Senate Bill sb1066c1

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    Florida Senate - 2004                           CS for SB 1066

    By the Committee on Health, Aging, and Long-Term Care; and
    Senator Saunders




    317-1131-04

  1                      A bill to be entitled

  2         An act relating to health maintenance

  3         organizations; amending s. 408.7056, F.S.;

  4         changing the name of the Statewide Provider and

  5         Subscriber Assistance Program to the Subscriber

  6         Assistance Program; revising a definition;

  7         requiring certain records and reports to be

  8         provided to the Subscriber Assistance Panel;

  9         providing for penalties; requiring that a

10         quorum be present before a grievance can be

11         heard or voted upon; establishing a maximum

12         number of panel members; amending s. 641.3154,

13         F.S.; conforming provisions to changes made by

14         the act; amending s. 641.511, F.S.; conforming

15         provisions; adopting the federal claims

16         procedures for certain commercial health

17         maintenance organizations; amending s. 641.58,

18         F.S.; conforming provisions; providing an

19         effective date.

20  

21  Be It Enacted by the Legislature of the State of Florida:

22  

23         Section 1.  Section 408.7056, Florida Statutes, is

24  amended to read:

25         408.7056  Statewide Provider and Subscriber Assistance

26  Program.--

27         (1)  As used in this section, the term:

28         (a)  "Agency" means the Agency for Health Care

29  Administration.

30         (b)  "Department" means the Department of Financial

31  Services.

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 1         (c)  "Grievance procedure" means an established set of

 2  rules that specify a process for appeal of an organizational

 3  decision.

 4         (d)  "Health care provider" or "provider" means a

 5  state-licensed or state-authorized facility, a facility

 6  principally supported by a local government or by funds from a

 7  charitable organization that holds a current exemption from

 8  federal income tax under s. 501(c)(3) of the Internal Revenue

 9  Code, a licensed practitioner, a county health department

10  established under part I of chapter 154, a prescribed

11  pediatric extended care center defined in s. 400.902, a

12  federally supported primary care program such as a migrant

13  health center or a community health center authorized under s.

14  329 or s. 330 of the United States Public Health Services Act

15  that delivers health care services to individuals, or a

16  community facility that receives funds from the state under

17  the Community Alcohol, Drug Abuse, and Mental Health Services

18  Act and provides mental health services to individuals.

19         (e)  "Managed care entity" means a health maintenance

20  organization or a prepaid health clinic certified under

21  chapter 641, a prepaid health plan authorized under s.

22  409.912, or an exclusive provider organization certified under

23  s. 627.6472.

24         (f)  "Office" means the Office of Insurance Regulation

25  of the Financial Services Commission.

26         (g)  "Panel" means a statewide provider and subscriber

27  assistance panel selected as provided in subsection (11).

28         (2)  The agency shall adopt and implement a program to

29  provide assistance to subscribers and providers, including

30  those whose grievances are not resolved by the managed care

31  entity to the satisfaction of the subscriber or provider. The

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 1  program shall consist of one or more panels that meet as often

 2  as necessary to timely review, consider, and hear grievances

 3  and recommend to the agency or the office any actions that

 4  should be taken concerning individual cases heard by the

 5  panel. The panel shall hear every grievance filed by

 6  subscribers and providers on behalf of subscribers, unless the

 7  grievance:

 8         (a)  Relates to a managed care entity's refusal to

 9  accept a provider into its network of providers;

10         (b)  Is part of an internal grievance in a Medicare

11  managed care entity or a reconsideration appeal through the

12  Medicare appeals process which does not involve a quality of

13  care issue;

14         (c)  Is related to a health plan not regulated by the

15  state such as an administrative services organization,

16  third-party administrator, or federal employee health benefit

17  program;

18         (d)  Is related to appeals by in-plan suppliers and

19  providers, unless related to quality of care provided by the

20  plan;

21         (e)  Is part of a Medicaid fair hearing pursued under

22  42 C.F.R. ss. 431.220 et seq.;

23         (f)  Is the basis for an action pending in state or

24  federal court;

25         (g)  Is related to an appeal by nonparticipating

26  providers, unless related to the quality of care provided to a

27  subscriber by the managed care entity and the provider is

28  involved in the care provided to the subscriber;

29         (h)  Was filed before the subscriber or provider

30  completed the entire internal grievance procedure of the

31  managed care entity, the managed care entity has complied with

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 1  its timeframes for completing the internal grievance

 2  procedure, and the circumstances described in subsection (6)

