensive
1786Health Association as of the date the plan is implemented.
1787     (b)  The board may provide a list of medical or health
1788conditions for which a person shall be eligible for coverage
1789under the plan without applying for health insurance pursuant to
1790paragraph (a). A person who can demonstrate the existence or
1791history of any medical or health conditions on the list provided
1792by the board shall not be required to provide the evidence
1793specified in paragraph (a). The list shall be effective on the
1794first day of the operation of the plan and may be amended as
1795appropriate.
1796     (c)  Each resident dependent of a person who is eligible
1797for coverage under the plan shall also be eligible for such
1798coverage.
1799     (d)  A person shall not be eligible for coverage under the
1800plan if:
1801     1.  The person has or obtains health insurance coverage
1802substantially similar to or more comprehensive than a plan
1803policy, or would be eligible to obtain such coverage, unless a
1804person may maintain other coverage for the period of time the
1805person is satisfying any preexisting condition waiting period
1806under a plan policy or may maintain plan coverage for the period
1807of time the person is satisfying a preexisting condition waiting
1808period under another health insurance policy intended to replace
1809the plan policy.
1810     2.  The person is determined to be eligible for health care
1811benefits under Medicaid, the state's children's health insurance
1812program, or any other federal, state, or local government
1813program that provides health benefits;
1814     3.  The person voluntarily terminated plan coverage unless
181512 months have elapsed since such termination;
1816     4.  The person is an inmate or resident of a public
1817institution; or
1818     5.  The person's premiums are paid for or reimbursed under
1819any government-sponsored program or by any government agency or
1820health care provider, except as an otherwise qualifying fulltime
1821employee, or dependent thereof, of a government agency or health
1822care provider.
1823     (e)  Coverage shall cease:
1824     1.  On the date a person is no longer a resident of this
1825state;
1826     2.  On the date a person requests coverage to end;
1827     3.  Upon the death of the covered person;
1828     4.  On the date state law requires cancellation of the
1829policy; or
1830     5.  At the option of the plan, 30 days after the plan makes
1831any inquiry concerning the person's eligibility or place of
1832residence to which the person does not reply.
1833     (f)  Except under the circumstances described in this
1834subsection, coverage of a person who ceases to meet the
1835eligibility requirements of this subsection may be terminated at
1836the end of the policy period for which the necessary premiums
1837have been paid.
1838     (10)  UNFAIR REFERRAL TO PLAN.--It is an unfair trade
1839practice for the purposes of part IX of chapter 626 or s.
1840641.3901 for an insurer, health maintenance organization
1841insurance agent, insurance broker, or third-party administrator
1842to refer an individual employee to the plan, or arrange for an
1843individual employee to apply to the plan, for the purpose of
1844separating that employee from group health insurance coverage
1845provided in connection with the employee's employment.
1846     (11)  PLAN ADMINISTRATOR.--The board shall select through a
1847competitive bidding process a plan administrator to administer
1848the plan. The board shall evaluate bids submitted based on
1849criteria established by the board, which shall include:
1850     (a)  The plan administrator's proven ability to handle
1851health insurance coverage to individuals.
1852     (b)  The efficiency and timeliness of the plan
1853administrator's claim processing procedures.
1854     (c)  An estimate of total charges for administering the
1855plan.
1856     (d)  The plan administrator's ability to apply effective
1857cost-containment programs and procedures and to administer the
1858plan in a cost-efficient manner.
1859     (e)  The financial condition and stability of the plan
1860administrator.
1861
1862The administrator shall be an insurer, a health maintenance
1863organization, or a third-party administrator, or another
1864organization duly authorized to provide insurance pursuant to
1865the Florida Insurance Code.
1866     (12)  ADMINISTRATOR TERM LIMITS.--The plan administrator
1867shall serve for a period specified in the contract between the
1868plan and the plan administrator subject to removal for cause and
1869subject to any terms, conditions, and limitations of the
1870contract between the plan and the plan administrator. At least 1
1871year prior to the expiration of each period of service by a plan
1872administrator, the board shall invite eligible entities,
1873including the current plan administrator, to submit bids to
1874serve as the plan administrator. Selection of the plan
1875administrator for each succeeding period shall be made at least
18766 months prior to the end of the current period.
1877     (13)  DUTIES OF THE PLAN ADMINISTRATOR.--
1878     (a)  The plan administrator shall perform such functions
1879relating to the plan as may be assigned to it, including, but
1880not limited to:
1881     1.  Determination of eligibility.
1882     2.  Payment of claims.
1883     3.  Establishment of a premium billing procedure for
1884collection of premiums from persons covered under the plan.
1885     4.  Other necessary functions to ensure timely payment of
1886benefits to covered persons under the plan.
1887     (b)  The plan administrator shall submit regular reports to
1888the board regarding the operation of the plan. The frequency,
1889content, and form of the reports shall be specified in the
1890contract between the board and the plan administrator.
1891     (c)  On March 1 following the close of each calendar year,
1892the plan administrator shall determine net written and earned
1893premiums, the expense of administration, and the paid and
1894incurred losses for the year and report this information to the
1895board and the Governor on a form prescribed by the Governor.
1896     (14)  PAYMENT OF THE PLAN ADMINISTRATOR.--The plan
1897administrator shall be paid as provided in the contract between
1898the plan and the plan administrator.
1899     (15)  FUNDING OF THE PLAN.--
1900     (a)  Premiums.--
1901     1.  The plan shall establish premium rates for plan
1902coverage as provided in this section. Separate schedules of
1903premium rates based on age, sex, and geographical location may
1904apply for individual risks. Premium rates and schedules shall be
1905submitted to the office for approval prior to use.
1906     2.  Initial rates for plan coverage shall be limited to 200
1907percent of rates established as applicable for individual
1908standard risks as specified in s. 627.6675(3)(c). Subject to the
1909limits provided in this paragraph, subsequent rates shall be
1910established to provide fully for the expected costs of claims,
1911including recovery of prior losses, expenses of operation,
1912investment income of claim reserves, and any other cost factors
1913subject to the limitations described herein, but in no event
1914shall premiums exceed the 200-percent rate limitation provided
1915in this section. Notwithstanding the 200-percent rate
1916limitation, sliding scale premium surcharges based upon the
1917insured's income may apply to all enrollees except those
1918obtaining coverage in accordance with s. 627.6487.
1919     (b)  Assessment for Health Insurance Portability and
1920Accountability Act of 1996 individuals.--As a condition of doing
1921business in this state an insurer or an administrative service
1922only organization providing services for a health insurer
1923operating in this state shall pay an assessment to the board in
1924the amount prescribed by this section. For operating losses
1925incurred on July 1, 2004, and thereafter, by persons qualified
1926for guaranteed availability pursuant to s. 627.6487, each
1927insurer or an administrative service only organization providing
1928services for a health insurer operating in this state shall
1929annually be assessed by the board in the following calendar year
1930a portion of such incurred operating losses of the plan. Such
1931portion shall be determined by multiplying such operating losses
1932by a fraction, the numerator of which equals the insurer's
1933earned premium pertaining to direct writings of health insurance
1934in the state during the calendar year preceding that for which
1935the assessment is levied and the denominator of which equals the
1936total of all such premiums earned by participating insurers in
1937the state during such calendar year.
1938     1.  The total of all assessments in this section upon a
1939participating insurer or an administrative service only
1940organization providing services for a health insurer operating
1941in this state shall not exceed 1 percent of such insurer's
1942health insurance premium earned in this state during the
1943calendar year preceding the year for which the assessments were
1944levied.
1945     2.  All rights, title, and interest in the assessment funds
1946collected shall vest in this state. However, all of such funds
1947and interest earned shall be used by the plan to pay claims and
1948administrative expenses.
1949     3.  If assessments and other receipts by the plan, board,
1950or administrator exceed the actual losses and administrative
1951expenses of the plan, the excess shall be held in interest and
1952used by the board to offset future losses. As used in this
1953subsection, the term "future losses" includes reserves for
1954claims incurred but not reported.
1955     4.  Each assessment shall be determined annually by the
1956board or administrator based on annual statements and other
1957reports deemed necessary by the board or administrator and filed
1958with it by the insurer. Any deficit incurred under the plan by
1959persons qualified for guaranteed availability pursuant to s.
1960627.6487 shall be recouped by the assessments against
1961participating insurers by the board or administrator in the
1962manner provided in subsection (2) and the insurer may recover
1963the assessment in the normal course of the respective business
1964without time limitation.
1965     (c)  Sources of additional revenue.--Any deficit incurred
1966by the plan shall be primarily funded through amounts
1967appropriated by the Legislature from general revenue sources,
1968including, but not limited to, a portion of the annual growth in
1969existing net insurance premium taxes. The board shall operate
1970the plan in such a manner that the estimated cost of providing
1971health insurance during any fiscal year will not exceed total
1972income the plan expects to receive from policy premiums and
1973funds appropriated by the Legislature, including any interest on
1974investments. After determining the amount of funds appropriated
1975to the board for a fiscal year, the board shall estimate the
1976number of new policies it believes the plan has the financial
1977capacity to insure during that year so that costs do not exceed
1978income. The board shall take steps necessary to ensure that plan
1979enrollment does not exceed the number of residents it has
1980estimated it has the financial capacity to insure.
