SENATE AMENDMENT

    Bill No. CS for CS for SB 362, 1st Eng.

    Amendment No. ___   Barcode 732110

                            CHAMBER ACTION
              Senate                               House
                                   .
                                   .
  1                                .
                                   .
  2                                .
                                   .
  3                                .
                                   .
  4  ______________________________________________________________

  5

  6

  7

  8

  9

10  ______________________________________________________________

11  Senator Campbell moved the following amendment:

12

13         Senate Amendment (with title amendment) 

14         On page 30, line 12, delete that line

15

16  and insert:

17         (14)  A permissive error ratio of 5 percent is

18  established for organizations claims payment violations of s.

19  641.3155(3)(a), (b), (c), and (e) and s. (4)(a), (b), (c), and

20  (e). If the error ratio of a particular organization does not

21  exceed the permissible error ratio of 5 percent for an audit

22  period, a fine may not be assessed for the noted claims

23  violations for the audit period. The error ratio shall be

24  determined by dividing the number of claims with violations

25  found on a statistically valid sample of claims for the audit

26  period divided by the total number of claims in the sample. If

27  the error ratio exceeds the permissible error ratio of 5

28  percent, a fine may be assessed according to s. 624.4211 for

29  the claims payment violations that exceed the error ratio.

30  Notwithstanding the provisions of this section, the department

31  may fine a health maintenance organization for claims payment

                                  1
    12:03 PM   03/05/02                             s0362c2c-33c2r




                                                  SENATE AMENDMENT

    Bill No. CS for CS for SB 362, 1st Eng.

    Amendment No. ___   Barcode 732110





  1  violations of s. 641.3155(3)(e) and (4)(e) which create an

  2  uncontestable obligation to pay the claim. The department may

  3  not fine organizations for violations that the department

  4  determines were due to circumstances beyond the organization's

  5  control.

  6         (15)  The provisions of this section may not be waived,

  7

  8

  9  ================ T I T L E   A M E N D M E N T ===============

10  And the title is amended as follows:

11         On page 2, line 29, after the semicolon,

12

13  insert:

14         establishing a permissive error ratio and

15         providing guidelines for applying the ratio;

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

                                  2
    12:03 PM   03/05/02                             s0362c2c-33c2r