Florida Senate - 2012                      CS for CS for SB 1860
       
       
       
       By the Committees on Budget; and Banking and Insurance; and
       Senator Negron
       
       
       
       576-04369-12                                          20121860c2
    1                        A bill to be entitled                      
    2         An act relating to motor vehicle personal injury
    3         protection insurance; amending s. 316.066, F.S.;
    4         revising the conditions for completing the long-form
    5         traffic crash report; revising the information
    6         contained in the short-form report; revising the
    7         requirements relating to the driver’s responsibility
    8         for submitting a report for crashes not requiring a
    9         law enforcement report; amending s. 400.9905, F.S.;
   10         providing that certain entities exempt from licensure
   11         as a health care clinic must nonetheless be licensed
   12         in order to receive reimbursement for the provision of
   13         personal injury protection benefits; amending s.
   14         400.991, F.S.; requiring that an application for
   15         licensure, or exemption from licensure, as a health
   16         care clinic include a statement regarding insurance
   17         fraud; amending s. 626.989, F.S.; providing that
   18         knowingly submitting false, misleading, or fraudulent
   19         documents relating to licensure as a health care
   20         clinic, or submitting a claim for personal injury
   21         protection relating to clinic licensure documents, is
   22         a fraudulent insurance act under certain conditions;
   23         amending s. 626.9894, F.S.; conforming provisions to
   24         changes made by act; creating s. 626.9895, F.S.;
   25         providing definitions; authorizing the Division of
   26         Insurance Fraud of the Department of Financial
   27         Services to establish a direct-support organization
   28         for the purpose of prosecuting, investigating, and
   29         preventing motor vehicle insurance fraud; providing
   30         requirements for, and duties of, the organization;
   31         requiring that the organization operate pursuant to a
   32         contract with the division; providing for the
   33         requirements of the contract; providing for a board of
   34         directors; authorizing the organization to use the
   35         division’s property and facilities subject to certain
   36         requirements; requiring that the department adopt
   37         rules relating to procedures for the organization’s
   38         governance and relating to conditions for the use of
   39         the division’s property or facilities; authorizing
   40         contributions from insurers; authorizing any moneys
   41         received by the organization to be held in a separate
   42         depository account in the name of the organization;
   43         requiring that the division deposit certain proceeds
   44         into the Insurance Regulatory Trust Fund; amending s.
   45         627.736, F.S.; excluding massage and acupuncture from
   46         medical benefits that may be reimbursed under the
   47         motor vehicle no-fault law; requiring that an insurer
   48         give priority to the payment of death benefits under
   49         certain conditions; requiring that an insurer repay
   50         any benefits covered by the Medicaid program;
   51         requiring that an insurer provide a claimant an
   52         opportunity to revise claims that contain errors;
   53         including hospitals within a requirement for insurers
   54         to reserve a portion of personal injury protection
   55         benefits; requiring that an insurer create and
   56         maintain a log of personal injury protection benefits
   57         paid and that the insurer provide to the insured or an
   58         assignee of the insured, upon request, a copy of the
   59         log; revising the Medicare fee schedules that an
   60         insurer may use as a basis for limiting reimbursement
   61         of personal injury protection benefits; providing that
   62         the Medicare fee schedule in effect on a specific date
   63         applies for purposes of limiting such reimbursement;
   64         authorizing insurers to apply certain Medicare coding
   65         policies and payment methodologies; requiring that an
   66         insurer that limits payments based on the statutory
   67         fee schedule include a notice in insurance policies at
   68         the time of issuance or renewal; deleting obsolete
   69         provisions; providing that certain entities exempt
   70         from licensure as a clinic must nonetheless be
   71         licensed to receive reimbursement for the provision of
   72         personal injury protection benefits; providing
   73         exceptions; requiring that an insurer notify parties
   74         in disputes over personal injury protection claims
   75         when policy limits are reached; providing exceptions;
   76         providing criteria for determining when a demand
   77         letter is deficient; consolidating provisions relating
   78         to unfair or deceptive practices under certain
   79         conditions; eliminating a requirement that all parties
   80         mutually and expressly agree for the use of electronic
   81         transmission of data; amending s. 817.234, F.S.;
   82         providing that it is insurance fraud to present a
   83         claim for personal injury protection benefits payable
   84         to a person or entity that knowingly submitted false,
   85         misleading, or fraudulent documents relating to
   86         licensure as a health care clinic; providing that a
   87         licensed health care practitioner guilty of certain
   88         insurance fraud loses his or her license and may not
   89         receive reimbursement for personal injury protection
   90         benefits for a specified period; defining the term
   91         “insurer”; amending s. 316.065, F.S.; conforming a
   92         cross-reference; requiring that the Office of
   93         Insurance Regulation perform a data call relating to
   94         personal injury protection; prescribing required
   95         elements of the data call; providing for severability;
   96         providing effective dates.
