Bill Text: FL S0784 | 2015 | Regular Session | Comm Sub
Bill Title: Health Care
Spectrum: Bipartisan Bill
Status: (Failed) 2015-05-01 - Died in Appropriations [S0784 Detail]
Download: Florida-2015-S0784-Comm_Sub.html
Florida Senate - 2015 CS for SB 784
By the Committee on Banking and Insurance; and Senator Gaetz
597-01931A-15 2015784c1
1 A bill to be entitled
2 An act relating to health care; providing that this
3 act shall be known as the “Right Medicine, Right Time
4 Act”; creating s. 402.90, F.S.; creating the Clinical
5 Practices Review Commission; housing the commission,
6 for administrative purposes, within the Division of
7 Medical Quality Assurance of the Department of Health;
8 specifying the composition of, qualifications for
9 appointment to, and standards imposed on commission
10 members; designating the members as public officers;
11 requiring the executive director to submit to the
12 Commission on Ethics a list of certain people subject
13 to public disclosure requirements; providing penalties
14 for failure to comply with such standards; specifying
15 the duties and responsibilities of the commission;
16 amending s. 409.967, F.S.; requiring a managed care
17 plan that establishes a prescribed drug formulary or
18 preferred drug list to provide a broad range of
19 therapeutic options to the patient; requiring coverage
20 limitations to be supported by clinical evidence;
21 setting coverage limitation approval standards;
22 creating s. 627.6051, F.S.; requiring sufficient
23 clinical evidence to support a proposed coverage
24 limitation at the point of service; defining the terms
25 “a coverage limitation imposed at the point of
26 service” and “sufficient clinical evidence”; requiring
27 the commission to determine whether sufficient
28 clinical evidence exists and the Office of Insurance
29 Regulation to approve coverage limitations if the
30 commission determines that such evidence exists;
31 providing for the liability of a health insurer and
32 its chief medical officer for injuries and damages
33 resulting from restricted access to services if the
34 insurer has imposed coverage limitations without the
35 approval of the office; requiring insurers to
36 establish reserves to pay for such damages; amending
37 ss. 627.642 and 627.6699, F.S.; requiring an outline
38 of coverage and certain plans offered by a small
39 employer carrier to include summary statements
40 identifying specific prescription drugs and procedures
41 that are subject to specified restrictions and
42 limitations; requiring insurers and small employer
43 carriers to post the summaries on the Internet;
44 amending s. 627.6471, F.S.; requiring an insurer to
45 post a link to the list of preferred providers on its
46 website and to update the list within 10 business days
47 after a change; amending s. 627.651, F.S.; conforming
48 a cross-reference; amending s. 627.662, F.S.;
49 specifying that specified provisions relating to
50 coverage limitations on prescription drugs and
51 diagnostic or therapeutic procedures apply to group
52 health insurance, blanket health insurance, and
53 franchise health insurance; amending s. 641.31, F.S.;
54 requiring a health maintenance contract summary
55 statement to include a statement of any limitations on
56 benefits, the identification of specific prescription
57 drugs, and certain procedures that are subject to
58 specified restrictions and limitations; requiring a
59 health maintenance organization to post the summaries
60 on the Internet; prohibiting a health maintenance
61 organization from establishing certain procedures and
62 requirements that restrict access to covered services;
63 requiring a coverage limitation to be supported, as
64 determined by the commission, by clinical evidence
65 demonstrating that the limitation does not inhibit the
66 diagnosis or treatment of the patient; defining the
67 term “a coverage limitation imposed by a health
68 maintenance organization at the point of service”;
69 amending s. 641.3155, F.S.; prohibiting the
70 retroactive denial of a claim because of subscriber
71 ineligibility at any time if the health maintenance
72 organization verified the eligibility of such
73 subscriber at the time of treatment and provided an
74 authorization number; providing an effective date.
75
76 Be It Enacted by the Legislature of the State of Florida:
77
78 Section 1. This act shall be known as the “Right Medicine,
79 Right Time Act.”
80 Section 2. Section 402.90, Florida Statutes, is created to
81 read:
82 402.90 Clinical Practices Review Commission.—There is
83 created the Clinical Practices Review Commission, which is a
84 commission as defined in s. 20.03.
