Florida Legislation

SB 700 amends Florida Statutes section 627.688 to change previously optional mental health benefits to required benefits that must be offered by group insurance policies or contracts at no additional premium and with no greater cost-sharing limitations than imposed on other medical benefits. Such required benefits include benefits or levels of benefits defined by the standard nomenclature of the American Psychiatric Association or equitable alternative benefits, including residential services.  Covered Inpatient benefits may be no less than 45 days per year, however, policies may allow that unused inpatient benefits be transferred to outpatient or residential benefits. Outpatients benefits may be no less than 30 hours of consultation a year.

HB 307 amends Florida Statutes section 409.967  by adding a new subsection to require managed care plans to the Agency for Health Care Administration reports regarding compliance with parity requirements according to specified guidelines. Additionally, the bill amends 627.6675, amends section  627.668 by renumbering the section to 627.4193, and specifying in 627.4193 that individual and group plans and prepaid health plans must comply with the Federal Parity Law and its implementing regulations and offer specified benefits for Substance Use Disorders by referencing new section 627.4193.  Additionally, section 627.4193 is amended to require insurers, health maintenance organizations, and nonprofit hospital and medical service plan corporations transacting individual or group health insurance or prepaid health care to submit to the Office of Insurance Regulation a report that demonstrates parity compliance according to specified guidelines. Additionally, the Office of Insurance Regulation must implement and enforce the Federal Parity Law, its implementing regulations, and related state laws and produce an annual report to the Legislature detailing enforcement activities. This report must be made public.

 SB 360 amends Florida Statute section 409.967 by adding a new subsection and amending section 627.688 (by transferring, renumbering as section 627.4193) by adding a new subsection to require managed care plans,  insurers, health maintenance organizations, and
nonprofit hospital and medical service plan corporations transacting individual or group health insurance or providing prepaid health care to submit annual reports demonstrating parity compliance using specified guidelines.

Additionally, the bill amends section 627.688 (by transferring, renumbering as section 627.4193) by adding a new subsection to require managed care plans,  insurers, health maintenance organizations, and
nonprofit hospital and medical service plan corporations transacting individual or group health insurance or providing  prepaid health care to comply with the Federal Parity Law as well as offer mental health and SUD benefits as defined by the DSM V. Such plans must also submit report demonstrating compliance with the federal parity law using specified guidelines.

Finally, the bill amends section 627.688 (by transferring, renumbering as section 627.4193 amended) by adding a new subsection to require the Office of Insurance Regulation to implement and enforce the Federal Parity Law and submit a report to the Legislature describing the methodology used to ensure compliance. This report must be posted on a public website.

This bill amends Florida Statutes §409.967(2) to require managed care plans submit to the Office of Insurance Regulation annual comparative reports heavily focused on NQTLs to demonstrate compliance with parity requirements. Additionally, it amends Florida Statutes §627.668 (renumbered 627.4193) to expand the insurers that must comply with parity requirements to include individual plans and requires every insurer, health maintenance organization, and nonprofit hospital and medical service plan corporation transacting individual or group health insurance or providing prepaid health care to submit to the Office of Insurance Regulation annual comparative reports heavily focused on NQTLs to demonstrate compliance with parity requirements. The Office of Insurance Regulation is required to implement, enforce and ensure parity compliance, detect violations, accept and respond to complaints, perform market conduct examinations, and submit a report written in clear language to the Legislature describing such activities and make such report available on a publicly available website.

• Residential treatment is included
• Annual limit for inpatient days increases to 45 from 30
• Requires coverage for 30 outpatient visits per year instead of $1,000 of coverage per year for outpatient care
• Requires coverage for at least 121 days of partial hospitalization
• Allowed any unused inpatient coverage to outpatient coverage or coverage for residential treatment

• Residential treatment is included
• Residential treatment is defined as “the continuous observation, monitoring, and treatment by professional staff” of individuals with behavioral health conditions
• Annual limit for inpatient days increases to 45 from 30
• Requires coverage for 30 outpatient visits per year instead of $1,000 of coverage per year for outpatient care
• Requires coverage for at least 121 days of partial hospitalization
• Allowed any unused inpatient coverage to outpatient coverage or coverage for residential treatment

Among many other things, this bill tried to change the sections of state law about autism coverage so that large employer fully-insured plans must cover at least outpatient visits per year for screening or diagnosis of autism.

Among many other things, this bill tried to change the sections of state law about autism coverage so that large employer fully-insured plans must cover at least outpatient visits per year for screening or diagnosis of autism.

This bill tried to create a task force within the Department of Children and Families called the Behavioral Health Task Force. One of its many duties would have been to write a report about Florida’s progress in implementing the Federal Parity Law. The report would have included a proposed strategy to help the implementation process.

This bill included more details than SB 1338 about what should be in the report, including:

• Prices of various behavioral health insurance plans in Florida
• Listing of insurance plans that require prior authorization and step therapy for behavioral health services but don’t for other medical services (a common parity violation)
• Insurance plans’ medical necessity criteria for behavioral health coverage
• Copayments, deductibles, annual maximums, and lifetime maximums for behavioral health coverage

• Schizophrenia and psychotic disorders
• Mood disorders (ie. depression and bipolar disorder)
• Anxiety disorders
• Substance use disorders
• Eating disorders
• Childhood attention deficit disorders

For conditions not listed above it would have required coverage for 45 days of inpatient care and 60 visits of outpatient care.

This also would have repealed the current section of the law about coverage for substance use disorders (see below under Florida Parity Law).

This also would have required Office of Insurance Regulation to file a report to the Governor about the effect this proposed law would have on healthcare costs and if insurance plans were following the law.

Among many other things, this bill tried to repeal the section of the state insurance law relevant to parity. It also would have repealed one of the sections of the law about autism. This would have meant that only health maintenance organizations would have been required to cover autism services.