   97  
   98  Be It Enacted by the Legislature of the State of Florida:
   99  
  100         Section 1. Subsection (1) of section 316.066, Florida
  101  Statutes, is amended to read:
  102         316.066 Written reports of crashes.—
  103         (1)(a) A Florida Traffic Crash Report, Long Form must is
  104  required to be completed and submitted to the department within
  105  10 days after completing an investigation is completed by the
  106  every law enforcement officer who in the regular course of duty
  107  investigates a motor vehicle crash that:
  108         1. Resulted in death or personal injury;.
  109         2. Involved a violation of s. 316.061(1) or s. 316.193;.
  110         3. Rendered a vehicle inoperable to a degree that required
  111  a wrecker to remove it from the scene of the crash; or
  112         4. Involved a commercial motor vehicle.
  113         (b) In any every crash for which a Florida Traffic Crash
  114  Report, Long Form is not required by this section and which
  115  occurs on the public roadways of this state, the law enforcement
  116  officer shall may complete a short-form crash report or provide
  117  a driver exchange-of-information form, to be completed by all
  118  drivers and passengers each party involved in the crash, which
  119  requires the identification of each vehicle that the drivers and
  120  passengers were in. The short-form report must include:
  121         1. The date, time, and location of the crash.
  122         2. A description of the vehicles involved.
  123         3. The names and addresses of the parties involved,
  124  including all drivers and passengers, and the identification of
  125  the vehicle in which each was a passenger.
  126         4. The names and addresses of witnesses.
  127         5. The name, badge number, and law enforcement agency of
  128  the officer investigating the crash.
  129         6. The names of the insurance companies for the respective
  130  parties involved in the crash.
  131         (c) Each party to the crash must provide the law
  132  enforcement officer with proof of insurance, which must be
  133  documented in the crash report. If a law enforcement officer
  134  submits a report on the crash, proof of insurance must be
  135  provided to the officer by each party involved in the crash. Any
  136  party who fails to provide the required information commits a
  137  noncriminal traffic infraction, punishable as a nonmoving
  138  violation as provided in chapter 318, unless the officer
  139  determines that due to injuries or other special circumstances
  140  such insurance information cannot be provided immediately. If
  141  the person provides the law enforcement agency, within 24 hours
  142  after the crash, proof of insurance that was valid at the time
  143  of the crash, the law enforcement agency may void the citation.
  144         (d) The driver of a vehicle that was in any manner involved
  145  in a crash resulting in damage to a any vehicle or other
  146  property which does not require a law enforcement report in an
  147  amount of $500 or more which was not investigated by a law
  148  enforcement agency, shall, within 10 days after the crash,
  149  submit a written report of the crash to the department. The
  150  report shall be submitted on a form approved by the department.
  151  The entity receiving the report may require witnesses of the
  152  crash to render reports and may require any driver of a vehicle
  153  involved in a crash of which a written report must be made to
  154  file supplemental written reports if the original report is
  155  deemed insufficient by the receiving entity.
  156         (e) Long-form and short-form crash reports prepared by law
  157  enforcement must be submitted to the department and may shall be
  158  maintained by the law enforcement officer’s agency.
  159         Section 2. Subsection (4) of section 400.9905, Florida
  160  Statutes, is amended to read:
  161         400.9905 Definitions.—
  162         (4) “Clinic” means an entity where at which health care
  163  services are provided to individuals and which tenders charges
  164  for reimbursement for such services, including a mobile clinic
  165  and a portable equipment provider. As used in For purposes of
  166  this part, the term does not include and the licensure
  167  requirements of this part do not apply to:
  168         (a) Entities licensed or registered by the state under
  169  chapter 395; or entities licensed or registered by the state and
  170  providing only health care services within the scope of services
  171  authorized under their respective licenses granted under ss.
