January 21, 2020
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Amendment
Bill No. 2994
Amendment No. 578289
CHAMBER ACTION
Senate House
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1Representative 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
6section 627.736, Florida Statutes, are amended to read:
7     627.736  Required personal injury protection benefits;
8exclusions; priority; claims.--
9     (5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
10     (b)1.  An insurer or insured is not required to pay a claim
11or charges:
12     a.  Made by a broker or by a person making a claim on
13behalf of a broker;
14     b.  For any service or treatment that was not lawful at the
15time rendered;
16     c.  To any person who knowingly submits a false or
17misleading statement relating to the claim or charges;
18     d.  With respect to a bill or statement that does not
19substantially meet the applicable requirements of paragraph (d);
20     e.  For any treatment or service that is upcoded, or that
21is unbundled when such treatment or services should be bundled,
22in accordance with paragraph(d). To facilitate prompt payment of
23lawful services, an insurer may change codes that it determines
24to have been improperly or incorrectly upcoded or unbundled, and
25may make payment based on the changed codes, without affecting
26the right of the provider to dispute the change by the insurer,
27provided that before doing so, the insurer must contact the
28health care provider and discuss the reasons for the insurer's
29change and the health care provider's reason for the coding, or
30make a reasonable good faith effort to do so, as documented in
31the insurer's file; and
32     f.  For medical services or treatment billed by a physician
33and not provided in a hospital unless such services are rendered
34by the physician or are incident to his or her professional
35services and are included on the physician's bill, including
36documentation verifying that the physician is responsible for
37the medical services that were rendered and billed.
38     2.  Charges for medically necessary cephalic thermograms,
39peripheral thermograms, spinal ultrasounds, extremity
40ultrasounds, video fluoroscopy, and surface electromyography
41shall not exceed the maximum reimbursement allowance for such
42procedures as set forth in the applicable fee schedule or other
43payment methodology established pursuant to s. 440.13.
44     3.  Allowable amounts that may be charged to a personal
45injury protection insurance insurer and insured for medically
46necessary nerve conduction testing when done in conjunction with
47a needle electromyography procedure and both are performed and
48billed solely by a physician licensed under chapter 458, chapter
49459, chapter 460, or chapter 461 who is also certified by the
50American Board of Electrodiagnostic Medicine or by a board
51recognized by the American Board of Medical Specialties or the
52American Osteopathic Association or who holds diplomate status
53with the American Chiropractic Neurology Board or its
54predecessors shall not exceed 200 percent of the allowable
55amount under the participating physician fee schedule of
56Medicare Part B for year 2001, for the area in which the
57treatment was rendered, adjusted annually on August 1 to reflect
58the prior calendar year's changes in the annual Medical Care
59Item of the Consumer Price Index for All Urban Consumers in the
60South Region as determined by the Bureau of Labor Statistics of
61the United States Department of Labor.
62     4.  Allowable amounts that may be charged to a personal
63injury protection insurance insurer and insured for medically
64necessary nerve conduction testing that does not meet the
65requirements of subparagraph 3. shall not exceed the applicable
66fee schedule or other payment methodology established pursuant
67to s. 440.13.
68     5.  Effective upon this act becoming a law and before
69November 1, 2001, allowable amounts that may be charged to a
70personal injury protection insurance insurer and insured for
71magnetic resonance imaging services shall not exceed 200 percent
72of the allowable amount under Medicare Part B for year 2001, for
73the area in which the treatment was rendered. Beginning November
741, 2001, allowable amounts that may be charged to a personal
75injury protection insurance insurer and insured for magnetic
76resonance imaging services shall not exceed 175 percent of the
77allowable amount under the participating physician fee schedule
78of Medicare Part B for year 2001, for the area in which the
79treatment was rendered, adjusted annually on August 1 to reflect
80the prior calendar year's changes in the annual Medical Care
81Item of the Consumer Price Index for All Urban Consumers in the
82South Region as determined by the Bureau of Labor Statistics of
83the United States Department of Labor for the 12-month period
84ending June 30 of that year, except that allowable amounts that
85may be charged to a personal injury protection insurance insurer
86and insured for magnetic resonance imaging services provided in
87facilities accredited by the Accreditation Association for
88Ambulatory Health Care, the American College of Radiology, or
89the Joint Commission on Accreditation of Healthcare
90Organizations shall not exceed 200 percent of the allowable
91amount under the participating physician fee schedule of
92Medicare Part B for year 2001, for the area in which the
93treatment was rendered, adjusted annually on August 1 to reflect
94the prior calendar year's changes in the annual Medical Care
95Item of the Consumer Price Index for All Urban Consumers in the
96South Region as determined by the Bureau of Labor Statistics of
97the United States Department of Labor for the 12-month period
98ending June 30 of that year. This paragraph does not apply to
99charges for magnetic resonance imaging services and nerve
100conduction testing for inpatients and emergency services and
101care as defined in chapter 395 rendered by facilities licensed
102under chapter 395.
