Bill Text: FL S1836 | 2020 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health Insurance Benefits
Spectrum: Bipartisan Bill
Status: (Failed) 2020-03-14 - Died in Appropriations Subcommittee on Agriculture, Environment, and General Government [S1836 Detail]
Download: Florida-2020-S1836-Introduced.html
Bill Title: Health Insurance Benefits
Spectrum: Bipartisan Bill
Status: (Failed) 2020-03-14 - Died in Appropriations Subcommittee on Agriculture, Environment, and General Government [S1836 Detail]
Download: Florida-2020-S1836-Introduced.html
Florida Senate - 2020 SB 1836 By Senator Bean 4-01734-20 20201836__ 1 A bill to be entitled 2 An act relating to health insurance and prescription 3 drug coverage; amending s. 110.123, F.S.; requiring 4 the state group insurance program to allow enrollees 5 to obtain health care services and prescription drugs 6 from out-of-network providers and pharmacies if 7 certain conditions are met; providing for the payment 8 to be applied towards the enrollee’s deductible and 9 out-of-pocket maximum; providing notice requirements; 10 amending s. 110.12303, F.S.; revising provider 11 organizations included in benefit packages for the 12 state group insurance program; revising requirements 13 for the contracts between the Department of Management 14 Services and health insurers; requiring the department 15 to offer specified reimbursement as a voluntary 16 supplemental benefit option in the state group 17 insurance program; amending s. 110.12315, F.S.; 18 requiring the state employees’ prescription drug 19 program to allow members and members’ dependents to 20 obtain prescription drugs from out-of-network 21 pharmacies if certain conditions are met; providing 22 for the payment to be applied towards the deductible 23 and out-of-pocket maximum; providing notice 24 requirements; amending s. 110.1238, F.S.; requiring 25 state group health insurance plans to allow 26 participants to obtain health care services and 27 prescription drugs from out-of-network providers and 28 pharmacies if certain conditions are met; providing 29 for the payment to be applied towards the deductible 30 and out-of-pocket maximum; providing notice 31 requirements; creating s. 465.203, F.S.; defining the 32 term “covered individual”; prohibiting pharmacy 33 benefit managers from engaging in specified acts under 34 certain circumstances; creating s. 627.4435, F.S.; 35 defining the term “health insurer”; requiring health 36 insurers to apply certain payments toward deductibles 37 and out-of-pocket maximums within a specified 38 timeframe under certain circumstances; prohibiting 39 health insurers from engaging in specified acts under 40 certain circumstances; providing construction; 41 providing publication and notification requirements; 42 amending ss. 627.6387, 627.6648, and 641.31076, F.S.; 43 revising definitions; requiring, rather than 44 authorizing, health insurers and health maintenance 45 organizations to offer shared savings incentive 46 programs; revising duties of health insurers and 47 health maintenance organizations with respect to 48 shared savings incentive programs; providing an 49 effective date. 50 51 Be It Enacted by the Legislature of the State of Florida: 52 53 Section 1. Subsection (14) is added to section 110.123, 54 Florida Statutes, to read: 55 110.123 State group insurance program.— 56 (14) OUT-OF-NETWORK PROVIDERS.— 57 (a) The state group insurance program shall allow its 58 enrollees to obtain a covered health care service from an out 59 of-network provider at a cost that is the same or less than the 60 in-network average that an enrollee’s insurance plan pays for 61 that health care service. The state group insurance program 62 shall apply, within a reasonable timeframe not to exceed 1 year, 63 the payment made by, or required of, an enrollee for that health 64 care service toward the enrollee’s deductible and out-of-pocket 65 maximum as specified in the enrollee’s insurance plan as if the 66 health care service had been provided by an in-network provider. 67 (b) If an enrollee uses a pharmacy discount program, drug 68 manufacturer rebate, or other discount or rebate program, 69 including purchasing a prescription drug from a licensed 70 prescribing provider such as a direct primary care provider, and 71 such use results in a lower cost than would have been paid for a 72 covered prescription drug had the enrollee used the enrollee’s 73 insurance plan to purchase the prescription drug, the state 74 group insurance program shall apply, within a reasonable 75 timeframe not to exceed 1 year, the payment made by the enrollee 76 for that covered prescription drug toward the enrollee’s 77 deductible and out-of-pocket maximum as specified in the 78 enrollee’s insurance plan as if the prescription drug had been 79 purchased from an in-network pharmacy. 