Florida 2024 Regular Session

Florida House Bill H0659 Compare Versions

Only one version of the bill is available at this time.

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3	3	HB 659 2024
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7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb0659-00
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10	10	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
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14	14	A bill to be entitled 1
15	15	An act relating to health plans; amending s. 408.7057, 2
16	16	F.S.; prohibiting health plans from declining to 3
17	17	participate in filed claims; providing defaults 4
18	18	against health plans for failure to respond; requiring 5
19	19	the Agency for Health Care Administration to provide 6
20	20	health plans with notices of failure to pay providers 7
21	21	the amounts provided in claim dispute orders under 8
22	22	certain circumstances; requiring health plans to pa y 9
23	23	providers the amounts provided in claim dispute orders 10
24	24	under certain circumstances; providing penalties for 11
25	25	failure to pay such amounts; amending s. 627.4302, 12
26	26	F.S.; requiring certain health insurance and health 13
27	27	maintenance organization benefits -identification cards 14
28	28	to include specified information in a certain manner; 15
29	29	providing applicability; providing rulemaking 16
30	30	authority; amending ss. 627.642, 627.657, and 641.31, 17
31	31	F.S.; requiring certain health insurance and health 18
32	32	maintenance organization identificatio n cards to 19
33	33	include specified information in a certain manner; 20
34	34	providing applicability; providing rulemaking 21
35	35	authority; providing an effective date. 22
36	36	23
37	37	Be It Enacted by the Legislature of the State of Florida: 24
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40	40	HB 659 2024
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44	44	CODING: Words stricken are deletions; words underlined are additions.
45	45	hb0659-00
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47	47	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
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51	51	Section 1. Subsection (7) of section 408 .7057, Florida 26
52	52	Statutes, is renumbered as subsection (8), subsection (5) is 27
53	53	amended, paragraph (i) is added to subsection (2), and a new 28
54	54	subsection (7) is added to that section, to read: 29
55	55	408.7057 Statewide provider and health plan claim dispute 30
56	56	resolution program.— 31
57	57	(2) 32
58	58	(i) A health plan may not decline to participate in a 33
59	59	filed claim. Failure to respond as provided in paragraph (f) 34
60	60	shall result in a default against the health plan. 35
61	61	(5) The agency shall notify within 7 days the appropriate 36
62	62	licensure or certification entity whenever there is : 37
63	63	(a) A failure to pay as provided in subsection (7); or 38
64	64	(b) A violation of a final order issued by the agency 39
65	65	pursuant to this section. 40
66	66	(7) A health plan that does not prevail in the agency's 41
67	67	order shall pay the provider the amount provided in the order 42
68	68	within 35 days after the order is entered. A health plan that 43
69	69	does not pay the required amount within this timeframe is 44
70	70	subject to a penalty of not more than $500 per day until the 45
71	71	amount is paid. 46
72	72	Section 2. Subsection (2) of section 627.4302, Florida 47
73	73	Statutes, is amended to read: 48
74	74	627.4302 Identification cards for processing prescription 49
75	75	drug claims.— 50
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77	77	HB 659 2024
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81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb0659-00
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84	84	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
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88	88	(2) Any health insurer or health maintenance organization 51
89	89	and all state and local government entities ent ering into an 52
90	90	agreement to provide coverage for prescription drugs on an 53
91	91	outpatient basis shall provide a benefits -identification card 54
92	92	containing the following information: 55
93	93	(a) The name of the claim processor. 56
94	94	(b) The electronic-claims payor identification number or 57
95	95	the issuer identification number, also referred to as the 58
96	96	Banking Identification Number or "BIN," assigned by the American 59
97	97	National Standards Institute. 60
98	98	(c) The insured's prescription group number. 61
99	99	(d) The insured's identificat ion number. 62
100	100	(e) The insured's name. 63
101	101	(f) The claims submission name and address. 64
102	102	(g) The help desk telephone number. 65
103	103	(h) The type of plan, only if the plan is filed in this 66
104	104	state; an indication that the plan is self -funded; or the name 67
105	105	of the network. 68
106	106	1. If the plan is subject to state regulation, the 69
107	107	identification card must include the letters "FL" on the back 70
108	108	left-hand corner of the card, under which a quick response (QR) 71
109	109	code must be displayed directing the insured or the subscriber 72
110	110	to the consumer services website of the Division of Consumer 73
111	111	Services of the department. Based on the plan, the website may 74
112	112	display the name of the regulatory entity with relevant contact 75
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114	114	HB 659 2024
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118	118	CODING: Words stricken are deletions; words underlined are additions.
