September 23, 2020
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HB 1629CS

CHAMBER ACTION




1The Committee on Insurance 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;
10providing a definition; providing for a fine for failure
11to provide such information; amending s. 381.734, F.S.;
12including participation by health care providers, small
13businesses, and health insurers in the Healthy
14Communities, Healthy People Program; requiring the
15Department of Health to provide public Internet access to
16certain public health programs; requiring the department
17to monitor and assess the effectiveness of such programs;
18requiring a report; requiring the Office of Program Policy
19and Government Accountability to evaluate the
20effectiveness of such programs; requiring a report;
21amending s. 395.1041, F.S.; authorizing hospitals to
22develop certain emergency room diversion programs;
23amending s. 395.301, F.S.; requiring certain licensed
24facilities to provide prospective patients certain
25estimates of charges for services; requiring such
26facilities to provide patients with certain bill
27verification information; providing for a fine for failure
28to provide such information; providing charge limitations;
29requiring such facilities to establish a patient question
30review and response methodology; providing requirements;
31requiring certain licensed facilities to provide public
32Internet access to certain financial information; amending
33s. 408.061, F.S.; requiring the Agency for Health Care
34Administration to require health care facilities, health
35care providers, and health insurers to submit certain
36information; providing requirements; requiring the agency
37to adopt certain risk and severity adjustment
38methodologies; requiring the agency to adopt certain
39rules; requiring certain information to be certified;
40amending s. 408.062, F.S.; requiring the agency to conduct
41certain health care costs and access research, analyses,
42and studies; expanding the scope of such studies to
43include collection of pharmacy retail price data, use of
44emergency departments, physician information, and Internet
45patient charge information availability; requiring a
46report; requiring the agency to conduct additional data-
47based studies and make recommendations to the Legislature;
48requiring the agency to develop and implement a strategy
49to adopt and use electronic health records; authorizing
50the agency to develop rules to protect electronic records
51confidentiality; requiring a report to the Governor and
52Legislature; amending s. 408.05, F.S.; requiring the
53agency to develop a plan to make performance outcome and
54financial data available to consumers for health care
55services comparison purposes; requiring submittal of the
56plan to the Governor and Legislature; requiring the agency
57to update the plan; requiring the agency to make the plan
58available electronically; providing plan requirements;
59amending s. 409.9066, F.S.; requiring the agency to
60provide certain information relating to the Medicare
61prescription discount program; amending s. 408.7056, F.S.;
62renaming the Statewide Provider and Subscriber Assistance
63Program as the Subscriber Assistance Program; revising
64provisions to conform; expanding certain records
65availability provisions; revising membership provisions
66relating to a subscriber grievance hearing panel; revising
67a list of grievances the panel may consider; providing
68hearing procedures; amending s. 641.3154, F.S., to conform
69to the renaming of the Subscriber Assistance Program;
70amending s. 641.511, F.S., to conform to the renaming of
71the Subscriber Assistance Program; adopting and
72incorporating by reference the Employee Retirement Income
73Security Act of 1974, as implemented by federal
74regulations; amending s. 641.58, F.S., to conform to the
75renaming of the Subscriber Assistance Program; amending s.
76408.909, F.S.; expanding a definition of "health flex plan
77entity" to include public-private partnerships; making a
78pilot health flex plan program apply permanently
79statewide; providing additional program requirements;
80creating s. 381.0271, F.S.; providing definitions;
81creating the Florida Patient Safety Corporation;
82authorizing the corporation to create additional not-for-
83profit corporate subsidiaries for certain purposes;
84specifying application of public records and public
85meetings requirements; exempting the corporation and
86subsidiaries from public procurement provisions; providing
87purposes; providing for a board of directors; providing
88for membership; authorizing the corporation to establish
89certain advisory committees; providing for organization of
90the corporation; providing for meetings; providing powers
91and duties of the corporation; requiring the corporation
92to collect, analyze, and evaluate patient safety data and
93related information; requiring the corporation to
94establish a pilot project to identify and report near
95misses relating to patient safety; requiring the
96corporation to work with state agencies to develop
97electronic health records; providing for an active library
98of evidence-based medicine and patient safety practices;
99requiring the corporation to develop and recommend core
100competencies in patient safety and public education
101programs; requiring an annual report; providing report
102requirements; authorizing the corporation to seek funding
103and apply for grants; requiring the Office of Program
104Policy Analysis and Government Accountability, the
105Department of Health, and the Agency for Health Care
106Administration to develop performance standards to
107evaluate the corporation; amending s. 409.91255, F.S.;
108expanding assistance to certain health centers to include
109community emergency room diversion programs and urgent
110care services; amending s. 627.410, F.S.; requiring
111insurers to file certain rates with the Office of
112Insurance Regulation; amending s. 627.6487, F.S.; revising
113a definition; creating s. 627.64872, F.S.; providing
114legislative intent; creating the Florida Health Insurance
115Plan for certain purposes; providing definitions;
116providing exclusions; providing requirements for operation
117of the plan; providing for a board of directors; providing
118for appointment of members; providing for terms;
119specifying service without compensation; providing for
120travel and per diem expenses; requiring a plan of
121operation; providing requirements; providing for powers of
122the plan; requiring reports to the Governor and
123Legislature; providing for an actuarial study; providing
124certain immunity from liability for plan obligations;
125authorizing the board to provide for indemnification of
126certain costs; requiring an annually audited financial
127statement; providing for eligibility for coverage under
128the plan; providing criteria, requirements, and
129limitations; specifying certain activity as an unfair
130trade practice; providing for a plan administrator;
131providing criteria; providing requirements; providing term
132limits for the plan administrator; providing duties;
133providing for paying the administrator; providing for
134premium rates for plan coverage; providing rate
135limitations; providing for sources of additional revenue;
136specifying benefits under the plan; providing criteria,
137requirements, and limitations; providing for
138nonduplication of benefits; providing for annual and
139maximum lifetime benefits; providing for tax exempt
140status; providing for abolition of the Florida
141Comprehensive Health Association upon implementation of
142the plan; providing for continued operation of the Florida
143Comprehensive Health Association until adoption of a plan
144of operation for the Florida Health Insurance Plan;
145providing for enrollment in the plan of persons enrolled
146in the association; requiring insurers to pay certain
147assessments to the board for certain purposes; providing
148criteria, requirements, and limitations for such
149assessments; providing for repeal of ss. 627.6488,
150627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
151627.6498, F.S., relating to the Florida Comprehensive
152Health Association, upon implementation of the plan;
153amending s. 627.662, F.S.; providing for application of
154certain claim payment methodologies to certain types of
155insurance; providing for certain actions relating to
156inappropriate utilization of emergency care; amending s.
157627.6699, F.S.; revising provisions requiring small
158employer carriers to offer certain health benefit plans;
159preserving a right to open enrollment for certain small
160groups; requiring small employer carriers to file and
161provide coverage under certain high deductible plans;
162including high deductible plans under certain required
163plan provisions; creating the Small Employers Access
164Program; providing legislative intent; providing
165definitions; providing participation eligibility
166requirements and criteria; requiring the Office of
167Insurance Regulation to administer the program by
168selecting an insurer through competitive bidding;
169providing requirements; specifying insurer qualifications;
170providing duties of the insurer; providing a contract
171term; providing insurer reporting requirements; providing
172application requirements; providing for benefits under the
173program; requiring the office to annually report to the
174Governor and Legislature; creating ss. 627.6405 and
175641.31097, F.S.; providing for decreasing inappropriate
176use of emergency care; providing legislative findings and
177intent; requiring health insurers and health maintenance
178organizations to provide certain information
179electronically and develop community emergency department
180diversion programs; authorizing health insurers to require
181higher copayments for certain uses of emergency
182departments; amending s. 627.9175, F.S.; requiring certain
183health insurers to annually report certain coverage
184information to the office; providing requirements;
185deleting certain reporting requirements; retitling ch.
186636, F.S.; designating ss. 636.002-636.067, F.S., as pt. I
187of ch. 636, F.S.; providing a part title; amending s.
188636.003, F.S.; revising the definition of "prepaid limited
189health service organization" to exclude discount medical
190plan organizations; creating pt. II of ch. 636, F.S.,
191consisting of ss. 636.202-636.244, F.S.; providing a part
192title; providing definitions; providing for regulation and
193operation of discount medical plan organizations;
194requiring corporate licensure before doing business as a
195discount medical plan; specifying application
196requirements; requiring license fees; providing for
197expiration and renewal of licenses; requiring such
198organizations to establish an Internet website; requiring
199publication of certain information on the website;
200specifying collection and deposit of the licensing fee;
201authorizing the office to examine or investigate the
202business affairs of such organizations; requiring
203examinations and investigations; authorizing the office to
204order production of documents and take statements;
205requiring organizations to pay certain expenses;
206specifying grounds for denial or revocation under certain
207circumstances; specifying permitted activities of a
208discount medical plan organization; prohibiting certain
209activities; requiring certain disclosures to prospective
210members; requiring provider agreements to provide services
211under a medical discount plan; providing agreement
212requirements; requiring forms and rates to be filed with
213the office; requiring annual reports to be filed with the
214office; providing requirements; providing for fines and
215administrative sanctions for failing to file annual
216reports; establishing minimum capital requirements;
217providing for suspension or revocation of licenses under
218certain circumstances; providing for suspension of
219enrollment of new members under certain circumstances;
220providing terms of suspensions; requiring notice of any
221change of an organization's name; requiring discount
222medical plan organizations to maintain provider names
223listings; specifying marketing requirements of discount
224medical plans; providing limitations; specifying fee
225disclosure requirements for bundling discount medical
226plans with other insurance products; authorizing the
227commission to adopt rules; applying insurer service of
228process requirements on discount medical plan
229organizations; requiring a security deposit; prohibiting
230levy on certain deposit assets or securities under certain
231circumstances; providing criminal penalties; authorizing
232the office to seek certain injunctive relief under certain
233circumstances; providing limitations; providing for civil
234actions for damages for certain violations; providing for
235awards of court costs and attorney fees; specifying
236application of unauthorized insurer provisions of law to
237unlicensed discount medical plan organizations; creating
238ss. 627.65626 and 627.6402, F.S.; providing for insurance
239rebates for healthy lifestyles; providing for rebate of
240certain premiums for participation in health wellness,
241maintenance, or improvement programs under certain
242circumstances; providing requirements; amending s. 641.31,
243F.S.; authorizing health maintenance organizations
244offering certain point-of-service riders to offer such
245riders to certain employers for certain employees;
246providing requirements and limitations; providing for
247application of certain claim payment methodologies to
248certain types of insurance; providing for rebate of
249certain premiums for participation in health wellness,
250maintenance, or improvement programs under certain
251circumstances; providing requirements; amending s.
252626.015, F.S.; defining "insurance advisor"; amending ss.
253626.016, 626.342, 626.536, 626.561, 626.572, and 626.601,
254F.S., to include application of such provisions to
255insurance advisors; providing penalties; creating s.
256626.593, F.S.; providing fee and commission limitations
257for health insurance advisors; requiring a written
258contract for compensation; providing contract
259requirements; requiring a rebate of commission under
260certain circumstances; creating s. 626.594, F.S.;
261providing qualification requirements for an insurance
262advisor license; providing an exemption; providing
263limitations; amending ss. 626.171, 626.191, and 626.201,
264F.S.; clarifying certain application requirements;
265amending ss. 624.509 and 626.7845, F.S.; correcting cross
266references; preserving certain rights to enrollment in
267certain health benefit coverage programs for certain
268groups under certain circumstances; creating s. 465.0244,
269F.S.; requiring each pharmacy to make available on its
270Internet website a link to certain performance outcome and
271financial data of the Agency for Health Care
272Administration and a notice of the availability of such
273information; amending s. 627.6499, F.S.; requiring each
274health insurer to make available on its Internet website a
275link to certain performance outcome and financial data of
276the Agency for Health Care Administration and a notice in
277policies of the availability of such information; amending
278s. 641.54, F.S.; requiring health maintenance
279organizations to make certain insurance financial
280information available to subscribers; requiring health
281maintenance organizations to make available on its
282Internet website a link to certain performance outcome and
283financial data of the Agency for Health Care
284Administration and a notice in policies of the
285availability of such information; repealing s. 408.02,
286F.S., relating to the development, endorsement,
287implementation, and evaluation of patient management
288practice parameters by the Agency for Health Care
289Administration; providing appropriations; providing
290effective dates.
291
292     WHEREAS, according to the Kaiser Family Foundation, eight
293out of ten uninsured Americans are workers or dependents of
294workers and nearly eight out of ten uninsured Americans have
295family incomes above the poverty level, and
296     WHEREAS, fifty-five percent of those who do not have
297insurance state the reason they don't have insurance is lack of
298affordability, and
299     WHEREAS, average health insurance premium increases for the
300last two years have been in the range of ten to twenty percent
301for Florida's employers, and
302     WHEREAS, an increasing number of employers are opting to
303cease providing insurance coverage to their employees due to the
304high cost, and
305     WHEREAS, an increasing number of employers who continue
306providing coverage are forced to shift more premium cost to
307their employees, thus diminishing the value of employee wage
308increases, and
309     WHEREAS, according to studies, the rate of avoidable
310hospitalization is fifty to seventy percent lower for the
311insured versus the uninsured, and
312     WHEREAS, according to Florida Cancer Registry data, the
313uninsured have a seventy percent greater chance of a late
314diagnosis, thus decreasing the chances of a positive health
315outcome, and
316     WHEREAS, according to the Agency for Health Care
317Administration's 2002 financial data, uncompensated care in
318Florida's hospitals is growing at the rate of twelve to thirteen
319percent per year, and, at $4.3 billion in 2001, this cost, when
320shifted to Floridians who remain insured, is not sustainable,
321and
322     WHEREAS, the Florida Legislature, through the creation of
323Health Flex, has already identified the need for lower cost
324alternatives, and
325     WHEREAS, it is of vital importance and in the best
326interests of the people of the State of Florida that the issue
327of available, affordable health care insurance be addressed in a
328cohesive and meaningful manner, and  
329     WHEREAS, there is general recognition that the issues
330surrounding the problem of access to affordable health insurance
331are complicated and multifaceted, and
332     WHEREAS, on August 14, 2003, Speaker Johnnie Byrd created
333the Select Committee on Affordable Health Care for Floridians in
334an effort to address the issue of affordable and accessible
335employment-based insurance, and
336     WHEREAS, the Select Committee on Affordable Health Care for
337Floridians held public hearings with predetermined themes around
338the state, specifically, in Orlando, Miami, Jacksonville, Tampa,
339Pensacola, Boca Raton, and Tallahassee, from October through
340November 2003 to effectively probe the operation of the private
341insurance marketplace, to understand the health insurance market
342trends, to learn from past policy initiatives, and to identify,
343explore, and debate new ideas for change, and
344     WHEREAS, recommendations from the Select Committee on
345Affordable Health Care were adopted on February 4, 2004, to
346address the multifaceted issues attributed to the increase in
347health care cost, and
348     WHEREAS, these recommendations were presented to the
349Speaker of the House of Representatives in a final report from
350the committee on February 18, 2004, and subsequent legislation
351was drafted creating the "The 2004 Affordable Health Care for
352Floridians Act," NOW, THEREFORE,
353
354Be It Enacted by the Legislature of the State of Florida:
355
356     Section 1.  This act may be referred to by the popular name
357"The 2004 Affordable Health Care for Floridians Act."
358     Section 2.  The purpose of this act is to address the
359underlying cause of the double-digit increases in health
360insurance premiums by mitigating the overall growth in health
361care costs.
362     Section 3.  Paragraph (c) of subsection (4) of section
363381.026, Florida Statutes, is amended to read:
364     381.026  Florida Patient's Bill of Rights and
365Responsibilities.--
366     (4)  RIGHTS OF PATIENTS.--Each health care facility or
367provider shall observe the following standards:
368     (c)  Financial information and disclosure.--
369     1.  A patient has the right to be given, upon request, by
370the responsible provider, his or her designee, or a
371representative of the health care facility full information and
372necessary counseling on the availability of known financial
373resources for the patient's health care.
374     2.  A health care provider or a health care facility shall,
375upon request, disclose to each patient who is eligible for
376Medicare, in advance of treatment, whether the health care
377provider or the health care facility in which the patient is
378receiving medical services accepts assignment under Medicare
379reimbursement as payment in full for medical services and
380treatment rendered in the health care provider's office or
381health care facility.
382     3.  A health care provider or a health care facility shall,
383upon request, furnish a patient, prior to provision of medical
384services, a reasonable estimate of charges for such services.
385Such reasonable estimate shall not preclude the health care
386provider or health care facility from exceeding the estimate or
387making additional charges based on changes in the patient's
388condition or treatment needs.
389     4.  Each licensed facility not operated by the state shall
390make available to the public on its Internet website or by other
391electronic means information regarding the package price of
392service. The term "package price" means all facility-related
393charges for all services typically associated with a procedure
394or diagnosis related group. The facility shall maintain on its
395website a description of and a link to the agency's website
396which provides an average cost of the top 50 inpatient and top
39750 outpatient services provided. The facility shall place a
398notice in the reception areas that such information is available
399electronically and the website address. The licensed facility
400may indicate that the pricing information is based on a
401compilation of charges for the average patient and that each
402patient's bill may vary from the average depending upon the
403severity of illness and individual resources consumed. The
404licensed facility may also indicate that the price of service is
405negotiable for eligible patients based upon the patient's
406ability to pay.
407     5.4.  A patient has the right to receive a copy of an
408itemized bill upon request. A patient has a right to be given an
409explanation of charges upon request.
410     6.  Failure to provide data upon request shall result in a
411fine of $500 for each instance of the facility's failure to
412provide the requested information.
413     Section 4.  Subsection (1) and paragraph (g) of subsection
414(3) of section 381.734, Florida Statutes, are amended, and
415subsections (4), (5), and (6) are added to said section, to
416read:
417     381.734  Healthy Communities, Healthy People Program.--
418     (1)  The department shall develop and implement the Healthy
419Communities, Healthy People Program, a comprehensive and
420community-based health promotion and wellness program. The
421program shall be designed to reduce major behavioral risk
422factors associated with chronic diseases, including those
423chronic diseases identified in chapter 385, by enhancing the
424knowledge, skills, motivation, and opportunities for
425individuals, organizations, health care providers, small
426businesses, health insurers, and communities to develop and
427maintain healthy lifestyles.
428     (3)  The program shall include:
429     (g)  The establishment of a comprehensive program to inform
430the public, health care professionals, health insurers, and
431communities about the prevalence of chronic diseases in the
432state; known and potential risks, including social and
433behavioral risks; and behavior changes that would reduce risks.
434     (4)  The department shall make available on its Internet
435website, no later than October 1, 2004, and in a hard-copy
436format upon request, a listing of age-specific, disease-
437specific, and community-specific health promotion, preventive
438care, and wellness programs offered and established under the
439Healthy Communities, Healthy People Program. The website shall
440also provide residents with information to identify behavior
441risk factors that lead to diseases that are preventable by
442maintaining a healthy lifestyle. The website shall allow
443consumers to select by county or region disease-specific
444statistical information.
445     (5)  The department shall monitor and assess the
446effectiveness of such programs. The department shall submit a
447status report based on this monitoring and assessment to the
448Governor, the Speaker of the House of Representatives, the
449President of the Senate, and the substantive committees of each
450house of the Legislature, with the first annual report due
451January 31, 2005.
452     (6)  The Office of Program Policy and Government
453Accountability shall evaluate and report to the Governor, the
454President of the Senate, and the Speaker of the House of
455Representatives, by March 1, 2005, on the effectiveness of the
456department's monitoring and assessment of the program's
457effectiveness.
458     Section 5.  Subsection (7) is added to section 395.1041,
459Florida Statutes, to read:
460     395.1041  Access to emergency services and care.--
461     (7)  EMERGENCY ROOM DIVERSION PROGRAMS.--Hospitals may
462develop emergency room diversion programs, including, but not
463limited to, an "Emergency Hotline" which allows patients to help
464determine if emergency department services are appropriate or if
465other health care settings may be more appropriate for care, and
466a "Fast Track" program allowing nonemergency patients to be
467treated at an alternative site. Alternative sites may include
468health care programs funded with local tax revenue and federally
469funded community health centers, county health departments, or
470other nonhospital providers of health care services. The program
471may include provisions for followup care and case management.
472     Section 6.  Subsections (1), (2), and (3) of section
473395.301, Florida Statutes, are amended, and subsections (7),
474(8), (9), and (10) are added to said section, to read:
475     395.301  Itemized patient bill; form and content prescribed
476by the agency.--
477     (1)  A licensed facility not operated by the state shall
478notify each patient during admission and at discharge of his or
479her right to receive an itemized bill upon request. Within 7
480days following the patient's discharge or release from a
481licensed facility not operated by the state, or within 7 days
482after the earliest date at which the loss or expense from the
483service may be determined, the licensed facility providing the
484service shall, upon request, submit to the patient, or to the
485patient's survivor or legal guardian as may be appropriate, an
486itemized statement detailing in language comprehensible to an
487ordinary layperson the specific nature of charges or expenses
488incurred by the patient, which in the initial billing shall
489contain a statement of specific services received and expenses
490incurred for such items of service, enumerating in detail the
491constituent components of the services received within each
492department of the licensed facility and including unit price
493data on rates charged by the licensed facility, as prescribed by
494the agency.
495     (2)(a)  Each such statement submitted pursuant to this
496section:
497     1.(a)  May not include charges of hospital-based physicians
498if billed separately.
499     2.(b)  May not include any generalized category of expenses
500such as "other" or "miscellaneous" or similar categories.
501     3.(c)  Shall list drugs by brand or generic name and not
502refer to drug code numbers when referring to drugs of any sort.
503     4.(d)  Shall specifically identify therapy treatment as to
504the date, type, and length of treatment when therapy treatment
505is a part of the statement.
506     (b)  Any person receiving a statement pursuant to this
507section shall be fully and accurately informed as to each charge
508and service provided by the institution preparing the statement.
