HOUSE AMENDMENT

                                                   Bill No. HB 913

    Amendment No. 2 (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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 5                                           ORIGINAL STAMP BELOW

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10                                                                

11  The Committee on Health Care Licensing & Regulation offered

12  the following:

13

14         Amendment (with title amendment) 

15  Remove from the bill:  Everything after the enacting clause

16

17  and insert in lieu thereof:

18         Section 1. Present subsections (4), (5), (6), (7), (8),

19  (9), and (10) of section 641.51, Florida Statutes are

20  redesignated as subsections (5), (6), (7), (8), (9), (10), and

21  (11), respectively, and a new subsection (4) is added to that

22  section to read:

23         641.51 Quality assurance program; second medical

24  opinion requirement.--

25         (4)The organization shall ensure that only a physician

26  licensed under chapter 458 or chapter 459, or a physician

27  licensed in another state with similar licensing requirements,

28  may render an adverse determination regarding a service

29  provided by a physician licensed in this state. The

30  organization shall submit to the treating provider and the

31  subscriber written notification regarding the organization's

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    File original & 9 copies    03/09/00
    hcs0005                     04:24 pm         00913-hcl -943087




                                                   HOUSE AMENDMENT

                                                   Bill No. HB 913

    Amendment No. 2 (for drafter's use only)





 1  adverse determination within 2 working days after the

 2  subscriber or provider is notified of the adverse

 3  determination. The written notification must include the

 4  utilization review criteria or benefits provisions used in the

 5  adverse determination, and be signed by an authorized

 6  representative of the organization. The organization must

 7  include with the notification of an adverse determination

 8  information concerning the appeal process for adverse

 9  determinations.

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11

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

13  And the title is amended as follows:

14  remove from the title of the bill:  Everything before the

15  enacting clause

16

17  and insert in lieu thereof:

18                      A bill to be entitled

19         An act relating to adverse determinations;

20         amending s. 641.51, F.S.; relating to quality

21         assurance program requirements for certain

22         managed care organizations; allowing the

23         rendering of adverse determinations by

24         physicians licensed in any state; requiring the

25         submission of facts and documentation

26         pertaining to rendered adverse determinations;

27         providing timeframe for organizations to submit

28         facts and documentation to providers and

29         subscribers in writing; requiring authorized

30         representative to sign the notification;

31         providing an effective date.

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    File original & 9 copies    03/09/00
    hcs0005                     04:24 pm         00913-hcl -943087