HOUSE AMENDMENT
                                                   Bill No. HB 159
    Amendment No. ___ (for drafter's use only)
                            CHAMBER ACTION
              Senate                               House
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11  Representative(s) Harrell offered the following:
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13         Amendment to Amendment (093461) (with title amendment) 
14         On page 1, between lines 17 and 18,
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16  insert:  
17         Section 2.  Paragraphs (b) and (f) of subsection (4),
18  and paragraph (b) of subsection (5) and paragraph (a) of
19  subsection (7) of section 627.736, Florida Statutes, are
20  amended to read:
21         627.736  Required personal injury protection benefits;
22  exclusions; priority; claims.--
23         (4)  BENEFITS; WHEN DUE.--Benefits due from an insurer
24  under ss. 627.730-627.7405 shall be primary, except that
25  benefits received under any workers' compensation law shall be
26  credited against the benefits provided by subsection (1) and
27  shall be due and payable as loss accrues, upon receipt of
28  reasonable proof of such loss and the amount of expenses and
29  loss incurred which are covered by the policy issued under ss.
30  627.730-627.7405. When the Agency for Health Care
31  Administration provides, pays, or becomes liable for medical
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    File original & 9 copies    04/27/01                          
    hbd0001                     11:54 am         00159-0081-942283

HOUSE AMENDMENT Bill No. HB 159 Amendment No. ___ (for drafter's use only) 1 assistance under the Medicaid program related to injury, 2 sickness, disease, or death arising out of the ownership, 3 maintenance, or use of a motor vehicle, benefits under ss. 4 627.730-627.7405 shall be subject to the provisions of the 5 Medicaid program. 6 (b) Personal injury protection insurance benefits paid 7 pursuant to this section shall be overdue if not paid within 8 30 days after the insurer is furnished written notice of the 9 fact of a covered loss and of the amount of same. If such 10 written notice is not furnished to the insurer as to the 11 entire claim, any partial amount supported by written notice 12 is overdue if not paid within 30 days after such written 13 notice is furnished to the insurer. Any part or all of the 14 remainder of the claim that is subsequently supported by 15 written notice is overdue if not paid within 30 days after 16 such written notice is furnished to the insurer. However, any 17 payment shall not be deemed overdue when the insurer has 18 reasonable proof to establish that the insurer is not 19 responsible for the payment that written notice has been 20 furnished to the insurer. For the purpose of calculating the 21 extent to which any benefits are overdue, payment shall be 22 treated as being made on the date a draft or other valid 23 instrument which is equivalent to payment was placed in the 24 United States mail in a properly addressed, postpaid envelope 25 or, if not so posted, on the date of delivery. This paragraph 26 does not preclude or limit the ability of the insurer to 27 assert that the claim was unrelated, was not medically 28 necessary, or was unreasonable or that the amount of the 29 charge was in excess of that permitted under, or in violation 30 of, subsection (5). Such assertion by the insurer may be made 31 at any time, including after payment of the claim or after the 2 File original & 9 copies 04/27/01 hbd0001 11:54 am 00159-0081-942283
HOUSE AMENDMENT Bill No. HB 159 Amendment No. ___ (for drafter's use only) 1 30-day time period for payment set forth in this paragraph. 2 (f) Medical payments insurance, if available in a 3 policy of motor vehicle insurance, shall pay the portion of 4 any claim for personal injury protection medical benefits 5 which is otherwise covered but is not payable due to the 6 coinsurance provision of paragraph (1)(a), regardless of 7 whether the full amount of personal injury protection coverage 8 has been exhausted. The benefits shall not be payable for the 9 amount of any deductible which has been selected. 10 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.-- 11 (b) With respect to any treatment or service, other 12 than medical services billed by a hospital or other provider 13 for emergency services as defined in s. 395.002 or inpatient 14 services rendered at a hospital-owned facility, the statement 15 of charges must be furnished to the insurer by the provider 16 and may not include, and the insurer is not required to pay, 17 charges for treatment or services rendered more than 35 30 18 days before the postmark date of the statement, except for 19 past due amounts previously billed on a timely basis under 20 this paragraph, and except that, if the provider submits to 21 the insurer a notice of initiation of treatment within 21 days 22 after its first examination or treatment of the claimant, the 23 statement may include charges for treatment or services 24 rendered up to, but not more than, 75 60 days before the 25 postmark date of the statement. The injured party is not 26 liable for, and the provider shall not bill the injured party 27 for, charges that are unpaid because of the provider's failure 28 to comply with this paragraph. Any agreement requiring the 29 injured person or insured to pay for such charges is 30 unenforceable. If, however, the insured fails to furnish the 31 provider with the correct name and address of the insured's 3 File original & 9 copies 04/27/01 hbd0001 11:54 am 00159-0081-942283