509     (3)  On each such itemized statement submitted pursuant to
510subsection (1) there shall appear the words "A FOR-PROFIT (or
511NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
512CENTER) LICENSED BY THE STATE OF FLORIDA" or substantially
513similar words sufficient to identify clearly and plainly the
514ownership status of the licensed facility. Each itemized
515statement must prominently display the phone number of the
516medical facility's patient liaison who is responsible for
517expediting the resolution of any billing dispute between the
518patient, or his or her representative, and the billing
519department.
520     (7)  Each licensed facility not operated by the state shall
521provide, prior to provision of any medical services, a written
522good-faith estimate of reasonably anticipated charges for the
523facility to treat the patient's condition upon request of a
524prospective patient who does not have insurance coverage or
525whose insurer or health maintenance organization does not have a
526contract with the hospital and an emergency medical condition
527does not exist or the service is not a covered service. The
528estimate may be the average charges for that diagnosis related
529group or the average charges for that procedure. Upon request,
530the facility shall notify the patient of any revision to the
531good-faith estimate. Such estimate shall not preclude the actual
532charges from exceeding the estimate. The facility shall place a
533notice in reception areas that such information is available
534electronically and the facility's website address. Failure to
535provide data upon request shall result in a fine of $500 for
536each instance of the facility's failure to provide the requested
537information.
538     (8)  A licensed facility shall make available to a patient
539all records necessary for verification of the accuracy of the
540patient's bill within 30 business days after the request for
541such records. The verification information must be made
542available in the facility's offices. Such records shall be
543available to the patient prior to and after payment of the bill
544or claim. The facility may not charge the patient for making
545such verification records available; however, the facility may
546charge its usual fee for providing copies of records as
547specified in s. 395.3025.
548     (9)  Each facility shall establish a method for reviewing
549and responding to questions from patients concerning the
550patient's itemized bill. Such response shall be provided within
55130 days after the date a question is received. If the patient is
552not satisfied with the response, the facility must provide the
553patient with the address of the agency to which the issue may be
554sent for review.
555     (10)  Each licensed facility shall make available on its
556Internet website a link to the performance outcome and financial
557data that is published by the Agency for Health Care
558Administration pursuant to s. 408.05(3)(l).
559     Section 7.  Subsection (1) of section 408.061, Florida
560Statutes, is amended to read:
561     408.061  Data collection; uniform systems of financial
562reporting; information relating to physician charges;
563confidential information; immunity.--
564     (1)  The agency shall may require the submission by health
565care facilities, health care providers, and health insurers of
566data necessary to carry out the agency's duties. Specifications
567for data to be collected under this section shall be developed
568by the agency with the assistance of technical advisory panels
569including representatives of affected entities, consumers,
570purchasers, and such other interested parties as may be
571determined by the agency.
572     (a)  Data to be submitted by health care facilities,
573including the facilities as defined in chapter 395, shall may
574include, but are not limited to: case-mix data, patient
575admission and or discharge data, outpatient data which shall
576include the number of patients treated in the emergency
577department of a licensed hospital reported by patient acuity
578level, data on hospital-acquired infections as specified by
579rule, data on complications as specified by rule, data on
580readmissions as specified by rule, with patient and provider-
581specific identifiers included, actual charge data by diagnostic
582groups, financial data, accounting data, operating expenses,
583expenses incurred for rendering services to patients who cannot
584or do not pay, interest charges, depreciation expenses based on
585the expected useful life of the property and equipment involved,
586and demographic data. The agency shall adopt the 3M All Patient
587Refined Diagnosis Related Group software risk and severity
588adjustment methodology for all data submitted as required by
589this section. Data may be obtained from documents such as, but
590not limited to: leases, contracts, debt instruments, itemized
591patient bills, medical record abstracts, and related diagnostic
592information. Reported data elements shall be reported
593electronically in accordance with Rule 59E-7.012, Florida
594Administrative Code. Data submitted shall be certified by the
595chief executive officer or an appropriate and duly authorized
596representative or employee of the licensed facility that the
597information submitted is true and accurate.
598     (b)  Data to be submitted by health care providers may
599include, but are not limited to: Medicare and Medicaid
600participation, types of services offered to patients, amount of
601revenue and expenses of the health care provider, and such other
602data which are reasonably necessary to study utilization
603patterns.
604     (c)  Data to be submitted by health insurers may include
605percentage of claims denied, percentage of claims meeting prompt
606pay requirements, and medical and administrative loss ratios,
607but are not limited to: claims, premium, administration, and
608financial information. Data submitted shall be certified by the
609appropriate and duly authorized representative or employee of
610the insurer that the information submitted is true and accurate.
611     (d)  Data required to be submitted by health care
612facilities, health care providers, or health insurers shall not
613include specific provider contract reimbursement information.
614However, such specific provider reimbursement data shall be
615reasonably available for onsite inspection by the agency as is
616necessary to carry out the agency's regulatory duties. Any such
617data obtained by the agency as a result of onsite inspections
618may not be used by the state for purposes of direct provider
619contracting and are confidential and exempt from the provisions
620of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
621     (e)  A requirement to submit data shall be adopted by rule
622if the submission of data is being required of all members of
623any type of health care facility, health care provider, or
624health insurer. Rules are not required, however, for the
625submission of data for a special study mandated by the
626Legislature or when information is being requested for a single
627health care facility, health care provider, or health insurer.
628     Section 8.  Subsections (1) and (4) of section 408.062,
629Florida Statutes, are amended, and subsection (5) is added to
630said section, to read:
631     408.062  Research, analyses, studies, and reports.--
632     (1)  The agency shall have the authority to conduct
633research, analyses, and studies relating to health care costs
634and access to and quality of health care services as access and
635quality are affected by changes in health care costs. Such
636research, analyses, and studies shall include, but not be
637limited to, research and analysis relating to:
638     (a)  The financial status of any health care facility or
639facilities subject to the provisions of this chapter.
640     (b)  The impact of uncompensated charity care on health
641care facilities and health care providers.
642     (c)  The state's role in assisting to fund indigent care.
643     (d)  In conjunction with the Office of Insurance
644Regulation, the availability and affordability of health
645insurance for small businesses.
646     (e)  Total health care expenditures in the state according
647to the sources of payment and the type of expenditure.
648     (f)  The quality of health services, using techniques such
649as small area analysis, severity adjustments, and risk-adjusted
650mortality rates.
651     (g)  The development of physician information payment
652systems which are capable of providing data for health care
653consumers taking into account the amount of resources consumed
654at licensed facilities as defined in chapter 395 and the
655outcomes produced in the delivery of care.
656     (h)  The collection of a statistically valid sample of data
657on the retail prices charged by pharmacies for the 50 most
658frequently prescribed medicines from any pharmacy licensed by
659this state as a special study authorized by the Legislature to
660be performed by the agency quarterly. If the drug is available
661generically, price data shall be reported for the generic drug
662and price data of a brand-named drug for which the generic drug
663is the equivalent shall be reported. The agency shall make
664available on its Internet website for each pharmacy, no later
665than October 1, 2005, drug prices for a 30-day supply at a
666standard dose. The data collected shall be reported for each
667drug by pharmacy and by metropolitan statistical area or region
668and updated quarterly The impact of subacute admissions on
669hospital revenues and expenses for purposes of calculating
670adjusted admissions as defined in s. 408.07.
671     (i)  The use of emergency department services by patient
672acuity level and the implication of increasing hospital cost by
673providing nonurgent care in emergency departments. The agency
674shall submit an annual report based on this monitoring and
675assessment to the Governor, the Speaker of the House of
676Representatives, the President of the Senate, and the
677substantive legislative committees with the first report due
678January 1, 2006.
679     (j)  The making available on its Internet website no later
680than October 1, 2004, and in a hard-copy format upon request, of
681patient charge, volumes, length of stay, and performance outcome
682indicators collected from health care facilities pursuant to s.
683408.061(1)(a) for specific medical conditions, surgeries, and
684procedures provided in inpatient and outpatient facilities as
685determined by the agency. In making the determination of
686specific medical conditions, surgeries, and procedures to
687include, the agency shall consider such factors as volume,
688severity of the illness, urgency of admission, individual and
689societal costs, and whether the condition is acute or chronic.
690Performance outcome indicators shall be risk adjusted or
691severity adjusted, as applicable, using 3M All Patient Refined
692Diagnosis Related Groups. The website shall also provide an
693interactive search that allows consumers to view and compare the
694information for specific facilities, a map that allows consumers
695to select a county or region, definitions of all of the data,
696descriptions of each procedure, and an explanation about why the
697data may differ from facility to facility. Such public data
698shall be updated quarterly. The agency shall submit an annual
699status report on the collection of data and publication of
700performance outcome indicators to the Governor, the Speaker of
701the House of Representatives, the President of the Senate, and
702the substantive legislative committees with the first status
703report due January 1, 2005.
704     (4)(a)  The agency shall may conduct data-based studies and
705evaluations and make recommendations to the Legislature and the
706Governor concerning exemptions, the effectiveness of limitations
707of referrals, restrictions on investment interests and
708compensation arrangements, and the effectiveness of public
709disclosure. Such analysis shall may include, but need not be
710limited to, utilization of services, cost of care, quality of
711care, and access to care. The agency may require the submission
712of data necessary to carry out this duty, which may include, but
713need not be limited to, data concerning ownership, Medicare and
714Medicaid, charity care, types of services offered to patients,
715revenues and expenses, patient-encounter data, and other data
716reasonably necessary to study utilization patterns and the
717impact of health care provider ownership interests in health-
718care-related entities on the cost, quality, and accessibility of
719health care.
720     (b)  The agency may collect such data from any health
721facility or licensed health care provider as a special study.
722     (5)  The agency shall develop and implement a strategy for
723the adoption and use of electronic health records. The agency
724may develop rules to facilitate the functionality and protect
725the confidentiality of electronic health records. The agency
726shall report to the Governor, the Speaker of the House of
727Representatives, and the President of the Senate on legislative
728recommendations to protect the confidentiality of electronic
729health records.
730     Section 9.  Paragraph (l) is added to subsection (3) of
731section 408.05, Florida Statutes, to read:
732     408.05  State Center for Health Statistics.--
733     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
734produce comparable and uniform health information and
735statistics, the agency shall perform the following functions:
736     (l)  Develop, in conjunction with the State Comprehensive
737Health Information System Advisory Council, and implement a
738long-range plan for making available performance outcome and
739financial data that will allow consumers to compare health care
740services. The performance outcomes and financial data the agency
741must make available shall include, but is not limited to,
742pharmaceuticals, physicians, health care facilities, and health
743plans and managed care entities. The agency shall submit the
744initial plan to the Governor, the President of the Senate, and
745the Speaker of the House of Representatives by March 1, 2005,
746and shall update the plan and report on the status of its
747implementation annually thereafter. The agency shall also make
748the plan and status report available to the public on its
749Internet website. As part of the plan, the agency shall identify
750the process and timeframes for implementation, any barriers to
751implementation, and recommendations of changes in the law that
752may be enacted by the Legislature to eliminate the barriers. As
753preliminary elements of the plan, the agency shall:
754     1.  Make available performance outcome and patient charge
755data collected from health care facilities pursuant to s.
756408.061(1)(a) and (2). The agency shall determine which
757conditions and procedures, performance outcomes, and patient
758charge data to disclose based upon input from the council. When
759determining which conditions and procedures are to be disclosed,
760the council and the agency shall consider variation in costs,
761variation in outcomes, and magnitude of variations and other
762relevant information. When determining which performance
763outcomes to disclose, the agency:
764     a.  Shall consider such factors as volume of cases; average
765patient charges; average length of stay; complication rates;
766mortality rates; and infection rates, among others, which shall
767be adjusted for case mix and severity, if applicable.
768     b.  May consider such additional measures that are adopted
769by the Centers for Medicare and Medicaid Studies, National
770Quality Forum, the Joint Commission on Accreditation of
771Healthcare Organizations, the Agency for Healthcare Research and
772Quality, or a similar national entity that establishes standards
773to measure the performance of health care providers, or by other
774states.
775
776When determining which patient charge data to disclose, the
777agency shall consider such measures as average charge, average
778net revenue per adjusted patient day, average cost per adjusted
779patient day, and average cost per admission, among others.
780     2.  Make available performance measures, benefit design,
781and premium cost data from health plans licensed pursuant to
782chapter 627 or chapter 641. The agency shall determine which
783performance outcome and member and subscriber cost data to
784disclose, based upon input from the council. When determining
785which data to disclose, the agency shall consider information
786that may be required by either individual or group purchasers to
787assess the value of the product, which may include membership
788satisfaction, quality of care, current enrollment or membership,
789coverage areas, accreditation status, premium costs, plan costs,
790premium increases, range of benefits, copayments and
791deductibles, accuracy and speed of claims payment, credentials
792of physicians, number of providers, names of network providers,
793and hospitals in the network.
794     3.  Determine the method and format for public disclosure
795of data reported pursuant to this paragraph. The agency shall
796make its determination based upon input from the Comprehensive
797Health Information System Advisory Council. At a minimum, the
798data shall be made available on the agency's Internet website in
799a manner that allows consumers to conduct an interactive search
800that allows them to view and compare the information for
801specific providers. The website must include such additional
802information as is determined necessary to ensure that the
803website enhances informed decision making among consumers and
804health care purchasers, which shall include, at a minimum,
805appropriate guidance on how to use the data and an explanation
806of why the data may vary from provider to provider. The data
807specified in subparagraph 1. shall be released no later than
808March 1, 2005. The data specified in subparagraph 2. shall be
809released no later than March 1, 2006.
810     Section 10.  Subsection (3) of section 409.9066, Florida
811Statutes, is amended to read:
812     409.9066  Medicare prescription discount program.--
813     (3)  The Agency for Health Care Administration shall
814publish, on a free website available to the public, the most
815recent average wholesale prices for the 200 drugs most
816frequently dispensed to the elderly and, to the extent possible,
817shall provide a mechanism that consumers may use to calculate
818the retail price and the price that should be paid after the
819discount required in subsection (1) is applied. The agency shall
820provide retail information by geographic area and retail
821information by provider within geographical areas.
822     Section 11.  Section 408.7056, Florida Statutes, is amended
823to read:
824     408.7056  Statewide Provider and Subscriber Assistance
825Program.--
826     (1)  As used in this section, the term:
827     (a)  "Agency" means the Agency for Health Care
828Administration.
829     (b)  "Department" means the Department of Financial
830Services.
831     (c)  "Grievance procedure" means an established set of
832rules that specify a process for appeal of an organizational
833decision.
834     (d)  "Health care provider" or "provider" means a state-
835licensed or state-authorized facility, a facility principally
836supported by a local government or by funds from a charitable
837organization that holds a current exemption from federal income
838tax under s. 501(c)(3) of the Internal Revenue Code, a licensed
839practitioner, a county health department established under part
840I of chapter 154, a prescribed pediatric extended care center
841defined in s. 400.902, a federally supported primary care
842program such as a migrant health center or a community health
843center authorized under s. 329 or s. 330 of the United States
844Public Health Services Act that delivers health care services to
845individuals, or a community facility that receives funds from
846the state under the Community Alcohol, Drug Abuse, and Mental
847Health Services Act and provides mental health services to
848individuals.
849     (e)  "Managed care entity" means a health maintenance
850organization or a prepaid health clinic certified under chapter
851641, a prepaid health plan authorized under s. 409.912, or an
852exclusive provider organization certified under s. 627.6472.
853     (f)  "Office" means the Office of Insurance Regulation of
854the Financial Services Commission.
855     (g)  "Panel" means a statewide provider and subscriber
856assistance panel selected as provided in subsection (11).
857     (2)  The agency shall adopt and implement a program to
858provide assistance to subscribers and providers, including those
859whose grievances are not resolved by the managed care entity to
860the satisfaction of the subscriber or provider. The program
861shall consist of one or more panels that meet as often as
862necessary to timely review, consider, and hear grievances and
863recommend to the agency or the office any actions that should be
864taken concerning individual cases heard by the panel. The panel
865shall hear every grievance filed by subscribers and providers on
866behalf of subscribers, unless the grievance:
867     (a)  Relates to a managed care entity's refusal to accept a
868provider into its network of providers;
869     (b)  Is part of an internal grievance in a Medicare managed
870care entity or a reconsideration appeal through the Medicare
871appeals process which does not involve a quality of care issue;
872     (c)  Is related to a health plan not regulated by the state
873such as an administrative services organization, third-party
874administrator, or federal employee health benefit program;
875     (d)  Is related to appeals by in-plan suppliers and
876providers, unless related to quality of care provided by the
877plan;
878     (e)  Is part of a Medicaid fair hearing pursued under 42
879C.F.R. ss. 431.220 et seq.;
880     (f)  Is the basis for an action pending in state or federal
881court;
882     (g)  Is related to an appeal by nonparticipating providers,
883unless related to the quality of care provided to a subscriber
884by the managed care entity and the provider is involved in the
885care provided to the subscriber;
886     (h)  Was filed before the subscriber or provider completed
887the entire internal grievance procedure of the managed care
888entity, the managed care entity has complied with its timeframes
889for completing the internal grievance procedure, and the
890circumstances described in subsection (6) do not apply;
891     (i)  Has been resolved to the satisfaction of the
892subscriber or provider who filed the grievance, unless the
893managed care entity's initial action is egregious or may be
894indicative of a pattern of inappropriate behavior;
895     (j)  Is limited to seeking damages for pain and suffering,
896lost wages, or other incidental expenses, including accrued
897interest on unpaid balances, court costs, and transportation
898costs associated with a grievance procedure;
899     (k)  Is limited to issues involving conduct of a health
900care provider or facility, staff member, or employee of a
901managed care entity which constitute grounds for disciplinary
902action by the appropriate professional licensing board and is
903not indicative of a pattern of inappropriate behavior, and the
904agency, office, or department has reported these grievances to
905the appropriate professional licensing board or to the health
906facility regulation section of the agency for possible
907investigation; or
908     (l)  Is withdrawn by the subscriber or provider. Failure of
909the subscriber or the provider to attend the hearing shall be
910considered a withdrawal of the grievance; or
911     (m)  Is related to a specific exclusion, an express
912limitation, or a benefit or service not covered by the
913subscriber contract issued to the member.
914     (3)  The agency shall review all grievances within 60 days
915after receipt and make a determination whether the grievance
916shall be heard. Once the agency notifies the panel, the
917subscriber or provider, and the managed care entity that a
918grievance will be heard by the panel, the panel shall hear the
919grievance either in the network area or by teleconference no
920later than 120 days after the date the grievance was filed. The
921agency shall notify the parties, in writing, by facsimile
922transmission, or by phone, of the time and place of the hearing.
923The panel may take testimony under oath, request certified
924copies of documents, and take similar actions to collect
925information and documentation that will assist the panel in
926making findings of fact and a recommendation. The panel shall
927issue a written recommendation, supported by findings of fact,
928to the provider or subscriber, to the managed care entity, and
929to the agency or the office no later than 15 working days after
930hearing the grievance. If at the hearing the panel requests
931additional documentation or additional records, the time for
932issuing a recommendation is tolled until the information or
933documentation requested has been provided to the panel. The
934proceedings of the panel are not subject to chapter 120.
935     (4)  If, upon receiving a proper patient authorization
936along with a properly filed grievance, the agency requests
937medical records from a health care provider or managed care
938entity, the health care provider or managed care entity that has
939custody of the records has 10 days to provide the records to the
940agency. Records include medical records, communication logs
941associated with the grievance both to and from the subscriber,
942contracts, and any other contents of the internal grievance file
943associated with the complaint filed with the Subscriber
944Assistance Program. Failure to provide requested medical records
945may result in the imposition of a fine of up to $500. Each day
946that records are not produced is considered a separate
947violation.
948     (5)  Grievances that the agency determines pose an
949immediate and serious threat to a subscriber's health must be
950given priority over other grievances. The panel may meet at the
951call of the chair to hear the grievances as quickly as possible
952but no later than 45 days after the date the grievance is filed,
953unless the panel receives a waiver of the time requirement from
954the subscriber. The panel shall issue a written recommendation,
955supported by findings of fact, to the office or the agency
956within 10 days after hearing the expedited grievance.
957     (6)  When the agency determines that the life of a
958subscriber is in imminent and emergent jeopardy, the chair of
959the panel may convene an emergency hearing, within 24 hours
960after notification to the managed care entity and to the
961subscriber, to hear the grievance. The grievance must be heard
962notwithstanding that the subscriber has not completed the
963internal grievance procedure of the managed care entity. The
964panel shall, upon hearing the grievance, issue a written
965emergency recommendation, supported by findings of fact, to the
966managed care entity, to the subscriber, and to the agency or the
967office for the purpose of deferring the imminent and emergent
968jeopardy to the subscriber's life. Within 24 hours after receipt
969of the panel's emergency recommendation, the agency or office
970may issue an emergency order to the managed care entity. An
971emergency order remains in force until:
972     (a)  The grievance has been resolved by the managed care
973entity;
974     (b)  Medical intervention is no longer necessary; or
975     (c)  The panel has conducted a full hearing under
976subsection (3) and issued a recommendation to the agency or the
977office, and the agency or office has issued a final order.
978     (7)  After hearing a grievance, the panel shall make a
979recommendation to the agency or the office which may include
980specific actions the managed care entity must take to comply
981with state laws or rules regulating managed care entities.
982     (8)  A managed care entity, subscriber, or provider that is
983affected by a panel recommendation may within 10 days after
984receipt of the panel's recommendation, or 72 hours after receipt
985of a recommendation in an expedited grievance, furnish to the
986agency or office written evidence in opposition to the
987recommendation or findings of fact of the panel.
988     (9)  No later than 30 days after the issuance of the
989panel's recommendation and, for an expedited grievance, no later
990than 10 days after the issuance of the panel's recommendation,
991the agency or the office may adopt the panel's recommendation or
992findings of fact in a proposed order or an emergency order, as
993provided in chapter 120, which it shall issue to the managed
994care entity. The agency or office may issue a proposed order or
995an emergency order, as provided in chapter 120, imposing fines
996or sanctions, including those contained in ss. 641.25 and
997641.52. The agency or the office may reject all or part of the
998panel's recommendation. All fines collected under this
999subsection must be deposited into the Health Care Trust Fund.
1000     (10)  In determining any fine or sanction to be imposed,
1001the agency and the office may consider the following factors:
1002     (a)  The severity of the noncompliance, including the
1003probability that death or serious harm to the health or safety
1004of the subscriber will result or has resulted, the severity of
1005the actual or potential harm, and the extent to which provisions
1006of chapter 641 were violated.
