Amendment

Bill No. 2038

Amendment No. 602777

CHAMBER ACTION
Senate		House
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1	Representative Rivera offered the following:
2
3	Amendment (with title amendment)
4	On page 37, line 31,
5	remove:  all of said line,
6
7	and insert:
8	repealed.
9	Section 21.  Paragraphs (b) and (e) of subsection (5) of
10	section 627.736, Florida Statutes, are amended to read:
11	627.736  Required personal injury protection benefits;
12	exclusions; priority; claims.--
13	(5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
14	(b)1.  An insurer or insured is not required to pay a claim
15	or charges:
16	a.  Made by a broker or by a person making a claim on
17	behalf of a broker;
18	b.  For any service or treatment that was not lawful at the
19	time rendered;
20	c.  To any person who knowingly submits a false or
21	misleading statement relating to the claim or charges;
22	d.  With respect to a bill or statement that does not
23	substantially meet the applicable requirements of paragraph (d);
24	e.  For any treatment or service that is upcoded, or that
25	is unbundled when such treatment or services should be bundled,
26	in accordance with paragraph (d). To facilitate prompt payment
27	of lawful services, an insurer may change codes that it
28	determines to have been improperly or incorrectly upcoded or
29	unbundled, and may make payment based on the changed codes,
30	without affecting the right of the provider to dispute the
31	change by the insurer, provided that before doing so, the
32	insurer must contact the health care provider and discuss the
33	reasons for the insurer's change and the health care provider's
34	reason for the coding, or make a reasonable good faith effort to
35	do so, as documented in the insurer's file; and
36	f.  For medical services or treatment billed by a physician
37	and not provided in a hospital unless such services are rendered
38	by the physician or are incident to his or her professional
39	services and are included on the physician's bill, including
40	documentation verifying that the physician is responsible for
41	the medical services that were rendered and billed.
42	2.  Charges for medically necessary cephalic thermograms,
43	peripheral thermograms, spinal ultrasounds, extremity
44	ultrasounds, video fluoroscopy, and surface electromyography
45	shall not exceed the maximum reimbursement allowance for such
46	procedures as set forth in the applicable fee schedule or other
47	payment methodology established pursuant to s. 440.13.
48	3.  Allowable amounts that may be charged to a personal
49	injury protection insurance insurer and insured for medically
50	necessary nerve conduction testing when done in conjunction with
51	a needle electromyography procedure and both are performed and
52	billed solely by a physician licensed under chapter 458, chapter
53	459, chapter 460, or chapter 461 who is also certified by the
54	American Board of Electrodiagnostic Medicine or by a board
55	recognized by the American Board of Medical Specialties or the
56	American Osteopathic Association or who holds diplomate status
57	with the American Chiropractic Neurology Board or its
58	predecessors shall not exceed 200 percent of the allowable
59	amount under the participating physician fee schedule of
60	Medicare Part B for year 2001, for the area in which the
61	treatment was rendered, adjusted annually on August 1 to reflect
62	the prior calendar year's changes in the annual Medical Care
63	Item of the Consumer Price Index for All Urban Consumers in the
64	South Region as determined by the Bureau of Labor Statistics of
65	the United States Department of Labor.
66	4.  Allowable amounts that may be charged to a personal
67	injury protection insurance insurer and insured for medically
68	necessary nerve conduction testing that does not meet the
69	requirements of subparagraph 3. shall not exceed the applicable
70	fee schedule or other payment methodology established pursuant
71	to s. 440.13.
72	5.  Effective upon this act becoming a law and before
73	November 1, 2001, allowable amounts that may be charged to a
74	personal injury protection insurance insurer and insured for
75	magnetic resonance imaging services shall not exceed 200 percent
76	of the allowable amount under Medicare Part B for year 2001, for
77	the area in which the treatment was rendered. Beginning November
78	1, 2001, allowable amounts that may be charged to a personal
79	injury protection insurance insurer and insured for magnetic
80	resonance imaging services shall not exceed 175 percent of the
81	allowable amount under the participating physician fee schedule
82	of Medicare Part B for year 2001, for the area in which the
83	treatment was rendered, adjusted annually on August 1 to reflect
84	the prior calendar year's changes in the annual Medical Care
85	Item of the Consumer Price Index for All Urban Consumers in the
86	South Region as determined by the Bureau of Labor Statistics of
87	the United States Department of Labor for the 12-month period
88	ending June 30 of that year, except that allowable amounts that
89	may be charged to a personal injury protection insurance insurer
90	and insured for magnetic resonance imaging services provided in
91	facilities accredited by the Accreditation Association for
92	Ambulatory Health Care, the American College of Radiology, or
93	the Joint Commission on Accreditation of Healthcare
94	Organizations shall not exceed 200 percent of the allowable
95	amount under the participating physician fee schedule of
96	Medicare Part B for year 2001, for the area in which the
97	treatment was rendered, adjusted annually on August 1 to reflect
98	the prior calendar year's changes in the annual Medical Care
99	Item of the Consumer Price Index for All Urban Consumers in the
100	South Region as determined by the Bureau of Labor Statistics of
