SENATE AMENDMENT

    Bill No. CS for SB 1028

    Amendment No.    

                            CHAMBER ACTION
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11  Senators Campbell and Cowin moved the following amendment to

12  amendment (540324):

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14         Senate Amendment (with title amendment) 

15         On page 63, between lines 21 and 22,

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17  insert:

18         Section 41.  Subsections (4) through (10) of section

19  641.51, Florida Statutes, are redesignated as subsections (5)

20  through (11), respectively, and a new subsection (4) is added

21  to said section to read:

22         641.51  Quality assurance program; second medical

23  opinion requirement.--

24         (4)  The organization shall ensure that only a

25  physician licensed under chapter 458 or chapter 459 or an

26  allopathic or osteopathic physician with an active,

27  unencumbered license in another state with similar licensing

28  requirements may render an adverse determination regarding a

29  service provided by a physician licensed in this state. The

30  organization shall submit to the treating provider and the

31  subscriber written notification regarding the organization's

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 1028

    Amendment No.    





 1  adverse determination within 2 working days after the

 2  subscriber or provider is notified of the adverse

 3  determination. The written notification must include the

 4  utilization review criteria or benefits provisions used in the

 5  adverse determination, identify the physician who rendered the

 6  adverse determination, and be signed by an authorized

 7  representative of the organization or the physician who

 8  rendered the adverse determination. The organization must

 9  include with the notification of an adverse determination

10  information concerning the appeal process for adverse

11  determinations.

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13  (Redesignate subsequent sections.)

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16  ================ T I T L E   A M E N D M E N T ===============

17  And the title is amended as follows:

18         On page 68, line 8, after the semicolon

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20  insert:

21         amending s. 641.51, F.S., relating to quality

22         assurance program requirements for certain

23         managed care organizations; allowing the

24         rendering of adverse determinations by

25         physicians licensed in Florida or states with

26         similar requirements; requiring the submission

27         of facts and documentation pertaining to

28         rendered adverse determinations; providing

29         timeframe for organizations to submit facts and

30         documentation to providers and subscribers in

31         writing; requiring an authorized representative

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 1028

    Amendment No.    





 1         to sign the notification;

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