80 (c) At a minimum, the state group insurance program shall 81 inform enrollees on its website and in its benefit plan 82 materials of the options of obtaining covered health care 83 services from out-of-network providers and prescription drugs 84 from out-of-network pharmacies under paragraphs (a) and (b), 85 respectively, with the enrollees’ payments applied to 86 deductibles and out-of-pocket maximums. On its website and in 87 its benefit plan materials, the state group insurance program 88 shall also provide information on how to use the options under 89 paragraphs (a) and (b) if an enrollee is interested in doing so. 90 Section 2. Present paragraph (e) of subsection (3) and 91 present subsection (4) of section 110.12303, Florida Statutes, 92 are redesignated as subsections (4) and (5), respectively, a new 93 paragraph (e) is added to subsection (3) of that section, and 94 paragraph (e) of subsection (1), paragraph (a) of subsection 95 (2), paragraph (d) of subsection (3), and present subsection (4) 96 of that section are amended, to read: 97 110.12303 State group insurance program; additional 98 benefits; price transparency program; reporting.— 99 (1) In addition to the comprehensive package of health 100 insurance and other benefits required or authorized to be 101 included in the state group insurance program, the package of 102 benefits may also include products and services offered by: 103 (e) Provider organizations, including service networks, 104 group practices, professional associations, and other 105 incorporated organizations of providers, who sell service 106 contracts and arrangements for a specified amount and type of 107 health services, including direct primary or other medical care 108 provided on a subscription basis. 109 (2)(a) The department shall contract with at least one 110 entity that provides comprehensive pricing and inclusive 111 services for surgery and other medical procedures which may be 112 accessed at the option of the enrollee. The contract shall 113 require the entity to: 114 1. Have procedures and evidence-based standards to ensure 115 the inclusion of only high-quality health care providers. 116 2. Provide assistance to the enrollee in accessing and 117 coordinating care. 118 3. Provide cost savings to the state group insurance 119 program to be shared with both the state and the enrollee. Cost 120 savings payable to an enrollee may be: 121 a. Credited to the enrollee’s flexible spending account; 122 b. Credited to the enrollee’s health savings account; 123 c. Credited to the enrollee’s health reimbursement account; 124or125 d. Credited to the enrollee as a premium or out-of-pocket 126 cost reduction; or 127 e. Paid directly to the enrollee as cash or a cash 128 equivalentadditional health plan reimbursements not exceeding129the amount of the enrollee’s out-of-pocket medical expenses. 130 4. Provide an educational campaign for enrollees to learn 131 about the services offered by the entity. 132 (3) The department shall contract with an entity that 133 provides enrollees with online information on the cost and 134 quality of health care services and providers, allows an 135 enrollee to shop for health care services and providers, and 136 rewards the enrollee by sharing savings generated by the 137 enrollee’s choice of services or providers. The contract shall 138 require the entity to: 139 (d) Identify the savings realized to the enrollee and state 140 if the enrollee chooses high-quality, lower-cost health care 141 services or providers, and facilitate a shared savings payment 142 to the enrollee. The amount of shared savings shall be 143 determined by a methodology approved by the department and shall 144 maximize value-based purchasing by enrollees. The amount payable 145 to the enrollee may be: 146 1. Credited to the enrollee’s flexible spending account; 147 2. Credited to the enrollee’s health savings account; 148 3. Credited to the enrollee’s health reimbursement account; 149or150 4. Credited to the enrollee as a premium or out-of-pocket 151 cost reduction; or 152 5. Paid directly to the enrollee as cash or a cash 153 equivalentadditional health plan reimbursements not exceeding154the amount of the enrollee’s out-of-pocket medical expenses. 155 (e) Include infusion therapy in the shared savings 156 incentive program. 157 (5)(4)The department shall offer, as a voluntary 158 supplemental benefit option:,159 (a) International prescription services that offer safe 160 maintenance medications at a reduced cost to enrollees and that 161 meet the standards of the United States Food and Drug 162 Administration personal importation policy. 163 (b) At a minimum, reimbursement of direct primary care 164 subscription fees. 165 Section 3. Subsection (11) is added to section 110.12315, 166 Florida Statutes, to read: 167 110.12315 Prescription drug program.