Florida Senate - 2014 COMMITTEE AMENDMENT
Bill No. SB 1646
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LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/01/2014 .
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(Garcia) recommended the following:
1 Senate Amendment (with title amendment)
2
3 Between lines 360 and 361
4 insert:
5 Section 7. Subsection (3) is added to section 627.645,
6 Florida Statutes, to read:
7 627.645 Denial of health insurance claims restricted.—
8 (3) A claim for payment under a health insurance policy for
9 medical care or treatment may not be denied on the basis of a
10 medical necessity determination conducted via telemedicine as
11 defined in s. 456.4502 unless the determination is made by a
12 physician licensed under chapter 458 or chapter 459.
13 Section 8. Paragraph (m) is added to subsection (1) of
14 section 641.185, Florida Statutes, to read:
15 641.185 Health maintenance organization subscriber
16 protections.—
17 (1) With respect to the provisions of this part and part
18 III, the principles expressed in the following statements shall
19 serve as standards to be followed by the commission, the office,
20 the department, and the Agency for Health Care Administration in
21 exercising their powers and duties, in exercising administrative
22 discretion, in administrative interpretations of the law, in
23 enforcing its provisions, and in adopting rules:
24 (m) A health maintenance organization may not deny a claim
25 for payment for medical care or treatment on the basis of a
26 medical necessity determination conducted via telemedicine as
27 defined in s. 456.4502 unless the determination is made by a
28 physician licensed under chapter 458 or chapter 459.
29 Section 9. Paragraph (c) of subsection (2) of section
30 409.967, Florida Statutes, is amended to read:
31 409.967 Managed care plan accountability.—
32 (2) The agency shall establish such contract requirements
33 as are necessary for the operation of the statewide managed care
34 program. In addition to any other provisions the agency may deem
35 necessary, the contract must require:
36 (c) Access.—
37 1. The agency shall establish specific standards for the
38 number, type, and regional distribution of providers in managed
39 care plan networks to ensure access to care for both adults and
40 children. Each plan must maintain a regionwide network of
41 providers in sufficient numbers to meet the access standards for
42 specific medical services for all recipients enrolled in the
43 plan. A plan may not use telemedicine providers as defined in s.
44 456.4502 to meet this requirement unless the provider is
45 licensed under chapter 458 or chapter 459. The exclusive use of
46 mail-order pharmacies may not be sufficient to meet network
47 access standards. Consistent with the standards established by
48 the agency, provider networks may include providers located
49 outside the region. A plan may contract with a new hospital
50 facility before the date the hospital becomes operational if the
51 hospital has commenced construction, will be licensed and
52 operational by January 1, 2013, and a final order has issued in
53 any civil or administrative challenge. Each plan shall establish
54 and maintain an accurate and complete electronic database of
55 contracted providers, including information about licensure or
56 registration, locations and hours of operation, specialty
57 credentials and other certifications, specific performance
58 indicators, and such other information as the agency deems
59 necessary. The database must be available online to both the
60 agency and the public and have the capability to compare the
61 availability of providers to network adequacy standards and to
62 accept and display feedback from each provider’s patients. Each
63 plan shall submit quarterly reports to the agency identifying
64 the number of enrollees assigned to each primary care provider.
65 2. Each managed care plan must publish any prescribed drug
66 formulary or preferred drug list on the plan’s website in a
67 manner that is accessible to and searchable by enrollees and
68 providers. The plan must update the list within 24 hours after
69 making a change. Each plan must ensure that the prior
70 authorization process for prescribed drugs is readily accessible
71 to health care providers, including posting appropriate contact
72 information on its website and providing timely responses to
73 providers. For Medicaid recipients diagnosed with hemophilia who
74 have been prescribed anti-hemophilic-factor replacement
75 products, the agency shall provide for those products and
76 hemophilia overlay services through the agency’s hemophilia
77 disease management program.
78 3. Managed care plans, and their fiscal agents or
79 intermediaries, must accept prior authorization requests for any
80 service electronically.
81
82 ================= T I T L E A M E N D M E N T ================
83 And the title is amended as follows:
84 Delete line 34
85 and insert:
86 providing for future repeal; amending ss. 627.645 and
87 641.185, F.S.; prohibiting the denial of a claim for
88 payment for medical services based on a medical
89 necessity determination conducted via telemedicine
90 unless the determination is made by a physician;
91 prohibiting a managed care plan under Medicaid from
92 using telemedicine providers that are not physicians;
93 providing an effective date.