CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
Bill No. HB 2427
Amendment No. (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 Representative(s) Frankel offered the following:
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13 Amendment (with title amendment)
14 On page 17, between lines 25 and 26 of the bill
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16 insert:
17 Section 8. Present subsections (4), (5), (6), (7),
18 (8), (9), and (10) of section 641.51, Florida Statutes, are
19 redesignated as subsections (5), (6), (7), (8), (9), (10), and
20 (11), respectively, and a new subsection (4) is added to that
21 section to read:
22 641.51 Quality assurance program; second medical
23 opinion requirement.--
24 (4) A health maintenance organization must ensure that
25 only a physician licensed under chapter 458 or chapter 459,
26 Florida Statutes, may make the final decision on an adverse
27 determination regarding a service provided by a physician
28 licensed under chapter 458 or chapter 459, Florida Statutes.
29 The physician making the final decision shall be required to
30 submit, in writing, to the provider and the subscriber, the
31 facts and documentation regarding the health maintenance
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File original & 9 copies 05/01/00
hmo0006 11:49 am 02427-0085-490689
HOUSE AMENDMENT
Bill No. HB 2427
Amendment No. (for drafter's use only)
1 organization's adverse determination within 2 working days
2 after the subscriber or provider is made aware of the adverse
3 determination. Such physician shall also be required to sign
4 the adverse determination. The health maintenance
5 organization must include, with the notification of an adverse
6 determination, information explaining the appeals process for
7 adverse determinations.
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10 ================ T I T L E A M E N D M E N T ===============
11 And the title is amended as follows:
12 On page 3, line 11,
13 remove from the title of the bill: all of said line
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15 and insert in lieu thereof:
16 authorization; amending s. 641.51, F.S.,
17 relating to quality assurance program
18 requirements for certain managed care
19 organizations; restricting the rendering of
20 adverse determinations to certain physicians
21 regarding certain services; requiring the
22 submission of facts and documentation
23 pertaining to rendered adverse determinations;
24 providing a timeframe for organizations to
25 submit facts and documentation providers and
26 subscribers, in writing, of adverse
27 determinations; requiring physicians who render
28 adverse determinations to sign the facts and
29 documentation statement; requiring the
30 organization to include information regarding
31 the appeal processing
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File original & 9 copies 05/01/00
hmo0006 11:49 am 02427-0085-490689