Senate Bill sb1800

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2005                                  SB 1800

    By the Committee on Banking and Insurance





    597-1612-05

  1                      A bill to be entitled

  2         An act relating to health maintenance

  3         organizations; amending s. 641.316, F.S.;

  4         redefining the term "fiscal intermediary

  5         services organization"; amending s. 641.234,

  6         F.S.; expanding the requirement that a health

  7         maintenance organization remains responsible

  8         for violations of certain statutory

  9         requirements if the organization transfers to

10         any entity the obligations to pay any provider

11         for claims arising from services to subscribers

12         of the organization; providing an effective

13         date.

14  

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

16  

17         Section 1.  Paragraph (b) of subsection (2) of section

18  641.316, Florida Statutes, is amended to read:

19         641.316  Fiscal intermediary services.--

20         (2)

21         (b)  The term "fiscal intermediary services

22  organization" means a person or entity that which performs

23  fiduciary or fiscal intermediary services to health care

24  professionals who contract with health maintenance

25  organizations other than a fiscal intermediary services

26  organization owned, operated, or controlled by a hospital

27  licensed under chapter 395, an insurer licensed under chapter

28  624, a third-party administrator licensed under chapter 626, a

29  prepaid limited health service organization licensed under

30  chapter 636, a health maintenance organization licensed under

31  this chapter, or physician group practices as defined in s.

                                  1

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






    Florida Senate - 2005                                  SB 1800
    597-1612-05




 1  456.053(3)(h) and providing services under the scope of

 2  licenses of the members of the group practice.

 3         Section 2.  Subsection (4) of section 641.234, Florida

 4  Statutes, is amended to read:

 5         641.234  Administrative, provider, and management

 6  contracts.--

 7         (4)(a)  If a health maintenance organization, through a

 8  health care risk contract, transfers to any entity the

 9  obligations to pay any provider for any claims arising from

10  services provided to or for the benefit of any subscriber of

11  the organization, the health maintenance organization shall

12  remain responsible for any violations of ss. 641.3155,

13  641.3156, and 641.51(4). The provisions of ss.

14  624.418-624.4211 and 641.52 shall apply to any such

15  violations.

16         (b)  As used in this subsection,:

17         1.  The term "health care risk contract" means a

18  contract under which an entity receives compensation in

19  exchange for providing to the health maintenance organization

20  a provider network or other services, which may include

21  administrative services.

22         2.  the term "entity" means a person licensed as an

23  administrator under s. 626.88 and does not include any

24  provider or group practice, as defined in s. 456.053,

25  providing services under the scope of the license of the

26  provider or the members of the group practice. The term does

27  not include a hospital providing billing, claims, and

28  collection services solely on its own and its physicians'

29  behalf and providing services under the scope of its license.

30         Section 3.  This act shall take effect October 1, 2005.

31  

                                  2

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






    Florida Senate - 2005                                  SB 1800
    597-1612-05




 1            *****************************************

 2                          SENATE SUMMARY

 3    Redefines the term "fiscal intermediary services
      organization" to remove an exclusion provided for certain
 4    organizations owned, operated, or controlled by a
      hospital and to clarify that the term includes certain
 5    group practices. Provides that a health maintenance
      organization remains responsible for certain violations
 6    regardless of the form of certain transfers of the
      obligation to pay claims.
 7  

 8  

 9  

10  

11  

12  

13  

14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  3

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