Senate Bill sb1066c2
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    Florida Senate - 2004                    CS for CS for SB 1066
    By the Committees on Banking and Insurance; Health, Aging, and
    Long-Term Care; and Senator Saunders
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  1                      A bill to be entitled
  2         An act relating to health maintenance
  3         organizations; amending s. 408.7056, F.S.;
  4         changing the name of the Statewide Provider and
  5         Subscriber Assistance Program to the Subscriber
  6         Assistance Program; revising a definition;
  7         requiring certain records and reports to be
  8         provided to the Subscriber Assistance Panel;
  9         providing for penalties; requiring that a
10         quorum be present before a grievance can be
11         heard or voted upon; establishing a maximum
12         number of panel members; amending s. 641.3154,
13         F.S.; conforming provisions to changes made by
14         the act; amending s. 641.511, F.S.; conforming
15         provisions; adopting the federal claims
16         procedures for certain commercial health
17         maintenance organizations; amending s. 641.58,
18         F.S.; conforming provisions; providing an
19         effective date.
20  
21  Be It Enacted by the Legislature of the State of Florida:
22  
23         Section 1.  Section 408.7056, Florida Statutes, is
24  amended to read:
25         408.7056  Statewide Provider and Subscriber Assistance
26  Program.--
27         (1)  As used in this section, the term:
28         (a)  "Agency" means the Agency for Health Care
29  Administration.
30         (b)  "Department" means the Department of Financial
31  Services.
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 1         (c)  "Grievance procedure" means an established set of
 2  rules that specify a process for appeal of an organizational
 3  decision.
 4         (d)  "Health care provider" or "provider" means a
 5  state-licensed or state-authorized facility, a facility
 6  principally supported by a local government or by funds from a
 7  charitable organization that holds a current exemption from
 8  federal income tax under s. 501(c)(3) of the Internal Revenue
 9  Code, a licensed practitioner, a county health department
10  established under part I of chapter 154, a prescribed
11  pediatric extended care center defined in s. 400.902, a
12  federally supported primary care program such as a migrant
13  health center or a community health center authorized under s.
14  329 or s. 330 of the United States Public Health Services Act
15  that delivers health care services to individuals, or a
16  community facility that receives funds from the state under
17  the Community Alcohol, Drug Abuse, and Mental Health Services
18  Act and provides mental health services to individuals.
19         (e)  "Managed care entity" means a health maintenance
20  organization or a prepaid health clinic certified under
21  chapter 641, a prepaid health plan authorized under s.
22  409.912, or an exclusive provider organization certified under
23  s. 627.6472.
24         (f)  "Office" means the Office of Insurance Regulation
25  of the Financial Services Commission.
26         (g)  "Panel" means a statewide provider and subscriber
27  assistance panel selected as provided in subsection (11).
28         (2)  The agency shall adopt and implement a program to
29  provide assistance to subscribers and providers, including
30  those whose grievances are not resolved by the managed care
31  entity to the satisfaction of the subscriber or provider. The
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 1  program shall consist of one or more panels that meet as often
 2  as necessary to timely review, consider, and hear grievances
 3  and recommend to the agency or the office any actions that
 4  should be taken concerning individual cases heard by the
 5  panel. The panel shall hear every grievance filed by
 6  subscribers and providers on behalf of subscribers, unless the
 7  grievance:
 8         (a)  Relates to a managed care entity's refusal to
 9  accept a provider into its network of providers;
10         (b)  Is part of an internal grievance in a Medicare
11  managed care entity or a reconsideration appeal through the
12  Medicare appeals process which does not involve a quality of
13  care issue;
14         (c)  Is related to a health plan not regulated by the
15  state such as an administrative services organization,
16  third-party administrator, or federal employee health benefit
17  program;
18         (d)  Is related to appeals by in-plan suppliers and
19  providers, unless related to quality of care provided by the
20  plan;
21         (e)  Is part of a Medicaid fair hearing pursued under
22  42 C.F.R. ss. 431.220 et seq.;
23         (f)  Is the basis for an action pending in state or
24  federal court;
25         (g)  Is related to an appeal by nonparticipating
26  providers, unless related to the quality of care provided to a
27  subscriber by the managed care entity and the provider is
28  involved in the care provided to the subscriber;
29         (h)  Was filed before the subscriber or provider
30  completed the entire internal grievance procedure of the
31  managed care entity, the managed care entity has complied with
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 1  its timeframes for completing the internal grievance
 2  procedure, and the circumstances described in subsection (6)
 3  do not apply;
 4         (i)  Has been resolved to the satisfaction of the
 5  subscriber or provider who filed the grievance, unless the
 6  managed care entity's initial action is egregious or may be
 7  indicative of a pattern of inappropriate behavior;
 8         (j)  Is limited to seeking damages for pain and
 9  suffering, lost wages, or other incidental expenses, including
10  accrued interest on unpaid balances, court costs, and
11  transportation costs associated with a grievance procedure;
12         (k)  Is limited to issues involving conduct of a health
13  care provider or facility, staff member, or employee of a
14  managed care entity which constitute grounds for disciplinary
15  action by the appropriate professional licensing board and is
16  not indicative of a pattern of inappropriate behavior, and the
17  agency, office, or department has reported these grievances to
18  the appropriate professional licensing board or to the health
19  facility regulation section of the agency for possible
20  investigation; or
21         (l)  Is withdrawn by the subscriber or provider.
