Senate Bill sb0590

    Florida Senate - 2007                                   SB 590

    By Senator Saunders





    37-691-07

  1                      A bill to be entitled

  2         An act relating to health maintenance

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

  4         a health maintenance organization to provide in

  5         writing a disclosure of rights to new

  6         subscribers who reside at a continuing care

  7         facility or retirement facility; providing that

  8         if a subscriber's request to be referred to the

  9         skilled nursing unit or assisted living

10         facility that is part of the subscriber's place

11         of residence is not honored, the subscriber may

12         use a specified grievance process; providing an

13         effective date.

14  

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

16  

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

18  Statutes, is amended to read:

19         641.31  Health maintenance contracts.--

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

21  care facility certified under chapter 651 or a retirement

22  facility consisting of a nursing home or assisted living

23  facility and residential apartments, the subscriber's primary

24  care physician must refer the subscriber to that facility's

25  skilled nursing unit or assisted living facility if requested

26  by the subscriber and agreed to by the facility if the primary

27  care physician finds that it is in the best interest of the

28  patient to do so; if the facility agrees to be reimbursed at

29  the health maintenance organization's contract rate negotiated

30  with similar providers for the same services and supplies; and

31  if the facility meets all guidelines established by the health

                                  1

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






    Florida Senate - 2007                                   SB 590
    37-691-07




 1  maintenance organization related to quality of care,

 2  utilization, referral authorization, risk assumption, use of

 3  the health maintenance organization's network, and other

 4  criteria applicable to providers under contract for the same

 5  services and supplies. If a health maintenance organization

 6  enrolls a new subscriber who already resides in a continuing

 7  care facility or a retirement facility as described in this

 8  subsection, the health maintenance organization must provide

 9  in writing a disclosure of the subscriber's rights under this

10  subsection. If a subscriber's request to be referred to the

11  skilled nursing unit or assisted living facility that is part

12  of the subscriber's place of residence is not honored, the

13  subscriber may use the grievance process provided in s.

14  641.511.

15         Section 2.  This act shall take effect July 1, 2007.

16  

17            *****************************************

18                          SENATE SUMMARY

19    Requires a health maintenance organization to provide in
      writing a disclosure of rights to new subscribers who
20    reside at a continuing care facility or retirement
      facility. Provides a grievance process for a subscriber
21    whose request to be referred to the skilled nursing unit
      or assisted living facility that is part of the
22    subscriber's place of residence is not honored.

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  2

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