Small Employer Health Insurance; Deleting and revising definitions; deleting provisions relating to the creation of the Florida Small Employer Health Reinsurance Program, etc.
Health Care Services Jurisdiction and Reimbursement; Providing that health insurance, health maintenance organization coverage, health plan coverage, and travel insurance providers are subject to the jurisdiction of the courts of this state under certain circumstances; defining the terms “emergency services” and “health care provider”; prohibiting health care providers from collecting or attempting to collect from patients any sums owed by insurers and health maintenance organizations, respectively, for emergency services rendered, etc.
Health Care Services Jurisdiction and Reimbursement; Provides that health insurance, health maintenance organization coverage, health plan coverage, & travel insurance providers are subject to jurisdiction of courts of this state under certain circumstances; prohibits health care providers from collecting & attempting to collect from patients any sums owed by insurers & HMOs for emergency services rendered; authorizes nonparticipating health care providers to pursue causes of action for quantum meruit for specified purpose.
Experimental Treatments for Terminal Conditions and Life-threatening Rare Diseases; Authorizes licensed physicians to prescribe & eligible facilities to administer experimental treatments; requires approval of specified platform or master protocol by institutional review board; requires DOH to establish & maintain patient registry; requires DOH to annually publish specified report; encourages health insurers & health maintenance organizations to provide specified insurance coverage for experimental treatments; authorizes licensed physicians & eligible facilities to receive reimbursement for experimental treatments; requires manufacturers of experimental treatments to provide for specified temporary price concession; requires DOH to adopt by rule certain procedures for licensing of experimental treatment centers.
Insurance Claims Payments to Health Care Providers; Prohibiting payment adjudicators from downcoding health care services under certain circumstances; specifying that payment adjudicators are solely responsible for certain violations of law; requiring certain utilization review entities to only use a certain prior authorization form; revising the definition of the term “claim”, etc.
Drug Prices and Coverage; Requiring the Agency for Health Care Administration to contract with an entity to designate reference price source countries and analyze certain data; requiring the agency to publish annually prescription drug reference prices; prohibiting pharmacies from charging cash-paying customers more than the reference prices for prescribed drugs and biological products; requiring prescription drug manufacturer permitholders to annually report to the agency international drug price data beginning on a specified date; requiring certain health insurers to limit covered prescription drug reimbursement to reference prices, etc.
Florida Birth-Related Neurological Injury Compensation Association; Requires agency to recover full amount of medical assistance from neurological injury compensation association; 766.302, F.S.; provides & revising definitions; removes limitation on time subject to plan compensation; provides & revising definitions; removes limitation on time subject to plan compensation; revises terminology; revises provisions relating to filing claims; conforms cross-reference; revises items that are eligible for award providing compensation; requires compensation to be provided for certain actual expenses; requires compensation for costs of major medical health coverage; requires plan to reimburse certain payments made for services provided; exempts expenses for professional custodial care in certain circumstances; requires that, upon entry of final order for compensation, parents or legal guardians obtain private health insurance or submit application for Medicaid program; requires directors to maintain plan of operation; requires certain assessments to be paid into Florida Birth-Related Neurological Injury Compensation Association at certain times for certain purposes; requires plan of operation to include provision for fraud; removes obsolete provisions; revises provisions relating to actuarial valuation of plan; requires association to submit quarterly estimates; requires association to state whether plan is actuarially sound; authorizes transfer of funds to association from Insurance Regulatory Trust Fund if plan is not actuarially sound; requires association to require each entity to issue casualty insurance and pay annual assessment; provides requirements for annual assessments; requires increase in assessments after certain findings.
Prohibitions Against Discriminatory Practices relating to 340B Entities and 340B Drugs; Prohibits drug manufacturers from engaging in certain acts against acquisitions of 340B drugs by & delivery of such drugs to specified pharmacies & from interfering with pharmacies' rights to contract with 340B entities; prohibits health insurance issuers, PBMs & other third-party payors, & agents, from engaging in discriminatory acts relating to reimbursement to 340B entities for 340B drugs; prohibits health insurers & HMOs from engaging in discriminatory acts relating to reimbursement to 340B entities for 340B drugs; provides that each commission of certain acts constitutes violation of Florida Deceptive & Unfair Trade Practices Act & subjects violator to certain actions & penalties.
Insurer Disclosures on Prescription Drug Coverage; Requiring individual and group health insurers to provide notice of prescription drug formulary changes within a certain timeframe to current and prospective insureds and the insureds’ treating physicians; requiring insurers to maintain a record of formulary changes; defining the term “cost-sharing requirement”; providing an exception to requirements relating to changes in a health maintenance organization’s group contract, etc.
Required Coverage for Imaging and Genetic Testing for Cancer Risk; Requires individual health policies, group, blanket, & franchise policies, & health maintenance contracts to provide coverage for evidence-based cancer imaging & genetic testing for hereditary cancer risk, without any cost-sharing requirements, for specified individuals.
