Florida Senate - 2014                        COMMITTEE AMENDMENT
       Bill No. SB 1646
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/01/2014           .                                

       (Garcia) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Between lines 360 and 361
    4  insert:
    5         Section 7. Subsection (3) is added to section 627.645,
    6  Florida Statutes, to read:
    7         627.645 Denial of health insurance claims restricted.—
    8         (3) A claim for payment under a health insurance policy for
    9  medical care or treatment may not be denied on the basis of a
   10  medical necessity determination conducted via telemedicine as
   11  defined in s. 456.4502 unless the determination is made by a
   12  physician licensed under chapter 458 or chapter 459.
   13         Section 8. Paragraph (m) is added to subsection (1) of
   14  section 641.185, Florida Statutes, to read:
   15         641.185 Health maintenance organization subscriber
   16  protections.—
   17         (1) With respect to the provisions of this part and part
   18  III, the principles expressed in the following statements shall
   19  serve as standards to be followed by the commission, the office,
   20  the department, and the Agency for Health Care Administration in
   21  exercising their powers and duties, in exercising administrative
   22  discretion, in administrative interpretations of the law, in
   23  enforcing its provisions, and in adopting rules:
   24         (m) A health maintenance organization may not deny a claim
   25  for payment for medical care or treatment on the basis of a
   26  medical necessity determination conducted via telemedicine as
   27  defined in s. 456.4502 unless the determination is made by a
   28  physician licensed under chapter 458 or chapter 459.
   29         Section 9. Paragraph (c) of subsection (2) of section
   30  409.967, Florida Statutes, is amended to read:
   31         409.967 Managed care plan accountability.—
   32         (2) The agency shall establish such contract requirements
   33  as are necessary for the operation of the statewide managed care
   34  program. In addition to any other provisions the agency may deem
   35  necessary, the contract must require:
   36         (c) Access.—
   37         1. The agency shall establish specific standards for the
   38  number, type, and regional distribution of providers in managed
   39  care plan networks to ensure access to care for both adults and
   40  children. Each plan must maintain a regionwide network of
   41  providers in sufficient numbers to meet the access standards for
   42  specific medical services for all recipients enrolled in the
   43  plan. A plan may not use telemedicine providers as defined in s.
   44  456.4502 to meet this requirement unless the provider is
   45  licensed under chapter 458 or chapter 459. The exclusive use of
   46  mail-order pharmacies may not be sufficient to meet network
   47  access standards. Consistent with the standards established by
   48  the agency, provider networks may include providers located
   49  outside the region. A plan may contract with a new hospital
   50  facility before the date the hospital becomes operational if the
   51  hospital has commenced construction, will be licensed and
   52  operational by January 1, 2013, and a final order has issued in
   53  any civil or administrative challenge. Each plan shall establish
   54  and maintain an accurate and complete electronic database of
   55  contracted providers, including information about licensure or
   56  registration, locations and hours of operation, specialty
   57  credentials and other certifications, specific performance
   58  indicators, and such other information as the agency deems
   59  necessary. The database must be available online to both the
   60  agency and the public and have the capability to compare the
   61  availability of providers to network adequacy standards and to
   62  accept and display feedback from each provider’s patients. Each
   63  plan shall submit quarterly reports to the agency identifying
   64  the number of enrollees assigned to each primary care provider.
   65         2. Each managed care plan must publish any prescribed drug
   66  formulary or preferred drug list on the plan’s website in a
   67  manner that is accessible to and searchable by enrollees and
   68  providers. The plan must update the list within 24 hours after
   69  making a change. Each plan must ensure that the prior
   70  authorization process for prescribed drugs is readily accessible
   71  to health care providers, including posting appropriate contact
   72  information on its website and providing timely responses to
   73  providers. For Medicaid recipients diagnosed with hemophilia who
   74  have been prescribed anti-hemophilic-factor replacement
   75  products, the agency shall provide for those products and
   76  hemophilia overlay services through the agency’s hemophilia
   77  disease management program.
   78         3. Managed care plans, and their fiscal agents or
   79  intermediaries, must accept prior authorization requests for any
   80  service electronically.
   82  ================= T I T L E  A M E N D M E N T ================
   83  And the title is amended as follows:
   84         Delete line 34
   85  and insert:
   86         providing for future repeal; amending ss. 627.645 and
   87         641.185, F.S.; prohibiting the denial of a claim for
   88         payment for medical services based on a medical
   89         necessity determination conducted via telemedicine
   90         unless the determination is made by a physician;
   91         prohibiting a managed care plan under Medicaid from
   92         using telemedicine providers that are not physicians;
   93         providing an effective date.