  172  383.30-383.335, chapter 390, chapter 394, chapter 397, this
  173  chapter except part X, chapter 429, chapter 463, chapter 465,
  174  chapter 466, chapter 478, part I of chapter 483, chapter 484, or
  175  chapter 651; end-stage renal disease providers authorized under
  176  42 C.F.R. part 405, subpart U; or providers certified under 42
  177  C.F.R. part 485, subpart B or subpart H; or any entity that
  178  provides neonatal or pediatric hospital-based health care
  179  services or other health care services by licensed practitioners
  180  solely within a hospital licensed under chapter 395.
  181         (b) Entities that own, directly or indirectly, entities
  182  licensed or registered by the state pursuant to chapter 395; or
  183  entities that own, directly or indirectly, entities licensed or
  184  registered by the state and providing only health care services
  185  within the scope of services authorized pursuant to their
  186  respective licenses granted under ss. 383.30-383.335, chapter
  187  390, chapter 394, chapter 397, this chapter except part X,
  188  chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
  189  part I of chapter 483, chapter 484, chapter 651; end-stage renal
  190  disease providers authorized under 42 C.F.R. part 405, subpart
  191  U; or providers certified under 42 C.F.R. part 485, subpart B or
  192  subpart H; or any entity that provides neonatal or pediatric
  193  hospital-based health care services by licensed practitioners
  194  solely within a hospital licensed under chapter 395.
  195         (c) Entities that are owned, directly or indirectly, by an
  196  entity licensed or registered by the state pursuant to chapter
  197  395; or entities that are owned, directly or indirectly, by an
  198  entity licensed or registered by the state and providing only
  199  health care services within the scope of services authorized
  200  pursuant to their respective licenses granted under ss. 383.30
  201  383.335, chapter 390, chapter 394, chapter 397, this chapter
  202  except part X, chapter 429, chapter 463, chapter 465, chapter
  203  466, chapter 478, part I of chapter 483, chapter 484, or chapter
  204  651; end-stage renal disease providers authorized under 42
  205  C.F.R. part 405, subpart U; or providers certified under 42
  206  C.F.R. part 485, subpart B or subpart H; or any entity that
  207  provides neonatal or pediatric hospital-based health care
  208  services by licensed practitioners solely within a hospital
  209  under chapter 395.
  210         (d) Entities that are under common ownership, directly or
  211  indirectly, with an entity licensed or registered by the state
  212  pursuant to chapter 395; or entities that are under common
  213  ownership, directly or indirectly, with an entity licensed or
  214  registered by the state and providing only health care services
  215  within the scope of services authorized pursuant to their
  216  respective licenses granted under ss. 383.30-383.335, chapter
  217  390, chapter 394, chapter 397, this chapter except part X,
  218  chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
  219  part I of chapter 483, chapter 484, or chapter 651; end-stage
  220  renal disease providers authorized under 42 C.F.R. part 405,
  221  subpart U; or providers certified under 42 C.F.R. part 485,
  222  subpart B or subpart H; or any entity that provides neonatal or
  223  pediatric hospital-based health care services by licensed
  224  practitioners solely within a hospital licensed under chapter
  225  395.
  226         (e) An entity that is exempt from federal taxation under 26
  227  U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
  228  under 26 U.S.C. s. 409 that has a board of trustees at least not
  229  less than two-thirds of which are Florida-licensed health care
  230  practitioners and provides only physical therapy services under
  231  physician orders, any community college or university clinic,
  232  and any entity owned or operated by the federal or state
  233  government, including agencies, subdivisions, or municipalities
  234  thereof.
  235         (f) A sole proprietorship, group practice, partnership, or
  236  corporation that provides health care services by physicians
  237  covered by s. 627.419, that is directly supervised by one or
  238  more of such physicians, and that is wholly owned by one or more
  239  of those physicians or by a physician and the spouse, parent,
  240  child, or sibling of that physician.
