House Bill 0149

    Florida House of Representatives - 2000                 HB 149

        By Representative Villalobos






  1                      A bill to be entitled

  2         An act relating to health maintenance

  3         organizations; amending s. 641.31, F.S.;

  4         providing that an organization's subscriber

  5         contract shall not contain any provision

  6         prohibiting or restricting a contracted

  7         physician's ability to provide inpatient

  8         hospital services to the subscriber; amending

  9         s. 641.315, F.S.; providing that an

10         organization's provider contract shall not

11         contain any provision prohibiting or

12         restricting the provider's ability to provide

13         inpatient hospital services to the provider's

14         patients; amending s. 641.3155, F.S.; providing

15         that an organization shall not deny payment to

16         a contract provider for medically necessary

17         inpatient hospital services provided to the

18         provider's patients which are covered under the

19         organization's provider contract; providing an

20         effective date.

21

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

23

24         Section 1.  Subsection (39) is added to section 641.31,

25  Florida Statutes, to read:

26         641.31  Health maintenance contracts.--

27         (39)  No health maintenance contract may contain any

28  provision prohibiting or restricting a contracted physician's

29  ability to provide inpatient hospital services to the

30  subscriber.

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






    Florida House of Representatives - 2000                 HB 149

    509-173-00






  1         Section 2.  Subsection (11) is added to section

  2  641.315, Florida Statutes, to read:

  3         641.315  Provider contracts.--

  4         (11)  A contract between a health maintenance

  5  organization and a provider of health care services shall not

  6  contain any provision prohibiting or restricting the

  7  provider's ability to provide inpatient hospital services to

  8  the provider's patients.

  9         Section 3.  Subsection (5) is added to section

10  641.3155, Florida Statutes, to read:

11         641.3155  Provider contracts; payment of claims.--

12         (5)  A health maintenance organization shall not deny

13  payment to a contract provider for inpatient hospital services

14  provided by the contracted provider, if medically necessary,

15  to the provider's patients, as long as such services are

16  covered services under the organization's contract with the

17  contract holder.

18         Section 4.  This act shall take effect July 1, 2000,

19  and shall apply to all contracts renewed or entered into on or

20  after that date.

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22            *****************************************

23                          HOUSE SUMMARY

24
      Prohibits HMO subscriber or provider contracts from
25    containing any provision prohibiting or restricting a
      contracted physician's or provider's ability to provide
26    inpatient hospital services to the subscriber or to the
      provider's patients. Prohibits denial of payment by an
27    HMO to a contract provider for medically necessary
      inpatient hospital services provided to the provider's
28    patients which are covered under the HMO's provider
      contract.
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