Florida Senate - 2016                          SENATOR AMENDMENT
       Bill No. CS/CS/CS/HB 221, 1st Eng.
       
       
       
       
       
       
                                Ì938054-Î938054                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                 Floor: WD/RM          .                                
             03/11/2016 04:58 PM       .                                
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       Senator Garcia moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Between lines 312 and 313
    4  insert:
    5         Section 12. Paragraph (b) of subsection (3) of section
    6  627.6686, Florida Statutes, is amended to read:
    7         627.6686 Coverage for individuals with autism spectrum
    8  disorder required; exception.—
    9         (3) A health insurance plan issued or renewed on or after
   10  April 1, 2009, shall provide coverage to an eligible individual
   11  for:
   12         (b) Treatment of autism spectrum disorder and down syndrome
   13  through speech therapy, occupational therapy, physical therapy,
   14  and applied behavior analysis. Applied behavior analysis
   15  services shall be provided by an individual certified pursuant
   16  to s. 393.17 or an individual licensed under chapter 490 or
   17  chapter 491.
   18         Section 13. Paragraph (b) of subsection (3) of section
   19  641.31098, Florida Statutes, is amended to read:
   20         641.31098 Coverage for individuals with developmental
   21  disabilities.—
   22         (3) A health maintenance contract issued or renewed on or
   23  after April 1, 2009, shall provide coverage to an eligible
   24  individual for:
   25         (b) Treatment of autism spectrum disorder and down
   26  syndrome, through speech therapy, occupational therapy, physical
   27  therapy, and applied behavior analysis services. Applied
   28  behavior analysis services shall be provided by an individual
   29  certified pursuant to s. 393.17 or an individual licensed under
   30  chapter 490 or chapter 491.
   31         Section 14. Notwithstanding the enactment of subsection (2)
   32  made to s. 627.42392, Florida Statutes, by HB 423, 1st Eng.,
   33  2016 Regular Session, subsection (2) of s. 627.42392, Florida
   34  Statutes, is enacted to read:
   35         (2) Notwithstanding any other provision of law,
   36  effective  January 1, 2017 or six (6) months after the effective
   37  date of the rule adopting the prior authorization form,
   38  whichever is later, a health insurer, or a pharmacy benefits
   39  manager on behalf of the health insurer, which does not provide
   40  an electronic prior authorization process for use by its
   41  contracted providers, shall only use the prior authorization
   42  form  that has been approved by the Financial Services
   43  Commission for granting a prior authorization for a medical
   44  procedure, course of treatment, or prescription drug benefit.
   45  Such form may not exceed two pages in length, excluding any
   46  instructions or guiding documentation, and must include all
   47  clinical documentation necessary for health insurer to make a
   48  decision. At a minimum, the form must include: (1) sufficient
   49  patient information to identify the member, date of birth, full
   50  name, and Health Plan ID number; (2) Provider name, address and
   51  phone number; (3) the medical procedure, course of treatment, or
   52  prescription drug benefit being requested, including the medical
   53  reason therefor, and all services tried and failed; (4) any
   54  laboratory documentation required; and (5) an attestation that
   55  all information provided is true and accurate.
   56         Section 15. It is the intent of the Legislature that the
   57  enactment of s. 627.42392(2), Florida Statutes, made by this act
   58  shall control over the enactment of that subsection made by HB
   59  423, 1st Eng., 2016 Regular Session, regardless of the order in
   60  which the bills are enacted.
   61  
   62  
   63  ================= T I T L E  A M E N D M E N T ================
   64  And the title is amended as follows:
   65         Delete line 46
   66  and insert:
   67         insurance, and franchise health insurance; amending s.
   68         627.6686, F.S.; requiring a specified health insurance
   69         plan to provide specified coverage for treatment of
   70         down syndrome; amending s. 641.31098, F.S.; requiring
   71         a specified health maintenance contract to provide
   72         specified health maintenance contract to provide
   73         specified coverage for treatment of down syndrome;
   74         enacting s. 627.42392, F.S.; requiring a health
   75         insurer or a pharmacy benefits manager to only use a
   76         certain form; providing requirements for such form;
   77         providing