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121	121	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
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123	123
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125	125	information, including a telephone number or website hyperlink 76
126	126	for the entity. The website may also include the following 77
127	127	notice: "If your plan card does not display 'FL' on the back 78
128	128	left-hand corner of the card, your plan may be regulated by 79
129	129	another state, another Florida state agency, or the Federal 80
130	130	Government. If you need assistan ce in locating the appropriate 81
131	131	regulator for your plan, please visit the Get Insurance Help web 82
132	132	page of the Division of Consumer Services." 83
133	133	2. Subparagraph 1. applies to benefits -identification 84
134	134	cards issued or reissued on or after January 1, 2025. 85
135	135	3. The department may adopt rules to implement necessary 86
136	136	changes to the consumer services website and hotline of the 87
137	137	Division of Consumer Services to best assist insureds or 88
138	138	subscribers who are at an impasse with their insurers or health 89
139	139	maintenance organizati ons, respectively. 90
140	140	(i)(h) Any other information that the entity finds will 91
141	141	assist in the processing of the claim. 92
142	142	93
143	143	The information required in paragraphs (a), (b), (g), and (i) 94
144	144	(h) must be provided on the card, unless instruction is provided 95
145	145	on the card for ready access to such information by electronic 96
146	146	means. 97
147	147	Section 3. Paragraph (c) of subsection (3) of section 98
148	148	627.642, Florida Statutes, is amended to read: 99
149	149	627.642 Outline of coverage. — 100
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151	151	HB 659 2024
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155	155	CODING: Words stricken are deletions; words underlined are additions.
156	156	hb0659-00
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158	158	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
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162	162	(3) In addition to the outline of coverage, a policy as 101
163	163	specified in s. 627.6699(3)(k) must be accompanied by an 102
164	164	identification card that contains, at a minimum: 103
165	165	(c) The type of plan , only if the plan is filed in this 104
166	166	the state;, an indication that the plan is self -funded;, or the 105
167	167	name of the network. 106
168	168	1. If the plan is subject to state regulation, the 107
169	169	identification card must include the letters "FL" on the back 108
170	170	left-hand corner of the card, under which a quick response (QR) 109
171	171	code must be displayed directing the insured to the consumer 110
172	172	services website of the Di vision of Consumer Services of the 111
173	173	department. Based on the plan, the website may display the name 112
174	174	of the regulatory entity with relevant contact information, 113
175	175	including a telephone number or website hyperlink for the 114
176	176	entity. The website may also include th e following notice: "If 115
177	177	your plan card does not display 'FL' on the back left -hand 116
178	178	corner of the card, your plan may be regulated by another state, 117
179	179	another Florida state agency, or the Federal Government. If you 118
180	180	need assistance in locating the appropriate regulator for your 119
181	181	plan, please visit the Get Insurance Help web page of the 120
182	182	Division of Consumer Services." 121
183	183	2. Subparagraph 1. applies to identification cards issued 122
184	184	or reissued on or after January 1, 2025. 123
185	185	3. The department may adopt rules to impleme nt necessary 124
186	186	changes to the consumer services website and hotline of the 125
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188	188	HB 659 2024
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191	191
192	192	CODING: Words stricken are deletions; words underlined are additions.
193	193	hb0659-00
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195	195	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
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197	197
198	198
199	199	Division of Consumer Services to best assist insureds who are at 126
200	200	an impasse with their insurers. 127
201	201	128
202	202	The identification card must present the information in a 129
203	203	readily identifiable manner or, alternatively, the information 130
204	204	may be embedded on the card and available through magnetic 131
205	205	stripe or smart card. The information may also be provided 132
206	206	through other electronic technology. 133
207	207	Section 4. Paragraph (c) of subsection (2) of section 134
208	208	627.657, Florida Statutes, is amended to read: 135
209	209	627.657 Provisions of group health insurance policies. — 136
210	210	(2) The medical policy as specified in s. 627.6699(3)(k) 137
211	211	must be accompanied by an identification card that contains, at 138
212	212	a minimum: 139
213	213	(c) The type of plan , only if the plan is filed in the 140
214	214	state;, an indication that the plan is self -funded;, or the name 141
215	215	of the network. 142
216	216	1. If the plan is subject to state regulation, the 143
217	217	identification card must include the letters "FL" on the back 144
218	218	left-hand corner of the car d, under which a quick response (QR) 145
219	219	code must be displayed directing the insured or the subscriber 146
220	220	to the consumer services website of the Division of Consumer 147
221	221	Services of the department. Based on the plan, the website may 148
222	222	display the name of the regulato ry entity with relevant contact 149
223	223	information, including a telephone number or website hyperlink 150
224	224
225	225	HB 659 2024
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229	229	CODING: Words stricken are deletions; words underlined are additions.