22  Failure of the subscriber or the provider to attend the
23  hearing shall be considered a withdrawal of the grievance.
24         (3)  The agency shall review all grievances within 60
25  days after receipt and make a determination whether the
26  grievance shall be heard.  Once the agency notifies the panel,
27  the subscriber or provider, and the managed care entity that a
28  grievance will be heard by the panel, the panel shall hear the
29  grievance either in the network area or by teleconference no
30  later than 120 days after the date the grievance was filed.
31  The agency shall notify the parties, in writing, by facsimile
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 1  transmission, or by phone, of the time and place of the
 2  hearing. The panel may take testimony under oath, request
 3  certified copies of documents, and take similar actions to
 4  collect information and documentation that will assist the
 5  panel in making findings of fact and a recommendation. The
 6  panel shall issue a written recommendation, supported by
 7  findings of fact, to the provider or subscriber, to the
 8  managed care entity, and to the agency or the office no later
 9  than 15 working days after hearing the grievance.  If at the
10  hearing the panel requests additional documentation or
11  additional records, the time for issuing a recommendation is
12  tolled until the information or documentation requested has
13  been provided to the panel. The proceedings of the panel are
14  not subject to chapter 120.
15         (4)  If, upon receiving a proper patient authorization
16  along with a properly filed grievance, the agency requests
17  medical records from a health care provider or managed care
18  entity, the health care provider or managed care entity that
19  has custody of the records has 10 days to provide the records
20  to the agency. Records include medical records, communication
21  logs associated with the grievance both to and from the
22  subscriber, contracts, and any other contents of the internal
23  grievance file associated with the complaint filed with the
24  Subscriber Assistance Program. Failure to provide requested
25  medical records may result in the imposition of a fine of up
26  to $500.  Each day that records are not produced is considered
27  a separate violation.
28         (5)  Grievances that the agency determines pose an
29  immediate and serious threat to a subscriber's health must be
30  given priority over other grievances. The panel may meet at
31  the call of the chair to hear the grievances as quickly as
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 1  possible but no later than 45 days after the date the
 2  grievance is filed, unless the panel receives a waiver of the
 3  time requirement from the subscriber.  The panel shall issue a
 4  written recommendation, supported by findings of fact, to the
 5  office or the agency within 10 days after hearing the
 6  expedited grievance.
 7         (6)  When the agency determines that the life of a
 8  subscriber is in imminent and emergent jeopardy, the chair of
 9  the panel may convene an emergency hearing, within 24 hours
10  after notification to the managed care entity and to the
11  subscriber, to hear the grievance.  The grievance must be
12  heard notwithstanding that the subscriber has not completed
13  the internal grievance procedure of the managed care entity.
14  The panel shall, upon hearing the grievance, issue a written
15  emergency recommendation, supported by findings of fact, to
16  the managed care entity, to the subscriber, and to the agency
17  or the office for the purpose of deferring the imminent and
18  emergent jeopardy to the subscriber's life.  Within 24 hours
19  after receipt of the panel's emergency recommendation, the
20  agency or office may issue an emergency order to the managed
21  care entity. An emergency order remains in force until:
22         (a)  The grievance has been resolved by the managed
23  care entity;
24         (b)  Medical intervention is no longer necessary; or
25         (c)  The panel has conducted a full hearing under
26  subsection (3) and issued a recommendation to the agency or
27  the office, and the agency or office has issued a final order.
