HB 1501 2022
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hb1501-00
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to the state group insurance program; 2
amending s. 110.107, F.S.; defining the term 3
"reference-based pricing"; amending s. 110.12303, 4
F.S.; authorizing cost savings to be paid in cash to 5
an enrollee; requiring certain contracted entities to 6
use a reference-based pricing program to set 7
reimbursement rates; providing an effective date. 8
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Be It Enacted by the Legislature of the State of Florida: 10
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Section 1. Subsections (27) through (32) of section 12
110.107, Florida Statutes, are renumbered as subsections (28) 13
through (33), respectively, and a new subsection (27) is added 14
to that section, to read: 15
110.107 Definitions. —As used in this chapter, the term: 16
(27) "Reference-based pricing" means a flat payment paid 17
by the department in compensation for specific procedures or 18
services performed by a healthcare provider. 19
Section 2. Paragraph (a) of subsection (2) and paragraph 20
(d) of subsection (3) of section 110.12303, Florida Statutes, 21
are amended to read: 22
110.12303 State group insurance program; additional 23
benefits; price transparency program; reporting. — 24
(2)(a) The department shall contract with at least one 25
HB 1501 2022
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
entity that provides co mprehensive pricing and inclusive 26
services for surgery and other medical procedures which may be 27
accessed at the option of the enrollee. The contract shall 28
require the entity to: 29
1. Have procedures and evidence -based standards to ensure 30
the inclusion of only high-quality health care providers. 31
2. Provide assistance to the enrollee in accessing and 32
coordinating care. 33
3. Provide cost savings to the state group insurance 34
program to be shared with both the state and the enrollee. Cost 35
savings payable to a n enrollee may be: 36
a. Credited to the enrollee's flexible spending account; 37
b. Credited to the enrollee's health savings account; 38
c. Credited to the enrollee's health reimbursement 39
account; or 40
d. Paid as additional health plan reimbursements not 41
exceeding the amount of the enrollee's out -of-pocket medical 42
expenses; or 43
e. Paid in cash to the enrollee . 44
4. Provide an educational campaign for enrollees to learn 45
about the services offered by the entity. 46
5. Use a reference-based pricing program based on paid 47
market claims to set reimbursement rates that are not solely 48
based on a percentage of Medicare rates. 49
(3) The department shall contract with an entity that 50
HB 1501 2022
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
provides enrollees with online information on the cost and 51
quality of health care services and providers, allows an 52
enrollee to shop for health care services and providers, and 53
rewards the enrollee by sharing savings generated by the 54
enrollee's choice of services or providers. The contract shall 55
require the entity to: 56
(d) Identify the savings realized to the enrollee and 57
state if the enrollee chooses high -quality, lower-cost health 58
care services or providers, and facilitate a shared savings 59
payment to the enrollee. The amount of shared savings sh all be 60
determined by a methodology approved by the department and shall 61
maximize value-based purchasing by enrollees. The amount payable 62
to the enrollee may be: 63
1. Credited to the enrollee's flexible spending account; 64
2. Credited to the enrollee's heal th savings account; 65
3. Credited to the enrollee's health reimbursement 66
account; or 67
4. Paid as additional health plan reimbursements not 68
exceeding the amount of the enrollee's out -of-pocket medical 69
expenses; or 70
5. Paid in cash to the enrollee . 71
Section 3. This act shall take effect July 1, 2022. 72