CODING: Words stricken are deletions; words underlined are additions.



                                                   HOUSE AMENDMENT

                           Bill No. CS for CS for SB 108, 1st Eng.

    Amendment No. ___ (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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  4  ______________________________________________________________

  5                                           ORIGINAL STAMP BELOW

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10  ______________________________________________________________

11  Representative(s) Ross offered the following:

12

13         Amendment (with title amendment) 

14         On page 14, lines 3-11

15  remove:  all of said lines

16

17  and insert:

18         Section 7.  Subsection (12) and paragraph (b) of

19  subsection (14) of section 440.13, Florida Statutes, are

20  amended to read:

21         (12)  CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM

22  REIMBURSEMENT ALLOWANCES.--

23         (a)  A three-member panel is created, consisting of the

24  Insurance Commissioner, or the Insurance Commissioner's

25  designee, and two members to be appointed by the Governor,

26  subject to confirmation by the Senate, one member who, on

27  account of present or previous vocation, employment, or

28  affiliation, shall be classified as a representative of

29  employers, the other member who, on account of previous

30  vocation, employment, or affiliation, shall be classified as a

31  representative of employees. The panel shall determine

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                                                   HOUSE AMENDMENT

                           Bill No. CS for CS for SB 108, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  statewide schedules of maximum reimbursement allowances for

  2  medically necessary treatment, care, and attendance provided

  3  by physicians, hospitals, ambulatory surgical centers,

  4  work-hardening programs, pain programs, and durable medical

  5  equipment. The maximum reimbursement allowances for inpatient

  6  hospital care shall be based on a schedule of per diem rates,

  7  to be approved by the three-member panel no later than March

  8  1, 1994, to be used in conjunction with a precertification

  9  manual as determined by the division. All compensable charges

10  for hospital outpatient care shall be reimbursed at 75 percent

11  of usual and customary charges. Until the three-member panel

12  approves a schedule of per diem rates for inpatient hospital

13  care and it becomes effective, all compensable charges for

14  hospital inpatient care must be reimbursed at 75 percent of

15  their usual and customary charges. Annually, the three-member

16  panel shall adopt schedules of maximum reimbursement

17  allowances for physicians, hospital inpatient care, hospital

18  outpatient care, ambulatory surgical centers, work-hardening

19  programs, and pain programs. However, the maximum percentage

20  of increase in the individual reimbursement allowance may not

21  exceed the percentage of increase in the Consumer Price Index

22  for the previous year. An individual physician, hospital,

23  ambulatory surgical center, pain program, or work-hardening

24  program shall be reimbursed either the usual and customary

25  charge for treatment, care, and attendance, the agreed-upon

26  contract price, or the maximum reimbursement allowance in the

27  appropriate schedule, whichever is less.

28         (b)  As to reimbursement for a prescription medication,

29  the reimbursement amount for a prescription shall be the

30  average wholesale price times 1.2 plus $4.18 for the

31  dispensing fee, except where the carrier has contracted for a

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                                                   HOUSE AMENDMENT

                           Bill No. CS for CS for SB 108, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  lower amount. Fees for pharmaceuticals and pharmaceutical

  2  services shall be reimbursable at the applicable fee schedule

  3  amount. Where the employer or carrier has contracted for such

  4  services and the employee elects to obtain them through a

  5  provider not a party to the contract, the carrier shall

  6  reimburse at the schedule, negotiated, or contract price,

  7  whichever is lower.

  8         (c)  Reimbursement for all fees and other charges for

  9  such treatment, care, and attendance, including treatment,

10  care, and attendance provided by any hospital or other health

11  care provider, ambulatory surgical center, work-hardening

12  program, or pain program, must not exceed the amounts provided

13  by the uniform schedule of maximum reimbursement allowances as

14  determined by the panel or as otherwise provided in this

15  section. This subsection also applies to independent medical

16  examinations performed by health care providers under this

17  chapter. Until the three-member panel approves a uniform

18  schedule of maximum reimbursement allowances and it becomes

19  effective, all compensable charges for treatment, care, and

20  attendance provided by physicians, ambulatory surgical

21  centers, work-hardening programs, or pain programs shall be

22  reimbursed at the lowest maximum reimbursement allowance

23  across all 1992 schedules of maximum reimbursement allowances

24  for the services provided regardless of the place of service.

