624.916 Developmental disabilities compact.
624.916 Developmental disabilities compact.
(1) This section may be cited as the “Window of Opportunity Act.”
(2) The Office of Insurance Regulation shall convene a workgroup by August 31, 2008, for the purpose of negotiating a compact that includes a binding agreement among the participants relating to insurance and access to services for persons with developmental disabilities. The workgroup shall consist of the following:
(a) Representatives of all health insurers licensed under this chapter.
(b) Representatives of all health maintenance organizations licensed under part I of chapter 641.
(c) Representatives of employers with self-insured health benefit plans.
(d) Two designees of the Governor, one of whom must be a consumer advocate.
(e) A designee of the President of the Senate.
(f) A designee of the Speaker of the House of Representatives.
(3) The Office of Insurance Regulation shall convene a consumer advisory workgroup for the purpose of providing a forum for comment on the compact negotiated in subsection (2). The office shall convene the workgroup prior to finalization of the compact.
(4) The agreement shall include the following components:
(a) A requirement that each signatory to the agreement increase coverage for behavior analysis and behavior assistant services as defined in s. 409.815(2)(r) and speech therapy, physical therapy, and occupational therapy when medically necessary due to the presence of a developmental disability.
(b) Procedures for clear and specific notice to policyholders identifying the amount, scope, and conditions under which coverage is provided for behavior analysis and behavior assistant services as defined in s. 409.815(2)(r) and speech therapy, physical therapy, and occupational therapy when medically necessary due to the presence of a developmental disability.
(c) Penalties for documented cases of denial of claims for medically necessary services due to the presence of a developmental disability.
(d) Proposals for new product lines that may be offered in conjunction with traditional health insurance and provide a more appropriate means of spreading risk, financing costs, and accessing favorable prices.
(5) Upon completion of the negotiations for the compact, the office shall report the results to the Governor, the President of the Senate, and the Speaker of the House of Representatives.
(6) Beginning February 15, 2009, and continuing annually thereafter, the Office of Insurance Regulation shall provide a report to the Governor, the President of the Senate, and the Speaker of the House of Representatives regarding the implementation of the agreement negotiated under this section. The report shall include:
(a) The signatories to the agreement.
(b) An analysis of the coverage provided under the agreement in comparison to the coverage required under ss. 627.6686 and 641.31098.
(c) An analysis of the compliance with the agreement by the signatories, including documented cases of claims denied in violation of the agreement.
(7) The Office of Insurance Regulation shall continue to monitor participation, compliance, and effectiveness of the agreement and report its findings at least annually.
(8) As used in this section, the term “developmental disabilities” includes:
(a) The term as defined in s. 393.063;
(b) Down syndrome, a genetic disorder caused by the presence of extra chromosomal material on chromosome 21. Causes of the syndrome may include Trisomy 21, Mosaicism, Robertsonian Translocation, and other duplications of a portion of chromosome 21; and
(c) Autism spectrum disorder, as defined in s. 627.6686.
History. s. 2, ch. 2008-30.