April 6, 2000

ISSUE PAPER

ISSUE 1. Florida is ahead of the nation in providing patient protections. Those protections are, however, scattered throughout the statutes. The "Patient Protection Act of 2000" guarantees existing patient protections by solidifying into one clear, concise, consumer-friendly format.

ISSUE 2. Consumer awareness will also be enhanced by a new requirement that, as part of their HMO contract, physicians and hospitals must post a notice of the toll-free telephone number where assistance is available in case they have a complaint against their health maintenance organization.

ISSUE 3. The review process for introduction of new health care services is streamlined and certain projects are exempted - beginning the phase out of the certificate of need review process.

ISSUE 4. The current annual 1.5% assessment on each hospital's net operating revenues attributable to outpatient services and on the net operating revenues of ambulatory surgical centers, clinical laboratories, and diagnostic imaging centers is eliminated. The expenditure cap imposed annually on Medicaid payments for hospital outpatient services provided to adults is increased from $1,000 to $1,500.

ISSUE 5. HMO contracts will be prevented from prohibiting or restricting a physician from providing inpatient services in a contracted hospital if the HMO determines the services are "medically necessary." Patients will be able to have their own doctor continue to treat them in the hospital.

ISSUE 6. An assessment (including, but not limited to, the cost and benefit) of the impact of current mandated health coverages will be required. Data will be gathered to enable informed decisions as to the advisability of mandating certain health benefits.

ISSUE 7. Adverse determinations will be required to be made by a licensed physician who is active and in good standing. No longer will HMO administrators be allowed to deny care.

ISSUE 8. Racial and ethnic health outcome disparities will be reduced through a grant program administered by the Department of Health.

ISSUE 9. A comprehensive statewide strategy will be developed for improving health care delivery systems through meaningful reporting standards, data collection and review, and quality measurement. The focus will be on quality improvement and preventing medical errors in the first place.

ISSUES 10. and 11. Small employer health insurance reforms are encouraged through authorizing carriers to issue group policies to small employer health alliances organized as not-for-profit entities and by revising the "modified community rating" method.

ISSUE 12. A number of different Medicaid topics are addressed including budget issues, Medicaid fraud issues, Medicaid certified school match program and Medicaid eligibility.