(1) Notwithstanding other provisions of this chapter, a health maintenance organization may issue a contract that limits coverage to home health care services only. The organization and the contract shall be subject to all of the requirements of this part that do not require or otherwise apply to specific benefits other than home care services. To this extent, all of the requirements of this part apply to any organization or contract that limits coverage to home care services, except the requirements for providing comprehensive health care services as provided in ss. 641.19(4), (11), and (12), and 641.31(1), except ss. 641.31(9), (12), (17), (18), (19), (20), (21), and (24) and 641.31095.
(2) Notwithstanding the other provisions of this chapter, a health maintenance organization may apply for and obtain a certificate of authority from the office pursuant to this part and a health care provider certificate pursuant to part III, which certificate limits the authority of the organization to the issuance of contracts that limit coverage to home health care services pursuant to subsection (1). In addition to all applicable requirements of this part, as specified in subsection (1), all of the requirements of part III apply to an organization applying for such a limited certificate, except to the extent that such requirements directly conflict with the limited nature of the coverage provided.
(3) Any contract that limits coverage to home health care benefits as provided in this section must also meet all of the requirements of ss. 627.9403-627.9408 of the Long-Term Care Insurance Act, except s. 627.9407(3)(c) and (9).
History.—s. 6, ch. 96-275; s. 51, ch. 99-3; s. 1557, ch. 2003-261; s. 10, ch. 2006-254.
Structure Florida Statutes
Chapter 641 - Health Care Service Programs
Part I - Health Maintenance Organizations (Ss. 641.17-641.3923)
641.18 - Declaration of legislative intent, findings, and purposes.
641.183 - Statutory accounting procedures; transition provisions.
641.185 - Health maintenance organization subscriber protections.
641.201 - Applicability of other laws.
641.2011 - Insurance holding companies.
641.2015 - Incorporation required.
641.2017 - Insurance business not authorized.
641.2018 - Limited coverage for home health care authorized.
641.20185 - High-deductible contracts for medical savings accounts.
641.2019 - Provider service network certificate of authority.
641.21 - Application for certificate.
641.217 - Minority recruitment and retention plans required.
641.22 - Issuance of certificate of authority.
641.221 - Continued eligibility for certificate of authority.
641.225 - Surplus requirements.
641.227 - Rehabilitation Administrative Expense Fund.
641.228 - Florida Health Maintenance Organization Consumer Assistance Plan.
641.234 - Administrative, provider, and management contracts.
641.2342 - Contract providers.
641.25 - Administrative penalty in lieu of suspension or revocation.
641.255 - Acquisition, merger, or consolidation.
641.26 - Annual and quarterly reports.
641.261 - Other reporting requirements.
641.27 - Examination by the department.
641.282 - Payment of judgment by health maintenance organization.
641.285 - Insolvency protection.
641.286 - Levy upon deposit limited.
641.30 - Construction and relationship to other laws.
641.3005 - Application of ch. 85-177.
641.3007 - HIV infection and AIDS for contract purposes.
641.305 - Language used in contracts and advertisements; translations.
641.309 - Standards for marketing to persons eligible for Medicare.
641.31 - Health maintenance contracts.
641.3101 - Additional contract contents.
641.3102 - Restrictions upon expulsion or refusal to issue or renew contract.
641.3103 - Charter, bylaw provisions.
641.3104 - Execution of contracts.
641.3105 - Validity of noncomplying contracts.
641.3106 - Construction of contracts.
641.3107 - Delivery of contract; definitions.
641.31071 - Preexisting conditions.
641.31072 - Special enrollment periods.
641.31074 - Guaranteed renewability of coverage.
641.31075 - Advanced practice registered nurse services.
641.31076 - Shared savings incentive program.
641.31077 - Coverage for organ transplants.
641.3108 - Notice of cancellation of contract.
641.31085 - Disclosures to subscribers; coverage of behavioral health care services.
641.31094 - Nondiscrimination of coverage for certain surgical procedures involving bones or joints.
641.31095 - Coverage for mammograms.
641.31096 - Requirements with respect to breast cancer and routine followup care.
641.31097 - Decreasing inappropriate utilization of emergency care.
641.31098 - Coverage for individuals with developmental disabilities.
641.31099 - Restrictions on use of state and federal funds for state exchanges.
641.3111 - Extension of benefits.
641.314 - Pharmacy benefit manager contracts.
641.3154 - Organization liability; provider billing prohibited.
641.3155 - Prompt payment of claims.
641.3156 - Treatment authorization; payment of claims.
641.316 - Fiscal intermediary services.
641.33 - Certain words prohibited in name of organization.
641.35 - Assets, liabilities, and investments.
641.36 - Adoption of rules; penalty for violation.
641.37 - Prohibited activities; penalties.
641.38 - Operational health maintenance organizations; issuance of certificate.
641.385 - Order to discontinue certain advertising.
641.386 - Agent licensing and appointment required; exceptions.
641.3901 - Unfair methods of competition and unfair or deceptive acts or practices prohibited.
641.3903 - Unfair methods of competition and unfair or deceptive acts or practices defined.
641.3905 - General powers and duties of the department and office.
641.3909 - Cease and desist and penalty orders.
641.3911 - Appeals from the department or office.
641.3913 - Penalty for violation of cease and desist orders.
641.3915 - Health maintenance organization anti-fraud plans and investigative units.
641.3921 - Conversion on termination of eligibility.