 3  do not apply;

 4         (i)  Has been resolved to the satisfaction of the

 5  subscriber or provider who filed the grievance, unless the

 6  managed care entity's initial action is egregious or may be

 7  indicative of a pattern of inappropriate behavior;

 8         (j)  Is limited to seeking damages for pain and

 9  suffering, lost wages, or other incidental expenses, including

10  accrued interest on unpaid balances, court costs, and

11  transportation costs associated with a grievance procedure;

12         (k)  Is limited to issues involving conduct of a health

13  care provider or facility, staff member, or employee of a

14  managed care entity which constitute grounds for disciplinary

15  action by the appropriate professional licensing board and is

16  not indicative of a pattern of inappropriate behavior, and the

17  agency, office, or department has reported these grievances to

18  the appropriate professional licensing board or to the health

19  facility regulation section of the agency for possible

20  investigation; or

21         (l)  Is withdrawn by the subscriber or provider.

22  Failure of the subscriber or the provider to attend the

23  hearing shall be considered a withdrawal of the grievance.

24         (3)  The agency shall review all grievances within 60

25  days after receipt and make a determination whether the

26  grievance shall be heard.  Once the agency notifies the panel,

27  the subscriber or provider, and the managed care entity that a

28  grievance will be heard by the panel, the panel shall hear the

29  grievance either in the network area or by teleconference no

30  later than 120 days after the date the grievance was filed.

31  The agency shall notify the parties, in writing, by facsimile

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 1  transmission, or by phone, of the time and place of the

 2  hearing. The panel may take testimony under oath, request

 3  certified copies of documents, and take similar actions to

 4  collect information and documentation that will assist the

 5  panel in making findings of fact and a recommendation. The

 6  panel shall issue a written recommendation, supported by

 7  findings of fact, to the provider or subscriber, to the

 8  managed care entity, and to the agency or the office no later

 9  than 15 working days after hearing the grievance.  If at the

10  hearing the panel requests additional documentation or

11  additional records, the time for issuing a recommendation is

12  tolled until the information or documentation requested has

13  been provided to the panel. The proceedings of the panel are

14  not subject to chapter 120.

15         (4)  If, upon receiving a proper patient authorization

16  along with a properly filed grievance, the agency requests

17  medical records from a health care provider or managed care

18  entity, the health care provider or managed care entity that

19  has custody of the records has 10 days to provide the records

20  to the agency. Records include medical records, communication

21  logs associated with the grievance both to and from the

22  subscriber, contracts, and any other contents of the internal

23  grievance file associated with the complaint filed with the

24  Subscriber Assistance Program. Failure to provide requested

25  medical records may result in the imposition of a fine of up

26  to $500.  Each day that records are not produced is considered

27  a separate violation.

28         (5)  Grievances that the agency determines pose an

29  immediate and serious threat to a subscriber's health must be

30  given priority over other grievances. The panel may meet at

31  the call of the chair to hear the grievances as quickly as

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 1  possible but no later than 45 days after the date the

 2  grievance is filed, unless the panel receives a waiver of the

 3  time requirement from the subscriber.  The panel shall issue a

 4  written recommendation, supported by findings of fact, to the

 5  office or the agency within 10 days after hearing the

 6  expedited grievance.

 7         (6)  When the agency determines that the life of a

 8  subscriber is in imminent and emergent jeopardy, the chair of

 9  the panel may convene an emergency hearing, within 24 hours

10  after notification to the managed care entity and to the

11  subscriber, to hear the grievance.  The grievance must be

12  heard notwithstanding that the subscriber has not completed

13  the internal grievance procedure of the managed care entity.

14  The panel shall, upon hearing the grievance, issue a written

15  emergency recommendation, supported by findings of fact, to

16  the managed care entity, to the subscriber, and to the agency

17  or the office for the purpose of deferring the imminent and

18  emergent jeopardy to the subscriber's life.  Within 24 hours

19  after receipt of the panel's emergency recommendation, the

20  agency or office may issue an emergency order to the managed

21  care entity. An emergency order remains in force until:

22         (a)  The grievance has been resolved by the managed

23  care entity;

24         (b)  Medical intervention is no longer necessary; or

25         (c)  The panel has conducted a full hearing under

26  subsection (3) and issued a recommendation to the agency or

27  the office, and the agency or office has issued a final order.

28         (7)  After hearing a grievance, the panel shall make a

29  recommendation to the agency or the office which may include

30  specific actions the managed care entity must take to comply

31  with state laws or rules regulating managed care entities.

