641.511 – Subscriber grievance reporting and resolution requirements.
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 that a subscriber must submit a grievance within 1 year after the date of occurrence of the action that initiated the grievance. An organization […]
641.512 – Accreditation and external quality assurance assessment.
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 health maintenance organization and prepaid health clinic to be accredited within 1 year of the organization’s receipt of its certificate of authority and to […]
641.513 – Requirements for providing emergency services and care.
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 or treatment or for emergency services and care. (b) Indicate that emergencies are covered only if care is secured within a certain period […]
641.514 – Coverage for air ambulance services.
1641.514 Coverage for air ambulance services.— (1) As used in this section, the term: (a) “Air ambulance service” has the same meaning as provided in s. 401.23. (b) “Health maintenance organization” has the same meaning as provided in s. 641.19(12). (c) “Reasonable reimbursement” means reimbursement that considers the direct cost to provide the air ambulance transportation service to the subscriber, […]
641.515 – Investigation by the agency.
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 s. 641.511. The agency shall also investigate further any information that indicates that the organization does not meet accreditation standards or the standards of the review organization performing the external quality assurance assessment […]
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.
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 compliance within […]
641.453 – Civil liability.
641.453 Civil liability.—The provisions of this part are cumulative to the rights under the general civil law and common law, and no action of the office shall abrogate such rights to damages or other relief in any court. History.—ss. 10, 11, ch. 84-313; ss. 187, 188, ch. 91-108; s. 4, ch. 91-429; s. 1621, ch. 2003-261.
641.54 – Information disclosure.
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 to which hospitals the organization may refer particular subscribers for nonemergency services. The list shall also include all physicians under the organization’s direct employ or who are under […]
641.454 – Civil action to enforce prepaid health clinic contract; attorney’s fees; court costs.
641.454 Civil action to enforce prepaid health clinic contract; attorney’s fees; court costs.—In any civil action brought to enforce the terms and conditions of a prepaid health clinic contract, the prevailing party is entitled to recover reasonable attorney’s fees and court costs. This section shall not be construed to authorize a civil action against the commission […]
641.545 – Subscriber risk assessments; requirements.
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 within 3 months after the Medicaid subscriber enrolls, in order to perform a health risk assessment. The health risk assessment instrument must include questions regarding early and […]