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





                                                   HOUSE AMENDMENT

                                                   Bill No. HB 913

    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) Casey offered the following:

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13         Amendment (with title amendment) 

14  Remove from the bill:  Everything after the enacting clause

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16  and insert in lieu thereof:

17         Section 1.  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)  The organization shall ensure that only a

25  physician licensed under chapter 458 or chapter 459; or an

26  M.D. or D.O. physician with an active, unencumbered license in

27  another state with similar licensing requirements may render

28  an adverse determination regarding a service provided by a

29  physician licensed in this state. The organization shall

30  submit to the treating provider and the subscriber written

31  notification regarding the organization's adverse

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    File original & 9 copies    04/18/00
    hbd0001                     11:14 am         00913-0022-541491




                                                   HOUSE AMENDMENT

                                                   Bill No. HB 913

    Amendment No.     (for drafter's use only)





 1  determination within 2 working days after the subscriber or

 2  provider is notified of the adverse determination. The written

 3  notification must include the utilization review criteria or

 4  benefits provisions used in the adverse determination,

 5  identify the physician who rendered the adverse determination,

 6  and be signed by an authorized representative of the

 7  organization or the physician who renders the adverse

 8  determination. The organization must include with the

 9  notification of an adverse determination information

10  concerning the appeal process for adverse determinations.

11         Section 2.  This act shall take effect July 1, 2000.

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

15  And the title is amended as follows:

16  remove from the title of the bill:  the entire title

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18  and insert in lieu thereof:

19                  A bill to be entitled

20         An act relating to adverse determinations;

21         amending s. 641.51, F.S., relating to quality

22         assurance program requirements for certain

23         managed-care organizations; allowing the

24         rendering of adverse determinations by

25         physicians licensed in Florida or states with

26         similar requirements; requiring the submission

27         of facts and documentation pertaining to

28         rendered adverse determinations; providing

29         timeframe for organizations to submit facts and

30         documentation to providers and subscribers in

31         writing; requiring an authorized representative

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    File original & 9 copies    04/18/00
    hbd0001                     11:14 am         00913-0022-541491




                                                   HOUSE AMENDMENT

                                                   Bill No. HB 913

    Amendment No.     (for drafter's use only)





 1         to sign the notification; providing an

 2         effective date.

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    File original & 9 copies    04/18/00
    hbd0001                     11:14 am         00913-0022-541491