Senate Bill sb1568

    Florida Senate - 2001                                  SB 1568

    By Senator Sebesta





    20-598-01

  1                      A bill to be entitled

  2         An act relating to health care service

  3         programs; amending s. 641.51, F.S.; requiring

  4         that only certain physicians licensed in this

  5         state may render adverse determinations for

  6         health maintenance organizations and prepaid

  7         health clinics; providing an effective date.

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

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

12  Statutes, is amended to read:

13         641.51  Quality assurance program; second medical

14  opinion requirement.--

15         (4)  The organization shall ensure that only a

16  physician holding an active, unencumbered license issued

17  licensed under chapter 458 or chapter 459, or an allopathic or

18  osteopathic physician with an active, unencumbered license in

19  another state with similar licensing requirements may render

20  an adverse determination regarding a service provided by a

21  physician licensed in this state. The organization shall

22  submit to the treating provider and the subscriber written

23  notification regarding the organization's adverse

24  determination within 2 working days after the subscriber or

25  provider is notified of the adverse determination. The written

26  notification must include the utilization review criteria or

27  benefits provisions used in the adverse determination,

28  identify the physician who rendered the adverse determination,

29  and be signed by an authorized representative of the

30  organization or the physician who rendered the adverse

31  determination. The organization must include with the

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    Florida Senate - 2001                                  SB 1568
    20-598-01




  1  notification of an adverse determination information

  2  concerning the appeal process for adverse determinations.

  3         Section 2.  This act shall take effect July 1, 2001.

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  6                          SENATE SUMMARY

  7    Requires that adverse determinations for health
      maintenance organizations and prepaid health clinics be
  8    rendered only by certain physicians licensed in this
      state.
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CODING: Words stricken are deletions; words underlined are additions.