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 1         (8)  A managed care entity, subscriber, or provider

 2  that is affected by a panel recommendation may within 10 days

 3  after receipt of the panel's recommendation, or 72 hours after

 4  receipt of a recommendation in an expedited grievance, furnish

 5  to the agency or office written evidence in opposition to the

 6  recommendation or findings of fact of the panel.

 7         (9)  No later than 30 days after the issuance of the

 8  panel's recommendation and, for an expedited grievance, no

 9  later than 10 days after the issuance of the panel's

10  recommendation, the agency or the office may adopt the panel's

11  recommendation or findings of fact in a proposed order or an

12  emergency order, as provided in chapter 120, which it shall

13  issue to the managed care entity.  The agency or office may

14  issue a proposed order or an emergency order, as provided in

15  chapter 120, imposing fines or sanctions, including those

16  contained in ss. 641.25 and 641.52.  The agency or the office

17  may reject all or part of the panel's recommendation. All

18  fines collected under this subsection must be deposited into

19  the Health Care Trust Fund.

20         (10)  In determining any fine or sanction to be

21  imposed, the agency and the office may consider the following

22  factors:

23         (a)  The severity of the noncompliance, including the

24  probability that death or serious harm to the health or safety

25  of the subscriber will result or has resulted, the severity of

26  the actual or potential harm, and the extent to which

27  provisions of chapter 641 were violated.

28         (b)  Actions taken by the managed care entity to

29  resolve or remedy any quality-of-care grievance.

30         (c)  Any previous incidents of noncompliance by the

31  managed care entity.

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 1         (d)  Any other relevant factors the agency or office

 2  considers appropriate in a particular grievance.

 3         (11)  The panel shall consist of the Insurance Consumer

 4  Advocate, or designee thereof, established by s. 627.0613; at

 5  least two members employed by the agency and at least two

 6  members employed by the department, chosen by their respective

 7  agencies; a consumer appointed by the Governor; a physician

 8  appointed by the Governor, as a standing member; and, if

 9  necessary, physicians who have expertise relevant to the case

10  to be heard, on a rotating basis. The agency may contract with

11  a medical director, and a primary care physician, or both, who

12  shall provide additional technical expertise to the panel but

13  who shall not be voting members of the panel.  The medical

14  director shall be selected from a health maintenance

15  organization with a current certificate of authority to

16  operate in Florida.

17         (12)  A majority of those panel members required under

18  subsection (11) shall constitute a quorum for any meeting or

19  hearing of the panel. A grievance may not be heard or voted

20  upon at any panel meeting or hearing unless a quorum is

21  present, except that a minority of the panel may adjourn a

22  meeting or hearing until a quorum is present. A panel convened

23  for the purpose of hearing a subscriber's grievance in

24  accordance with subsections (2) and (3) shall not consist of

25  more than 11 members.

26         (13)(12)  Every managed care entity shall submit a

27  quarterly report to the agency, the office, and the department

28  listing the number and the nature of all subscribers' and

29  providers' grievances which have not been resolved to the

30  satisfaction of the subscriber or provider after the

31  subscriber or provider follows the entire internal grievance

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 1  procedure of the managed care entity. The agency shall notify

 2  all subscribers and providers included in the quarterly

 3  reports of their right to file an unresolved grievance with

 4  the panel.

 5         (14)(13)  A proposed order issued by the agency or

 6  office which only requires the managed care entity to take a

 7  specific action under subsection (7) is subject to a summary

 8  hearing in accordance with s. 120.574, unless all of the

 9  parties agree otherwise. If the managed care entity does not

10  prevail at the hearing, the managed care entity must pay

11  reasonable costs and attorney's fees of the agency or the

12  office incurred in that proceeding.

13         (15)(14)(a)  Any information that identifies a

14  subscriber which is held by the panel, agency, or department

15  pursuant to this section is confidential and exempt from the

16  provisions of s. 119.07(1) and s. 24(a), Art. I of the State

17  Constitution. However, at the request of a subscriber or

18  managed care entity involved in a grievance procedure, the

19  panel, agency, or department shall release information

20  identifying the subscriber involved in the grievance procedure

21  to the requesting subscriber or managed care entity.

22         (b)  Meetings of the panel shall be open to the public

23  unless the provider or subscriber whose grievance will be

24  heard requests a closed meeting or the agency or the

25  department determines that information which discloses the

26  subscriber's medical treatment or history or information

27  relating to internal risk management programs as defined in s.