101	the United States Department of Labor for the 12-month period
102	ending June 30 of that year. This paragraph does not apply to
103	charges for magnetic resonance imaging services and nerve
104	conduction testing for inpatients and emergency services and
105	care as defined in chapter 395 rendered by facilities licensed
106	under chapter 395.
107	6.  The Department of Health, in consultation with the
108	appropriate professional licensing boards, shall adopt, by rule,
109	a list of diagnostic tests deemed not to be medically necessary
110	for use in the treatment of persons sustaining bodily injury
111	covered by personal injury protection benefits under this
112	section. The initial list shall be adopted by January 1, 2004,
113	and shall be revised from time to time as determined by the
114	Department of Health, in consultation with the respective
115	professional licensing boards. Inclusion of a test on the list
116	of invalid diagnostic tests shall be based on lack of
117	demonstrated medical value and a level of general acceptance by
118	the relevant provider community and shall not be dependent for
119	results entirely upon subjective patient response.
120	Notwithstanding its inclusion on a fee schedule in this
121	subsection, an insurer or insured is not required to pay any
122	charges or reimburse claims for any invalid diagnostic test as
123	determined by the Department of Health.
124	(e)1.  At the initial treatment or service provided, each
125	physician, other licensed professional, clinic, or other medical
126	institution providing medical services upon which a claim for
127	personal injury protection benefits is based shall require an
128	insured person, or his or her guardian, to execute a disclosure
129	and acknowledgment form, which reflects at a minimum that:
130	a.  The insured, or his or her guardian, must countersign
131	the form attesting to the fact that the services set forth
132	therein were actually rendered;
133	b.  The insured, or his or her guardian, has both the right
134	and affirmative duty to confirm that the services were actually
135	rendered;
136	c.  The insured, or his or her guardian, was not solicited
137	by any person to seek any services from the medical provider;
138	d.  That the physician, other licensed professional,
139	clinic, or other medical institution rendering services for
140	which payment is being claimed explained the services to the
141	insured or his or her guardian; and
142	e.  If the insured notifies the insurer in writing of a
143	billing error, the insured may be entitled to a certain
144	percentage of a reduction in the amounts paid by the insured's
145	motor vehicle insurer.
146	2.  The physician, other licensed professional, clinic, or
147	other medical institution rendering services for which payment
148	is being claimed has the affirmative duty to explain the
149	services rendered to the insured, or his or her guardian, so
150	that the insured, or his or her guardian, countersigns the form
151	with informed consent.
152	3.  Countersignature by the insured, or his or her
153	guardian, is not required for the reading of diagnostic tests or
154	other services that are of such a nature that they are not
155	required to be performed in the presence of the insured.
156	4.  The licensed medical professional rendering treatment
157	for which payment is being claimed must sign, by his or her own
158	hand, the form complying with this paragraph.
159	5.  The original completed disclosure and acknowledgment
160	form shall be furnished to the insurer pursuant to paragraph
161	(4)(b) and may not be electronically furnished.
162	6.  This disclosure and acknowledgment form is not required
163	for services billed by a provider for emergency services as
164	defined in s. 395.002, for emergency services and care as
165	defined in s. 395.002 rendered in a hospital emergency
166	department, for services rendered in an ambulatory surgical
167	center as defined in s. 395.002, or for transport and treatment
168	rendered by an ambulance provider licensed pursuant to part III
169	of chapter 401.
170	7.  The Financial Services Commission shall adopt, by rule,
171	a standard disclosure and acknowledgment form that shall be used
172	to fulfill the requirements of this paragraph, effective 90 days
173	after such form is adopted and becomes final. The commission
174	shall adopt a proposed rule by October 1, 2003. Until the rule
175	is final, the provider may use a form of its own which otherwise
176	complies with the requirements of this paragraph.
177	8.  As used in this paragraph, "countersigned" means a
178	second or verifying signature, as on a previously signed
179	document, and is not satisfied by the statement "signature on
180	file" or any similar statement.
181	9.  The requirements of this paragraph apply only with
182	respect to the initial treatment or service of the insured by a
183	provider. For subsequent treatments or service, the provider
184	must maintain a patient log signed by the patient, in
185	chronological order by date of service, that is consistent with
186	the services being rendered to the patient as claimed. The
187	requirements of this subparagraph for maintaining a patient log
188	signed by the patient may be met by a hospital or ambulatory
189	surgical center that maintains medical records as required by s.
190	395.3025 and applicable rules and makes such records available
191	to the insurer upon request.
192
193	================= T I T L E  A M E N D M E N T =================
194	On page 3, between lines 10 and 11,
195	insert:  amending s. 627.736, F.S.; revising limitations on
196	charges for treatment of injured persons; including ambulatory
197	surgical centers in certain notice requirement provisions;

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