CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for SB 866
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator King moved the following amendment:
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13 Senate Amendment (with title amendment)
14 Delete everything after the enacting clause
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16 and 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 866
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. This act shall take effect July 1, 2000,
19 and shall apply to provider contracts entered into or renewed
20 on or after that date.
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24 And the title is amended as follows:
25 Delete everything before the enacting clause
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27 and insert:
28 A bill to be entitled
29 An act relating to health maintenance
30 organizations; amending ss. 641.31, 641.315,
31 and 641.3155, F.S.; prohibiting a health
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SENATE AMENDMENT
Bill No. CS for SB 866
Amendment No.
1 maintenance organization from restricting a
2 provider's ability to provide inpatient
3 hospital services to a subscriber; requiring
4 payment for medically necessary inpatient
5 hospital services; providing a limitation;
6 providing an effective date.
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