  241         (g) A sole proprietorship, group practice, partnership, or
  242  corporation that provides health care services by licensed
  243  health care practitioners under chapter 457, chapter 458,
  244  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
  245  chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
  246  chapter 490, chapter 491, or part I, part III, part X, part
  247  XIII, or part XIV of chapter 468, or s. 464.012, and that is
  248  which are wholly owned by one or more licensed health care
  249  practitioners, or the licensed health care practitioners set
  250  forth in this paragraph and the spouse, parent, child, or
  251  sibling of a licensed health care practitioner if, so long as
  252  one of the owners who is a licensed health care practitioner is
  253  supervising the business activities and is legally responsible
  254  for the entity’s compliance with all federal and state laws.
  255  However, a health care practitioner may not supervise services
  256  beyond the scope of the practitioner’s license, except that, for
  257  the purposes of this part, a clinic owned by a licensee in s.
  258  456.053(3)(b) which that provides only services authorized
  259  pursuant to s. 456.053(3)(b) may be supervised by a licensee
  260  specified in s. 456.053(3)(b).
  261         (h) Clinical facilities affiliated with an accredited
  262  medical school at which training is provided for medical
  263  students, residents, or fellows.
  264         (i) Entities that provide only oncology or radiation
  265  therapy services by physicians licensed under chapter 458 or
  266  chapter 459 or entities that provide oncology or radiation
  267  therapy services by physicians licensed under chapter 458 or
  268  chapter 459 which are owned by a corporation whose shares are
  269  publicly traded on a recognized stock exchange.
  270         (j) Clinical facilities affiliated with a college of
  271  chiropractic accredited by the Council on Chiropractic Education
  272  at which training is provided for chiropractic students.
  273         (k) Entities that provide licensed practitioners to staff
  274  emergency departments or to deliver anesthesia services in
  275  facilities licensed under chapter 395 and that derive at least
  276  90 percent of their gross annual revenues from the provision of
  277  such services. Entities claiming an exemption from licensure
  278  under this paragraph must provide documentation demonstrating
  279  compliance.
  280         (l) Orthotic or prosthetic clinical facilities that are a
  281  publicly traded corporation or that are wholly owned, directly
  282  or indirectly, by a publicly traded corporation. As used in this
  283  paragraph, a publicly traded corporation is a corporation that
  284  issues securities traded on an exchange registered with the
  285  United States Securities and Exchange Commission as a national
  286  securities exchange.
  287  
  288  Notwithstanding this subsection, an entity shall be deemed a
  289  clinic and must be licensed under this part in order to receive
  290  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
  291  627.730-627.7405, unless exempted under s. 627.736(5)(h).
  292         Section 3. Subsection (6) is added to section 400.991,
  293  Florida Statutes, to read:
  294         400.991 License requirements; background screenings;
  295  prohibitions.—
  296         (6) All agency forms for licensure application or exemption
  297  from licensure under this part must contain the following
  298  statement:
  299  
  300         INSURANCE FRAUD NOTICE.—A person who knowingly submits
  301         a false, misleading, or fraudulent application or
  302         other document when applying for licensure as a health
  303         care clinic, seeking an exemption from licensure as a
  304         health care clinic, or demonstrating compliance with
  305         part X of chapter 400, Florida Statutes, with the
  306         intent to use the license, exemption from licensure,
  307         or demonstration of compliance to provide services or
  308         seek reimbursement under the Florida Motor Vehicle No
  309         Fault Law, commits a fraudulent insurance act, as
  310         defined in s. 626.989, Florida Statutes. A person who
  311         presents a claim for personal injury protection
  312         benefits knowing that the payee knowingly submitted
  313         such health care clinic application or document,
  314         commits insurance fraud, as defined in s. 817.234,
  315         Florida Statutes.
  316         Section 4. Subsection (1) of section 626.989, Florida
  317  Statutes, is amended to read:
  318         626.989 Investigation by department or Division of
  319  Insurance Fraud; compliance; immunity; confidential information;
  320  reports to division; division investigator’s power of arrest.—
  321         (1) For the purposes of this section:,
  322         (a) A person commits a “fraudulent insurance act” if the
  323  person:
  324         1. Knowingly and with intent to defraud presents, causes to
  325  be presented, or prepares with knowledge or belief that it will
  326  be presented, to or by an insurer, self-insurer, self-insurance
  327  fund, servicing corporation, purported insurer, broker, or any
  328  agent thereof, any written statement as part of, or in support
  329  of, an application for the issuance of, or the rating of, any
  330  insurance policy, or a claim for payment or other benefit
  331  pursuant to any insurance policy, which the person knows to
  332  contain materially false information concerning any fact
  333  material thereto or if the person conceals, for the purpose of
  334  misleading another, information concerning any fact material
  335  thereto.
