641.455 – Disposition of moneys collected under this part.
641.455 Disposition of moneys collected under this part.—Fees, administrative penalties, examination expenses, and other sums collected by the office under this part shall be deposited to the credit of the Insurance Regulatory Trust Fund; however, fees, examination expenses, and other sums collected by, or allocated to, the Agency for Health Care Administration under this part shall […]
641.55 – Internal risk management program.
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 components: (a) The investigation and analysis of the frequency and causes of general categories and specific types of adverse incidents causing injury to patients; (b) The development of […]
641.457 – Exemption for certain operational prepaid health clinics.
641.457 Exemption for certain operational prepaid health clinics.—The provisions of this part do not apply to those prepaid health clinics providing the services defined in ss. 641.40-641.459, which clinics have been continuously engaged in providing such services since January 1, 1947, provided that any prepaid health clinic claiming an exemption under this section notified the former […]
641.56 – Rulemaking authority.
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 duties upon it. History.—ss. 24, 27, ch. 87-236; ss. 187, 188, ch. 91-108; s. 91, ch. 91-282; s. 4, ch. 91-429; s. 38, ch. 96-199; s. 215, ch. 98-200.
641.459 – Construction and relationship to other laws.
641.459 Construction and relationship to other laws.— (1) Except as provided in this part, the Florida Insurance Code, as defined in s. 624.01, does not apply to prepaid health clinics certificated under this part; and prepaid health clinics certificated under this part are not subject to part I of this chapter. (2) The solicitation of subscribers by a […]
641.47 – Definitions.
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 health care service has been reviewed and, based upon the information provided, does not meet the organization’s requirements for medical necessity, appropriateness, health care setting, level of care or […]
641.48 – Purpose and application of part.
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 this purpose, this part requires all such organizations to obtain a health care provider certificate from the agency as a condition precedent to obtaining a certificate […]
641.49 – Certification of health maintenance organization and prepaid health clinic as health care providers; application procedure.
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 a health care provider certificate under this part. (2) The office shall not issue a certificate […]
641.495 – Requirements for issuance and maintenance of certificate.
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 of the prescribed fee, and upon the agency’s being satisfied that the applicant has the ability to provide quality of care consistent with […]
641.51 – Quality assurance program; second medical opinion requirement.
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 prevailing standards of medical practice in the community. (2) Each organization shall have an ongoing internal quality assurance program for its health care services. […]