1981     (16)  BENEFITS.--
1982     (a)  The benefits provided shall be the same as the
1983standard and basic plans for small employers as outlined in s.
1984627.6699. The board shall also establish an option of
1985alternative coverage such as catastrophic coverage that includes
1986a minimum level of primary care coverage and a high deductible
1987plan that meets the federal requirements of a health savings
1988account.
1989     (b)  In establishing the plan coverage, the board shall
1990take into consideration the levels of health insurance provided
1991in the state and such medical economic factors as may be deemed
1992appropriate and adopt benefit levels, deductibles, copayments,
1993coinsurance factors, exclusions, and limitations determined to
1994be generally reflective of and commensurate with health
1995insurance provided through a representative number of large
1996employers in the state.
1997     (c)  The board may adjust any deductibles and coinsurance
1998factors annually according to the medical component of the
1999Consumer Price Index.
2000     (d)1.  Plan coverage shall exclude charges or expenses
2001incurred during the first 6 months following the effective date
2002of coverage for any condition for which medical advice, care, or
2003treatment was recommended or received for such condition during
2004the 6-month period immediately preceding the effective date of
2005coverage.
2006     2.  Such preexisting condition exclusions shall be waived
2007to the extent that similar exclusions, if any, have been
2008satisfied under any prior health insurance coverage which was
2009involuntarily terminated, provided application for pool coverage
2010is made not later than 63 days following such involuntary
2011termination. In such case, coverage under the plan shall be
2012effective from the date on which such prior coverage was
2013terminated and the applicant is not eligible for continuation or
2014conversion rights that would provide coverage substantially
2015similar to plan coverage.
2016     (17)  NONDUPLICATION OF BENEFITS.--
2017     (a)  The plan shall be payor of last resort of benefits
2018whenever any other benefit or source of third-party payment is
2019available. Benefits otherwise payable under plan coverage shall
2020be reduced by all amounts paid or payable through any other
2021health insurance, by all hospital and medical expense benefits
2022paid or payable under any workers' compensation coverage,
2023automobile medical payment, or liability insurance, whether
2024provided on the basis of fault or nonfault, and by any hospital
2025or medical benefits paid or payable under or provided pursuant
2026to any state or federal law or program.
2027     (b)  The plan shall have a cause of action against an
2028eligible person for the recovery of the amount of benefits paid
2029that are not for covered expenses. Benefits due from the plan
2030may be reduced or refused as a setoff against any amount
2031recoverable under this paragraph.
2032     (18)  ANNUAL AND MAXIMUM BENEFITS.--Maximum benefits under
2033the plan shall be determined by the board.
2034     (19)  TAXATION.--The plan is exempt from any tax imposed by
2035this state. The plan shall apply for federal tax exemption
2036status.
2037     (20)  COMBINING MEMBERSHIP OF THE FLORIDA COMPREHENSIVE
2038HEALTH ASSOCIATION.--
2039     (a)1. Upon implementation of the plan, the Florida
2040Comprehensive Health Association is abolished and all high-risk
2041individuals actively enrolled in the Florida Comprehensive
2042Health Association shall be enrolled in the plan subject to its
2043rules and requirements.
2044     2.  Persons formerly enrolled in the Florida Comprehensive
2045Health Association are only eligible for the benefits authorized
2046under subsection (18).
2047     (b)1.  As a condition of doing business in this state, an
2048insurer shall pay an assessment to the board in the amount
2049prescribed by this paragraph. For operating losses incurred on
2050or after July 1, 2004, by persons previously enrolled in the
2051Florida Comprehensive Health Association, each insurer shall
2052annually be assessed by the board in the following calendar year
2053a portion of such incurred operating losses of the plan. Such
2054portion shall be determined by multiplying such operating losses
2055by a fraction, the numerator of which equals the insurer's
2056earned premium pertaining to direct writings of health insurance
2057in the state during the calendar year proceeding that for which
2058the assessment is levied, and the denominator of which equals
2059the total of all such premiums earned by participating insurers
2060in the state during such calendar year.
2061     2.  The total of all assessments under this paragraph upon
2062a participating insurer shall not exceed 1 percent of such
2063insurer's health insurance premium earned in this state during
2064the calendar year preceding the year for which the assessments
2065were levied.
2066     3.  All rights, title, and interest in the assessment funds
2067collected under this paragraph shall vest in this state.
2068However, all of such funds and interest earned shall be used by
2069the plan to pay claims and administrative expenses.
2070     (c)  If assessments and other receipts by the plan, board,
2071or plan administrator exceed the actual losses and
2072administrative expenses of the plan, the excess shall be held in
2073interest and used by the board to offset future losses. As used
2074in this subsection, the term "future losses" includes reserves
2075for claims incurred but not reported.
2076     (d)  Each insurer's assessment shall be determined annually
2077by the board or plan administrator based on annual statements
2078and other reports deemed necessary by the board or plan
2079administrator and filed with the board or plan administrator by
2080the insurer. Any deficit incurred under the plan by persons
2081previously enrolled in the Florida Comprehensive Health
2082Association shall be recouped by the assessments against
2083participating insurers by the board or plan administrator in the
2084manner provided in paragraph (b), and the insurers may recover
2085the assessment in the normal course of their respective
2086businesses without time limitation.
2087     (e)  If a person enrolled in the Florida Comprehensive
2088Health Association as of July 1, 2004, loses eligibility for
2089participation in the plan, such person shall not be included in
2090the calculation of incurred operational losses as described in
2091paragraph (b) if the person later regains eligibility for
2092participation in the plan.
2093     (f)  After all persons enrolled in the Florida
2094Comprehensive Health Association as of July 1, 2004, are no
2095longer eligible for participation in the plan, the plan, board,
2096or plan administrator shall no longer be allowed to assess
2097insurers in this state for incurred losses as described in
2098paragraph (b).
2099     Section 21.  Upon implementation, as defined in s.
2100627.64872(2), Florida Statutes, and provided in s.
2101627.64872(20), Florida Statutes, of the Florida Health Benefit
2102Plan created under s. 627.64872, Florida Statutes, sections
2103627.6488, 627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
2104627.6498, Florida Statutes, are repealed.
2105     Section 22.  Subsection (12) is added to section 627.662,
2106Florida Statutes, to read:
2107     627.662  Other provisions applicable.--The following
2108provisions apply to group health insurance, blanket health
2109insurance, and franchise health insurance:
2110     (12)  Section 627.6044, relating to the use of specific
2111methodology for payment of claims.
2112     Section 23.  Paragraphs (c) and (d) of subsection (5),
2113paragraph (b) of subsection (6), and subsection (12) of section
2114627.6699, Florida Statutes, are amended, subsections (15) and
2115(16) of said section are renumbered as subsections (16) and
2116(17), respectively, present subsection (15) of said section is
2117amended, and new subsections (15) and (18) are added to said
2118section, to read:
2119     627.6699  Employee Health Care Access Act.--
2120     (5)  AVAILABILITY OF COVERAGE.--
2121     (c)  Every small employer carrier must, as a condition of
2122transacting business in this state:
2123     1.  Offer and issue all small employer health benefit plans
2124on a guaranteed-issue basis to every eligible small employer,
2125with 2 to 50 eligible employees, that elects to be covered under
2126such plan, agrees to make the required premium payments, and
2127satisfies the other provisions of the plan. A rider for
2128additional or increased benefits may be medically underwritten
2129and may only be added to the standard health benefit plan. The
2130increased rate charged for the additional or increased benefit
2131must be rated in accordance with this section.
2132     2.  In the absence of enrollment availability in the
2133Florida Health Insurance Plan, offer and issue basic and
2134standard small employer health benefit plans on a guaranteed-
2135issue basis, during a 31-day open enrollment period of August 1
2136through August 31 of each year, to every eligible small
2137employer, with fewer than two eligible employees, which small
2138employer is not formed primarily for the purpose of buying
2139health insurance and which elects to be covered under such plan,
2140agrees to make the required premium payments, and satisfies the
2141other provisions of the plan. Coverage provided under this
2142subparagraph shall begin on October 1 of the same year as the
2143date of enrollment, unless the small employer carrier and the
2144small employer agree to a different date. A rider for additional
2145or increased benefits may be medically underwritten and may only
2146be added to the standard health benefit plan. The increased rate
2147charged for the additional or increased benefit must be rated in
2148accordance with this section. For purposes of this subparagraph,
2149a person, his or her spouse, and his or her dependent children
2150constitute a single eligible employee if that person and spouse
2151are employed by the same small employer and either that person
2152or his or her spouse has a normal work week of less than 25
2153hours. Any right to an open enrollment of health benefit
2154coverage for groups of fewer than two employees, pursuant to
2155this section, shall remain in full force and effect in the
2156absence of the availability of new enrollment into the Florida
2157Health Insurance Plan.
2158     3.  This paragraph does not limit a carrier's ability to
2159offer other health benefit plans to small employers if the
2160standard and basic health benefit plans are offered and
2161rejected.
2162     (d)  A small employer carrier must file with the office, in
2163a format and manner prescribed by the committee, a standard
2164health care plan, a high deductible plan that meets the federal
2165requirements of a health savings account plan, and a basic
2166health care plan to be used by the carrier.
