Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. CS for CS for SB 1442
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  02/25/2016           .                                

       The Committee on Appropriations (Grimsley and Negron)
       recommended the following:
    1         Senate Amendment (with title amendment)
    3         Between lines 146 and 147
    4  insert:
    5         Section 8. Subsection (11) of section 627.6131, Florida
    6  Statutes, is amended to read:
    7         627.6131 Payment of claims.—
    8         (11) A health insurer may not retroactively deny a claim
    9  because of insured ineligibility:
   10         (a)At any time, if the health insurer verified the
   11  eligibility of an insured at the time of treatment and provided
   12  an authorization number.
   13         (b) More than 1 year after the date of payment of the
   14  claim.
   15         Between lines 277 and 278
   16  insert:
   17         Section 13. Subsection (10) of section 641.3155, Florida
   18  Statutes, is amended to read:
   19         641.3155 Prompt payment of claims.—
   20         (10) A health maintenance organization may not
   21  retroactively deny a claim because of subscriber ineligibility:
   22         (a)At any time, if the health maintenance organization
   23  verified the eligibility of a subscriber at the time of
   24  treatment and provided an authorization number.
   25         (b) More than 1 year after the date of payment of the
   26  claim.
   28  ================= T I T L E  A M E N D M E N T ================
   29  And the title is amended as follows:
   30         Delete lines 2 - 42
   31  and insert:
   32         An act relating to health care services; amending s.
   33         395.003, F.S.; requiring hospitals, ambulatory
   34         surgical centers, specialty hospitals, and urgent care
   35         centers to comply with certain provisions as a
   36         condition of licensure; amending s. 395.301, F.S.;
   37         requiring a hospital to post on its website certain
   38         information regarding its contracts with health
   39         insurers, health maintenance organizations, and health
   40         care practitioners and practice groups and specified
   41         notice to patients and prospective patients; amending
   42         s. 408.7057, F.S.; providing requirements for
   43         settlement offers between certain providers and health
   44         plans in a specified dispute resolution program;
   45         requiring a final order to be subject to judicial
   46         review; amending ss. 456.072, 458.331, and 459.015,
   47         F.S.; providing additional acts that constitute
   48         grounds for denial of a license or disciplinary
   49         action, to which penalties apply; amending s.
   50         626.9541, F.S.; specifying an additional unfair method
   51         of competition and unfair or deceptive act or
   52         practice; amending s. 627.6131, F.S.; prohibiting a
   53         health insurer from retroactively denying a claim
   54         under specified circumstances; creating s. 627.64194,
   55         F.S.; defining terms; providing that an insurer is
   56         solely liable for payment of certain fees to a
   57         nonparticipating provider; providing limitations and
   58         requirements for reimbursements by an insurer to a
   59         nonparticipating provider; providing that certain
   60         disputes relating to reimbursement of a
   61         nonparticipating provider shall be resolved in a court
   62         of competent jurisdiction or through a specified
   63         voluntary dispute resolution process; amending s.
   64         627.6471, F.S.; requiring an insurer that issues a
   65         policy including coverage for the services of a
   66         preferred provider to post on its website certain
   67         information about participating providers and
   68         physicians; requiring that specified notice be
   69         included in policies issued after a specified date
   70         which provide coverage for the services of a preferred
   71         provider; amending s. 627.662, F.S.; providing
   72         applicability of provisions relating to coverage for
   73         services and payment collection limitations to group
   74         health insurance, blanket health insurance, and
   75         franchise health insurance; amending s. 641.3155,
   76         F.S.; prohibiting a health maintenance organization
   77         from retroactively denying a claim under specified
   78         circumstances; providing