SENATE AMENDMENT
Bill No. CS for SB 2482
Amendment No. ___ Barcode 094390
CHAMBER ACTION
Senate House
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11 Senator Campbell moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 1, line 14, through
15 page 7, line 27, delete those lines
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17 and insert:
18 Section 1. Subsections (16) and (17) are added to
19 section 627.732, Florida Statutes, to read:
20 627.732 Definitions.--As used in ss. 627.730-627.7405,
21 the term:
22 (16) "Biometrics" means a computer-based biological
23 imprint generally recognized by the scientific or law
24 enforcement community as capable of identifying an individual.
25 (17) "Biometric time date technology" means technology
26 that uses biometric imprints to document the exact date and
27 time a biological imprint was made or recognized.
28 Section 2. Paragraphs (a), (b), and (e) of subsection
29 (5) of section 627.736, Florida Statutes, are amended to read:
30 627.736 Required personal injury protection benefits;
31 exclusions; priority; claims.--
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Bill No. CS for SB 2482
Amendment No. ___ Barcode 094390
1 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
2 (a) Any physician, hospital, clinic, or other person
3 or institution lawfully rendering treatment to an injured
4 person for a bodily injury covered by personal injury
5 protection insurance may charge the insurer and injured party
6 only a reasonable amount pursuant to this section for the
7 services and supplies rendered, and the insurer providing such
8 coverage may pay for such charges directly to such person or
9 institution lawfully rendering such treatment, if the insured
10 receiving such treatment or his or her guardian has
11 countersigned the properly completed invoice, bill, or claim
12 form approved by the office upon which such charges are to be
13 paid for as having actually been rendered, to the best
14 knowledge of the insured or his or her guardian. In no event,
15 however, may such a charge be in excess of the amount the
16 person or institution customarily charges for like services or
17 supplies. With respect to a determination of whether a charge
18 for a particular service, treatment, or otherwise is
19 reasonable, consideration may be given to evidence of usual
20 and customary charges and payments accepted by the provider
21 involved in the dispute, and reimbursement levels in the
22 community and various federal and state medical fee schedules
23 applicable to automobile and other insurance coverages, and
24 other information relevant to the reasonableness of the
25 reimbursement for the service, treatment, or supply. A
26 provider may use biometric time date technology, located in
27 the provider's office, to document that the insured was
28 present at a specific time, date, and place at which a
29 biometric imprint was made.
30 (b)1. An insurer or insured is not required to pay a
31 claim or charges:
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Amendment No. ___ Barcode 094390
1 a. Made by a broker or by a person making a claim on
2 behalf of a broker;
3 b. For any service or treatment that was not lawful at
4 the time rendered;
5 c. To any person who knowingly submits a false or
6 misleading statement relating to the claim or charges;
7 d. With respect to a bill or statement that does not
8 substantially meet the applicable requirements of paragraph
9 (d);
10 e. For any treatment or service that is upcoded, or
11 that is unbundled when such treatment or services should be
12 bundled, in accordance with paragraph (d). To facilitate
13 prompt payment of lawful services, an insurer may change codes
14 that it determines to have been improperly or incorrectly
15 upcoded or unbundled, and may make payment based on the
16 changed codes, without affecting the right of the provider to
17 dispute the change by the insurer, provided that before doing
18 so, the insurer must contact the health care provider and
19 discuss the reasons for the insurer's change and the health
20 care provider's reason for the coding, or make a reasonable
21 good faith effort to do so, as documented in the insurer's
22 file; and
23 f. For medical services or treatment billed by a
24 physician and not provided in a hospital unless such services
25 are rendered by the physician or are incident to his or her
26 professional services and are included on the physician's
27 bill, including documentation verifying that the physician is
28 responsible for the medical services that were rendered and
29 billed.
30 2. Charges for medically necessary cephalic
31 thermograms, peripheral thermograms, spinal ultrasounds,
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1 extremity ultrasounds, video fluoroscopy, and surface
2 electromyography shall not exceed the maximum reimbursement
3 allowance for such procedures as set forth in the applicable
4 fee schedule or other payment methodology established pursuant
5 to s. 440.13.
