CODING: Words stricken are deletions; words underlined are additions.
House Bill 0365c1




    Florida House of Representatives - 1997              CS/HB 365

        By the Committee on Health Care Standards & Regulatory
    Reform and Representatives Posey, Jones, King, Littlefield,
    Jacobs, Kelly, Brooks, Peaden, Minton and Bronson




  1                      A bill to be entitled

  2         An act relating to managed care; amending s.

  3         627.6472, F.S.; requiring exclusive provider

  4         organizations to provide direct patient access

  5         to a dermatologist under contract with the

  6         organization and to develop criteria for

  7         compliance; providing a definition; amending s.

  8         641.31, F.S.; requiring health maintenance

  9         organizations to provide direct patient access

10         to a dermatologist under contract with the

11         organization and to develop criteria for

12         compliance; providing a definition; providing

13         an effective date.

14

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

16

17         Section 1.  Subsection (16) is added to section

18  627.6472, Florida Statutes, 1996 Supplement, to read:

19         627.6472  Exclusive provider organizations.--

20         (16)  Notwithstanding any provision of this section to

21  the contrary, an exclusive provider organization which offers

22  dermatological services shall provide direct patient access,

23  for office visits and minor procedures and testing, to a

24  dermatologist who is under contract with the exclusive

25  provider organization. The term "direct patient access" means

26  the ability of an insured to obtain such services without a

27  referral or other authorization before receiving services. The

28  exclusive provider organization shall, by July 1, 1997,

29  develop criteria for compliance with the provisions of this

30  subsection which do not impede or inhibit access to

31  dermatological services for policyholders of the exclusive

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






    Florida House of Representatives - 1997              CS/HB 365

    601-116-97






  1  provider organization. The criteria may include a limit of

  2  five office visits to a dermatologist, without prior

  3  authorization, for a dermatologic problem within a 12-month

  4  period.

  5         Section 2.  Subsection (29) is added to section 641.31,

  6  Florida Statutes, 1996 Supplement, to read:

  7         641.31  Health maintenance contracts.--

  8         (29)  Notwithstanding any provision of this section to

  9  the contrary, a health maintenance organization which offers

10  dermatological services shall provide direct patient access,

11  for office visits and minor procedures and testing, to a

12  dermatologist who is under contract with the health

13  maintenance organization. The term "direct patient access"

14  means the ability of a subscriber to obtain such services

15  without a referral or other authorization before receiving

16  services. The health maintenance organization shall, by July

17  1, 1997, develop criteria for compliance with the provisions

18  of this subsection which do not impede or inhibit access to

19  dermatological services for policyholders of the health

20  maintenance organization. The criteria may include a limit of

21  five office visits to a dermatologist, without prior

22  authorization, for a dermatologic problem within a 12-month

23  period.

24         Section 3.  This act shall take effect upon becoming a

25  law.

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