Florida Senate - 2018                        COMMITTEE AMENDMENT
       Bill No. CS for SB 98
       
       
       
       
       
       
                                Ì636818HÎ636818                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  01/11/2018           .                                
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       The Committee on Rules (Steube) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 40 - 71
    4  and insert:
    5  an individual or group health insurance policy that provides
    6  major medical or similar comprehensive coverage health insurance
    7  as defined in s. 624.603, a managed care plan as defined in s.
    8  409.962(10), or a health maintenance organization as defined in
    9  s. 641.19(12).
   10         (b) “Urgent care situation” has the same meaning as in s.
   11  627.42393.
   12         (2) Notwithstanding any other provision of law, effective
   13  January 1, 2017, or six (6) months after the effective date of
   14  the rule adopting the prior authorization form, whichever is
   15  later, a health insurer, or a pharmacy benefits manager on
   16  behalf of the health insurer, which does not provide an
   17  electronic prior authorization process for use by its contracted
   18  providers, shall only use the prior authorization form that has
   19  been approved by the Financial Services Commission for granting
   20  a prior authorization for a medical procedure, course of
   21  treatment, or prescription drug benefit. Such form may not
   22  exceed two pages in length, excluding any instructions or
   23  guiding documentation, and must include all clinical
   24  documentation necessary for the health insurer to make a
   25  decision. At a minimum, the form must include: (1) sufficient
   26  patient information to identify the member, date of birth, full
   27  name, and Health Plan ID number; (2) provider name, address and
   28  phone number; (3) the medical procedure, course of treatment, or
   29  prescription drug benefit being requested, including the medical
   30  reason therefor, and all services tried and failed; (4) any
   31  laboratory documentation required; and (5) an attestation that
   32  all information provided is true and accurate. The form, whether
   33  in electronic or paper format, may not require information that
   34  is not necessary for the determination of medical necessity of,
   35  or coverage for, the requested medical procedure, course of
   36  treatment, or prescription drug. The commission may adopt rules
   37  prescribing such necessary information.
   38  
   39  ================= T I T L E  A M E N D M E N T ================
   40  And the title is amended as follows:
   41         Delete line 6
   42  and insert:
   43         requiring certain information; authorizing the
   44         Financial Services Commission to adopt certain rules;
   45         requiring health