House Bill 0953e1

                                           HB 953, First Engrossed



  1                      A bill to be entitled

  2         An act relating to access to obstetrical and

  3         gynecological service; amending ss. 627.6472

  4         and 641.51, 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; providing an effective date.

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

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

13  627.6472, Florida Statutes, 1998 Supplement, to read:

14         627.6472  Exclusive provider organizations.--

15         (18)  The organization shall not require prior

16  authorization for female subscribers for

17  obstetrical-gynecological care, as defined below, with

18  obstetrician-gynecologists contracting with the organization.

19  As used in this subsection, "obstetrical-gynecological care"

20  means up to two annual visits, including one well-woman visit

21  and one additional visit to address acute gynecological

22  problems, as well as all medically necessary followup care to

23  treat the specific obstetrical-gynecological condition

24  detected by the obstetrician-gynecologist during these visits.

25  Nothing in this subsection shall prevent a plan from requiring

26  that an obstetrician-gynecologist treating a covered patient

27  coordinate the medical care through the patient's primary care

28  physician, if applicable.

29         Section 2.  Subsection (6) of section 641.51, Florida

30  Statutes, is amended to read:

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






                                           HB 953, First Engrossed



  1         641.51  Quality assurance program; second medical

  2  opinion requirement.--

  3         (6)  Each organization shall develop and maintain

  4  written policies and procedures for the provision of standing

  5  referrals to subscribers with chronic and disabling conditions

  6  which require ongoing specialty care. The organization shall

  7  not require prior authorization for female subscribers for

  8  obstetrical-gynecological care, as defined below, with

  9  obstetrician-gynecologists contracting with the organization.

10  As used in this subsection, "obstetrical-gynecological care"

11  means up to two annual visits, including one well-woman visit

12  and one additional visit to address acute gynecological

13  problems, as well as all medically necessary followup care to

14  treat the specific obstetrical-gynecological condition

15  detected by the obstetrician-gynecologist during these visits.

16  Nothing in this subsection shall prevent a plan from requiring

17  that an obstetrician-gynecologist treating a covered patient

18  coordinate the medical care through the patient's primary care

19  physician, if applicable.

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