HB 983

1	A bill to be entitled
2	An act relating to payment for services provided by
3	licensed psychologists; amending ss. 627.6131 and
4	641.3155, F.S.; adding licensed psychologists to the
5	list of health care providers who are protected by a
6	limitations period from claims for overpayment being
7	sought by health insurers or health maintenance
8	organizations; adding licensed psychologists to the
9	list of health care providers who are subject to a
10	limitations period for submitting claims to health
11	insurers or health maintenance organizations for
12	underpayment; amending s. 627.638, F.S.; adding
13	licensed psychologists to the list of health care
14	providers who are eligible for direct payment for
15	medical services by a health insurer under certain
16	circumstances; providing an effective date.
17
18	Be It Enacted by the Legislature of the State of Florida:
19
20	Section 1.  Subsections (18) and (19) of section 627.6131,
21	Florida Statutes, are amended to read:
22	627.6131  Payment of claims.-
23	(18)  Notwithstanding the 30-month period provided in
24	subsection (6), all claims for overpayment submitted to a
25	provider licensed under chapter 458, chapter 459, chapter 460,
26	chapter 461, or chapter 466, or chapter 490 must be submitted to
27	the provider within 12 months after the health insurer's payment
28	of the claim. A claim for overpayment may not be permitted
29	beyond 12 months after the health insurer's payment of a claim,
30	except that claims for overpayment may be sought beyond that
31	time from providers convicted of fraud pursuant to s. 817.234.
32	(19)  Notwithstanding any other provision of this section,
33	all claims for underpayment from a provider licensed under
34	chapter 458, chapter 459, chapter 460, chapter 461, or chapter
35	466, or chapter 490 must be submitted to the insurer within 12
36	months after the health insurer's payment of the claim. A claim
37	for underpayment may not be permitted beyond 12 months after the
38	health insurer's payment of a claim.
39	Section 2.  Subsections (16) and (17) of section 641.3155,
40	Florida Statutes, are amended to read:
41	641.3155  Prompt payment of claims.-
42	(16)  Notwithstanding the 30-month period provided in
43	subsection (5), all claims for overpayment submitted to a
44	provider licensed under chapter 458, chapter 459, chapter 460,
45	chapter 461, or chapter 466, or chapter 490 must be submitted to
46	the provider within 12 months after the health maintenance
47	organization's payment of the claim. A claim for overpayment may
48	not be permitted beyond 12 months after the health maintenance
49	organization's payment of a claim, except that claims for
50	overpayment may be sought beyond that time from providers
51	convicted of fraud pursuant to s. 817.234.
52	(17)  Notwithstanding any other provision of this section,
53	all claims for underpayment from a provider licensed under
54	chapter 458, chapter 459, chapter 460, chapter 461, or chapter
55	466 or chapter 490 must be submitted to the health maintenance
56	organization within 12 months after the health maintenance
57	organization's payment of the claim. A claim for underpayment
58	may not be permitted beyond 12 months after the health
59	maintenance organization's payment of a claim.
60	Section 3.  Contingent upon the Office of Program Policy
61	Analysis and Government Accountability not presenting the
62	finding specified in section 2 of chapter 2009-124, Laws of
63	Florida, and the text of subsection (2) of section 627.638,
64	Florida Statutes, not reverting to that in existence on June 30,
65	2009, that subsection is amended to read:
66	627.638  Direct payment for hospital, medical services.-
67	(2)  Whenever, in any health insurance claim form, an
68	insured specifically authorizes payment of benefits directly to
69	any recognized hospital, licensed ambulance provider, physician,
70	dentist, psychologist, or other person who provided the services
71	in accordance with the provisions of the policy, the insurer
72	shall make such payment to the designated provider of such
73	services. The insurance contract may not prohibit, and claims
74	forms must provide an option for, the payment of benefits
75	directly to a licensed hospital, licensed ambulance provider,
76	physician, dentist, psychologist, or other person who provided
77	the services in accordance with the provisions of the policy for
78	care provided. The insurer may require written attestation of
79	assignment of benefits. Payment to the provider from the insurer
80	may not be more than the amount that the insurer would otherwise
81	have paid without the assignment.
82	Section 4.  Contingent upon the Office of Program Policy
83	Analysis and Government Accountability presenting the finding
84	specified in section 2 of chapter 2009-124, Laws of Florida, and
85	the text of subsection (2) of section 627.638, Florida Statutes,
86	reverting to that in existence on June 30, 2009, that subsection
87	is amended to read:
88	627.638  Direct payment for hospital, medical services.-
89	(2)  Whenever, in any health insurance claim form, an
90	insured specifically authorizes payment of benefits directly to
91	any recognized hospital, licensed ambulance provider, physician,
92	or dentist, or psychologist, the insurer shall make such payment
93	to the designated provider of such services, unless otherwise
94	provided in the insurance contract. The insurance contract may
95	not prohibit, and claims forms must provide an option for, the
96	payment of benefits directly to a licensed hospital, licensed
97	ambulance provider, physician, or dentist, or psychologist for
98	care provided pursuant to s. 395.1041 or part III of chapter
99	401. The insurer may require written attestation of assignment
100	of benefits. Payment to the provider from the insurer may not be
101	more than the amount that the insurer would otherwise have paid
102	without the assignment.
103	Section 5.  This act shall take effect July 1, 2012.

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