1007     (b)  Actions taken by the managed care entity to resolve or
1008remedy any quality-of-care grievance.
1009     (c)  Any previous incidents of noncompliance by the managed
1010care entity.
1011     (d)  Any other relevant factors the agency or office
1012considers appropriate in a particular grievance.
1013     (11)(a)  The panel shall consist of the Insurance Consumer
1014Advocate, or designee thereof, established by s. 627.0613; at
1015least two members employed by the agency and at least two
1016members employed by the department, chosen by their respective
1017agencies; a consumer appointed by the Governor; a physician
1018appointed by the Governor, as a standing member; and, if
1019necessary, physicians who have expertise relevant to the case to
1020be heard, on a rotating basis. The agency may contract with a
1021medical director, and a primary care physician, or both, who
1022shall provide additional technical expertise to the panel but
1023shall not be voting members of the panel. The medical director
1024shall be selected from a health maintenance organization with a
1025current certificate of authority to operate in Florida.
1026     (b)  A majority of those panel members required under
1027paragraph (a) shall constitute a quorum for any meeting or
1028hearing of the panel. A grievance may not be heard or voted upon
1029at any panel meeting or hearing unless a quorum is present,
1030except that a minority of the panel may adjourn a meeting or
1031hearing until a quorum is present. A panel convened for the
1032purpose of hearing a subscriber's grievance in accordance with
1033subsections (2) and (3) shall not consist of more than 11
1034members.
1035     (12)  Every managed care entity shall submit a quarterly
1036report to the agency, the office, and the department listing the
1037number and the nature of all subscribers' and providers'
1038grievances which have not been resolved to the satisfaction of
1039the subscriber or provider after the subscriber or provider
1040follows the entire internal grievance procedure of the managed
1041care entity. The agency shall notify all subscribers and
1042providers included in the quarterly reports of their right to
1043file an unresolved grievance with the panel.
1044     (13)  A proposed order issued by the agency or office which
1045only requires the managed care entity to take a specific action
1046under subsection (7) is subject to a summary hearing in
1047accordance with s. 120.574, unless all of the parties agree
1048otherwise. If the managed care entity does not prevail at the
1049hearing, the managed care entity must pay reasonable costs and
1050attorney's fees of the agency or the office incurred in that
1051proceeding.
1052     (14)(a)  Any information that identifies a subscriber which
1053is held by the panel, agency, or department pursuant to this
1054section is confidential and exempt from the provisions of s.
1055119.07(1) and s. 24(a), Art. I of the State Constitution.
1056However, at the request of a subscriber or managed care entity
1057involved in a grievance procedure, the panel, agency, or
1058department shall release information identifying the subscriber
1059involved in the grievance procedure to the requesting subscriber
1060or managed care entity.
1061     (b)  Meetings of the panel shall be open to the public
1062unless the provider or subscriber whose grievance will be heard
1063requests a closed meeting or the agency or the department
1064determines that information which discloses the subscriber's
1065medical treatment or history or information relating to internal
1066risk management programs as defined in s. 641.55(5)(c), (6), and
1067(8) may be revealed at the panel meeting, in which case that
1068portion of the meeting during which a subscriber's medical
1069treatment or history or internal risk management program
1070information is discussed shall be exempt from the provisions of
1071s. 286.011 and s. 24(b), Art. I of the State Constitution. All
1072closed meetings shall be recorded by a certified court reporter.
1073     Section 12.  Paragraph (c) of subsection (4) of section
1074641.3154, Florida Statutes, is amended to read:
1075     641.3154  Organization liability; provider billing
1076prohibited.--
1077     (4)  A provider or any representative of a provider,
1078regardless of whether the provider is under contract with the
1079health maintenance organization, may not collect or attempt to
1080collect money from, maintain any action at law against, or
1081report to a credit agency a subscriber of an organization for
1082payment of services for which the organization is liable, if the
1083provider in good faith knows or should know that the
1084organization is liable. This prohibition applies during the
1085pendency of any claim for payment made by the provider to the
1086organization for payment of the services and any legal
1087proceedings or dispute resolution process to determine whether
1088the organization is liable for the services if the provider is
1089informed that such proceedings are taking place. It is presumed
1090that a provider does not know and should not know that an
1091organization is liable unless:
1092     (c)  The office or agency makes a final determination that
1093the organization is required to pay for such services subsequent
1094to a recommendation made by the Statewide Provider and
1095Subscriber Assistance Panel pursuant to s. 408.7056; or
1096     Section 13.  Subsection (1), paragraphs (b) and (e) of
1097subsection (3), paragraph (d) of subsection (4), subsection (5),
1098paragraph (g) of subsection (6), and subsections (9), (10), and
1099(11) of section 641.511, Florida Statutes, are amended to read:
1100     641.511  Subscriber grievance reporting and resolution
1101requirements.--
1102     (1)  Every organization must have a grievance procedure
1103available to its subscribers for the purpose of addressing
1104complaints and grievances. Every organization must notify its
1105subscribers that a subscriber must submit a grievance within 1
1106year after the date of occurrence of the action that initiated
1107the grievance, and may submit the grievance for review to the
1108Statewide Provider and Subscriber Assistance Program panel as
1109provided in s. 408.7056 after receiving a final disposition of
1110the grievance through the organization's grievance process. An
1111organization shall maintain records of all grievances and shall
1112report annually to the agency the total number of grievances
1113handled, a categorization of the cases underlying the
1114grievances, and the final disposition of the grievances.
1115     (3)  Each organization's grievance procedure, as required
1116under subsection (1), must include, at a minimum:
1117     (b)  The names of the appropriate employees or a list of
1118grievance departments that are responsible for implementing the
1119organization's grievance procedure. The list must include the
1120address and the toll-free telephone number of each grievance
1121department, the address of the agency and its toll-free
1122telephone hotline number, and the address of the Statewide
1123Provider and Subscriber Assistance Program and its toll-free
1124telephone number.
1125     (e)  A notice that a subscriber may voluntarily pursue
1126binding arbitration in accordance with the terms of the contract
1127if offered by the organization, after completing the
1128organization's grievance procedure and as an alternative to the
1129Statewide Provider and Subscriber Assistance Program. Such
1130notice shall include an explanation that the subscriber may
1131incur some costs if the subscriber pursues binding arbitration,
1132depending upon the terms of the subscriber's contract.
1133     (4)
1134     (d)  In any case when the review process does not resolve a
1135difference of opinion between the organization and the
1136subscriber or the provider acting on behalf of the subscriber,
1137the subscriber or the provider acting on behalf of the
1138subscriber may submit a written grievance to the Statewide
1139Provider and Subscriber Assistance Program.
1140     (5)  Except as provided in subsection (6), the organization
1141shall resolve a grievance within 60 days after receipt of the
1142grievance, or within a maximum of 90 days if the grievance
1143involves the collection of information outside the service area.
1144These time limitations are tolled if the organization has
1145notified the subscriber, in writing, that additional information
1146is required for proper review of the grievance and that such
1147time limitations are tolled until such information is provided.
1148After the organization receives the requested information, the
1149time allowed for completion of the grievance process resumes.
1150The Employee Retirement Income Security Act of 1974, as
1151implemented by 29 C.F.R. 2560.503-1, is adopted and incorporated
1152by reference as applicable to all organizations that administer
1153small and large group health plans that are subject to 29 C.F.R.
11542560.503-1. The claims procedures of the regulations of the
1155Employee Retirement Income Security Act of 1974 as implemented
1156by 29 C.F.R. 2560.503-1 shall be the minimum standards for
1157grievance processes for claims for benefits for small and large
1158group health plans that are subject to 29 C.F.R. 2560.503-1.
1159     (6)
1160     (g)  In any case when the expedited review process does not
1161resolve a difference of opinion between the organization and the
1162subscriber or the provider acting on behalf of the subscriber,
1163the subscriber or the provider acting on behalf of the
1164subscriber may submit a written grievance to the Statewide
1165Provider and Subscriber Assistance Program.
1166     (9)(a)  The agency shall advise subscribers with grievances
1167to follow their organization's formal grievance process for
1168resolution prior to review by the Statewide Provider and
1169Subscriber Assistance Program. The subscriber may, however,
1170submit a copy of the grievance to the agency at any time during
1171the process.
1172     (b)  Requiring completion of the organization's grievance
1173process before the Statewide Provider and Subscriber Assistance
1174Program panel's review does not preclude the agency from
1175investigating any complaint or grievance before the organization
1176makes its final determination.
1177     (10)  Each organization must notify the subscriber in a
1178final decision letter that the subscriber may request review of
1179the organization's decision concerning the grievance by the
1180Statewide Provider and Subscriber Assistance Program, as
1181provided in s. 408.7056, if the grievance is not resolved to the
1182satisfaction of the subscriber. The final decision letter must
1183inform the subscriber that the request for review must be made
1184within 365 days after receipt of the final decision letter, must
1185explain how to initiate such a review, and must include the
1186addresses and toll-free telephone numbers of the agency and the
1187Statewide Provider and Subscriber Assistance Program.
1188     (11)  Each organization, as part of its contract with any
1189provider, must require the provider to post a consumer
1190assistance notice prominently displayed in the reception area of
1191the provider and clearly noticeable by all patients. The
1192consumer assistance notice must state the addresses and toll-
1193free telephone numbers of the Agency for Health Care
1194Administration, the Statewide Provider and Subscriber Assistance
1195Program, and the Department of Financial Services. The consumer
1196assistance notice must also clearly state that the address and
1197toll-free telephone number of the organization's grievance
1198department shall be provided upon request. The agency may adopt
1199rules to implement this section.
1200     Section 14.  Subsection (4) of section 641.58, Florida
1201Statutes, is amended to read:
1202     641.58  Regulatory assessment; levy and amount; use of
1203funds; tax returns; penalty for failure to pay.--
1204     (4)  The moneys received and deposited into the Health Care
1205Trust Fund shall be used to defray the expenses of the agency in
1206the discharge of its administrative and regulatory powers and
1207duties under this part, including conducting an annual survey of
1208the satisfaction of members of health maintenance organizations;
1209contracting with physician consultants for the Statewide
1210Provider and Subscriber Assistance Panel; maintaining offices
1211and necessary supplies, essential equipment, and other
1212materials, salaries and expenses of required personnel; and
1213discharging the administrative and regulatory powers and duties
1214imposed under this part.
1215     Section 15.  Paragraph (f) of subsection (2) and
1216subsections (3) and (9) of section 408.909, Florida Statutes,
1217are amended to read:
1218     408.909  Health flex plans.--
1219     (2)  DEFINITIONS.--As used in this section, the term:
1220     (f)  "Health flex plan entity" means a health insurer,
1221health maintenance organization, health-care-provider-sponsored
1222organization, local government, health care district, or other
1223public or private community-based organization, or public-
1224private partnership that develops and implements an approved
1225health flex plan and is responsible for administering the health
1226flex plan and paying all claims for health flex plan coverage by
1227enrollees of the health flex plan.
1228     (3)  PILOT PROGRAM.--The agency and the office shall each
1229approve or disapprove health flex plans that provide health care
1230coverage for eligible participants who reside in the three areas
1231of the state that have the highest number of uninsured persons,
1232as identified in the Florida Health Insurance Study conducted by
1233the agency and in Indian River County. A health flex plan may
1234limit or exclude benefits otherwise required by law for insurers
1235offering coverage in this state, may cap the total amount of
1236claims paid per year per enrollee, may limit the number of
1237enrollees, or may take any combination of those actions. A
1238health flex plan offering may include the option of a
1239catastrophic plan supplementing the health flex plan.
1240     (a)  The agency shall develop guidelines for the review of
1241applications for health flex plans and shall disapprove or
1242withdraw approval of plans that do not meet or no longer meet
1243minimum standards for quality of care and access to care. The
1244agency shall ensure that the health flex plans follow
1245standardized grievance procedures similar to those required of
1246health maintenance organizations.
1247     (b)  The office shall develop guidelines for the review of
1248health flex plan applications and provide regulatory oversight
1249of health flex plan advertisement and marketing procedures. The
1250office shall disapprove or shall withdraw approval of plans
1251that:
1252     1.  Contain any ambiguous, inconsistent, or misleading
1253provisions or any exceptions or conditions that deceptively
1254affect or limit the benefits purported to be assumed in the
1255general coverage provided by the health flex plan;
1256     2.  Provide benefits that are unreasonable in relation to
1257the premium charged or contain provisions that are unfair or
1258inequitable or contrary to the public policy of this state, that
1259encourage misrepresentation, or that result in unfair
1260discrimination in sales practices; or
1261     3.  Cannot demonstrate that the health flex plan is
1262financially sound and that the applicant is able to underwrite
1263or finance the health care coverage provided.
1264     (c)  The agency and the Financial Services Commission may
1265adopt rules as needed to administer this section.
1266     (9)  PROGRAM EVALUATION.--The agency and the office shall
1267evaluate the pilot program and its effect on the entities that
1268seek approval as health flex plans, on the number of enrollees,
1269and on the scope of the health care coverage offered under a
1270health flex plan; shall provide an assessment of the health flex
1271plans and their potential applicability in other settings; shall
1272use health flex plans to gather more information to evaluate
1273low-income consumer driven benefit packages; and shall, by
1274January 1, 2005, and annually thereafter 2004, jointly submit a
1275report to the Governor, the President of the Senate, and the
1276Speaker of the House of Representatives.
1277     Section 16.  Section 381.0271, Florida Statutes, is created
1278to read:
1279     381.0271  Florida Patient Safety Corporation.--
1280     (1)  DEFINITIONS.--As used in this section, the term:
1281     (a)  "Adverse incident" has the same meanings provided in
1282ss. 395.0197, 458.351, and 459.026.
1283     (b)  "Corporation" means the Florida Patient Safety
1284Corporation.
1285     (c)  "Patient safety data" has the same meaning provided in
1286s. 766.1016.
1287     (2)  CREATION.--
1288     (a)  The Florida Patient Safety Corporation is created as a
1289not-for-profit corporation and shall be registered,
1290incorporated, organized, and operated in compliance with chapter
1291617. The corporation may create not-for-profit corporate
1292subsidiaries that are organized under the provisions of chapter
1293617, upon the prior approval of the board of directors, as
1294necessary, to fulfill its mission.
1295     (b)  The corporation and any authorized and approved
1296subsidiary are not an agency as defined in s. 20.03(11).
1297     (c)  The corporation and any authorized and approved
1298subsidiary are subject to the public meetings and records
1299requirements of s. 24, Art. I of the State Constitution, chapter
1300119, and s. 286.011.
1301     (d)  The corporation and any authorized and approved
1302subsidiary are not subject to the provisions of chapter 287.
1303     (e)  The corporation is a patient safety organization as
1304defined in s. 766.1016.
1305     (3)  PURPOSE.--
1306     (a)  The purpose of the corporation is to serve as a
1307learning organization dedicated to assisting health care
1308providers in this state to improve the quality and safety of
1309health care rendered and to reduce harm to patients. The
1310corporation shall promote the development of a culture of
1311patient safety in the health care system in this state. The
1312corporation shall not regulate health care providers in this
1313state.
1314     (b)  In fulfilling its purpose, the corporation shall work
1315with a consortium of patient safety centers and other patient
1316safety programs.
1317     (4)  BOARD OF DIRECTORS; MEMBERSHIP.--The corporation shall
1318be governed by a board of directors. The board of directors
1319shall consist of:
1320     (a)  The chair of the Florida Council of Medical School
1321Deans.
1322     (b)  Two persons responsible for patient safety issues for
1323the authorized health insurer and authorized health maintenance
1324organization with the largest market shares, respectively, as
1325measured by premiums written in the state for the most recent
1326calendar year, appointed by such insurer.
1327     (c)  A representative of an authorized medical malpractice
1328insurer appointed by the Florida Insurance Council.
1329     (d)  The president of the Central Florida Health Care
1330Coalition.
1331     (e)  Two representatives of a hospital in this state that
1332is implementing innovative patient safety initiatives, appointed
1333by the Florida Hospital Association.
1334     (f)  A physician with expertise in patient safety,
1335appointed by the Florida Medical Association.
1336     (g)  A physician with expertise in patient safety,
1337appointed by the Florida Osteopathic Medical Association.
1338     (h)  A physician with expertise in patient safety,
1339appointed by the Florida Podiatric Medical Association.
1340     (i)  A physician with expertise in patient safety,
1341appointed by the Florida Chiropractic Association.
1342     (j)  A dentist with expertise in patient safety, appointed
1343by the Florida Dental Association.
1344     (k)  A nurse with expertise in patient safety, appointed by
1345the Florida Nurses Association.
1346     (l)  An institutional pharmacist, appointed by the Florida
1347Society of Health-System Pharmacists.
1348     (m)  A representative of Florida AARP, appointed by the
1349state director of Florida AARP.
1350     (5)  ADVISORY COMMITTEES.--In addition to any committees
1351that the corporation may establish, the corporation shall
1352establish the following advisory committees:
1353     (a)  A scientific research advisory committee that
1354includes, at a minimum, a representative from each patient
1355safety center or other patient safety program in the
1356universities of the state who are physicians licensed pursuant
1357to chapter 458 or chapter 459, with experience in patient safety
1358and evidenced-based medicine. The duties of the advisory
1359committee shall include, but not be limited to, the analysis of
1360existing data and research to improve patient safety and
1361encourage evidence-based medicine.
1362     (b)  A technology advisory committee that includes, at a
1363minimum, a representative of a hospital that has implemented a
1364computerized physician order entry system and a health care
1365provider that has implemented an electronic medical records
1366system. The duties of the advisory committee shall include, but
1367not be limited to, implementation of new technologies, including
1368electronic medical records.
1369     (c)  A health care provider advisory committee that
1370includes, at a minimum, representatives of hospitals, ambulatory
1371surgical centers, physicians, nurses, and pharmacists licensed
1372in this state and a representative of the Veterans Integrated
1373Service Network 8, Virginia Patient Safety Center. The duties of
1374the advisory committee shall include, but not be limited to,
1375promotion of a culture of patient safety that reduces errors.
1376     (d)  A health care consumer advisory committee that
1377includes, at a minimum, representatives of businesses that
1378provide health insurance coverage to their employees, consumer
1379advocacy groups, and representatives of patient safety
1380organizations. The duties of the advisory committee shall
1381include, but not be limited to, incentives to encourage patient
1382safety and the efficiency and quality of care.
1383     (e)  A state agency advisory committee that includes, at a
1384minimum, a representative from each state agency that has
1385regulatory responsibilities related to patient safety. The
1386duties of the advisory committee shall include, but not be
1387limited to, interagency coordination of patient safety efforts.
1388     (f)  A tort advisory committee that includes, at a minimum,
1389representatives of medical malpractice attorneys for plaintiffs
1390and defendants and a representative of each law school in the
1391state. The duties of the advisory committee shall include, but
1392not be limited to, alternatives systems to compensate for
1393injuries.
1394     (6)  ORGANIZATION; MEETINGS.--
1395     (a)  The Agency for Health Care Administration shall assist
1396the corporation in its organizational activities required under
1397chapter 617, including, but not limited to:
1398     1.  Eliciting appointments for the initial board of
1399directors.
1400     2.  Convening the first meeting of the board of directors
1401and assisting with other meetings of the board of directors,
1402upon request of the board of directors, during the first year of
1403operation of the corporation.
1404     3.  Drafting articles of incorporation for the board of
1405directors and, upon request of the board of directors,
1406delivering articles of incorporation to the Department of State
1407for filing.
1408     4.  Drafting proposed bylaws for the corporation.
1409     5.  Paying fees related to incorporation.
1410     6.  Providing office space and administrative support, at
1411the request of the board of directors, but not beyond July 1,
14122005.
1413     (b)  The board of directors must conduct its first meeting
1414no later than August 1, 2004, and shall meet thereafter as
1415frequently as necessary to carry out the duties of the
1416corporation.
1417     (7)  POWERS AND DUTIES.--
1418     (a)  In addition to the powers and duties prescribed in
1419chapter 617, and the articles and bylaws adopted under that
1420chapter, the corporation shall, directly or through contract:
1421     1.  Secure staff necessary to properly administer the
1422corporation.
1423     2.  Collect, analyze, and evaluate patient safety data and
1424quality and patient safety indicators, medical malpractice
1425closed claims, and adverse incidents reported to the Agency for
1426Health Care Administration and the Department of Health for the
1427purpose of recommending changes in practices and procedures that
1428may be implemented by health care practitioners and health care
1429facilities to improve health care quality and to prevent future
1430adverse incidents. Notwithstanding any other provision of law,
1431the Agency for Health Care Administration and the Department of
1432Health shall make available to the corporation any adverse
1433incident report submitted under ss. 395.0197, 458.351, and
1434459.026. To the extent that adverse incident reports submitted
1435under s. 395.0197 are confidential and exempt, the confidential
1436and exempt status of such reports shall be maintained by the
1437corporation.
1438     3.  Establish a 3-year pilot project of a "near-miss,"
1439patient safety reporting system. The purpose of the near-miss
1440reporting system is to: identify potential systemic problems
1441that could lead to adverse incidents; enable publication of
1442systemwide alerts of potential harm; and facilitate development
1443of both facility-specific and statewide options to avoid adverse
1444incidents and improve patient safety. The reporting system shall
1445record "near misses" submitted by hospitals, birthing centers,
1446and ambulatory surgical facilities and other providers. For the
1447purpose of the reporting system:
1448     a.  A "near miss" means any potentially harmful event that
1449could have had an adverse result but, through chance or
1450intervention in which, harm was prevented.
1451     b.  The near-miss reporting system shall be voluntary and
1452anonymous and independent of mandatory reporting systems used
1453for regulatory purposes.
1454     c.  Near-miss data submitted to the corporation is patient
1455safety data as defined in s. 766.1016.
1456     d.  Reports of near-miss data shall be published on a
1457regular basis and special alerts shall be published as needed
1458regarding newly identified, significant risks.
1459     e.  Aggregated data shall be made available publicly.
1460     f.  The corporation shall report the performance and
1461results of the pilot project in its annual report.
1462     4.  Work collaboratively with the appropriate state
1463agencies in the development of electronic health records.
