House Bill 0149c1

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







    Florida House of Representatives - 2000              CS/HB 149

        By the Committee on Health Care Services and
    Representatives Villalobos, Casey, Jacobs, A. Greene,
    Betancourt, Cantens, Morroni, Wallace, Ritchie, Kyle, Farkas,
    Bense, Melvin, Levine, Barreiro, Wilson, Garcia, Bush, Sobel,
    Chestnut, Cosgrove, Gottlieb, Fasano, Crow and Murman


  1                      A bill to be entitled

  2         An act relating to health maintenance

  3         organizations; amending ss. 641.31, 641.315,

  4         and 641.3155, F.S.; prohibiting a health

  5         maintenance organization from restricting a

  6         provider's ability to provide inpatient

  7         hospital services to a subscriber; requiring

  8         payment for medically necessary inpatient

  9         hospital services; providing for the

10         applicability of the provisions of the act;

11         providing an effective date.

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

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

16  Florida Statutes, to read:

17         641.31  Health maintenance contracts.--

18         (39)  A health maintenance organization contract may

19  not prohibit or restrict a contracted primary care or

20  admitting physician from providing inpatient services in a

21  contracted hospital to a subscriber if such services are

22  determined by the organization to be medically necessary and

23  covered services under the organization's contract with the

24  contract holder.

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

26  641.315, Florida Statutes, to read:

27         641.315  Provider contracts.--

28         (11)  A contract between a health maintenance

29  organization and a contracted primary care or admitting

30  physician may not contain any provision that prohibits such

31  physician from providing inpatient services in a contracted

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






    Florida House of Representatives - 2000              CS/HB 149

    169-442-00






  1  hospital to a subscriber if such services are determined by

  2  the organization to be medically necessary and covered

  3  services under the organization's contract with the contract

  4  holder.

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

  6  641.3155, Florida Statutes, to read:

  7         641.3155  Provider contracts; payment of claims.--

  8         (5)  A health maintenance organization shall pay a

  9  contracted primary care or admitting physician, pursuant to

10  such physician's contract, for providing inpatient services in

11  a contracted hospital to a subscriber, if such services are

12  determined by the organization to be medically necessary and

13  covered services under the organization's contract with the

14  contract holder.

15         Section 4.  Nothing in this act shall require a

16  hospital to accept an admission from a physician to whom the

17  hospital has not extended admitting privileges.

18         Section 5.  This act shall take effect July 1, 2000.

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