HB 1235

CS

CHAMBER ACTION

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

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