85 (1) The commission shall be housed for administrative
86 purposes in the Division of Medical Quality Assurance of the
87 Department of Health.
88 (2) The commission shall consist of seven members
89 appointed, subject to confirmation by the Senate, as follows:
90 (a) Five physicians, one appointed by the Governor, two
91 appointed by the President of the Senate, and two appointed by
92 the Speaker of the House of Representatives, who are currently
93 practicing medicine in this state and have clinical expertise,
94 as evidenced by the following:
95 1. A doctoral degree in medicine or osteopathic medicine
96 from an accredited school;
97 2. An active and clear license issued by this state or
98 another state;
99 3. Board certification in one or more medical specialties;
100 and
101 4. At least 15 years of clinical experience.
102 (b) One individual, appointed by the Governor, with a
103 doctorate in either pharmacology or pharmacy and at least 10
104 years of experience in research or clinical practice with
105 applicable postlicensure credentials.
106 (c) One member, appointed by the Governor, with expertise
107 in the analysis of clinical research, evidenced by a doctoral
108 degree in biostatistics or a related field and at least 10 years
109 of experience in clinical research.
110 (3) A commission member may not currently be an officer,
111 director, owner, operator, employee, or consultant of any entity
112 subject to regulation by the commission. The executive director,
113 senior managers, and members of the commission are subject to
114 part III of chapter 112, including, but not limited to, the Code
115 of Ethics for Public Officers and Employees and the public
116 disclosure and reporting of financial interests pursuant to s.
117 112.3145. For purposes of applying part III of chapter 112 to
118 the activities of the executive director, senior managers, and
119 members of the commission, such persons shall be considered
120 public officers or employees and the commission shall be
121 considered their agency.
122 (a) Notwithstanding s. 112.3143(2), a commission member may
123 not vote on any measure that would inure to his or her special
124 private gain or loss; that he or she knows would inure to the
125 special private gain or loss of any principal by whom he or she
126 is retained, or to the parent organization or subsidiary of a
127 corporate principal by which he or she is retained, other than
128 an agency as defined in s. 112.312; or that he or she knows
129 would inure to the special private gain or loss of a relative or
130 business associate of the public officer. A commission member
131 who is prohibited from voting for such reasons shall publicly
132 state to the assembly, before such a vote is taken, the nature
133 of his or her interest in the matter from which he or she is
134 abstaining from voting and, within 15 days after the vote,
135 disclose the nature of his or her interest as a public record in
136 a memorandum filed with the person responsible for recording the
137 minutes of the meeting, who shall incorporate the memorandum in
138 the minutes.
139 (b) Senior managers and commission members shall also file
140 the disclosures required under paragraph (a) with the Commission
141 on Ethics. The executive director of the commission or his or
142 her designee shall notify each standing and newly appointed
143 commission member and senior manager of his or her duty to
144 comply with the reporting requirements of part III of chapter
145 112. At least quarterly, the executive director or his or her
146 designee shall submit to the Commission on Ethics a list of
147 names of the senior managers and members of the commission who
148 are subject to the public disclosure requirements under s.
149 112.3145.
150 (c) Notwithstanding s. 112.3148, s. 112.3149, or any other
151 law, an employee or member of the commission may not knowingly
152 accept, directly or indirectly, any gift or expenditure from a
153 person or entity, or an employee or representative of such
154 person or entity, which has a contractual relationship with the
155 commission or which is under consideration for a contract.
156 (d) An employee or member of the commission who fails to
157 comply with this subsection is subject to the penalties provided
158 under ss. 112.317 and 112.3173.
159 (4) The duties and responsibilities of the commission
160 include:
161 (a) Development and implementation of policies and
162 procedures for the review of prior authorization, step therapy,
163 or other protocols that limit, at the point of service, access
164 to covered services, including diagnostic procedures,
165 pharmaceutical services, and other therapeutic interventions.
166 (b) Development of any operational policies and procedures
167 that would facilitate the work of the commission, including the
168 establishment of bylaws, the election of a chair, and other
169 administrative procedures.
170 (c) Determination as to the sufficiency of clinical
171 evidence submitted in support of any proposed coverage
172 limitation.
173 (d) Preparation of reports and recommendations that
174 document the proceedings of the commission and identify
175 necessary resources or legislative action.
176 (5) Subject to appropriations, a commission member may
177 receive compensation and per diem and travel expenses as
178 provided in s. 112.061.
