Senate Bill sb1088c1

    Florida Senate - 2004                           CS for SB 1088

    By the Committee on Banking and Insurance; and Senator Cowin





    311-1992-04

  1                      A bill to be entitled

  2         An act relating to provider contracts for

  3         health care services; amending s. 641.315,

  4         F.S.; requiring that a health maintenance

  5         organization disclose to the provider the

  6         schedule of fees for which the health

  7         maintenance organization and the provider of

  8         health care services have contracted, including

  9         any additional deviations; providing for

10         application; providing an effective date.

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

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14         Section 1.  Subsection (4) of section 641.315, Florida

15  Statutes, is amended to read:

16         641.315 Provider contracts.--

17         (4)  Whenever a contract exists between a health

18  maintenance organization and a provider, the health

19  maintenance organization shall disclose to the provider:

20         (a)  The mailing address or electronic address where

21  claims should be sent for processing;

22         (b)  The telephone number that a provider may call to

23  have questions and concerns regarding claims addressed; and

24         (c)  The address of any separate claims-processing

25  centers for specific types of services; and.

26         (d)  The complete schedule of all fees for which the

27  health maintenance organization and the provider of health

28  care services have contracted, including any deviations from

29  the contracted schedule of fees requested by the health

30  maintenance organization and agreed upon by the provider of

31  the health care services.

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






    Florida Senate - 2004                           CS for SB 1088
    311-1992-04




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 2  A health maintenance organization shall provide to its

 3  contracted providers no less than 30 calendar days' prior

 4  written notice of any changes in the information required in

 5  this subsection.

 6         Section 2.  This act shall take effect January 1, 2005,

 7  and shall apply to contracts entered into or renewed on or

 8  after that date.

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10          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
11                         Senate Bill 1088

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13  Clarifies that the schedule of fees for which HMOs and
    providers have contracted shall be "complete" and include
14  "all" fees. Removes the word "additional" to clarify that
    deviations from the contracted fee schedule are to be included
15  in the disclosure by the HMO to the provider.

16  Changes the effective date to January 1, 2005, and clarifies
    that the bill applies to contracts entered into or renewed on
17  or after that date.

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