| 1 | Representative Homan offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Remove everything after the enacting clause and insert: |
| 5 | Section 1. Subsections (16) through (20) of section |
| 6 | 641.19, Florida Statutes, are renumbered as subsections (17) |
| 7 | through (21), respectively, and a new subsection (16) is added |
| 8 | to said section to read: |
| 9 | 641.19 Definitions.--As used in this part, the term: |
| 10 | (16) "Schedule of reimbursements" means a schedule of fees |
| 11 | to be paid by a health maintenance organization to a physician |
| 12 | provider for reimbursement for specific services pursuant to the |
| 13 | terms of a contract. The physician provider's net reimbursement |
| 14 | may vary after consideration of other factors, including, but |
| 15 | not limited to, bundling codes together into another code and |
| 16 | member cost-sharing responsibility, as long as these factors are |
| 17 | disclosed and included in the terms of the contract between the |
| 18 | health maintenance organization and provider. The reimbursement |
| 19 | schedule may be stated as: |
| 20 | (a) A percentage of the Medicare fee schedule for specific |
| 21 | relative-value services; |
| 22 | (b) A listing of the reimbursements to be paid by Current |
| 23 | Procedural Terminology codes for physicians that pertain to each |
| 24 | physician's practice; or |
| 25 | (c) Any other method agreed upon by the parties. |
| 26 |
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| 27 | Specific non-relative-value services shall be stated separately |
| 28 | from relative-value services, and reimbursement for unclassified |
| 29 | services shall be on a reasonable basis. |
| 30 | Section 2. Subsection (4) of section 641.315, Florida |
| 31 | Statutes, is amended to read: |
| 32 | 641.315 Provider contracts.-- |
| 33 | (4) Whenever a contract exists between a health |
| 34 | maintenance organization and a provider, the health maintenance |
| 35 | organization shall disclose to the provider: |
| 36 | (a) The mailing address or electronic address where claims |
| 37 | should be sent for processing.; |
| 38 | (b) The telephone number that a provider may call to have |
| 39 | questions and concerns regarding claims addressed.; and |
| 40 | (c) The address of any separate claims-processing centers |
| 41 | for specific types of services. |
| 42 | (d)1. The complete schedule of reimbursements for all the |
| 43 | services for which a health maintenance organization and a |
| 44 | provider have contracted and any changes in or deviations from |
| 45 | the contracted schedule of reimbursements. The health |
| 46 | maintenance organization may satisfy this requirement by: |
| 47 | a. Providing the schedule of reimbursements or changes in |
| 48 | or deviations from the schedule by electronic means to the |
| 49 | provider; or |
| 50 | b. Providing a written copy of the schedule of |
| 51 | reimbursements or changes or deviations from the schedule if |
| 52 | requested by the provider. |
| 53 | 2. The schedule of reimbursements is subject to the |
| 54 | nondisclosure provisions of the contract, and the provider shall |
| 55 | maintain the confidentiality of the schedule. For purposes of |
| 56 | this paragraph, the term "provider" means a physician licensed |
| 57 | under chapter 458, chapter 459, chapter 460, chapter 461, or |
| 58 | chapter 466. |
| 59 |
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| 60 | A health maintenance organization shall provide to its |
| 61 | contracted providers no less than 30 calendar days' prior |
| 62 | written notice of any changes in the information required in |
| 63 | this subsection. |
| 64 | Section 3. This act shall take effect January 1, 2005. |
| 65 |
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| 66 | ================= T I T L E A M E N D M E N T ================= |
| 67 | Remove the entire title and insert: |
| 68 | A bill to be entitled |
| 69 | An act relating to health maintenance organization |
| 70 | provider contracts; amending s. 641.19, F.S.; defining the |
| 71 | term "schedule of reimbursements"; amending s. 641.315, |
| 72 | F.S.; requiring a contract between a health maintenance |
| 73 | organization and a provider to disclose a complete |
| 74 | schedule of reimbursements for contracted services, |
| 75 | including changes and deviations; providing criteria, |
| 76 | requirements, and limitations; providing a definition; |
| 77 | providing an effective date. |