6 3. Allowable amounts that may be charged to a personal
7 injury protection insurance insurer and insured for medically
8 necessary nerve conduction testing when done in conjunction
9 with a needle electromyography procedure and both are
10 performed and billed solely by a physician licensed under
11 chapter 458, chapter 459, chapter 460, or chapter 461 who is
12 also certified by the American Board of Electrodiagnostic
13 Medicine or by a board recognized by the American Board of
14 Medical Specialties or the American Osteopathic Association or
15 who holds diplomate status with the American Chiropractic
16 Neurology Board or its predecessors shall not exceed 200
17 percent of the allowable amount under the participating
18 physician fee schedule of Medicare Part B for year 2001, for
19 the area in which the treatment was rendered, adjusted
20 annually on August 1 to reflect the prior calendar year's
21 changes in the annual Medical Care Item of the Consumer Price
22 Index for All Urban Consumers in the South Region as
23 determined by the Bureau of Labor Statistics of the United
24 States Department of Labor.
25 4. Allowable amounts that may be charged to a personal
26 injury protection insurance insurer and insured for medically
27 necessary nerve conduction testing that does not meet the
28 requirements of subparagraph 3. shall not exceed the
29 applicable fee schedule or other payment methodology
30 established pursuant to s. 440.13.
31 5. Effective upon this act becoming a law and before
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1 November 1, 2001, allowable amounts that may be charged to a
2 personal injury protection insurance insurer and insured for
3 magnetic resonance imaging services shall not exceed 200
4 percent of the allowable amount under Medicare Part B for year
5 2001, for the area in which the treatment was rendered.
6 Beginning November 1, 2001, allowable amounts that may be
7 charged to a personal injury protection insurance insurer and
8 insured for magnetic resonance imaging services shall not
9 exceed 175 percent of the allowable amount under the
10 participating physician fee schedule of Medicare Part B for
11 year 2001, for the area in which the treatment was rendered,
12 adjusted annually on August 1 to reflect the prior calendar
13 year's changes in the annual Medical Care Item of the Consumer
14 Price Index for All Urban Consumers in the South Region as
15 determined by the Bureau of Labor Statistics of the United
16 States Department of Labor for the 12-month period ending June
17 30 of that year, except that allowable amounts that may be
18 charged to a personal injury protection insurance insurer and
19 insured for magnetic resonance imaging services provided in
20 facilities accredited by the Accreditation Association for
21 Ambulatory Health Care, the American College of Radiology, or
22 the Joint Commission on Accreditation of Healthcare
23 Organizations shall not exceed 200 percent of the allowable
24 amount under the participating physician fee schedule of
25 Medicare Part B for year 2001, for the area in which the
26 treatment was rendered, adjusted annually on August 1 to
27 reflect the prior calendar year's changes in the annual
28 Medical Care Item of the Consumer Price Index for All Urban
29 Consumers in the South Region as determined by the Bureau of
30 Labor Statistics of the United States Department of Labor for
31 the 12-month period ending June 30 of that year. This
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1 paragraph does not apply to charges for magnetic resonance
2 imaging services and nerve conduction testing for inpatients
3 and emergency services and care as defined in chapter 395
4 rendered by facilities licensed under chapter 395.
5 6. The Department of Health, in consultation with the
6 appropriate professional licensing boards, shall adopt, by
7 rule, a list of diagnostic tests deemed not to be medically
8 necessary for use in the treatment of persons sustaining
9 bodily injury covered by personal injury protection benefits
10 under this section. The initial list shall be adopted by
11 January 1, 2004, and shall be revised from time to time as
12 determined by the Department of Health, in consultation with
13 the respective professional licensing boards. Inclusion of a
14 test on the list of invalid diagnostic tests shall be based on
15 lack of demonstrated medical value and a level of general
16 acceptance by the relevant provider community and shall not be
17 dependent for results entirely upon subjective patient
18 response. Notwithstanding its inclusion on a fee schedule in
19 this subsection, an insurer or insured is not required to pay
20 any charges or reimburse claims for any invalid diagnostic
21 test as determined by the Department of Health.
