Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. CS for CS for SB 1442
       
       
       
       
       
       
                                Ì457464>Î457464                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  02/26/2016           .                                
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       The Committee on Appropriations (Negron) recommended the
       following:
       
    1         Senate Amendment 
    2  
    3         Delete lines 165 - 193
    4  and insert:
    5  is not an exclusive provider as defined in s. 627.6472.
    6         1. For purposes of covered emergency services under this
    7  section, a facility licensed under chapter 395 or an urgent care
    8  center as defined in s. 395.002(30) is a nonparticipating
    9  provider if the facility has not contracted with an insurer to
   10  provide emergency services to its insureds at a specified rate.
   11         2. For purposes of covered nonemergency services under
   12  subsection (3), the term does not include an anesthesiologist as
   13  defined in s. 458.3475(1)(a) or s. 459.023(1)(a), an
   14  anesthesiologist assistant as defined in s. 458.3475(1)(b) or s.
   15  459.023(1)(b), a certified registered nurse anesthetist as
   16  described in s. 464.012(4)(a), or a radiologist as defined in s.
   17  468.301(16).
   18         (f) “Participating provider” means, for purposes of this
   19  section, a preferred provider as defined in s. 627.6471 or an
   20  exclusive provider as defined in s. 627.6472.
   21         (2) An insurer is solely liable for payment of fees to a
   22  nonparticipating provider of covered emergency services provided
   23  to an insured in accordance with the coverage terms of the
   24  health insurance policy, and such insured is not liable for
   25  payment of fees for covered services to a nonparticipating
   26  provider of emergency services, other than applicable
   27  copayments, coinsurance, and deductibles. An insurer must
   28  provide coverage for emergency services that:
   29         (a) May not require prior authorization.
   30         (b) Must be provided regardless of whether the services are
   31  furnished by a participating provider or a nonparticipating
   32  provider.
   33         (c) May impose a coinsurance amount, copayment, or
   34  limitation of benefits requirement for a nonparticipating
   35  provider only if the same requirement applies to a participating
   36  provider.
   37  
   38  The provisions of s. 627.638 apply to this subsection.
   39         (3) An insurer is solely liable for payment of fees to a
   40  nonparticipating provider, except a provider described in
   41  subparagraph (1)(e)2., of covered nonemergency services