—The state employees’ 168 prescription drug program is established. This program shall be 169 administered by the Department of Management Services, according 170 to the terms and conditions of the plan as established by the 171 relevant provisions of the annual General Appropriations Act and 172 implementing legislation, subject to the following conditions: 173 (11)(a) If a member or a member’s dependent uses a pharmacy 174 discount program, drug manufacturer rebate, or other discount or 175 rebate program, including purchasing a prescription drug from a 176 licensed prescribing provider such as a direct primary care 177 provider, and such use results in a lower cost than would have 178 been paid for a covered prescription drug had the member or 179 member’s dependent used the state group health insurance plan or 180 a pharmacy participating in the state employees’ prescription 181 drug program to purchase the prescription drug, the department 182 must apply the payments made by the member or member’s dependent 183 for that covered prescription drug toward the member’s 184 deductible and out-of-pocket maximum as specified in the state 185 group health insurance plan or state employees’ prescription 186 drug program as if the prescription drug had been purchased from 187 a pharmacy participating in the state employees’ prescription 188 drug program. 189 (b) At a minimum, the department, on its website and in its 190 materials, shall inform the program’s members on the program 191 benefits of the option of obtaining prescription drugs from 192 nonparticipating pharmacies under paragraph (a) and shall 193 provide information on how to use such option to a member or a 194 member’s dependent. 195 Section 4. Section 110.1238, Florida Statutes, is amended 196 to read: 197 110.1238 State group health insurance plans; refunds with 198 respect to overcharges by providers; out-of-network providers.— 199 (1) A participant in a state group health insurance plan 200 who discovers that he or she was overcharged by a health care 201 provider shall receive a refund of 50 percent of any amount 202 recovered as a result of such overcharge, up to a maximum of 203 $1,000. 204 (2) A state group health insurance plan shall allow its 205 participants to obtain a covered health care service from an 206 out-of-network provider at a cost that is the same or less than 207 the in-network average that the state group health insurance 208 plan pays for that health care service. The state group health 209 insurance plan shall apply, within a reasonable timeframe not to 210 exceed 1 year, the payment made by, or required of, a 211 participant for that health care service toward the 212 participant’s deductible and out-of-pocket maximum as specified 213 in the state group health insurance plan as if the health care 214 service had been provided by an in-network provider. 215 (3) If a participant uses a pharmacy discount program, drug 216 manufacturer rebate, or other discount or rebate program, 217 including purchasing a prescription drug from a licensed 218 prescribing provider such as a direct primary care provider, and 219 such use results in a lower cost than would have been paid for a 220 covered prescription drug had the participant used the state 221 group health insurance plan to purchase the prescription drug, 222 the state group health insurance plan must apply the payment 223 made by the participant for that covered prescription drug 224 toward the participant’s deductible and out-of-pocket maximum as 225 specified in the state group health insurance plan as if the 226 prescription drug had been purchased from an in-network 227 pharmacy. 228 (4) At a minimum, a state group health insurance plan shall 229 inform participants on its website and in its benefit plan 230 materials of the options of obtaining covered health care 231 services from out-of-network providers and prescription drugs 232 from out-of-network pharmacies under subsections (2) and (3), 233 respectively, with the participants’ payments applied to 234 deductibles and out-of-pocket maximums. On its website and in 235 its benefit plan materials, a state group health insurance plan 236 shall also provide information on how to use the options under 237 subsections (2) and (3) if a participant is interested in doing 238 so. 239 Section 5. Section 465.203, Florida Statutes, is created to 240 read: 241 465.203 Pharmacy benefit managers; prohibited acts.— 242 (1) As used in this section, the term “covered individual” 243 means a member, a participant, an enrollee, a contract holder, a 244 policyholder, or a beneficiary of a health plan, health plan 245 sponsor, health plan provider, health insurer, health 246 maintenance organization, or any other payor that uses pharmacy 247 benefit management services in this state. 