25  In determining the uniform schedule, the panel shall first

26  approve the data which it finds representative of prevailing

27  charges in the state for similar treatment, care, and

28  attendance of injured persons. Each health care provider,

29  health care facility, ambulatory surgical center,

30  work-hardening program, or pain program receiving workers'

31  compensation payments shall maintain records verifying their

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                                                   HOUSE AMENDMENT

                           Bill No. CS for CS for SB 108, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  usual charges. In establishing the uniform schedule of maximum

  2  reimbursement allowances, the panel must consider:

  3         1.  The levels of reimbursement for similar treatment,

  4  care, and attendance made by other health care programs or

  5  third-party providers;

  6         2.  The impact upon cost to employers for providing a

  7  level of reimbursement for treatment, care, and attendance

  8  which will ensure the availability of treatment, care, and

  9  attendance required by injured workers;

10         3.  The financial impact of the reimbursement

11  allowances upon health care providers and health care

12  facilities, including trauma centers as defined in s.

13  395.4001, and its effect upon their ability to make available

14  to injured workers such medically necessary remedial

15  treatment, care, and attendance. The uniform schedule of

16  maximum reimbursement allowances must be reasonable, must

17  promote health care cost containment and efficiency with

18  respect to the workers' compensation health care delivery

19  system, and must be sufficient to ensure availability of such

20  medically necessary remedial treatment, care, and attendance

21  to injured workers; and

22         4.  The most recent average maximum allowable rate of

23  increase for hospitals determined by the Health Care Board

24  under chapter 408.

25         (d)  In addition to establishing the uniform schedule

26  of maximum reimbursement allowances, the panel shall:

27         1.  Take testimony, receive records, and collect data

28  to evaluate the adequacy of the workers'compensation fee

29  schedule, nationally recognized fee schedules and alternative

30  methods of reimbursement to certified health care providers

31  and health care facilities for inpatient and outpatient

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                                                   HOUSE AMENDMENT

                           Bill No. CS for CS for SB 108, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  treatment and care.

  2         2.  Survey certified health care providers and health

  3  care facilities to determine the availability and

  4  accessibility of workers' compensation health care delivery

  5  systems for injured workers.

  6         3.  Survey carriers to determine the estimated impact

  7  on carrier costs and workers' compensation premium rates by

  8  implementing changes to the carrier reimbursement schedule or

  9  implementing alternative reimbursement methods.

10         4.  Submit recommendations on or before January 1,

11  2003, and biennially thereafter, to the President of the

12  Senate and the Speaker of the House of Representatives on

13  methods to improve the workers' compensation health care

14  delivery system.

15

16  The division shall provide data to the panel, including but

17  not limited to utilization trends in the workers' compensation

18  health care delivery system. The division shall provide the

19  panel with an annual report regarding the resolution of

20  medical reimbursement disputes and any actions pursuant to s.

21  440.13(8). The division shall provide administrative support

22  and service to the panel to the extent requested by the panel.

23         (14)  PAYMENT OF MEDICAL FEES.--

24         (b)  Fees charged for remedial treatment, care, and

25  attendance, except for independent medical examinations, may

26  not exceed the applicable fee schedules adopted under this

27  chapter.

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29

30  ================ T I T L E   A M E N D M E N T ===============

31  And the title is amended as follows:

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                                                   HOUSE AMENDMENT

                           Bill No. CS for CS for SB 108, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1         On page 33,line 23 of the title of the bill

  2

  3  after the semicolon, insert:

  4         providing for responsibilities of the

  5         three-member panel; requiring provision of data

  6         and support services by the division;

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