22 (e)1. At the initial treatment or service provided,
23 each physician, other licensed professional, clinic, or other
24 medical institution providing medical services upon which a
25 claim for personal injury protection benefits is based shall
26 require an insured person, or his or her guardian, to execute
27 a disclosure and acknowledgment form, which reflects at a
28 minimum that:
29 a. The insured, or his or her guardian, must
30 countersign the form attesting to the fact that the services
31 set forth therein were actually rendered;
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1 b. The insured, or his or her guardian, has both the
2 right and affirmative duty to confirm that the services were
3 actually rendered;
4 c. The insured, or his or her guardian, was not
5 solicited by any person to seek any services from the medical
6 provider;
7 d. That the physician, other licensed professional,
8 clinic, or other medical institution rendering services for
9 which payment is being claimed explained the services to the
10 insured or his or her guardian; and
11 e. If the insured notifies the insurer in writing of a
12 billing error, the insured may be entitled to a certain
13 percentage of a reduction in the amounts paid by the insured's
14 motor vehicle insurer.
15 2. The physician, other licensed professional, clinic,
16 or other medical institution rendering services for which
17 payment is being claimed has the affirmative duty to explain
18 the services rendered to the insured, or his or her guardian,
19 so that the insured, or his or her guardian, countersigns the
20 form with informed consent.
21 3. Countersignature by the insured, or his or her
22 guardian, is not required for the reading of diagnostic tests
23 or other services that are of such a nature that they are not
24 required to be performed in the presence of the insured.
25 4. The licensed medical professional rendering
26 treatment for which payment is being claimed must sign, by his
27 or her own hand, the form complying with this paragraph.
28 5. The original completed disclosure and
29 acknowledgment form shall be furnished to the insurer pursuant
30 to paragraph (4)(b) and may not be electronically furnished.
31 6. This disclosure and acknowledgment form is not
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Amendment No. ___ Barcode 094390
1 required for services billed by a provider for emergency
2 services as defined in s. 395.002, for emergency services and
3 care as defined in s. 395.002 rendered in a hospital emergency
4 department, for services rendered in an ambulatory surgical
5 center as defined in s. 395.002, or for transport and
6 treatment rendered by an ambulance provider licensed pursuant
7 to part III of chapter 401.
8 7. The Financial Services Commission shall adopt, by
9 rule, a standard disclosure and acknowledgment form that shall
10 be used to fulfill the requirements of this paragraph,
11 effective 90 days after such form is adopted and becomes
12 final. The commission shall adopt a proposed rule by October
13 1, 2003. Until the rule is final, the provider may use a form
14 of its own which otherwise complies with the requirements of
15 this paragraph.
16 8. As used in this paragraph, "countersigned" means a
17 second or verifying signature, as on a previously signed
18 document, and is not satisfied by the statement "signature on
19 file" or any similar statement.
20 9. The requirements of this paragraph apply only with
21 respect to the initial treatment or service of the insured by
22 a provider. For subsequent treatments or service, the provider
23 must maintain a patient log signed by the patient, in
24 chronological order by date of service, that is consistent
25 with the services being rendered to the patient as claimed.
26 For purposes of the patient signing a log on subsequent
27 visits, the provider may use biometric time date technology as
28 an electronic signature under ss. 668.003 and 668.004. The
29 requirements of this subparagraph for maintaining a patient
30 log signed by the patient may be met by a hospital or
31 ambulatory surgical center that maintains medical records as
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Amendment No. ___ Barcode 094390
1 required by s. 395.3025 and applicable rules and makes such
2 records available to the insurer upon request.
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4 (Redesignate subsequent sections.)
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7 ================ T I T L E A M E N D M E N T ===============
8 And the title is amended as follows:
9 On page 1, lines 1-3, delete those lines
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11 and insert:
12 A bill to be entitled
13 An act relating to motor vehicle insurance;
14 amending s. 627.732, F.S.; defining the terms
15 "biometrics" and "biometric time date
16 technology"; amending s. 627.736, F.S.;
17 providing a presumption and revising a
18 procedure with respect to the use of biometric
19 time date technology under personal injury
20 protection benefits; amending
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