Bill Text: FL S1016 | 2013 | Regular Session | Comm Sub
Bill Title: Dentistry
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Failed) 2013-05-03 - Died in Messages [S1016 Detail]
Download: Florida-2013-S1016-Comm_Sub.html
Florida Senate - 2013 CS for CS for SB 1016 By the Committees on Judiciary; and Health Policy; and Senator Hays 590-03867-13 20131016c2 1 A bill to be entitled 2 An act relating to dentistry; 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 amending s. 766.1115, F.S.; revising a definition; 45 requiring a contract with a governmental contractor 46 for health care services to include a provision for a 47 health care provider licensed under ch. 466, F.S., as 48 an agent of the governmental contractor, to allow a 49 patient or a parent or guardian of the patient to 50 voluntarily contribute a fee to cover costs of dental 51 laboratory work related to the services provided to 52 the patient without forfeiting sovereign immunity; 53 prohibiting the contribution from exceeding the actual 54 amount of the dental laboratory charges; providing 55 that the contribution complies with the requirements 56 of s. 766.1115, F.S.; providing for applicability; 57 providing an effective date. 58 59 Be It Enacted by the Legislature of the State of Florida: 60 61 Section 1. Section 627.6474, Florida Statutes, is amended 62 to read: 63 627.6474 Provider contracts.— 64 (1) A health insurer mayshallnot require a contracted 65 health care practitioner as defined in s. 456.001(4) to accept 66 the terms of other health care practitioner contracts with the 67 insurer or any other insurer, or health maintenance 68 organization, under common management and control with the 69 insurer, including Medicare and Medicaid practitioner contracts 70 and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or 71 s. 641.315, except for a practitioner in a group practice as 72 defined in s. 456.053 who must accept the terms of a contract 73 negotiated for the practitioner by the group, as a condition of 74 continuation or renewal of the contract. Any contract provision 75 that violates this section is void. A violation of this 76 subsectionsectionis not subject to the criminal penalty 77 specified in s. 624.15. 78 (2)(a) A contract between a health insurer and a dentist 79 licensed under chapter 466 for the provision of services to an 80 insured may not contain any provision that requires the dentist 81 to provide services to the insured under such contract at a fee 82 set by the health insurer unless such services are covered 83 services under the applicable contract. 84 (b) Covered services are those services that are listed as 85 a benefit that the insured is entitled to receive under the 86 contract. An insurer may not provide merely de minimis 87 reimbursement or coverage in order to avoid the requirements of 88 this section. Fees for covered services shall be set in good 89 faith and must not be nominal. 90 (c) A health insurer may not require as a condition of the 91 contract that the dentist participate in a discount medical plan 92 under part II of chapter 636. 93 Section 2. Subsection (13) is added to section 636.035, 94 Florida Statutes, to read: 95 636.035 Provider arrangements.— 96 (13)(a) A contract between a prepaid limited health service 97 organization and a dentist licensed under chapter 466 for the 98 provision of services to a subscriber of the prepaid limited 99 health service organization may not contain any provision that 100 requires the dentist to provide services to the subscriber of 101 the prepaid limited health service organization at a fee set by 102 the prepaid limited health service organization unless such 103 services are covered services under the applicable contract. 104 (b) Covered services are those services that are listed as 105 a benefit that the subscriber is entitled to receive under the 106 contract. A prepaid limited health service organization may not 107 provide merely de minimis reimbursement or coverage in order to 108 avoid the requirements of this section. Fees for covered 109 services shall be set in good faith and must not be nominal. 110 (c) A prepaid limited health service organization may not 111 require as a condition of the contract that the dentist 112 participate in a discount medical plan under part II of this 113 chapter. 114 Section 3. Subsection (11) is added to section 641.315, 115 Florida Statutes, to read: 116 641.315 Provider contracts.— 117 (11)(a) A contract between a health maintenance 118 organization and a dentist licensed under chapter 466 for the 119 provision of services to a subscriber of the health maintenance 120 organization may not contain any provision that requires the 121 dentist to provide services to the subscriber of the health 122 maintenance organization at a fee set by the health maintenance 123 organization unless such services are covered services under the 124 applicable contract. 125 (b) Covered services are those services that are listed as 126 a benefit that the subscriber is entitled to receive under the 127 contract. A health maintenance organization may not provide 128 merely de minimis reimbursement or coverage in order to avoid 129 the requirements of this section. Fees for covered services 130 shall be set in good faith and must not be nominal. 131 (c) A health maintenance organization may not require as a 132 condition of the contract that the dentist participate in a 133 discount medical plan under part II of chapter 636. 134 Section 4. Paragraph (a) of subsection (3) of section 135 766.1115, Florida Statutes, is amended, and paragraph (h) is 136 added to subsection (4) of that section, to read: 137 766.1115 Health care providers; creation of agency 138 relationship with governmental contractors.— 139 (3) DEFINITIONS.—As used in this section, the term: 140 (a) “Contract” means an agreement executed in compliance 141 with this section between a health care provider and a 142 governmental contractor which allows. This contract shall allow143 the health care provider to deliver health care services to low 144 income recipients as an agent of the governmental contractor. 145 The contract must be for volunteer, uncompensated services. For 146 services to qualify as volunteer, uncompensated services under 147 this section, the health care provider must receive no 148 compensation from the governmental contractor foranyservices 149 provided under the contract and must not bill or accept 150 compensation from the recipient, or aanypublic or private 151 third-party payor, for the specific services provided to the 152 low-income recipients covered by the contract. 153 (4) CONTRACT REQUIREMENTS.—A health care provider that 154 executes a contract with a governmental contractor to deliver 155 health care services on or after April 17, 1992, as an agent of 156 the governmental contractor is an agent for purposes of s. 157 768.28(9), while acting within the scope of duties under the 158 contract, if the contract complies with the requirements of this 159 section and regardless of whether the individual treated is 160 later found to be ineligible. A health care provider under 161 contract with the state may not be named as a defendant in any 162 action arising out of medical care or treatment provided on or 163 after April 17, 1992, under contracts entered into under this 164 section. The contract must provide that: 165 (h) As an agent of the governmental contractor for purposes 166 of s. 768.28(9), while acting within the scope of duties under 167 the contract, a health care provider licensed under chapter 466 168 may allow a patient or a parent or guardian of the patient to 169 voluntarily contribute a fee to cover costs of dental laboratory 170 work related to the services provided to the patient. This 171 contribution may not exceed the actual cost of the dental 172 laboratory charges and is deemed in compliance with this 173 section. 174 175 A governmental contractor that is also a health care provider is 176 not required to enter into a contract under this section with 177 respect to the health care services delivered by its employees. 178 Section 5. The amendments to ss. 627.6474, 636.035, and 179 641.315, Florida Statutes, apply to contracts entered into or 180 renewed on or after July 1, 2013. 181 Section 6. This act shall take effect July 1, 2013.