SENATE AMENDMENT
Bill No. CS for CS for SB 1202
Amendment No. ___ Barcode 035576
CHAMBER ACTION
Senate House
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11 Senator Alexander moved the following amendment:
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13 Senate Amendment
14 On page 61, line 28, through page 62, line 29, delete
15 those lines,
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17 and insert:
18 (12) PEER REVIEW.--
19 (a) Applicability.--This subsection applies to all
20 benefits payable under this section.
21 (b) Definitions.--As used in this subsection, the
22 term:
23 1. "Agency" means the Agency for Health Care
24 Administration.
25 2. "Claimant" means the insured injured person or the
26 provider involved in a dispute under this subsection.
27 3. "Initiating party" means the party filing a notice.
28 4. "Notice means the notice initiating peer review.
29 5. "Peer reviewer" shall mean:
30 a. A health care practitioner licensed in Florida
31 under the same chapter as the health care practitioner
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3:13 PM 04/28/03 s1202.bi17.SS
SENATE AMENDMENT
Bill No. CS for CS for SB 1202
Amendment No. ___ Barcode 035576
1 involved in the dispute, under contract with a peer review
2 organization to whom a particular dispute has been referred by
3 the peer review organization. Such health care practitioners
4 may not derive more than 25 percent of his or her income from
5 insurers for other work of any kind, and must have an active
6 patient practice of at least 8 hours per week. The peer review
7 organization must use such health care practitioners for all
8 disputes that involve medical issues, including but not
9 limited to, whether a service or treatment is medically
10 necessary, reasonable in the amount charged, correctly coded,
11 and including any non-medical disputes that are raised in a
12 dispute that aggregates medical and non-medical issues.
13 b. A person employed by, or under contract with, a
14 peer review organization, to whom a particular dispute has
15 been referred by the peer review organization. For issues
16 other than issues that must be submitted to a health care
17 practitioner pursuant to sub-subparagraph a., the person
18 serving as peer reviewer must qualify for approval by the
19 agency as a reviewer by meeting the following qualifications:
20 (I) Possess a masters or doctorate degree in
21 psychology, counseling, business, accounting, or economics; be
22 a member of The Florida Bar; be licensed as a certified public
23 accountant; or have completed training in the following:
24 (A) Conflict management and intervention skills.
25 (B) Insurance nomenclature.
26 (C) The provisions of this section and additional
27 training if required as to any person not trained concerning
28 applicable principles of law.
29 6. "Peer review organization" means one or more
30 qualified entities selected by and contracted with the agency
31 that employs or contracts with peer reviewers.
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3:13 PM 04/28/03 s1202.bi17.SS
SENATE AMENDMENT
Bill No. CS for CS for SB 1202
Amendment No. ___ Barcode 035576
1 7. "Respondent" means the party upon whom a notice is
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3:13 PM 04/28/03 s1202.bi17.SS