28         (7)  After hearing a grievance, the panel shall make a
29  recommendation to the agency or the office which may include
30  specific actions the managed care entity must take to comply
31  with state laws or rules regulating managed care entities.
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 1         (8)  A managed care entity, subscriber, or provider
 2  that is affected by a panel recommendation may within 10 days
 3  after receipt of the panel's recommendation, or 72 hours after
 4  receipt of a recommendation in an expedited grievance, furnish
 5  to the agency or office written evidence in opposition to the
 6  recommendation or findings of fact of the panel.
 7         (9)  No later than 30 days after the issuance of the
 8  panel's recommendation and, for an expedited grievance, no
 9  later than 10 days after the issuance of the panel's
10  recommendation, the agency or the office may adopt the panel's
11  recommendation or findings of fact in a proposed order or an
12  emergency order, as provided in chapter 120, which it shall
13  issue to the managed care entity.  The agency or office may
14  issue a proposed order or an emergency order, as provided in
15  chapter 120, imposing fines or sanctions, including those
16  contained in ss. 641.25 and 641.52.  The agency or the office
17  may reject all or part of the panel's recommendation. All
18  fines collected under this subsection must be deposited into
19  the Health Care Trust Fund.
20         (10)  In determining any fine or sanction to be
21  imposed, the agency and the office may consider the following
22  factors:
23         (a)  The severity of the noncompliance, including the
24  probability that death or serious harm to the health or safety
25  of the subscriber will result or has resulted, the severity of
26  the actual or potential harm, and the extent to which
27  provisions of chapter 641 were violated.
28         (b)  Actions taken by the managed care entity to
29  resolve or remedy any quality-of-care grievance.
30         (c)  Any previous incidents of noncompliance by the
31  managed care entity.
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 1         (d)  Any other relevant factors the agency or office
 2  considers appropriate in a particular grievance.
 3         (11)  The panel shall consist of the Insurance Consumer
 4  Advocate, or designee thereof, established by s. 627.0613; at
 5  least two members employed by the agency and at least two
 6  members employed by the department, chosen by their respective
 7  agencies; a consumer appointed by the Governor; a physician
 8  appointed by the Governor, as a standing member; and, if
 9  necessary, physicians who have expertise relevant to the case
10  to be heard, on a rotating basis. The agency may contract with
11  a medical director, and a primary care physician, or both, who
12  shall provide additional technical expertise to the panel but
13  who shall not be voting members of the panel.  The medical
14  director shall be selected from a health maintenance
15  organization with a current certificate of authority to
16  operate in Florida.
17         (12)  A majority of those panel members required under
18  subsection (11) shall constitute a quorum for any meeting or
19  hearing of the panel. A grievance may not be heard or voted
20  upon at any panel meeting or hearing unless a quorum is
21  present, except that a minority of the panel may adjourn a
22  meeting or hearing until a quorum is present. A panel convened
23  for the purpose of hearing a subscriber's grievance in
24  accordance with subsections (2) and (3) shall not consist of
25  more than 11 members.
26         (13)(12)  Every managed care entity shall submit a
27  quarterly report to the agency, the office, and the department
28  listing the number and the nature of all subscribers' and
29  providers' grievances which have not been resolved to the
30  satisfaction of the subscriber or provider after the
31  subscriber or provider follows the entire internal grievance
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 1  procedure of the managed care entity. The agency shall notify
 2  all subscribers and providers included in the quarterly
 3  reports of their right to file an unresolved grievance with
 4  the panel.
 5         (14)(13)  A proposed order issued by the agency or
 6  office which only requires the managed care entity to take a
 7  specific action under subsection (7) is subject to a summary
 8  hearing in accordance with s. 120.574, unless all of the
 9  parties agree otherwise. If the managed care entity does not
10  prevail at the hearing, the managed care entity must pay
11  reasonable costs and attorney's fees of the agency or the
12  office incurred in that proceeding.
13         (15)(14)(a)  Any information that identifies a
14  subscriber which is held by the panel, agency, or department
15  pursuant to this section is confidential and exempt from the
16  provisions of s. 119.07(1) and s. 24(a), Art. I of the State
17  Constitution. However, at the request of a subscriber or
18  managed care entity involved in a grievance procedure, the
19  panel, agency, or department shall release information
20  identifying the subscriber involved in the grievance procedure
21  to the requesting subscriber or managed care entity.
