House Bill 0953

    Florida House of Representatives - 1999                 HB 953

        By Representatives Sanderson, Murman, Peaden, Casey,
    Farkas and Hafner





  1                      A bill to be entitled

  2         An act relating to access to obstetrical and

  3         gynecological service; amending ss. 627.6472

  4         and 641.31, F.S.; requiring exclusive provider

  5         organizations and health maintenance

  6         organizations to provide direct patient access

  7         to certain obstetrical or gynecological

  8         services; prohibiting extraordinary additional

  9         copayments or deductibles; providing an

10         effective date.

11

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

13

14         Section 1.  Subsection (18) is added to section

15  627.6472, Florida Statutes, 1998 Supplement, to read:

16         627.6472  Exclusive provider organizations.--

17         (18)(a)  An exclusive provider organization shall

18  provide direct patient access to services provided by a

19  board-certified or board-eligible obstetrician or gynecologist

20  who is under contract with the health maintenance organization

21  if the exclusive provider organization covers obstetrical or

22  gynecological services. The term "direct patient access" means

23  the ability of a subscriber to obtain services without a

24  referral or other authorization before receiving services.

25         (b)  An exclusive provider organization shall not

26  impose any additional coinsurance or deductible upon a

27  subscriber who obtains services under the provisions of this

28  subsection unless the additional copayment or deductible is

29  imposed on all other primary care physician services.

30         Section 2.  Subsection (36) is added to section 641.31,

31  Florida Statutes, 1998 Supplement, to read:

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






    Florida House of Representatives - 1999                 HB 953

    228-203-99






  1         641.31  Health maintenance contracts.--

  2         (36)(a)  A health maintenance organization shall

  3  provide direct patient access to services provided by a

  4  board-certified or board-eligible obstetrician or gynecologist

  5  who is under contract with the health maintenance

  6  organization. The term "direct patient access" means the

  7  ability of a subscriber to obtain services without a referral

  8  or other authorization before receiving services.

  9         (b)  A health maintenance organization shall not impose

10  any additional copayment upon a subscriber who obtains

11  services under the provisions of this subsection unless the

12  additional copayment is imposed on all other primary care

13  physician services.

14         Section 3.  This act shall apply to contracts entered

15  into or renewed on or after October 1, 1999.

16         Section 4.  This act shall take effect October 1, 1999.

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18            *****************************************

19                          HOUSE SUMMARY

20
      Requires exclusive provider organizations and health
21    maintenance organizations to provide direct patient
      access to services provided by licensed obstetricians or
22    gynecologists under contract with the organizations.
      Prohibits extraordinary additional copayments or
23    deductbiles for such access.

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