1464     5.  Provide for access to an active library of evidence-
1465based medicine and patient safety practices, together with the
1466emerging evidence supporting their retention or modification,
1467and make this information available to health care
1468practitioners, health care facilities, and the public. Support
1469for implementation of evidence-based medicine shall include:
1470     a.  A report to the Governor, the President of the Senate,
1471the Speaker of the House of Representatives, and the Agency for
1472Health Care Administration by January 1, 2005, on:
1473     (I)  The ability to join or support efforts for the use of
1474evidence-based medicine already underway, such as those of the
1475Leapfrog Group, the international group Bandolier, and the
1476Healthy Florida Foundation.
1477     (II)  The means by which to promote research using Medicaid
1478and other data collected by the Agency for Health Care
1479Administration to identify and quantify the most cost-effective
1480treatment and interventions, including disease management and
1481prevention programs.
1482     (III)  The means by which to encourage development of
1483systems to measure and reward providers who implement evidence-
1484based medical practices.
1485     (IV)  The review of other state and private initiatives and
1486published literature for promising approaches and the
1487dissemination of information about them to providers.
1488     (V)  The encouragement of the Florida health care boards
1489under the Department of Health to regularly publish findings
1490related to the cost-effectiveness of disease-specific, evidence-
1491based standards.
1492     (VI)  Public and private sector initiatives related to
1493evidence-based medicine and communication systems for the
1494sharing of clinical information among caregivers.
1495     (VII)  Regulatory barriers that interfere with the sharing
1496of clinical information among caregivers.
1497     b.  An implementation plan reported to the Governor, the
1498President of the Senate, the Speaker of the House of
1499Representatives, and the Agency for Health Care Administration
1500by September 1, 2005, that must include, but need not be limited
1501to: estimated costs and savings, capital investment
1502requirements, recommended investment incentives, initial
1503committed provider participation by region, standards of
1504functionality and features, a marketing plan, and implementation
1505schedules for key components.
1506     6.  Develop and recommend core competencies in patient
1507safety that can be incorporated into the curricula in schools of
1508medicine, nursing, and allied health in the state.
1509     7.  Develop and recommend programs to educate the public
1510about the role of health care consumers in promoting patient
1511safety.
1512     8.  Provide recommendations for interagency coordination of
1513patient safety efforts in the state.
1514     (b)  In carrying out its powers and duties, the corporation
1515may also:
1516     1.  Assess the patient safety culture at volunteering
1517hospitals and recommend methods to improve the working
1518environment related to patient safety at these hospitals.
1519     2.  Inventory the information technology capabilities
1520related to patient safety of health care facilities and health
1521care practitioners and recommend a plan for expediting the
1522implementation of patient safety technologies statewide.
1523     3.  Recommend continuing medical education regarding
1524patient safety to practicing health care practitioners.
1525     4.  Study and facilitate the testing of alternative systems
1526of compensating injured patients as a means of reducing and
1527preventing medical errors and promoting patient safety.
1528     (8)  ANNUAL REPORT.--By December 1, 2004, the corporation
1529shall prepare a report on the startup activities of the
1530corporation and any proposals for legislative action that are
1531needed for the corporation to fulfill its purposes under this
1532section. By December 1 of each year thereafter, the corporation
1533shall prepare a report for the preceding fiscal year. The
1534report, at a minimum, must include:
1535     (a)  A description of the activities of the corporation
1536under this section.
1537     (b)  Progress made in improving patient safety and reducing
1538medical errors.
1539     (c)  Policies and programs that have been implemented and
1540their outcomes.
1541     (d)  A compliance and financial audit of the accounts and
1542records of the corporation at the end of the preceding fiscal
1543year conducted by an independent certified public accountant.
1544     (e)  Recommendations for legislative action needed to
1545improve patient safety in the state.
1546     (f)  An assessment of the ability of the corporation to
1547fulfill the duties specified in this section.
1548
1549The corporation shall submit the report to the Governor, the
1550President of the Senate, and the Speaker of the House of
1551Representatives.
1552     (9)  FUNDING.--The corporation is required to seek private
1553sector funding and apply for grants to accomplish its goals and
1554duties.
1555     (10)  PERFORMANCE EXPECTATIONS.--The Office of Program
1556Policy Analysis and Government Accountability, the Agency for
1557Health Care Administration, and the Department of Health shall
1558develop performance standards by which to measure the success of
1559the corporation in fulfilling the purposes established in this
1560section. Using the performance standards, the Office of Program
1561Policy Analysis and Government Accountability shall conduct a
1562performance audit of the corporation during 2006 and shall
1563submit a report to the Governor, the President of the Senate,
1564and the Speaker of the House of Representatives by January 1,
15652007.
1566     Section 17.  Subsection (3) of section 409.91255, Florida
1567Statutes, is amended to read:
1568     409.91255  Federally qualified health center access
1569program.--
1570     (3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.--The
1571Department of Health shall develop a program for the expansion
1572of federally qualified health centers for the purpose of
1573providing comprehensive primary and preventive health care and
1574urgent care services, including services that may reduce the
1575morbidity, mortality, and cost of care among the uninsured
1576population of the state. The program shall provide for
1577distribution of financial assistance to federally qualified
1578health centers that apply and demonstrate a need for such
1579assistance in order to sustain or expand the delivery of primary
1580and preventive health care services. In selecting centers to
1581receive this financial assistance, the program:
1582     (a)  Shall give preference to communities that have few or
1583no community-based primary care services or in which the current
1584services are unable to meet the community's needs.
1585     (b)  Shall require that primary care services be provided
1586to the medically indigent using a sliding fee schedule based on
1587income.
1588     (c)  Shall allow innovative and creative uses of federal,
1589state, and local health care resources.
1590     (d)  Shall require that the funds provided be used to pay
1591for operating costs of a projected expansion in patient
1592caseloads or services or for capital improvement projects.
1593Capital improvement projects may include renovations to existing
1594facilities or construction of new facilities, provided that an
1595expansion in patient caseloads or services to a new patient
1596population will occur as a result of the capital expenditures.
1597The department shall include in its standard contract document a
1598requirement that any state funds provided for the purchase of or
1599improvements to real property are contingent upon the contractor
1600granting to the state a security interest in the property at
1601least to the amount of the state funds provided for at least 5
1602years from the date of purchase or the completion of the
1603improvements or as further required by law. The contract must
1604include a provision that, as a condition of receipt of state
1605funding for this purpose, the contractor agrees that, if it
1606disposes of the property before the department's interest is
1607vacated, the contractor will refund the proportionate share of
1608the state's initial investment, as adjusted by depreciation.
1609     (e)  May require in-kind support from other sources.
1610     (f)  May encourage coordination among federally qualified
1611health centers, other private-sector providers, and publicly
1612supported programs.
1613     (g)  Shall allow the development of community emergency
1614room diversion programs in conjunction with local resources,
1615providing extended hours of operation to urgent care patients.
1616Diversion programs shall include case management for emergency
1617room followup care.
1618     Section 18.  Paragraph (a) of subsection (6) of section
1619627.410, Florida Statutes, is amended to read:
1620     627.410  Filing, approval of forms.--
1621     (6)(a)  An insurer shall not deliver or issue for delivery
1622or renew in this state any health insurance policy form until it
1623has filed with the office a copy of every applicable rating
1624manual, rating schedule, change in rating manual, and change in
1625rating schedule; if rating manuals and rating schedules are not
1626applicable, the insurer must file with the office order
1627applicable premium rates and any change in applicable premium
1628rates. This paragraph does not apply to group health insurance
1629policies, effectuated and delivered in this state, insuring
1630groups of 51 or more persons, except for Medicare supplement
1631insurance, long-term care insurance, and any coverage under
1632which the increase in claim costs over the lifetime of the
1633contract due to advancing age or duration is prefunded in the
1634premium.
1635     Section 19.  Paragraph (b) of subsection (3) of section
1636627.6487, Florida Statutes, is amended to read:
1637     627.6487  Guaranteed availability of individual health
1638insurance coverage to eligible individuals.--
1639     (3)  For the purposes of this section, the term "eligible
1640individual" means an individual:
1641     (b)  Who is not eligible for coverage under:
1642     1.  A group health plan, as defined in s. 2791 of the
1643Public Health Service Act;
1644     2.  A conversion policy or contract issued by an authorized
1645insurer or health maintenance organization under s. 627.6675 or
1646s. 641.3921, respectively, offered to an individual who is no
1647longer eligible for coverage under either an insured or self-
1648insured employer plan;
1649     3.  Part A or part B of Title XVIII of the Social Security
1650Act; or
1651     4.  A state plan under Title XIX of such act, or any
1652successor program, and does not have other health insurance
1653coverage; or
1654     5.  The Florida Health Insurance Plan as specified in s.
1655627.64872 and such plan is accepting new enrollment;
1656     Section 20.  Section 627.64872, Florida Statutes, is
1657created to read:
1658     627.64872  Uninsurable risk assumption plan.--
1659     (1)  LEGISLATIVE INTENT; FLORIDA HEALTH INSURANCE PLAN.--
1660     (a)  The Legislature recognizes that to secure a more
1661stable and orderly health insurance market, the establishment of
1662a plan to assume risks deemed uninsurable by the private
1663marketplace is required.
1664     (b)  The Florida Health Insurance Plan is to make coverage
1665available to individuals who have no other option for similar
1666coverage, at a premium that is commensurate with the risk and
1667benefits provided, and with benefit designs that are reasonable
1668in relation to the general market. While plan operations may
1669include supplementary funding, the plan shall fundamentally
1670operate on sound actuarial principles, using basic insurance
1671management techniques to ensure that the plan is run in an
1672economical, cost-efficient, and sound manner, conserving plan
1673resources to serve the maximum number of people possible in a
1674sustainable fashion.
1675     (2)  DEFINITIONS.--As used in this section:
1676     (a)  "Board" means the board of directors of the plan.
1677     (b)  "Dependent" means a resident spouse or resident
1678unmarried child under the age of 19 years, a child who is a
1679student under the age of 25 years and who is financially
1680dependent upon the parent, or a child of any age who is disabled
1681and dependent upon the parent.
1682     (c)  "Director" means the director of the Office of
1683Insurance Regulation.
1684     (d)  "Health insurance" means any hospital or medical
1685expense incurred policy, health maintenance organization
1686subscriber contract pursuant to chapter 641. The term does not
1687include short term, accident, dental-only, vision-only, fixed
1688indemnity, limited benefit, or credit insurance; disability
1689income insurance; coverage for onsite medical clinics; insurance
1690coverage specified in federal regulations issued pursuant to
1691Pub. L. No. 104-191, under which benefits for medical care are
1692secondary or incidental to other insurance benefits; benefits
1693for long-term care, nursing home care, home health care,
1694community-based care, or any combination thereof, or other
1695similar, limited benefits specified in federal regulations
1696issued pursuant to Pub. L. No. 104-191; benefits provided under
1697a separate policy, certificate, or contract of insurance, under
1698which there is no coordination between the provision of the
1699benefits and any exclusion of benefits under any group health
1700plan maintained by the same plan sponsor and the benefits are
1701paid with respect to an event without regard to whether benefits
1702are provided with respect to such an event under any group
1703health plan maintained by the same plan sponsor, such as for
1704coverage only for a specified disease or illness; hospital
1705indemnity or other fixed indemnity insurance; coverage offered
1706as a separate policy, certificate, or contract of insurance,
1707such as Medicare supplemental health insurance as defined under
1708s. 1882(g)(1) of the Social Security Act; coverage supplemental
1709to the coverage provided under Chapter 55 of Title 10, United
1710States Code, the Civilian Health and Medical Program of the
1711Uniformed Services (CHAMPUS); similar supplemental coverage
1712provided to coverage under a group health plan; coverage issued
1713as a supplement to liability insurance; insurance arising out of
1714a workers' compensation or similar law; automobile medical
1715payment insurance; or insurance under which benefits are payable
1716with or without regard to fault and which is statutorily
1717required to be contained in any liability insurance policy or
1718equivalent selfinsurance.
1719     (e)  "Implementation" means the effective date of the
1720establishment of the board.
1721     (f)  "Insurer" means any entity that provides health
1722insurance in this state. For purposes of this section, insurer
1723includes an insurance company with a valid certificate in
1724accordance with chapter 624, a health maintenance organization
1725with a valid certificate of authority in accordance with part I
1726or part III of chapter 641, a prepaid health clinic authorized
1727to transact business in this state pursuant to part II of
1728chapter 641, multiple employer welfare arrangements authorized
1729to transact business in this state pursuant to ss. 624.436-
1730624.45, or a fraternal benefit society providing health benefits
1731to its members as authorized pursuant to chapter 632.
1732     (g)  "Medicare" means coverage under both Parts A and B of
1733Title XVIII of the Social Security Act, 42 USC 1395 et seq., as
1734amended.
1735     (h)  "Medicaid" means coverage under Title XIX of the
1736Social Security Act.
1737     (i)  "Office" means the Office of Insurance Regulation of
1738the Financial Services Commission.
1739     (j)  "Participating insurer" means any insurer providing
1740health insurance to citizens of this state.
1741     (k)  "Provider" means any physician, hospital, or other
1742institution, organization, or person that furnishes health care
1743services and is licensed or otherwise authorized to practice in
1744the state.
1745     (l)  "Plan" means the Florida Health Insurance Plan created
1746in subsection (1).
1747     (m)  "Plan of operation" means the articles, bylaws, and
1748operating rules and procedures adopted by the board pursuant to
1749this section.
1750     (n)  "Resident" means an individual who has been legally
1751domiciled in this state for a period of at least 12 months with
1752exception of residents deemed eligible under the federal Health
1753Insurance Portability and Accountability Act of 1996.
1754     (3)  BOARD OF DIRECTORS.--
1755     (a)  The plan shall operate subject to the supervision and
1756control of the board. The board shall consist of the director or
1757his or her designated representative, who shall serve as a
1758member of the board and shall be its chair, and an additional
1759eight members, five of whom shall be appointed by the Governor,
1760at least two of whom shall be individuals not representative of
1761insurers or health care providers, one of whom shall be
1762appointed by the President of the Senate, one of whom shall be
1763appointed by the Speaker of the House of Representatives, and
1764one of whom shall be appointed by the Chief Financial Officer.
1765     (b)  The initial board members shall be appointed as
1766follows: one-third of the members to serve a term of 2 years;
1767one-third of the members to serve a term of 4 years; and one-
1768third of the members to serve a term of 6 years. Subsequent
1769board members shall serve for a term of 3 years. A board
1770member's term shall continue until his or her successor is
1771appointed.
1772     (c)  Vacancies in the board shall be filled by the
1773appointing authority, such authority being the Governor, the
1774President of the Senate, the Speaker of the House of
1775Representatives, or the Chief Financial Officer. Board members
1776may be removed by the appointing authority for cause.
1777     (d)  The board shall conduct its first meeting by September
17781, 2004.
1779     (e)  Members shall not be compensated in their capacity as
1780board members but shall be reimbursed for reasonable expenses
1781incurred in the necessary performance of their duties in
1782accordance with s. 112.061.
1783     (f)  The board shall submit to the Financial Services
1784Commission a plan of operation for the plan and any amendments
1785thereto necessary or suitable to ensure the fair, reasonable,
1786and equitable administration of the plan. The plan of operation
1787shall ensure that the plan qualifies to apply for any available
1788funding from the Federal Government that adds to the financial
1789viability of the plan. The plan of operation shall become
1790effective upon approval in writing by the Financial Services
1791Commission consistent with the date on which the coverage under
1792this section must be made available. If the board fails to
1793submit a suitable plan of operation within one year after the
1794appointment of the board of directors, or at any time thereafter
1795fails to submit suitable amendments to the plan of operation,
1796the Financial Services Commission shall adopt such rules as are
1797necessary or advisable to effectuate the provisions of this
1798section. Such rules shall continue in force until modified by
1799the office or superseded by a plan of operation submitted by the
1800board and approved by the Financial Services Commission.
1801     (4)  PLAN OF OPERATION.--The plan of operation shall:
1802     (a)  Establish procedures for operation of the plan.
1803     (b)  Establish procedures for selecting an administrator in
1804accordance with subsection (11).
1805     (c)  Establish procedures to create a fund, under
1806management of the board, for administrative expenses.
1807     (d)  Establish procedures for the handling, accounting, and
1808auditing of assets, moneys, and claims of the plan and the plan
1809administrator.
1810     (e)  Develop and implement a program to publicize the
1811existence of the plan, plan eligibility requirements, and
1812procedures for enrollment and maintain public awareness of the
1813plan.
1814     (f)  Establish procedures under which applicants and
1815participants may have grievances reviewed by a grievance
1816committee appointed by the board. The grievances shall be
1817reported to the board after completion of the review, with the
1818committee's recommendation for grievance resolution. The board
1819shall retain all written grievances regarding the plan for at
1820least 3 years.
1821     (g)  Provide for other matters as may be necessary and
1822proper for the execution of the board's powers, duties, and
1823obligations under this section.
1824     (5)  POWERS OF THE PLAN.--The plan shall have the general
1825powers and authority granted under the laws of this state to
1826health insurers and, in addition thereto, the specific authority
1827to:
1828     (a)  Enter into such contracts as are necessary or proper
1829to carry out the provisions and purposes of this section,
1830including the authority, with the approval of the Chief
1831Financial Officer, to enter into contracts with similar plans of
1832other states for the joint performance of common administrative
1833functions, or with persons or other organizations for the
1834performance of administrative functions.
1835     (b)  Take any legal actions necessary or proper to recover
1836or collect assessments due the plan.
1837     (c)  Take such legal action as is necessary to:
1838     1.  Avoid payment of improper claims against the plan or
1839the coverage provided by or through the plan;
1840     2.  Recover any amounts erroneously or improperly paid by
1841the plan;
1842     3.  Recover any amounts paid by the plan as a result of
1843mistake of fact or law; or
1844     4.  Recover other amounts due the plan.
1845     (d)  Establish, and modify as appropriate, rates, rate
1846schedules, rate adjustments, expense allowances, agents'
1847commissions, claims reserve formulas, and any other actuarial
1848functions appropriate to the operation of the plan. Rates and
1849rate schedules may be adjusted for appropriate factors such as
1850age, sex, and geographic variation in claim cost and shall take
1851into consideration appropriate factors in accordance with
1852established actuarial and underwriting practices. For purposes
1853of this paragraph, usual and customary agent's commissions shall
1854be paid for the initial placement of coverage with the plan and
1855for one renewal only.
1856     (e)  Issue policies of insurance in accordance with the
1857requirements of this section.
1858     (f)  Appoint appropriate legal, actuarial, investment, and
1859other committees as necessary to provide technical assistance in
1860the operation of the plan and develop and educate its
1861policyholders regarding health savings accounts, policy and
1862contract design, and any other function within the authority of
1863the plan.
1864     (g)  Borrow money to effectuate the purposes of the plan.
1865Any notes or other evidence of indebtedness of the plan not in
1866default shall be legal investments for insurers and may be
1867carried as admitted assets.
1868     (h)  Employ and fix the compensation of employees.
1869     (i)  Prepare and distribute certificate of eligibility
1870forms and enrollment instruction forms to insurance producers
1871and to the general public.
1872     (j)  Provide for reinsurance of risks incurred by the plan.
1873     (k)  Provide for and employ cost-containment measures and
1874requirements, including, but not limited to, preadmission
1875screening, second surgical opinion, concurrent utilization
1876review, and individual case management for the purpose of making
1877the plan more cost-effective.
1878     (l)  Design, use, contract, or otherwise arrange for the
1879delivery of cost-effective health care services, including, but
1880not limited to, establishing or contracting with preferred
1881provider organizations, health maintenance organizations, and
1882other limited network provider arrangements.
1883     (m)  Adopt such bylaws, policies, and procedures as may be
1884necessary or convenient for the implementation of this section
1885and the operation of the plan.
1886     (6)  INTERIM REPORT; ANNUAL REPORT.--
1887     (a)  By no later than December 1, 2004, the board shall
1888report to the Governor, the President of the Senate, and the
1889Speaker of the House of Representatives the results of an
1890actuarial study conducted by the board to determine, including,
1891but not being limited to:
1892     1.  The impact the creation of the plan will have on the
1893small group insurance market and the individual market on
1894premiums paid by insureds. This shall include an estimate of the
1895total anticipated aggregate savings for all small employers in
1896the state.
1897     2.  The number of individuals the pool could reasonably
1898cover at various funding levels, specifically, the number of
1899people the pool may cover at each of those funding levels.
1900     3.  A recommendation as to the best source of funding for
1901the anticipated deficits of the pool.
1902
1903The board shall take no action to implement the Florid Health
1904Insurance Plan, other than the completion of the actuarial study
1905authorized in this paragraph, until funds are appropriated for
1906startup cost and any projected deficits.
1907     (b)  No later than December 1, 2005, and annually
1908thereafter, the board shall submit to the Governor, the
1909President of the Senate, the Speaker of the House of
1910Representatives, and the substantive legislative committees of
1911the Legislature a report which includes an independent actuarial
1912study to determine, including, but not be limited to:
1913     1.  The impact the creation of the plan has on the small
1914group and individual insurance market, specifically on the
1915premiums paid by insureds. This shall include an estimate of the
1916total anticipated aggregate savings for all small employers in
1917the state.
1918     2.  The actual number of individuals covered at the current
1919funding and benefit level, the projected number of individuals
1920that may seek coverage in the forthcoming fiscal year, and the
1921projected funding needed to cover anticipated increase or
1922decrease in plan participation.
1923     3.  A recommendation as to the best source of funding for
1924the anticipated deficits of the pool.
1925     4.  A summarization of the activities of the plan in the
1926preceding calendar year, including the net written and earned
1927premiums, plan enrollment, the expense of administration, and
1928the paid and incurred losses.
1929     5.  A review of the operation of the plan as to whether the
1930plan has met the intent of this section.
1931     (7)  LIABILITY OF THE PLAN.--Neither the board nor its
1932employees shall be liable for any obligations of the plan. No
1933member or employee of the board shall be liable, and no cause of
1934action of any nature may arise against a member or employee of
1935the board, for any act or omission related to the performance of
1936any powers and duties under this section, unless such act or
1937omission constitutes willful or wanton misconduct. The board may
1938provide in its bylaws or rules for indemnification of, and legal
1939representation for, its members and employees.
