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