| 1 | A bill to be entitled |
| 2 | An act relating to health care clinics; amending s. |
| 3 | 400.9905, F.S.; revising the definition of the term |
| 4 | "clinic" to provide that pt. X of ch. 400, F.S., the |
| 5 | Health Care Clinic Act, does not apply to entities that do |
| 6 | not seek reimbursement from insurance companies for |
| 7 | medical services paid pursuant to personal injury |
| 8 | protection coverage; amending s. 400.9935, F.S.; providing |
| 9 | for a unique identification number for licensed clinics |
| 10 | and entities holding certificates of exemption; requiring |
| 11 | the Office of Insurance Regulation to issue unique |
| 12 | identification numbers, under certain circumstances, and |
| 13 | publish the numbers on its Internet website in a specified |
| 14 | format; amending s. 627.736, F.S.; providing that personal |
| 15 | injury protection insurance carriers are not required to |
| 16 | pay claims or charges for service or treatment billed by a |
| 17 | provider not holding an identification number issued by |
| 18 | the office; providing an effective date. |
| 19 |
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| 20 | Be It Enacted by the Legislature of the State of Florida: |
| 21 |
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| 22 | Section 1. Paragraph (m) is added to subsection (4) of |
| 23 | section 400.9905, Florida Statutes, to read: |
| 24 | 400.9905 Definitions.-- |
| 25 | (4) "Clinic" means an entity at which health care services |
| 26 | are provided to individuals and which tenders charges for |
| 27 | reimbursement for such services, including a mobile clinic and a |
| 28 | portable equipment provider. For purposes of this part, the term |
| 29 | does not include and the licensure requirements of this part do |
| 30 | not apply to: |
| 31 | (m) Entities that do not seek reimbursement from insurance |
| 32 | companies for medical services paid pursuant to personal injury |
| 33 | protection coverage required by s. 627.736. |
| 34 | Section 2. Subsection (10) is added to section 400.9935, |
| 35 | Florida Statutes, to read: |
| 36 | 400.9935 Clinic responsibilities.-- |
| 37 | (10) Any clinic holding an active license and any entity |
| 38 | holding a current certificate of exemption may request a unique |
| 39 | identification number from the Office of Insurance Regulation |
| 40 | for the purposes of submitting claims to personal injury |
| 41 | protection insurance carriers for services or treatment pursuant |
| 42 | to part XI of chapter 627. Upon request, the Office of Insurance |
| 43 | Regulation shall assign a unique identification number to a |
| 44 | clinic holding an active license or an entity holding a current |
| 45 | certificate of exemption. The Office of Insurance Regulation |
| 46 | shall publish the identification number of each clinic and |
| 47 | entity on its Internet website in a searchable format that is |
| 48 | readily accessible to personal injury protection insurance |
| 49 | carriers for the purposes of s. 627.736(5)(b)1.g. |
| 50 | Section 3. Paragraph (b) of subsection (5) of section |
| 51 | 627.736, Florida Statutes, is amended to read: |
| 52 | 627.736 Required personal injury protection benefits; |
| 53 | exclusions; priority; claims.-- |
| 54 | (5) CHARGES FOR TREATMENT OF INJURED PERSONS.-- |
| 55 | (b)1. An insurer or insured is not required to pay a claim |
| 56 | or charges: |
| 57 | a. Made by a broker or by a person making a claim on |
| 58 | behalf of a broker; |
| 59 | b. For any service or treatment that was not lawful at the |
| 60 | time rendered; |
| 61 | c. To any person who knowingly submits a false or |
| 62 | misleading statement relating to the claim or charges; |
| 63 | d. With respect to a bill or statement that does not |
| 64 | substantially meet the applicable requirements of paragraph (d); |
| 65 | e. For any treatment or service that is upcoded, or that |
| 66 | is unbundled when such treatment or services should be bundled, |
| 67 | in accordance with paragraph (d). To facilitate prompt payment |
| 68 | of lawful services, an insurer may change codes that it |
| 69 | determines to have been improperly or incorrectly upcoded or |
| 70 | unbundled, and may make payment based on the changed codes, |
| 71 | without affecting the right of the provider to dispute the |
| 72 | change by the insurer, provided that before doing so, the |
| 73 | insurer must contact the health care provider and discuss the |
| 74 | reasons for the insurer's change and the health care provider's |
| 75 | reason for the coding, or make a reasonable good faith effort to |
| 76 | do so, as documented in the insurer's file; and |
| 77 | f. For medical services or treatment billed by a physician |
| 78 | and not provided in a hospital unless such services are rendered |
| 79 | by the physician or are incident to his or her professional |
| 80 | services and are included on the physician's bill, including |
| 81 | documentation verifying that the physician is responsible for |
| 82 | the medical services that were rendered and billed; and |
| 83 | g. For any service or treatment billed by a provider not |
| 84 | holding an identification number issued by the office pursuant |
| 85 | to s. 400.9935(10). |
| 86 | 2. The Department of Health, in consultation with the |
| 87 | appropriate professional licensing boards, shall adopt, by rule, |
| 88 | a list of diagnostic tests deemed not to be medically necessary |
| 89 | for use in the treatment of persons sustaining bodily injury |
| 90 | covered by personal injury protection benefits under this |
| 91 | section. The initial list shall be adopted by January 1, 2004, |
| 92 | and shall be revised from time to time as determined by the |
| 93 | Department of Health, in consultation with the respective |
| 94 | professional licensing boards. Inclusion of a test on the list |
| 95 | of invalid diagnostic tests shall be based on lack of |
| 96 | demonstrated medical value and a level of general acceptance by |
| 97 | the relevant provider community and shall not be dependent for |
| 98 | results entirely upon subjective patient response. |
| 99 | Notwithstanding its inclusion on a fee schedule in this |
| 100 | subsection, an insurer or insured is not required to pay any |
| 101 | charges or reimburse claims for any invalid diagnostic test as |
| 102 | determined by the Department of Health. |
| 103 | Section 4. This act shall take effect July 1, 2009. |