22         (b)  Meetings of the panel shall be open to the public
23  unless the provider or subscriber whose grievance will be
24  heard requests a closed meeting or the agency or the
25  department determines that information which discloses the
26  subscriber's medical treatment or history or information
27  relating to internal risk management programs as defined in s.
28  641.55(5)(c), (6), and (8) may be revealed at the panel
29  meeting, in which case that portion of the meeting during
30  which a subscriber's medical treatment or history or internal
31  risk management program information is discussed shall be
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 1  exempt from the provisions of s. 286.011 and s. 24(b), Art. I
 2  of the State Constitution. All closed meetings shall be
 3  recorded by a certified court reporter.
 4         Section 2.  Subsection (4) of section 641.3154, Florida
 5  Statutes, is amended to read:
 6         641.3154  Organization liability; provider billing
 7  prohibited.--
 8         (4)  A provider or any representative of a provider,
 9  regardless of whether the provider is under contract with the
10  health maintenance organization, may not collect or attempt to
11  collect money from, maintain any action at law against, or
12  report to a credit agency a subscriber of an organization for
13  payment of services for which the organization is liable, if
14  the provider in good faith knows or should know that the
15  organization is liable. This prohibition applies during the
16  pendency of any claim for payment made by the provider to the
17  organization for payment of the services and any legal
18  proceedings or dispute resolution process to determine whether
19  the organization is liable for the services if the provider is
20  informed that the such proceedings are taking place. It is
21  presumed that a provider does not know and should not know
22  that an organization is liable unless:
23         (a)  The provider is informed by the organization that
24  it accepts liability;
25         (b)  A court of competent jurisdiction determines that
26  the organization is liable;
27         (c)  The office or agency makes a final determination
28  that the organization is required to pay for the such services
29  subsequent to a recommendation made by the Statewide Provider
30  and Subscriber Assistance Panel pursuant to s. 408.7056; or
31  
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 1         (d)  The agency issues a final order that the
 2  organization is required to pay for such services subsequent
 3  to a recommendation made by a resolution organization pursuant
 4  to s. 408.7057.
 5         Section 3.  Section 641.511, Florida Statutes, is
 6  amended to read:
 7         641.511  Subscriber grievance reporting and resolution
 8  requirements.--
 9         (1)  Every organization must have a grievance procedure
10  available to its subscribers for the purpose of addressing
11  complaints and grievances. Every organization must notify its
12  subscribers that a subscriber must submit a grievance within 1
13  year after the date of occurrence of the action that initiated
14  the grievance, and may submit the grievance for review to the
15  Statewide Provider and Subscriber Assistance Program panel as
16  provided in s. 408.7056 after receiving a final disposition of
17  the grievance through the organization's grievance process.
18  An organization shall maintain records of all grievances and
19  shall report annually to the agency the total number of
20  grievances handled, a categorization of the cases underlying
21  the grievances, and the final disposition of the grievances.
22         (2)  When an organization receives an initial complaint
23  from a subscriber, the organization must respond to the
24  complaint within a reasonable time after its submission.  At
25  the time of receipt of the initial complaint, the organization
26  shall inform the subscriber that the subscriber has a right to
27  file a written grievance at any time and that assistance in
28  preparing the written grievance shall be provided by the
29  organization.
30         (3)  Each organization's grievance procedure, as
31  required under subsection (1), must include, at a minimum:
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 1         (a)  An explanation of how to pursue redress of a
 2  grievance.
 3         (b)  The names of the appropriate employees or a list
 4  of grievance departments that are responsible for implementing
 5  the organization's grievance procedure.  The list must include
 6  the address and the toll-free telephone number of each
 7  grievance department, the address of the agency and its
 8  toll-free telephone hotline number, and the address of the
 9  Statewide Provider and Subscriber Assistance Program and its
10  toll-free telephone number.
11         (c)  The description of the process through which a
12  subscriber may, at any time, contact the toll-free telephone
13  hotline of the agency to inform it of the unresolved
14  grievance.
15         (d)  A procedure for establishing methods for
16  classifying grievances as urgent and for establishing time
17  limits for an expedited review within which such grievances
18  must be resolved.
19         (e)  A notice that a subscriber may voluntarily pursue
20  binding arbitration in accordance with the terms of the
21  contract if offered by the organization, after completing the
22  organization's grievance procedure and as an alternative to
23  the Statewide Provider and Subscriber Assistance Program. Such
24  notice shall include an explanation that the subscriber may
25  incur some costs if the subscriber pursues binding
26  arbitration, depending upon the terms of the subscriber's
27  contract.
