HOUSE AMENDMENT

    hbd-05                              Bill No. HB 1625, 1st Eng.

    Amendment No.     (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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 5                                           ORIGINAL STAMP BELOW

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10                                                                

11  Representative(s) Casey offered the following:

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13         Amendment (with title amendment) 

14         On page 68, after line 31 of the bill

15

16  insert:

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

18  641.51, Florida Statutes, are redesignated as subsections (5)

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

20  to said section to read:

21         641.51  Quality assurance program; second medical

22  opinion requirement.--

23         (4)  The organization shall ensure that only a

24  physician licensed under chapter 458 or chapter 459 or an

25  allopathic or osteopathic physician with an active,

26  unencumbered license in another state with similar licensing

27  requirements may render an adverse determination regarding a

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

29  organization shall submit to the treating provider and the

30  subscriber written notification regarding the organization's

31  adverse determination within 2 working days after the

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    File original & 9 copies    05/02/00
    hbd0007                     10:33 am         01625-0022-333617




                                                   HOUSE AMENDMENT

    hbd-05                              Bill No. HB 1625, 1st Eng.

    Amendment No.     (for drafter's use only)





 1  subscriber or provider is notified of the adverse

 2  determination. The written notification must include the

 3  utilization review criteria or benefits provisions used in the

 4  adverse determination, identify the physician who rendered the

 5  adverse determination, and be signed by an authorized

 6  representative of the organization or the physician who

 7  rendered the adverse determination. The organization must

 8  include with the notification of an adverse determination

 9  information concerning the appeal process for adverse

10  determinations.

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

14  And the title is amended as follows:

15         On page 5, line 10 after the semicolon

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17  insert:

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

19         assurance program requirements for certain

20         managed care organizations; allowing the

21         rendering of adverse determinations by

22         physicians licensed in Florida or states with

23         similar requirements; requiring the submission

24         of facts and documentation pertaining to

25         rendered adverse determinations; providing

26         timeframe for organizations to submit facts and

27         documentation to providers and subscribers in

28         writing; requiring an authorized representative

29         to sign the notification;

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    File original & 9 copies    05/02/00
    hbd0007                     10:33 am         01625-0022-333617