28  641.55(5)(c), (6), and (8) may be revealed at the panel

29  meeting, in which case that portion of the meeting during

30  which a subscriber's medical treatment or history or internal

31  risk management program information is discussed shall be

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 1  exempt from the provisions of s. 286.011 and s. 24(b), Art. I

 2  of the State Constitution. All closed meetings shall be

 3  recorded by a certified court reporter.

 4         Section 2.  Subsection (4) of section 641.3154, Florida

 5  Statutes, is amended to read:

 6         641.3154  Organization liability; provider billing

 7  prohibited.--

 8         (4)  A provider or any representative of a provider,

 9  regardless of whether the provider is under contract with the

10  health maintenance organization, may not collect or attempt to

11  collect money from, maintain any action at law against, or

12  report to a credit agency a subscriber of an organization for

13  payment of services for which the organization is liable, if

14  the provider in good faith knows or should know that the

15  organization is liable. This prohibition applies during the

16  pendency of any claim for payment made by the provider to the

17  organization for payment of the services and any legal

18  proceedings or dispute resolution process to determine whether

19  the organization is liable for the services if the provider is

20  informed that the such proceedings are taking place. It is

21  presumed that a provider does not know and should not know

22  that an organization is liable unless:

23         (a)  The provider is informed by the organization that

24  it accepts liability;

25         (b)  A court of competent jurisdiction determines that

26  the organization is liable;

27         (c)  The office or agency makes a final determination

28  that the organization is required to pay for the such services

29  subsequent to a recommendation made by the Statewide Provider

30  and Subscriber Assistance Panel pursuant to s. 408.7056; or

31  

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 1         (d)  The agency issues a final order that the

 2  organization is required to pay for such services subsequent

 3  to a recommendation made by a resolution organization pursuant

 4  to s. 408.7057.

 5         Section 3.  Section 641.511, Florida Statutes, is

 6  amended to read:

 7         641.511  Subscriber grievance reporting and resolution

 8  requirements.--

 9         (1)  Every organization must have a grievance procedure

10  available to its subscribers for the purpose of addressing

11  complaints and grievances. Every organization must notify its

12  subscribers that a subscriber must submit a grievance within 1

13  year after the date of occurrence of the action that initiated

14  the grievance, and may submit the grievance for review to the

15  Statewide Provider and Subscriber Assistance Program panel as

16  provided in s. 408.7056 after receiving a final disposition of

17  the grievance through the organization's grievance process.

18  An organization shall maintain records of all grievances and

19  shall report annually to the agency the total number of

20  grievances handled, a categorization of the cases underlying

21  the grievances, and the final disposition of the grievances.

22         (2)  When an organization receives an initial complaint

23  from a subscriber, the organization must respond to the

24  complaint within a reasonable time after its submission.  At

25  the time of receipt of the initial complaint, the organization

26  shall inform the subscriber that the subscriber has a right to

27  file a written grievance at any time and that assistance in

28  preparing the written grievance shall be provided by the

29  organization.

30         (3)  Each organization's grievance procedure, as

31  required under subsection (1), must include, at a minimum:

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 1         (a)  An explanation of how to pursue redress of a

 2  grievance.

 3         (b)  The names of the appropriate employees or a list

 4  of grievance departments that are responsible for implementing

 5  the organization's grievance procedure.  The list must include

 6  the address and the toll-free telephone number of each

 7  grievance department, the address of the agency and its

 8  toll-free telephone hotline number, and the address of the

 9  Statewide Provider and Subscriber Assistance Program and its

10  toll-free telephone number.

11         (c)  The description of the process through which a

12  subscriber may, at any time, contact the toll-free telephone

13  hotline of the agency to inform it of the unresolved

14  grievance.

15         (d)  A procedure for establishing methods for

16  classifying grievances as urgent and for establishing time

17  limits for an expedited review within which such grievances

18  must be resolved.

19         (e)  A notice that a subscriber may voluntarily pursue

20  binding arbitration in accordance with the terms of the

21  contract if offered by the organization, after completing the

22  organization's grievance procedure and as an alternative to

23  the Statewide Provider and Subscriber Assistance Program. Such

24  notice shall include an explanation that the subscriber may

25  incur some costs if the subscriber pursues binding

26  arbitration, depending upon the terms of the subscriber's

27  contract.

28         (f)  A process whereby the grievance manager

29  acknowledges the grievance and investigates the grievance in

30  order to notify the subscriber of a final decision in writing.

