Florida Senate - 2013                        COMMITTEE AMENDMENT
       Bill No. SB 662
       
       
       
       
       
       
                                Barcode 213550                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/25/2013           .                                
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       The Committee on Appropriations (Hays) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (12) of section 440.13, Florida
    6  Statutes, is amended to read:
    7         440.13 Medical services and supplies; penalty for
    8  violations; limitations.—
    9         (12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM
   10  REIMBURSEMENT ALLOWANCES.—
   11         (a) A three-member panel is created, consisting of the
   12  Chief Financial Officer, or the Chief Financial Officer’s
   13  designee, and two members to be appointed by the Governor,
   14  subject to confirmation by the Senate, one member who, on
   15  account of present or previous vocation, employment, or
   16  affiliation, shall be classified as a representative of
   17  employers, the other member who, on account of previous
   18  vocation, employment, or affiliation, shall be classified as a
   19  representative of employees. The panel shall determine statewide
   20  schedules of maximum reimbursement allowances for medically
   21  necessary treatment, care, and attendance provided by
   22  physicians, hospitals, ambulatory surgical centers, work
   23  hardening programs, pain programs, and durable medical
   24  equipment. The maximum reimbursement allowances for inpatient
   25  hospital care shall be based on a schedule of per diem rates, to
   26  be approved by the three-member panel no later than March 1,
   27  1994, to be used in conjunction with a precertification manual
   28  as determined by the department, including maximum hours in
   29  which an outpatient may remain in observation status, which
   30  shall not exceed 23 hours. All compensable charges for hospital
   31  outpatient care shall be reimbursed at 75 percent of usual and
   32  customary charges, except as otherwise provided by this
   33  subsection. Annually, the three-member panel shall adopt
   34  schedules of maximum reimbursement allowances for physicians,
   35  hospital inpatient care, hospital outpatient care, ambulatory
   36  surgical centers, work-hardening programs, and pain programs. An
   37  individual physician, hospital, ambulatory surgical center, pain
   38  program, or work-hardening program shall be reimbursed either
   39  the agreed-upon contract price or the maximum reimbursement
   40  allowance in the appropriate schedule.
   41         (b) It is the intent of the Legislature to increase the
   42  schedule of maximum reimbursement allowances for selected
   43  physicians effective January 1, 2004, and to pay for the
   44  increases through reductions in payments to hospitals. Revisions
   45  developed pursuant to this subsection are limited to the
   46  following:
   47         1. Payments for outpatient physical, occupational, and
   48  speech therapy provided by hospitals shall be reduced to the
   49  schedule of maximum reimbursement allowances for these services
   50  which applies to nonhospital providers.
   51         2. Payments for scheduled outpatient nonemergency
   52  radiological and clinical laboratory services that are not
   53  provided in conjunction with a surgical procedure shall be
   54  reduced to the schedule of maximum reimbursement allowances for
   55  these services which applies to nonhospital providers.
   56         3. Outpatient reimbursement for scheduled surgeries shall
   57  be reduced from 75 percent of charges to 60 percent of charges.
   58         4. Maximum reimbursement for a physician licensed under
   59  chapter 458 or chapter 459 shall be increased to 110 percent of
   60  the reimbursement allowed by Medicare, using appropriate codes
   61  and modifiers or the medical reimbursement level adopted by the
   62  three-member panel as of January 1, 2003, whichever is greater.
   63         5. Maximum reimbursement for surgical procedures shall be
   64  increased to 140 percent of the reimbursement allowed by
   65  Medicare or the medical reimbursement level adopted by the
   66  three-member panel as of January 1, 2003, whichever is greater.
   67         (c) As to reimbursement for a prescription medication, the
   68  reimbursement amount for a prescription shall be the average
   69  wholesale price plus $4.18 for the dispensing fee, except where
   70  the carrier has contracted for a lower amount. For repackaged or
   71  relabeled prescription medications dispensed by a dispensing
   72  practitioner as provided in s. 465.0276, the fee schedule for
   73  reimbursement shall be 112.5 percent of the average wholesale
   74  price, plus $8.00 for the dispensing fee. For purposes of this
   75  subsection, the average wholesale price shall be calculated by
   76  multiplying the number of units dispensed times the per-unit
   77  average wholesale price set by the original manufacturer of the
   78  underlying drug dispensed by the practitioner, based upon the
   79  published manufacturer’s average wholesale price published in
   80  the Medi-Span Master Drug Database as of the date of dispensing.
   81  All pharmaceutical claims submitted for repackaged or relabeled
   82  prescription medications must include the National Drug Code of
   83  the original manufacturer. Fees for pharmaceuticals and
   84  pharmaceutical services shall be reimbursable at the applicable
   85  fee schedule amount except where the employer or carrier, or a
   86  service company, third party administrator, or any entity acting
   87  on behalf of the employer or carrier directly contracts with the
   88  provider seeking reimbursement for a lower amount. Where the