248 (2) A pharmacy benefit manager may not impose on a covered 249 individual a copayment or any other charge that exceeds the 250 claim cost of a prescription drug. If information related to a 251 covered individual’s out-of-pocket cost, the clinical efficacy 252 of a prescription drug, or alternative medication is available 253 to a pharmacy provider, a pharmacy benefit manager may not 254 penalize the pharmacy provider for providing that information to 255 the covered individual. 256 Section 6. Section 627.4435, Florida Statutes, is created 257 to read: 258 627.4435 Coverage for out-of-network providers and 259 prescription drugs.— 260 (1) DEFINITION.—As used in this section, the term “health 261 insurer” has the same meaning as provided in s. 408.07. 262 (2) HEALTH CARE SERVICES FROM OUT-OF-NETWORK PROVIDERS. 263 Beginning on January 1, 2021, upon approval of a health 264 insurer’s rate filings: 265 (a) If an insured obtains a covered health care service 266 from an out-of-network provider at a cost that is the same or 267 less than the in-network average that the health insurer pays 268 for that health care service, the health insurer must apply, 269 within a reasonable timeframe not to exceed 1 year, the payment 270 made by, or required of, an insured for that health care service 271 toward the insured’s deductible and out-of-pocket maximum as 272 specified in the insured’s health insurance policy, plan, or 273 contract as if the health care service had been provided by an 274 in-network provider. 275 (b) A health insurer may not deny payment for any in 276 network health care service covered under an insured’s health 277 insurance policy, plan, or contract based solely on the basis 278 that the insured’s referral was made by an out-of-network 279 provider. The health insurer may not apply a deductible, 280 coinsurance, or copayment greater than the applicable 281 deductible, coinsurance, or copayment that would apply to the 282 same health care service if the health care service was referred 283 by an in-network provider. 284 (3) PRESCRIPTION DRUGS.— 285 (a) A health insurer or a pharmacy benefit manager on 286 behalf of a health insurer may not impose on an insured a 287 copayment or other charge that exceeds the claim cost of a 288 prescription drug. If information related to an insured’s out 289 of-pocket cost, the clinical efficacy of a prescription drug, or 290 alternative medication is available to a pharmacy provider, a 291 health insurer or a pharmacy benefit manager on behalf of a 292 health insurer may not penalize the pharmacy provider for 293 providing that information to the insured. 294 (b) If an insured uses a pharmacy discount program, drug 295 manufacturer rebate, or other discount or rebate program, 296 including purchasing a prescription drug from a licensed 297 prescribing provider such as a direct primary care provider, and 298 such use results in a lower cost than would have been paid for a 299 covered prescription drug had the insured used the health 300 insurance policy, plan, or contract to purchase the prescription 301 drug, the health insurer or the pharmacy benefit manager on 302 behalf of a health insurer shall apply the payment made by the 303 insured for that covered prescription drug toward the insured’s 304 deductible and out-of-pocket maximum as specified in the 305 insured’s health insurance policy, plan, or contract as if the 306 prescription drug had been purchased from an in-network 307 pharmacy. 308 (c) This section does not restrict a health insurer from 309 requiring standard preauthorization or other precertification 310 requirements, such as the use of a formulary, that would 311 otherwise be required under the insured’s health insurance 312 policy, plan, or contract. 313 (4) NOTIFICATION TO INSUREDS.— 314 (a) At a minimum, a health insurer shall inform insureds on 315 its website and in its benefit policy, plan, or contract 316 materials of the options of obtaining health care services from 317 out-of-network providers and prescription drugs from out-of 318 network pharmacies under subsections (2) and (3), respectively, 319 with the insureds’ payments applied to deductibles and out-of 320 pocket maximums. On its website and in its benefit policy, plan, 321 or contract materials, the health insurer shall also inform 322 insureds on the process to obtain information on the average 323 amount paid to an in-network provider or in-network pharmacy for 324 a procedure, service, or prescription drug. The health insurer 325 shall provide on its website a downloadable or interactive form 326 for insureds to submit proof of payment to an out-of-network 327 provider or out-of-network pharmacy. 