House Bill hb1011

    Florida House of Representatives - 2001                HB 1011

        By Representative Cusack






  1                      A bill to be entitled

  2         An act relating to adverse determinations under

  3         a quality assurance program; amending s.

  4         641.51, F.S.; revising physicians authorized to

  5         render adverse determinations; providing an

  6         effective date.

  7

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

  9

10         Section 1.  Subsection (4) of section 641.51, Florida

11  Statutes, is amended to read:

12         641.51  Quality assurance program; second medical

13  opinion requirement.--

14         (4)  A physician who renders an adverse determination

15  shall be licensed under chapter 458 or chapter 459, shall be

16  in active practice in this state, and shall be certified in

17  the specialty under which the physician is rendering the

18  adverse determination. The organization shall ensure that only

19  such a physician renders licensed under chapter 458 or chapter

20  459, or an allopathic or osteopathic physician with an active,

21  unencumbered license in another state with similar licensing

22  requirements may render an adverse determination regarding a

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

24  organization shall submit to the treating provider and the

25  subscriber written notification regarding the organization's

26  adverse determination within 2 working days after the

27  subscriber or provider is notified of the adverse

28  determination. The written notification must include the

29  utilization review criteria or benefits provisions used in the

30  adverse determination, identify the physician who rendered the

31  adverse determination, and be signed by an authorized

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






    Florida House of Representatives - 2001                HB 1011

    799-105-01






  1  representative of the organization or the physician who

  2  rendered the adverse determination. The organization must

  3  include with the notification of an adverse determination

  4  information concerning the appeal process for adverse

  5  determinations.

  6         Section 2.  This act shall take effect upon becoming a

  7  law.

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10                          HOUSE SUMMARY

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      Requires a physician rendering an adverse determination
12    to be licensed in this state, in active practice in this
      state, and certified in the specialty under which the
13    physician renders the adverse determination. Deletes
      authorization for allopathic or osteopathic physicians
14    with an active, unencumbered license in another state
      with similar licensing requirements to make adverse
15    determinations.

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