179 Section 3. Paragraph (c) of subsection (2) of section
180 409.967, Florida Statutes, is amended to read:
181 409.967 Managed care plan accountability.—
182 (2) The agency shall establish such contract requirements
183 as are necessary for the operation of the statewide managed care
184 program. In addition to any other provisions the agency may deem
185 necessary, the contract must require:
186 (c) Access.—
187 1. The agency shall establish specific standards for the
188 number, type, and regional distribution of providers in managed
189 care plan networks to ensure access to care for both adults and
190 children. Each plan must maintain a regionwide network of
191 providers in sufficient numbers to meet the access standards for
192 specific medical services for all recipients enrolled in the
193 plan. The exclusive use of mail-order pharmacies may not be
194 sufficient to meet network access standards. Consistent with the
195 standards established by the agency, provider networks may
196 include providers located outside the region. A plan may
197 contract with a new hospital facility before the date the
198 hospital becomes operational if the hospital has commenced
199 construction, will be licensed and operational by January 1,
200 2013, and a final order has issued in any civil or
201 administrative challenge. Each plan shall establish and maintain
202 an accurate and complete electronic database of contracted
203 providers, including information about licensure or
204 registration, locations and hours of operation, specialty
205 credentials and other certifications, specific performance
206 indicators, and such other information as the agency deems
207 necessary. The database must be available online to both the
208 agency and the public and have the capability to compare the
209 availability of providers to network adequacy standards and to
210 accept and display feedback from each provider’s patients. Each
211 plan shall submit quarterly reports to the agency identifying
212 the number of enrollees assigned to each primary care provider.
213 2. A managed care plan that establishes a prescribed drug
214 formulary or preferred drug list shall:
215 a. Provide a broad range of therapeutic options for the
216 treatment of disease states which are consistent with the
217 general needs of an outpatient population. If feasible, the
218 formulary or preferred drug list must include at least two
219 products in each therapeutic class.
220 b.2. Each managed care plan must Publish the any prescribed
221 drug formulary or preferred drug list on the plan’s website in a
222 manner that is accessible to and searchable by enrollees and
223 providers. The plan must update the list within 24 hours after
224 making a change. Each plan must ensure that the prior
225 authorization process for prescribed drugs is readily accessible
226 to health care providers, including posting appropriate contact
227 information on its website and providing timely responses to
228 providers.
229 3. For enrollees Medicaid recipients diagnosed with
230 hemophilia who have been prescribed anti-hemophilic-factor
231 replacement products, the agency shall provide for those
232 products and hemophilia overlay services through the agency’s
233 hemophilia disease management program.
234 4.3. Managed care plans, and their fiscal agents or
235 intermediaries, must accept prior authorization requests for any
236 service electronically.
237 5.4. Managed care plans serving children in the care and
238 custody of the Department of Children and Families shall must
239 maintain complete medical, dental, and behavioral health
240 encounter information and participate in making such information
241 available to the department or the applicable contracted
242 community-based care lead agency for use in providing
243 comprehensive and coordinated case management. The agency and
244 the department shall establish an interagency agreement to
245 provide guidance for the format, confidentiality, recipient,
246 scope, and method of information to be made available and the
247 deadlines for submission of the data. The scope of information
248 available to the department is shall be the data that managed
249 care plans are required to submit to the agency. The agency
250 shall determine the plan’s compliance with standards for access
251 to medical, dental, and behavioral health services; the use of
252 medications; and followup on all medically necessary services
253 recommended as a result of early and periodic screening,
254 diagnosis, and treatment.
255 6. Managed care plans shall only establish coverage
256 limitations that are supported by sufficient clinical evidence
257 as defined by 627.6051(1). The agency may not approve coverage
258 limitations without an assessment of the supporting evidence by
259 the Clinical Services Review Commission established pursuant to
260 s. 402.90.
261 Section 4. Section 627.6051, Florida Statutes, is created
262 to read:
263 627.6051 Required approval for certain coverage
264 limitations.—
265 (1) A coverage limitation imposed by the insurer at the
266 point of service must be supported by sufficient clinical
267 evidence proving that the limitation does not inhibit timely
268 diagnosis or effective treatment of the specific illness or
269 condition for the covered patient.
270 (a) For purposes of this section, the term, “a coverage
271 limitation imposed at the point of service” means a limitation
272 that is not universally applicable to all covered lives, but
273 instead depends on an insurer’s consideration of specific
274 patient characteristics and conditions that have been reported
275 by a physician in the process of providing medical care.
