Amendment No. 1 - PCS for CS/CS/HB 895 (Commerce Committee, 2020)

Summary

Amendment No. 1 to PCS for CS/CS/HB 895 (2020), offered by Representative Santiago for the Commerce Committee, an amendment with title amendment. It removes lines 127-130 and inserts Section 3, amending paragraph (a) of subsection (5) and subsection (10) of section 627.736, Florida Statutes, on required personal injury protection benefits and charges for treatment of injured persons. The inserted text provides that the insurer may limit reimbursement to 80 percent of a schedule of maximum charges. The title amendment refers to revising allowable maximum medical charges.

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                                          COMMITTEE/SUBCOMMITTEE AMENDMENT
                                     Bill No. PCS for CS/CS/HB 895     (2020)
       Amendment No. 1




            COMMITTEE/SUBCOMMITTEE ACTION
       ADOPTED                         (Y/N)
       ADOPTED AS AMENDED              (Y/N)
       ADOPTED W/O OBJECTION           (Y/N)
       FAILED TO ADOPT                 (Y/N)
       WITHDRAWN                       (Y/N)
       OTHER


1      Committee/Subcommittee hearing bill:       Commerce Committee
2      Representative Santiago offered the following:
3
4           Amendment (with title amendment)
5           Remove lines 127-130 and insert:
6           Section 3.   Paragraph (a) of subsection (5) and subsection
7      (10) of section 627.736, Florida Statutes, are amended to read:
8           627.736    Required personal injury protection benefits;
9      exclusions; priority; claims.—
10          (5)    CHARGES FOR TREATMENT OF INJURED PERSONS.—
11          (a)    A physician, hospital, clinic, or other person or
12     institution lawfully rendering treatment to an injured person
13     for a bodily injury covered by personal injury protection
14     insurance may charge the insurer and injured party only a
15     reasonable amount pursuant to this section for the services and
16     supplies rendered, and the insurer providing such coverage may
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                                          COMMITTEE/SUBCOMMITTEE AMENDMENT
                                    Bill No. PCS for CS/CS/HB 895     (2020)
       Amendment No. 1


17     pay for such charges directly to such person or institution
18     lawfully rendering such treatment if the insured receiving such
19     treatment or his or her guardian has countersigned the properly
20     completed invoice, bill, or claim form approved by the office
21     upon which such charges are to be paid for as having actually
22     been rendered, to the best knowledge of the insured or his or
23     her guardian. However, such a charge may not exceed the amount
24     the person or institution customarily charges for like services
25     or supplies. In determining whether a charge for a particular
26     service, treatment, or otherwise is reasonable, consideration
27     may be given to evidence of usual and customary charges and
28     payments accepted by the provider involved in the dispute,
29     reimbursement levels in the community and various federal and
30     state medical fee schedules applicable to motor vehicle and
31     other insurance coverages, and other information relevant to the
32     reasonableness of the reimbursement for the service, treatment,
33     or supply.
34          1.   The insurer may limit reimbursement to 80 percent of
35     the following schedule of maximum charges:
36          a.   For emergency transport and treatment by providers
37     licensed under chapter 401, 200 percent of Medicare.
38          b.   For emergency services and care provided by a hospital
39     licensed under chapter 395, 200 percent of Medicare 75 percent
40     of the hospital's usual and customary charges.
41          c.   For emergency services and care as defined by s.
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                                      Bill No. PCS for CS/CS/HB 895   (2020)
       Amendment No. 1


