Florida Senate - 2020                             CS for SB 1836
       
       
        
       By the Committee on Governmental Oversight and Accountability;
       and Senator Bean
       
       
       
       
       585-03764-20                                          20201836c1
    1                        A bill to be entitled                      
    2         An act relating to health insurance benefits; amending
    3         s. 408.05, F.S.; requiring the Agency for Health Care
    4         Administration to publish by a specified date an
    5         annual report identifying certain health care
    6         services; amending ss. 627.6387, 627.6648, and
    7         641.31076, F.S.; revising the definition of the term
    8         “shoppable health care service”; revising duties of
    9         certain health insurers and health maintenance
   10         organizations; providing an effective date.
   11          
   12  Be It Enacted by the Legislature of the State of Florida:
   13  
   14         Section 1. Paragraph (l) is added to subsection (3) of
   15  section 408.05, Florida Statutes, to read:
   16         408.05 Florida Center for Health Information and
   17  Transparency.—
   18         (3) HEALTH INFORMATION TRANSPARENCY.—In order to
   19  disseminate and facilitate the availability of comparable and
   20  uniform health information, the agency shall perform the
   21  following functions:
   22         (l) By July 1 of each year, publish a report identifying
   23  the health care services with the most significant price
   24  variation both statewide and regionally.
   25         Section 2. Paragraph (e) of subsection (2) and paragraph
   26  (e) of subsection (3) of section 627.6387, Florida Statutes, are
   27  amended to read:
   28         627.6387 Shared savings incentive program.—
   29         (2) As used in this section, the term:
   30         (e) “Shoppable health care service” means a lower-cost,
   31  high-quality nonemergency health care service for which a shared
   32  savings incentive is available for insureds under a health
   33  insurer’s shared savings incentive program. Shoppable health
   34  care services may be provided within or outside this state and
   35  include, but are not limited to:
   36         1. Clinical laboratory services.
   37         2. Infusion therapy.
   38         3. Inpatient and outpatient surgical procedures.
   39         4. Obstetrical and gynecological services.
   40         5. Inpatient and outpatient nonsurgical diagnostic tests
   41  and procedures.
   42         6. Physical and occupational therapy services.
   43         7. Radiology and imaging services.
   44         8. Prescription drugs.
   45         9. Services provided through telehealth.
   46         10. Any additional services published by the Agency for
   47  Health Care Administration that have the most significant price
   48  variation pursuant to s. 408.05(3)(l).
   49         (3) A health insurer may offer a shared savings incentive
   50  program to provide incentives to an insured when the insured
   51  obtains a shoppable health care service from the health
   52  insurer’s shared savings list. An insured may not be required to
   53  participate in a shared savings incentive program. A health
   54  insurer that offers a shared savings incentive program must:
   55         (e) At least quarterly, credit or deposit the shared
   56  savings incentive amount to the insured’s account as a return or
   57  reduction in premium, or credit the shared savings incentive
   58  amount to the insured’s flexible spending account, health
   59  savings account, or health reimbursement account, or reward the
   60  insured directly with cash or a cash equivalent such that the
   61  amount does not constitute income to the insured.
   62         Section 3. Paragraph (e) of subsection (2) and paragraph
   63  (e) of subsection (3) of section 627.6648, Florida Statutes, are
   64  amended to read:
   65         627.6648 Shared savings incentive program.—
   66         (2) As used in this section, the term:
   67         (e) “Shoppable health care service” means a lower-cost,
   68  high-quality nonemergency health care service for which a shared
   69  savings incentive is available for insureds under a health
   70  insurer’s shared savings incentive program. Shoppable health
   71  care services may be provided within or outside this state and
   72  include, but are not limited to:
   73         1. Clinical laboratory services.
   74         2. Infusion therapy.
   75         3. Inpatient and outpatient surgical procedures.
   76         4. Obstetrical and gynecological services.
   77         5. Inpatient and outpatient nonsurgical diagnostic tests
   78  and procedures.
   79         6. Physical and occupational therapy services.
   80         7. Radiology and imaging services.
   81         8. Prescription drugs.
   82         9. Services provided through telehealth.
   83         10. Any additional services published by the Agency for
   84  Health Care Administration that have the most significant price
   85  variation pursuant to s. 408.05(3)(l).
   86         (3) A health insurer may offer a shared savings incentive
   87  program to provide incentives to an insured when the insured
   88  obtains a shoppable health care service from the health
   89  insurer’s shared savings list. An insured may not be required to
   90  participate in a shared savings incentive program. A health
   91  insurer that offers a shared savings incentive program must:
   92         (e) At least quarterly, credit or deposit the shared
   93  savings incentive amount to the insured’s account as a return or
   94  reduction in premium, or credit the shared savings incentive
   95  amount to the insured’s flexible spending account, health
   96  savings account, or health reimbursement account, or reward the
   97  insured directly with cash or a cash equivalent such that the
   98  amount does not constitute income to the insured.
   99         Section 4. Paragraph (e) of subsection (2) and paragraph
  100  (e) of subsection (3) of section 641.31076, Florida Statutes,
  101  are amended to read:
  102         641.31076 Shared savings incentive program.—
  103         (2) As used in this section, the term:
  104         (e) “Shoppable health care service” means a lower-cost,
  105  high-quality nonemergency health care service for which a shared
  106  savings incentive is available for subscribers under a health
  107  maintenance organization’s shared savings incentive program.
  108  Shoppable health care services may be provided within or outside
  109  this state and include, but are not limited to:
  110         1. Clinical laboratory services.
  111         2. Infusion therapy.
  112         3. Inpatient and outpatient surgical procedures.
  113         4. Obstetrical and gynecological services.
  114         5. Inpatient and outpatient nonsurgical diagnostic tests
  115  and procedures.
  116         6. Physical and occupational therapy services.
  117         7. Radiology and imaging services.
  118         8. Prescription drugs.
  119         9. Services provided through telehealth.
  120         10. Any additional services published by the Agency for
  121  Health Care Administration that have the most significant price
  122  variation pursuant to s. 408.05(3)(l).
  123         (3) A health maintenance organization may offer a shared
  124  savings incentive program to provide incentives to a subscriber
  125  when the subscriber obtains a shoppable health care service from
  126  the health maintenance organization’s shared savings list. A
  127  subscriber may not be required to participate in a shared
  128  savings incentive program. A health maintenance organization
  129  that offers a shared savings incentive program must:
  130         (e) At least quarterly, credit or deposit the shared
  131  savings incentive amount to the subscriber’s account as a return
  132  or reduction in premium, or credit the shared savings incentive
  133  amount to the subscriber’s flexible spending account, health
  134  savings account, or health reimbursement account, or reward the
  135  subscriber directly with cash or a cash equivalent such that the
  136  amount does not constitute income to the subscriber.
  137         Section 5. This act shall take effect January 1, 2021.