House Bill 1087e1

                                       CS/HB 1087, First Engrossed



  1                      A bill to be entitled

  2         An act relating to health care; amending s.

  3         641.51, F.S.; requiring health maintenance

  4         organizations to provide a subscriber continued

  5         access to a treating physician terminated by

  6         the organization; providing limitations;

  7         amending s. 641.315, F.S.; revising the notice

  8         requirements for termination of provider

  9         contracts; providing an effective date.

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11  Be It Enacted by the Legislature of the State of Florida:

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13         Section 1.  Subsection (7) of section 641.51, Florida

14  Statutes, is amended to read:

15         641.51  Quality assurance program; second medical

16  opinion requirement.--

17         (7)  When an organization terminates a contract with a

18  treating physician licensed under chapter 458, chapter 459,

19  chapter 460, or chapter 461, for any reason other than for

20  cause, the Each organization shall allow subscribers for whom

21  the terminated physician was a treating physician to continue

22  care for 60 days with the a terminated treating physician

23  through completion of treatment of a condition for which the

24  subscriber was receiving care at the time of the termination,

25  until the subscriber selects another treating physician, or

26  until the next open enrollment period offered by the

27  organization, whichever occurs first, but no longer than 1

28  year after termination of the physician contract, provider

29  when medically necessary, provided the subscriber has a

30  life-threatening condition or a disabling and degenerative

31  condition.  Each organization shall allow a subscriber who is


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CODING: Words stricken are deletions; words underlined are additions.






                                       CS/HB 1087, First Engrossed



  1  in the third trimester of pregnancy to continue care with a

  2  terminated treating physician provider until completion of

  3  postpartum care. For care continued under this subsection, the

  4  organization and the physician provider shall continue to be

  5  bound by the terms of the terminated contract for such

  6  continued care. This subsection shall not apply to treating

  7  physicians providers who have been terminated by the

  8  organization for cause.

  9         Section 2.  Subsections (6) and (7) of section 641.315,

10  Florida Statutes, are amended to read:

11         641.315  Provider contracts.--

12         (6)(a)  For all provider contracts executed after

13  October 1, 1998 1991, and within 180 days after October 1,

14  1991, for contracts in existence as of October 1, 1991:

15         1.  The contracts must provide that the provider shall

16  provide 90 60 days' advance written notice to the health

17  maintenance organization and the department before canceling

18  the contract with the health maintenance organization for any

19  reason; and

20         2.  The contract must also provide that nonpayment for

21  goods or services rendered by the provider to the health

22  maintenance organization shall not be a valid reason for

23  avoiding the 90-day 60-day advance notice of cancellation.

24         (b)  For all provider contracts executed after October

25  1, 1998, 1996, and within 180 days after October 1, 1996, for

26  contracts in existence as of October 1, 1996, the contracts

27  must provide that the health maintenance organization will

28  provide 90 60 days' advance written notice to the provider and

29  the department before canceling, without cause, the contract

30  with the provider, except in a case in which a patient's

31  health is subject to imminent danger or a physician's ability


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CODING: Words stricken are deletions; words underlined are additions.






                                       CS/HB 1087, First Engrossed



  1  to practice medicine is effectively impaired by an action by

  2  the Board of Medicine or other governmental agency.

  3         (7)  Upon receipt by the health maintenance

  4  organization of a 90-day 60-day cancellation notice, the

  5  health maintenance organization may, if requested by the

  6  provider, terminate the contract in less than 90 60 days if

  7  the health maintenance organization is not financially

  8  impaired or insolvent.

  9         Section 3.  This act shall take effect October 1 of the

10  year in which enacted.

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