HOUSE AMENDMENT Bill No. HB 159 Amendment No. ___ (for drafter's use only) 1 personal injury protection insurer, the provider has 35 days 2 from the date the provider obtains the correct information to 3 furnish the insurer with a statement of the charges. The 4 insurer is not required to pay for such charges, unless the 5 provider includes with the statement documentary evidence that 6 was provided by the insured during the 35-day period 7 demonstrating that the provider reasonably relied on erroneous 8 information from the insured and either: 9 1. A denial letter from the incorrect insurer; or 10 2. Proof of mailing, which may include an affidavit 11 under penalty of perjury, reflecting timely mailing to the 12 incorrect address or insurer. For emergency services and care 13 as defined in s. 395.002 rendered in a hospital emergency 14 department or for transport and treatment rendered by an 15 ambulance provider licensed pursuant to part III of chapter 16 401, the provider is not required to furnish the statement of 17 charges within the time periods established by this paragraph; 18 and the insurer shall not be considered to have been furnished 19 with notice of the amount of covered loss for purposes of 20 paragraph (4)(b) until it receives a statement complying with 21 paragraph (e) (5)(d), or copy thereof, which specifically 22 identifies the place of service to be a hospital emergency 23 department or an ambulance in accordance with billing 24 standards recognized by the Health Care Finance 25 Administration. Each notice of insured's rights under s. 26 627.7401 must include the following statement in type no 27 smaller than 12 points: 28 BILLING REQUIREMENTS.--Florida Statutes provide 29 that with respect to any treatment or services, 30 other than certain hospital and emergency 31 services, the statement of charges furnished to 4 File original & 9 copies 04/27/01 hbd0001 11:54 am 00159-0081-942283
HOUSE AMENDMENT Bill No. HB 159 Amendment No. ___ (for drafter's use only) 1 the insurer by the provider may not include, 2 and the insurer and the injured party are not 3 required to pay, charges for treatment or 4 services rendered more than 35 30 days before 5 the postmark date of the statement, except for 6 past due amounts previously billed on a timely 7 basis, and except that, if the provider submits 8 to the insurer a notice of initiation of 9 treatment within 21 days after its first 10 examination or treatment of the claimant, the 11 statement may include charges for treatment or 12 services rendered up to, but not more than, 75 13 60 days before the postmark date of the 14 statement. 15 (7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON; 16 REPORTS.-- 17 (a) Whenever the mental or physical condition of an 18 injured person covered by personal injury protection is 19 material to any claim that has been or may be made for past or 20 future personal injury protection insurance benefits, such 21 person shall, upon the request of an insurer, submit to mental 22 or physical examination by a physician or physicians. The 23 costs of any examinations requested by an insurer shall be 24 borne entirely by the insurer. Such examination shall be 25 conducted within the municipality where the insured is 26 receiving treatment, or in a location reasonably accessible to 27 the insured, which, for purposes of this paragraph, means any 28 location within the municipality in which the insured resides, 29 or any location within 10 miles by road of the insured's 30 residence, provided such location is within the county in 31 which the insured resides. If the examination is to be 5 File original & 9 copies 04/27/01 hbd0001 11:54 am 00159-0081-942283
HOUSE AMENDMENT Bill No. HB 159 Amendment No. ___ (for drafter's use only) 1 conducted in a location reasonably accessible to the insured, 2 and if there is no qualified physician to conduct the 3 examination in a location reasonably accessible to the 4 insured, then such examination shall be conducted in an area 5 of the closest proximity to the insured's residence. Personal 6 protection insurers are authorized to include reasonable 7 provisions in personal injury protection insurance policies 8 for mental and physical examination of those claiming personal 9 injury protection insurance benefits. An insurer may not 10 withdraw payment of a treating physician without the consent 11 of the injured person covered by the personal injury 12 protection, unless the insurer first obtains a valid report by 13 a physician licensed under the same chapter as the treating 14 physician whose treatment authorization is sought to be 15 withdrawn, stating that treatment was not reasonable, related, 16 or necessary. A valid report is one prepared and signed by 17 the physician examining the injured person or reviewing the 18 treatment records of the injured person and is factually 19 supported by the examination or treatment records, if 20 reviewed, and which has not been modified by anyone other than 21 the physician. The physician preparing the report must be in 22 active practice, unless the physician is physically disabled. 23 Active practice means that during the 3 years immediately 24 preceding the date of the physical examination or review of 25 the treatment record, the physician devoted professional time 26 to the active clinical practice of evaluation, diagnosis, or 27 treatment of medical conditions; or the instruction of 28 students in an accredited health professional school or 29 accredited residency, or at a clinical research program or a 30 clinical research program affiliated with an accredited health 31 professional school or teaching hospital, or a clinical 6 File original & 9 copies 04/27/01 hbd0001 11:54 am 00159-0081-942283
HOUSE AMENDMENT Bill No. HB 159 Amendment No. ___ (for drafter's use only) 1 research program affiliated with an accredited health 2 professional school or accredited residency, or clinical 3 research program. 4 5 6 ================ T I T L E A M E N D M E N T =============== 7 And the title is amended as follows: 8 On page 15, between lines 11 and 12, 9 10 insert: 11 amending s. 627.736, F.S.; relating to required 12 personal injury protection benefits; revising 13 provisions relating to personal injury 14 protection benefits; 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 7 File original & 9 copies 04/27/01 hbd0001 11:54 am 00159-0081-942283