  336         2. Knowingly submits:
  337         a. A false, misleading, or fraudulent application or other
  338  document when applying for licensure as a health care clinic,
  339  seeking an exemption from licensure as a health care clinic, or
  340  demonstrating compliance with part X of chapter 400 with an
  341  intent to use the license, exemption from licensure, or
  342  demonstration of compliance to provide services or seek
  343  reimbursement under the Florida Motor Vehicle No-Fault Law.
  344         b. A claim for payment or other benefit pursuant to a
  345  personal injury protection insurance policy under the Florida
  346  Motor Vehicle No-Fault Law if the person knows that the payee
  347  knowingly submitted a false, misleading, or fraudulent
  348  application or other document when applying for licensure as a
  349  health care clinic, seeking an exemption from licensure as a
  350  health care clinic, or demonstrating compliance with part X of
  351  chapter 400. For the purposes of this section,
  352         (b) The term “insurer” also includes a any health
  353  maintenance organization, and the term “insurance policy” also
  354  includes a health maintenance organization subscriber contract.
  355         Section 5. Subsection (5) of section 626.9894, Florida
  356  Statutes, is amended to read:
  357         626.9894 Gifts and grants.—
  358         (5) Notwithstanding the provisions of s. 216.301 and
  359  pursuant to s. 216.351, any balance of moneys deposited into the
  360  Insurance Regulatory Trust Fund pursuant to this section or s.
  361  626.9895 remaining at the end of any fiscal year is shall be
  362  available for carrying out the duties and responsibilities of
  363  the division. The department may request annual appropriations
  364  from the grants and donations received pursuant to this section
  365  or s. 626.9895 and cash balances in the Insurance Regulatory
  366  Trust Fund for the purpose of carrying out its duties and
  367  responsibilities related to the division’s anti-fraud efforts,
  368  including the funding of dedicated prosecutors and related
  369  personnel.
  370         Section 6. Section 626.9895, Florida Statutes, is created
  371  to read:
  372         626.9895Motor vehicle insurance fraud direct-support
  373  organization.—
  374         (1) DEFINITIONS.—As used in this section, the term:
  375         (a) “Division” means the Division of Insurance Fraud of the
  376  Department of Financial Services.
  377         (b) “Motor vehicle insurance fraud” means any act defined
  378  as a “fraudulent insurance act” under s. 626.989, which relates
  379  to the coverage of motor vehicle insurance as described in part
  380  XI of chapter 627.
  381         (c) “Organization” means the direct-support organization
  382  established under this section.
  383         (2) ORGANIZATION ESTABLISHED.—The division may establish a
  384  direct-support organization, to be known as the “Automobile
  385  Insurance Fraud Strike Force,” whose sole purpose is to support
  386  the prosecution, investigation, and prevention of motor vehicle
  387  insurance fraud. The organization shall:
  388         (a) Be a not-for-profit corporation incorporated under
  389  chapter 617 and approved by the Department of State.
  390         (b) Be organized and operated to conduct programs and
  391  activities; raise funds; request and receive grants, gifts, and
  392  bequests of money; acquire, receive, hold, invest, and
  393  administer, in its own name, securities, funds, objects of
  394  value, or other property, real or personal; and make grants and
  395  expenditures to or for the direct or indirect benefit of the
  396  division, state attorneys’ offices, the statewide prosecutor,
  397  the Agency for Health Care Administration, and the Department of
  398  Health to the extent that such grants and expenditures are used
  399  exclusively to advance the prosecution, investigation, or
  400  prevention of motor vehicle insurance fraud. Grants and
  401  expenditures may include the cost of salaries or benefits of
  402  motor vehicle insurance fraud investigators, prosecutors, or
  403  support personnel if such grants and expenditures do not
  404  interfere with prosecutorial independence or otherwise create
  405  conflicts of interest which threaten the success of
  406  prosecutions.
  407         (c) Be determined by the division to operate in a manner
  408  that promotes the goals of laws relating to motor vehicle
  409  insurance fraud, that is in the best interest of the state, and
  410  that is in accordance with the adopted goals and mission of the
  411  division.