2167     (6)  RESTRICTIONS RELATING TO PREMIUM RATES.--
2168     (b)  For all small employer health benefit plans that are
2169subject to this section and are issued by small employer
2170carriers on or after January 1, 1994, premium rates for health
2171benefit plans subject to this section are subject to the
2172following:
2173     1.  Small employer carriers must use a modified community
2174rating methodology in which the premium for each small employer
2175must be determined solely on the basis of the eligible
2176employee's and eligible dependent's gender, age, family
2177composition, tobacco use, or geographic area as determined under
2178paragraph (5)(j) and in which the premium may be adjusted as
2179permitted by this paragraph.
2180     2.  Rating factors related to age, gender, family
2181composition, tobacco use, or geographic location may be
2182developed by each carrier to reflect the carrier's experience.
2183The factors used by carriers are subject to office review and
2184approval.
2185     3.  Small employer carriers may not modify the rate for a
2186small employer for 12 months from the initial issue date or
2187renewal date, unless the composition of the group changes or
2188benefits are changed. However, a small employer carrier may
2189modify the rate one time prior to 12 months after the initial
2190issue date for a small employer who enrolls under a previously
2191issued group policy that has a common anniversary date for all
2192employers covered under the policy if:
2193     a.  The carrier discloses to the employer in a clear and
2194conspicuous manner the date of the first renewal and the fact
2195that the premium may increase on or after that date.
2196     b.  The insurer demonstrates to the office that
2197efficiencies in administration are achieved and reflected in the
2198rates charged to small employers covered under the policy.
2199     4.  A carrier may issue a group health insurance policy to
2200a small employer health alliance or other group association with
2201rates that reflect a premium credit for expense savings
2202attributable to administrative activities being performed by the
2203alliance or group association if such expense savings are
2204specifically documented in the insurer's rate filing and are
2205approved by the office. Any such credit may not be based on
2206different morbidity assumptions or on any other factor related
2207to the health status or claims experience of any person covered
2208under the policy. Nothing in this subparagraph exempts an
2209alliance or group association from licensure for any activities
2210that require licensure under the insurance code. A carrier
2211issuing a group health insurance policy to a small employer
2212health alliance or other group association shall allow any
2213properly licensed and appointed agent of that carrier to market
2214and sell the small employer health alliance or other group
2215association policy. Such agent shall be paid the usual and
2216customary commission paid to any agent selling the policy.
2217     5.  Any adjustments in rates for claims experience, health
2218status, or duration of coverage may not be charged to individual
2219employees or dependents. For a small employer's policy, such
2220adjustments may not result in a rate for the small employer
2221which deviates more than 15 percent from the carrier's approved
2222rate. Any such adjustment must be applied uniformly to the rates
2223charged for all employees and dependents of the small employer.
2224A small employer carrier may make an adjustment to a small
2225employer's renewal premium, not to exceed 10 percent annually,
2226due to the claims experience, health status, or duration of
2227coverage of the employees or dependents of the small employer.
2228Semiannually, small group carriers shall report information on
2229forms adopted by rule by the commission, to enable the office to
2230monitor the relationship of aggregate adjusted premiums actually
2231charged policyholders by each carrier to the premiums that would
2232have been charged by application of the carrier's approved
2233modified community rates. If the aggregate resulting from the
2234application of such adjustment exceeds the premium that would
2235have been charged by application of the approved modified
2236community rate by 5 percent for the current reporting period,
2237the carrier shall limit the application of such adjustments only
2238to minus adjustments beginning not more than 60 days after the
2239report is sent to the office. For any subsequent reporting
2240period, if the total aggregate adjusted premium actually charged
2241does not exceed the premium that would have been charged by
2242application of the approved modified community rate by 4 5
2243percent, the carrier may apply both plus and minus adjustments.
2244A small employer carrier may provide a credit to a small
2245employer's premium based on administrative and acquisition
2246expense differences resulting from the size of the group. Group
2247size administrative and acquisition expense factors may be
2248developed by each carrier to reflect the carrier's experience
2249and are subject to office review and approval.
2250     6.  A small employer carrier rating methodology may include
2251separate rating categories for one dependent child, for two
2252dependent children, and for three or more dependent children for
2253family coverage of employees having a spouse and dependent
2254children or employees having dependent children only. A small
2255employer carrier may have fewer, but not greater, numbers of
2256categories for dependent children than those specified in this
2257subparagraph.
2258     7.  Small employer carriers may not use a composite rating
2259methodology to rate a small employer with fewer than 10
2260employees. For the purposes of this subparagraph, a "composite
2261rating methodology" means a rating methodology that averages the
2262impact of the rating factors for age and gender in the premiums
2263charged to all of the employees of a small employer.
2264     8.a.  A carrier may separate the experience of small
2265employer groups with less than 2 eligible employees from the
2266experience of small employer groups with 2-50 eligible employees
2267for purposes of determining an alternative modified community
2268rating.
2269     b.  If a carrier separates the experience of small employer
2270groups as provided in sub-subparagraph a., the rate to be
2271charged to small employer groups of less than 2 eligible
2272employees may not exceed 150 percent of the rate determined for
2273small employer groups of 2-50 eligible employees. However, the
2274carrier may charge excess losses of the experience pool
2275consisting of small employer groups with less than 2 eligible
2276employees to the experience pool consisting of small employer
2277groups with 2-50 eligible employees so that all losses are
2278allocated and the 150-percent rate limit on the experience pool
2279consisting of small employer groups with less than 2 eligible
2280employees is maintained. Notwithstanding s. 627.411(1), the rate
2281to be charged to a small employer group of fewer than 2 eligible
2282employees, insured as of July 1, 2002, may be up to 125 percent
2283of the rate determined for small employer groups of 2-50
2284eligible employees for the first annual renewal and 150 percent
2285for subsequent annual renewals.
2286     (12)  STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH
2287BENEFIT PLANS.--
2288     (a)1.  The Chief Financial Officer shall appoint a health
2289benefit plan committee composed of four representatives of
2290carriers which shall include at least two representatives of
2291HMOs, at least one of which is a staff model HMO, two
2292representatives of agents, four representatives of small
2293employers, and one employee of a small employer. The carrier
2294members shall be selected from a list of individuals recommended
2295by the board. The Chief Financial Officer may require the board
2296to submit additional recommendations of individuals for
2297appointment.
2298     2.  The plans shall comply with all of the requirements of
2299this subsection.
2300     3.  The plans must be filed with and approved by the office
2301prior to issuance or delivery by any small employer carrier.
2302     4.  After approval of the revised health benefit plans, if
2303the office determines that modifications to a plan might be
2304appropriate, the Chief Financial Officer shall appoint a new
2305health benefit plan committee in the manner provided in
2306subparagraph 1. to submit recommended modifications to the
2307office for approval.
2308     (b)1.  Each small employer carrier issuing new health
2309benefit plans shall offer to any small employer, upon request, a
2310standard health benefit plan, and a basic health benefit plan,
2311and a high deductible plan that meets the requirements of a
2312health savings account plan as defined by federal law, that meet
2313meets the criteria set forth in this section.
2314     2.  For purposes of this subsection, the terms "standard
2315health benefit plan," and "basic health benefit plan," and "high
2316deductible plan" mean policies or contracts that a small
2317employer carrier offers to eligible small employers that
2318contain:
2319     a.  An exclusion for services that are not medically
2320necessary or that are not covered preventive health services;
2321and
2322     b.  A procedure for preauthorization by the small employer
2323carrier, or its designees.
2324     3.  A small employer carrier may include the following
2325managed care provisions in the policy or contract to control
2326costs:
2327     a.  A preferred provider arrangement or exclusive provider
2328organization or any combination thereof, in which a small
2329employer carrier enters into a written agreement with the
2330provider to provide services at specified levels of
2331reimbursement or to provide reimbursement to specified
2332providers. Any such written agreement between a provider and a
2333small employer carrier must contain a provision under which the
2334parties agree that the insured individual or covered member has
2335no obligation to make payment for any medical service rendered
2336by the provider which is determined not to be medically
2337necessary. A carrier may use preferred provider arrangements or
2338exclusive provider arrangements to the same extent as allowed in
2339group products that are not issued to small employers.
2340     b.  A procedure for utilization review by the small
2341employer carrier or its designees.
2342
2343This subparagraph does not prohibit a small employer carrier
2344from including in its policy or contract additional managed care
2345and cost containment provisions, subject to the approval of the
2346office, which have potential for controlling costs in a manner
2347that does not result in inequitable treatment of insureds or
2348subscribers. The carrier may use such provisions to the same
2349extent as authorized for group products that are not issued to
2350small employers.
2351     4.  The standard health benefit plan shall include:
2352     a.  Coverage for inpatient hospitalization;
2353     b.  Coverage for outpatient services;
2354     c.  Coverage for newborn children pursuant to s. 627.6575;
2355     d.  Coverage for child care supervision services pursuant
2356to s. 627.6579;
2357     e.  Coverage for adopted children upon placement in the
2358residence pursuant to s. 627.6578;
2359     f.  Coverage for mammograms pursuant to s. 627.6613;
2360     g.  Coverage for handicapped children pursuant to s.
2361627.6615;
2362     h.  Emergency or urgent care out of the geographic service
2363area; and
2364     i.  Coverage for services provided by a hospice licensed
2365under s. 400.602 in cases where such coverage would be the most
2366appropriate and the most cost-effective method for treating a
2367covered illness.
