Bill Text: FL S0418 | 2019 | Regular Session | Comm Sub


Bill Title: Essential Health Benefits Under Health Plans

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced - Dead) 2019-05-03 - Died on Calendar, companion bill(s) passed, see CS/CS/SB 322 (Ch. 2019-129) [S0418 Detail]

Download: Florida-2019-S0418-Comm_Sub.html
       Florida Senate - 2019                       CS for CS for SB 418
       
       
        
       By the Committees on Rules; and Banking and Insurance; and
       Senator Simpson
       
       
       
       
       595-04132-19                                           2019418c2
    1                        A bill to be entitled                      
    2         An act relating to essential health benefits under
    3         health plans; defining the terms “EHB-benchmark plan”
    4         and “office”; requiring the Office of Insurance
    5         Regulation to conduct a study evaluating this state’s
    6         current benchmark plan for essential health benefits
    7         under the federal Patient Protection and Affordable
    8         Care Act (PPACA) and options for changing the
    9         benchmark plan for future plan years; requiring the
   10         office, in conducting the study, to consider plans and
   11         certain benefits used by other states and to compare
   12         costs with those of this state; requiring the office
   13         to solicit and consider proposed health plans from
   14         health insurers and health maintenance organizations
   15         in developing recommendations; requiring the office,
   16         by a certain date, to provide a report with certain
   17         recommendations and a certain analysis to the Governor
   18         and the Legislature; creating s. 627.443, F.S.;
   19         defining the terms “EHB-benchmark plan” and “PPACA”;
   20         authorizing health insurers and health maintenance
   21         organizations to create new health insurance policies
   22         and health maintenance contracts meeting certain
   23         criteria for essential health benefits under PPACA;
   24         providing that such criteria may be met by certain
   25         means; providing construction; providing that such
   26         policies and contracts created by health insurers and
   27         health maintenance organizations may be submitted to
   28         the office for certain purposes; providing an
   29         effective date.
   30          
   31  Be It Enacted by the Legislature of the State of Florida:
   32  
   33         Section 1. Study of state essential health benefits
   34  benchmark plan; report.—
   35         (1)As used in this section, the term:
   36         (a)“EHB-benchmark plan” has the same meaning as provided
   37  in 45 C.F.R. s. 156.20.
   38         (b)“Office” means the Office of Insurance Regulation.
   39         (2)The office shall conduct a study to evaluate this
   40  state’s current EHB-benchmark plan for nongrandfathered
   41  individual and group health plans and options for changing the
   42  EHB-benchmark plan pursuant to 45 C.F.R. s. 156.111 for future
   43  plan years. In conducting the study, the office shall:
   44         (a)Consider EHB-benchmark plans and benefits under the 10
   45  essential health benefits categories established under 45 C.F.R.
   46  s. 156.110(a) which are used by the other 49 states;
   47         (b)Compare the costs of benefits within such categories
   48  and overall costs of EHB-benchmark plans used by other states
   49  with the costs of benefits within the categories and overall
   50  costs of the current EHB-benchmark plan of this state; and
   51         (c)Solicit and consider proposed individual and group
   52  health plans from health insurers and health maintenance
   53  organizations in developing recommendations for changes to the
   54  current EHB-benchmark plan.
   55         (3)By October 30, 2019, the office shall submit a report
   56  to the Governor, the President of the Senate, and the Speaker of
   57  the House of Representatives which must include recommendations
   58  for changing the current EHB-benchmark plan to provide
   59  comprehensive care at a lower cost than this state’s current
   60  EHB-benchmark plan. In its report, the office shall provide an
   61  analysis as to whether proposed health plans it receives under
   62  paragraph (2)(c) meet the requirements for an EHB-benchmark plan
   63  under 45 C.F.R. s. 156.111(b).
   64         Section 2. Section 627.443, Florida Statutes, is created to
   65  read:
   66         627.443 Essential health benefits.—
   67         (1) As used in this section, the term:
   68         (a)“EHB-benchmark plan” has the same meaning as provided
   69  in 45 C.F.R. s. 156.20.
   70         (b)“PPACA” has the same meaning as in s. 627.402.
   71         (2) A health insurer or health maintenance organization
   72  issuing or delivering an individual or a group health insurance
   73  policy or health maintenance contract in this state may create a
   74  new health insurance policy or health maintenance contract that:
   75         (a) Must include at least one service or coverage under
   76  each of the 10 essential health benefits categories under 42
   77  U.S.C. s. 18022(b) which are required under PPACA;
   78         (b) May fulfill the requirement in paragraph (a) by
   79  selecting one or more services or coverages for each of the
   80  required categories from the list of essential health benefits
   81  required by any single state or multiple states; and
   82         (c) May comply with paragraphs (a) and (b) by selecting one
   83  or more services or coverages from any one or more of the
   84  required categories of essential health benefits from one state
   85  or multiple states.
   86         (3) This section specifically authorizes an insurer or
   87  health maintenance organization to include any combination of
   88  services or coverages required by any one or a combination of
   89  states to provide the 10 categories of essential health benefits
   90  required under PPACA in a policy or contract issued in this
   91  state.
   92         (4)Health insurance policies and health maintenance
   93  contracts created by health insurers and health maintenance
   94  organizations under this section:
   95         (a) May be submitted to the office for consideration as
   96  part of the office’s study of this state’s essential health
   97  benefits benchmark plan; and
   98         (b) May also be submitted to the office for evaluation as
   99  equivalent to the current state EHB-benchmark plan or to any
  100  EHB-benchmark plan created in the future.
  101         Section 3. This act shall take effect upon becoming a law.

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