1

The Committee on Banking and Insurance (Posey) recommended the

2

following amendment to amendment (355928):

3

4

     Senate Amendment (with directory and title amendments)

5

     Between lines 7 and 8

6

insert:

7

8

     Section 1.  Paragraph (a) of subsection (5) of section

9

627.736, Florida Statutes, is amended to read:

10

     627.736  Required personal injury protection benefits;

11

exclusions; priority; claims.--

12

     (5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--

13

     (a)1.  Any physician, hospital, clinic, or other person or

14

institution lawfully rendering treatment to an injured person for

15

a bodily injury covered by personal injury protection insurance

16

may charge the insurer and injured party only a reasonable amount

17

pursuant to this section for the services and supplies rendered,

18

and the insurer providing such coverage may pay for such charges

19

directly to such person or institution lawfully rendering such

20

treatment, if the insured receiving such treatment or his or her

21

guardian has countersigned the properly completed invoice, bill,

22

or claim form approved by the office upon which such charges are

23

to be paid for as having actually been rendered, to the best

24

knowledge of the insured or his or her guardian. In no event,

25

however, may such a charge be in excess of the amount the person

26

or institution customarily charges for like services or supplies.

27

With respect to a determination of whether a charge for a

28

particular service, treatment, or otherwise is reasonable,

29

consideration may be given to evidence of usual and customary

30

charges and payments accepted by the provider involved in the

31

dispute, and reimbursement levels in the community and various

32

federal and state medical fee schedules applicable to automobile

33

and other insurance coverages, and other information relevant to

34

the reasonableness of the reimbursement for the service,

35

treatment, or supply.

36

     2.  The insurer may limit reimbursement to 80 percent of the

37

following schedule of maximum charges:

38

     a.  For emergency transport and treatment by providers

39

licensed under chapter 401, 200 percent of Medicare.

40

     b.  For emergency services and care provided by a hospital

41

licensed under chapter 395, 75 percent of the hospital's usual

42

and customary charges.

43

     c.  For emergency services and care as defined by s.

44

395.002(10) provided in a facility licensed under chapter 395

45

rendered by a physician or dentist, and related hospital

46

inpatient services rendered by a physician or dentist, the usual

47

and customary charges in the community.

48

     d.  For hospital inpatient services, other than emergency

49

services and care, 200 percent of the Medicare Part A prospective

50

payment applicable to the specific hospital providing the

51

inpatient services.

52

     e.  For hospital outpatient services, other than emergency

53

services and care, 200 percent of the Medicare Part A Ambulatory

54

Payment Classification for the specific hospital providing the

55

outpatient services.

56

     f.  For all other medical services, supplies, and care, 200

57

percent of the applicable Medicare Part B fee schedule for

58

participating physicians. However, if such services, supplies, or

59

care is not reimbursable under Medicare Part B, the insurer may

60

limit reimbursement to 80 percent of the maximum reimbursable

61

allowance under workers' compensation, as determined under s.

62

440.13 and rules adopted thereunder which are in effect at the

63

time such services, supplies, or care is provided. Services,

64

supplies, or care that is not reimbursable under Medicare or

65

workers' compensation is not required to be reimbursed by the

66

insurer.

67

     3.  For purposes of subparagraph 2., the applicable fee

68

schedule or payment limitation under Medicare is the fee schedule

69

or payment limitation in effect at the time the services,

70

supplies, or care was rendered and for the area in which such

71

services were rendered, except that it may not be less than the

72

applicable 2007 Medicare Part B fee schedule for participating

73

physicians for medical services, supplies, and care subject to

74

Medicare Part B.

75

     4.  Subparagraph 2. does not allow the insurer to apply any

76

limitation on the number of treatments or other utilization

77

limits that apply under Medicare or workers' compensation. An

78

insurer that applies the allowable payment limitations of

79

subparagraph 2. must reimburse a provider who lawfully provided

80

care or treatment under the scope of his or her license,

81

regardless of whether such provider would be entitled to

82

reimbursement under Medicare due to restrictions or limitations

83

on the types or discipline of health care providers who may be

84

reimbursed for particular procedures or procedure codes.

85

     5.  If an insurer limits payment as authorized by

86

subparagraph 2., the person providing such services, supplies, or

87

care may not bill or attempt to collect from the insured any

88

amount in excess of such limits, except for amounts that are not

89

covered by the insured's personal injury protection coverage due

90

to the coinsurance amount or maximum policy limits.

91

92

================ T I T L E  A M E N D M E N T ================

93

And the title is amended as follows:

94

     On line 82, delete "false and fraudulent insurance claims;"

95

and insert:

96

motor vehicle insurance; amending s. 627.736, F.S.;

97

revising the schedule of maximum charges on which an

98

insurer may base a limited reimbursement for certain

99

medical services, supplies, and care for injured persons

100

covered by personal injury protection; specifying a

101

minimum amount for the applicable fee schedule or payment

102

limitation under Medicare for such reimbursements;

3/18/2008  7:47:00 AM     597-05184-08