§ 627.6405 — Decreasing inappropriate utilization of emergency care

Florida § 627.6405

• Jurisdiction: Florida
• Title: XXXVII
• Ch. 627: INSURANCE RATES AND CONTRACTS

Text

(1) A health insurer shall post on its website, and update annually, information regarding appropriate utilization of emergency care services which shall include, but need not be limited to: (a) A list of alternative urgent care contracted providers; (b) The types of services offered by these providers; (c) At least two examples illustrating the impact on insured and insurer paid amounts of inappropriate utilization of nonemergent services and care in a hospital emergency department setting compared to utilization of nonemergent services and care in an urgent care center; (d) An interactive tool to locate local in-network and out-of-network urgent care centers; and (e) What to do in the event of a true emergency.

(2) Health insurers shall develop community emergency department diversion programs. Such programs may include, at the discretion of the insurer, but not be limited to, enlisting providers to be on call to insurers after hours, coordinating care through local community resources, and providing incentives to providers for case management.

(3) As a disincentive for insureds to inappropriately use emergency department services for nonemergency care, health insurers may require higher copayments for urgent care or primary care provided in an emergency department and higher copayments for use of out-of-network emergency departments. Higher copayments may not be charged for the utilization of the emergency department for emergency care. For the purposes of this section, the term “emergency care” has the same meaning as the term “emergency services and care” as defined in s. 395.002(9) and includes services provided to rule out an emergency medical condition.

Legislative History

s. 25, ch. 2004-297; s. 4, ch. 2021-112.