Florida Senate - 2012                        COMMITTEE AMENDMENT
       Bill No. SB 668
                                Barcode 409686                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: RE            .                                
                  02/23/2012           .                                

       The Committee on Health Regulation (Garcia) recommended the
    1         Senate Substitute for Amendment (766998) (with title
    2  amendment)
    4         Delete everything after the enacting clause
    5  and insert:
    6         Section 1. Paragraph (a) of subsection (3) and paragraph
    7  (c) of subsection (12) of section 440.13, Florida Statutes, are
    8  amended, paragraph (k) is added to subsection (3), paragraphs
    9  (d) and (e) of subsection (12) are redesignated as paragraphs
   10  (c) and (d), respectively, present subsections (15) through (17)
   11  are renumbered as subsections (16) through (18), respectively,
   12  and a new subsection (15) is added to that section, to read:
   13         440.13 Medical services and supplies; penalty for
   14  violations; limitations.—
   16         (a) As a condition for to eligibility for payment under
   17  this chapter, a health care provider who renders services must
   18  be a certified health care provider and must receive
   19  authorization from the carrier before providing treatment. This
   20  paragraph does not apply to emergency care. An employer or a
   21  carrier may not refuse to authorize a physician to treat an
   22  injured employee solely because the physician is a dispensing
   23  practitioner, as defined in s. 465.0276. The department shall
   24  adopt rules to administer implement the certification of health
   25  care providers.
   26         (k) If a physician who is a dispensing practitioner as
   27  defined in s. 465.0276 receives authorization from an employer
   28  or a carrier to treat a claimant pursuant to paragraph (a), the
   29  physician may dispense and fill prescriptions for medicines
   30  under this chapter. For purposes of dispensing and filling
   31  prescriptions for medicines, the department, employer, or
   32  carrier, or an agent or representative of the department,
   33  employer, or carrier, may not select the pharmacy, pharmacist,
   34  or dispensing practitioner that the claimant must use.
   37         (c) As to reimbursement for a prescription medication, the
   38  reimbursement amount for a prescription shall be the average
   39  wholesale price plus $4.18 for the dispensing fee, except where
   40  the carrier has contracted for a lower amount. Fees for
   41  pharmaceuticals and pharmaceutical services shall be
   42  reimbursable at the applicable fee schedule amount. Where the
   43  employer or carrier has contracted for such services and the
   44  employee elects to obtain them through a provider not a party to
   45  the contract, the carrier shall reimburse at the schedule,
   46  negotiated, or contract price, whichever is lower. No such
   47  contract shall rely on a provider that is not reasonably
   48  accessible to the employee.
   50  reimbursement amount for prescription medication shall be the
   51  average wholesale price plus $4.18 for the dispensing fee,
   52  unless the carrier and the provider seeking reimbursement have
   53  directly contracted with each other for a lower reimbursement
   54  amount.
   55         (a) If a prescription has been repackaged or relabeled, the
   56  provider shall give a $15 credit to the insurance carrier or
   57  self-insured employer for each prescription that costs more than
   58  $25. The credit shall be reflected in the Explanation of Bill
   59  Review provided by the carrier or employer. The credit does not
   60  apply if the carrier and the provider seeking reimbursement have
   61  directly contracted with each other for a lower reimbursement
   62  amount.
   63         (b) A physician or the physician’s assignee may not hold an
   64  ownership interest in a licensed pharmaceutical repackaging
   65  entity and may not set or cause to be set a repackaged
   66  pharmaceutical average wholesale price.
   67         (c) An insurance carrier or self-insured employer that
   68  improperly denies or delays payment of a valid claim for
   69  reimbursement of a prescription medication is subject to an
   70  administrative fine of $250 per instance of improper
   71  reimbursement. If the department determines that a carrier or
   72  employer has improperly denied or delayed reimbursement claims
   73  more than 15 times in any one calendar year, the administrative
   74  penalty increases to $1,000 per instance of improper
   75  reimbursement. If the department determines that a carrier or
   76  employer has improperly denied or delayed reimbursement claims
   77  more than 100 times in any one calendar year, the insurer or
   78  employer must show cause to the department as to why its
   79  certificate of authority to underwrite workers’ compensation
   80  insurance should not be revoked or suspended. The penalties in
   81  this paragraph are not exclusive and are in addition to remedies
   82  provided under part IX of chapter 626.
   83         (d) Pursuant to subsection (7), a provider may challenge a
   84  disallowance, denial, or adjustment of payment by filing a
   85  petition for dispute resolution with the department within 30
   86  days after receiving the final Explanation of Bill Review issued
   87  by the insurance carrier or self-insured employer. The carrier
   88  or self-insured employer must clearly state on the face of the
   89  final Explanation of Bill Review when the 30-day period for
   90  filing a petition for dispute resolution with the department
   91  commences.
   92         Section 2. This act shall take effect July 1, 2012.
   94  ================= T I T L E  A M E N D M E N T ================
   95         And the title is amended as follows:
   96         Delete everything before the enacting clause
   97  and insert:
   98                        A bill to be entitled                      
   99         An act relating to workers’ compensation medical
  100         services; amending s. 440.13, F.S.; prohibiting an
  101         employer or carrier from refusing to authorize a
  102         physician who is a prescribing physician; prohibiting
  103         the Department of Financial Services, the employer, or
  104         the carrier from selecting a claimant’s pharmacy;
  105         revising requirements for determining the amount of a
  106         reimbursement for prescription medications;
  107         prohibiting a physician from having an ownership
  108         interest in a pharmacy repackaging entity or setting
  109         pharmaceutical wholesale prices; providing penalties
  110         for an employer or carrier’s improper delay or denial
  111         of payment and procedures for a provider to challenge
  112         a disallowance, denial, or adjustment of payment;
  113         providing an effective date.