28         (f)  A process whereby the grievance manager
29  acknowledges the grievance and investigates the grievance in
30  order to notify the subscriber of a final decision in writing.
31  
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 1         (g)  A procedure for providing individuals who are
 2  unable to submit a written grievance with access to the
 3  grievance process, which shall include assistance by the
 4  organization in preparing the grievance and communicating back
 5  to the subscriber.
 6         (4)(a)  With respect to a grievance concerning an
 7  adverse determination, an organization shall make available to
 8  the subscriber a review of the grievance by an internal review
 9  panel; the such review must be requested within 30 days after
10  the organization's transmittal of the final determination
11  notice of an adverse determination.  A majority of the panel
12  shall be persons who previously were not involved in the
13  initial adverse determination.  A person who previously was
14  involved in the adverse determination may appear before the
15  panel to present information or answer questions.  The panel
16  shall have the authority to bind the organization to the
17  panel's decision.
18         (b)  An organization shall ensure that a majority of
19  the persons reviewing a grievance involving an adverse
20  determination are providers who have appropriate expertise.
21  An organization shall issue a copy of the written decision of
22  the review panel to the subscriber and to the provider, if
23  any, who submits a grievance on behalf of a subscriber. In
24  cases where there has been a denial of coverage of service,
25  the reviewing provider shall not be a provider previously
26  involved with the adverse determination.
27         (c)  An organization shall establish written procedures
28  for a review of an adverse determination.  Review procedures
29  shall be available to the subscriber and to a provider acting
30  on behalf of a subscriber.
31  
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 1         (d)  In any case when the review process does not
 2  resolve a difference of opinion between the organization and
 3  the subscriber or the provider acting on behalf of the
 4  subscriber, the subscriber or the provider acting on behalf of
 5  the subscriber may submit a written grievance to the Statewide
 6  Provider and Subscriber Assistance Program.
 7         (5)  Except as provided in subsection (6), the
 8  organization shall resolve a grievance within 60 days after
 9  receipt of the grievance, or within a maximum of 90 days if
10  the grievance involves the collection of information outside
11  the service area. These time limitations are tolled if the
12  organization has notified the subscriber, in writing, that
13  additional information is required for proper review of the
14  grievance and that the such time limitations are tolled until
15  such information is provided. After the organization receives
16  the requested information, the time allowed for completion of
17  the grievance process resumes. The Employee Retirement Income
18  Security Act of 1974 (ERISA) as implemented by 29 C.F.R.
19  2560.503-1 is adopted and incorporated by reference as
20  applicable to all organizations that administer small and
21  large group health plans that are subject to 29 C.F.R.
22  2560.503-1. The claims procedures of the regulations of the
23  Employee Retirement Income Security Act of 1974 (ERISA) as
24  implemented by 29 C.F.R. 2560.503-1 shall be the minimum
25  standards for grievance processes for claims for benefits for
26  small and large group health plans that are subject to 29
27  C.F.R. 2560.503-1.
28         (6)(a)  An organization shall establish written
29  procedures for the expedited review of an urgent grievance. A
30  request for an expedited review may be submitted orally or in
31  writing and shall be subject to the review procedures of this
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 1  section, if it meets the criteria of this section. Unless it
 2  is submitted in writing, for purposes of the grievance
 3  reporting requirements in subsection (1), the request shall be
 4  considered an appeal of a utilization review decision and not
 5  a grievance. Expedited review procedures shall be available to
 6  a subscriber and to the provider acting on behalf of a
 7  subscriber. For purposes of this subsection, "subscriber"
 8  includes the legal representative of a subscriber.
 9         (b)  Expedited reviews shall be evaluated by an
10  appropriate clinical peer or peers. The clinical peer or peers
11  shall not have been involved in the initial adverse
12  determination.
13         (c)  In an expedited review, all necessary information,
14  including the organization's decision, shall be transmitted
15  between the organization and the subscriber, or the provider
16  acting on behalf of the subscriber, by telephone, facsimile,
17  or the most expeditious method available.
18         (d)  In an expedited review, an organization shall make
19  a decision and notify the subscriber, or the provider acting
20  on behalf of the subscriber, as expeditiously as the
21  subscriber's medical condition requires, but in no event more
22  than 72 hours after receipt of the request for review. If the
23  expedited review is a concurrent review determination, the
24  service shall be continued without liability to the subscriber
25  until the subscriber has been notified of the determination.