31  

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 1         (g)  A procedure for providing individuals who are

 2  unable to submit a written grievance with access to the

 3  grievance process, which shall include assistance by the

 4  organization in preparing the grievance and communicating back

 5  to the subscriber.

 6         (4)(a)  With respect to a grievance concerning an

 7  adverse determination, an organization shall make available to

 8  the subscriber a review of the grievance by an internal review

 9  panel; the such review must be requested within 30 days after

10  the organization's transmittal of the final determination

11  notice of an adverse determination.  A majority of the panel

12  shall be persons who previously were not involved in the

13  initial adverse determination.  A person who previously was

14  involved in the adverse determination may appear before the

15  panel to present information or answer questions.  The panel

16  shall have the authority to bind the organization to the

17  panel's decision.

18         (b)  An organization shall ensure that a majority of

19  the persons reviewing a grievance involving an adverse

20  determination are providers who have appropriate expertise.

21  An organization shall issue a copy of the written decision of

22  the review panel to the subscriber and to the provider, if

23  any, who submits a grievance on behalf of a subscriber. In

24  cases where there has been a denial of coverage of service,

25  the reviewing provider shall not be a provider previously

26  involved with the adverse determination.

27         (c)  An organization shall establish written procedures

28  for a review of an adverse determination.  Review procedures

29  shall be available to the subscriber and to a provider acting

30  on behalf of a subscriber.

31  

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 1         (d)  In any case when the review process does not

 2  resolve a difference of opinion between the organization and

 3  the subscriber or the provider acting on behalf of the

 4  subscriber, the subscriber or the provider acting on behalf of

 5  the subscriber may submit a written grievance to the Statewide

 6  Provider and Subscriber Assistance Program.

 7         (5)  Except as provided in subsection (6), the

 8  organization shall resolve a grievance within 60 days after

 9  receipt of the grievance, or within a maximum of 90 days if

10  the grievance involves the collection of information outside

11  the service area. These time limitations are tolled if the

12  organization has notified the subscriber, in writing, that

13  additional information is required for proper review of the

14  grievance and that the such time limitations are tolled until

15  such information is provided. After the organization receives

16  the requested information, the time allowed for completion of

17  the grievance process resumes. The Employee Retirement Income

18  Security Act of 1974 (ERISA) as implemented by 29 C.F.R.

19  2560.503-1 is adopted and incorporated by reference as

20  applicable to all organizations that administer small and

21  large group health plans that are subject to 29 C.F.R.

22  2560.503-1. The claims procedures of the regulations of the

23  Employee Retirement Income Security Act of 1974 (ERISA) as

24  implemented by 29 C.F.R. 2560.503-1 shall be the minimum

25  standards for grievance processes for small and large group

26  health plans that are subject to 29 C.F.R. 2560.503-1.

27         (6)(a)  An organization shall establish written

28  procedures for the expedited review of an urgent grievance. A

29  request for an expedited review may be submitted orally or in

30  writing and shall be subject to the review procedures of this

31  section, if it meets the criteria of this section. Unless it

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 1  is submitted in writing, for purposes of the grievance

 2  reporting requirements in subsection (1), the request shall be

 3  considered an appeal of a utilization review decision and not

 4  a grievance. Expedited review procedures shall be available to

 5  a subscriber and to the provider acting on behalf of a

 6  subscriber. For purposes of this subsection, "subscriber"

 7  includes the legal representative of a subscriber.

 8         (b)  Expedited reviews shall be evaluated by an

 9  appropriate clinical peer or peers. The clinical peer or peers

10  shall not have been involved in the initial adverse

11  determination.

12         (c)  In an expedited review, all necessary information,

13  including the organization's decision, shall be transmitted

14  between the organization and the subscriber, or the provider

15  acting on behalf of the subscriber, by telephone, facsimile,

16  or the most expeditious method available.

17         (d)  In an expedited review, an organization shall make

18  a decision and notify the subscriber, or the provider acting

19  on behalf of the subscriber, as expeditiously as the

20  subscriber's medical condition requires, but in no event more

21  than 72 hours after receipt of the request for review. If the

22  expedited review is a concurrent review determination, the

23  service shall be continued without liability to the subscriber

24  until the subscriber has been notified of the determination.

25         (e)  An organization shall provide written confirmation

26  of its decision concerning an expedited review within 2

27  working days after providing notification of that decision, if

28  the initial notification was not in writing.

