Senate Bill sb2350

    Florida Senate - 2004                                  SB 2350

    By Senator Fasano





    11-1700-04

  1                      A bill to be entitled

  2         An act relating to emergency medical services

  3         provided by health maintenance organizations;

  4         amending s. 641.513, F.S.; limiting the amount

  5         of reimbursement available to a provider for

  6         hospital services if the provider does not have

  7         a contract with the health maintenance

  8         organization; requiring reimbursement for

  9         hospital emergency services that are provided

10         to a subscriber as specified, regardless of the

11         existence of an emergency medical condition;

12         providing an effective date.

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

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16         Section 1.  Subsection (5) of section 641.513, Florida

17  Statutes, is amended to read:

18         641.513  Requirements for providing emergency services

19  and care.--

20         (5)  Reimbursement for services pursuant to this

21  section by a provider who does not have a contract with the

22  health maintenance organization shall be the lesser of:

23         (a)  The provider's charges;

24         (b)  The usual and customary provider charges for

25  similar services in the community where the services were

26  provided; or

27         (c)  The charge mutually agreed to by the health

28  maintenance organization and the provider within 60 days of

29  the submittal of the claim; or.

30         (d)  For hospital services only, 120 percent of the

31  Medicare rate.

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






    Florida Senate - 2004                                  SB 2350
    11-1700-04




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 2  Such reimbursement shall be net of any applicable copayment

 3  authorized pursuant to subsection (4). If a hospital provides

 4  emergency services, whether outpatient or inpatient, to a

 5  subscriber, reimbursement for hospital services covered under

 6  the subscriber's contract shall be in accordance with this

 7  subsection, regardless of the existence of an emergency

 8  medical condition.

 9         Section 2.  This act shall take effect July 1, 2004.

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12                          SENATE SUMMARY

13    Limits reimbursement for emergency medical services
      provided if the provider does not have a contract with
14    the health maintenance organization.  Requires
      reimbursement as specified when a hospital has provided
15    emergency services to a subscriber, regardless of the
      existence of an emergency medical condition.
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CODING: Words stricken are deletions; words underlined are additions.