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Home > Laws > 2004 Florida Statutes > Title XXXVII > Chapter 641 > Section 513
Title XXXVII INSURANCE
Chapter 641 HEALTH CARE SERVICE PROGRAMS Entire Chapter
Requirements for providing emergency services and care.
Section 641.513, Florida Statutes 2004
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 of time.
(c) Use terms such as "life threatening" or "bona fide" to qualify the kind of emergency that is covered.
(d) Deny payment based on the subscriber's failure to notify the health maintenance organization in advance of seeking treatment or within a certain period of time after the care is given.
(2) Prehospital and hospital-based trauma services and emergency services and care must be provided to a subscriber of a health maintenance organization as required under ss. 395.1041, 395.4045, and 401.45
(3)(a) When a subscriber is present at a hospital seeking emergency services and care, the determination as to whether an emergency medical condition, as defined in s. 641.47 exists shall be made, for the purposes of treatment, by a physician of the hospital or, to the extent permitted by applicable law, by other appropriate licensed professional hospital personnel under the supervision of the hospital physician. The physician or the appropriate personnel shall indicate in the patient's chart the results of the screening, examination, and evaluation. The health maintenance organization shall compensate the provider for the screening, evaluation, and examination that is reasonably calculated to assist the health care provider in arriving at a determination as to whether the patient's condition is an emergency medical condition. The health maintenance organization shall compensate the provider for emergency services and care. If a determination is made that an emergency medical condition does not exist, payment for services rendered subsequent to that determination is governed by the contract under which the subscriber is covered.
(b) If a determination has been made that an emergency medical condition exists and the subscriber has notified the hospital, or the hospital emergency personnel otherwise have knowledge that the patient is a subscriber of the health maintenance organization, the hospital must make a reasonable attempt to notify the subscriber's primary care physician, if known, or the health maintenance organization, if the health maintenance organization had previously requested in writing that the notification be made directly to the health maintenance organization, of the existence of the emergency medical condition. If the primary care physician is not known, or has not been contacted, the hospital must:
1. Notify the health maintenance organization as soon as possible prior to discharge of the subscriber from the emergency care area; or
2. Notify the health maintenance organization within 24 hours or on the next business day after admission of the subscriber as an inpatient to the hospital.
If notification required by this paragraph is not accomplished, the hospital must document its attempts to notify the health maintenance organization of the circumstances that precluded attempts to notify the health maintenance organization. A health maintenance organization may not deny payment for emergency services and care based on a hospital's failure to comply with the notification requirements of this paragraph. Nothing in this paragraph shall alter any contractual responsibility of a subscriber to make contact with the health maintenance organization, subsequent to receiving treatment for the emergency medical condition.
(c) If the subscriber's primary care physician responds to the notification, the hospital physician and the primary care physician may discuss the appropriate care and treatment of the subscriber. The health maintenance organization may have a member of the hospital staff with whom it has a contract participate in the treatment of the subscriber within the scope of the physician's hospital staff privileges. The subscriber may be transferred, in accordance with state and federal law, to a hospital that has a contract with the health maintenance organization and has the service capability to treat the subscriber's emergency medical condition. Notwithstanding any other state law, a hospital may request and collect insurance or financial information from a patient in accordance with federal law, which is necessary to determine if the patient is a subscriber of a health maintenance organization, if emergency services and care are not delayed.
1(4) A subscriber may be charged a reasonable copayment, as provided in s. 641.31(12), for the use of an emergency room.
1(5) Reimbursement for services pursuant to this section by a provider who does not have a contract with the health maintenance organization shall be the lesser of:
(a) The provider's charges;
(b) The usual and customary provider charges for similar services in the community where the services were provided; or
(c) The charge mutually agreed to by the health maintenance organization and the provider within 60 days of the submittal of the claim.
Such reimbursement shall be net of any applicable copayment authorized pursuant to subsection (4).
(6) Reimbursement for services under this section provided to subscribers who are Medicaid recipients by a provider for whom no contract exists between the provider and the health maintenance organization shall be the lesser of:
(b) The usual and customary provider charges for similar services in the community where the services were provided;
(c) The charge mutually agreed to by the entity and the provider within 60 days after submittal of the claim; or
(d) The Medicaid rate.
History.--s. 33, ch. 96-199; s. 9, ch. 96-223.
1Note.--As created by s. 33, ch. 96-199. As created by s. 9, ch. 96-223, s. 641.513(4) and (5) read:
(4) A subscriber may be charged a reasonable copayment, as provided in s. 641.31(12), for the use of an emergency room, except for Medicaid recipients. Nothing in this section is intended to prohibit or limit application of a nominal copayment as provided in s. 409.9081 for the use of an emergency room for services other than emergency services and care.
(5) Reimbursement for services under this section provided to subscribers who are not Medicaid recipients by a provider for whom no contract exists between the provider and the health maintenance organization shall be the lesser of:
(c) The charge mutually agreed to by the health maintenance organization and the provider within 60 days after the submittal of the claim.


