Fla. Admin. Code R. 59A-12.008

Current through Reg. 50, No. 235-239, December 10, 2024

Section 59A-12.008 - Referral Procedures

Each HMO or PHC must have in place:

(1) A system to facilitate referral of subscribers to contracted or non-contracted physician and hospital providers; and, in the case of non-contracted providers, include a procedure for prior authorization and written notification regarding such referral to the subscriber.

(2) A means for notifying the subscribers of the referral system, including the procedures for the subscribers to obtain a second medical opinion. Such notification shall be clearly stated in either the subscriber contract, member handbook or other written communication.

Fla. Admin. Code Ann. R. 59A-12.008

Rulemaking Authority 641.56 FS. Law Implemented 641.51(4), 641.495(3) FS.

New 1-28-88, Amended 3-11-92, Formerly 10D-100.008.

New 1-28-88, Amended 3-11-92, Formerly 10D-100.008.