October 26, 2020
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_h0291__
HB 291

1
A bill to be entitled
2An act relating to provider contracts; amending ss.
3627.6474, 636.035, and 641.315, F.S.; proscribing certain
4fee setting provisions in certain contracts between health
5care practitioners and certain health insurance entities
6under certain circumstances; providing a definition;
7providing application; providing an effective date.
8
9Be It Enacted by the Legislature of the State of Florida:
10
11     Section 1.  Section 627.6474, Florida Statutes, is amended
12to read:
13     627.6474  Provider contracts.--
14     (1)  A health insurer shall not require a contracted health
15care practitioner as defined in s. 456.001(4) to accept the
16terms of other health care practitioner contracts with the
17insurer or any other insurer, or health maintenance
18organization, under common management and control with the
19insurer, including Medicare and Medicaid practitioner contracts
20and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
21s. 641.315, except for a practitioner in a group practice as
22defined in s. 456.053 who must accept the terms of a contract
23negotiated for the practitioner by the group, as a condition of
24continuation or renewal of the contract. Any contract provision
25that violates this section is void. A violation of this section
26is not subject to the criminal penalty specified in s. 624.15.
27     (2)  A contract between a health insurer and a health care
28practitioner as defined in s. 456.001 for the provision of
29services to patients may not contain any provision that requires
30the practitioner to provide services to the policyholders of the
31health insurer at a fee set by the health insurer unless such
32services are covered services under the applicable health
33insurance policy. For purposes of this subsection, the term
34"covered services" means services reimbursable under the
35applicable health insurance policy, subject to any contractual
36limitations on an insured's benefits that may apply. This
37subsection applies to all contracts entered into or renewed on
38or after July 1, 2010.
39     Section 2.  Subsection (13) is added to section 636.035,
40Florida Statutes, to read:
41     636.035  Provider contracts arrangements.--
42     (13)  A contract between a prepaid limited health service
43organization and a health care practitioner as defined in s.
44456.001 for the provision of services to patients may not
45contain any provision that requires the practitioner to provide
46services to the organization's subscribers at a fee set by the
47organization unless such services are covered services under the
48applicable subscriber agreement. For purposes of this
49subsection, the term "covered services" means services
50reimbursable under the applicable subscriber agreement, subject
51to any contractual limitations on subscriber benefits that may
52apply. This subsection applies to all contracts entered into or
53renewed on or after July 1, 2010.
54     Section 3.  Subsection (11) is added to section 641.315,
55Florida Statutes, read:
56     641.315  Provider contracts.--
57     (11)  A contract between a health maintenance organization
58and a health care practitioner as defined in s. 456.001 for the
59provision of services to patients may not contain any provision
60that requires the practitioner to provide services to the
61organization's subscribers at a fee set by the organization
62unless such services are covered services under the applicable
63subscriber agreement. For purposes of this subsection, the term
64"covered services" means services reimbursable under the
65applicable subscriber agreement, subject to any contractual
66limitations on subscriber benefits that may apply. This
67subsection applies to all contracts entered into or renewed on
68or after July 1, 2010.
69     Section 4.  This act shall take effect July 1, 2010.


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