328 (b) If an insured who is in a group health insurance 329 policy, plan, or contract has paid for a health care service and 330 the paid contracted rate for the provider was in the highest 331 third for in-network providers for that insured’s group health 332 insurance policy, plan, or contract, the health insurer must 333 inform the insured, by mail, electronic transmission, or 334 telephone, that the insured has overpaid for the health care 335 service, and the health insurer must also inform the insured of 336 tools or methods the insured could use next time to elect a 337 lower-cost option if the insured is interested in doing so. 338 Section 7. Paragraphs (c), (d), and (e) of subsection (2) 339 and subsection (3) of section 627.6387, Florida Statutes, are 340 amended to read: 341 627.6387 Shared savings incentive program.— 342 (2) As used in this section, the term: 343 (c) “Shared savings incentive” means avoluntary and344optionalfinancial incentive that a health insurer providesmay345provideto an insured for choosing certain shoppable health care 346 services under a shared savings incentive program and may 347 include, but is not limited to, the incentives described in s. 348 626.9541(4)(a). 349 (d) “Shared savings incentive program” means ana voluntary350and optionalincentive program established by a health insurer 351 pursuant to this section. 352 (e) “Shoppable health care service” means a lower-cost, 353 high-quality nonemergency health care service for which a shared 354 savings incentive is available for insureds under a health 355 insurer’s shared savings incentive program. Shoppable health 356 care services may be provided within or outside this state and 357 include, but are not limited to: 358 1. Clinical laboratory services. 359 2. Infusion therapy. 360 3. Inpatient and outpatient surgical procedures. 361 4. Obstetrical and gynecological services. 362 5. Inpatient and outpatient nonsurgical diagnostic tests 363 and procedures. 364 6. Physical and occupational therapy services. 365 7. Radiology and imaging services. 366 8. Prescription drugs. 367 9. Services provided through telehealth. 368 10. Any additional services identified by the Florida 369 Center for Health Information and Transparency which commonly 370 have a wide price variation. 371 (3) A health insurer shallmayoffer a shared savings 372 incentive program to provide incentives to an insured when the 373 insured obtains a shoppable health care service from the health 374 insurer’s shared savings list. An insured may not be required to 375 participate in a shared savings incentive program. A health 376 insurerthat offers a shared savings incentive programmust: 377(a)Establish the program as a component part of the policy378or certificate of insurance provided by the health insurer and379notify the insureds and the office at least 30 days before380program termination.381 (a)(b)File a description of the program on a form 382 prescribed by commission rule. The office must review the filing 383 and determine whether the shared savings incentive program 384 complies with this section. 385 (b)(c)Notify an insured annually and at the time of 386 renewal, and an applicant for insurance at the time of 387 enrollment, of the availability of the shared savings incentive 388 program and the procedure to participate in the program. 389 (c)(d)Publish on a webpage easily accessible to insureds 390 and to applicants for insurance a list of shoppable health care 391 services and health care providers and the shared savings 392 incentive amount applicable for each service. A shared savings 393 incentive may not be less than 25 percent of the savings 394 generated by the insured’s participation in any shared savings 395 incentive offered by the health insurer. The baseline for the 396 savings calculation is the average in-network amount paid for 397 that service in the most recent 12-month period or some other 398 methodology established by the health insurer and approved by 399 the office. The health insurer must also offer a toll-free 400 telephone number that an insured may call to compare services 401 that qualify for a shared savings incentive. 402 (d)(e)At least quarterly, credit or deposit the shared 403 savings incentive amount to the insured’s account as a return or 404 reduction in premium, or credit the shared savings incentive 405 amount to the insured’s flexible spending account, health 406 savings account, or health reimbursement account, or reward the 407 insured directly with cash or a cash equivalentsuch that the408amount does not constitute income to the insured. 409 (e)(f)Submit an annual report to the office within 90 410 business days after the close of each plan year. At a minimum, 411 the report must include the following information: 412 1. The number of insureds who participated in the program 413 during the plan year and the number of instances of 414 participation. 415 2. The total cost of services provided as a part of the 416 program. 417 3. The total value of the shared savings incentive payments 418 made to insureds participating in the program and the values 419 distributed as premium reductions, credits to flexible spending 420 accounts, credits to health savings accounts, or credits to 421 health reimbursement accounts. 