Florida Senate - 2016 COMMITTEE AMENDMENT
Bill No. CS for SB 1442
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LEGISLATIVE ACTION
Senate . House
Comm: WD .
02/16/2016 .
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The Committee on Banking and Insurance (Negron) recommended the
following:
1 Senate Amendment to Amendment (418472) (with title
2 amendment)
3
4 Between lines 104 and 105
5 insert:
6 Section 8. Subsection (11) of section 627.6131, Florida
7 Statutes, is amended to read:
8 627.6131 Payment of claims.—
9 (11) A health insurer may not retroactively deny a claim
10 because of insured ineligibility:
11 (a) At any time, if the health insurer verified the
12 eligibility of an insured at the time of treatment and provided
13 an authorization number.
14 (b) More than 1 year after the date of payment of the
15 claim.
16
17 Between lines 235 and 236
18 insert:
19 Section 12. Subsection (10) of section 641.3155, Florida
20 Statutes, is amended to read:
21 641.3155 Prompt payment of claims.—
22 (10) A health maintenance organization may not
23 retroactively deny a claim because of subscriber ineligibility:
24 (a) At any time, if the health maintenance organization
25 verified the eligibility of a subscriber at the time of
26 treatment and provided an authorization number.
27 (b) More than 1 year after the date of payment of the
28 claim.
29
30 ================= T I T L E A M E N D M E N T ================
31 And the title is amended as follows:
32 Delete lines 246 - 286
33 and insert:
34 An act relating to health care services; amending s.
35 395.003, F.S.; requiring hospitals, ambulatory
36 surgical centers, specialty hospitals, and urgent care
37 centers to comply with certain provisions as a
38 condition of licensure; amending s. 395.301, F.S.;
39 requiring a hospital to post on its website certain
40 information regarding its contracts with health
41 insurers, health maintenance organizations, and health
42 care practitioners and practice groups and specified
43 notice to patients and prospective patients; amending
44 s. 408.7057, F.S.; providing requirements for
45 settlement offers between certain providers and health
46 plans in a specified dispute resolution program;
47 requiring a final order to be subject to judicial
48 review; amending ss. 456.072, 458.331, and 459.015,
49 F.S.; providing additional acts that constitute
50 grounds for denial of a license or disciplinary
51 action, to which penalties apply; amending s.
52 626.9541, F.S.; specifying an additional unfair method
53 of competition and unfair or deceptive act or
54 practice; amending s. 627.6131, F.S.; prohibiting a
55 health insurer from retroactively denying a claim
56 under specified circumstances; creating s. 627.64194,
57 F.S.; defining terms; providing that an insurer is
58 solely liable for payment of certain fees to a
59 nonparticipating provider; providing limitations and
60 requirements for reimbursements by an insurer to a
61 nonparticipating provider; providing that certain
62 disputes relating to reimbursement of a
63 nonparticipating provider shall be resolved in a court
64 of competent jurisdiction or through a specified
65 voluntary dispute resolution process; amending s.
66 627.6471, F.S.; requiring an insurer that issues a
67 policy including coverage for the services of a
68 preferred provider to post on its website certain
69 information about participating providers and
70 physicians; requiring that specified notice be
71 included in policies issued after a specified date
72 which provide coverage for the services of a preferred
73 provider; amending s. 627.662, F.S.; providing
74 applicability of provisions relating to coverage for
75 services and payment collection limitations to group
76 health insurance, blanket health insurance, and
77 franchise health insurance; amending s. 641.3155,
78 F.S.; prohibiting a health maintenance organization
79 from retroactively denying a claim under specified
80 circumstances; providing