103     6.  The Department of Health, in consultation with the
104appropriate professional licensing boards, shall adopt, by rule,
105a list of diagnostic tests deemed not to be medically necessary
106for use in the treatment of persons sustaining bodily injury
107covered by personal injury protection benefits under this
108section. The initial list shall be adopted by January 1, 2004,
109and shall be revised from time to time as determined by the
110Department of Health, in consultation with the respective
111professional licensing boards. Inclusion of a test on the list
112of invalid diagnostic tests shall be based on lack of
113demonstrated medical value and a level of general acceptance by
114the relevant provider community and shall not be dependent for
115results entirely upon subjective patient response.
116Notwithstanding its inclusion on a fee schedule in this
117subsection, an insurer or insured is not required to pay any
118charges or reimburse claims for any invalid diagnostic test as
119determined by the Department of Health.
120     (e)1.  At the initial treatment or service provided, each
121physician, other licensed professional, clinic, or other medical
122institution providing medical services upon which a claim for
123personal injury protection benefits is based shall require an
124insured person, or his or her guardian, to execute a disclosure
125and acknowledgment form, which reflects at a minimum that:
126     a.  The insured, or his or her guardian, must countersign
127the form attesting to the fact that the services set forth
128therein were actually rendered;
129     b.  The insured, or his or her guardian, has both the right
130and affirmative duty to confirm that the services were actually
131rendered;
132     c.  The insured, or his or her guardian, was not solicited
133by any person to seek any services from the medical provider;
134     d.  That the physician, other licensed professional,
135clinic, or other medical institution rendering services for
136which payment is being claimed explained the services to the
137insured or his or her guardian; and
138     e.  If the insured notifies the insurer in writing of a
139billing error, the insured may be entitled to a certain
140percentage of a reduction in the amounts paid by the insured's
141motor vehicle insurer.
142     2.  The physician, other licensed professional, clinic, or
143other medical institution rendering services for which payment
144is being claimed has the affirmative duty to explain the
145services rendered to the insured, or his or her guardian, so
146that the insured, or his or her guardian, countersigns the form
147with informed consent.
148     3.  Countersignature by the insured, or his or her
149guardian, is not required for the reading of diagnostic tests or
150other services that are of such a nature that they are not
151required to be performed in the presence of the insured.
152     4.  The licensed medical professional rendering treatment
153for which payment is being claimed must sign, by his or her own
154hand, the form complying with this paragraph.
155     5.  The original completed disclosure and acknowledgment
156form 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
159for services billed by a provider for emergency services as
160defined in s. 395.002, for emergency services and care as
161defined in s. 395.002 rendered in a hospital emergency
162department, for services rendered in an ambulatory surgical
163center as defined in s. 395.002, or for transport and treatment
164rendered by an ambulance provider licensed pursuant to part III
165of chapter 401.
166     7.  The Financial Services Commission shall adopt, by rule,
167a standard disclosure and acknowledgment form that shall be used
168to fulfill the requirements of this paragraph, effective 90 days
169after such form is adopted and becomes final. The commission
170shall adopt a proposed rule by October 1, 2003. Until the rule
171is final, the provider may use a form of its own which otherwise
172complies with the requirements of this paragraph.
173     8.  As used in this paragraph, "countersigned" means a
174second or verifying signature, as on a previously signed
175document, and is not satisfied by the statement "signature on
176file" or any similar statement.
177     9.  The requirements of this paragraph apply only with
178respect to the initial treatment or service of the insured by a
179provider. For subsequent treatments or service, the provider
180must maintain a patient log signed by the patient, in
181chronological order by date of service, that is consistent with
182the services being rendered to the patient as claimed. The
183requirements of this subparagraph for maintaining a patient log
184signed by the patient may be met by a hospital or ambulatory
185surgical center that maintains medical records as required by s.
186395.3025 and applicable rules and makes such records available
187to 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:
192Program; amending s. 627.736, F.S.; deleting the period of
193time relating to adjustments in the Medical Care Item of
194the Consumer Price Index which applies to allowable
195amounts that may be charged to a personal injury
196protection insurance insurer and insured for magnetic
197resonance imaging services; exempting services rendered by
198an ambulatory surgical center from certain disclosure
199requirements; providing that the transfer of the


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