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



                                                  SENATE AMENDMENT

    Bill No. CS for SB 420

    Amendment No. ___

                            CHAMBER ACTION
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11  Senator King moved the following amendment:

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13         Senate Amendment (with title amendment) 

14         On page 3, between lines 5 and 6,

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16  insert:

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

18  Florida Statutes, to read:

19         641.31  Health maintenance contracts.--

20         (39)  A health maintenance organization contract may

21  not prohibit or restrict a subscriber from receiving inpatient

22  services in a contracted hospital from a contracted primary

23  care or admitting physician if such services are determined by

24  the organization to be medically necessary and covered

25  services under the organization's contract with the contract

26  holder.

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

28  641.315, Florida Statutes, to read:

29         641.315  Provider contracts.--

30         (11)  A contract between a health maintenance

31  organization and a contracted primary care or admitting

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 420

    Amendment No. ___





  1  physician may not contain any provision that prohibits such

  2  physician from providing inpatient services in a contracted

  3  hospital to a subscriber if such services are determined by

  4  the organization to be medically necessary and covered

  5  services under the organization's contract with the contract

  6  holder.

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

  8  641.3155, Florida Statutes, to read:

  9         641.3155  Provider contracts; payment of claims.--

10         (5)  A health maintenance organization shall pay a

11  contracted primary care or admitting physician, pursuant to

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

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

14  determined by the organization to be medically necessary and

15  covered services under the organization's contract with the

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

17  not be reimbursed twice for the same service.

18         Section 4.  Sections 1 through 3 shall take effect July

19  1, 2000, and shall apply to provider contracts entered into or

20  renewed on or after that date.

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22  (Redesignate subsequent sections.)

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

26  And the title is amended as follows:

27         On page 1, line 2, delete that line

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29  and insert:

30         An act relating to health care; amending ss.

31         641.31, 641.315, and 641.3155, F.S.;

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 420

    Amendment No. ___





  1         prohibiting a health maintenance organization

  2         from restricting a provider's ability to

  3         provide inpatient hospital services to a

  4         subscriber; requiring payment for medically

  5         necessary inpatient hospital services;

  6         providing a limitation;

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