2368     5.  The standard health benefit plan and the basic health
2369benefit plan may include a schedule of benefit limitations for
2370specified services and procedures. If the committee develops
2371such a schedule of benefits limitation for the standard health
2372benefit plan or the basic health benefit plan, a small employer
2373carrier offering the plan must offer the employer an option for
2374increasing the benefit schedule amounts by 4 percent annually.
2375     6.  The basic health benefit plan shall include all of the
2376benefits specified in subparagraph 4.; however, the basic health
2377benefit plan shall place additional restrictions on the benefits
2378and utilization and may also impose additional cost containment
2379measures.
2380     7.  Sections 627.419(2), (3), and (4), 627.6574, 627.6612,
2381627.66121, 627.66122, 627.6616, 627.6618, 627.668, and 627.66911
2382apply to the standard health benefit plan and to the basic
2383health benefit plan. However, notwithstanding said provisions,
2384the plans may specify limits on the number of authorized
2385treatments, if such limits are reasonable and do not
2386discriminate against any type of provider.
2387     8.  The plan associated with a health savings account shall
2388include all the benefits specified in subparagraph 4.
2389     9.8.  Each small employer carrier that provides for
2390inpatient and outpatient services by allopathic hospitals may
2391provide as an option of the insured similar inpatient and
2392outpatient services by hospitals accredited by the American
2393Osteopathic Association when such services are available and the
2394osteopathic hospital agrees to provide the service.
2395     (c)  If a small employer rejects, in writing, the standard
2396health benefit plan, and the basic health benefit plan, and the
2397high deductible health savings account plan, the small employer
2398carrier may offer the small employer a limited benefit policy or
2399contract.
2400     (d)1.  Upon offering coverage under a standard health
2401benefit plan, a basic health benefit plan, or a limited benefit
2402policy or contract for any small employer, the small employer
2403carrier shall provide such employer group with a written
2404statement that contains, at a minimum:
2405     a.  An explanation of those mandated benefits and providers
2406that are not covered by the policy or contract;
2407     b.  An explanation of the managed care and cost control
2408features of the policy or contract, along with all appropriate
2409mailing addresses and telephone numbers to be used by insureds
2410in seeking information or authorization; and
2411     c.  An explanation of the primary and preventive care
2412features of the policy or contract.
2413
2414Such disclosure statement must be presented in a clear and
2415understandable form and format and must be separate from the
2416policy or certificate or evidence of coverage provided to the
2417employer group.
2418     2.  Before a small employer carrier issues a standard
2419health benefit plan, a basic health benefit plan, or a limited
2420benefit policy or contract, it must obtain from the prospective
2421policyholder a signed written statement in which the prospective
2422policyholder:
2423     a.  Certifies as to eligibility for coverage under the
2424standard health benefit plan, basic health benefit plan, or
2425limited benefit policy or contract;
2426     b.  Acknowledges the limited nature of the coverage and an
2427understanding of the managed care and cost control features of
2428the policy or contract;
2429     c.  Acknowledges that if misrepresentations are made
2430regarding eligibility for coverage under a standard health
2431benefit plan, a basic health benefit plan, or a limited benefit
2432policy or contract, the person making such misrepresentations
2433forfeits coverage provided by the policy or contract; and
2434     d.  If a limited plan is requested, acknowledges that the
2435prospective policyholder had been offered, at the time of
2436application for the insurance policy or contract, the
2437opportunity to purchase any health benefit plan offered by the
2438carrier and that the prospective policyholder had rejected that
2439coverage.
2440
2441A copy of such written statement shall be provided to the
2442prospective policyholder no later than at the time of delivery
2443of the policy or contract, and the original of such written
2444statement shall be retained in the files of the small employer
2445carrier for the period of time that the policy or contract
2446remains in effect or for 5 years, whichever period is longer.
2447     3.  Any material statement made by an applicant for
2448coverage under a health benefit plan which falsely certifies as
2449to the applicant's eligibility for coverage serves as the basis
2450for terminating coverage under the policy or contract.
2451     4.  Each marketing communication that is intended to be
2452used in the marketing of a health benefit plan in this state
2453must be submitted for review by the office prior to use and must
2454contain the disclosures stated in this subsection.
2455     (e)  A small employer carrier may not use any policy,
2456contract, form, or rate under this section, including
2457applications, enrollment forms, policies, contracts,
2458certificates, evidences of coverage, riders, amendments,
2459endorsements, and disclosure forms, until the insurer has filed
2460it with the office and the office has approved it under ss.
2461627.410 and 627.411 and this section.
2462     (15)  SMALL EMPLOYERS ACCESS PROGRAM.--
2463     (a)  Popular name.--This subsection may be referred to by
2464the popular name "The Small Employers Access Program."
2465     (b)  Intent.--The Legislature finds that increased access
2466to health care coverage for small employers with up to 25
2467employees could improve employees' health and reduce the
2468incidence and costs of illness and disabilities among residents
2469in this state. Many employers do not offer health care benefits
2470to their employees citing the increased cost of this benefit. It
2471is the intent of the Legislature to create the Small Business
2472Health Plan to provide small employers the option and ability to
2473provide health care benefits to their employees at an affordable
2474cost through the creation of purchasing pools for employers with
2475up to 25 employees, and rural hospital employers and nursing
2476home employers regardless of the number of employees.
2477     (c)  Definitions.--For purposes of this subsection:
2478     1.  "Fair commission" means a commission structure
2479determined by the insurers and reflected in the insurers' rate
2480filings made pursuant to this subsection.
2481     2.  "Insurer" means any entity that provides health
2482insurance in this state. For purposes of this subsection,
2483insurer includes an insurance company holding a certificate of
2484authority pursuant to chapter 624 or a health maintenance
2485organization holding a certificate of authority pursuant to
2486chapter 641, which qualifies to provide coverage to small
2487employer groups pursuant to this section.
2488     3.  "Mutually supported benefit plan" means an optional
2489alternative coverage plan developed within a defined geographic
2490region which may include, but is not limited to, a minimum level
2491of primary care coverage in which the percentage of the premium
2492is distributed among the employer, the employee, and community-
2493generated revenue either alone or in conjunction with federal
2494matching funds.
2495     4.  "Office" means the Office of Insurance Regulation of
2496the Department of Financial Services.
2497     5.  "Participating insurer" means any insurer providing
2498health insurance to small employers that has been selected by
2499the office in accordance with this subsection for its designated
2500region.
2501     6.  "Program" means the Small Employer Access Program as
2502created by this subsection.
2503     (d)  Eligibility.--
2504     1.  Any small employer group of up to 25 employees that has
2505had no prior coverage for the last 6 months may participate.
2506     2.  Rural hospital employers as defined by law may
2507participate.
2508     3.  Nursing home employers may participate.
2509     4.  Each dependent of a person eligible for coverage is
2510also eligible to participate.
2511     5.  Any small employer that is actively engaged in
2512business, has its principal place of business in this state,
2513employed up to 25 eligible employees on business days during the
2514preceding calendar year, and employs at least 2 employees on the
2515first day of the plan year may participate.
2516
2517Coverage for a small employer group that ceases to meet the
2518eligibility requirements of this section may be terminated at
2519the end of the policy period for which the necessary premiums
2520have been paid.
2521     (e)  Administration.--
2522     1.  The office shall by competitive bid, in accordance with
2523current state law, select an insurer to provide coverage through
2524the program to eligible small employers within an established
2525geographical area of this state. The office may develop
2526exclusive regions for the program similar to those used by the
2527Healthy Kids Corporation. However the office is not precluded
2528from developing, in conjunction with insurers, regions different
2529from those used by the Healthy Kids Corporation if the office
2530deems that such a region will carry out the intentions of this
2531subsection.
2532     2.  The office shall evaluate bids submitted based upon
2533criteria established by the office, which shall include, but not
2534be limited to:
2535     a.  The insurer's proven ability to handle health insurance
2536coverage to small employer groups.
2537     b.  The efficiency and timeliness of the insurer's claim
2538processing procedures.
2539     c.  The insurer's ability to apply effective cost-
2540containment programs and procedures and to administer the
2541program in a cost-efficient manner.
2542     d.  The financial condition and stability of the insurer.
2543e.  The insurer's ability to develop an optional mutually
2544supported benefit plan.
2545
2546The office may use any financial information available to it
2547through its regulatory duties to make this evaluation.
2548     (f)  Insurer qualifications.--The insurer shall be a duly
2549authorized insurer or health maintenance organization.
2550     (g)  Duties of the insurer.--The insurer shall:
2551     1.  Develop and implement a program to publicize the
2552existence of the program, program eligibility requirements, and
2553procedures for enrollment and maintain public awareness of the
2554program.
2555     2.  Maintain employer awareness of the program.
2556     3.  Demonstrate the ability to use delivery of cost-
2557effective health care services.
2558     4.  Encourage, educate, advise, and administer the
2559effective use of health savings accounts by covered employees
2560and dependents.
2561     5.  Serve for a period specified in the contract between
2562the office and the insurer, subject to removal for cause and
2563subject to any terms, conditions, and limitations of the
2564contract between the office and the insurer as may be specified
2565in the request for proposal.
