Amendment
Bill No. 0805

Amendment No. 180333

CHAMBER ACTION
Senate		House
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1	Representative(s) Benson offered the following:
2
3	Amendment (with directory and title amendments)
4	Remove lines 153-249 and insert:
5	(6)(a)  A health maintenance organization shall provide a
6	hospital, physician, or other person rendering services covered
7	by the policy electronic access to the covered person's
8	eligibility and benefits information through a secure Internet
9	website. The eligibility and benefits information shall comply
10	with the transaction standards specified in ANSI ASC X12N 270
11	for health care claim eligibility inquiries and ANSI ASC X12N
12	271 for health care claim eligibility responses, or successor
13	transaction standards, pursuant to the Health Insurance
14	Portability and Accountability Act.
15	(b)  A health maintenance organization shall develop an
16	implementation plan to comply with paragraph (a) no later than
17	March 31, 2007, and shall make the eligibility and benefits
18	information described in this subsection available through a
19	secure Internet website no later than July 1, 2007.
20	Section 5.  Paragraph (j) of subsection (3) of section
21	383.145, Florida Statutes, is amended to read:
22	383.145  Newborn and infant hearing screening.--
23	(3)  REQUIREMENTS FOR SCREENING OF NEWBORNS; INSURANCE
24	COVERAGE; REFERRAL FOR ONGOING SERVICES.--
25	(j)  The initial procedure for screening the hearing of the
26	newborn or infant and any medically necessary followup
27	reevaluations leading to diagnosis shall be a covered benefit,
28	reimbursable under Medicaid as an expense compensated
29	supplemental to the per diem rate for Medicaid patients enrolled
30	in MediPass or Medicaid patients covered by a fee for service
31	program. For Medicaid patients enrolled in HMOs, providers shall
32	be reimbursed directly by the Medicaid Program Office at the
33	Medicaid rate. This service may not be considered a covered
34	service for the purposes of establishing the payment rate for
35	Medicaid HMOs. All health insurance policies and health
36	maintenance organizations as provided under ss. 627.6416,
37	627.6579, and 641.31(32)(30), except for supplemental policies
38	that only provide coverage for specific diseases, hospital
39	indemnity, or Medicare supplement, or to the supplemental
40	polices, shall compensate providers for the covered benefit at
41	the contracted rate. Nonhospital-based providers shall be
42	eligible to bill Medicaid for the professional and technical
43	component of each procedure code.
44	Section 6.  Paragraphs (b) and (i) of subsection (1) of
45	section 641.185, Florida Statutes, are amended to read:
46	641.185  Health maintenance organization subscriber
47	protections.--
48	(1)  With respect to the provisions of this part and part
49	III, the principles expressed in the following statements shall
50	serve as standards to be followed by the commission, the office,
51	the department, and the Agency for Health Care Administration in
52	exercising their powers and duties, in exercising administrative
53	discretion, in administrative interpretations of the law, in
54	enforcing its provisions, and in adopting rules:
55	(b)  A health maintenance organization subscriber should
56	receive quality health care from a broad panel of providers,
57	including referrals, preventive care pursuant to s. 641.402(1),
58	emergency screening and services pursuant to ss. 641.31(14)(12)
59	and 641.513, and second opinions pursuant to s. 641.51.
60	(i)  A health maintenance organization subscriber should
61	receive timely and, if necessary, urgent grievances and appeals
62	within the health maintenance organization pursuant to ss.
63	641.228, 641.31(7)(5), 641.47, and 641.511.
64	Section 7.  Subsection (1) of section 641.2018, Florida
65	Statutes, is amended to read:
66	641.2018  Limited coverage for home health care
67	authorized.--
68	(1)  Notwithstanding other provisions of this chapter, a
69	health maintenance organization may issue a contract that limits
70	coverage to home health care services only. The organization and
71	the contract shall be subject to all of the requirements of this
72	part that do not require or otherwise apply to specific benefits
73	other than home care services. To this extent, all of the
74	requirements of this part apply to any organization or contract
75	that limits coverage to home care services, except the
76	requirements for providing comprehensive health care services as
77	provided in ss. 641.19(4), (11), and (12), and 641.31(1), except
78	ss. 641.31(11)(9), (14)(12), (17), (18), (19), (20), (21), (23),
79	and (26)(24) and 641.31095.
80	Section 8.  Section 641.3107, Florida Statutes, is amended
81	to read:
82	641.3107  Delivery of contract.--Unless delivered upon
83	execution or issuance, a health maintenance contract,
84	certificate of coverage, or member handbook shall be mailed or
85	delivered to the subscriber or, in the case of a group health
86	maintenance contract, to the employer or other person who will
87	hold the contract on behalf of the subscriber group within 10
88	working days from approval of the enrollment form by the health
89	maintenance organization or by the effective date of coverage,
90	whichever occurs first. However, if the employer or other person
91	who will hold the contract on behalf of the subscriber group
92	requires retroactive enrollment of a subscriber, the
93	organization shall deliver the contract, certificate, or member
94	handbook to the subscriber within 10 days after receiving notice
95	from the employer of the retroactive enrollment. This section
96	does not apply to the delivery of those contracts specified in
97	s. 641.31(15)(13).
98	Section 9.  Paragraph (a) of subsection (7) of section
99	641.3922, Florida Statutes, is amended to read:
100	641.3922  Conversion contracts; conditions.--Issuance of a
101	converted contract shall be subject to the following conditions:
102	(7)  REASONS FOR CANCELLATION; TERMINATION.--The converted
103	health maintenance contract must contain a cancellation or
104	nonrenewability clause providing that the health maintenance
105	organization may refuse to renew the contract of any person
106	covered thereunder, but cancellation or nonrenewal must be
107	limited to one or more of the following reasons:
108	(a)  Fraud or intentional misrepresentation, subject to the
109	limitations of s. 641.31(25)(23), in applying for any benefits
110	under the converted health maintenance contract.;
111	Section 10.  Subsection (4) of section 641.513, Florida
112	Statutes, is amended to read:
113	641.513  Requirements for providing emergency services and
114	care.--
115	(4)  A subscriber may be charged a reasonable copayment, as
116	provided in s. 641.31(14)(12), for the use of an emergency room.
117
118	====== D I R E C T O R Y  A M E N D M E N T =====
119	Remove lines 118 and 119 and insert:
120	641.31, Florida Statutes, are renumbered as subsections (7)
121	through (42), respectively, and new subsections (5) and (6) are
122	added to
123
124	======= T I T L E  A M E N D M E N T =======
125	Remove line 18 and insert:
126	maintenance contract; requiring certain health maintenance
127	organizations to provide to certain service providers by an
128	Internet website certain information relating to a covered
129	person; providing criteria; specifying time requirements for
130	such health maintenance organizations to implement such
131	requirements; amending ss. 383.145, 641.185,

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