HB 0455 2003
1	A bill to be entitled
2	An act relating to the provision of health care services;
3	specifying conditions under which a health care provider
4	must be permitted to participate as a service provider
5	under a health plan offered by a managed care
6	organization; defining the term "managed care
7	organization"; providing for civil penalties; amending s.
8	627.419, F.S.; providing for construction of policies;
9	providing for application; providing an effective date.
10
11	Be It Enacted by the Legislature of the State of Florida:
12
13	Section 1. Health care provider as an authorized service
14	provider; penalties.--
15	(1) A managed care organization must allow any health care
16	provider to participate as a service provider under a health
17	plan offered by the managed care organization if the health care
18	provider agrees to:
19	(a) Accept the reimbursement rates negotiated by the
20	managed care organization with other health care providers that
21	provide the same service under the health plan; and
22	(b) Comply with all guidelines relating to quality of care
23	and utilization criteria which must be met by other employee or
24	nonemployee providers.
25	(2) As used in this section, the term "managed care
26	organization" means a health maintenance organization or prepaid
27	health clinic certified under chapter 641, Florida Statutes, a
28	health insurer that issues an exclusive provider organization
29	policy under section 627.6472 or section 627.662(9), Florida
30	Statutes, or a health insurer that issues a preferred provider
31	organization policy under section 627.6472 or section
32	627.662(8), Florida Statutes.
33	(3) A managed care organization that violates subsection
34	(1) is subject to a civil fine in the amount of:
35	(a) Up to $25,000 for each violation; or
36	(b) If the Director of Health Care Administration
37	determines that the entity has engaged in a pattern of
38	violations of subsection (1), up to $100,000 for each violation.
39	Section 2. Subsection (10) is added to section 627.419,
40	Florida Statutes, to read:
41	627.419 Construction of policies.--
42	(10)(a) Any health insurance policy, health care services
43	plan, or other contract that provides for payment for medical
44	expense benefits or procedures must allow any health care
45	provider to participate as a service provider under a health
46	plan offered by the health insurance policy, health care
47	services plan, or other contract that provides for payment for
48	medical expense benefits or procedures if the health care
49	provider agrees to:
50	1. Accept the reimbursement rates negotiated by the health
51	insurance policy, health care services plan, or other contract
52	that provides for payment for medical expense benefits or
53	procedures with other health care providers that provide the
54	same service under the health plan; and
55	2. Comply with all guidelines relating to quality of care
56	and utilization criteria which must be met by other providers
57	with whom the health insurance policy, health care services
58	plan, or other contract that provides for payment for medical
59	expense benefits or procedures has contractual arrangements for
60	those services.
61	(b) The provider of any health insurance policy, health
62	care services plan, or other contract that violates paragraph
63	(a) is subject to a civil fine in the amount of:
64	1. Up to $25,000 for each violation; or
65	2. If the Insurance Commissioner determines that the
66	provider has engaged in a pattern of violations of paragraph
67	(a), up to $100,000 for each violation.
68	Section 3. Sections 1 and 2 of this act do not apply to
69	any health insurance policy that is in force before the
70	effective date of this act but do apply to such policies at the
71	next renewal period immediately following October 1, 2003.
72	Section 4. This act shall take effect October 1, 2003.