2566     (h)  Contract term.--The contract term shall not exceed 3
2567years. At least 6 months prior to the expiration of each
2568contract period, the office shall invite eligible entities,
2569including the current insurer, to submit bids to serve as the
2570insurer for a designated geographic area. Selection of the
2571insurer for the succeeding period shall be made at least 3
2572months prior to the end of the current period. If a protest is
2573filed and not resolved by the end of the contract period, the
2574contract with the existing administrator may be extended for a
2575period not to exceed 6 months. During the contract extension
2576period, the administrator shall be paid at a rate to be
2577negotiated by the office.
2578     (i)  Insurer reporting requirements.--On March 1 following
2579the close of each calendar year, the insurer shall determine net
2580written and earned premiums, the expense of administration, and
2581the paid and incurred losses for the year and report this
2582information to the office on a form prescribed by the office.
2583     (j)  Application requirements.--The insurer shall permit or
2584allow any licensed and duly appointed health insurance agent
2585residing in the designated region to submit applications for
2586coverage, and such agent shall be paid a fair commission if
2587coverage is written. The agent must be appointed to at least one
2588insurer.
2589     (k)  Benefits.--The benefits provided by the plan shall be
2590the same as the coverage required for small employers under
2591subsection (12). Upon the approval of the office, the insurer
2592may also establish an optional mutually supported benefit plan
2593which is an alternative plan developed within a defined
2594geographic region of this state or any other such alternative
2595plan which will carry out the intent of this subsection. Any
2596small employer carrier issuing new health benefit plans may
2597offer a benefit plan with coverages similar to, but not less
2598than, any alternative coverage plan developed pursuant to this
2599subsection.
2600     (l)  Annual reporting.--The office shall make an annual
2601report to the Governor, the President of the Senate, and the
2602Speaker of the House of Representatives. The report shall
2603summarize the activities of the program in the preceding
2604calendar year, including the net written and earned premiums,
2605program enrollment, the expense of administration, and the paid
2606and incurred losses. The report shall be submitted no later than
2607March 15 following the close of the prior calendar year.
2608     (16)(15)  APPLICABILITY OF OTHER STATE LAWS.--
2609     (a)  Except as expressly provided in this section, a law
2610requiring coverage for a specific health care service or
2611benefit, or a law requiring reimbursement, utilization, or
2612consideration of a specific category of licensed health care
2613practitioner, does not apply to a standard or basic health
2614benefit plan policy or contract or a limited benefit policy or
2615contract offered or delivered to a small employer unless that
2616law is made expressly applicable to such policies or contracts.
2617A law restricting or limiting deductibles, coinsurance,
2618copayments, or annual or lifetime maximum payments does not
2619apply to any health plan policy, including a standard or basic
2620health benefit plan policy or contract, offered or delivered to
2621a small employer unless such law is made expressly applicable to
2622such policy or contract. However, every small employer carrier
2623must offer to eligible small employers the standard benefit plan
2624and the basic benefit plan, as required by subsection (5), as
2625such plans have been approved by the office pursuant to
2626subsection (12).
2627     (b)  Except as provided in this section, a standard or
2628basic health benefit plan policy or contract or limited benefit
2629policy or contract offered to a small employer is not subject to
2630any provision of this code which:
2631     1.  Inhibits a small employer carrier from contracting with
2632providers or groups of providers with respect to health care
2633services or benefits;
2634     2.  Imposes any restriction on a small employer carrier's
2635ability to negotiate with providers regarding the level or
2636method of reimbursing care or services provided under a health
2637benefit plan; or
2638     3.  Requires a small employer carrier to either include a
2639specific provider or class of providers when contracting for
2640health care services or benefits or to exclude any class of
2641providers that is generally authorized by statute to provide
2642such care.
2643     (c)  Any second tier assessment paid by a carrier pursuant
2644to paragraph (11)(j) may be credited against assessments levied
2645against the carrier pursuant to s. 627.6494.
2646     (d)  Notwithstanding chapter 641, a health maintenance
2647organization is authorized to issue contracts providing benefits
2648equal to the standard health benefit plan, the basic health
2649benefit plan, and the limited benefit policy authorized by this
2650section.
2651     (17)(16)  RULEMAKING AUTHORITY.--The commission may adopt
2652rules to administer this section, including rules governing
2653compliance by small employer carriers and small employers.
2654     (18)  DECREASE IN INAPPROPRIATE UTILIZATION OF EMERGENCY
2655CARE.--
2656     (a)  The Legislature finds and declares it to be of vital
2657importance that emergency services and care be provided by
2658hospitals and physicians to every person in need of such care,
2659but with the double-digit increases in health insurance
2660premiums, health care providers and insurers should encourage
2661patients and the insured to assume responsibility for their
2662treatment, including emergency care. The Legislature finds that
2663inappropriate utilization of emergency department services
2664increases the overall cost of providing health care and these
2665costs are ultimately borne by the hospital, the insured
2666patients, and, many times, by the taxpayers of this state.
2667Finally, the Legislature declares that the providers and
2668insurers must share the responsibility of providing alternative
2669treatment options to urgent care patients outside of the
2670emergency department. Therefore, it is the intent of the
2671Legislature to place the obligation for educating consumers and
2672creating mechanisms for delivery of care that will decrease the
2673overutilization of emergency service on health insurers and
2674providers.
2675     (b)  Health insurers shall provide on their websites
2676information regarding appropriate utilization of emergency care
2677services which shall include, but not be limited to, a list of
2678alternative urgent care contracted providers, the types of
2679services offered by these providers, and what to do in the event
2680of a true emergency.
2681     (c)  Health insurers shall develop community emergency
2682department diversion programs. Such programs may include, but
2683not be limited to, enlisting providers to be on call to insurers
2684after hours, coordinating care through local community
2685resources, and incentives to providers for case management.
2686     (d)  As a disincentive for insureds to inappropriately use
2687emergency department services, health insurers may require
2688higher copayments for nonemergency use of emergency departments
2689and higher copayments for use of out-of-network emergency
2690departments. For the purposes of this section, the term
2691"emergency care" has the same meaning as provided in s. 395.002,
2692and shall include services provided to rule out an emergency
2693medical condition.
2694     Section 24.  Subsection (1) of section 627.9175, Florida
2695Statutes, is amended to read:
2696     627.9175  Reports of information on health and accident
2697insurance.--
2698     (1)  Each health insurer, prepaid limited health services
2699organization, and health maintenance organization shall submit,
2700no later than April 1 of each year, annually to the office
2701information concerning health and accident insurance coverage
2702and medical plans being marketed and currently in force in this
2703state. The required information shall be described by market
2704segment, to include, but not be limited to:
2705     (a)  Issuing, servicing company, and entity contact
2706information.
2707     (b)  Information on all health and accident insurance
2708policies and prepaid limited health service organizations and
2709health maintenance organization contracts in force and issued in
2710the previous year. Such information shall include, but not be
2711limited to, direct premiums earned, direct losses incurred,
2712number of policies, number of certificates, number of covered
2713lives, number or the percentage of claims denied and claims
2714meeting prompt pay requirements, and the average number of days
2715taken to pay claims. as to policies of individual health
2716insurance:
2717     (a)  A summary of typical benefits, exclusions, and
2718limitations for each type of individual policy form currently
2719being issued in the state. The summary shall include, as
2720appropriate:
2721     1.  The deductible amount;
2722     2.  The coinsurance percentage;
2723     3.  The out-of-pocket maximum;
2724     4.  Outpatient benefits;
2725     5.  Inpatient benefits; and
2726     6.  Any exclusions for preexisting conditions.
2727
2728The commission shall determine other appropriate benefits,
2729exclusions, and limitations to be reported for inclusion in the
2730consumer's guide published pursuant to this section.
2731     (b)  A schedule of rates for each type of individual policy
2732form reflecting typical variations by age, sex, region of the
2733state, or any other applicable factor which is in use and is
2734determined to be appropriate for inclusion by the commission.
2735
2736The commission may establish rules governing shall provide by
2737rule a uniform format for the submission of this information
2738described in this section, including the use of uniform formats
2739and electronic data transmission order to allow for meaningful
2740comparisons of premiums charged for comparable benefits. The
2741office shall provide this information to the department, which
2742shall publish annually a consumer's guide which summarizes and
2743compares the information required to be reported under this
2744subsection.
2745     Section 25.  Subsection (7) of section 636.003, Florida
2746Statutes, is amended to read:
2747     636.003  Definitions.--As used in this act, the term:
2748     (7)  "Prepaid limited health service organization" means
2749any person, corporation, partnership, or any other entity which,
2750in return for a prepayment, undertakes to provide or arrange
2751for, or provide access to, the provision of a limited health
2752service to enrollees through an exclusive panel of providers or
2753undertakes to provide access to any discounted medical services.
2754Prepaid limited health service organization does not include:
2755     (a)  An entity otherwise authorized pursuant to the laws of
2756this state to indemnify for any limited health service;
2757     (b)  A provider or entity when providing limited health
2758services pursuant to a contract with a prepaid limited health
2759service organization, a health maintenance organization, a
2760health insurer, or a self-insurance plan; or
2761     (c)  Any person who, in exchange for fees, dues, charges or
2762other consideration, provides access to a limited health service
2763provider without assuming any responsibility for payment for the
2764limited health service or any portion thereof; or
2765     (d)  Any plan or program of discounted medical services for
2766which fees, dues, charges, or other consideration paid to the
2767plan by consumers do not exceed $15 per month or $180 per year
2768and which, in its advertising and contracts:
2769     1.  Clearly indicates that the plan is not insurance, that
2770the plan is not obligated to pay any portion of the discounted
2771medical fees, and that the consumer is responsible for paying
2772the full amount of the discounted fees.
