House Bill hb0159

    Florida House of Representatives - 2001                 HB 159

        By Representative Rubio






  1                      A bill to be entitled

  2         An act relating to health maintenance

  3         organizations; amending s. 641.51, F.S.;

  4         providing a licensure requirement for a

  5         physician who renders an adverse determination

  6         regarding services provided by another

  7         state-licensed physician; eliminating authority

  8         of certain out-of-state physicians to render

  9         such determinations; providing an effective

10         date.

11

12  Be It Enacted by the Legislature of the State of Florida:

13

14         Section 1.  Subsection (4) of section 641.51, Florida

15  Statutes, is amended to read:

16         641.51  Quality assurance program; second medical

17  opinion requirement.--

18         (4)  The organization shall ensure that only a

19  physician with an active, unencumbered license licensed under

20  chapter 458 or chapter 459, or an allopathic or osteopathic

21  physician with an active, unencumbered license in another

22  state with similar licensing requirements may render an

23  adverse determination regarding a service provided by a

24  physician licensed in this state. The organization shall

25  submit to the treating provider and the subscriber written

26  notification regarding the organization's adverse

27  determination within 2 working days after the subscriber or

28  provider is notified of the adverse determination. The written

29  notification must include the utilization review criteria or

30  benefits provisions used in the adverse determination,

31  identify the physician who rendered the adverse determination,

                                  1

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 2001                 HB 159

    736-110A-01






  1  and be signed by an authorized representative of the

  2  organization or the physician who rendered the adverse

  3  determination. The organization must include with the

  4  notification of an adverse determination information

  5  concerning the appeal process for adverse determinations.

  6         Section 2.  This act shall take effect upon becoming a

  7  law.

  8

  9            *****************************************

10                          HOUSE SUMMARY

11
      Requires the state license of a physician who renders an
12    adverse determination for a health maintenance
      organization, regarding services provided by another
13    physician, to be an active, unencumbered license.
      Eliminates a provision that allows such determinations to
14    be made by certain out-of-state physicians.

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

                                  2

CODING: Words stricken are deletions; words underlined are additions.