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NAV CANADA and Moncton Campus
As NBCC prepares learners for careers in their chosen fields, community and industry partners play a vital role. Whether they donate bursary funds or equipment, host workplace practicums, provide applied learning opportunities, visit classrooms as guest speakers, or hire graduates, their contributions help make the NBCC experience extraordinary for students.
At the Moncton Campus, the not-for-profit company that provides air traffic control services across Canada is one of the College's most important partners. NAV CANADA looks to NBCC for three quarters of its New Brunswick and Nova Scotia technological workforce, and helps the College match its curriculum to industry needs. This high-flying company that keeps Canada's skies safe is the recipient of the 2020 Partner Award for the Moncton Campus.
"It's almost as if I've never left the College," joked Brenda Hopper, Manager of Technical Operations at NAV CANADA and a 1981 graduate of the Electronics Engineering Technology program at NBCC. "I would always go back for Women in Non-Traditional Careers days and things like that, and now we're involved in helping NBCC keep the program current to what industry needs."
NAV CANADA employs approximately 630 Electronics Engineering Technologists (EETs) across the country. In New Brunswick and Nova Scotia, the majority of the company's EETs are NBCC grads.
"We continue to see high quality grads coming out of the course," said Hopper. "We're confident that the education they're getting gives them the opportunity to do anything they choose to do in this field.
"We've been actively involved in a program advisory role for over 25 years, we attend senior project presentations at the College and we attend career fairs," she added. "The students know who we are, and they know that we hire for careers."
While most NBCC grads who work for NAV CANADA do so in Atlantic Canada, some are working for the company in other parts of the country. In her company, Hopper has gained a reputation for having ready access to knowledgeable, competent EETs. At times her colleagues in central and western Canada turn to her for recruitment help.
"The success we've had with NBCC grads has been noticed across the country and at times other areas come to me looking for new EETs," she said. "And some NBCC grads want to work in other parts of the country."
Since 1996, NAV CANADA has provided air traffic control, airport advisory and aeronautical information services, and weather briefings for more than 18 million square kilometres of Canadian domestic and international airspace.
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Called, "Miniaturely Tablets" in Japanese, these items are actually candy cases inspired by Sailor Moon items. Each one opens up and can store candy or other sort of pills inside. These items are being released in Japan through the Gashapon capsule toy machines and have very limited runs which is why the older sets are now harder to come by and the newer ones are more readily available. The colour variation set and the Moon Castle stand are particularly rare.
As with most of the Japanese Sailor Moon merchandise, if you think you might want these later, it's better to get them now while you can.
For more information on each set, and for shipping prices and details, please view the individual item pages via the links under each image. Enjoy!


Welcome to Norwalk Public Schools' World Language Program!
The World Language program of Norwalk Public Schools is aligned with the standards of the Connecticut State Department of Education, The American Council on the Teaching of Foreign Languages (ACTFL), and the Common Core State Standards.
Our curriculum standards have been prioritized to emphasize the communication skills that will prepare our students for success in many endeavors including school, work, travel, recreation, and relationships throughout their lives. World Language education supports the development of the essential literacy skills outlined in the Common Core Standards, as well as critical 21st century skills that students need to have productive careers and function effectively as members of a global society.
We are dedicated to developing our students' proficiencies as speakers, listeners, readers, writers, and viewers of the language they study, along with a profound appreciation and understanding of the various cultures where the language is spoken. This rigorously demanding program focuses on students as active classroom participants whose primary goal is to learn how to function and communicate in a variety of real-life situations within different cultural contexts.
The experience of studying a World Language will enrich the lives of our students, enhance their skills and broaden their perspectives as citizens of the world! We wish them every success and encourage you to contact your child's school for ongoing communication to enhance world language learning for your child.


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Armchair QBs
Martinsville, VA (24112)
Mostly clear. Low 69F. Winds light and variable..
Mostly clear. Low 69F. Winds light and variable.
Teen birth rates soar
KIM BARTO Bulletin Staff Writer
Teen pregnancy is on the rise across the country for the second year in a row, statistics indicate, but local teen pregnancy rates continue to grow faster than the rest of the state and nation.
A report released this week by the National Center for Health Statistics shows the national birthrate among girls ages 15 to 19 increased by 1.4 percent between 2006 and 2007, from 41.9 births per 1,000 females to 42.5. From 2005 to 2006, the birthrate for this age group rose 3.4 percent.
But in Martinsville and Henry County, pregnancy rates in girls younger than 20 rose even more between 2005 to 2007, according to Virginia Department of Health statistics.
In Martinsville, the number of pregnancies per 1,000 females between ages 10 and 19 jumped 40 percent, from 47.5 in 2005 to 66.5 in 2006. In 2007, the latest year for which figures were available, the rate was 70.2 per 1,000.
This was more than two-and-a-half times the statewide rate of pregnancies in this age group, which was 27.2 per 1,000 females in 2007, VDH statistics indicate.
Lack of work in the area may have played a major role in this rise, said Patricia Carter, co-director of For the Children Partners in Prevention.
"With a high rate of unemployment, we also see a high number of unintended pregnancy," Carter said. "Risky behavior follows poverty."