2773     2.  Does not use the terms "affordable health care" or
2774"coverage" or other terms which misrepresent the nature of the
2775program.
2776     3.  Requires a statement, together with the provider
2777network, on the discount card alerting the network providers and
2778facilities that the cardholder does not have insurance and is
2779merely entitled to the network discount rate for services
2780provided.
2781     Section 26.  Section 627.65626, Florida Statutes, is
2782created to read:
2783     627.65626  Insurance rebates for healthy lifestyles.--
2784     (1)  Any rate, rating schedule, or rating manual for a
2785health insurance policy filed with the office shall provide for
2786an appropriate rebate of premiums paid in the last calendar year
2787when the majority of members of a health plan have enrolled and
2788maintained participation in any health wellness, maintenance, or
2789improvement program offered by the employer. The employer must
2790provide evidence of demonstrative maintenance or improvement of
2791the enrollees' health status as determined by assessments of
2792agreed-upon health status indicators between the employer and
2793the health insurer, including, but not limited to, reduction in
2794weight, body mass index, and smoking cessation. Any rebate
2795provided by the health insurer is presumed to be appropriate
2796unless credible data demonstrates otherwise, but shall not
2797exceed 10 percent of paid premiums.
2798     (2)  The premium rebate authorized by this section shall be
2799effective for an insured on an annual basis, unless the number
2800of participating employees becomes less than the majority of the
2801employees eligible for participation in the wellness program.
2802     Section 27.  Section 627.6402, Florida Statutes, is created
2803to read:
2804     627.6402  Insurance rebates for healthy lifestyles.--
2805     (1)  Any rate, rating schedule, or rating manual for an
2806individual health insurance policy filed with the office shall
2807provide for an appropriate rebate of premiums paid in the last
2808calendar year when the individual covered by such plan is
2809enrolled in and maintains participation in any health wellness,
2810maintenance, or improvement program approved by the health plan.
2811The individual must provide evidence of demonstrative
2812maintenance or improvement of the individual's health status as
2813determined by assessments of agreed-upon health status
2814indicators between the individual and the health insurer,
2815including, but not limited to, reduction in weight, body mass
2816index, and smoking cessation. Any rebate provided by the health
2817insurer is presumed to be appropriate unless credible data
2818demonstrates otherwise, but shall not exceed 10 percent of paid
2819premiums.
2820     (2)  The premium rebate authorized by this section shall be
2821effective for an insured on an annual basis, unless the
2822individual fails to maintain or improve his or her health status
2823while participating in an approved wellness program, or credible
2824evidence demonstrates that the individual is not participating
2825in the approved wellness program.
2826     Section 28.  Subsection (38) of section 641.31, Florida
2827Statutes, is amended, and subsection (40) is added to said
2828section, to read:
2829     641.31  Health maintenance contracts.--
2830     (38)(a)  Notwithstanding any other provision of this part,
2831a health maintenance organization that meets the requirements of
2832paragraph (b) may, through a point-of-service rider to its
2833contract providing comprehensive health care services, include a
2834point-of-service benefit. Under such a rider, a subscriber or
2835other covered person of the health maintenance organization may
2836choose, at the time of covered service, a provider with whom the
2837health maintenance organization does not have a health
2838maintenance organization provider contract. The rider may not
2839require a referral from the health maintenance organization for
2840the point-of-service benefits.
2841     (b)  A health maintenance organization offering a point-of-
2842service rider under this subsection must have a valid
2843certificate of authority issued under the provisions of the
2844chapter, must have been licensed under this chapter for a
2845minimum of 3 years, and must at all times that it has riders in
2846effect maintain a minimum surplus of $5 million. A health
2847maintenance organization offering a point-of-service rider to
2848its contract providing comprehensive health care services may
2849offer the rider to employers who have employees living and
2850working outside the health maintenance organization's approved
2851geographic service area without having to obtain a health care
2852provider certificate, as long as the master group contract is
2853issued to an employer that maintains its primary place of
2854business within the health maintenance organization's approved
2855service area. Any member or subscriber that lives and works
2856outside the health maintenance organization's service area and
2857elects coverage under the health maintenance organization's
2858point-of-service rider must provide a statement to the health
2859maintenance organization that indicates the member or subscriber
2860understands the limitations of his or her policy and that only
2861those benefits under the point-of-service rider will be covered
2862when services are provided outside the service area.
2863     (c)  Premiums paid in for the point-of-service riders may
2864not exceed 15 percent of total premiums for all health plan
2865products sold by the health maintenance organization offering
2866the rider. If the premiums paid for point-of-service riders
2867exceed 15 percent, the health maintenance organization must
2868notify the office and, once this fact is known, must immediately
2869cease offering such a rider until it is in compliance with the
2870rider premium cap.
2871     (d)  Notwithstanding the limitations of deductibles and
2872copayment provisions in this part, a point-of-service rider may
2873require the subscriber to pay a reasonable copayment for each
2874visit for services provided by a noncontracted provider chosen
2875at the time of the service. The copayment by the subscriber may
2876either be a specific dollar amount or a percentage of the
2877reimbursable provider charges covered by the contract and must
2878be paid by the subscriber to the noncontracted provider upon
2879receipt of covered services. The point-of-service rider may
2880require that a reasonable annual deductible for the expenses
2881associated with the point-of-service rider be met and may
2882include a lifetime maximum benefit amount. The rider must
2883include the language required by s. 627.6044 and must comply
2884with copayment limits described in s. 627.6471. Section 641.3154
2885does not apply to a point-of-service rider authorized under this
2886subsection.
2887     (e)  The point-of-service rider must contain provisions
2888that comply with s. 627.6044.
2889     (f)(e)  The term "point of service" may not be used by a
2890health maintenance organization except with riders permitted
2891under this section or with forms approved by the office in which
2892a point-of-service product is offered with an indemnity carrier.
2893     (g)(f)  A point-of-service rider must be filed and approved
2894under ss. 627.410 and 627.411.
2895     (40)(a)  Any rate, rating schedule, or rating manual for a
2896health maintenance organization policy filed with the office
2897shall provide for an appropriate rebate of premiums paid in the
2898last calendar year when the individual covered by such plan is
2899enrolled in and maintains participation in any health wellness,
2900maintenance, or improvement program approved by the health plan.
2901The individual must provide evidence of demonstrative
2902maintenance or improvement of his or her health status as
2903determined by assessments of agreed-upon health status
2904indicators between the individual and the health insurer,
2905including, but not limited to, reduction in weight, body mass
2906index, and smoking cessation. Any rebate provided by the health
2907insurer is presumed to be appropriate unless credible data
2908demonstrates otherwise, but shall not exceed 10 percent of paid
2909premiums.
2910     (b)  The premium rebate authorized by this section shall be
2911effective for an insured on an annual basis, unless the
2912individual fails to maintain or improve his or her health status
2913while participating in an approved wellness program, or credible
2914evidence demonstrates that the individual is not participating
2915in the approved wellness program.
2916     Section 29.  Subsection (2) of section 626.015, Florida
2917Statutes, is amended, subsections (8) through (17) of said
2918section are renumbered as subsections (9) through (18),
2919respectively, and a new subsection (8) is added to said section,
2920to read:
2921     626.015  Definitions.--As used in this part:
2922     (2)  "Agent" means a general lines agent, life agent,
2923health agent, or title agent, or all such agents, as indicated
2924by context. The term "agent" includes an insurance producer or
2925producer, but does not include a customer representative,
2926limited customer representative, or service representative but
2927does include an insurance advisor.
2928     (8)  "Insurance advisor" means any person who, for money,
2929fee, commission, or any other thing of value offers to examine
2930or examines any policy of life, accident, or health insurance,
2931any health benefit plan, or any annuity or pure endowment
2932contract for the purpose of giving, or gives, or offers to give,
2933any advice, counsel, recommendation, or information in respect
2934to the terms, conditions, benefits, coverage, or premium of any
2935such policy or contract, or in respect to the expediency or
2936advisability of altering, changing, exchanging, converting,
2937replacing, surrendering, continuing, or rejecting any such
2938policy, plan, or contract, or of accepting or procuring any such
2939policy, plan, or contract from any insurer or issuer of a health
2940benefit plan, or who in or on advertisements, cards, signs,
2941circulars, or letterheads, or elsewhere, or in any other way or
2942manner by which public announcements are made, uses the title
2943"insurance advisor," "insurance specialist," "insurance
2944counselor," "insurance analyst," "policyholders' adviser,"
2945"policyholders' counselor," or any other similar title, or any
2946title indicating that the person gives, or is engaged in the
2947business of giving advice, counsel, recommendation, or
2948information to an insured, or a beneficiary, or any person
2949having any interest in a life, accident, or health insurance
2950contract, health benefit plan contract, annuity, or pure
2951endowment contract. This definition is not intended to prevent a
2952person who has obtained the professional designation of life
2953underwriter, chartered financial consultant, or certified
2954financial planner by completing a course of instruction
2955recognized within the business of insurance from using that
2956designation to indicate professional achievement.