422 4. An inventory of the shoppable health care services 423 offered by the health insurer. 424 Section 8. Paragraphs (c), (d), and (e) of subsection (2) 425 and subsection (3) of section 627.6648, Florida Statutes, are 426 amended to read: 427 627.6648 Shared savings incentive program.— 428 (2) As used in this section, the term: 429 (c) “Shared savings incentive” means avoluntary and430optionalfinancial incentive that a health insurer providesmay431provideto an insured for choosing certain shoppable health care 432 services under a shared savings incentive program and may 433 include, but is not limited to, the incentives described in s. 434 626.9541(4)(a). 435 (d) “Shared savings incentive program” means ana voluntary436and optionalincentive program established by a health insurer 437 pursuant to this section. 438 (e) “Shoppable health care service” means a lower-cost, 439 high-quality nonemergency health care service for which a shared 440 savings incentive is available for insureds under a health 441 insurer’s shared savings incentive program. Shoppable health 442 care services may be provided within or outside this state and 443 include, but are not limited to: 444 1. Clinical laboratory services. 445 2. Infusion therapy. 446 3. Inpatient and outpatient surgical procedures. 447 4. Obstetrical and gynecological services. 448 5. Inpatient and outpatient nonsurgical diagnostic tests 449 and procedures. 450 6. Physical and occupational therapy services. 451 7. Radiology and imaging services. 452 8. Prescription drugs. 453 9. Services provided through telehealth. 454 10. Any additional services identified by the Florida 455 Center for Health Information and Transparency which commonly 456 have a wide price variation. 457 (3) A health insurer shallmayoffer a shared savings 458 incentive program to provide incentives to an insured when the 459 insured obtains a shoppable health care service from the health 460 insurer’s shared savings list. An insured may not be required to 461 participate in a shared savings incentive program. A health 462 insurerthat offers a shared savings incentive programmust: 463(a)Establish the program as a component part of the policy464or certificate of insurance provided by the health insurer and465notify the insureds and the office at least 30 days before466program termination.467 (a)(b)File a description of the program on a form 468 prescribed by commission rule. The office must review the filing 469 and determine whether the shared savings incentive program 470 complies with this section. 471 (b)(c)Notify an insured annually and at the time of 472 renewal, and an applicant for insurance at the time of 473 enrollment, of the availability of the shared savings incentive 474 program and the procedure to participate in the program. 475 (c)(d)Publish on a webpage easily accessible to insureds 476 and to applicants for insurance a list of shoppable health care 477 services and health care providers and the shared savings 478 incentive amount applicable for each service. A shared savings 479 incentive may not be less than 25 percent of the savings 480 generated by the insured’s participation in any shared savings 481 incentive offered by the health insurer. The baseline for the 482 savings calculation is the average in-network amount paid for 483 that service in the most recent 12-month period or some other 484 methodology established by the health insurer and approved by 485 the office. The health insurer must also offer a toll-free 486 telephone number that an insured may call to compare services 487 that qualify for a shared savings incentive. 488 (d)(e)At least quarterly, credit or deposit the shared 489 savings incentive amount to the insured’s account as a return or 490 reduction in premium, or credit the shared savings incentive 491 amount to the insured’s flexible spending account, health 492 savings account, or health reimbursement account, or reward the 493 insured directly with cash or a cash equivalentsuch that the494amount does not constitute income to the insured. 495 (e)(f)Submit an annual report to the office within 90 496 business days after the close of each plan year. At a minimum, 497 the report must include the following information: 498 1. The number of insureds who participated in the program 499 during the plan year and the number of instances of 500 participation. 501 2. The total cost of services provided as a part of the 502 program. 503 3. The total value of the shared savings incentive payments 504 made to insureds participating in the program and the values 505 distributed as premium reductions, credits to flexible spending 506 accounts, credits to health savings accounts, or credits to 507 health reimbursement accounts. 508 4. An inventory of the shoppable health care services 509 offered by the health insurer. 510 Section 9. Paragraphs (c), (d), and (e) of subsection (2) 511 and subsection (3) of section 641.31076, Florida Statutes, are 512 amended to read: 513 641.31076 Shared savings incentive program.