Amendment

Bill No. 2994

Amendment No. 578289

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

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