HOUSE AMENDMENT Bill No. HB 63B
1	CHAMBER ACTION
2	Senate House
3	.
4	.
5	.
6
7
8
9
10
11
12	Representative Gelber offered the following:
13
14	Substitute Amendment for Amendment (192267) (with title
15	amendment)
16	Between lines 1574 and 1575, insert:
17	Section 34. Subsections (12), (13), and (18) of section
18	641.19, Florida Statutes, are amended to read:
19	641.19 Definitions.--As used in this part, the term:
20	(12) "Health maintenance contract" means any contract
21	entered into by a health maintenance organization with a
22	subscriber or group of subscribers to provide coverage for
23	comprehensive health care services in exchange for a prepaid per
24	capita or prepaid aggregate fixed sum.
25	(13) "Health maintenance organization" means any
26	organization authorized under this part which:
27	(a) Provides, through arrangements with other persons,
28	emergency care, inpatient hospital services, physician care
29	including care provided by physicians licensed under chapters
30	458, 459, 460, and 461, ambulatory diagnostic treatment, and
31	preventive health care services.;
32	(b) Provides, either directly or through arrangements with
33	other persons, health care services to persons enrolled with
34	such organization, on a prepaid per capita or prepaid aggregate
35	fixed-sum basis.;
36	(c) Provides, either directly or through arrangements with
37	other persons, comprehensive health care services which
38	subscribers are entitled to receive pursuant to a contract.;
39	(d) Provides physician services, by physicians licensed
40	under chapters 458, 459, 460, and 461, directly through
41	physicians who are either employees or partners of such
42	organization or under arrangements with a physician or any group
43	of physicians.; and
44	(e) If offering services through a managed care system,
45	hasthen the managed care system must bea system in which a
46	primary physician licensed under chapter 458 or chapter 459 and
47	chapters 460 and 461 is designated for each subscriber upon
48	request of a subscriber requesting service by a physician
49	licensed under any of those chapters, and is responsible for
50	coordinating the health care of the subscriber of the
51	respectively requested service and for referring the subscriber
52	to other providers of the same discipline when necessary. Each
53	female subscriber may select as her primary physician an
54	obstetrician/gynecologist who has agreed to serve as a primary
55	physician and is in the health maintenance organization's
56	provider network.
57
58	No health care provider shall be deemed the employee, agent, or
59	apparent agent of a health maintenance organization unless the
60	totality of the circumstances establishes that the health
61	maintenance organization either exercised control or a right of
62	control over such health care provider or caused or allowed a
63	claimant to believe that the health care provider was an
64	employee or agent of the health maintenance organization and the
65	claimant justifiably relied upon that belief in dealing with the
66	health care provider.
67	(18) "Subscriber" means an entity or individual who has
68	contracted, or on whose behalf a contract has been entered into,
69	with a health maintenance organization for health care coverage
70	services or other persons who also receive health care coverage
71	servicesas a result of the contract.
72
73	================= T I T L E A M E N D M E N T =================
74	Remove line 122, and insert:
75	enforcement; amending s. 641.19, F.S.; providing that health
76	care providers providing services pursuant to coverage provided
77	under a health maintenance organization contract are not
78	employees or agents of the health maintenance organization;
79	providing exceptions; amending s. 766.106, F.S.; requiring the