Bill Text: FL S0086 | 2014 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Dentists
Spectrum: Bipartisan Bill
Status: (Passed) 2014-06-13 - Chapter No. 2014-64 [S0086 Detail]
Download: Florida-2014-S0086-Introduced.html
Bill Title: Dentists
Spectrum: Bipartisan Bill
Status: (Passed) 2014-06-13 - Chapter No. 2014-64 [S0086 Detail]
Download: Florida-2014-S0086-Introduced.html
Florida Senate - 2014 SB 86 By Senator Latvala 20-00001A-14 201486__ 1 A bill to be entitled 2 An act relating to dentists; amending s. 627.6474, 3 F.S.; prohibiting a contract between a health insurer 4 and a dentist from requiring the dentist to provide 5 services at a fee set by the insurer under certain 6 circumstances; providing that covered services are 7 those services listed as a benefit that the insured is 8 entitled to receive under a contract; prohibiting an 9 insurer from providing merely de minimis reimbursement 10 or coverage; requiring that fees for covered services 11 be set in good faith and not be nominal; prohibiting a 12 health insurer from requiring as a condition of a 13 contract that a dentist participate in a discount 14 medical plan; amending s. 636.035, F.S.; prohibiting a 15 contract between a prepaid limited health service 16 organization and a dentist from requiring the dentist 17 to provide services at a fee set by the organization 18 under certain circumstances; providing that covered 19 services are those services listed as a benefit that a 20 subscriber of a prepaid limited health service 21 organization is entitled to receive under a contract; 22 prohibiting a prepaid limited health service 23 organization from providing merely de minimis 24 reimbursement or coverage; requiring that fees for 25 covered services be set in good faith and not be 26 nominal; prohibiting the prepaid limited health 27 service organization from requiring as a condition of 28 a contract that a dentist participate in a discount 29 medical plan; amending s. 641.315, F.S.; prohibiting a 30 contract between a health maintenance organization and 31 a dentist from requiring the dentist to provide 32 services at a fee set by the organization under 33 certain circumstances; providing that covered services 34 are those services listed as a benefit that a 35 subscriber of a health maintenance organization is 36 entitled to receive under a contract; prohibiting a 37 health maintenance organization from providing merely 38 de minimis reimbursement or coverage; requiring that 39 fees for covered services be set in good faith and not 40 be nominal; prohibiting the health maintenance 41 organization from requiring as a condition of a 42 contract that a dentist participate in a discount 43 medical plan; providing for application of the act; 44 providing an effective date. 45 46 Be It Enacted by the Legislature of the State of Florida: 47 48 Section 1. Section 627.6474, Florida Statutes, is amended 49 to read: 50 627.6474 Provider contracts.— 51 (1) A health insurer mayshallnot require a contracted 52 health care practitioner as defined in s. 456.001(4) to accept 53 the terms of other health care practitioner contracts with the 54 insurer or any other insurer, or health maintenance 55 organization, under common management and control with the 56 insurer, including Medicare and Medicaid practitioner contracts 57 and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or 58 s. 641.315, except for a practitioner in a group practice as 59 defined in s. 456.053 who must accept the terms of a contract 60 negotiated for the practitioner by the group, as a condition of 61 continuation or renewal of the contract. Any contract provision 62 that violates this section is void. A violation of this 63 subsectionsectionis not subject to the criminal penalty 64 specified in s. 624.15. 65 (2)(a) A contract between a health insurer and a dentist 66 licensed under chapter 466 for the provision of services to an 67 insured may not contain a provision that requires the dentist to 68 provide services to the insured under such contract at a fee set 69 by the health insurer unless such services are covered services 70 under the applicable contract. 71 (b) Covered services are those services that are listed as 72 a benefit that the insured is entitled to receive under the 73 contract. An insurer may not provide merely de minimis 74 reimbursement or coverage in order to avoid the requirements of 75 this section. Fees for covered services shall be set in good 76 faith and must not be nominal. 77 (c) A health insurer may not require as a condition of the 78 contract that the dentist participate in a discount medical plan 79 under part II of chapter 636. 80 Section 2. Subsection (13) is added to section 636.035, 81 Florida Statutes, to read: 82 636.035 Provider arrangements.— 83 (13)(a) A contract between a prepaid limited health service 84 organization and a dentist licensed under chapter 466 for the 85 provision of services to a subscriber of the prepaid limited 86 health service organization may not contain a provision that 87 requires the dentist to provide services to the subscriber of 88 the prepaid limited health service organization at a fee set by 89 the prepaid limited health service organization unless such 90 services are covered services under the applicable contract. 91 (b) Covered services are those services that are listed as 92 a benefit that the subscriber is entitled to receive under the 93 contract. A prepaid limited health service organization may not 94 provide merely de minimis reimbursement or coverage in order to 95 avoid the requirements of this section. Fees for covered 96 services shall be set in good faith and must not be nominal. 97 (c) A prepaid limited health service organization may not 98 require as a condition of the contract that the dentist 99 participate in a discount medical plan under part II of this 100 chapter. 101 Section 3. Subsection (11) is added to section 641.315, 102 Florida Statutes, to read: 103 641.315 Provider contracts.— 104 (11)(a) A contract between a health maintenance 105 organization and a dentist licensed under chapter 466 for the 106 provision of services to a subscriber of the health maintenance 107 organization may not contain a provision that requires the 108 dentist to provide services to the subscriber of the health 109 maintenance organization at a fee set by the health maintenance 110 organization unless such services are covered services under the 111 applicable contract. 112 (b) Covered services are those services that are listed as 113 a benefit that the subscriber is entitled to receive under the 114 contract. A health maintenance organization may not provide 115 merely de minimis reimbursement or coverage in order to avoid 116 the requirements of this section. Fees for covered services 117 shall be set in good faith and must not be nominal. 118 (c) A health maintenance organization may not require as a 119 condition of the contract that the dentist participate in a 120 discount medical plan under part II of chapter 636. 121 Section 4. This act applies to contracts entered into or 122 renewed on or after July 1, 2014. 123 Section 5. This act shall take effect July 1, 2014.