House Bill 0149e1

                                        CS/HB 149, First Engrossed



  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 a limitation;

10         providing an effective date.

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

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

15  Florida Statutes, to read:

16         641.31  Health maintenance contracts.--

17         (39)  A health maintenance organization contract may

18  not prohibit or restrict a subscriber from receiving inpatient

19  services in a contracted hospital from a contracted primary

20  care or admitting physician if such services are determined by

21  the organization to be medically necessary and covered

22  services under the organization's contract with the contract

23  holder.

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

25  641.315, Florida Statutes, to read:

26         641.315  Provider contracts.--

27         (11)  A contract between a health maintenance

28  organization and a contracted primary care or admitting

29  physician may not contain any provision that prohibits such

30  physician from providing inpatient services in a contracted

31  hospital to a subscriber if such services are determined by


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






                                        CS/HB 149, First Engrossed



  1  the organization to be medically necessary and covered

  2  services under the organization's contract with the contract

  3  holder.

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

  5  641.3155, Florida Statutes, to read:

  6         641.3155  Provider contracts; payment of claims.--

  7         (5)  A health maintenance organization shall pay a

  8  contracted primary care or admitting physician, pursuant to

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

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

11  determined by the organization to be medically necessary and

12  covered services under the organization's contract with the

13  contract holder; provided, however, that the physician shall

14  not be reimbursed twice for the same service.

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

16  and shall apply to provider contracts entered into or renewed

17  on or after that date.

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