For Immediate Release
Tuesday, March 3, 2015
Contact
Sarah Bascom, sarah@[Link], 850.294.6336
Lyndsey Cruley, lyndsey@[Link], 850.524.5006
FAHP Releases 2015 Legislative Priorities Aimed at Improving Access to Affordable,
Quality Health Care
Tallahassee, Fla. The Florida Association of Health Plans, Inc. (FAHP) today announced its priorities for the
2015 Legislative Session.
This session, the Florida Legislature will debate many significant proposals that will have an impact on health
care and FAHP will play an active role in advocating for policies that will improve access to affordable, quality
health care, said Audrey Brown, president & CEO of FAHP.
Priorities identified by FAHP include:
Passage of Senate Bill 516 & House Bill 681, Health Insurance Coverage for Emergency Services: SB 516,
sponsored by Senator Aaron Bean (R-Jacksonville) and Senator Rene Garcia (R-Hialeah), and HB 681,
sponsored by Representative Carlos Trujillo (R-Miami), would ensure Florida consumers who have purchased
Preferred Provider Organization (PPO) major medical health insurance and must seek medical services to treat
an emergency condition are not subject to balance billing by health care providers.
This proposal by Senators Bean and Garcia and Representative Trujillo would prohibit hospital emergency
rooms from billing a consumer the balance of the retail charges for the emergency health care services above
the consumers copayment or co-insurance amount and the amount the insurer reimburses for the
services. Also, considering in this situation that no network contract exists between the emergency provider and
the consumer's insurance company, the proposal sets three options for the emergency services' out-of-network
reimbursement at the greater of: A negotiated rate, the usual and customary rate for the service in the
community or the Medicare rate. Under these options, no provider would be reimbursed less than the Medicare
rate for the emergency services unless the provider decided to agree to a lower rate.
Essentially, this bill limits the practice of balance billing for PPO policies, which, too often, leaves Florida
consumers with insurmountable medical bills after they have sought emergency services where they had little,
or no choice, of whether to be treated by an in-network or out-of-network emergency department, said Brown.
This is a win for Florida consumers and FAHP will be actively advocating for passage of this good bill this
session.
Passage of House Bill 731 & Senate Bill 968, Employee Health Care Plans: HB 731, sponsored by
Representative Scott Plakon (R-Longwood), and Senate Bill 968, sponsored by Senator Nancy Detert (RVenice), would modernize the current regulatory model by eliminating a requirement that carriers offer small
group standard and basic health plans, which cannot be sold in Florida because they are no longer considered
health insurance.
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FAHP | Page 2
The proposal to eliminate this unnecessary and burdensome requirement is a needed modernization in
Floridas current health care market, said Brown. We urge lawmakers to support it and look forward to
House Bill 731 passing its first committee today, Health Innovation Subcommittee, and its ongoing success
throughout the session.
Defeat of Senate Bill 784, Right Medicine, Right Time Act: SB 784, sponsored by Senator Don Gaetz (RDestin), would unnecessarily change the current, effective method of utilizing prior authorization, step edit
therapy and protocols. In addition, this proposal would establish a government-run and controlled commission
that would dictate how health plans manage covered health benefits.
Currently, health plans use prior authorization, step edit therapy and protocols to uphold the highest standards
of safety and effectiveness for the consumer by identifying inconsistencies when patients are on a number of
medications prescribed by different providers, detecting improper utilization of medication, having the ability to
implement age and diagnosis edits consistent with the Food and Drug Administration prescribing guidelines,
maintaining patient health, and preventing drug abuse and fraud, said Brown. Health plans also already work
directly with providers, through pharmaceutical and therapeutics committees, to create formularies to meet the
needs of their members for the best value. In addition, medical doctors and pharmacists participate in the
decision-making process and without this ability, plans would not be able to effectively manage their own
pharmacy costs and ensure patient safety, which would then increase the cost of health care delivery in the State
of Florida.
Defeat of Senate Bill 350 & House Bill 601, Statewide Prepaid Dental Program for Medicaid-eligible
Children: SB 350, sponsored by Senator Anitere Flores (R-Miami), and HB 601, sponsored by Representative
MaryLynn Magar (R-Tequesta), would erode the Statewide Medicaid Managed Care (SMMC) Program by
carving out adult dental services.
Currently, under the SMMC program, it is mandatory for health plans to provide pediatric dental services; but,
in doing this, health plans are also able to leverage provider networks and cover adult dental services in addition
to the mandatory pediatric dental services, said Brown. The special interests advocating for this proposal,
who would like dental services to be carved out for their own financial gain, would tell you this was at the
detriment of the pediatric dental services being offered by the plans, but that is wholly inaccurate. And in fact,
one of the main advocates behind the dental carve-out proposal is a limited insurance company that only
provides dental services and not health services, so the company was not able to bid on the SMMC program like
other fully-licensed insurers.
Further evidence that dental services being carved in is successful, is the fact that 800,000 Floridians now have
the opportunity to receive dental coverage and the expanded dental benefits to the state are valued at more than
$100 million over the next five years, continued Brown. This is incredibly significant as we know that good
oral health is a component of good overall health and that preventative dental services keeps people from
making costly trips to the emergency room.
The Florida Legislature did the right thing last session by rejecting a fragmented system of care that has failed
to provide critical services to Floridians; and, FAHP will, once again, advocate that the Florida Legislature
reject this bad public policy and, instead, keep the SMMC program on track and intact to ensure that Floridians
receiving Medicaid services have access to affordable, quality health care, concluded Brown.
Defeat of Senate Bill 860 & House Bill 555, Pharmacy: SB 860, sponsored by Senator Rene Garcia (RHialeah), and House Bill 555, sponsored by Representative Matt Gaetz (R-Fort Walton Beach), would
restructure the system governing maximum allowable cost for what will be reimbursed to pharmacists for their
FAHP | Page 3
drug purchases, which, if adopted, would ultimately raise the cost of prescription drugs for consumers and small
businesses by removing an essential incentive for pharmacists to purchase drugs at a competitive rate.
This bill disincentives pharmacists from purchasing drugs at a competitive rate, a critical component to
keeping prescription costs low for both consumers and small business; ultimately hurting FAHPs goal of
ensuring access to affordable care for that reason we will be standing in opposition to this proposal this
session, said Brown.
Passage of Senate Bill 478 & House Bill 545, Telehealth/Telemedicine: SB 478, sponsored by Senator Bean
and Senator Arthenia Joyner (D-Tampa), and HB 545, sponsored by Representative Travis Cummings (ROrange Park) and Representative Mia Jones (D-Jacksonville), would provide health care to patients in rural
parts of the state, as well as underserved regions, using technology, such as the Internet and smartphones, to
connect physicians to patients in their own home.
This good public policy advances FAHPs objective of increasing access to affordable, quality health care,
and, as such, FAHP will be a vocal supporter of it, said Brown.
This is going to be a busy session for the health care industry, and FAHP stands ready to work with the Florida
Legislature to ensure good, sound public policy is adopted this session, concluded Brown.
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The Florida Association of Health Plans, Inc. (FAHP) is the states trade association representing Floridas health plans. FAHPs
mission is to better the health of Floridas citizens by developing meaningful relationships between health plans, providers,
government partners and employer groups, as well as focusing on educating policymakers and the public about the benefits health
plans provide. For more information on FAHP, please visit [Link].