Teen pregnancy rates in Henry County, which has less unemployment than the city, are "a little bit lower, but not that much," Carter said.
Henry County's pregnancy rate climbed from 33.8 per 1,000 females aged 10 to 19 in 2005 to 40.9 in 2006 and 41.2 in 2007, according to VDH figures.
In the city, Carter said, For the Children has been working with Martinsville School Superintendent Scott Kizner "very closely, trying to mobilize public support for funding to implement programs" to address teen pregnancy.
"He's been a real advocate for this," Carter said of Kizner.
"It's a cycle that needs to be broken," Kizner said of the teen pregnancy rate. "That should not be something we accept as a way of life. ... We have to decide as a community if that's going to be an acceptable number."
Martinsville had the second highest rate of teen pregnancies in the state for 2007, behind Greenville, Kizner said. One out of four Martinsville children in 2006 were born to mothers who did not have high school educations, he added.
The city school division has been targeting dropout prevention for teen parents and has had "real success with that," Kizner said.
However, he added, while many of these teenagers are school-aged, teen pregnancy is not a problem that should be shouldered entirely by the schools.
The issue affects the entire community, he said, so "if we're going to address this, it must involve many agencies."
When students drop out of school due to pregnancy, "there are great costs we all bear," he said, leading to "many social and economic problems in our community."
Kizner said teen parents are more likely to be unemployed or have low-paying jobs. Another problem is that babies born to teens are more likely to have low birth weight, he said.
"When a child's born with low birth weight and needs special services, all taxpayers pay for it," he said. "When somebody drops out of school and needs welfare or food stamps, we all pay for it."
Thus, the city school division's approach has been "to mobilize other agencies to provide services for our students in our schools," Kizner said.
The schools have been working with Piedmont Community Services and the Health Department, he said, and they have had preliminary discussions with the health coordinator at The Harvest Foundation.
Counseling is available at the high school, and the local health department has been meeting with school nurses to make sure pregnant teens are getting proper nutrition. Kizner said he hopes to expand these services even more in the next school year.
"One of the challenges for our students is accessing services," Kizner said. "It's often a barrier for our students to have to get to different agencies because they don't have transportation, or the hours ... conflict with the school hours."
On April 1, he said, representatives from the schools and the health department will visit two high school programs run by Roanoke City Schools and hopefully implement them in Martinsville.
Kizner said he would like to open a health center similar to Roanoke's in the fall, which would "provide our students access to information, family planning, counseling and career counseling, all made available where the students are."
He has pushed for offering day care in the schools in the past, but the division was not able to implement it "because of budgetary issues," he said.
The division currently provides classes in the early evenings at the former Druid Hills School for "any student who needs an alternative schedule," he said.
These students not only include teen parents, he said, but students who have to work during the day because their families need the money. This year, 10 to 12 students are enrolled, Kizner said.
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Athletes of the Year
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For Early RA With a Poor Prognosis, MTX-First is Best
RheumatologyNetwork Staff
Contrary to American College of Rheumatology recommendations, analysis of data from a clinical trial reveals methotrexate monotherapy as the best initial treatment for early rheumatoid arthritis that has a poor outlook.
O'Dell JR, Curtis JR, Mikuls TR et al., Validation of the Methotrexate-First Strategy in Patients With Early, Poor-Prognosis Rheumatoid Arthritis: Results From a Two-Year Randomized, Double-Blind Trial.Arthritis & Rheumatism. (2013) 65:1985–1994.
Post hoc analysis of data from a clinical trial not only confirms methotrexate (MTX) monotherapy as the best first-line therapy for early rheumatoid arthritis (RA) patients with a poor prognosis, but also shows patients starting on MTX alone fare just as well as -- if not better than -- those given immediate combination therapy.
Researchers conducted the Treatment of Early Rheumatoid Arthritis (TEAR) trial in two stages, testing 755 patients with early RA. They first randomized the participants into one of four treatment groups:
• MTX monotherapy
• MTX plus the TNFα inhibitor etanercept
• Triple therapy with MTX and the DMARDS sulfasalazine and hydroxychloroquine
• MTX alone with the option to step up to a combination therapy at 24 weeks
Retrospective information from two comparator groups informed the post-hoc analysis:
• Patients needing step-up therapy
• Patients given immediate combination therapy
Their DAS28-ER and radiographic progression scores (modified Sharp/van der Heijde) were compared at 48 and 102 weeks.
Overall, 28% of participants on MTX alone (n=89) had DAS28-ESR scores <3.2 at 24 weeks and did not need step-up therapy with potentially costly or toxic medication. These outcomes were similar to those among the patients who initially took combination therapy.
Among good responders to MTX, DAS28-ESR scores remained significantly lower at 36 weeks and nominally lower through 102 weeks.
There were no differences in adverse events across the treatment arms.
The researchers conclude that, although current American College of Rheumatology recommendations call for RA patients with poor prognoses to start with combination therapy, MTX monotherapy is clearly the most practical approach. This "will need to be considered when these recommendations are updated," they add.
Arthritis | Focus on Rheumatoid Arthritis


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