Senate Bill sb1568c1

    Florida Senate - 2001                           CS for SB 1568

    By the Committee on Banking and Insurance; and Senators
    Sebesta, Crist and Cowin




    311-1951-01

  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; clarifying the authority of the

  8         Board of Medicine and the Board of Osteopathic

  9         Medicine; providing an effective date.

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

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

14  Statutes, is amended to read:

15         641.51  Quality assurance program; second medical

16  opinion requirement.--

17         (4)  The organization shall ensure that only a

18  physician holding an active, unencumbered license issued

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

20  osteopathic physician with an active, unencumbered license in

21  another state with similar licensing requirements may render

22  an adverse determination regarding a service provided by a

23  physician licensed in this state. The organization shall

24  submit to the treating provider and the subscriber written

25  notification regarding the organization's adverse

26  determination within 2 working days after the subscriber or

27  provider is notified of the adverse determination. The written

28  notification must include the utilization review criteria or

29  benefits provisions used in the adverse determination,

30  identify the physician who rendered the adverse determination,

31  and be signed by an authorized representative of the

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






    Florida Senate - 2001                           CS for SB 1568
    311-1951-01




  1  organization or the physician who rendered the adverse

  2  determination. The organization must include with the

  3  notification of an adverse determination information

  4  concerning the appeal process for adverse determinations. This

  5  subsection does not create authority for the Board of Medicine

  6  or the Board of Osteopathic Medicine to regulate the

  7  organization; however, the Board of Medicine and the Board of

  8  Osteopathic Medicine each continue to have jurisdiction over

  9  its licensees.

10         Section 2.  This act shall take effect January 1, 2002.

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12          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
13                             SB 1568

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15  Clarifies that provisions in the bill do not create authority
    for either the Board of Medicine or the Board of Osteopathic
16  Medicine to regulate health maintenance organizations (HMOs)
    or prepaid health clinics, however, such boards may continue
17  to have jurisdiction over licensees of their respective
    boards.
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    Changes the effective date from July 1, 2001 to January 1,
19  2002.

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