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Florida Statutes § 641.51

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“Quality assurance program; second medical opinion requirement under the insurance law”

A health maintenance organization must ensure that the health care services provided to enrollees are delivered under reasonable standards of quality of care. Each health maintenance organization must have an ongoing internal quality assurance program for its health care services.

An enrollee of a health maintenance organization has the right to a second medical opinion. Each health maintenance organization must develop a policy to determine when exceptional referrals to out-of-network specially qualified providers should be provided to address the unique medical needs of the enrollee. A health maintenance organization is also responsible for policies to provide referrals to enrollees with chronic and disabling conditions which require ongoing specialty care.

Each health maintenance organization must release to the Agency for Health Care Administration must release the following indicators of access and quality of care: access and quality of care measures; accreditation activities and standards; management of chronic diseases; preventive health care for adults and children; prenatal care; and health checkups for children. The agency must publish the data for the public every 2 years.



Current as of June 2015