The Florida Senate

641.60  Statewide Managed Care Ombudsman Committee.--

(1)  As used in ss. 641.60-641.75:

(a)  "Agency" means the Agency for Health Care Administration.

(b)  "Covered medical service" means a service that has been contracted for under the managed care program agreement.

(c)  "District" means one of the health service planning districts as defined in s. 408.032.

(d)  "District committee" means a district managed care ombudsman committee.

(e)  "Enrollee" means an individual who has contracted, or on whose behalf a contract has been entered into, with a managed care program for health care.

(f)  "Managed care program" means a health care delivery system that emphasizes primary care and integrates the financing and delivery of services to enrolled individuals through arrangements with selected providers, formal quality assurance and utilization review, and financial incentives for enrollees to use the program's providers. Such a health care delivery system may include arrangements in which providers receive prepaid set payments to coordinate and deliver all inpatient and outpatient services to enrollees or arrangements in which providers receive a case management fee to coordinate services and are reimbursed on a fee-for-service basis for the services they provide. A managed care program may include a state-licensed health maintenance organization, a Medicaid prepaid health plan, a Medicaid primary care case management program, or other similar program.

(g)  "Physician" means a person licensed under chapter 458, chapter 459, chapter 460, or chapter 461.

(h)  "Statewide committee" means the Statewide Managed Care Ombudsman Committee.

(2)  There is created within the Agency for Health Care Administration a Statewide Managed Care Ombudsman Committee. The statewide committee shall act as a consumer protection and advocacy organization on behalf of all health care consumers receiving services through managed care programs in the state. The statewide committee shall work in conjunction with the agency in protecting the public health, safety, and welfare, as provided under this section and ss. 641.65, 641.70, and 641.75. The statewide committee shall have administrative authority over the district committees established in s. 641.65.

(3)  The statewide committee shall consist of the chairpersons of the district committees.

(4)  The members of the statewide committee shall elect a chairperson to a term of 1 year. A person may not serve as chairperson for more than two consecutive terms.

(5)(a)  Members of the statewide committee shall receive no compensation, but may be reimbursed for travel expenses in accordance with s. 112.061.

(b)  Travel expenses for the statewide committee shall be funded from the Health Care Trust Fund created by s. 408.16. The statewide committee may solicit grants, gifts, donations, bequests, or other payments including money, property, or services from any governmental or public entity or private entity or person to fund other expenses of the committee and the district committees. Any such moneys received shall be deposited into a trust fund administered by the agency.

(6)  The statewide committee or a member of the committee:

(a)  Shall serve as a volunteer organization to protect the rights of all enrollees participating in managed care programs in this state.

(b)  Shall receive complaints regarding quality of care from the agency, and may assist the agency with the investigation and resolution of complaints.

(c)  May conduct site visits with the agency, as the agency determines is appropriate.

(d)  May review existing and new or revised managed care quality assurance programs of the agency and make recommendations as to how the rights of managed care enrollees are affected by such programs.

(e)  May submit a report to the Legislature, no later than January 1, as appropriate, concerning activities, recommendations, and complaints reviewed or developed by the statewide committee and district committees during the preceding year.

(f)  Shall conduct meetings at least two times a year at the call of the chairperson and at other times at the call of the secretary of the agency or by written request of three members.

(g)  Shall adopt agency guidelines to carry out its purposes and responsibilities and those of the district committees.

(h)  Shall monitor the district committees and provide technical assistance to members of district committees.

History.--s. 1, ch. 96-391; s. 12, ch. 97-270; s. 175, ch. 98-166; s. 23, ch. 2000-305.