26         (e)  An organization shall provide written confirmation
27  of its decision concerning an expedited review within 2
28  working days after providing notification of that decision, if
29  the initial notification was not in writing.
30         (f)  An organization shall provide reasonable access,
31  not to exceed 24 hours after receiving a request for an
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 1  expedited review, to a clinical peer who can perform the
 2  expedited review.
 3         (g)  In any case when the expedited review process does
 4  not resolve a difference of opinion between the organization
 5  and the subscriber or the provider acting on behalf of the
 6  subscriber, the subscriber or the provider acting on behalf of
 7  the subscriber may submit a written grievance to the Statewide
 8  Provider and Subscriber Assistance Program.
 9         (h)  An organization shall not provide an expedited
10  retrospective review of an adverse determination.
11         (7)  Each organization shall send to the agency a copy
12  of its quarterly grievance reports submitted to the office
13  under s. 408.7056(13) pursuant to s. 408.7056(12).
14         (8)  The agency shall investigate all reports of
15  unresolved quality of care grievances received from:
16         (a)  Annual and quarterly grievance reports submitted
17  by the organization to the office.
18         (b)  Review requests of subscribers whose grievances
19  remain unresolved after the subscriber has followed the full
20  grievance procedure of the organization.
21         (9)(a)  The agency shall advise subscribers with
22  grievances to follow their organization's formal grievance
23  process for resolution prior to review by the Statewide
24  Provider and Subscriber Assistance Program. The subscriber
25  may, however, submit a copy of the grievance to the agency at
26  any time during the process.
27         (b)  Requiring completion of the organization's
28  grievance process before the Statewide Provider and Subscriber
29  Assistance Program panel's review does not preclude the agency
30  from investigating any complaint or grievance before the
31  organization makes its final determination.
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 1         (10)  Each organization must notify the subscriber in a
 2  final decision letter that the subscriber may request review
 3  of the organization's decision concerning the grievance by the
 4  Statewide Provider and Subscriber Assistance Program, as
 5  provided in s. 408.7056, if the grievance is not resolved to
 6  the satisfaction of the subscriber. The final decision letter
 7  must inform the subscriber that the request for review must be
 8  made within 365 days after receipt of the final decision
 9  letter, must explain how to initiate such a review, and must
10  include the addresses and toll-free telephone numbers of the
11  agency and the Statewide Provider and Subscriber Assistance
12  Program.
13         (11)  Each organization, as part of its contract with
14  any provider, must require the provider to post a consumer
15  assistance notice prominently displayed in the reception area
16  of the provider and clearly noticeable by all patients. The
17  consumer assistance notice must state the addresses and
18  toll-free telephone numbers of the Agency for Health Care
19  Administration, the Statewide Provider and Subscriber
20  Assistance Program, and the Department of Financial Services.
21  The consumer assistance notice must also clearly state that
22  the address and toll-free telephone number of the
23  organization's grievance department shall be provided upon
24  request. The agency may adopt rules to implement this section.
25         (12)  The agency may impose administrative sanction, in
26  accordance with s. 641.52, against an organization for
27  noncompliance with this section.
28         Section 4.  Subsection (4) of section 641.58, Florida
29  Statutes, is amended to read:
30         641.58  Regulatory assessment; levy and amount; use of
31  funds; tax returns; penalty for failure to pay.--
                                  17
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    Florida Senate - 2004                    CS for CS for SB 1066
    311-1317-04
 1         (4)  The moneys received and deposited into the Health
 2  Care Trust Fund shall be used to defray the expenses of the
 3  agency in the discharge of its administrative and regulatory
 4  powers and duties under this part, including conducting an
 5  annual survey of the satisfaction of members of health
 6  maintenance organizations; contracting with physician
 7  consultants for the Statewide Provider and Subscriber
 8  Assistance Panel; maintaining offices and necessary supplies,
 9  essential equipment, and other materials, salaries and
10  expenses of required personnel; and discharging the
11  administrative and regulatory powers and duties imposed under
12  this part.
13         Section 5.  This act shall take effect upon becoming a
14  law.
15  
16          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
17                          CS for SB 1066
18                                 
19  Clarifies that the ERISA (Employee Retirement Income Security
    Act of 1974) claims procedures for grievance processes which
20  are adopted under the bill are limited to claims for benefits
    for small and large group health plans.
21  
22  
23  
24  
25  
26  
27  
28  
29  
30  
31  
                                  18
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