Each HMO or PHC must have in place:

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Terms Used In Florida Regulations 59A-12.008

  • Contract: A legal written agreement that becomes binding when signed.
    (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.
Rulemaking Authority 641.56 FS. Law Implemented 641.51(4), 641.495(3) FS. History-New 1-28-88, Amended 3-11-92, Formerly 10D-100.008.