HOUSE AMENDMENT Bill No. HB 1837 CS
1	CHAMBER ACTION
2	Senate House
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12	Representative Brown offered the following:
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14	Amendment
15	Remove line(s) 2466 through 2503, 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, and one member who, on account of previous vocation,
25	employment or affiliation, shall be classified as a
26	representative of employees. The panel shall determine
27	statewide schedules of maximum reimbursement allowances for
28	medically 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. The
37	maximum number of hours an outpatient may remain in observation
38	status shall not exceed 23 hours, starting with and including
39	the time that the patient arrivesagency. All compensable
40	charges for hospital outpatient care shall be reimbursed at 75
41	percent of usual and customary charges, except as otherwise
42	provided by this subsectionUntil the three-member panel
43	approves a schedule of per diem rates for inpatient hospital
44	care and it becomes effective, all compensable charges for
45	hospital inpatient care must be reimbursed at 75 percent of
46	their usual and customary charges. Annually, the three-member
47	panel shall adopt schedules of maximum reimbursement allowances
48	for physicians, hospital inpatient care, hospital outpatient
49	care, ambulatory surgical centers, work-hardening programs, and
50	pain programs. However, the maximum percentage of increase in
51	the individual reimbursement allowance may not exceed the
52	percentage of increase in the Consumer Price Index for the
53	previous year. An individual physician, hospital, ambulatory
54	surgical center, pain program, or work-hardening program shall
55	be reimbursed either the usual and customary charge for
56	treatment, care, and attendance,the agreed-upon contract price,
57	or the maximum reimbursement allowance in the appropriate
58	schedule, whichever is less.