HB 0743 2003
1	CHAMBER ACTION
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6	The Committee on Insurance recommends the following:
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8	Committee Substitute
9	Remove the entire bill and insert:
10	A bill to be entitled
11	An act relating to health care practice parameters;
12	repealing s. 408.02, F.S., to delete the requirement that
13	the Agency for Health Care Administration develop,
14	endorse, and implement health care practice parameters;
15	amending s. 440.13, F.S.; specifying practice parameters
16	and protocols under the Workers' Compensation Law;
17	deleting duty of the Agency for Health Care Administration
18	with respect to the development of workers' compensation
19	practice parameters; amending ss. 440.134, 627.6418, and
20	627.6613, F.S., relating to workers' compensation managed
21	care plans and health insurance policy coverage for
22	mammograms; revising references and legislative intent, to
23	conform; providing an effective date.
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25	Be It Enacted by the Legislature of the State of Florida:
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27	Section 1. Section 408.02, Florida Statutes, is repealed.
28	Section 2. Subsection (15) of section 440.13, Florida
29	Statutes, is amended to read:
30	440.13 Medical services and supplies; penalty for
31	violations; limitations.--
32	(15) PRACTICE PARAMETERS AND PROTOCOLS.--The practice
33	parameters and protocols mandated under this chapter shall be
34	the Workers' Compensation Utilization Management Standards
35	adopted by the American Accreditation Health Care Commission in
36	effect on January 1, 2003.
37	(a) The Agency for Health Care Administration, in
38	conjunction with the department and appropriate health
39	professional associations and health-related organizations shall
40	develop and may adopt by rule scientifically sound practice
41	parameters for medical procedures relevant to workers'
42	compensation claimants. Practice parameters developed under this
43	section must focus on identifying effective remedial treatments
44	and promoting the appropriate utilization of health care
45	resources. Priority must be given to those procedures that
46	involve the greatest utilization of resources either because
47	they are the most costly or because they are the most frequently
48	performed. Practice parameters for treatment of the 10 top
49	procedures associated with workers' compensation injuries
50	including the remedial treatment of lower-back injuries must be
51	developed by December 31, 1994.
52	(b) The guidelines may be initially based on guidelines
53	prepared by nationally recognized health care institutions and
54	professional organizations but should be tailored to meet the
55	workers' compensation goal of returning employees to full
56	employment as quickly as medically possible, taking into
57	consideration outcomes data collected from managed care
58	providers and any other inpatient and outpatient facilities
59	serving workers' compensation claimants.
60	(c) Procedures must be instituted which provide for the
61	periodic review and revision of practice parameters based on the
62	latest outcomes data, research findings, technological
63	advancements, and clinical experiences, at least once every 3
64	years.
65	(d) Practice parameters developed under this section must
66	be used by carriers and the agency in evaluating the
67	appropriateness and overutilization of medical services provided
68	to injured employees.
69	Section 3. Subsection (11) of section 440.134, Florida
70	Statutes, is amended to read:
71	440.134 Workers' compensation managed care arrangement.--
72	(11) A description of the use of workers' compensation
73	practice parameters and protocols of treatmentfor health care
74	services when adopted by the agency.
75	Section 4. Subsection (1) of section 627.6418, Florida
76	Statutes, is amended to read:
77	627.6418 Coverage for mammograms.--
78	(1) An accident or health insurance policy issued,
79	amended, delivered, or renewed in this state must provide
80	coverage for at least the following:
81	(a) A baseline mammogram for any woman who is 35 years of
82	age or older, but younger than 40 years of age.
83	(b) A mammogram every 2 years for any woman who is 40
84	years of age or older, but younger than 50 years of age, or more
85	frequently based on the patient's physician's recommendation.
86	(c) A mammogram every year for any woman who is 50 years
87	of age or older.
88	(d) One or more mammograms a year, based upon a
89	physician's recommendation, for any woman who is at risk for
90	breast cancer because of a personal or family history of breast
91	cancer, because of having a history of biopsy-proven benign
92	breast disease, because of having a mother, sister, or daughter
93	who has or has had breast cancer, or because a woman has not
94	given birth before the age of 30.
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96	It is the intent of the Legislature that the requirements of
97	this section conform to the practice parameters relating to
98	mammograms as recognized by the United States Agency for
99	Healthcare Research and Quality, when practice parameters for
100	the delivery of mammography services are developed pursuant to
101	s. 408.02(7), the Legislature review the requirements of this
102	section and conform to the practice parameters.
103	Section 5. Subsection (1) of section 627.6613, Florida
104	Statutes, is amended to read:
105	627.6613 Coverage for mammograms.--
106	(1) A group, blanket, or franchise accident or health
107	insurance policy issued, amended, delivered, or renewed in this
108	state must provide coverage for at least the following:
109	(a) A baseline mammogram for any woman who is 35 years of
110	age or older, but younger than 40 years of age.
111	(b) A mammogram every 2 years for any woman who is 40
112	years of age or older, but younger than 50 years of age, or more
113	frequently based on the patient's physician's recommendation.
114	(c) A mammogram every year for any woman who is 50 years
115	of age or older.
116	(d) One or more mammograms a year, based upon a
117	physician's recommendation, for any woman who is at risk for
118	breast cancer because of a personal or family history of breast
119	cancer, because of having a history of biopsy-proven benign
120	breast disease, because of having a mother, sister, or daughter
121	who has or has had breast cancer, or because a woman has not
122	given birth before the age of 30.
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124	It is the intent of the Legislature that the requirements of
125	this section conform to the practice parameters relating to
126	mammograms as recognized by the United States Agency for
127	Healthcare Research and Quality, when practice parameters for
128	the delivery of mammography services are developed pursuant to
129	s. 408.02(7), the Legislature review the requirements of this
130	section and conform to the practice parameters.
131	Section 6. This act shall take effect upon becoming a law.