Senate Bill sb1568er

    ENROLLED

    2001 Legislature                                CS for SB 1568



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  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.




    ENROLLED

    2001 Legislature                                CS for SB 1568



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