42     395.002 provided in a facility licensed under chapter 395
43     rendered by a physician or dentist, and related hospital
44     inpatient services rendered by a physician or dentist, 200
45     percent of Medicare the usual and customary charges in the
46     community.
47          d.     For hospital inpatient services, other than emergency
48     services and care, 200 percent of the Medicare Part A
49     prospective payment applicable to the specific hospital
50     providing the inpatient services.
51          e.     For hospital outpatient services, other than emergency
52     services and care, 200 percent of the Medicare Part A Ambulatory
53     Payment Classification for the specific hospital providing the
54     outpatient services.
55          f.     For all other medical services, supplies, and care, 200
56     percent of the allowable amount under:
57          (I)     The participating physicians fee schedule of Medicare
58     Part B, except as provided in sub-sub-subparagraphs (II) and
59     (III).
60          (II)     Medicare Part B, in the case of services, supplies,
61     and care provided by ambulatory surgical centers and clinical
62     laboratories.
63          (III)     The Durable Medical Equipment Prosthetics/Orthotics
64     and Supplies fee schedule of Medicare Part B, in the case of
65     durable medical equipment.
66
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       Amendment No. 1


67     However, if such services, supplies, or care is not reimbursable
68     under Medicare Part B, as provided in this sub-subparagraph, the
69     insurer may limit reimbursement to 80 percent of the maximum
70     reimbursable allowance under workers' compensation, as
71     determined under s. 440.13 and rules adopted thereunder which
72     are in effect at the time such services, supplies, or care is
73     provided. Services, supplies, or care that is not reimbursable
74     under Medicare or workers' compensation is not required to be
75     reimbursed by the insurer.
76          2.   For purposes of subparagraph 1., the applicable fee
77     schedule or payment limitation under Medicare is the fee
78     schedule or payment limitation in effect on March 1 of the
79     service year in which the services, supplies, or care is
80     rendered and for the area in which such services, supplies, or
81     care is rendered, and the applicable fee schedule or payment
82     limitation applies to services, supplies, or care rendered
83     during that service year, notwithstanding any subsequent change
84     made to the fee schedule or payment limitation, except that it
85     may not be less than the allowable amount under the applicable
86     schedule of Medicare Part B for 2007 for medical services,
87     supplies, and care subject to Medicare Part B. For purposes of
88     this subparagraph, the term "service year" means the period from
89     March 1 through the end of February of the following year.
90          3.   Subparagraph 1. does not allow the insurer to apply any
91     limitation on the number of treatments or other utilization
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                                     Bill No. PCS for CS/CS/HB 895     (2020)
        Amendment No. 1


92      limits that apply under Medicare or workers' compensation. An
93      insurer that applies the allowable payment limitations of
94      subparagraph 1. must reimburse a provider who lawfully provided
95      care or treatment under the scope of his or her license,
96      regardless of whether such provider is entitled to reimbursement
97      under Medicare due to restrictions or limitations on the types
98      or discipline of health care providers who may be reimbursed for
99      particular procedures or procedure codes. However, subparagraph
100     1. does not prohibit an insurer from using the Medicare coding
101     policies and payment methodologies of the federal Centers for
102     Medicare and Medicaid Services, including applicable modifiers,
103     to determine the appropriate amount of reimbursement for medical
104     services, supplies, or care if the coding policy or payment
105     methodology does not constitute a utilization limit.
106          4.   If an insurer limits payment as authorized by
107     subparagraph 1., the person providing such services, supplies,
108     or care may not bill or attempt to collect from the insured any
109     amount in excess of such limits, except for amounts that are not
110     covered by the insured's personal injury protection coverage due
111     to the coinsurance amount or maximum policy limits.
112          5.   An insurer may limit payment as authorized by this
113     paragraph only if the insurance policy includes a notice at the
114     time of issuance or renewal that the insurer may limit payment
115     pursuant to the schedule of charges specified in this paragraph.
116     A policy form approved by the office satisfies this requirement.
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                                      Bill No. PCS for CS/CS/HB 895   (2020)
        Amendment No. 1


117     If a provider submits a charge for an amount less than the
118     amount allowed under subparagraph 1., the insurer may pay the
119     amount of the charge submitted.
120
121
122           -----------------------------------------------------
123                       T I T L E    A M E N D M E N T
124          Remove line 24 and insert:
125     s. 627.736, F.S.; revising allowable maximum medical charges;
126     specifying information required as




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