276 (b) The term “sufficient clinical evidence” means:
277 1. A body of research consisting of well-controlled studies
278 conducted by independent researchers and published in peer
279 reviewed journals or comparable publications which consistently
280 support the treatment protocol or other coverage limitation as a
281 best practice for the specific diagnosis or combination of
282 presenting complaints.
283 2. Results of a multivariate predictive model which
284 indicate that the probability of achieving desired outcomes is
285 not negatively altered or delayed by adherence to the proposed
286 protocol.
287 (2) The Clinical Practices Review Commission established
288 under s. 402.90 shall determine whether sufficient clinical
289 evidence exists for a proposed coverage limitation imposed by
290 the insurer at the point of service. In each instance in which
291 the commission finds that sufficient clinical evidence exists to
292 support a coverage limitation, the office shall approve the
293 coverage limitation.
294 (3) If an insurer, without the approval of the office,
295 imposes a coverage limitation at the point of service,
296 including, but not limited to, a prior authorization procedure,
297 step therapy requirement, treatment protocol, or other
298 utilization management procedure that restricts access to
299 covered services, the insurer and its chief medical officer
300 shall be liable for any injuries or damages, as defined in s.
301 766.202, and economic damages, as defined in s. 768.81(1)(b),
302 that result from the restricted access to services determined
303 medically necessary by the physician treating the patient. An
304 insurer that imposes such a coverage limitation at the point of
305 service shall establish reserves sufficient to pay for such
306 damages.
307 Section 5. Subsection (2) of section 627.642, Florida
308 Statutes, is amended to read:
309 627.642 Outline of coverage.—
310 (2) The outline of coverage must shall contain:
311 (a) A statement identifying the applicable category of
312 coverage afforded by the policy, based on the minimum basic
313 standards set forth in the rules issued to effect compliance
314 with s. 627.643.
315 (b) A brief description of the principal benefits and
316 coverage provided in the policy.
317 (c) A summary statement of the principal exclusions and
318 limitations or reductions contained in the policy, including,
319 but not limited to, preexisting conditions, probationary
320 periods, elimination periods, deductibles, coinsurance, and any
321 age limitations or reductions.
322 (d) A summary statement identifying specific prescription
323 drugs that are subject to prior authorization, step therapy, or
324 any other coverage limitation and the applicable coverage
325 limitation policy or protocol. The insurer shall post the
326 summary statement at a prominent and readily accessible location
327 on the Internet.
328 (e) A summary statement identifying any specific diagnostic
329 or therapeutic procedures that are subject to prior
330 authorization or other coverage limitations and the applicable
331 coverage limitation policy or protocol. The insurer shall post
332 the summary statement at a prominent and readily accessible
333 location on the Internet.
334 (f)(d) A summary statement of the renewal and cancellation
335 provisions, including any reservation of the insurer of a right
336 to change premiums.
337 (g)(e) A statement that the outline contains a summary only
338 of the details of the policy as issued or of the policy as
339 applied for and that the issued policy should be referred to for
340 the actual contractual governing provisions.
341 (h)(f) When home health care coverage is provided, a
342 statement that such benefits are provided in the policy.
343 Section 6. Subsection (2) of section 627.6471, Florida
344 Statutes, is amended to read:
345 627.6471 Contracts for reduced rates of payment;
346 limitations; coinsurance and deductibles.—
347 (2) An Any insurer issuing a policy of health insurance in
348 this state that, which insurance includes coverage for the
349 services of a preferred provider, must provide each policyholder
350 and certificateholder with a current list of preferred
351 providers, and must make the list available for public
352 inspection during regular business hours at the principal office
353 of the insurer within the state, and must post a link to the
354 list of preferred providers on the home page of the insurer’s
355 website. Such insurer must post on its website a change to the
356 list of preferred providers within 10 business days after such
357 change.
358 Section 7. Subsection (4) of section 627.651, Florida
359 Statutes, is amended to read:
360 627.651 Group contracts and plans of self-insurance must
361 meet group requirements.—
362 (4) This section does not apply to any plan that which is
363 established or maintained by an individual employer in
364 accordance with the Employee Retirement Income Security Act of
365 1974, Pub. L. No. 93-406, or to a multiple-employer welfare
366 arrangement as defined in s. 624.437(1), except that a multiple
367 employer welfare arrangement shall comply with ss. 627.419,
368 627.657, 627.6575, 627.6578, 627.6579, 627.6612, 627.66121,
369 627.66122, 627.6615, 627.6616, and 627.662(8) 627.662(7). This
370 subsection does not allow an authorized insurer to issue a group
371 health insurance policy or certificate which does not comply
372 with this part.