   89  employer or carrier has contracted for such services and the
   90  employee elects to obtain them through a provider not a party to
   91  the contract, the carrier shall reimburse at the schedule,
   92  negotiated, or contract price, whichever is lower. No Such
   93  contract shall rely on a provider that is not reasonably
   94  accessible to the employee.
   95         (d) Reimbursement for all fees and other charges for such
   96  treatment, care, and attendance, including treatment, care, and
   97  attendance provided by any hospital or other health care
   98  provider, ambulatory surgical center, work-hardening program, or
   99  pain program, must not exceed the amounts provided by the
  100  uniform schedule of maximum reimbursement allowances as
  101  determined by the panel or as otherwise provided in this
  102  section. This subsection also applies to independent medical
  103  examinations performed by health care providers under this
  104  chapter. In determining the uniform schedule, the panel shall
  105  first approve the data which it finds representative of
  106  prevailing charges in the state for similar treatment, care, and
  107  attendance of injured persons. Each health care provider, health
  108  care facility, ambulatory surgical center, work-hardening
  109  program, or pain program receiving workers’ compensation
  110  payments shall maintain records verifying their usual charges.
  111  In establishing the uniform schedule of maximum reimbursement
  112  allowances, the panel must consider:
  113         1. The levels of reimbursement for similar treatment, care,
  114  and attendance made by other health care programs or third-party
  115  providers;
  116         2. The impact upon cost to employers for providing a level
  117  of reimbursement for treatment, care, and attendance which will
  118  ensure the availability of treatment, care, and attendance
  119  required by injured workers;
  120         3. The financial impact of the reimbursement allowances
  121  upon health care providers and health care facilities, including
  122  trauma centers as defined in s. 395.4001, and its effect upon
  123  their ability to make available to injured workers such
  124  medically necessary remedial treatment, care, and attendance.
  125  The uniform schedule of maximum reimbursement allowances must be
  126  reasonable, must promote health care cost containment and
  127  efficiency with respect to the workers’ compensation health care
  128  delivery system, and must be sufficient to ensure availability
  129  of such medically necessary remedial treatment, care, and
  130  attendance to injured workers; and
  131         4. The most recent average maximum allowable rate of
  132  increase for hospitals determined by the Health Care Board under
  133  chapter 408.
  134         (e) In addition to establishing the uniform schedule of
  135  maximum reimbursement allowances, the panel shall:
  136         1. Take testimony, receive records, and collect data to
  137  evaluate the adequacy of the workers’ compensation fee schedule,
  138  nationally recognized fee schedules and alternative methods of
  139  reimbursement to certified health care providers and health care
  140  facilities for inpatient and outpatient treatment and care.
  141         2. Survey certified health care providers and health care
  142  facilities to determine the availability and accessibility of
  143  workers’ compensation health care delivery systems for injured
  144  workers.
  145         3. Survey carriers to determine the estimated impact on
  146  carrier costs and workers’ compensation premium rates by
  147  implementing changes to the carrier reimbursement schedule or
  148  implementing alternative reimbursement methods.
  149         4. Submit recommendations on or before January 1, 2003, and
  150  biennially thereafter, to the President of the Senate and the
  151  Speaker of the House of Representatives on methods to improve
  152  the workers’ compensation health care delivery system.
  153  
  154  The department, as requested, shall provide data to the panel,
  155  including, but not limited to, utilization trends in the
  156  workers’ compensation health care delivery system. The
  157  department shall provide the panel with an annual report
  158  regarding the resolution of medical reimbursement disputes and
  159  any actions pursuant to subsection (8). The department shall
  160  provide administrative support and service to the panel to the
  161  extent requested by the panel. For prescription medication
  162  purchased under the requirements of this subsection, a
  163  dispensing practitioner shall not possess such medication unless
  164  payment has been made by the practitioner, the practitioner’s
  165  professional practice, or the practitioner’s practice management
  166  company or employer to the supplying manufacturer, wholesaler,
  167  distributor, or drug repackager within 60 days of the dispensing
  168  practitioner taking possession of that medication.
  169         Section 2. This act shall take effect July 1, 2013.
  170  
  171  ================= T I T L E  A M E N D M E N T ================
  172         And the title is amended as follows:
  173         Delete everything before the enacting clause
  174  and insert:
  175                        A bill to be entitled                      
  176         An act relating to workers’ compensation; amending s.
  177         440.13, F.S.; revising requirements for determining
  178         the amount of a reimbursement for repackaged or
  179         relabeled prescription medication; providing an
  180         exception; prohibiting a dispensing manufacturer from
  181         possession of a medicinal drug until certain persons
  182         are paid; providing an effective date.