CS/HB 1001

1	A bill to be entitled
2	An act relating to health maintenance contracts; amending
3	s. 641.31, F.S.; requiring a health maintenance
4	organization to provide in writing a disclosure of rights
5	to new subscribers who reside at a continuing care
6	facility or retirement facility; providing that if a
7	subscriber's request to be referred to the skilled nursing
8	unit or assisted living facility that is part of the
9	subscriber's place of residence is not honored, the
10	subscriber may use a specified grievance process;
11	providing an effective date.
12
13	Be It Enacted by the Legislature of the State of Florida:
14
15	Section 1.  Subsection (25) of section 641.31, Florida
16	Statutes, is amended to read:
17	641.31  Health maintenance contracts.--
18	(25)  If a subscriber is a resident of a continuing care
19	facility certified under chapter 651 or a retirement facility
20	consisting of a nursing home or assisted living facility and
21	residential apartments, the subscriber's primary care physician
22	must refer the subscriber to that facility's skilled nursing
23	unit or assisted living facility if requested by the subscriber
24	and agreed to by the facility; if the primary care physician
25	finds that such care is medically necessary it is in the best
26	interest of the patient to do so; if the facility agrees to be
27	reimbursed at the health maintenance organization's contract
28	rate negotiated with similar providers for the same services and
29	supplies; and if the facility meets all guidelines established
30	by the health maintenance organization related to quality of
31	care, utilization, referral authorization, risk assumption, use
32	of the health maintenance organization's network, and other
33	criteria applicable to providers under contract for the same
34	services and supplies. If a health maintenance organization
35	enrolls a new subscriber who already resides in a continuing
36	care facility or a retirement facility as described in this
37	subsection, the health maintenance organization must provide in
38	writing a disclosure of the subscriber's rights under this
39	subsection. If a subscriber's request to be referred to the
40	skilled nursing unit or assisted living facility that is part of
41	the subscriber's place of residence is not honored, the
42	subscriber may use the grievance process provided in s. 641.511.
43	Section 2.  This act shall take effect July 1, 2007.

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