373 Section 8. Present subsections (7) through (14) of section
374 627.662, Florida Statutes, are redesignated as subsections (8)
375 through (15), respectively, and a new subsection (7) is added to
376 that section, to read:
377 627.662 Other provisions applicable.—The following
378 provisions apply to group health insurance, blanket health
379 insurance, and franchise health insurance:
380 (7) Section 627.642(2)(d) and (e), relating to coverage
381 limitations on prescription drugs and diagnostic or therapeutic
382 procedures.
383 Section 9. Paragraph (b) of subsection (12) of section
384 627.6699, Florida Statutes, is amended to read:
385 627.6699 Employee Health Care Access Act.—
386 (12) STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH
387 BENEFIT PLANS.—
388 (b)1. Each small employer carrier issuing new health
389 benefit plans shall offer to any small employer, upon request, a
390 standard health benefit plan, a basic health benefit plan, and a
391 high deductible plan that meets the requirements of a health
392 savings account plan as defined by federal law or a health
393 reimbursement arrangement as authorized by the Internal Revenue
394 Service, which that meet the criteria set forth in this section.
395 2. For purposes of this subsection, the terms “standard
396 health benefit plan,” “basic health benefit plan,” and “high
397 deductible plan” mean policies or contracts that a small
398 employer carrier offers to eligible small employers which that
399 contain:
400 a. An exclusion for services that are not medically
401 necessary or that are not covered preventive health services;
402 and
403 b. A procedure for preauthorization or prior authorization
404 by the small employer carrier, or its designees;
405 c. A summary statement identifying specific prescription
406 drugs that are subject to prior authorization, step therapy, or
407 any other coverage limitation and the applicable coverage
408 limitation policy or protocol. The carrier shall post the
409 summary statement in a prominent and readily accessible location
410 on the Internet; and
411 d. A summary statement identifying any specific diagnostic
412 or therapeutic procedures subject to prior authorization or
413 other coverage limitations and the applicable coverage
414 limitation policy or protocol. The carrier shall post the
415 summary statement in a prominent and readily accessible location
416 on the Internet.
417 3. A small employer carrier may include the following
418 managed care provisions in the policy or contract to control
419 costs:
420 a. A preferred provider arrangement or exclusive provider
421 organization or any combination thereof, in which a small
422 employer carrier enters into a written agreement with the
423 provider to provide services at specified levels of
424 reimbursement or to provide reimbursement to specified
425 providers. Any such written agreement between a provider and a
426 small employer carrier must contain a provision under which the
427 parties agree that the insured individual or covered member has
428 no obligation to make payment for any medical service rendered
429 by the provider which is determined not to be medically
430 necessary. A carrier may use preferred provider arrangements or
431 exclusive provider arrangements to the same extent as allowed in
432 group products that are not issued to small employers.
433 b. A procedure for utilization review by the small employer
434 carrier or its designees.
435
436 This subparagraph does not prohibit a small employer carrier
437 from including in its policy or contract additional managed care
438 and cost containment provisions, subject to the approval of the
439 office, which have potential for controlling costs in a manner
440 that does not result in inequitable treatment of insureds or
441 subscribers. The carrier may use such provisions to the same
442 extent as authorized for group products that are not issued to
443 small employers.
444 4. The standard health benefit plan shall include:
445 a. Coverage for inpatient hospitalization;
446 b. Coverage for outpatient services;
447 c. Coverage for newborn children pursuant to s. 627.6575;
448 d. Coverage for child care supervision services pursuant to
449 s. 627.6579;
450 e. Coverage for adopted children upon placement in the
451 residence pursuant to s. 627.6578;
452 f. Coverage for mammograms pursuant to s. 627.6613;
453 g. Coverage for children with disabilities handicapped
454 children pursuant to s. 627.6615;
455 h. Emergency or urgent care out of the geographic service
456 area; and
457 i. Coverage for services provided by a hospice licensed
458 under s. 400.602 in cases where such coverage would be the most
459 appropriate and the most cost-effective method for treating a
460 covered illness.
