Senate Bill 2080c1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 2080
By the Committee on Banking and Insurance; and Senator
Sullivan
311-2183-98
1 A bill to be entitled
2 An act relating to health care; amending s.
3 641.315, F.S.; revising the notice requirements
4 for termination of contracts between health
5 maintenance organizations and providers;
6 amending s. 641.51, F.S.; requiring health
7 maintenance organizations to provide a
8 subscriber with continued access to a treating
9 physician terminated by the organization;
10 providing limitations; providing an effective
11 date.
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13 Be It Enacted by the Legislature of the State of Florida:
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15 Section 1. Subsections (6) and (7) of section 641.315,
16 Florida Statutes, are amended to read:
17 641.315 Provider contracts.--
18 (6)(a) For all provider contracts executed after
19 October 1, 1998 1991, and within 180 days after October 1,
20 1991, for contracts in existence as of October 1, 1991:
21 1. The contracts must provide that the provider shall
22 provide 90 60 days' advance written notice to the health
23 maintenance organization and the department before canceling
24 the contract with the health maintenance organization for any
25 reason; and
26 2. The contract must also provide that nonpayment for
27 goods or services rendered by the provider to the health
28 maintenance organization shall not be a valid reason for
29 avoiding the 90-day 60-day advance notice of cancellation.
30 (b) For all provider contracts executed after October
31 1, 1998, 1996, and within 180 days after October 1, 1996, for
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CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 2080
311-2183-98
1 contracts in existence as of October 1, 1996, the contracts
2 must provide that the health maintenance organization will
3 provide 90 60 days' advance written notice to the provider and
4 the department before canceling, without cause, the contract
5 with the provider, except in a case in which a patient's
6 health is subject to imminent danger or a physician's ability
7 to practice medicine is effectively impaired by an action by
8 the Board of Medicine or other governmental agency.
9 (7) Upon receipt by the health maintenance
10 organization of a 90-day 60-day cancellation notice, the
11 health maintenance organization may, if requested by the
12 provider, terminate the contract in less than 90 60 days if
13 the health maintenance organization is not financially
14 impaired or insolvent.
15 Section 2. Subsection (7) of section 641.51, Florida
16 Statutes, is amended to read:
17 641.51 Quality assurance program; second medical
18 opinion requirement.--
19 (7) When an organization terminates a contract with a
20 treating physician licensed under chapter 458, chapter 459,
21 chapter 460, or chapter 461, for any reason other than for
22 cause, the Each organization shall allow subscribers for whom
23 the terminated physician was a treating physician to continue
24 care for 60 days with the a terminated treating physician
25 through completion of treatment of a condition for which the
26 subscriber was receiving care at the time of the termination
27 until the subscriber selects another treating physician, or
28 until the next open enrollment period offered by the
29 organization, whichever occurs first, but no longer than 1
30 year after termination of the physician contract, provider
31 when medically necessary, provided the subscriber has a
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 2080
311-2183-98
1 life-threatening condition or a disabling and degenerative
2 condition. Each organization shall allow a subscriber who is
3 in the third trimester of pregnancy to continue care with a
4 terminated treating physician provider until completion of
5 postpartum care. For care continued under this subsection, the
6 organization and the physician provider shall continue to be
7 bound by the terms of the terminated contract for such
8 continued care. This subsection shall not apply to treating
9 physicians providers who have been terminated by the
10 organization for cause.
11 Section 3. This act shall take effect October 1, 1998.
12
13 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
14 Senate Bill 2080
15
16 Increases the time period from 60 to 90 days when advance
written notice must be provided prior to cancellation of
17 provider contracts by either a health maintenance organization
(HMO) or the provider, applicable to all HMO provider
18 contracts executed after October 1, 1998.
19 Increases the maximum time period from 60 days to 1 year as
the required period for a HMO to continue care for subscribers
20 with life-threatening or disabling and degenerative conditions
who are under the treatment of a physician who is terminated
21 by a HMO, applicable to contracts by HMOs with a treating
physician licensed under chapter 458 (physicians), chapter 459
22 (osteopathic physicians), chapter 460 (chiropractic
physicians), or chapter 461 (podiatric physicians), as
23 compared to the current law's application to any "provider."
24 Deletes the bill's provisions prohibiting a managed care plan
from terminating a health care provider contract without a
25 hearing, if requested by a health care provider.
26 Deletes the bill's provisions declaring it to be an unfair or
deceptive act if a HMO takes any adverse action against a
27 provider for communicating information to the provider's
patient regarding medical care or treatment options.
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