HOUSE AMENDMENT Bill No. HB 63B
1	CHAMBER ACTION
2	Senate House
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12	Representative Brown offered the following:
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14	Amendment (with title amendment)
15	Between lines 1574 and 1575, insert:
16	Section 34. Subsections (12), (13), and (18) of section
17	641.19, Florida Statutes, are amended to read:
18	641.19 Definitions.--As used in this part, the term:
19	(12) "Health maintenance contract" means any contract
20	entered into by a health maintenance organization with a
21	subscriber or group of subscribers to provide coverage for
22	comprehensive health care services in exchange for a prepaid per
23	capita or prepaid aggregate fixed sum.
24	(13) "Health maintenance organization" means any
25	organization authorized under this part which:
26	(a) Provides, through arrangements with other persons,
27	emergency care, inpatient hospital services, physician care
28	including care provided by physicians licensed under chapters
29	458, 459, 460, and 461, ambulatory diagnostic treatment, and
30	preventive health care services.;
31	(b) Provides, either directly or through arrangements with
32	other persons, health care services to persons enrolled with
33	such organization, on a prepaid per capita or prepaid aggregate
34	fixed-sum basis.;
35	(c) Provides, either directly or through arrangements with
36	other persons, comprehensive health care services which
37	subscribers are entitled to receive pursuant to a contract.;
38	(d) Provides physician services, by physicians licensed
39	under chapters 458, 459, 460, and 461, directly through
40	physicians who are either employees or partners of such
41	organization or under arrangements with a physician or any group
42	of physicians.; and
43	(e) If offering services through a managed care system,
44	then the managed care system must be a system in which a primary
45	physician licensed under chapter 458 or chapter 459 and chapters
46	460 and 461 is designated for each subscriber upon request of a
47	subscriber requesting service by a physician licensed under any
48	of those chapters, and is responsible for coordinating the
49	health care of the subscriber of the respectively requested
50	service and for referring the subscriber to other providers of
51	the same discipline when necessary. Each female subscriber may
52	select as her primary physician an obstetrician/gynecologist who
53	has agreed to serve as a primary physician and is in the health
54	maintenance organization's provider network.
55	(f) Except in cases in which the health care provider is
56	an employee of the health maintenance organization, the fact
57	that the health maintenance organization arranges for the
58	provision of health care services under this chapter does not
59	create an actual agency, apparent agency, or employer-employee
60	relationship between the health care provider and the health
61	maintenance organization for purposes of vicarious liability for
62	the medical negligence of the health care provider.
63	(18) "Subscriber" means an entity or individual who has
64	contracted, or on whose behalf a contract has been entered into,
65	with a health maintenance organization for health care coverage
66	services or other persons who also receive health care coverage
67	servicesas a result of the contract.
68	Section 35. Subsection (3) of section 641.51, Florida
69	Statutes, is amended to read:
70	641.51 Quality assurance program; second medical opinion
71	requirement.--
72	(3) The health maintenance organization shall not have the
73	right to control theprofessional judgment of a physician
74	licensed under chapter 458, chapter 459, chapter 460, or chapter
75	461 concerning the proper course of treatment of a subscriber
76	shall not be subject to modification by the organization or its
77	board of directors, officers, or administrators, unless the
78	course of treatment prescribed is inconsistent with the
79	prevailing standards of medical practice in the community.
80	However, this subsection shall not be considered to restrict a
81	utilization management program established by an organization or
82	to affect an organization’s decision as to payment for covered
83	services. Except in cases in which the health care provider is
84	an employee of the health maintenance organization, the health
85	maintenance organization shall not be vicariously liable for the
86	medical negligence of the health care provider, whether such
87	claim is alleged under a theory of actual agency, apparent
88	agency, or employer-employee relationship.
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90	================= T I T L E A M E N D M E N T =================
91	Remove line(s) 122, and insert:
92	enforcement; amending s. 641.19, F.S.; providing that health
93	care providers providing services pursuant to coverage provided
94	under a health maintenance organization contract are not
95	employees or agents of the health maintenance organization;
96	providing exceptions; amending s. 641.51, F.S.; proscribing a
97	health maintenance organization’s right to control the
98	professional judgment of a physician; providing that a health
99	maintenance organization shall not be vicariously liable for the
100	medical negligence of a health care provider; providing
101	exceptions; amending s. 766.106, F.S.; requiring the