2957     Section 30.  Subsection (1) of section 626.016, Florida
2958Statutes, is amended to read:
2959     626.016  Powers and duties of department, commission, and
2960office.--
2961     (1)  The powers and duties of the Chief Financial Officer
2962and the department specified in this part apply only with
2963respect to insurance agents, insurance advisors, managing
2964general agents, reinsurance intermediaries, viatical settlement
2965brokers, customer representatives, service representatives, and
2966agencies.
2967     Section 31.  Section 626.171, Florida Statutes, is amended
2968to read:
2969     626.171  Application for license.--
2970     (1)  The department or office shall not issue a license as
2971agent, insurance advisor, customer representative, adjuster,
2972insurance agency, service representative, managing general
2973agent, or reinsurance intermediary to any person except upon
2974written application therefor filed with it, qualification
2975therefor, and payment in advance of all applicable fees. Any
2976such application shall be made under the oath of the applicant
2977and be signed by the applicant. Beginning November 1, 2002, The
2978department shall accept the uniform application for nonresident
2979agent licensing. The department may adopt revised versions of
2980the uniform application by rule.
2981     (2)  In the application, the applicant shall set forth:
2982     (a)  His or her full name, age, social security number,
2983residence address, business address, and mailing address.
2984     (b)  Proof that he or she has completed or is in the
2985process of completing any required prelicensing course.
2986     (c)  Whether he or she has been refused or has voluntarily
2987surrendered or has had suspended or revoked a license to solicit
2988insurance by the department or by the supervising officials of
2989any state.
2990     (d)  Whether any insurer or any managing general agent
2991claims the applicant is indebted under any agency contract or
2992otherwise and, if so, the name of the claimant, the nature of
2993the claim, and the applicant's defense thereto, if any.
2994     (e)  Proof that the applicant meets the requirements for
2995the type of license for which he or she is applying.
2996     (f)  Such other or additional information as the department
2997or office may deem proper to enable it to determine the
2998character, experience, ability, and other qualifications of the
2999applicant to hold himself or herself out to the public as an
3000insurance representative.
3001     (3)  An application for an insurance agency license shall
3002be signed by the owner or owners of the agency. If the agency is
3003incorporated, the application shall be signed by the president
3004and secretary of the corporation.
3005     (3)(4)  Each application shall be accompanied by payment of
3006any applicable fee.
3007     (4)(5)  An application for a license as an agent, customer
3008representative, adjuster, insurance agency, service
3009representative, managing general agent, or reinsurance
3010intermediary must be accompanied by a set of the individual
3011applicant's fingerprints, or, if the applicant is not an
3012individual, by a set of the fingerprints of the sole proprietor,
3013majority owner, partners, officers, and directors, on a form
3014adopted by rule of the department or commission and accompanied
3015by the fingerprint processing fee set forth in s. 624.501.
3016Fingerprints shall be used to investigate the applicant's
3017qualifications pursuant to s. 626.201. The fingerprints shall be
3018taken by a law enforcement agency or other department-approved
3019entity.
3020     (5)(6)  The application for license filing fee prescribed
3021in s. 624.501 is not subject to refund.
3022     (6)(7)  Pursuant to the federal Personal Responsibility and
3023Work Opportunity Reconciliation Act of 1996, each party is
3024required to provide his or her social security number in
3025accordance with this section. Disclosure of social security
3026numbers obtained through this requirement shall be limited to
3027the purpose of administration of the Title IV-D program for
3028child support enforcement.
3029     Section 32.  Section 626.191, Florida Statutes, is amended
3030to read:
3031     626.191  Repeated applications.--The failure of an
3032applicant to secure a license upon an application shall not
3033preclude the applicant him or her from applying again as many
3034times as desired, but the department or office shall not give
3035consideration to or accept any further application by the same
3036individual for a similar license dated or filed within 30 days
3037subsequent to the date the department or office denied the last
3038application, except as provided in s. 626.281.
3039     Section 33.  Subsection (1) of section 626.201, Florida
3040Statutes, is amended to read:
3041     626.201  Investigation.--
3042     (1)  The department or office may propound any reasonable
3043interrogatories in addition to those contained in the
3044application, to any applicant for license or appointment, or on
3045any renewal, reinstatement, or continuation thereof, relating to
3046the applicant's his or her qualifications, residence,
3047prospective place of business, and any other matter which, in
3048the opinion of the department or office, is deemed necessary or
3049advisable for the protection of the public and to ascertain the
3050applicant's qualifications.
3051     Section 34.  Subsections (1) and (2) of section 626.342,
3052Florida Statutes, are amended to read:
3053     626.342  Furnishing supplies to unlicensed life, health, or
3054general lines agent prohibited; civil liability.--
3055     (1)  An insurer, a managing general agent, an insurance
3056advisor, or an agent, directly or through any representative,
3057may not furnish to any agent any blank forms, applications,
3058stationery, or other supplies to be used in soliciting,
3059negotiating, or effecting contracts of insurance on its behalf
3060unless such blank forms, applications, stationery, or other
3061supplies relate to a class of business with respect to which the
3062agent is licensed and appointed, whether for that insurer or
3063another insurer.
3064     (2)  Any insurer, general agent, insurance advisor, or
3065agent who furnishes any of the supplies specified in subsection
3066(1) to any agent or prospective agent not appointed to represent
3067the insurer and who accepts from or writes any insurance
3068business for such agent or agency is subject to civil liability
3069to any insured of such insurer to the same extent and in the
3070same manner as if such agent or prospective agent had been
3071appointed or authorized by the insurer or such agent to act in
3072its or his or her behalf. The provisions of this subsection do
3073not apply to insurance risk apportionment plans under s.
3074627.351.
3075     Section 35.  Section 626.536, Florida Statutes, is amended
3076to read:
3077     626.536  Reporting of actions.--An agent or insurance
3078advisor shall submit to the department, within 30 days after the
3079final disposition of any administrative action taken against the
3080agent by a governmental agency in this or any other state or
3081jurisdiction relating to the business of insurance, the sale of
3082securities, or activity involving fraud, dishonesty,
3083trustworthiness, or breach of a fiduciary duty, a copy of the
3084order, consent to order, or other relevant legal documents. The
3085department may adopt rules implementing the provisions of this
3086section.
3087     Section 36.  Subsections (1) and (3) of section 626.561,
3088Florida Statutes, are amended to read:
3089     626.561  Reporting and accounting for funds.--
3090     (1)  All premiums, return premiums, or other funds
3091belonging to insurers or others received by an insurance
3092advisor, agent, customer representative, or adjuster in
3093transactions under a his or her license are trust funds received
3094by the licensee in a fiduciary capacity. An agent or insurance
3095advisor shall keep the funds belonging to each insurer for which
3096an agent or insurance advisor he or she is not appointed, other
3097than a surplus lines insurer, in a separate account so as to
3098allow the department or office to properly audit such funds. The
3099licensee in the applicable regular course of business shall
3100account for and pay the same to the insurer, insured, or other
3101person entitled thereto.
3102     (3)  Any insurance advisor, agent, customer representative,
3103or adjuster who, not being lawfully entitled thereto, either
3104temporarily or permanently diverts or misappropriates such funds
3105or any portion thereof or deprives the other person of a benefit
3106therefrom commits the offense specified below:
3107     (a)  If the funds diverted or misappropriated are $300 or
3108less, a misdemeanor of the first degree, punishable as provided
3109in s. 775.082 or s. 775.083.
3110     (b)  If the funds diverted or misappropriated are more than
3111$300, but less than $20,000, a felony of the third degree,
3112punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
3113     (c)  If the funds diverted or misappropriated are $20,000
3114or more, but less than $100,000, a felony of the second degree,
3115punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
3116     (d)  If the funds diverted or misappropriated are $100,000
3117or more, a felony of the first degree, punishable as provided in
3118s. 775.082, s. 775.083, or s. 775.084.
3119     Section 37.  Subsections (1) and (2) of section 626.572,
3120Florida Statutes, are amended to read:
3121     626.572  Rebating; when allowed.--
3122     (1)  No insurance advisor or agent shall rebate any portion
3123of a his or her commission except as follows:
3124     (a)  The rebate shall be available to all insureds in the
3125same actuarial class.
3126     (b)  The rebate shall be in accordance with a rebating
3127schedule filed by the agent with the insurer issuing the policy
3128to which the rebate applies.
3129     (c)  The rebating schedule shall be uniformly applied in
3130that all insureds who purchase the same policy through the agent
3131for the same amount of insurance receive the same percentage
3132rebate.
3133     (d)  Rebates shall not be given to an insured with respect
3134to a policy purchased from an insurer that prohibits its agents
3135from rebating commissions.
3136     (e)  The rebate schedule is prominently displayed in public
3137view in the agent's place of doing business and a copy is
3138available to insureds on request at no charge.
3139     (f)  The age, sex, place of residence, race, nationality,
3140ethnic origin, marital status, or occupation of the insured or
3141location of the risk is not utilized in determining the
3142percentage of the rebate or whether a rebate is available.
