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.  Subsections (4) through (10) of section

18  641.51, Florida Statutes, are redesignated as subsections (5)

19  through (11), respectively, and a new subsection (4) is added

20  to said section to read:

21         641.51  Quality assurance program; second medical

22  opinion requirement.--

23         (4)  The organization shall ensure that only a

24  physician licensed under chapter 458 or chapter 459 or an

25  allopathic or osteopathic physician with an active,

26  unencumbered license in another state with similar licensing

27  requirements may render an adverse determination regarding a

28  service provided by a physician licensed in this state. The

29  organization shall submit to the treating provider and the

30  subscriber written notification regarding the organization's

31  adverse determination within 2 working days after the

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    File original & 9 copies    04/26/00
    hbd0011                     08:34 am         00913-0022-740143




                                                   HOUSE AMENDMENT

                                                   Bill No. HB 913

    Amendment No.     (for drafter's use only)





 1  subscriber or provider is notified of the adverse

 2  determination. The written notification must include the

 3  utilization review criteria or benefits provisions used in the

 4  adverse determination, identify the physician who rendered the

 5  adverse determination, and be signed by an authorized

 6  representative of the organization or the physician who

 7  rendered the adverse determination. The organization must

 8  include with the notification of an adverse determination

 9  information concerning the appeal process for adverse

10  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:  everything before the

17  enacting clause

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19  and insert in lieu thereof:

20                      A bill to be entitled

21         An act relating to adverse determinations;

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

23         assurance program requirements for certain

24         managed care organizations; allowing the

25         rendering of adverse determinations by

26         physicians licensed in Florida or states with

27         similar requirements; requiring the submission

28         of facts and documentation pertaining to

29         rendered adverse determinations; providing

30         timeframe for organizations to submit facts and

31         documentation to providers and subscribers in

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    File original & 9 copies    04/26/00
    hbd0011                     08:34 am         00913-0022-740143




                                                   HOUSE AMENDMENT

                                                   Bill No. HB 913

    Amendment No.     (for drafter's use only)





 1         writing; requiring an authorized representative

 2         to sign the notification; providing an

 3         effective date.

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    File original & 9 copies    04/26/00
    hbd0011                     08:34 am         00913-0022-740143