230	230	hb0659-00
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232	232	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
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236	236	for the entity. The website may also include the following 151
237	237	notice: "If your plan card does not display 'FL' on the back 152
238	238	left-hand corner of the card, your plan m ay be regulated by 153
239	239	another state, another Florida state agency, or the Federal 154
240	240	Government. If you need assistance in locating the appropriate 155
241	241	regulator for your plan, please visit the Get Insurance Help web 156
242	242	page of the Division of Consumer Services." 157
243	243	2. Subparagraph 1. applies to identification cards issued 158
244	244	or reissued on or after January 1, 2025. 159
245	245	3. The department may adopt rules to implement necessary 160
246	246	changes to the consumer services website and hotline of the 161
247	247	Division of Consumer Services to best ass ist insureds who are at 162
248	248	an impasse with their insurers. 163
249	249	164
250	250	The identification card must present the information in a 165
251	251	readily identifiable manner or, alternatively, the information 166
252	252	may be embedded on the card and available through magnetic 167
253	253	stripe or smart card. The information may also be provided 168
254	254	through other electronic technology. 169
255	255	Section 5. Paragraph (c) of subsection (42) of section 170
256	256	641.31, Florida Statutes, is amended to read: 171
257	257	641.31 Health maintenance contracts. — 172
258	258	(42) The contract, certificat e, or member handbook must be 173
259	259	accompanied by an identification card that contains, at a 174
260	260	minimum: 175
261	261
262	262	HB 659 2024
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265	265
266	266	CODING: Words stricken are deletions; words underlined are additions.
267	267	hb0659-00
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269	269	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
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273	273	(c) A statement that the health plan is a health 176
274	274	maintenance organization. Only a health plan with a certificate 177
275	275	of authority issued under this chapter may b e identified as a 178
276	276	health maintenance organization. 179
277	277	1. If the plan is subject to state regulation, the 180
278	278	identification card must include the letters "FL" on the back 181
279	279	left-hand corner of the card, under which a quick response (QR) 182
280	280	code must be displayed dir ecting the insured or the subscriber 183
281	281	to the consumer services website of the Division of Consumer 184
282	282	Services of the department. Based on the plan, the website may 185
283	283	display the name of the regulatory entity with relevant contact 186
284	284	information, including a teleph one number or website hyperlink 187
285	285	for the entity. The website may also include the following 188
286	286	notice: "If your plan card does not display 'FL' on the back 189
287	287	left-hand corner of the card, your plan may be regulated by 190
288	288	another state, another Florida state agency, or the Federal 191
289	289	Government. If you need assistance in locating the appropriate 192
290	290	regulator for your plan, please visit the help web page of the 193
291	291	Division of Consumer Services." 194
292	292	2. Subparagraph 1. applies to identification cards issued 195
293	293	or reissued on or afte r January 1, 2025. 196
294	294	3. The department may adopt rules to implement necessary 197
295	295	changes to the consumer services website and hotline of the 198
296	296	Division of Consumer Services to best assist subscribers who are 199
297	297	at an impasse with their health maintenance organizat ions. 200
298	298
299	299	HB 659 2024
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303	303	CODING: Words stricken are deletions; words underlined are additions.
304	304	hb0659-00
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306	306	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
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311	311	The identification card must present the information in a 202
312	312	readily identifiable manner or, alternatively, the information 203
313	313	may be embedded on the card and available through magnetic 204
314	314	stripe or smart card. The information may also be provided 205
315	315	through other electronic technology. 206
316	316	Section 6. This act shall take effect January 1, 2025. 207