Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. SB 1930
                                Barcode 507024                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/13/2011           .                                

       The Committee on Banking and Insurance (Bogdanoff) recommended
       the following:
    1         Senate Amendment to Amendment (100124) (with title
    2  amendment)
    4         Delete lines 328 - 418
    5  and insert:
    6         (10)(2) “Medically necessary” refers to a medical service
    7  or supply that a prudent physician would provide for the purpose
    8  of preventing, diagnosing, or treating an illness, injury,
    9  disease, or symptom in a manner that is:
   10         (a) In accordance with generally accepted standards of
   11  medical practice;
   12         (b) Clinically appropriate in terms of type, frequency,
   13  extent, site, and duration; and
   14         (c) Not primarily for the convenience of the patient,
   15  physician, or other health care provider.
   16         (11)(3) “Motor vehicle” means a any self-propelled vehicle
   17  with four or more wheels which is of a type both designed and
   18  required to be licensed for use on the highways of this state,
   19  and any trailer or semitrailer designed for use with such
   20  vehicle, and includes:
   21         (a) A “private passenger motor vehicle,” which is any motor
   22  vehicle that which is a sedan, station wagon, or jeep-type
   23  vehicle and, if not used primarily for occupational,
   24  professional, or business purposes, a motor vehicle of the
   25  pickup, panel, van, camper, or motor home type.
   26         (b) A “commercial motor vehicle,” which is any motor
   27  vehicle that which is not a private passenger motor vehicle.
   29  The term “motor vehicle” does not include a mobile home or any
   30  motor vehicle that which is used in mass transit, other than
   31  public school transportation, and designed to transport more
   32  than five passengers exclusive of the operator of the motor
   33  vehicle and that which is owned by a municipality, a transit
   34  authority, or a political subdivision of the state.
   35         (12)(4) “Named insured” means a person, usually the owner
   36  of a vehicle, identified in a policy by name as the insured
   37  under the policy.
   38         (13) “No-fault law” means the Florida Motor Vehicle No
   39  Fault Law codifed at ss. 627.730-627.7407.
   40         (14)(5) “Owner” means a person who holds the legal title to
   41  a motor vehicle; or, if in the event a motor vehicle is the
   42  subject of a security agreement or lease with an option to
   43  purchase with the debtor or lessee having the right to
   44  possession, then the debtor or lessee is shall be deemed the
   45  owner for the purposes of the no-fault law ss. 627.730-627.7405.
   46         (16)(6) “Relative residing in the same household” means a
   47  relative of any degree by blood or by marriage who usually makes
   48  her or his home in the same family unit, whether or not
   49  temporarily living elsewhere.
   50         (2)(7) “Certify” means to swear or attest to being true or
   51  represented in writing.
   52         (3) “Claimant” means the person, organization, or entity
   53  seeking benefits, including all assignees.
   54         (4) “Entity wholly owned” means a proprietorship, group
   55  practice, partnership, or corporation that provides health care
   56  services rendered by licensed health care practitioners. In
   57  order to be wholly owned, licensed health care practitioners
   58  must be the business owners of all aspects of the business
   59  entity, including, but not limited to, being reflected as the
   60  business owners on the title or lease of the physical facility,
   61  filing taxes as the business owners, being account holders on
   62  the entity’s bank account, being listed as the principals on all
   63  incorporation documents required by this state, and having
   64  ultimate authority over all personnel and compensation decisions
   65  relating to the entity.
   66         (6)(8) “Immediate personal supervision,” as it relates to
   67  the performance of medical services by nonphysicians not in a
   68  hospital, means that an individual licensed to perform the
   69  medical service or provide the medical supplies must be present
   70  within the confines of the physical structure where the medical
   71  services are performed or where the medical supplies are
   72  provided such that the licensed individual can respond
   73  immediately to any emergencies if needed.
   74         (7)(9) “Incident,” with respect to services considered as
   75  incident to a physician’s professional service, for a physician
   76  licensed under chapter 458, chapter 459, chapter 460, or chapter
   77  461, if not furnished in a hospital, means such services that
   78  are must be an integral, even if incidental, part of a covered
   79  physician’s service.
   80         (8)(10) “Knowingly” means that a person, with respect to
   81  information, has actual knowledge of the information,; acts in
   82  deliberate ignorance of the truth or falsity of the
   83  information,; or acts in reckless disregard of the information.,
   84  and Proof of specific intent to defraud is not required.
   85         (9)(11) “Lawful” or “lawfully” means in substantial
   86  compliance with all relevant applicable criminal, civil, and
   87  administrative requirements of state and federal law related to
   88  the provision of medical services or treatment.
   89         (5)(12) “Hospital” means a facility that, at the time
   90  services or treatment were rendered, was licensed under chapter
   91  395.
   92         (15)(13) “Properly completed” means providing truthful,
   93  substantially complete, and substantially accurate responses as
   94  to all material elements of to each applicable request for
   95  information or statement by a means that may lawfully be
   96  provided and that complies with this section, or as agreed by
   97  the parties.
   98         (18)(14) “Upcoding” means submitting an action that submits
   99  a billing code that would result in payment greater in amount
  100  than would be paid using a billing code that accurately
  101  describes the services performed. The term does not include an
  102  otherwise lawful bill by a magnetic resonance imaging facility,
  103  which globally combines both technical and professional
  104  components, if the amount of the global bill is not more than
  105  the components if billed separately; however, payment of such a
  106  bill constitutes payment in full for all components of such
  107  service.
  108         (17)(15) “Unbundling” means submitting an action that
  110  ================= T I T L E  A M E N D M E N T ================
  111         And the title is amended as follows:
  112         Delete line 1545
  113  and insert:
  114         defining the terms “claimant,” “entity wholly owned,”
  115         and “no-fault law”;