January 27, 2020
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       Florida Senate - 2010                              CS for SB 302
       
       
       
       By the Committee on Banking and Insurance; and Senators Jones,
       Gaetz, and Sobel
       
       
       
       597-04816-10                                           2010302c1
    1                        A bill to be entitled                      
    2         An act relating to dentists; amending s. 627.6474,
    3         F.S.; prohibiting contracts between health insurers
    4         and dentists from containing certain fee requirements
    5         set by the insurer under certain circumstances;
    6         providing a definition; providing application;
    7         amending s. 636.035, F.S.; prohibiting contracts
    8         between prepaid limited health service organizations
    9         and dentists from containing certain fee requirements
   10         set by the organization under certain circumstances;
   11         providing a definition; providing application;
   12         amending s. 641.315, F.S.; prohibiting contracts
   13         between health maintenance organizations and dentists
   14         from containing certain fee requirements set by the
   15         organization under certain circumstances; providing a
   16         definition; providing application; providing an
   17         effective date.
   18  
   19  Be It Enacted by the Legislature of the State of Florida:
   20  
   21         Section 1. Section 627.6474, Florida Statutes, is amended
   22  to read:
   23         627.6474 Provider contracts.—
   24         (1) A health insurer may shall not require a contracted
   25  health care practitioner as defined in s. 456.001(4) to accept
   26  the terms of other health care practitioner contracts with the
   27  insurer or any other insurer, or health maintenance
   28  organization, under common management and control with the
   29  insurer, including Medicare and Medicaid practitioner contracts
   30  and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
   31  s. 641.315, except for a practitioner in a group practice as
   32  defined in s. 456.053 who must accept the terms of a contract
   33  negotiated for the practitioner by the group, as a condition of
   34  continuation or renewal of the contract. Any contract provision
   35  that violates this section is void. A violation of this section
   36  is not subject to the criminal penalty specified in s. 624.15.
   37         (2)A contract between a health insurer and a dentist
   38  licensed under chapter 466 for the provision of services to
   39  patients may not contain any provision that requires the dentist
   40  to provide services to the insured under such contract at a fee
   41  set by the health insurer unless such services are covered
   42  services under the applicable contract. As used in this
   43  subsection, the term “covered services” means services
   44  reimbursable under the applicable contract, subject to such
   45  contractual limitations on benefits, such as deductibles,
   46  coinsurance, and copayments, as may apply. This subsection
   47  applies to all contracts entered into or renewed on or after
   48  July 1, 2010.
   49         Section 2. Subsection (13) is added to section 636.035,
   50  Florida Statutes, to read:
   51         636.035 Provider arrangements.—
   52         (13) A contract between a prepaid limited health service
   53  organization and a dentist licensed under chapter 466 for the
   54  provision of services to subscribers of the prepaid limited
   55  health service organization may not contain any provision that
   56  requires the dentist to provide services to subscribers of the
   57  prepaid limited health service organization at a fee set by the
   58  prepaid limited health service organization unless such services
   59  are covered services under the applicable contract. As used in
   60  this subsection, the term “covered services” means services
   61  reimbursable under the applicable contract, subject to such
   62  contractual limitations on benefits, such as deductibles,
   63  coinsurance, and copayments, as may apply. This subsection
   64  applies to all contracts entered into or renewed on or after
   65  July 1, 2010.
   66         Section 3. Subsection (11) is added to section 641.315,
   67  Florida Statutes, to read:
   68         641.315 Provider contracts.—
   69         (11) A contract between a health maintenance organization
   70  and a dentist licensed under chapter 466 for the provision of
   71  services to subscribers of the health maintenance organization
   72  may not contain any provision that requires the dentist to
   73  provide services to subscribers of the health maintenance
   74  organization at a fee set by the health maintenance organization
   75  unless such services are covered services under the applicable
   76  contract. As used in this subsection, the term “covered
   77  services” means services reimbursable under the applicable
   78  contract, subject to such contractual limitations on subscriber
   79  benefits, such as deductibles, coinsurance, and copayments, as
   80  may apply. This subsection applies to all contracts entered into
   81  or renewed on or after July 1, 2010.
   82         Section 4. This act shall take effect July 1, 2010.

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