Chapter 2019-100, Laws of Florida, creates sections 627.6387, 627.6648, and 641.31076, F.S., which require the Financial Service Commission to file a description of the program on a form and requires insurers to submit certain information to the ...

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NOS.:RULE TITLES:

69O-240.001Shared Savings Program Requirements

69O-240.002Annual Report

PURPOSE AND EFFECT: Chapter 2019-100, Laws of Florida, creates sections 627.6387, 627.6648, and 641.31076, F.S., which require the Financial Service Commission to file a description of the program on a form and requires insurers to submit certain information to the Office, so it may to determine the baseline for the savings calculation.

SUMMARY: Chapter 69O-240, F.A.C., will govern the regulation of shared savings programs. Rule 69O-240.001, F.A.C. addresses the requirements for approval of a shared savings program by the Office. Rule 69O-240.002, F.A.C. implements an annual report a health insurer or health maintenance organization must file with the Office.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Agency personnel familiar with the subject matter of the rule amendment have performed an economic analysis of the rule amendment that shows that the rule amendment is unlikely to have an adverse impact on the State economy in excess of the criteria established in Section 120.541(2)(a), Florida Statutes.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

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.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Michael Lawrence, Jr., Assistant General Counsel, Office of Insurance Regulation, [e-mail], [phone].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

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:

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

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

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

(b) A health insurer or health maintenance organization shall submit the forms listed in 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 _____.

 

69O-240.002 Annual Report.

A health insurer or health maintenance organization offering a shared savings program shall file Form OIR-B2-2217 with the Office electronically through http://www.floir.com/iportal within 90 business days after the close of each plan year.  Form OIR-B2-2217, “Shared Savings Program Annual Report,” effective 9/19, is hereby incorporated by reference and available at www.flrules.org/XXXXX.

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 _____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Michael Lawrence, Jr., Assistant General Counsel

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Financial Services Commission

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 3, 2019

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 19, 2019