Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. CS for CS for SB 1442
       
       
       
       
       
       
                                Ì7651285Î765128                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/26/2016           .                                
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       The Committee on Appropriations (Garcia) recommended the
       following:
       
    1         Senate Amendment (with directory and title amendments)
    2  
    3         Between lines 105 and 106
    4  insert:
    5         (3) The agency shall adopt rules to establish a process to
    6  be used by the resolution organization in considering claim
    7  disputes submitted by a provider or health plan which must
    8  include:
    9         (a) That the resolution organization review and consider
   10  all documentation submitted by both the health plan and the
   11  provider;
   12         (b) That the resolution organization’s recommendation make
   13  findings of fact;
   14         (c) That either party may request that the resolution
   15  organization conduct an evidentiary hearing in which both sides
   16  can present evidence and examine witnesses, and for which the
   17  cost of the hearing is equally shared by the parties;
   18         (d) That the resolution organization may not communicate ex
   19  parte with either the health plan or the provider during the
   20  dispute resolution;
   21         (e) That the resolution organization’s written
   22  recommendation, including findings of fact relating to the
   23  calculation under s. 641.513(5) for the recommended amount due
   24  for the disputed claim, include any evidence relied upon; and
   25         (f) That the issuance by the resolution organization issue
   26  of a written recommendation, supported by findings of fact, to
   27  the agency within 60 days after the requested information is
   28  received by the resolution organization within the timeframes
   29  specified by the resolution organization. In no event shall the
   30  review time exceed 90 days following receipt of the initial
   31  claim dispute submission by the resolution organization.
   32  
   33  ====== D I R E C T O R Y  C L A U S E  A M E N D M E N T ======
   34  And the directory clause is amended as follows:
   35         Delete lines 81 - 82
   36  and insert:
   37  section 408.7057, Florida Statutes, and subsections (3) and (4)
   38  of that section are amended, to read:
   39  
   40  ================= T I T L E  A M E N D M E N T ================
   41  And the title is amended as follows:
   42         Delete line 15
   43  and insert:
   44         dispute resolution program; requiring the Agency for
   45         Health Care Administration to include in its rules
   46         additional requirements relating to a resolution
   47         organization’s process in considering certain claim
   48         disputes; requiring a final order to