Senate Bill sb7060pb
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2005 (PROPOSED COMMITTEE BILL) SPB 7060
FOR CONSIDERATION By the Committee on Banking and Insurance
597-1612-05
1 A bill to be entitled
2 An act relating to health maintenance
3 organizations; amending s. 641.316, F.S.;
4 redefining the term "fiscal intermediary
5 services organization"; amending s. 641.234,
6 F.S.; expanding the requirement that a health
7 maintenance organization remains responsible
8 for violations of certain statutory
9 requirements if the organization transfers to
10 any entity the obligations to pay any provider
11 for claims arising from services to subscribers
12 of the organization; providing an effective
13 date.
14
15 Be It Enacted by the Legislature of the State of Florida:
16
17 Section 1. Paragraph (b) of subsection (2) of section
18 641.316, Florida Statutes, is amended to read:
19 641.316 Fiscal intermediary services.--
20 (2)
21 (b) The term "fiscal intermediary services
22 organization" means a person or entity that which performs
23 fiduciary or fiscal intermediary services to health care
24 professionals who contract with health maintenance
25 organizations other than a fiscal intermediary services
26 organization owned, operated, or controlled by a hospital
27 licensed under chapter 395, an insurer licensed under chapter
28 624, a third-party administrator licensed under chapter 626, a
29 prepaid limited health service organization licensed under
30 chapter 636, a health maintenance organization licensed under
31 this chapter, or physician group practices as defined in s.
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2005 (PROPOSED COMMITTEE BILL) SPB 7060
597-1612-05
1 456.053(3)(h) and providing services under the scope of
2 licenses of the members of the group practice.
3 Section 2. Subsection (4) of section 641.234, Florida
4 Statutes, is amended to read:
5 641.234 Administrative, provider, and management
6 contracts.--
7 (4)(a) If a health maintenance organization, through a
8 health care risk contract, transfers to any entity the
9 obligations to pay any provider for any claims arising from
10 services provided to or for the benefit of any subscriber of
11 the organization, the health maintenance organization shall
12 remain responsible for any violations of ss. 641.3155,
13 641.3156, and 641.51(4). The provisions of ss.
14 624.418-624.4211 and 641.52 shall apply to any such
15 violations.
16 (b) As used in this subsection,:
17 1. The term "health care risk contract" means a
18 contract under which an entity receives compensation in
19 exchange for providing to the health maintenance organization
20 a provider network or other services, which may include
21 administrative services.
22 2. the term "entity" means a person licensed as an
23 administrator under s. 626.88 and does not include any
24 provider or group practice, as defined in s. 456.053,
25 providing services under the scope of the license of the
26 provider or the members of the group practice. The term does
27 not include a hospital providing billing, claims, and
28 collection services solely on its own and its physicians'
29 behalf and providing services under the scope of its license.
30 Section 3. This act shall take effect October 1, 2005.
31
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2005 (PROPOSED COMMITTEE BILL) SPB 7060
597-1612-05
1 *****************************************
2 SENATE SUMMARY
3 Redefines the term "fiscal intermediary services
organization" to remove an exclusion provided for certain
4 organizations owned, operated, or controlled by a
hospital and to clarify that the term includes certain
5 group practices. Provides that a health maintenance
organization remains responsible for certain violations
6 regardless of the form of certain transfers of the
obligation to pay claims.
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
3
CODING: Words stricken are deletions; words underlined are additions.