Senate Bill sb0590c1

    Florida Senate - 2007                            CS for SB 590

    By the Committee on Health Regulation; and Senators Saunders
    and Atwater




    588-2155-07

  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

27  primary care physician finds that such care is medically

28  necessary it is in the best interest of the patient to do so;

29  if the facility agrees to be reimbursed at the health

30  maintenance organization's contract rate negotiated with

31  similar providers for the same services and supplies; and if

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






    Florida Senate - 2007                            CS for SB 590
    588-2155-07




 1  the facility meets all guidelines established by the health

 2  maintenance organization related to quality of care,

 3  utilization, referral authorization, risk assumption, use of

 4  the health maintenance organization's network, and other

 5  criteria applicable to providers under contract for the same

 6  services and supplies. If a health maintenance organization

 7  enrolls a new subscriber who already resides in a continuing

 8  care facility or a retirement facility as described in this

 9  subsection, the health maintenance organization must provide

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

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

12  skilled nursing unit or assisted living facility that is part

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

14  subscriber may use the grievance process provided in s.

15  641.511.

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

17  

18          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
19                         Senate Bill 590

20                                 

21  The committee substitute clarifies that the HMO primary care
    physician must make a determination that the referral for
22  nursing care or assisted living care is medically necessary.
    Once this determination is made, the insured subscriber has
23  the right to have that care provided at his or her own
    continuing care facility or retirement facility.
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CODING: Words stricken are deletions; words underlined are additions.