Senate Bill sb1828

    Florida Senate - 2006                                  SB 1828

    By Senator Miller





    18-489-06

  1                      A bill to be entitled

  2         An act relating to health maintenance

  3         contracts; amending s. 641.31, F.S.; requiring

  4         a subscriber's primary physician to refer the

  5         subscriber to a facility's skilled nursing unit

  6         under certain conditions; authorizing the

  7         subscriber to use a grievance process if his or

  8         her request for a referral is denied; providing

  9         an effective date.

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

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13         Section 1.  Subsection (25) of section 641.31, Florida

14  Statutes, is amended to read:

15         641.31  Health maintenance contracts.--

16         (25)  If a subscriber is a resident of a continuing

17  care facility certified under chapter 651 or a retirement

18  facility consisting of a nursing home and residential

19  apartments, the subscriber's primary care physician must refer

20  the subscriber to that facility's skilled nursing unit or

21  assisted living facility if requested by the subscriber and

22  agreed to by the facility if the primary care physician finds

23  that it is in the best interest of the patient to do so; if

24  the facility agrees to be reimbursed at the health maintenance

25  organization's contract rate negotiated with similar providers

26  for the same services and supplies or consistent with Medicare

27  reimbursement rates; and if the facility meets all guidelines

28  established by the health maintenance organization related to

29  quality of care, utilization, referral authorization, risk

30  assumption, use of the health maintenance organization's

31  network, and other criteria applicable to providers under

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






    Florida Senate - 2006                                  SB 1828
    18-489-06




 1  contract for the same services and supplies. If the

 2  subscriber's request for a referral to the facility's skilled

 3  nursing unit or assisted living facility is denied, the

 4  subscriber may use the grievance process provided in s.

 5  641.511.

 6         Section 2.  This act shall take effect upon becoming a

 7  law.

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10                          SENATE SUMMARY

11    Requires a subscriber's primary physician to refer the
      subscriber to a facility's skilled nursing unit under
12    certain conditions. Authorizes the subscriber to use a
      grievance process if his or her request for a referral is
13    denied.

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