29         (f)  An organization shall provide reasonable access,

30  not to exceed 24 hours after receiving a request for an

31  

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 1  expedited review, to a clinical peer who can perform the

 2  expedited review.

 3         (g)  In any case when the expedited review process does

 4  not resolve a difference of opinion between the organization

 5  and the subscriber or the provider acting on behalf of the

 6  subscriber, the subscriber or the provider acting on behalf of

 7  the subscriber may submit a written grievance to the Statewide

 8  Provider and Subscriber Assistance Program.

 9         (h)  An organization shall not provide an expedited

10  retrospective review of an adverse determination.

11         (7)  Each organization shall send to the agency a copy

12  of its quarterly grievance reports submitted to the office

13  under s. 408.7056(13) pursuant to s. 408.7056(12).

14         (8)  The agency shall investigate all reports of

15  unresolved quality of care grievances received from:

16         (a)  Annual and quarterly grievance reports submitted

17  by the organization to the office.

18         (b)  Review requests of subscribers whose grievances

19  remain unresolved after the subscriber has followed the full

20  grievance procedure of the organization.

21         (9)(a)  The agency shall advise subscribers with

22  grievances to follow their organization's formal grievance

23  process for resolution prior to review by the Statewide

24  Provider and Subscriber Assistance Program. The subscriber

25  may, however, submit a copy of the grievance to the agency at

26  any time during the process.

27         (b)  Requiring completion of the organization's

28  grievance process before the Statewide Provider and Subscriber

29  Assistance Program panel's review does not preclude the agency

30  from investigating any complaint or grievance before the

31  organization makes its final determination.

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 1         (10)  Each organization must notify the subscriber in a

 2  final decision letter that the subscriber may request review

 3  of the organization's decision concerning the grievance by the

 4  Statewide Provider and Subscriber Assistance Program, as

 5  provided in s. 408.7056, if the grievance is not resolved to

 6  the satisfaction of the subscriber. The final decision letter

 7  must inform the subscriber that the request for review must be

 8  made within 365 days after receipt of the final decision

 9  letter, must explain how to initiate such a review, and must

10  include the addresses and toll-free telephone numbers of the

11  agency and the Statewide Provider and Subscriber Assistance

12  Program.

13         (11)  Each organization, as part of its contract with

14  any provider, must require the provider to post a consumer

15  assistance notice prominently displayed in the reception area

16  of the provider and clearly noticeable by all patients. The

17  consumer assistance notice must state the addresses and

18  toll-free telephone numbers of the Agency for Health Care

19  Administration, the Statewide Provider and Subscriber

20  Assistance Program, and the Department of Financial Services.

21  The consumer assistance notice must also clearly state that

22  the address and toll-free telephone number of the

23  organization's grievance department shall be provided upon

24  request. The agency may adopt rules to implement this section.

25         (12)  The agency may impose administrative sanction, in

26  accordance with s. 641.52, against an organization for

27  noncompliance with this section.

28         Section 4.  Subsection (4) of section 641.58, Florida

29  Statutes, is amended to read:

30         641.58  Regulatory assessment; levy and amount; use of

31  funds; tax returns; penalty for failure to pay.--

                                  17

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2004                           CS for SB 1066
    317-1131-04




 1         (4)  The moneys received and deposited into the Health

 2  Care Trust Fund shall be used to defray the expenses of the

 3  agency in the discharge of its administrative and regulatory

 4  powers and duties under this part, including conducting an

 5  annual survey of the satisfaction of members of health

 6  maintenance organizations; contracting with physician

 7  consultants for the Statewide Provider and Subscriber

 8  Assistance Panel; maintaining offices and necessary supplies,

 9  essential equipment, and other materials, salaries and

10  expenses of required personnel; and discharging the

11  administrative and regulatory powers and duties imposed under

12  this part.

13         Section 5.  This act shall take effect upon becoming a

14  law.

15  

16          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
17                         Senate Bill 1066

18                                 

19  The Committee Substitute differs from SB 1066 in the following
    ways:
20  
    1. Membership of the Subscriber Assistance Panel is modified
21  to provide flexibility in the composition of the panel.

22  2. A maximum number of panel members is established.

23  3. A quorum must be present before a grievance can be heard or
    voted upon.
24  
    4. The January 1, 2005 effective date for compliance with
25  federal standards is deleted.

26  

27  

28  

29  

30  

31  

                                  18

CODING: Words stricken are deletions; words underlined are additions.