Senate Bill 0866c1

    Florida Senate - 2000                            CS for SB 866

    By the Committee on Banking and Insurance; and Senators King,
    Mitchell, Myers, Sullivan, Clary, Silver, Diaz-Balart,
    Campbell, Casas and Kirkpatrick



    311-1710-00

  1                      A bill to be entitled

  2         An act relating to health maintenance

  3         organizations; amending ss. 641.31, 641.315,

  4         641.3155, F.S.; prohibiting a health

  5         maintenance organization from restricting a

  6         provider's ability to provide in-patient

  7         hospital services to a subscriber; requiring

  8         payment for medically necessary in-patient

  9         hospital services; providing an effective date.

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11  Be It Enacted by the Legislature of the State of Florida:

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

14  Florida Statutes, to read:

15         641.31  Health maintenance contracts.--

16         (39)  A health maintenance organization contract may

17  not prohibit or restrict a subscriber from receiving

18  in-patient services in a contracted hospital from a contracted

19  primary care or admitting physician if such services are

20  determined by the organization to be medically necessary and

21  covered services under the organization's contract with the

22  contract holder.

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

24  641.315, Florida Statutes, to read:

25         641.315  Provider contracts.--

26         (11)  A contract between a health maintenance

27  organization and a contracted primary-care or admitting

28  physician may not contain any provision that prohibits such

29  physician from providing in-patient services in a contracted

30  hospital to a subscriber if such services are determined by

31  the organization to be medically necessary and covered

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






    Florida Senate - 2000                            CS for SB 866
    311-1710-00




  1  services under the organization's contract with the contract

  2  holder.

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

  4  641.3155, Florida Statutes, to read:

  5         641.3155  Provider contracts; payment of claims.--

  6         (5)  A health maintenance organization shall pay a

  7  contracted primary-care or admitting physician, pursuant to

  8  such physician's contract, for providing in-patient services

  9  in a contracted hospital to a subscriber, if such services are

10  determined by the organization to be medically necessary and

11  covered services under the organization's contract with the

12  contract holder.

13         Section 4.  This act shall take effect July 1, 2000,

14  and shall apply to provider contracts entered into or renewed

15  on or after that date.

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17          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
18                         Senate Bill 866

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    1.    Clarifies that health maintenance organization (HMO)
21        contracts may not prohibit or restrict a subscriber from
          receiving in-patient services in a contracted hospital
22        from a contracted primary care or admitting physician if
          such services are determined by the HMO to be medically
23        necessary and covered services under the organization's
          contract with the contract holder.
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    2.    Specifies that the act shall take effect July 1, 2000,
25        and shall apply to provider contracts entered into or
          renewed on or after that date.
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