1940     (8)  AUDITED FINANCIAL STATEMENT.--No later than June 1
1941following the close of each calendar year, the plan shall submit
1942to the Financial Services Commission an audited financial
1943statement prepared in accordance with statutory accounting
1944principles as adopted by the National Association of Insurance
1945Commissioners.
1946     (9)  ELIGIBILITY.--
1947     (a)  Any individual person who is and continues to be a
1948resident of this state shall be eligible for coverage under the
1949plan if:
1950     1.  Evidence is provided that the person received at least
1951two notices of rejection or refusal to issue substantially
1952similar insurance for health reasons by one insurer. A rejection
1953or refusal by an insurer offering only stoploss, excess of loss,
1954or reinsurance coverage with respect to the applicant shall not
1955be sufficient evidence under this paragraph.
1956     2.  The person is enrolled in the Florida Comprehensive
1957Health Association as of the date the plan is implemented.
1958     (b)  Each resident dependent of a person who is eligible
1959for coverage under the plan shall also be eligible for such
1960coverage.
1961     (c)  A person shall not be eligible for coverage under the
1962plan if:
1963     1.  The person has or obtains health insurance coverage
1964substantially similar to or more comprehensive than a plan
1965policy, or would be eligible to obtain such coverage, unless a
1966person may maintain other coverage for the period of time the
1967person is satisfying any preexisting condition waiting period
1968under a plan policy or may maintain plan coverage for the period
1969of time the person is satisfying a preexisting condition waiting
1970period under another health insurance policy intended to replace
1971the plan policy.
1972     2.  The person is determined to be eligible for health care
1973benefits under Medicaid, Medicare, the state's children's health
1974insurance program, or any other federal, state, or local
1975government program that provides health benefits;
1976     3.  The person voluntarily terminated plan coverage unless
197712 months have elapsed since such termination;
1978     4.  The person is an inmate or resident of a public
1979institution; or
1980     5.  The person's premiums are paid for or reimbursed under
1981any government-sponsored program or by any government agency or
1982health care provider.
1983     (d)  Coverage shall cease:
1984     1.  On the date a person is no longer a resident of this
1985state;
1986     2.  On the date a person requests coverage to end;
1987     3.  Upon the death of the covered person;
1988     4.  On the date state law requires cancellation or
1989nonrenewal of the policy; or
1990     5.  At the option of the plan, 30 days after the plan makes
1991any inquiry concerning the person's eligibility or place of
1992residence to which the person does not reply.
1993     6.  Upon failure of the insured to pay for continued
1994coverage.
1995     (e)  Except under the circumstances described in this
1996subsection, coverage of a person who ceases to meet the
1997eligibility requirements of this subsection shall be terminated
1998at the end of the policy period for which the necessary premiums
1999have been paid.
2000     (10)  UNFAIR REFERRAL TO PLAN.--It is an unfair trade
2001practice for the purposes of part IX of chapter 626 or s.
2002641.3901 for an insurer, health maintenance organization
2003insurance agent, insurance broker, or third-party administrator
2004to refer an individual employee to the plan, or arrange for an
2005individual employee to apply to the plan, for the purpose of
2006separating that employee from group health insurance coverage
2007provided in connection with the employee's employment.
2008     (11)  PLAN ADMINISTRATOR.--The board shall select through a
2009competitive bidding process a plan administrator to administer
2010the plan. The board shall evaluate bids submitted based on
2011criteria established by the board, which shall include:
2012     (a)  The plan administrator's proven ability to handle
2013health insurance coverage to individuals.
2014     (b)  The efficiency and timeliness of the plan
2015administrator's claim processing procedures.
2016     (c)  An estimate of total charges for administering the
2017plan.
2018     (d)  The plan administrator's ability to apply effective
2019cost-containment programs and procedures and to administer the
2020plan in a cost-efficient manner.
2021     (e)  The financial condition and stability of the plan
2022administrator.
2023
2024The administrator shall be an insurer, a health maintenance
2025organization, or a third-party administrator, or another
2026organization duly authorized to provide insurance pursuant to
2027the Florida Insurance Code.
2028     (12)  ADMINISTRATOR TERM LIMITS.--The plan administrator
2029shall serve for a period specified in the contract between the
2030plan and the plan administrator subject to removal for cause and
2031subject to any terms, conditions, and limitations of the
2032contract between the plan and the plan administrator. At least 1
2033year prior to the expiration of each period of service by a plan
2034administrator, the board shall invite eligible entities,
2035including the current plan administrator, to submit bids to
2036serve as the plan administrator. Selection of the plan
2037administrator for each succeeding period shall be made at least
20386 months prior to the end of the current period.
2039     (13)  DUTIES OF THE PLAN ADMINISTRATOR.--
2040     (a)  The plan administrator shall perform such functions
2041relating to the plan as may be assigned to it, including, but
2042not limited to:
2043     1.  Determination of eligibility.
2044     2.  Payment of claims.
2045     3.  Establishment of a premium billing procedure for
2046collection of premiums from persons covered under the plan.
2047     4.  Other necessary functions to ensure timely payment of
2048benefits to covered persons under the plan.
2049     (b)  The plan administrator shall submit regular reports to
2050the board regarding the operation of the plan. The frequency,
2051content, and form of the reports shall be specified in the
2052contract between the board and the plan administrator.
2053     (c)  On March 1 following the close of each calendar year,
2054the plan administrator shall determine net written and earned
2055premiums, the expense of administration, and the paid and
2056incurred losses for the year and report this information to the
2057board and the Governor on a form prescribed by the Governor.
2058     (14)  PAYMENT OF THE PLAN ADMINISTRATOR.--The plan
2059administrator shall be paid as provided in the contract between
2060the plan and the plan administrator.
2061     (15)  FUNDING OF THE PLAN.--
2062     (a)  Premiums.--
2063     1.  The plan shall establish premium rates for plan
2064coverage as provided in this section. Separate schedules of
2065premium rates based on age, sex, and geographical location may
2066apply for individual risks. Premium rates and schedules shall be
2067submitted to the office for approval prior to use.
2068     2.  Initial rates for plan coverage shall be limited to 200
2069percent of rates established as applicable for individual
2070standard risks as specified in s. 627.6675(3)(c). Subject to the
2071limits provided in this paragraph, subsequent rates shall be
2072established to provide fully for the expected costs of claims,
2073including recovery of prior losses, expenses of operation,
2074investment income of claim reserves, and any other cost factors
2075subject to the limitations described herein, but in no event
2076shall premiums exceed the 200-percent rate limitation provided
2077in this section. Notwithstanding the 200-percent rate
2078limitation, sliding scale premium surcharges based upon the
2079insured's income may apply to all enrollees except those
2080obtaining coverage in accordance with s. 627.6487.
2081     (b)  Sources of additional revenue.--Any deficit incurred
2082by the plan shall be primarily funded through amounts
2083appropriated by the Legislature from general revenue sources,
2084including, but not limited to, a portion of the annual growth in
2085existing net insurance premium taxes. The board shall operate
2086the plan in such a manner that the estimated cost of providing
2087health insurance during any fiscal year will not exceed total
2088income the plan expects to receive from policy premiums and
2089funds appropriated by the Legislature, including any interest on
2090investments. After determining the amount of funds appropriated
2091to the board for a fiscal year, the board shall estimate the
2092number of new policies it believes the plan has the financial
2093capacity to insure during that year so that costs do not exceed
2094income. The board shall take steps necessary to ensure that plan
2095enrollment does not exceed the number of residents it has
2096estimated it has the financial capacity to insure.
2097     (16)  BENEFITS.--
2098     (a)  The benefits provided shall be the same as the
2099standard and basic plans for small employers as outlined in s.
2100627.6699. The board shall also establish an option of
2101alternative coverage such as catastrophic coverage that includes
2102a minimum level of primary care coverage and a high deductible
2103plan that meets the federal requirements of a health savings
2104account.
2105     (b)  In establishing the plan coverage, the board shall
2106take into consideration the levels of health insurance provided
2107in the state and such medical economic factors as may be deemed
2108appropriate and adopt benefit levels, deductibles, copayments,
2109coinsurance factors, exclusions, and limitations determined to
2110be generally reflective of and commensurate with health
2111insurance provided through a representative number of large
2112employers in the state.
2113     (c)  The board may adjust any deductibles and coinsurance
2114factors annually according to the medical component of the
2115Consumer Price Index.
2116     (d)1.  Plan coverage shall exclude charges or expenses
2117incurred during the first 6 months following the effective date
2118of coverage for any condition for which medical advice, care, or
2119treatment was recommended or received for such condition during
2120the 6-month period immediately preceding the effective date of
2121coverage.
2122     2.  Such preexisting condition exclusions shall be waived
2123to the extent that similar exclusions, if any, have been
2124satisfied under any prior health insurance coverage which was
2125involuntarily terminated, provided application for pool coverage
2126is made not later than 63 days following such involuntary
2127termination. In such case, coverage under the plan shall be
2128effective from the date on which such prior coverage was
2129terminated and the applicant is not eligible for continuation or
2130conversion rights that would provide coverage substantially
2131similar to plan coverage.
2132     (17)  NONDUPLICATION OF BENEFITS.--
2133     (a)  The plan shall be payor of last resort of benefits
2134whenever any other benefit or source of third-party payment is
2135available. Benefits otherwise payable under plan coverage shall
2136be reduced by all amounts paid or payable through any other
2137health insurance, by all hospital and medical expense benefits
2138paid or payable under any workers' compensation coverage,
2139automobile medical payment, or liability insurance, whether
2140provided on the basis of fault or nonfault, and by any hospital
2141or medical benefits paid or payable under or provided pursuant
2142to any state or federal law or program.
2143     (b)  The plan shall have a cause of action against an
2144eligible person for the recovery of the amount of benefits paid
2145that are not for covered expenses. Benefits due from the plan
2146may be reduced or refused as a setoff against any amount
2147recoverable under this paragraph.
2148     (18)  ANNUAL AND MAXIMUM BENEFITS.--Maximum benefits under
2149the plan shall be determined by the board.
2150     (19)  TAXATION.--The plan is exempt from any tax imposed by
2151this state. The plan shall apply for federal tax exemption
2152status.
2153     (20)  COMBINING MEMBERSHIP OF THE FLORIDA COMPREHENSIVE
2154HEALTH ASSOCIATION.--
2155     (a)1. Upon implementation of the plan, the Florida
2156Comprehensive Health Association is abolished and all high-risk
2157individuals actively enrolled in the Florida Comprehensive
2158Health Association shall be enrolled in the plan subject to its
2159rules and requirements. Maximum lifetime benefits paid to an
2160individual in the plan shall not exceed the amount established
2161under subsection (18), and benefits previously paid for any
2162individual by the Florida Comprehensive Health Association shall
2163be used in the determination of total lifetime benefits paid
2164under the plan.
2165     2.  Persons formerly enrolled in the Florida Comprehensive
2166Health Association are only eligible for the benefits authorized
2167under subsection (18).
2168     3.  Except as otherwise provided in this paragraph, the
2169Florida Comprehensive Health Association shall operate under the
2170existing plan of operation without modification until the
2171adoption of the new plan of operation for the Florida Health
2172Insurance Plan.
2173     (b)1.  As a condition of doing business in this state, an
2174insurer shall pay an assessment to the board in the amount
2175prescribed by this paragraph. For operating losses incurred on
2176or after July 1, 2004, by persons previously enrolled in the
2177Florida Comprehensive Health Association, each insurer shall
2178annually be assessed by the board in the following calendar year
2179a portion of such incurred operating losses of the plan. Such
2180portion shall be determined by multiplying such operating losses
2181by a fraction, the numerator of which equals the insurer's
2182earned premium pertaining to direct writings of health insurance
2183in the state during the calendar year preceding that for which
2184the assessment is levied, and the denominator of which equals
2185the total of all such premiums earned by participating insurers
2186in the state during such calendar year.
2187     2.  The total of all assessments under this paragraph upon
2188a participating insurer shall not exceed 1 percent of such
2189insurer's health insurance premium earned in this state during
2190the calendar year preceding the year for which the assessments
2191were levied.
2192     3.  All rights, title, and interest in the assessment funds
2193collected under this paragraph shall vest in this state.
2194However, all of such funds and interest earned shall be used by
2195the plan to pay claims and administrative expenses.
2196     (c)  If assessments and other receipts by the plan, board,
2197or plan administrator exceed the actual losses and
2198administrative expenses of the plan, the excess shall be held in
2199interest and used by the board to offset future losses. As used
2200in this subsection, the term "future losses" includes reserves
2201for claims incurred but not reported.
2202     (d)  Each insurer's assessment shall be determined annually
2203by the board or plan administrator based on annual statements
2204and other reports deemed necessary by the board or plan
2205administrator and filed with the board or plan administrator by
2206the insurer. Any deficit incurred under the plan by persons
2207previously enrolled in the Florida Comprehensive Health
2208Association shall be recouped by the assessments against
2209participating insurers by the board or plan administrator in the
2210manner provided in paragraph (b), and the insurers may recover
2211the assessment in the normal course of their respective
2212businesses without time limitation.
2213     (e)  If a person enrolled in the Florida Comprehensive
2214Health Association as of July 1, 2004, loses eligibility for
2215participation in the plan, such person shall not be included in
2216the calculation of incurred operational losses as described in
2217paragraph (b) if the person later regains eligibility for
2218participation in the plan.
2219     (f)  After all persons enrolled in the Florida
2220Comprehensive Health Association as of July 1, 2004, are no
2221longer eligible for participation in the plan, the plan, board,
2222or plan administrator shall no longer be allowed to assess
2223insurers in this state for incurred losses as described in
2224paragraph (b).
2225     Section 21.  Upon implementation, as defined in s.
2226627.64872(2), Florida Statutes, and as provided in s.
2227627.64872(20), Florida Statutes, of the Florida Health Benefit
2228Plan created under s. 627.64872, Florida Statutes, sections
2229627.6488, 627.6489, 627.649, 627.6492, 627.6494, 627.6496, and
2230627.6498, Florida Statutes, are repealed.
2231     Section 22.  Subsections (12) and (13) are added to section
2232627.662, Florida Statutes, to read:
2233     627.662  Other provisions applicable.--The following
2234provisions apply to group health insurance, blanket health
2235insurance, and franchise health insurance:
2236     (12)  Section 627.6044, relating to the use of specific
2237methodology for payment of claims.
2238     (13)  Section 627.6405, relating to the inappropriate
2239utilization of emergency care.
2240     Section 23.  Paragraphs (c) and (d) of subsection (5),
2241paragraph (b) of subsection (6), and subsection (12) of section
2242627.6699, Florida Statutes, are amended, subsections (15) and
2243(16) of said section are renumbered as subsections (16) and
2244(17), respectively, present subsection (15) of said section is
2245amended, and new subsections (15) and (18) are added to said
2246section, to read:
2247     627.6699  Employee Health Care Access Act.--
2248     (5)  AVAILABILITY OF COVERAGE.--
2249     (c)  Every small employer carrier must, as a condition of
2250transacting business in this state:
2251     1.  Offer and issue all small employer health benefit plans
2252on a guaranteed-issue basis to every eligible small employer,
2253with 2 to 50 eligible employees, that elects to be covered under
2254such plan, agrees to make the required premium payments, and
2255satisfies the other provisions of the plan. A rider for
2256additional or increased benefits may be medically underwritten
2257and may only be added to the standard health benefit plan. The
2258increased rate charged for the additional or increased benefit
2259must be rated in accordance with this section.
2260     2.  In the absence of enrollment availability in the
2261Florida Health Insurance Plan, offer and issue basic and
2262standard small employer health benefit plans on a guaranteed-
2263issue basis, during a 31-day open enrollment period of August 1
2264through August 31 of each year, to every eligible small
2265employer, with fewer than two eligible employees, which small
2266employer is not formed primarily for the purpose of buying
2267health insurance and which elects to be covered under such plan,
2268agrees to make the required premium payments, and satisfies the
2269other provisions of the plan. Coverage provided under this
2270subparagraph shall begin on October 1 of the same year as the
2271date of enrollment, unless the small employer carrier and the
2272small employer agree to a different date. A rider for additional
2273or increased benefits may be medically underwritten and may only
2274be added to the standard health benefit plan. The increased rate
2275charged for the additional or increased benefit must be rated in
2276accordance with this section. For purposes of this subparagraph,
2277a person, his or her spouse, and his or her dependent children
2278constitute a single eligible employee if that person and spouse
2279are employed by the same small employer and either that person
2280or his or her spouse has a normal work week of less than 25
2281hours. Any right to an open enrollment of health benefit
2282coverage for groups of fewer than two employees, pursuant to
2283this section, shall remain in full force and effect in the
2284absence of the availability of new enrollment into the Florida
2285Health Insurance Plan.
2286     3.  This paragraph does not limit a carrier's ability to
2287offer other health benefit plans to small employers if the
2288standard and basic health benefit plans are offered and
2289rejected.
2290     (d)  A small employer carrier must file with the office, in
2291a format and manner prescribed by the committee, a standard
2292health care plan, a high deductible plan that meets the federal
2293requirements of a health savings account plan, and a basic
2294health care plan to be used by the carrier.
2295     (6)  RESTRICTIONS RELATING TO PREMIUM RATES.--
2296     (b)  For all small employer health benefit plans that are
2297subject to this section and are issued by small employer
2298carriers on or after January 1, 1994, premium rates for health
2299benefit plans subject to this section are subject to the
2300following:
2301     1.  Small employer carriers must use a modified community
2302rating methodology in which the premium for each small employer
2303must be determined solely on the basis of the eligible
2304employee's and eligible dependent's gender, age, family
2305composition, tobacco use, or geographic area as determined under
2306paragraph (5)(j) and in which the premium may be adjusted as
2307permitted by this paragraph.
2308     2.  Rating factors related to age, gender, family
2309composition, tobacco use, or geographic location may be
2310developed by each carrier to reflect the carrier's experience.
2311The factors used by carriers are subject to office review and
2312approval.
2313     3.  Small employer carriers may not modify the rate for a
2314small employer for 12 months from the initial issue date or
2315renewal date, unless the composition of the group changes or
2316benefits are changed. However, a small employer carrier may
2317modify the rate one time prior to 12 months after the initial
2318issue date for a small employer who enrolls under a previously
2319issued group policy that has a common anniversary date for all
2320employers covered under the policy if:
2321     a.  The carrier discloses to the employer in a clear and
2322conspicuous manner the date of the first renewal and the fact
2323that the premium may increase on or after that date.
2324     b.  The insurer demonstrates to the office that
2325efficiencies in administration are achieved and reflected in the
2326rates charged to small employers covered under the policy.
2327     4.  A carrier may issue a group health insurance policy to
2328a small employer health alliance or other group association with
2329rates that reflect a premium credit for expense savings
2330attributable to administrative activities being performed by the
2331alliance or group association if such expense savings are
2332specifically documented in the insurer's rate filing and are
2333approved by the office. Any such credit may not be based on
2334different morbidity assumptions or on any other factor related
2335to the health status or claims experience of any person covered
2336under the policy. Nothing in this subparagraph exempts an
2337alliance or group association from licensure for any activities
2338that require licensure under the insurance code. A carrier
2339issuing a group health insurance policy to a small employer
2340health alliance or other group association shall allow any
2341properly licensed and appointed agent of that carrier to market
2342and sell the small employer health alliance or other group
2343association policy. Such agent shall be paid the usual and
2344customary commission paid to any agent selling the policy.
2345     5.  Any adjustments in rates for claims experience, health
2346status, or duration of coverage may not be charged to individual
2347employees or dependents. For a small employer's policy, such
2348adjustments may not result in a rate for the small employer
2349which deviates more than 15 percent from the carrier's approved
2350rate. Any such adjustment must be applied uniformly to the rates
2351charged for all employees and dependents of the small employer.
2352A small employer carrier may make an adjustment to a small
2353employer's renewal premium, not to exceed 10 percent annually,
2354due to the claims experience, health status, or duration of
2355coverage of the employees or dependents of the small employer.
2356Semiannually, small group carriers shall report information on
2357forms adopted by rule by the commission, to enable the office to
2358monitor the relationship of aggregate adjusted premiums actually
2359charged policyholders by each carrier to the premiums that would
2360have been charged by application of the carrier's approved
2361modified community rates. If the aggregate resulting from the
2362application of such adjustment exceeds the premium that would
2363have been charged by application of the approved modified
2364community rate by 5 percent for the current reporting period,
2365the carrier shall limit the application of such adjustments only
2366to minus adjustments beginning not more than 60 days after the
2367report is sent to the office. For any subsequent reporting
2368period, if the total aggregate adjusted premium actually charged
2369does not exceed the premium that would have been charged by
2370application of the approved modified community rate by 4 5
2371percent, the carrier may apply both plus and minus adjustments.
2372A small employer carrier may provide a credit to a small
2373employer's premium based on administrative and acquisition
2374expense differences resulting from the size of the group. Group
2375size administrative and acquisition expense factors may be
2376developed by each carrier to reflect the carrier's experience
2377and are subject to office review and approval.
2378     6.  A small employer carrier rating methodology may include
2379separate rating categories for one dependent child, for two
2380dependent children, and for three or more dependent children for
2381family coverage of employees having a spouse and dependent
2382children or employees having dependent children only. A small
2383employer carrier may have fewer, but not greater, numbers of
2384categories for dependent children than those specified in this
2385subparagraph.
2386     7.  Small employer carriers may not use a composite rating
2387methodology to rate a small employer with fewer than 10
2388employees. For the purposes of this subparagraph, a "composite
2389rating methodology" means a rating methodology that averages the
2390impact of the rating factors for age and gender in the premiums
2391charged to all of the employees of a small employer.
2392     8.a.  A carrier may separate the experience of small
2393employer groups with less than 2 eligible employees from the
2394experience of small employer groups with 2-50 eligible employees
2395for purposes of determining an alternative modified community
2396rating.