461 5. The standard health benefit plan and the basic health
462 benefit plan may include a schedule of benefit limitations for
463 specified services and procedures. If the committee develops
464 such a schedule of benefits limitation for the standard health
465 benefit plan or the basic health benefit plan, a small employer
466 carrier offering the plan must offer the employer an option for
467 increasing the benefit schedule amounts by 4 percent annually.
468 6. The basic health benefit plan must shall include all of
469 the benefits specified in subparagraph 4.; however, the basic
470 health benefit plan must shall place additional restrictions on
471 the benefits and utilization and may also impose additional cost
472 containment measures.
473 7. Sections 627.419(2), (3), and (4), 627.6574, 627.6612,
474 627.66121, 627.66122, 627.6616, 627.6618, 627.668, and 627.66911
475 apply to the standard health benefit plan and to the basic
476 health benefit plan. However, notwithstanding such said
477 provisions, the plans may specify limits on the number of
478 authorized treatments, if such limits are reasonable and do not
479 discriminate against any type of provider.
480 8. The high-deductible high deductible plan associated with
481 a health savings account or a health reimbursement arrangement
482 must shall include all the benefits specified in subparagraph 4.
483 9. Each small employer carrier that provides for inpatient
484 and outpatient services by allopathic hospitals may provide as
485 an option of the insured similar inpatient and outpatient
486 services by hospitals accredited by the American Osteopathic
487 Association if when such services are available and the
488 osteopathic hospital agrees to provide the service.
489 Section 10. Subsection (4) of section 641.31, Florida
490 Statutes, is amended and subsection (44) is added to that
491 section, to read:
492 641.31 Health maintenance contracts.—
493 (4) Each Every health maintenance contract, certificate, or
494 member handbook must shall clearly state all of the services to
495 which a subscriber is entitled under the contract and must
496 include a clear and understandable statement of any limitations
497 on the benefits, services, or kinds of services to be provided,
498 including any copayment feature or schedule of benefits required
499 by the contract or by any insurer or entity that which is
500 underwriting any of the services offered by the health
501 maintenance organization. The contract, certificate, or member
502 handbook must shall also state where and in what manner the
503 comprehensive health care services may be obtained. The health
504 maintenance organization shall prominently post the statement
505 regarding limitations on benefits, services, or kinds of
506 services provided on its website in a readily accessible
507 location on the Internet. The statement must include, but need
508 not be limited to:
509 (a) The identification of specific prescription drugs that
510 are subject to prior authorization, step therapy, or any other
511 coverage limitation and the applicable coverage limitation
512 policy or protocol.
513 (b) The identification of any specific diagnostic or
514 therapeutic procedures that are subject to prior authorization
515 or other coverage limitations and the applicable coverage
516 limitation policy or protocol.
517 (44) Health maintenance organizations are prohibited from
518 establishing prior authorization procedures, step therapy
519 requirements, treatment protocols, or other utilization
520 management procedures that restrict access to covered services
521 unless expressly authorized to do so under this subsection. A
522 coverage limitation imposed by a health maintenance organization
523 at the point of service must be supported, as determined by the
524 Clinical Practices Review Commission established pursuant to s.
525 402.90, by sufficient clinical evidence, as defined in s.
526 627.6051(1), which demonstrates that the limitation does not
527 inhibit the timely diagnosis or optimal treatment of the
528 specific illness or condition for the covered patient. For
529 purposes of this subsection, the term, “a coverage limitation
530 imposed by a health maintenance organization at the point of
531 service” means a limitation that is not universally applicable
532 to all covered lives, but instead depends on a health
533 maintenance organization’s consideration of specific patient
534 characteristics and conditions that have been reported by a
535 physician in the process of providing medical care.
536 Section 11. Subsection (10) of section 641.3155, Florida
537 Statutes, is amended to read:
538 641.3155 Prompt payment of claims.—
539 (10) A health maintenance organization may not
540 retroactively deny a claim because of subscriber ineligibility
541 more than 1 year after the date of payment of the claim and may
542 not retroactively deny a claim because of subscriber
543 ineligibility at any time if the health maintenance organization
544 verified the eligibility of a subscriber at the time of
545 treatment and has provided an authorization number.
546 Section 12. This act shall take effect October 1, 2015.
