House Bill 0913
CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 2000 HB 913
By Representatives Casey, Ritchie, Farkas, Levine, Wilson,
Sobel, Jacobs, Crow, Wallace, Cosgrove, Ritter and Morroni
1 A bill to be entitled
2 An act relating to adverse determinations;
3 amending s. 458.305, F.S.; revising the
4 definition of the term "practice of medicine"
5 to include within the scope of such practice
6 the rendering of an adverse determination;
7 amending s. 459.003, F.S.; revising the
8 definition of the term "practice of osteopathic
9 medicine" to include within the scope of such
10 practice the rendering of an adverse
11 determination; amending s. 641.51, F.S.,
12 relating to quality assurance program
13 requirements for certain managed care
14 organizations; restricting the rendering of
15 adverse determinations by such organizations to
16 certain physicians regarding certain services;
17 requiring such physicians to submit to
18 providers and subscribers the facts and
19 documentation regarding an adverse
20 determination within a specified timeframe;
21 requiring such submission to be in writing and
22 signed by the physician rendering the adverse
23 determination and to include the utilization
24 review criteria or benefits provisions used in
25 the adverse determination; requiring
26 notifications of adverse determinations by such
27 organizations to include information concerning
28 the appeal process for such determinations;
29 providing an effective date.
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31 Be It Enacted by the Legislature of the State of Florida:
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CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 2000 HB 913
529-187A-00
1 Section 1. Subsection (3) of section 458.305, Florida
2 Statutes, is amended to read:
3 458.305 Definitions.--As used in this chapter:
4 (3) "Practice of medicine" means the diagnosis,
5 treatment, operation, or prescription for any human disease,
6 pain, injury, deformity, or other physical or mental
7 condition, including the rendering of an adverse determination
8 as defined in s. 641.47.
9 Section 2. Subsection (3) of section 459.003, Florida
10 Statutes, is amended to read:
11 459.003 Definitions.--As used in this chapter:
12 (3) "Practice of osteopathic medicine" means the
13 diagnosis, treatment, operation, or prescription for any human
14 disease, pain, injury, deformity, or other physical or mental
15 condition, including the rendering of an adverse determination
16 as defined in s. 641.47, which practice is based in part upon
17 educational standards and requirements which emphasize the
18 importance of the musculoskeletal structure and manipulative
19 therapy in the maintenance and restoration of health.
20 Section 3. Subsections (4) through (10) of section
21 641.51, Florida Statutes, are renumbered as subsections (5)
22 through (11), respectively, and a new subsection (4) is added
23 to said section to read:
24 641.51 Quality assurance program; second medical
25 opinion requirement.--
26 (4) The organization shall ensure that only a
27 physician licensed under chapter 458 or chapter 459 may render
28 an adverse determination regarding a service provided by a
29 physician licensed under chapter 458 or chapter 459 and shall
30 require the physician to submit to the provider and the
31 subscriber the facts and documentation regarding the
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CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 2000 HB 913
529-187A-00
1 organization's adverse determination within 2 working days
2 after the subscriber or provider is notified of the adverse
3 determination. The facts and documentation must be written,
4 include the utilization review criteria or benefits provisions
5 used in the adverse determination, and be signed by the
6 physician rendering the adverse determination. The
7 organization must include with the notification of an adverse
8 determination information concerning the appeal process for
9 adverse determinations.
10 Section 4. This act shall take effect July 1, 2000.
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13 HOUSE SUMMARY
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Revises definitions of the terms "practice of medicine"
15 and "practice of osteopathic medicine" to include within
the scope of such practices the rendering of adverse
16 determinations. Revises provisions relating to quality
assurance program requirements for certain managed care
17 organizations to restrict the rendering of adverse
determinations by such organizations to certain
18 physicians regarding certain services. Requires such
physicians to submit to providers and subscribers the
19 facts and documentation regarding an adverse
determination within a specified timeframe. Requires such
20 submission to be in writing and signed by the physician
rendering the adverse determination and to include the
21 utilization review criteria or benefits provisions used
in the adverse determination. Requires notifications of
22 adverse determinations by such organizations to include
information concerning the appeal process for such
23 determinations. See bill for details.
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