Florida Statutes Part III - Health Care Services (Ss. 641.47-641.75)

• 641.47 - Definitions.
  As used in this part, the term:(1) “Adverse determination” means a coverage determination by an organization that an admission, availability of care, continued stay, or other...
• 641.48 - Purpose And Application Of Part.
  The purpose of this part is to ensure that health maintenance organizations and prepaid health clinics deliver high-quality health care to their subscribers. To achieve...
• 641.49 - Certification Of Health Maintenance Organization And Prepaid Health Clinic As Health Care Providers; Application Procedure.
  (1) No person or governmental unit shall establish, conduct, or maintain a health maintenance organization or a prepaid health clinic in this state without first obtaining...
• 641.495 - Requirements For Issuance And Maintenance Of Certificate.
  (1) The agency shall issue a health care provider certificate to an applicant filing a completed application in conformity with ss. 641.48 and 641.49, upon payment...
• 641.51 - Quality Assurance Program; Second Medical Opinion Requirement.
  (1) The organization shall ensure that the health care services provided to subscribers shall be rendered under reasonable standards of quality of care consistent with the...
• 641.511 - Subscriber Grievance Reporting And Resolution Requirements.
  (1) Every organization must have a grievance procedure available to its subscribers for the purpose of addressing complaints and grievances. Every organization must notify its subscribers...
• 641.512 - Accreditation And External Quality Assurance Assessment.
  (1)(a) To promote the quality of health care services provided by health maintenance organizations and prepaid health clinics in this state, the office shall require each...
• 641.513 - Requirements For Providing Emergency Services And Care.
  (1) In providing for emergency services and care as a covered service, a health maintenance organization may not:(a) Require prior authorization for the receipt of prehospital transport...
• 641.515 - Investigation By The Agency.
  (1) The agency shall investigate further any quality of care issue contained in recommendations and reports submitted pursuant to ss. 408.7056 and 641.511. The agency shall...
• 641.52 - Revocation Of Certificate; Suspension Of New Enrollment; Suspension Of The Health Care Provider Certificate; Administrative Fine; Notice Of Action To The Office; Penalty For Use Of Unlicensed Providers.
  (1) The agency may suspend the authority of an organization to enroll new subscribers or revoke the health care provider certificate of any organization, or order...
• 641.54 - Information Disclosure.
  (1) Every health maintenance organization shall maintain a current list, by geographic area, of all hospitals which are routinely and regularly used by the organization, indicating...
• 641.545 - Subscriber Risk Assessments; Requirements.
  The agency shall require an organization, when providing services to Medicaid subscribers, to attempt, at least twice if necessary, to contact each new Medicaid subscriber...
• 641.55 - Internal Risk Management Program.
  (1) Every organization certified under this part shall, as a part of its administrative functions, establish an internal risk management program which shall include the following...
• 641.56 - Rulemaking Authority.
  The Agency for Health Care Administration has authority to adopt rules pursuant to ss. 120.536(1) and 120.54 to implement the provisions of this part conferring...
• 641.57 - Disposition Of Moneys Collected Under This Part.
  Fees, administrative penalties, examination expenses, and other sums collected by the Agency for Health Care Administration under this part shall be deposited to the credit...
• 641.58 - Regulatory Assessment; Levy And Amount; Use Of Funds; Tax Returns; Penalty For Failure To Pay.
  (1) In addition to any other license or excise tax now or hereafter imposed, and such taxes as may be imposed under other statutes, there is...
• 641.59 - Psychotherapeutic Services; Records And Reports.
  A health maintenance organization or prepaid health clinic, as defined in this chapter, must maintain strict confidentiality against unauthorized or inadvertent disclosure of confidential information...
• 641.60 - Statewide Managed Care Ombudsman Committee.
  (1) As used in ss. 641.60-641.75:(a) “Agency” means the Agency for Health Care Administration.(b) “Covered medical service” means a service that has been contracted for under the managed...
• 641.61 - Subscriber Satisfaction Assessment.
  Each organization must establish systems for:(1) Assessing subscriber satisfaction with providers, particularly primary care physicians;(2) Sharing subscriber-satisfaction indicators and scores with providers;(3) Publicly acknowledging providers with high positive...
• 641.62 - Chronic Diseases Among Subscriber Populations.
  Each organization must:(1) Annually study its subscriber population to determine the most prevalent chronic diseases of its subscribers, design intervention strategies to reduce the morbidities and...
• 641.65 - District Managed Care Ombudsman Committees.
  (1) A district managed care ombudsman committee is created in each district of the agency that has staff assigned for the regulation of managed care programs....
• 641.67 - District Managed Care Ombudsman Committee; Exemption From Public Records Requirements; Exceptions.
  The following information is confidential and exempt from the provisions of s. 119.07(1) and s. 24(a), Art. I of the State Constitution:(1) Patient records held by...
• 641.68 - District Managed Care Ombudsman Committee; Exemption From Public Meeting Requirements.
  That portion of a committee meeting conducted by a district managed care ombudsman committee created under s. 641.65, where patient records and information identifying a...
• 641.70 - Agency Duties Relating To The Statewide Managed Care Ombudsman Committee And The District Managed Care Ombudsman Committees.
  (1) The agency shall adopt rules that specify:(a) Procedures by which the statewide committee and district committees receive reports of enrollee complaints from the agency.(b) Procedures by which...
• 641.75 - Immunity From Liability; Limitation On Testimony.
  (1) Any member of the statewide committee or a district committee who receives or investigates a complaint of an enrollee of a managed care program in...

Last modified: September 23, 2016