House Bill hb0981

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    Florida House of Representatives - 2001                 HB 981

        By Representative Bucher






  1                      A bill to be entitled

  2         An act relating to the statewide and district

  3         managed care ombudsman committees; amending s.

  4         641.65, F.S.; revising district committee

  5         membership; revising provisions relating to

  6         district committee site visits and to referral

  7         of complaints to the district committees by the

  8         Agency for Health Care Administration; amending

  9         s. 641.70, F.S.; providing additional duties of

10         the district committees; revising facility and

11         administrative support services provided by the

12         agency to the statewide and district

13         committees; providing for annual appropriations

14         for operation of the district committees,

15         including members' travel expenses; providing

16         an effective date.

17

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

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20         Section 1.  Subsections (2) and (6) of section 641.65,

21  Florida Statutes, are amended, and subsection (7) is added to

22  said section, to read:

23         641.65  District managed care ombudsman committees.--

24         (2)  Each district committee shall have no fewer than 9

25  members and no more than 20 16 members, including, if

26  possible, at least:  one physician licensed under chapter 458,

27  one physician licensed under chapter 459, one physician

28  licensed under chapter 460, and one physician licensed under

29  chapter 461, one psychologist, one registered nurse, one

30  clinical social worker, one attorney, and at least one

31  recipients of managed care services one consumer. For the

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    Florida House of Representatives - 2001                 HB 981

    738-108-01






  1  members who are recipients of managed care services consumer

  2  member, preference shall be given to members of organized

  3  consumer or advocacy groups with national or statewide

  4  membership.  No member may be employed by or affiliated with a

  5  managed care program.

  6         (6)  Each district committee or member of the

  7  committee:

  8         (a)  Shall serve to protect the health, safety, and

  9  rights of all enrollees participating in managed care programs

10  in this state.

11         (b)  Shall receive complaints regarding quality of care

12  from the agency, and may assist the agency with the resolution

13  of complaints.

14         (c)  Shall May conduct site visits with the agency, as

15  the agency determines is appropriate.  A complaint shall may

16  be referred by the agency to the committee, as to whether an

17  enrollee's managed care program may have inappropriately

18  denied the enrollee a covered medical service, may be

19  inappropriately delaying the provision of a covered medical

20  service to the enrollee, or is providing substandard covered

21  medical services.  The committee shall establish and follow

22  uniform criteria in reviewing information and receiving

23  complaints.

24         (d)  Shall assist consumers in selecting health care

25  plans appropriate for their needs.

26         (e)  Shall train consumers to understand and use the

27  annual consumer guide on plan performance and the marketing

28  information prepared by plans.

29         (f)  Shall educate managed care plan enrollees about

30  their rights and responsibilities.

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    Florida House of Representatives - 2001                 HB 981

    738-108-01






  1         (g)  Shall identify, investigate, and resolve enrollee

  2  complaints about health care services in managed care plans.

  3         (h)  Shall assist enrollees with filing formal appeals

  4  of managed care plan determinations, including preservice

  5  denials and the termination of services.

  6         (i)(d)  Shall submit an annual report to the statewide

  7  committee concerning activities, recommendations, and

  8  complaints reviewed or developed by the district committee

  9  during the year.

10         (j)(e)  Shall conduct meetings as required at the call

11  of its chairperson, the call of the agency director, the call

12  of the statewide committee, or by written request of a

13  majority of the district committee members.

14         (7)  The agency is authorized to adopt rules pursuant

15  to the Administrative Procedure Act to implement the

16  provisions of this section.

17         Section 2.  Subsection (2) of section 641.70, Florida

18  Statutes, is amended to read:

19         641.70  Agency duties relating to the Statewide Managed

20  Care Ombudsman Committee and the district managed care

21  ombudsman committees.--

22         (2)  The agency for Health Care Administration shall

23  provide for location of the statewide and district committees

24  in the agency's district offices and shall provide necessary

25  training, equipment, and office supplies, including, at a

26  minimum, clerical and word-processing services, photocopiers,

27  telephone services, recordkeeping, and stationery and other

28  necessary supplies a meeting place for district committees in

29  agency offices and shall provide the necessary administrative

30  support to assist the statewide committee and district

31  committees, within available resources.

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    Florida House of Representatives - 2001                 HB 981

    738-108-01






  1         Section 3.  There shall be appropriated annually from

  2  the General Revenue Fund to the Agency for Health Care

  3  Administration the sum of $50,000 to be distributed on an

  4  equitable basis to each district managed care ombudsman

  5  committee, to fund the operation of the committee, including

  6  travel expenses for committee members in accordance with s.

  7  112.061, Florida Statutes.

  8         Section 4.  This act shall take effect July 1, 2001.

  9

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11                          HOUSE SUMMARY

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      Increases the maximum number of members on the district
13    managed care ombudsman committees. Provides for at least
      one member who is a recipient of managed care services.
14    Requires, rather than authorizes, the committees to
      conduct site visits with the Agency for Health Care
15    Administration. Requires the agency to refer certain
      complaints to the committees. Provides additional duties
16    of the committees relating to assisting and educating
      consumers and resolving complaints. Requires the agency
17    to provide for location of the district committees in its
      district offices, and specifies support services to be
18    provided. Provides for annual appropriations to fund
      district committee operations, including travel expenses
19    for members.

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