2397     b.  If a carrier separates the experience of small employer
2398groups as provided in sub-subparagraph a., the rate to be
2399charged to small employer groups of less than 2 eligible
2400employees may not exceed 150 percent of the rate determined for
2401small employer groups of 2-50 eligible employees. However, the
2402carrier may charge excess losses of the experience pool
2403consisting of small employer groups with less than 2 eligible
2404employees to the experience pool consisting of small employer
2405groups with 2-50 eligible employees so that all losses are
2406allocated and the 150-percent rate limit on the experience pool
2407consisting of small employer groups with less than 2 eligible
2408employees is maintained. Notwithstanding s. 627.411(1), the rate
2409to be charged to a small employer group of fewer than 2 eligible
2410employees, insured as of July 1, 2002, may be up to 125 percent
2411of the rate determined for small employer groups of 2-50
2412eligible employees for the first annual renewal and 150 percent
2413for subsequent annual renewals.
2414     (12)  STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH
2415BENEFIT PLANS.--
2416     (a)1.  The Chief Financial Officer shall appoint a health
2417benefit plan committee composed of four representatives of
2418carriers which shall include at least two representatives of
2419HMOs, at least one of which is a staff model HMO, two
2420representatives of agents, four representatives of small
2421employers, and one employee of a small employer. The carrier
2422members shall be selected from a list of individuals recommended
2423by the board. The Chief Financial Officer may require the board
2424to submit additional recommendations of individuals for
2425appointment.
2426     2.  The plans shall comply with all of the requirements of
2427this subsection.
2428     3.  The plans must be filed with and approved by the office
2429prior to issuance or delivery by any small employer carrier.
2430     4.  After approval of the revised health benefit plans, if
2431the office determines that modifications to a plan might be
2432appropriate, the Chief Financial Officer shall appoint a new
2433health benefit plan committee in the manner provided in
2434subparagraph 1. to submit recommended modifications to the
2435office for approval.
2436     (b)1.  Each small employer carrier issuing new health
2437benefit plans shall offer to any small employer, upon request, a
2438standard health benefit plan, and a basic health benefit plan,
2439and a high deductible plan that meets the requirements of a
2440health savings account plan as defined by federal law, that meet
2441meets the criteria set forth in this section.
2442     2.  For purposes of this subsection, the terms "standard
2443health benefit plan," and "basic health benefit plan," and "high
2444deductible plan" mean policies or contracts that a small
2445employer carrier offers to eligible small employers that
2446contain:
2447     a.  An exclusion for services that are not medically
2448necessary or that are not covered preventive health services;
2449and
2450     b.  A procedure for preauthorization by the small employer
2451carrier, or its designees.
2452     3.  A small employer carrier may include the following
2453managed care provisions in the policy or contract to control
2454costs:
2455     a.  A preferred provider arrangement or exclusive provider
2456organization or any combination thereof, in which a small
2457employer carrier enters into a written agreement with the
2458provider to provide services at specified levels of
2459reimbursement or to provide reimbursement to specified
2460providers. Any such written agreement between a provider and a
2461small employer carrier must contain a provision under which the
2462parties agree that the insured individual or covered member has
2463no obligation to make payment for any medical service rendered
2464by the provider which is determined not to be medically
2465necessary. A carrier may use preferred provider arrangements or
2466exclusive provider arrangements to the same extent as allowed in
2467group products that are not issued to small employers.
2468     b.  A procedure for utilization review by the small
2469employer carrier or its designees.
2470
2471This subparagraph does not prohibit a small employer carrier
2472from including in its policy or contract additional managed care
2473and cost containment provisions, subject to the approval of the
2474office, which have potential for controlling costs in a manner
2475that does not result in inequitable treatment of insureds or
2476subscribers. The carrier may use such provisions to the same
2477extent as authorized for group products that are not issued to
2478small employers.
2479     4.  The standard health benefit plan shall include:
2480     a.  Coverage for inpatient hospitalization;
2481     b.  Coverage for outpatient services;
2482     c.  Coverage for newborn children pursuant to s. 627.6575;
2483     d.  Coverage for child care supervision services pursuant
2484to s. 627.6579;
2485     e.  Coverage for adopted children upon placement in the
2486residence pursuant to s. 627.6578;
2487     f.  Coverage for mammograms pursuant to s. 627.6613;
2488     g.  Coverage for handicapped children pursuant to s.
2489627.6615;
2490     h.  Emergency or urgent care out of the geographic service
2491area; and
2492     i.  Coverage for services provided by a hospice licensed
2493under s. 400.602 in cases where such coverage would be the most
2494appropriate and the most cost-effective method for treating a
2495covered illness.
2496     5.  The standard health benefit plan and the basic health
2497benefit plan may include a schedule of benefit limitations for
2498specified services and procedures. If the committee develops
2499such a schedule of benefits limitation for the standard health
2500benefit plan or the basic health benefit plan, a small employer
2501carrier offering the plan must offer the employer an option for
2502increasing the benefit schedule amounts by 4 percent annually.
2503     6.  The basic health benefit plan shall include all of the
2504benefits specified in subparagraph 4.; however, the basic health
2505benefit plan shall place additional restrictions on the benefits
2506and utilization and may also impose additional cost containment
2507measures.
2508     7.  Sections 627.419(2), (3), and (4), 627.6574, 627.6612,
2509627.66121, 627.66122, 627.6616, 627.6618, 627.668, and 627.66911
2510apply to the standard health benefit plan and to the basic
2511health benefit plan. However, notwithstanding said provisions,
2512the plans may specify limits on the number of authorized
2513treatments, if such limits are reasonable and do not
2514discriminate against any type of provider.
2515     8.  The plan associated with a health savings account shall
2516include all the benefits specified in subparagraph 4.
2517     9.8.  Each small employer carrier that provides for
2518inpatient and outpatient services by allopathic hospitals may
2519provide as an option of the insured similar inpatient and
2520outpatient services by hospitals accredited by the American
2521Osteopathic Association when such services are available and the
2522osteopathic hospital agrees to provide the service.
2523     (c)  If a small employer rejects, in writing, the standard
2524health benefit plan, and the basic health benefit plan, and the
2525high deductible health savings account plan, the small employer
2526carrier may offer the small employer a limited benefit policy or
2527contract.
2528     (d)1.  Upon offering coverage under a standard health
2529benefit plan, a basic health benefit plan, or a limited benefit
2530policy or contract for any small employer, the small employer
2531carrier shall provide such employer group with a written
2532statement that contains, at a minimum:
2533     a.  An explanation of those mandated benefits and providers
2534that are not covered by the policy or contract;
2535     b.  An explanation of the managed care and cost control
2536features of the policy or contract, along with all appropriate
2537mailing addresses and telephone numbers to be used by insureds
2538in seeking information or authorization; and
2539     c.  An explanation of the primary and preventive care
2540features of the policy or contract.
2541
2542Such disclosure statement must be presented in a clear and
2543understandable form and format and must be separate from the
2544policy or certificate or evidence of coverage provided to the
2545employer group.
2546     2.  Before a small employer carrier issues a standard
2547health benefit plan, a basic health benefit plan, or a limited
2548benefit policy or contract, it must obtain from the prospective
2549policyholder a signed written statement in which the prospective
2550policyholder:
2551     a.  Certifies as to eligibility for coverage under the
2552standard health benefit plan, basic health benefit plan, or
2553limited benefit policy or contract;
2554     b.  Acknowledges the limited nature of the coverage and an
2555understanding of the managed care and cost control features of
2556the policy or contract;
2557     c.  Acknowledges that if misrepresentations are made
2558regarding eligibility for coverage under a standard health
2559benefit plan, a basic health benefit plan, or a limited benefit
2560policy or contract, the person making such misrepresentations
2561forfeits coverage provided by the policy or contract; and
2562     d.  If a limited plan is requested, acknowledges that the
2563prospective policyholder had been offered, at the time of
2564application for the insurance policy or contract, the
2565opportunity to purchase any health benefit plan offered by the
2566carrier and that the prospective policyholder had rejected that
2567coverage.
2568
2569A copy of such written statement shall be provided to the
2570prospective policyholder no later than at the time of delivery
2571of the policy or contract, and the original of such written
2572statement shall be retained in the files of the small employer
2573carrier for the period of time that the policy or contract
2574remains in effect or for 5 years, whichever period is longer.
2575     3.  Any material statement made by an applicant for
2576coverage under a health benefit plan which falsely certifies as
2577to the applicant's eligibility for coverage serves as the basis
2578for terminating coverage under the policy or contract.
2579     4.  Each marketing communication that is intended to be
2580used in the marketing of a health benefit plan in this state
2581must be submitted for review by the office prior to use and must
2582contain the disclosures stated in this subsection.
2583     (e)  A small employer carrier may not use any policy,
2584contract, form, or rate under this section, including
2585applications, enrollment forms, policies, contracts,
2586certificates, evidences of coverage, riders, amendments,
2587endorsements, and disclosure forms, until the insurer has filed
2588it with the office and the office has approved it under ss.
2589627.410 and 627.411 and this section.
2590     (15)  SMALL EMPLOYERS ACCESS PROGRAM.--
2591     (a)  Popular name.--This subsection may be referred to by
2592the popular name "The Small Employers Access Program."
2593     (b)  Intent.--The Legislature finds that increased access
2594to health care coverage for small employers with up to 25
2595employees could improve employees' health and reduce the
2596incidence and costs of illness and disabilities among residents
2597in this state. Many employers do not offer health care benefits
2598to their employees citing the increased cost of this benefit. It
2599is the intent of the Legislature to create the Small Business
2600Health Plan to provide small employers the option and ability to
2601provide health care benefits to their employees at an affordable
2602cost through the creation of purchasing pools for employers with
2603up to 25 employees, and rural hospital employers and nursing
2604home employers regardless of the number of employees.
2605     (c)  Definitions.--For purposes of this subsection:
2606     1.  "Fair commission" means a commission structure
2607determined by the insurers and reflected in the insurers' rate
2608filings made pursuant to this subsection.
2609     2.  "Insurer" means any entity that provides health
2610insurance in this state. For purposes of this subsection,
2611insurer includes an insurance company holding a certificate of
2612authority pursuant to chapter 624 or a health maintenance
2613organization holding a certificate of authority pursuant to
2614chapter 641, which qualifies to provide coverage to small
2615employer groups pursuant to this section.
2616     3.  "Mutually supported benefit plan" means an optional
2617alternative coverage plan developed within a defined geographic
2618region which may include, but is not limited to, a minimum level
2619of primary care coverage in which the percentage of the premium
2620is distributed among the employer, the employee, and community-
2621generated revenue either alone or in conjunction with federal
2622matching funds.
2623     4.  "Office" means the Office of Insurance Regulation of
2624the Department of Financial Services.
2625     5.  "Participating insurer" means any insurer providing
2626health insurance to small employers that has been selected by
2627the office in accordance with this subsection for its designated
2628region.
2629     6.  "Program" means the Small Employer Access Program as
2630created by this subsection.
2631     (d)  Eligibility.--
2632     1.  Any small employer group of up to 25 employees that has
2633had no prior coverage for the last 6 months may participate.
2634     2.  Any municipality, county, school district, or hospital
2635located in a rural community as defined in s. 288.0656(2)(b),
2636may participate.
2637     3.  Rural hospital employers as defined by law may
2638participate.
2639     4.  Nursing home employers may participate.
2640     5.  Each dependent of a person eligible for coverage is
2641also eligible to participate.
2642     6.  Any small employer that is actively engaged in
2643business, has its principal place of business in this state,
2644employed up to 25 eligible employees on business days during the
2645preceding calendar year, and employs at least 2 employees on the
2646first day of the plan year may participate.
2647
2648Any employer participating in the program must do so until the
2649end of the term for which the carrier providing the coverage is
2650obligated to provide such coverage to the program. Coverage for
2651a small employer group that ceases to meet the eligibility
2652requirements of this section may be terminated at the end of the
2653policy period for which the necessary premiums have been paid.
2654     (e)  Administration.--
2655     1.  The office shall by competitive bid, in accordance with
2656current state law, select an insurer to provide coverage through
2657the program to eligible small employers within an established
2658geographical area of this state. The office may develop
2659exclusive regions for the program similar to those used by the
2660Healthy Kids Corporation. However the office is not precluded
2661from developing, in conjunction with insurers, regions different
2662from those used by the Healthy Kids Corporation if the office
2663deems that such a region will carry out the intentions of this
2664subsection.
2665     2.  The office shall evaluate bids submitted based upon
2666criteria established by the office, which shall include, but not
2667be limited to:
2668     a.  The insurer's proven ability to handle health insurance
2669coverage to small employer groups.
2670     b.  The efficiency and timeliness of the insurer's claim
2671processing procedures.
2672     c.  The insurer's ability to apply effective cost-
2673containment programs and procedures and to administer the
2674program in a cost-efficient manner.
2675     d.  The financial condition and stability of the insurer.
2676e.  The insurer's ability to develop an optional mutually
2677supported benefit plan.
2678
2679The office may use any financial information available to it
2680through its regulatory duties to make this evaluation.
2681     (f)  Insurer qualifications.--The insurer shall be a duly
2682authorized insurer or health maintenance organization.
2683     (g)  Duties of the insurer.--The insurer shall:
2684     1.  Develop and implement a program to publicize the
2685existence of the program, program eligibility requirements, and
2686procedures for enrollment and maintain public awareness of the
2687program.
2688     2.  Maintain employer awareness of the program.
2689     3.  Demonstrate the ability to use delivery of cost-
2690effective health care services.
2691     4.  Encourage, educate, advise, and administer the
2692effective use of health savings accounts by covered employees
2693and dependents.
2694     5.  Serve for a period specified in the contract between
2695the office and the insurer, subject to removal for cause and
2696subject to any terms, conditions, and limitations of the
2697contract between the office and the insurer as may be specified
2698in the request for proposal.
2699     (h)  Contract term.--The contract term shall not exceed 3
2700years. At least 6 months prior to the expiration of each
2701contract period, the office shall invite eligible entities,
2702including the current insurer, to submit bids to serve as the
2703insurer for a designated geographic area. Selection of the
2704insurer for the succeeding period shall be made at least 3
2705months prior to the end of the current period. If a protest is
2706filed and not resolved by the end of the contract period, the
2707contract with the existing administrator may be extended for a
2708period not to exceed 6 months. During the contract extension
2709period, the administrator shall be paid at a rate to be
2710negotiated by the office.
2711     (i)  Insurer reporting requirements.--On March 1 following
2712the close of each calendar year, the insurer shall determine net
2713written and earned premiums, the expense of administration, and
2714the paid and incurred losses for the year and report this
2715information to the office on a form prescribed by the office.
2716     (j)  Application requirements.--The insurer shall permit or
2717allow any licensed and duly appointed health insurance agent
2718residing in the designated region to submit applications for
2719coverage, and such agent shall be paid a fair commission if
2720coverage is written. The agent must be appointed to at least one
2721insurer.
2722     (k)  Benefits.--The benefits provided by the plan shall be
2723the same as the coverage required for small employers under
2724subsection (12). Upon the approval of the office, the insurer
2725may also establish an optional mutually supported benefit plan
2726which is an alternative plan developed within a defined
2727geographic region of this state or any other such alternative
2728plan which will carry out the intent of this subsection. Any
2729small employer carrier issuing new health benefit plans may
2730offer a benefit plan with coverages similar to, but not less
2731than, any alternative coverage plan developed pursuant to this
2732subsection.
2733     (l)  Annual reporting.--The office shall make an annual
2734report to the Governor, the President of the Senate, and the
2735Speaker of the House of Representatives. The report shall
2736summarize the activities of the program in the preceding
2737calendar year, including the net written and earned premiums,
2738program enrollment, the expense of administration, and the paid
2739and incurred losses. The report shall be submitted no later than
2740March 15 following the close of the prior calendar year.
2741     (16)(15)  APPLICABILITY OF OTHER STATE LAWS.--
2742     (a)  Except as expressly provided in this section, a law
2743requiring coverage for a specific health care service or
2744benefit, or a law requiring reimbursement, utilization, or
2745consideration of a specific category of licensed health care
2746practitioner, does not apply to a standard or basic health
2747benefit plan policy or contract or a limited benefit policy or
2748contract offered or delivered to a small employer unless that
2749law is made expressly applicable to such policies or contracts.
2750A law restricting or limiting deductibles, coinsurance,
2751copayments, or annual or lifetime maximum payments does not
2752apply to any health plan policy, including a standard or basic
2753health benefit plan policy or contract, offered or delivered to
2754a small employer unless such law is made expressly applicable to
2755such policy or contract. However, every small employer carrier
2756must offer to eligible small employers the standard benefit plan
2757and the basic benefit plan, as required by subsection (5), as
2758such plans have been approved by the office pursuant to
2759subsection (12).
2760     (b)  Except as provided in this section, a standard or
2761basic health benefit plan policy or contract or limited benefit
2762policy or contract offered to a small employer is not subject to
2763any provision of this code which:
2764     1.  Inhibits a small employer carrier from contracting with
2765providers or groups of providers with respect to health care
2766services or benefits;
2767     2.  Imposes any restriction on a small employer carrier's
2768ability to negotiate with providers regarding the level or
2769method of reimbursing care or services provided under a health
2770benefit plan; or
2771     3.  Requires a small employer carrier to either include a
2772specific provider or class of providers when contracting for
2773health care services or benefits or to exclude any class of
2774providers that is generally authorized by statute to provide
2775such care.
2776     (c)  Any second tier assessment paid by a carrier pursuant
2777to paragraph (11)(j) may be credited against assessments levied
2778against the carrier pursuant to s. 627.6494.
2779     (d)  Notwithstanding chapter 641, a health maintenance
2780organization is authorized to issue contracts providing benefits
2781equal to the standard health benefit plan, the basic health
2782benefit plan, and the limited benefit policy authorized by this
2783section.
2784     (17)(16)  RULEMAKING AUTHORITY.--The commission may adopt
2785rules to administer this section, including rules governing
2786compliance by small employer carriers and small employers.
2787     Section 24.  Section 627.6405, Florida Statutes, is created
2788to read:
2789     627.6405  Decreasing inappropriate utilization of emergency
2790care.--
2791     (1)  The Legislature finds and declares it to be of vital
2792importance that emergency services and care be provided by
2793hospitals and physicians to every person in need of such care,
2794but with the double-digit increases in health insurance
2795premiums, health care providers and insurers should encourage
2796patients and the insured to assume responsibility for their
2797treatment, including emergency care. The Legislature finds that
2798inappropriate utilization of emergency department services
2799increases the overall cost of providing health care and these
2800costs are ultimately borne by the hospital, the insured
2801patients, and, many times, by the taxpayers of this state.
2802Finally, the Legislature declares that the providers and
2803insurers must share the responsibility of providing alternative
2804treatment options to urgent care patients outside of the
2805emergency department. Therefore, it is the intent of the
2806Legislature to place the obligation for educating consumers and
2807creating mechanisms for delivery of care that will decrease the
2808overutilization of emergency service on health insurers and
2809providers.
2810     (2)  Health insurers shall provide on their websites
2811information regarding appropriate utilization of emergency care
2812services which shall include, but not be limited to, a list of
2813alternative urgent care contracted providers, the types of
2814services offered by these providers, and what to do in the event
2815of a true emergency.
2816     (3)  Health insurers shall develop community emergency
2817department diversion programs. Such programs may include, but
2818not be limited to, enlisting providers to be on call to insurers
2819after hours, coordinating care through local community
2820resources, and providing incentives to providers for case
2821management.
2822     (4)  As a disincentive for insureds to inappropriately use
2823emergency department services for nonemergency care, health
2824insurers may require higher copayments for urgent care or
2825primary care provided in an emergency department and higher
2826copayments for use of out-of-network emergency departments.
2827Higher copayments may not be charged for the utilization of the
2828emergency department for emergency care. For the purposes of
2829this section, the term "emergency care" has the same meaning as
2830provided in s. 395.002, and shall include services provided to
2831rule out an emergency medical condition.
2832     Section 25.  Section 641.31097, Florida Statutes, is
2833created to read:
2834     641.31097  Decreasing inappropriate utilization of
2835emergency care.--
2836     (1)  The Legislature finds and declares it to be of vital
2837importance that emergency services and care be provided by
2838hospitals and physicians to every person in need of such care,
2839but with the double-digit increases in health insurance
2840premiums, health care providers and insurers should encourage
2841patients and the insured to assume responsibility for their
2842treatment, including emergency care. The Legislature finds that
2843inappropriate utilization of emergency department services
2844increases the overall cost of providing health care and these
2845costs are ultimately borne by the hospital, by the insured
2846patients, and, many times, by the taxpayers of this state.
2847Finally, the Legislature declares that the providers and
2848insurers must share the responsibility of providing alternative
2849treatment options to urgent care patients outside of the
2850emergency department. Therefore, it is the intent of the
2851Legislature to place the obligation for educating consumers and
2852creating mechanisms for delivery of care that will decrease the
2853overutilization of emergency service on health insurers and
2854providers.
2855     (2)  Health insurers shall provide on their Internet
2856websites information regarding appropriate utilization of
2857emergency care services, which shall include, but not be limited
2858to, a list of alternative urgent care contracted providers, the
2859types of services offered by these providers, and what to do in
2860the event of a true emergency.
2861     (3)  Health insurers shall develop community emergency
2862department diversion programs. Such programs may include, but
2863not be limited to, enlisting providers to be on call to insurers
2864after hours, coordinating care through local community
2865resources, and providing incentives to providers for case
2866management.
2867     (4)  As a disincentive for insureds to inappropriately use
2868emergency department services for nonemergency care, health
2869insurers may require higher copayments for urgent care or
2870primary care provided in an emergency department and higher
2871copayments for use of out-of-network emergency departments.
2872Higher copayments may not be charged for the utilization of the
2873emergency department for emergency care. For the purposes of
2874this section, the term "emergency care" has the same meaning as
2875provided in s. 395.002 and shall include services provided to
2876rule out an emergency medical condition.
2877     Section 26.  Subsection (1) of section 627.9175, Florida
2878Statutes, is amended to read:
2879     627.9175  Reports of information on health and accident
2880insurance.--
2881     (1)  Each health insurer, prepaid limited health services
2882organization, and health maintenance organization shall submit,
2883no later than April 1 of each year, annually to the office
2884information concerning health and accident insurance coverage
2885and medical plans being marketed and currently in force in this
2886state. The required information shall be described by market
2887segment, to include, but not be limited to:
2888     (a)  Issuing, servicing company, and entity contact
2889information.
