HOUSE AMENDMENT Bill No. HB 1837 CS
1	CHAMBER ACTION
2	Senate House
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12	Representative Ross offered the following:
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14	Amendment
15	Remove line(s) 2466-2528, and insert:
16	(12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM
17	REIMBURSEMENT ALLOWANCES.--
18	(a) A three-member panel is created, consisting of the
19	Insurance Commissioner, or the Insurance Commissioner's
20	designee, and two members to be appointed by the Governor,
21	subject to confirmation by the Senate, one member who, on
22	account of present or previous vocation, employment, or
23	affiliation, shall be classified as a representative of
24	employers, the other member who, on account of previous
25	vocation, employment, or affiliation, shall be classified as a
26	representative of employees. The panel shall determine statewide
27	schedules of maximum reimbursement allowances for medically
28	necessary treatment, care, and attendance provided by
29	physicians, hospitals, ambulatory surgical centers, work-
30	hardening programs, pain programs, and durable medical
31	equipment. The maximum reimbursement allowances for inpatient
32	hospital care shall be based on a schedule of per diem rates, to
33	be approved by the three-member panel no later than March 1,
34	1994, to be used in conjunction with a precertification manual
35	as determined by the department, including maximum hours in
36	which an outpatient may remain in observation status, which
37	shall not exceed 23 hoursagency. All compensable charges for
38	hospital outpatient care shall be reimbursed at 75 percent of
39	usual and customary charges, except as otherwise provided by
40	this subsection. Until the three-member panel approves a
41	schedule of per diem rates for inpatient hospital care and it
42	becomes effective, all compensable charges for hospital
43	inpatient care must be reimbursed at 75 percent of their usual
44	and customary charges.Annually, the three-member panel shall
45	adopt schedules of maximum reimbursement allowances for
46	physicians, hospital inpatient care, hospital outpatient care,
47	ambulatory surgical centers, work-hardening programs, and pain
48	programs. However, the maximum percentage of increase in the
49	individual reimbursement allowance may not exceed the percentage
50	of increase in the Consumer Price Index for the previous year.
51	An individual physician, hospital, ambulatory surgical center,
52	pain program, or work-hardening program shall be reimbursed
53	either the usual and customary charge for treatment, care, and
54	attendance, the agreed-upon contract price,or the maximum
55	reimbursement allowance in the appropriate schedule, whichever
56	is less.
57	(b) It is the intent of the Legislature to increase the
58	schedule of maximum reimbursement allowances for selected
59	physicians effective January 1, 2004, and to pay for the
60	increases through reductions in payments to hospitals. Revisions
61	developed pursuant to this subsection are limited to the
62	following:
63	1. Payments for outpatient physical, occupational, and
64	speech therapy provided by hospitals shall be reduced to the
65	schedule of maximum reimbursement allowances for these services
66	which applies to nonhospital providers.
67	2. Payments for scheduled outpatient nonemergency
68	radiological and clinical laboratory services that are not
69	provided in conjunction with a surgical procedure shall be
70	reduced to the schedule of maximum reimbursement allowances for
71	these services which applies to nonhospital providers.
72	3. Outpatient reimbursement for scheduled surgeries shall
73	be reduced from 75 percent of charges to 60 percent of charges.
74	4. Maximum reimbursement for a physician licensed under
75	chapter 458 or chapter 459 shall be increased to 110 percent of
76	the reimbursement allowed by Medicare, using appropriate codes
77	and modifiers or the medical reimbursement level adopted by the
78	three-member panel as of January 1, 2003, whichever is greater.
79	Effective January 1, 2005, the maximum reimbursement for
80	professional services rendered by a physician licensed under
81	chapter 458 or chapter 459 shall be increased by 5 percent per
82	year for 5 consecutive years, unless the three-member panel
83	determines that the 5 percent annual increase would result in a
84	rate increase for carriers.
85	5. Maximum reimbursement for surgical procedures shall be
86	increased to 140 percent of the reimbursement allowed by
87	Medicare or the medical reimbursement level adopted by the
88	three-member panel as of January 1, 2003, whichever is greater.
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