— 514 (2) As used in this section, the term: 515 (c) “Shared savings incentive” means avoluntary and516optionalfinancial incentive that a health maintenance 517 organization providesmay provideto a subscriber for choosing 518 certain shoppable health care services under a shared savings 519 incentive program and may include, but is not limited to, the 520 incentives described in s. 641.3903(15). 521 (d) “Shared savings incentive program” means ana voluntary522and optionalincentive program established by a health 523 maintenance organization pursuant to this section. 524 (e) “Shoppable health care service” means a lower-cost, 525 high-quality nonemergency health care service for which a shared 526 savings incentive is available for subscribers under a health 527 maintenance organization’s shared savings incentive program. 528 Shoppable health care services may be provided within or outside 529 this state and include, but are not limited to: 530 1. Clinical laboratory services. 531 2. Infusion therapy. 532 3. Inpatient and outpatient surgical procedures. 533 4. Obstetrical and gynecological services. 534 5. Inpatient and outpatient nonsurgical diagnostic tests 535 and procedures. 536 6. Physical and occupational therapy services. 537 7. Radiology and imaging services. 538 8. Prescription drugs. 539 9. Services provided through telehealth. 540 10. Any additional services identified by the Florida 541 Center for Health Information and Transparency which commonly 542 have a wide price variation. 543 (3) A health maintenance organization shallmayoffer a 544 shared savings incentive program to provide incentives to a 545 subscriber when the subscriber obtains a shoppable health care 546 service from the health maintenance organization’s shared 547 savings list. A subscriber may not be required to participate in 548 a shared savings incentive program. A health maintenance 549 organizationthat offers a shared savings incentive program550 must: 551(a)Establish the program as a component part of the552contract of coverage provided by the health maintenance553organization and notify the subscribers and the office at least55430 days before program termination.555 (a)(b)File a description of the program on a form 556 prescribed by commission rule. The office must review the filing 557 and determine whether the shared savings incentive program 558 complies with this section. 559 (b)(c)Notify a subscriber annually and at the time of 560 renewal, and an applicant for coverage at the time of 561 enrollment, of the availability of the shared savings incentive 562 program and the procedure to participate in the program. 563 (c)(d)Publish on a webpage easily accessible to 564 subscribers and to applicants for coverage a list of shoppable 565 health care services and health care providers and the shared 566 savings incentive amount applicable for each service. A shared 567 savings incentive may not be less than 25 percent of the savings 568 generated by the subscriber’s participation in any shared 569 savings incentive offered by the health maintenance 570 organization. The baseline for the savings calculation is the 571 average in-network amount paid for that service in the most 572 recent 12-month period or some other methodology established by 573 the health maintenance organization and approved by the office. 574 The health maintenance organization must also offer a toll-free 575 telephone number that a subscriber may call to compare services 576 that qualify for a shared savings incentive. 577 (d)(e)At least quarterly, credit or deposit the shared 578 savings incentive amount to the subscriber’s account as a return 579 or reduction in premium, or credit the shared savings incentive 580 amount to the subscriber’s flexible spending account, health 581 savings account, or health reimbursement account, or reward the 582 subscriber directly with cash or a cash equivalentsuch that the583amount does not constitute income to the subscriber. 584 (e)(f)Submit an annual report to the office within 90 585 business days after the close of each plan year. At a minimum, 586 the report must include the following information: 587 1. The number of subscribers who participated in the 588 program during the plan year and the number of instances of 589 participation. 590 2. The total cost of services provided as a part of the 591 program. 592 3. The total value of the shared savings incentive payments 593 made to subscribers participating in the program and the values 594 distributed as premium reductions, credits to flexible spending 595 accounts, credits to health savings accounts, or credits to 596 health reimbursement accounts. 597 4. An inventory of the shoppable health care services 598 offered by the health maintenance organization. 599 Section 10. This act shall take effect January 1, 2021.