Shared Savings Program Requirements, Annual Report

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NOS.:RULE TITLES:

69O-240.001Shared Savings Program Requirements

69O-240.002Annual Report

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 46 No. 12, January 17, 2020 issue of the Florida Administrative Register.

The changes are in response to written comments received from the Joint Administrative Procedures Committee and the public.

 

69O-240.001 Shared Savings Program Requirements

(1)(a) A health insurer or health maintenance organization that wants to implement a shared savings program shall submit the following:

(a)1. Form OIR-B2-2214, “Shared Savings Program Description,” effective 9/19 8/19, hereby incorporated by reference and available at www.flrules.org/XXXXX;

(b)2. Form OIR-B2-2215, “Shared Savings Program Policy Template,” effective 9/19, hereby incorporated by reference and available at www.flrules.org/XXXXX; and

(c)3. Form OIR-B2-2216, “Shared Savings Program Rates Template,” effective 9/19, hereby incorporated by reference and available at www.flrules.org/XXXXX.

(2)(b) A health insurer or health maintenance organization shall submit the forms listed in subsection (1) paragraph (1)(a) electronically through https://www.floir.com/iportal.

(2) The Office will accept the following baseline methodologies:

(a) A baseline equal to the average in-network amount paid for that service in the most recent 12-month period.  The average in-network amount may be calculated by using the statewide average or the average paid for the service within the insured’s or subscriber’s service area; or

(b) Another baseline methodology that yields a similar or greater savings as the methodology in paragraph (2)(a).

(3) The calculation for the shared savings amount is equal to baseline amount less the cost of the service which is then multiplied by the shared savings percentage [(baseline – cost) * shared savings percentage].  The shared savings amount may not be equal to less than 25 percent of the savings generated by the insured’s or subscriber’s participation in the program.  The shared savings percentage may vary by service or service area.

Rulemaking Authority 624.308(1), 627.6387(3)(b), 627.6387(5), 627.6648(3)(b), 627.6648(5), 641.31076(3)(b), 641.31076(5) FS. Law Implemented 627.6387, 627.6648, 641.31076 FS. History-New _____.

 

Form title added to Form OIR-B2-2214.

 

Form title format changed for Form OIR-B2-2215.

 

Typographical error corrected and form title added to Form OIR-B2-2216.

 

69O-240.002 Annual Report.

No change.

Rulemaking Authority 624.308(1), 627.6387(5), 627.6648(5), 641.31076(5) FS. Law Implemented 627.6387, 627.6648, 641.31076 FS. History-New _____.

 

Page two removed from Form OIR-B2-2217.