Florida Senate - 2010                                    SB 2504
       
       
       
       By Senator Lawson
       
       
       
       
       6-01822-10                                            20102504__
    1                        A bill to be entitled                      
    2         An act relating to hospital-based physicians;
    3         providing definitions; prohibiting a licensed facility
    4         from employing a hospital-based physician or group of
    5         hospital-based physicians or entering into a contract
    6         with such physicians unless those physicians are under
    7         contract with each health insurer that has contracted
    8         with the licensed facility to provide medical
    9         services; requiring the contract between a licensed
   10         facility and a hospital-based physician or group of
   11         hospital-based physicians to contain provisions that
   12         prohibit the physician or group of physicians from
   13         collecting from the enrollees or subscribers of a
   14         health insurer an amount in excess of the payment
   15         received from the health insurer other than the
   16         applicable copayment and certain other payments;
   17         prohibiting a hospital-based physician or group of
   18         hospital-based physicians from collecting from the
   19         enrollees or subscribers of a health insurer any
   20         amount in excess of the payment received from the
   21         health insurer other than the applicable copayment and
   22         certain other payments; providing for disciplinary
   23         action; providing an effective date.
   24  
   25  Be It Enacted by the Legislature of the State of Florida:
   26  
   27         Section 1. Hospital-based physicians.—
   28         (1) As used in this section, the term:
   29         (a) “Hospital-based physician” or “group of hospital-based
   30  physicians” means any physician or group of physicians,
   31  including, but not limited to, pathologists, emergency room
   32  physicians, anesthesiologists, and radiologists, who have
   33  entered into an arrangement, understanding, or contract with a
   34  licensed facility which:
   35         1. Allows the physician or group of physicians to provide
   36  medical services for a facility’s inpatients and outpatients
   37  without being specifically chosen by the patients;
   38         2. Precludes physicians of a similar specialty from
   39  providing medical services to the facility’s inpatients and
   40  outpatients; or
   41         3. Fosters the opportunity for the physician or group of
   42  physicians to be the providers of medical services to the
   43  facility’s inpatients and outpatients within that physician’s or
   44  group of physicians’ specialty type.
   45         (b) “Licensed facility” means a hospital, ambulatory
   46  surgical center, or mobile surgical facility licensed in
   47  accordance with chapter 395, Florida Statutes.
   48         (2) A licensed facility may not employ a hospital-based
   49  physician or group of hospital-based physicians, and may not
   50  enter into an arrangement, understanding, or contract with a
   51  hospital-based physician or group of hospital-based physicians
   52  unless the hospital-based physician or group of hospital-based
   53  physicians is under written contract, or agrees to a written
   54  contract within 90 days after the effective date of the
   55  arrangement with each health insurance company or health
   56  maintenance organization that has contracted with the licensed
   57  facility to provide medical services to its enrollees or
   58  subscribers. The hospital-based physician or group of hospital
   59  based physicians shall contract on terms that are reasonably
   60  comparable to the terms between similar health insurance
   61  companies, health maintenance organizations, and hospital-based
   62  physicians of a similar specialty in the facility’s geographic
   63  area.
   64         (3) Each arrangement, understanding, or contract between a
   65  licensed facility and a hospital-based physician or group of
   66  hospital-based physicians must contain terms that prohibit each
   67  such physician or group of physicians from collecting, or
   68  attempting to collect, from the enrollees or subscribers of a
   69  health insurance company or health maintenance organization any
   70  amount in excess of the payment received from the health
   71  insurance company or health maintenance organization other than
   72  the applicable copayment, deductible, coinsurance, or amounts
   73  for noncovered medical services.
   74         (4) A hospital-based physician or group of hospital-based
   75  physicians, in an arrangement, understanding, or contract as
   76  described in this section, may not collect, or attempt to
   77  collect, from the enrollees or subscribers of a health insurance
   78  company or health maintenance organization any amount other than
   79  the amount specified in subsection (3).
   80         (5) A violation of this section constitutes grounds for
   81  disciplinary actions specified in ss. 395.1065 and 456.072(2),
   82  Florida Statutes.
   83         Section 2. This act shall take effect July 1, 2010.