2890     (b)  Information on all health and accident insurance
2891policies and prepaid limited health service organizations and
2892health maintenance organization contracts in force and issued in
2893the previous year. Such information shall include, but not be
2894limited to, direct premiums earned, direct losses incurred,
2895number of policies, number of certificates, number of covered
2896lives, number or the percentage of claims denied and claims
2897meeting prompt pay requirements, and the average number of days
2898taken to pay claims. as to policies of individual health
2899insurance:
2900     (a)  A summary of typical benefits, exclusions, and
2901limitations for each type of individual policy form currently
2902being issued in the state. The summary shall include, as
2903appropriate:
2904     1.  The deductible amount;
2905     2.  The coinsurance percentage;
2906     3.  The out-of-pocket maximum;
2907     4.  Outpatient benefits;
2908     5.  Inpatient benefits; and
2909     6.  Any exclusions for preexisting conditions.
2910
2911The commission shall determine other appropriate benefits,
2912exclusions, and limitations to be reported for inclusion in the
2913consumer's guide published pursuant to this section.
2914     (b)  A schedule of rates for each type of individual policy
2915form reflecting typical variations by age, sex, region of the
2916state, or any other applicable factor which is in use and is
2917determined to be appropriate for inclusion by the commission.
2918
2919The commission may establish rules governing shall provide by
2920rule a uniform format for the submission of this information
2921described in this section, including the use of uniform formats
2922and electronic data transmission order to allow for meaningful
2923comparisons of premiums charged for comparable benefits. The
2924office shall provide this information to the department, which
2925shall publish annually a consumer's guide which summarizes and
2926compares the information required to be reported under this
2927subsection.
2928     Section 27.  Chapter 636, Florida Statutes, entitled
2929"Prepaid Limited Health Service Organizations," is retitled as
2930"Prepaid Limited Health Service Organizations and Discount
2931Medical Plan Organizations."
2932     Section 28.  Sections 636.002 through 636.067, Florida
2933Statutes, are designated as part I of chapter 636, Florida
2934Statutes, and entitled "Prepaid Limited Health Service
2935Organizations."
2936     Section 29.  Paragraph (c) of subsection (7) of section
2937636.003, Florida Statutes, is amended to read:
2938     636.003  Definitions.--As used in this act, the term:
2939     (7)  "Prepaid limited health service organization" means
2940any person, corporation, partnership, or any other entity which,
2941in return for a prepayment, undertakes to provide or arrange
2942for, or provide access to, the provision of a limited health
2943service to enrollees through an exclusive panel of providers.
2944Prepaid limited health service organization does not include:
2945     (c)  Any person who is licensed pursuant to part II as a
2946discount medical plan organization, in exchange for fees, dues,
2947charges or other consideration, provides access to a limited
2948health service provider without assuming any responsibility for
2949payment for the limited health service or any portion thereof.
2950     Section 30.  Effective January 1, 2005, part II of chapter
2951636, Florida Statutes, consisting of sections 636.202, 636.204,
2952636.206, 636.208, 636.210, 636.212, 636.214, 636.216, 636.218,
2953636.220, 636.222, 636.224, 636.226, 636.228, 636.230, 636.232,
2954636.234, 636.236, 636.238, 636.240, 636.242, and 636.244, is
2955created to read:
2956
PART II
2957
DISCOUNT MEDICAL PLAN ORGANIZATIONS
2958     636.202  Definitions.--As used in this part, the term:
2959     (1)  "Discount medical plan" means a business arrangement
2960or contract in which a person, in exchange for fees, dues,
2961charges, or other consideration, provides access for plan
2962members to providers of medical services and the right to
2963receive medical services from those providers at a discount.
2964     (2)  "Discount medical plan organization" means an entity
2965which, in exchange for fees, dues, charges, or other
2966consideration, provides access for plan members to providers of
2967medical services and the right to receive medical services from
2968those providers at a discount.
2969     (3)  "Marketer" means a person or entity which markets,
2970promotes, sells, or distributes a discount medical plan,
2971including a private label entity which places its name on and
2972markets or distributes a discount medical plan but does not
2973operate a discount medical plan.
2974     (4)  "Medical services" means any care, service, or
2975treatment of illness or dysfunction of, or injury to, the human
2976body, including, but not limited to, physician care, inpatient
2977care, hospital surgical services, emergency services, ambulance
2978services, dental care services, vision care services, mental
2979health services, substance abuse services, chiropractic
2980services, podiatric care services, laboratory services, and
2981medical equipment and supplies. The term does not include
2982pharmaceutical supplies or prescriptions.
2983     (5)  "Member" means any person who pays fees, dues,
2984charges, or other consideration for the right to receive the
2985purported benefits of a discount medical plan.
2986     (6)  "Provider" means any person or institution which is
2987contracted, directly or indirectly, with a discount medical plan
2988organization to provide medical services to members.
2989     (7)  "Provider network" means an entity which negotiates on
2990behalf of more than one provider with a discount medical plan
2991organization to provide medical services to members.
2992     636.204  License required.--
2993     (1)  Before doing business in this state as a discount
2994medical plan organization, an entity must be a corporation,
2995incorporated under the laws of this state or, if a foreign
2996corporation, authorized to transact business in this state, and
2997must possess a license as a discount medical plan organization
2998from the office.
2999     (2)  An application for a license to operate as a discount
3000medical plan organization must be filed with the office on a
3001form prescribed by the commission. Such application must be
3002sworn to by an officer or authorized representative of the
3003applicant and be accompanied by the following:
3004     (a)  A copy of the applicant's articles of incorporation,
3005including all amendments.
3006     (b)  A copy of the corporation's bylaws.
3007     (c)  A list of the names, addresses, official positions,
3008and biographical information of the individuals who are
3009responsible for conducting the applicant's affairs, including,
3010but not limited to, all members of the board of directors, board
3011of trustees, executive committee, or other governing board or
3012committee, the officers, contracted management company
3013personnel, and any person or entity owning or having the right
3014to acquire 10 percent or more of the voting securities of the
3015applicant. Such listing must fully disclose the extent and
3016nature of any contracts or arrangements between any individual
3017who is responsible for conducting the applicant's affairs and
3018the discount medical plan organization, including any possible
3019conflicts of interest.
3020     (d)  A complete biographical statement, on forms prescribed
3021by the commission, an independent investigation report, and a
3022set of fingerprints, as provided in chapter 624, with respect to
3023each individual identified under paragraph (c).
3024     (e)  A statement generally describing the applicant, its
3025facilities and personnel, and the medical services to be
3026offered.
3027     (f)  A copy of the form of all contracts made or to be made
3028between the applicant and any providers or provider networks
3029regarding the provision of medical services to members.
3030     (g)  A copy of the form of any contract made or arrangement
3031to be made between the applicant and any person listed in
3032paragraph (c).
3033     (h)  A copy of the form of any contract made or to be made
3034between the applicant and any person, corporation, partnership,
3035or other entity for the performance on the applicant's behalf of
3036any function, including, but not limited to, marketing,
3037administration, enrollment, investment management, and
3038subcontracting for the provision of health services to members.
3039     (i)  A copy of the applicant's most recent financial
3040statements audited by an independent certified public
3041accountant.
3042     (j)  A description of the proposed method of marketing.
3043     (k)  A description of the subscriber complaint procedures
3044to be established and maintained.
3045     (l)  The fee for issuance of a license.
3046     (m)  Such other information as the commission or office may
3047reasonably require to make the determinations required by this
3048part.
3049     (3)  The office shall issue a license which shall expire
3050one year later, and each year on that date thereafter, and which
3051the office shall renew if the licensee pays the annual license
3052fee of $50 and if the office is satisfied that the licensee is
3053in compliance with this part.
3054     (4)  Prior to licensure by the office, each discount
3055medical plan organization must establish an Internet website so
3056as to conform to the requirements of s. 636.226.
3057     (5)  The license fee under subsection (2) is $50 per year
3058per licensee. All amounts collected shall be deposited into the
3059General Revenue Fund.
3060     (6)  Nothing in this part requires a provider who provides
3061discounts to his or her own patients to obtain and maintain a
3062license as a discount medical plan organization.
3063     636.206  Examinations and investigations.--
3064     (1)  The office may examine or investigate the business and
3065affairs of any discount medical plan organization. The office
3066may order any discount medical plan organization or applicant to
3067produce any records, books, files, advertising and solicitation
3068materials, or other information and may take statements under
3069oath to determine whether the discount medical plan organization
3070or applicant is in violation of the law or is acting contrary to
3071the public interest. The expenses incurred in conducting any
3072examination or investigation must be paid by the discount
3073medical plan organization or applicant. Examinations and
3074investigations must be conducted as provided in chapter 624, and
3075discount medical plan organizations are subject to all
3076applicable provisions of the insurance code.
3077     (2)  Failure by the discount medical plan organization to
3078pay the expenses incurred under subsection (1) is grounds for
3079denial or revocation.
3080     636.208  Permitted activities of a discount medical plan
3081organization.--A discount medical plan organization may engage
3082in the following activities:
3083     (1)  Charge a monthly fee to its members, provided, if a
3084discount medical plan charges for a time period in excess of one
3085month, the plan must, in the event of cancellation of the
3086membership by either party, make a pro rata reimbursement of the
3087fees to the member.
3088     (2)  Enter into contracts with providers and provider
3089networks in which the providers or provider networks agree to
3090provide medical services at a discount to plan members.
3091     636.210  Prohibited activities of a discount medical plan
3092organization.--
3093     (1)  A discount medical plan organization may not:
3094     (a)  Use in its advertisements, marketing material,
3095brochures, and discount cards the term "insurance" except as
3096otherwise provided in this part;
3097     (b)  Use in its advertisements, marketing material,
3098brochures, and discount cards the terms "affordable healthcare,"
3099"health plan," "coverage," "copay," "copayments," "preexisting
3100conditions," "guaranteed issue," or "premium" or other terms
3101which could reasonably mislead a person into believing the
3102discount medical plan was health insurance;
3103     (c)  Have restrictions on free access to plan providers,
3104including, but not limited to, waiting periods and notification
3105periods; or
3106     (d)  Pay to providers any fees for medical services.
3107     (2)  A discount medical plan organization may not collect
3108or accept money from a member for payment to a provider for
3109specific medical services furnished or to be furnished to the
3110member unless the organization has an active certificate of
3111authority from the office to act as an administrator.
3112     636.212  Disclosures.--The following disclosures must be
3113made in writing to any prospective member and must be on the
3114first page of any advertisements, marketing materials, and
3115brochures relating to a discount medical plan, in not less than
311610-point type or no smaller than the largest type on the page if
3117larger than 10-point type:
3118     (1)  That the plan is not insurance.
3119     (2)  That the plan does not make payments directly to the
3120providers of medical services.
3121     (3)  That the plan member is obligated to pay to the
3122provider the full amount of the discounted fees.
3123     (4)  The corporate name and the locations of the licensed
3124discount medical plan organization.
3125     636.214  Provider agreements.--
3126     (1)  All providers offering medical services to members
3127under a discount medical plan must provide such services
3128pursuant to a written agreement. The agreement may be entered
3129into directly by the provider or by a provider network to which
3130the provider belongs.
3131     (2)  A provider agreement must provide the following:
3132     (a)  A list of the services and products to be provided at
3133a discount.
3134     (b)  The amount or amounts of the discounts or,
3135alternatively, a fee schedule which reflects the provider's
3136discounted rates.
3137     (c)  That the provider will not charge members more than
3138the discounted rates.
3139     (3)  A provider agreement between a discount medical plan
3140organization and a provider network shall require that the
3141provider network have written agreements with its providers
3142which:
3143     (a)  Contain the terms described in subsection (2).
3144     (b)  Authorize the provider network to contract with the
3145discount medical plan organization on behalf of the provider.
3146     (c)  Require the network to maintain an up-to-date list of
3147its contracted providers and to provide that list on a monthly
3148basis to the discount medical plan organization.
3149     (4)  The discount medical plan organization shall maintain
3150a copy of each active provider agreement.
3151     636.216  Form and rate filings.--
3152     (1)  All charges to members must be filed with the office
3153and must be approved by the office before the charges can be
3154used. The discount medical plan organization has the burden of
3155proof that the charges bear a reasonable relation to the
3156benefits received by the member.
3157     (2)  There must be a written agreement between the discount
3158medical plan organization and the member specifying the benefits
3159under the discount medical plan and complying with the
3160disclosure requirements of this part.
3161     (3)  All forms used, including the written agreement
3162pursuant to subsection (2), must first be filed with and
3163approved by the office. Every form filed shall be identified by
3164a unique form number placed in the lower left corner of each
3165form.
3166     (4)  If such filings are disapproved, the office shall
3167notify the discount medical plan organization and shall specify
3168in the notice the reasons for disapproval. The discount medical
3169plan organization has 21 days from the date of receipt of notice
3170to request a hearing before the office pursuant to chapter 120.
3171     636.218  Annual reports.--
3172     (1)  Each discount medical plan organization must file with
3173the office, within 3 months after the end of each fiscal year,
3174an annual report.
3175     (2)  Such reports must be on forms prescribed by the
3176commission and must include:
3177     (a)  Audited financial statements prepared in accordance
3178with generally accepted accounting principles certified by an
3179independent certified public accountant, including the
3180organization's balance sheet, income statement, and statement of
3181changes in cash flow for the preceding year.
3182     (b)  A list of the names and residence addresses of all
3183persons responsible for the conduct of the organization's
3184affairs, together with a disclosure of the extent and nature of
3185any contracts or arrangements between such persons and the
3186discount medical plan organization, including any possible
3187conflicts of interest.
3188     (c)  The number of discount medical plan members.
3189     (d)  Such other information relating to the performance of
3190the discount medical plan organization as is reasonably required
3191by the commission or office.
3192     (3)  Every discount medical plan organization which fails
3193to file an annual report in the form and within the time
3194required by this section shall forfeit up to $500 for each day
3195for the first 10 days during which the neglect continues and
3196shall forfeit up to $1,000 for each day after the first 10 days
3197during which the neglect continues; and, upon notice by the
3198office to that effect, the organization's authority to enroll
3199new members or to do business in this state ceases while such
3200default continues. The office shall deposit all sums collected
3201by the office under this section to the credit of the Insurance
3202Regulatory Trust Fund. The office may not collect more than
3203$50,000 for each report.
3204     636.220  Minimum capital requirements.?-
3205     (1)  Each discount medical plan organization must at all
3206times maintain a net worth of at least $150,000.
3207     (2)  The office may not issue a license unless the discount
3208medical plan organization has a net worth of at least $150,000.
3209     636.222  Suspension or revocation of license; suspension of
3210enrollment of new members; terms of suspension.--
3211     (1)  The office may suspend the authority of a discount
3212medical plan organization to enroll new members, revoke any
3213license issued to a discount medical plan organization, or order
3214compliance if the office finds that any of the following
3215conditions exist:
3216     (a)  The organization is not operating in compliance with
3217this part.
3218     (b)  The organization does not have the minimum net worth
3219as required by this part.
3220     (c)  The organization has advertised, merchandised, or
3221attempted to merchandise its services in such a manner as to
3222misrepresent its services or capacity for service or has engaged
3223in deceptive, misleading, or unfair practices with respect to
3224advertising or merchandising.
3225     (d)  The organization is not fulfilling its obligations as
3226a medical discount medical plan organization.
3227     (e)  The continued operation of the organization would be
3228hazardous to its members.
3229     (2)  If the office has cause to believe that grounds for
3230the suspension or revocation of a license exist, the office
3231shall notify the discount medical plan organization in writing
3232specifically stating the grounds for suspension or revocation
3233and shall pursue a hearing on the matter in accordance with the
3234provisions of chapter 120.
3235     (3)  When the license of a discount medical plan
3236organization is surrendered or revoked, such organization must
3237proceed, immediately following the effective date of the order
3238of revocation, to wind up its affairs transacted under the
3239license. The organization may not engage in any further
3240advertising, solicitation, collecting of fees, or renewal of
3241contracts.
3242     (4)  The office shall, in its order suspending the
3243authority of a discount medical plan organization to enroll new
3244members, specify the period during which the suspension is to be
3245in effect and the conditions, if any, which must be met by the
3246discount medical plan organization prior to reinstatement of its
3247license to enroll new members. The order of suspension is
3248subject to rescission or modification by further order of the
3249office prior to the expiration of the suspension period.
3250Reinstatement may not be made unless requested by the discount
3251medical plan organization; however, the office may not grant
3252reinstatement if it finds that the circumstances for which the
3253suspension occurred still exist or are likely to recur.
3254     636.224  Notice of change of name or address of discount
3255medical plan organization.--Each discount medical plan
3256organization must provide the office at least 30 days' advance
3257notice of any change in the discount medical plan organization's
3258name, address, principal business address, or mailing address.
3259     636.226  Provider name listing.?-Each discount medical plan
3260organization must maintain an up-to-date list of the names and
3261addresses of the providers with which it has contracted, on an
3262Internet website page, the address of which shall be prominently
3263displayed on all its advertisements, marketing materials,
3264brochures, and discount cards. This section applies to those
3265providers with whom the discount medical plan organization has
3266contracted directly, as well as those who are members of a
3267provider network with which the discount medical plan
3268organization has contracted.
3269     636.228  Marketing of discount medical plans.--
3270     (1)  All advertisements, marketing materials, brochures,
3271and discount cards used by marketers must be approved in writing
3272for such use by the discount medical plan organization.
3273     (2)  The discount medical plan organization shall have an
3274executed written agreement with a marketer prior to the
3275marketer's marketing, promoting, selling, or distributing the
3276discount medical plan.
3277     (3)  No person may act in the capacity of a marketer unless
3278licensed as an agent as defined in s. 626.015(2).
3279     (4)  No person may act in the capacity of a marketer for a
3280discount medical plan organization unless appointed by the
3281discount medical plan organization on a form prescribed by the
3282commission.
3283     636.230  Bundling discount medical plans with other
3284insurance products.?-When a marketer or discount medical plan
3285organization sells a discount medical plan together with any
3286other product, the fees for each individual product must be
3287provided in writing to the member and itemized.
3288     636.232  Rules.--The commission may adopt rules to
3289administer this part, including rules for the licensing of
3290discount medical plan organizations; establishing standards for
3291evaluating forms, advertisements, marketing materials,
3292brochures, and discount cards; providing for the collection of
3293data; relating to disclosures to plan members; and defining
3294terms used in this part.
3295     636.234  Service of process on a discount medical plan
3296organization.-?Sections 624.422 and 624.423 apply to a discount
3297medical plan organization as if the discount medical plan
3298organization were an insurer.
3299     636.236  Security deposit.--
3300     (1)  A licensed discount medical plan organization must
3301deposit and maintain deposited in trust with the department
3302securities eligible for deposit under s. 625.52, having at all
3303times a value of not less than $35,000, for use by the office in
3304protecting plan members.
3305     (2)  No judgment creditor or other claimant of a discount
3306medical plan organization, other than the office or department,
3307shall have the right to levy upon any of the assets or
3308securities held in this state as a deposit under subsection (1).
3309     636.238  Penalties for violation of this part.--
3310     (1)  Except as provided in subsection (2), a person who
3311violates any provision of this part commits a misdemeanor of the
3312second degree, punishable as provided in s. 775.082 or s.
3313775.083.
3314     (2)  A person who operates as or aids and abets another
3315operating as a discount medical plan organization in violation
3316of s. 636.204(1) commits a felony punishable as provided for in
3317s. 624.401(4)(b), as if the unlicensed discount medical plan
3318organization were an unauthorized insurer, and the fees, dues,
3319charges, or other consideration collected from the members by
3320the unlicensed discount medical plan organization or marketer
3321were insurance premium.
3322     (3)  A person who collects fees for purported membership in
3323a discount medical plan but fails to provide the promised
3324benefits commits a theft, punishable as provided in s. 812.014.
3325     636.240  Injunctions.--
3326     (1)  In addition to the penalties and other enforcement
3327provisions of this part, the office may seek both temporary and
3328permanent injunctive relief when:
3329     (a)  A discount medical plan is being operated by any
3330person or entity that is not licensed pursuant to this part.
3331     (b)  Any person, entity, or discount medical plan
3332organization has engaged in any activity prohibited by this part
3333or any rule adopted pursuant to this part.
3334     (2)  The venue for any proceeding bought pursuant to this
3335section shall be in the Circuit Court of Leon County.
3336     (3)  The office's authority to seek injunctive relief is
3337not conditioned on having conducted any proceeding pursuant to
3338chapter 120.
3339     636.242  Civil remedies.--Any person damaged by the acts of
3340a person in violation of this part may bring a civil action
3341against the person committing the violation in the circuit court
3342of the county in which the alleged violator resides or has a
3343principal place of business or in the county in which the
3344alleged violation occurred. Upon an adverse adjudication, the
3345defendant is liable for damages, together with court costs and
3346reasonable attorney's fees incurred by the plaintiff. When so
3347awarded, court costs and attorney's fees must be included in the
3348judgment or decree rendered in the case. If it appears to the
3349court that the suit brought by the plaintiff is frivolous or
3350brought for purposes of harassment, the court may apply
3351sanctions in accordance with chapter 57.
3352     636.244  Unlicensed discount medical plan
3353organizations.--The provisions of ss. 626.901-626.912 apply to
3354The provisions of ss. 626.901-626.912 apply to the activities of
3355an unlicensed discount medical plan organization as if the
3356unlicensed discount medical plan organization were an
3357unauthorized insurer.
3358     Section 31.  Section 627.65626, Florida Statutes, is
3359created to read:
3360     627.65626  Insurance rebates for healthy lifestyles.--
3361     (1)  Any rate, rating schedule, or rating manual for a
3362health insurance policy filed with the office shall provide for
3363an appropriate rebate of premiums paid in the last calendar year
3364when the majority of members of a health plan have enrolled and
3365maintained participation in any health wellness, maintenance, or
3366improvement program offered by the employer. The employer must
3367provide evidence of demonstrative maintenance or improvement of
3368the enrollees' health status as determined by assessments of
3369agreed-upon health status indicators between the employer and
3370the health insurer, including, but not limited to, reduction in
3371weight, body mass index, and smoking cessation. Any rebate
3372provided by the health insurer is presumed to be appropriate
3373unless credible data demonstrates otherwise, but shall not
3374exceed 10 percent of paid premiums.
