Bill Text: FL S1002 | 2010 | Regular Session | Introduced

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Bill Title: Medicaid [WPSC]

Sponsorship: Partisan Bill (Democrat 1)

Status: (Failed) 2010-04-30 - Died in Committee on Health Regulation [S1002 Detail]

Download: Florida-2010-S1002-Introduced.html

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Florida Senate - 2010                                    SB 1002 
 
By Senator Lawson 
6-00601-10                                            20101002__ 
1                        A bill to be entitled 
2         An act relating to Medicaid; providing a purpose; 
3         providing definitions; requiring each managed care 
4         organization to certify to the Agency for Health Care 
5         Administration its medical loss ratio and the medical 
6         loss ratio for its subcontractors; providing 
7         requirements for the reporting of the medical loss 
8         ratios; requiring the managed care organization to pay 
9         a certain amount to the agency if the certified 
10         medical loss ratio is less than a specified ratio; 
11         requiring the agency to adopt rules; requiring that 
12         fines collected supplement the agency’s Medicaid 
13         budget; providing that the requirements and penalties 
14         imposed are assigned in full to any parent 
15         corporation, subsequent owner, or successor in 
16         interest of the managed care organization; providing 
17         an effective date. 
18 
19  Be It Enacted by the Legislature of the State of Florida: 
20 
21         Section 1. (1) The purpose of this section is to ensure 
22  that a managed care organization that contracts to provide 
23  services for Medicaid beneficiaries in this state expend at 
24  least 85 percent of the total revenue it receives from monthly 
25  premiums on direct health care benefits for its enrollees. 
26         (2) As used in this section, the term: 
27         (a) “Agency” means the Agency for Health Care 
28  Administration. 
29         (b) “Medical loss ratio” means the ratio of total revenue 
30  from monthly premium payments received from the agency by a 
31  managed care organization and expended for direct health care 
32  benefits to the total amount of such payments expended for any 
33  other purpose. Costs and expenditures that are not related to 
34  direct health care benefits include, but are not limited to, 
35  profit, salaries, bonuses, and administration and operating 
36  expenses, including expenses relating to prior authorization or 
37  other utilization review regarding the provision of direct 
38  health care benefits. 
39         (c) “Managed care organization” means a health maintenance 
40  organization or prepaid health plan providing goods and services 
41  under s. 409.912, Florida Statutes. 
42         (3) If a managed care organization enrolls Medicaid 
43  beneficiaries under the pilot program established at s. 
44  409.91211, Florida Statutes, the pilot program and nonpilot 
45  program portions of the organization’s health care financing and 
46  delivery system shall be considered separate and distinct 
47  managed care organizations for purposes of this section. 
48         (4) Beginning December 15, 2010, and each quarter 
49  thereafter, each managed care organization shall certify to the 
50  agency its medical loss ratio and the medical loss ratio of each 
51  of its subcontractors. The medical loss ratio for behavioral 
52  health shall be reported separately by each managed care 
53  organization. 
54         (5) If any medical loss ratio certified to the agency under 
55  subsection (4) is less than 85 to 15, the managed care 
56  organization and its subcontractors shall immediately pay to the 
57  agency an amount equal to the difference between 85 percent of 
58  total revenue from their monthly premium payments and their 
59  corresponding expenditures for direct health care benefits for 
60  the relevant quarter. 
61         (6) The agency shall adopt rules to administer this 
62  section, including, but not limited to, a schedule of sanctions 
63  for any violation of the 85-to-15 requirements set forth in this 
64  section. Any fines collected shall be used to supplement the 
65  agency’s Medicaid budget and do not revert to the General 
66  Revenue Fund. 
67         (7) All requirements of this section and penalties imposed 
68  pursuant to this section against a managed care organization 
69  shall be assigned in full to any parent corporation, subsequent 
70  owner, or subsequent successor in interest of the managed care 
71  organization. 
72         Section 2. This act shall take effect July 1, 2010.