3143     (2)  The insurance advisor or agent shall maintain a copy
3144of all rebate schedules for the most recent 5 years and their
3145effective dates.
3146     Section 38.  Section 626.593, Florida Statutes, is created
3147to read:
3148     626.593  Insurance advisor; written contract for
3149compensation.--
3150     (1)  A person licensed as a health insurance advisor may
3151not receive any fee or commission or any other thing of value in
3152addition to the rates filed pursuant to chapter 627 for
3153examining any life, accident, or health insurance or any health
3154benefit plan for the purpose of giving or offering advice,
3155counsel, recommendation, or information in respect to terms,
3156conditions, benefits coverage, or premium of any such policy or
3157contract unless such compensation is based upon a written
3158contract signed by the party to be charged and specifying or
3159clearly defining the amount or extent of such compensation and
3160informing the party to be charged whether the health advisor is
3161also receiving a commission from an insurer in addition to any
3162other compensation disclosed in the contract.
3163     (2)  A copy of every such contract shall be retained by the
3164licensee for not less than 3 years after such services have been
3165fully performed.
3166     (3)  This section shall not prohibit the payment of a
3167commission by an insurer pursuant to any lawful contract between
3168an insurer and a licensed insurance advisor.
3169     (4)  An insurance advisor must be appointed by any insurer
3170with which coverage is placed on behalf of an insured.
3171     Section 39.  Subsection (1) of section 626.601, Florida
3172Statutes, is amended to read:
3173     626.601  Improper conduct; inquiry; fingerprinting.--
3174     (1)  The department or office may, upon its own motion or
3175upon a written complaint signed by any interested person and
3176filed with the department or office, inquire into any alleged
3177improper conduct of any licensed insurance advisor, agent,
3178adjuster, service representative, managing general agent,
3179customer representative, title insurance agent, title insurance
3180agency, continuing education course provider, instructor, school
3181official, or monitor group under this code. The department or
3182office may thereafter initiate an investigation of any such
3183licensee if it has reasonable cause to believe that the licensee
3184has violated any provision of the insurance code. During the
3185course of its investigation, the department or office shall
3186contact the licensee being investigated unless it determines
3187that contacting such person could jeopardize the successful
3188completion of the investigation or cause injury to the public.
3189     Section 40.  Section 626.6115, Florida Statutes, is amended
3190to read:
3191     626.6115  Grounds for compulsory refusal, suspension, or
3192revocation of insurance agency license.--The department shall
3193deny, suspend, revoke, or refuse to continue the license of any
3194insurance agency if it finds, as to any insurance agency or as
3195to any majority owner, partner, manager, director, officer, or
3196other person who manages or controls such agency, that any
3197either one or both of the following applicable grounds exist:
3198     (1)  Lack by the agency of one or more of the
3199qualifications for the license as specified in this code;.
3200     (2)  Material misstatement, misrepresentation, or fraud in
3201obtaining the license or in attempting to obtain the license; or
3202     (3)  Denial, suspension, or revocation of a license to
3203practice or conduct any regulated profession, business, or
3204vocation relating to the business of insurance by this state,
3205any other state, any nation, any possession or district of the
3206United States, any court, or any lawful agency thereof.
3207     Section 41.  Paragraph (b) of subsection (5) of section
3208624.509, Florida Statutes, is amended to read:
3209     624.509  Premium tax; rate and computation.--
3210     (5)  There shall be allowed a credit against the net tax
3211imposed by this section equal to 15 percent of the amount paid
3212by the insurer in salaries to employees located or based within
3213this state and who are covered by the provisions of chapter 443.
3214For purposes of this subsection:
3215     (b)  The term "employees" does not include independent
3216contractors or any person whose duties require that the person
3217hold a valid license under the Florida Insurance Code, except
3218persons defined in s. 626.015(1), (16)(15), and (18)(17).
3219     Section 42.  Subsection (2) of section 626.7845, Florida
3220Statutes, is amended to read:
3221     626.7845  Prohibition against unlicensed transaction of
3222life insurance.--
3223     (2)  Except as provided in s. 626.112(6), with respect to
3224any line of authority specified in s. 626.015(12)(11), no
3225individual shall, unless licensed as a life agent:
3226     (a)  Solicit insurance or annuities or procure
3227applications; or
3228     (b)  In this state, engage or hold himself or herself out
3229as engaging in the business of analyzing or abstracting
3230insurance policies or of counseling or advising or giving
3231opinions to persons relative to insurance or insurance contracts
3232other than:
3233     1.  As a consulting actuary advising an insurer; or
3234     2.  As to the counseling and advising of labor unions,
3235associations, trustees, employers, or other business entities,
3236the subsidiaries and affiliates of each, relative to their
3237interests and those of their members or employees under
3238insurance benefit plans.
3239     Section 43.  Paragraph (c) of subsection (2) of section
3240626.292, Florida Statutes, is amended to read:
3241     626.292  Transfer of license from another state.--
3242     (2)  To qualify for a license transfer, an individual
3243applicant must meet the following requirements:
3244     (c)  The individual shall submit a completed application
3245for this state which is received by the department within 90
3246days after the date the individual became a resident of this
3247state, along with payment of the applicable fees set forth in s.
3248624.501 and submission of the following documents:
3249     1.  A certification issued by the appropriate official of
3250the applicant's home state identifying the type of license and
3251lines of authority under the license and stating that, at the
3252time the license from the home state was canceled, the applicant
3253was in good standing in that state or that the state's Producer
3254Database records, maintained by the National Association of
3255Insurance Commissioners, its affiliates, or subsidiaries,
3256indicate that the agent is or was licensed in good standing for
3257the line of authority requested.
3258     2.  A set of the individual applicant's fingerprints in
3259accordance with s. 626.171(4)(5).
3260     Section 44.  Paragraph (a) of subsection (2) of section
3261626.321, Florida Statutes, is amended to read:
3262     626.321  Limited licenses.--
3263     (2)  An entity applying for a license under this section is
3264required to:
3265     (a)  Submit only one application for a license under s.
3266626.171. The requirements of s. 626.171(4)(5) shall only apply
3267to the officers and directors of the entity submitting the
3268application.
3269     Section 45.  Notwithstanding the amendment to s.
3270627.6699(5)(c), Florida Statutes, by this act, any right to an
3271open enrollment offer of health benefit coverage for groups of
3272fewer than two employees, pursuant to s. 627.6699(5)(c), Florida
3273Statutes, as it existed immediately before the effective date of
3274this act, shall remain in full force and effect until the
3275enactment of s. 627.64872, Florida Statutes, and the subsequent
3276date upon which such plan begins to accept new risks or members.
3277     Section 46.  Section 465.0244, Florida Statutes, is created
3278to read:
3279     465.0244  Information disclosure.--Every pharmacy shall
3280make available on its Internet website a link to the performance
3281outcome and financial data that is published by the Agency for
3282Health Care Administration pursuant to s. 408.05(3)(l) and shall
3283place in the area where customers receive filled prescriptions
3284notice that such information is available electronically and the
3285address of its Internet website.
3286     Section 47.  Section 627.6499, Florida Statutes, is amended
3287to read:
3288     627.6499  Reporting by insurers and third-party
3289administrators.--
3290     (1)  The office may require any insurer, third-party
3291administrator, or service company to report any information
3292reasonably required to assist the board in assessing insurers as
3293required by this act.
3294     (2)  Each health insurance issuer shall make available on
3295its Internet website a link to the performance outcome and
3296financial data that is published by the Agency for Health Care
3297Administration pursuant to s. 408.05(3)(l) and shall include in
3298every policy delivered or issued for delivery to any person in
3299the state or any materials provided as required by s. 627.64725
3300notice that such information is available electronically and the
3301address of its Internet website.
3302     Section 48.  Subsections (6) and (7) are added to section
3303641.54, Florida Statutes, to read:
3304     641.54  Information disclosure.--
3305     (6)  Each health maintenance organization shall make
3306available to its subscribers the estimated co-pay, coinsurance,
3307or deductible, whichever is applicable, for any covered
3308services, the status of the subscriber's maximum annual out-of-
3309pocket payments for a covered individual or family, and the
3310status of the subscriber's maximum lifetime benefit. Such
3311estimate shall not preclude the actual co-pay, coinsurance, or
3312deductible, whichever is applicable, from exceeding the
3313estimate.
3314     (7)  Each health maintenance organization shall make
3315available on its Internet website a link to the performance
3316outcome and financial data that is published by the Agency for
3317Health Care Administration pursuant to s. 408.05(3)(l) and shall
3318include in every policy delivered or issued for delivery to any
3319person in the state or any materials provided as required by s.
3320627.64725 notice that such information is available
3321electronically and the address of its Internet website.
3322     Section 49.  Section 408.02, Florida Statutes, is repealed.
3323     Section 50.  The sum of $250,000 is appropriated from the
3324Insurance Regulatory Trust Fund in the Department of Financial
3325Services to the Office of Insurance Regulation for the purpose
3326of implementing the provisions in this act relating to the Small
3327Business Health Plan.
3328     Section 51.  The sum of $2 million is appropriated from
3329General Revenue to the Agency for Health Care Administration for
3330funding activities relating to the Patient Safety Corporation as
3331created in this act.
3332     Section 52.  This act shall take effect October 1, 2004.


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