3375     (2)  The premium rebate authorized by this section shall be
3376effective for an insured on an annual basis, unless the number
3377of participating employees becomes less than the majority of the
3378employees eligible for participation in the wellness program.
3379     Section 32.  Section 627.6402, Florida Statutes, is created
3380to read:
3381     627.6402  Insurance rebates for healthy lifestyles.--
3382     (1)  Any rate, rating schedule, or rating manual for an
3383individual health insurance policy filed with the office shall
3384provide for an appropriate rebate of premiums paid in the last
3385calendar year when the individual covered by such plan is
3386enrolled in and maintains participation in any health wellness,
3387maintenance, or improvement program approved by the health plan.
3388The individual must provide evidence of demonstrative
3389maintenance or improvement of the individual's health status as
3390determined by assessments of agreed-upon health status
3391indicators between the individual and the health insurer,
3392including, but not limited to, reduction in weight, body mass
3393index, and smoking cessation. Any rebate provided by the health
3394insurer is presumed to be appropriate unless credible data
3395demonstrates otherwise, but shall not exceed 10 percent of paid
3396premiums.
3397     (2)  The premium rebate authorized by this section shall be
3398effective for an insured on an annual basis, unless the
3399individual fails to maintain or improve his or her health status
3400while participating in an approved wellness program, or credible
3401evidence demonstrates that the individual is not participating
3402in the approved wellness program.
3403     Section 33.  Subsection (38) of section 641.31, Florida
3404Statutes, is amended, and subsection (40) is added to said
3405section, to read:
3406     641.31  Health maintenance contracts.--
3407     (38)(a)  Notwithstanding any other provision of this part,
3408a health maintenance organization that meets the requirements of
3409paragraph (b) may, through a point-of-service rider to its
3410contract providing comprehensive health care services, include a
3411point-of-service benefit. Under such a rider, a subscriber or
3412other covered person of the health maintenance organization may
3413choose, at the time of covered service, a provider with whom the
3414health maintenance organization does not have a health
3415maintenance organization provider contract. The rider may not
3416require a referral from the health maintenance organization for
3417the point-of-service benefits.
3418     (b)  A health maintenance organization offering a point-of-
3419service rider under this subsection must have a valid
3420certificate of authority issued under the provisions of the
3421chapter, must have been licensed under this chapter for a
3422minimum of 3 years, and must at all times that it has riders in
3423effect maintain a minimum surplus of $5 million. A health
3424maintenance organization offering a point-of-service rider to
3425its contract providing comprehensive health care services may
3426offer the rider to employers who have employees living and
3427working outside the health maintenance organization's approved
3428geographic service area without having to obtain a health care
3429provider certificate, as long as the master group contract is
3430issued to an employer that maintains its primary place of
3431business within the health maintenance organization's approved
3432service area. Any member or subscriber that lives and works
3433outside the health maintenance organization's service area and
3434elects coverage under the health maintenance organization's
3435point-of-service rider must provide a statement to the health
3436maintenance organization that indicates the member or subscriber
3437understands the limitations of his or her policy and that only
3438those benefits under the point-of-service rider will be covered
3439when services are provided outside the service area.
3440     (c)  Premiums paid in for the point-of-service riders may
3441not exceed 15 percent of total premiums for all health plan
3442products sold by the health maintenance organization offering
3443the rider. If the premiums paid for point-of-service riders
3444exceed 15 percent, the health maintenance organization must
3445notify the office and, once this fact is known, must immediately
3446cease offering such a rider until it is in compliance with the
3447rider premium cap.
3448     (d)  Notwithstanding the limitations of deductibles and
3449copayment provisions in this part, a point-of-service rider may
3450require the subscriber to pay a reasonable copayment for each
3451visit for services provided by a noncontracted provider chosen
3452at the time of the service. The copayment by the subscriber may
3453either be a specific dollar amount or a percentage of the
3454reimbursable provider charges covered by the contract and must
3455be paid by the subscriber to the noncontracted provider upon
3456receipt of covered services. The point-of-service rider may
3457require that a reasonable annual deductible for the expenses
3458associated with the point-of-service rider be met and may
3459include a lifetime maximum benefit amount. The rider must
3460include the language required by s. 627.6044 and must comply
3461with copayment limits described in s. 627.6471. Section 641.3154
3462does not apply to a point-of-service rider authorized under this
3463subsection.
3464     (e)  The point-of-service rider must contain provisions
3465that comply with s. 627.6044.
3466     (f)(e)  The term "point of service" may not be used by a
3467health maintenance organization except with riders permitted
3468under this section or with forms approved by the office in which
3469a point-of-service product is offered with an indemnity carrier.
3470     (g)(f)  A point-of-service rider must be filed and approved
3471under ss. 627.410 and 627.411.
3472     (40)(a)  Any rate, rating schedule, or rating manual for a
3473health maintenance organization policy filed with the office
3474shall provide for an appropriate rebate of premiums paid in the
3475last calendar year when the individual covered by such plan is
3476enrolled in and maintains participation in any health wellness,
3477maintenance, or improvement program approved by the health plan.
3478The individual must provide evidence of demonstrative
3479maintenance or improvement of his or her health status as
3480determined by assessments of agreed-upon health status
3481indicators between the individual and the health insurer,
3482including, but not limited to, reduction in weight, body mass
3483index, and smoking cessation. Any rebate provided by the health
3484insurer is presumed to be appropriate unless credible data
3485demonstrates otherwise, but shall not exceed 10 percent of paid
3486premiums.
3487     (b)  The premium rebate authorized by this section shall be
3488effective for an insured on an annual basis, unless the
3489individual fails to maintain or improve his or her health status
3490while participating in an approved wellness program, or credible
3491evidence demonstrates that the individual is not participating
3492in the approved wellness program.
3493     Section 34.  Subsection (2) of section 626.015, Florida
3494Statutes, is amended, subsections (8) through (17) of said
3495section are renumbered as subsections (9) through (18),
3496respectively, and a new subsection (8) is added to said section,
3497to read:
3498     626.015  Definitions.--As used in this part:
3499     (2)  "Agent" means a general lines agent, life agent,
3500health agent, or title agent, or all such agents, as indicated
3501by context. The term "agent" includes an insurance producer or
3502producer, but does not include a customer representative,
3503limited customer representative, or service representative but
3504does include an insurance advisor.
3505     (8)  "Insurance advisor" means any person who, for money,
3506fee, commission, or any other thing of value offers to examine
3507or examines any policy of health insurance or any health benefit
3508plan for the purpose of giving, or gives, or offers to give, any
3509advice, counsel, recommendation, or information in respect to
3510the terms, conditions, benefits, coverage, or premium of any
3511such policy or contract, or in respect to the expediency or
3512advisability of altering, changing, exchanging, converting,
3513replacing, surrendering, continuing, or rejecting any such
3514policy, plan, or contract, or of accepting or procuring any such
3515policy, plan, or contract from any insurer or issuer of a health
3516benefit plan, or who in or on advertisements, cards, signs,
3517circulars, or letterheads, or elsewhere, or in any other way or
3518manner by which public announcements are made, uses the title
3519"insurance advisor," "insurance specialist," "insurance
3520counselor," "insurance analyst," "policyholders' adviser,"
3521"policyholders' counselor," or any other similar title, or any
3522title indicating that the person gives, or is engaged in the
3523business of giving advice, counsel, recommendation, or
3524information to an insured, or a beneficiary, or any person
3525having any interest in a health insurance contract or health
3526benefit plan contract. This definition is not intended to
3527prevent a person who has obtained the professional designation
3528of life underwriter, chartered financial consultant, or
3529certified financial planner by completing a course of
3530instruction recognized within the business of insurance from
3531using that designation to indicate professional achievement.
3532     Section 35.  Subsection (1) of section 626.016, Florida
3533Statutes, is amended to read:
3534     626.016  Powers and duties of department, commission, and
3535office.--
3536     (1)  The powers and duties of the Chief Financial Officer
3537and the department specified in this part apply only with
3538respect to insurance agents, insurance advisors, managing
3539general agents, reinsurance intermediaries, viatical settlement
3540brokers, customer representatives, service representatives, and
3541agencies.
3542     Section 36.  Subsection (1) of section 626.171, Florida
3543Statutes, is amended to read:
3544     626.171  Application for license.--
3545     (1)  The department or office shall not issue a license as
3546agent, insurance advisor, customer representative, adjuster,
3547insurance agency, service representative, managing general
3548agent, or reinsurance intermediary to any person except upon
3549written application therefor filed with it, qualification
3550therefor, and payment in advance of all applicable fees. Any
3551such application shall be made under the oath of the applicant
3552and be signed by the applicant. Beginning November 1, 2002, The
3553department shall accept the uniform application for nonresident
3554agent licensing. The department may adopt revised versions of
3555the uniform application by rule.
3556     Section 37.  Section 626.191, Florida Statutes, is amended
3557to read:
3558     626.191  Repeated applications.--The failure of an
3559applicant to secure a license upon an application shall not
3560preclude the applicant him or her from applying again as many
3561times as desired, but the department or office shall not give
3562consideration to or accept any further application by the same
3563individual for a similar license dated or filed within 30 days
3564subsequent to the date the department or office denied the last
3565application, except as provided in s. 626.281.
3566     Section 38.  Subsection (1) of section 626.201, Florida
3567Statutes, is amended to read:
3568     626.201  Investigation.--
3569     (1)  The department or office may propound any reasonable
3570interrogatories in addition to those contained in the
3571application, to any applicant for license or appointment, or on
3572any renewal, reinstatement, or continuation thereof, relating to
3573the applicant's his or her qualifications, residence,
3574prospective place of business, and any other matter which, in
3575the opinion of the department or office, is deemed necessary or
3576advisable for the protection of the public and to ascertain the
3577applicant's qualifications.
3578     Section 39.  Subsections (1) and (2) of section 626.342,
3579Florida Statutes, are amended to read:
3580     626.342  Furnishing supplies to unlicensed life, health, or
3581general lines agent prohibited; civil liability.--
3582     (1)  An insurer, a managing general agent, an insurance
3583advisor, or an agent, directly or through any representative,
3584may not furnish to any agent any blank forms, applications,
3585stationery, or other supplies to be used in soliciting,
3586negotiating, or effecting contracts of insurance on its behalf
3587unless such blank forms, applications, stationery, or other
3588supplies relate to a class of business with respect to which the
3589agent is licensed and appointed, whether for that insurer or
3590another insurer.
3591     (2)  Any insurer, general agent, insurance advisor, or
3592agent who furnishes any of the supplies specified in subsection
3593(1) to any agent or prospective agent not appointed to represent
3594the insurer and who accepts from or writes any insurance
3595business for such agent or agency is subject to civil liability
3596to any insured of such insurer to the same extent and in the
3597same manner as if such agent or prospective agent had been
3598appointed or authorized by the insurer or such agent to act in
3599its or his or her behalf. The provisions of this subsection do
3600not apply to insurance risk apportionment plans under s.
3601627.351.
3602     Section 40.  Section 626.536, Florida Statutes, is amended
3603to read:
3604     626.536  Reporting of actions.--An agent or insurance
3605advisor shall submit to the department, within 30 days after the
3606final disposition of any administrative action taken against the
3607agent by a governmental agency in this or any other state or
3608jurisdiction relating to the business of insurance, the sale of
3609securities, or activity involving fraud, dishonesty,
3610trustworthiness, or breach of a fiduciary duty, a copy of the
3611order, consent to order, or other relevant legal documents. The
3612department may adopt rules implementing the provisions of this
3613section.
3614     Section 41.  Subsections (1) and (3) of section 626.561,
3615Florida Statutes, are amended to read:
3616     626.561  Reporting and accounting for funds.--
3617     (1)  All premiums, return premiums, or other funds
3618belonging to insurers or others received by an insurance
3619advisor, agent, customer representative, or adjuster in
3620transactions under a his or her license are trust funds received
3621by the licensee in a fiduciary capacity. An agent or insurance
3622advisor shall keep the funds belonging to each insurer for which
3623an agent or insurance advisor he or she is not appointed, other
3624than a surplus lines insurer, in a separate account so as to
3625allow the department or office to properly audit such funds. The
3626licensee in the applicable regular course of business shall
3627account for and pay the same to the insurer, insured, or other
3628person entitled thereto.
3629     (3)  Any insurance advisor, agent, customer representative,
3630or adjuster who, not being lawfully entitled thereto, either
3631temporarily or permanently diverts or misappropriates such funds
3632or any portion thereof or deprives the other person of a benefit
3633therefrom commits the offense specified below:
3634     (a)  If the funds diverted or misappropriated are $300 or
3635less, a misdemeanor of the first degree, punishable as provided
3636in s. 775.082 or s. 775.083.
3637     (b)  If the funds diverted or misappropriated are more than
3638$300, but less than $20,000, a felony of the third degree,
3639punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
3640     (c)  If the funds diverted or misappropriated are $20,000
3641or more, but less than $100,000, a felony of the second degree,
3642punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
3643     (d)  If the funds diverted or misappropriated are $100,000
3644or more, a felony of the first degree, punishable as provided in
3645s. 775.082, s. 775.083, or s. 775.084.
3646     Section 42.  Subsections (1) and (2) of section 626.572,
3647Florida Statutes, are amended to read:
3648     626.572  Rebating; when allowed.--
3649     (1)  No insurance advisor or agent shall rebate any portion
3650of a his or her commission except as follows:
3651     (a)  The rebate shall be available to all insureds in the
3652same actuarial class.
3653     (b)  The rebate shall be in accordance with a rebating
3654schedule filed by the agent with the insurer issuing the policy
3655to which the rebate applies.
3656     (c)  The rebating schedule shall be uniformly applied in
3657that all insureds who purchase the same policy through the agent
3658for the same amount of insurance receive the same percentage
3659rebate.
3660     (d)  Rebates shall not be given to an insured with respect
3661to a policy purchased from an insurer that prohibits its agents
3662from rebating commissions.
3663     (e)  The rebate schedule is prominently displayed in public
3664view in the agent's place of doing business and a copy is
3665available to insureds on request at no charge.
3666     (f)  The age, sex, place of residence, race, nationality,
3667ethnic origin, marital status, or occupation of the insured or
3668location of the risk is not utilized in determining the
3669percentage of the rebate or whether a rebate is available.
3670     (2)  The insurance advisor or agent shall maintain a copy
3671of all rebate schedules for the most recent 5 years and their
3672effective dates.
3673     Section 43.  Section 626.593, Florida Statutes, is created
3674to read:
3675     626.593  Insurance advisor; written contract for
3676compensation.--
3677     (1)  No person licensed as an insurance advisor may receive
3678any fee or commission or any other thing of value in addition to
3679the rates filed pursuant to chapter 627 for examining any health
3680insurance or any health benefit plan for the purpose of giving
3681or offering advice, counsel, recommendation, or information in
3682respect to terms, conditions, benefits, coverage, or premium of
3683any such policy or contract unless such compensation is based
3684upon a written contract signed by the party to be charged and
3685specifying or clearly defining the amount or extent of such
3686compensation and informing the party to be charged that any
3687commission received from an insurer will be rebated to the party
3688in accordance with subsection (3). In addition, all compensation
3689to be paid to the insurance advisor must be disclosed in the
3690contract.
3691     (2)  A copy of every such contract shall be retained by the
3692licensee for not less than 3 years after such services have been
3693fully performed.
3694     (3)  Notwithstanding the provisions of s. 626.572, all
3695commissions received by an insurance advisor from an insurer in
3696connection with the issuance of a policy, when a separate fee or
3697other consideration has been paid to the insurance advisor by an
3698insured, shall be rebated to the insured or other party being
3699charged within 30 days after receipt of such commission by the
3700insurance advisor.
3701     Section 44.  Section 626.594, Florida Statutes, is created
3702to read:
3703     626.594  Qualifications for license; insurance advisor.-?An
3704applicant for license as an insurance advisor shall qualify as
3705such in the same manner as a health insurance agent pursuant to
3706this chapter. However, any such applicant who is otherwise
3707qualified and licensed as a health insurance agent in this state
3708shall be exempt from examination, as required by s. 626.211 and
3709the knowledge, experience, or instruction requirements of s.
3710626.8311. The authority of the insurance advisor is limited to
3711the specific lines of authority granted under the agent's
3712subsisting health insurance agent license.
3713     Section 45.  Subsection (1) of section 626.601, Florida
3714Statutes, is amended to read:
3715     626.601  Improper conduct; inquiry; fingerprinting.--
3716     (1)  The department or office may, upon its own motion or
3717upon a written complaint signed by any interested person and
3718filed with the department or office, inquire into any alleged
3719improper conduct of any licensed insurance advisor, agent,
3720adjuster, service representative, managing general agent,
3721customer representative, title insurance agent, title insurance
3722agency, continuing education course provider, instructor, school
3723official, or monitor group under this code. The department or
3724office may thereafter initiate an investigation of any such
3725licensee if it has reasonable cause to believe that the licensee
3726has violated any provision of the insurance code. During the
3727course of its investigation, the department or office shall
3728contact the licensee being investigated unless it determines
3729that contacting such person could jeopardize the successful
3730completion of the investigation or cause injury to the public.
3731     Section 46.  Paragraph (b) of subsection (5) of section
3732624.509, Florida Statutes, is amended to read:
3733     624.509  Premium tax; rate and computation.--
3734     (5)  There shall be allowed a credit against the net tax
3735imposed by this section equal to 15 percent of the amount paid
3736by the insurer in salaries to employees located or based within
3737this state and who are covered by the provisions of chapter 443.
3738For purposes of this subsection:
3739     (b)  The term "employees" does not include independent
3740contractors or any person whose duties require that the person
3741hold a valid license under the Florida Insurance Code, except
3742persons defined in s. 626.015(1), (16)(15), and (18)(17).
3743     Section 47.  Subsection (2) of section 626.7845, Florida
3744Statutes, is amended to read:
3745     626.7845  Prohibition against unlicensed transaction of
3746life insurance.--
3747     (2)  Except as provided in s. 626.112(6), with respect to
3748any line of authority specified in s. 626.015(12)(11), no
3749individual shall, unless licensed as a life agent:
3750     (a)  Solicit insurance or annuities or procure
3751applications; or
3752     (b)  In this state, engage or hold himself or herself out
3753as engaging in the business of analyzing or abstracting
3754insurance policies or of counseling or advising or giving
3755opinions to persons relative to insurance or insurance contracts
3756other than:
3757     1.  As a consulting actuary advising an insurer; or
3758     2.  As to the counseling and advising of labor unions,
3759associations, trustees, employers, or other business entities,
3760the subsidiaries and affiliates of each, relative to their
3761interests and those of their members or employees under
3762insurance benefit plans.
3763     Section 48.  Notwithstanding the amendment to s.
3764627.6699(5)(c), Florida Statutes, by this act, any right to an
3765open enrollment offer of health benefit coverage for groups of
3766fewer than two employees, pursuant to s. 627.6699(5)(c), Florida
3767Statutes, as it existed immediately before the effective date of
3768this act, shall remain in full force and effect until the
3769enactment of s. 627.64872, Florida Statutes, and the subsequent
3770date upon which such plan begins to accept new risks or members.
3771     Section 49.  Section 465.0244, Florida Statutes, is created
3772to read:
3773     465.0244  Information disclosure.--Every pharmacy shall
3774make available on its Internet website a link to the performance
3775outcome and financial data that is published by the Agency for
3776Health Care Administration pursuant to s. 408.05(3)(l) and shall
3777place in the area where customers receive filled prescriptions
3778notice that such information is available electronically and the
3779address of its Internet website.
3780     Section 50.  Section 627.6499, Florida Statutes, is amended
3781to read:
3782     627.6499  Reporting by insurers and third-party
3783administrators.--
3784     (1)  The office may require any insurer, third-party
3785administrator, or service company to report any information
3786reasonably required to assist the board in assessing insurers as
3787required by this act.
3788     (2)  Each health insurance issuer shall make available on
3789its Internet website a link to the performance outcome and
3790financial data that is published by the Agency for Health Care
3791Administration pursuant to s. 408.05(3)(l) and shall include in
3792every policy delivered or issued for delivery to any person in
3793the state or any materials provided as required by s. 627.64725
3794notice that such information is available electronically and the
3795address of its Internet website.
3796     Section 51.  Subsections (6) and (7) are added to section
3797641.54, Florida Statutes, to read:
3798     641.54  Information disclosure.--
3799     (6)  Each health maintenance organization shall make
3800available to its subscribers the estimated co-pay, coinsurance,
3801or deductible, whichever is applicable, for any covered
3802services, the status of the subscriber's maximum annual out-of-
3803pocket payments for a covered individual or family, and the
3804status of the subscriber's maximum lifetime benefit. Such
3805estimate shall not preclude the actual co-pay, coinsurance, or
3806deductible, whichever is applicable, from exceeding the
3807estimate.
3808     (7)  Each health maintenance organization shall make
3809available on its Internet website a link to the performance
3810outcome and financial data that is published by the Agency for
3811Health Care Administration pursuant to s. 408.05(3)(l) and shall
3812include in every policy delivered or issued for delivery to any
3813person in the state or any materials provided as required by s.
3814627.64725 notice that such information is available
3815electronically and the address of its Internet website.
3816     Section 52.  Section 408.02, Florida Statutes, is repealed.
3817     Section 53.  The sum of $250,000 is appropriated from the
3818Insurance Regulatory Trust Fund in the Department of Financial
3819Services to the Office of Insurance Regulation for the purpose
3820of implementing the provisions in this act relating to the Small
3821Employers Access Program.
3822     Section 54.  The sum of $2 million is appropriated from the
3823General Revenue Fund to the Agency for Health Care
3824Administration for the purpose of implementing the provisions of
3825this act relating to electronic medical records.
3826     Section 55.  The sum of $250,000 is appropriated from the
3827Insurance Regulatory Trust Fund to enable the board of the
3828Florida Health Insurance Plan to conduct an actuarial study
3829required under s. 627.64872, Florida Statutes.
3830     Section 56.  Except as otherwise provided herein, this act
3831shall take effect July 1, 2004.


CODING: Words stricken are deletions; words underlined are additions.
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