  412         (d) Use all of its grants and expenditures solely for the
  413  purpose of preventing and decreasing motor vehicle insurance
  414  fraud, and not for the purpose of lobbying as defined in s.
  415  11.045.
  416         (e) Be subject to an annual financial audit in accordance
  417  with s. 215.981.
  418         (3) CONTRACT.—The organization shall operate under written
  419  contract with the division. The contract must provide for:
  420         (a) Approval of the articles of incorporation and bylaws of
  421  the organization by the division.
  422         (b) Submission of an annual budget for approval of the
  423  division. The budget must require the organization to minimize
  424  costs to the division and its members at all times by using
  425  existing personnel and property and allowing for telephonic
  426  meetings if appropriate.
  427         (c) Certification by the division that the organization is
  428  complying with the terms of the contract and in a manner
  429  consistent with the goals and purposes of the department and in
  430  the best interest of the state. Such certification must be made
  431  annually and reported in the official minutes of a meeting of
  432  the organization.
  433         (d) Allocation of funds to address motor vehicle insurance
  434  fraud.
  435         (e) Reversion of moneys and property held in trust by the
  436  organization for motor vehicle insurance fraud prosecution,
  437  investigation, and prevention to the division if the
  438  organization is no longer approved to operate for the department
  439  or if the organization ceases to exist, or to the state if the
  440  division ceases to exist.
  441         (f) Specific criteria to be used by the organization’s
  442  board of directors to evaluate the effectiveness of funding used
  443  to combat motor vehicle insurance fraud.
  444         (g) The fiscal year of the organization, which begins July
  445  1 of each year and ends June 30 of the following year.
  446         (h) Disclosure of the material provisions of the contract,
  447  and distinguishing between the department and the organization
  448  to donors of gifts, contributions, or bequests, including
  449  providing such disclosure on all promotional and fundraising
  450  publications.
  451         (4) BOARD OF DIRECTORS.—
  452         (a) The board of directors of the organization shall
  453  consist of the following eleven members:
  454         1. The Chief Financial Officer, or designee, who shall
  455  serve as chair.
  456         2. Two state attorneys, one of whom shall be appointed by
  457  the Chief Financial Officer and one of whom shall be appointed
  458  by the Attorney General.
  459         3. Two representatives of motor vehicle insurers appointed
  460  by the Chief Financial Officer.
  461         4. Two representatives of local law enforcement agencies,
  462  one of whom shall be appointed by the Chief Financial Officer
  463  and one of whom shall be appointed by the Attorney General.
  464         5. Two representatives of the types of health care
  465  providers who regularly make claims for benefits under ss.
  466  627.730-627.7405, one of whom shall be appointed by the
  467  President of the Senate and one of whom shall be appointed by
  468  the Speaker of the House of Representatives. The appointees may
  469  not represent the same type of health care provider.
  470         6. A private attorney that has experience in representing
  471  claimants in actions for benefits under ss. 627.730-627.7405,
  472  who shall be appointed by the President of the Senate.
  473         7. A private attorney who has experience in representing
  474  insurers in actions for benefits under ss. 627.730-627.7405, who
  475  shall be appointed by the Speaker of the House of
  476  Representatives.
  477         (b) The officer who appointed a member of the board may
  478  remove that member for cause. The term of office of an appointed
  479  member expires at the same time as the term of the officer who
  480  appointed him or her or at such earlier time as the person
  481  ceases to be qualified.
  482         (5) USE OF PROPERTY.—The department may authorize, without
  483  charge, appropriate use of fixed property and facilities of the
  484  division by the organization, subject to this subsection.
  485         (a) The department may prescribe any condition with which
  486  the organization must comply in order to use the division’s
  487  property or facilities.
  488         (b) The department may not authorize the use of the
  489  division’s property or facilities if the organization does not
  490  provide equal membership and employment opportunities to all
  491  persons regardless of race, religion, sex, age, or national
  492  origin.
  493         (c) The department shall adopt rules prescribing the
  494  procedures by which the organization is governed and any
  495  conditions with which the organization must comply to use the
  496  division’s property or facilities.
  497         (6) CONTRIBUTIONS FROM INSURERS.—Contributions from an
  498  insurer to the organization shall be allowed as an appropriate
  499  business expense of the insurer for all regulatory purposes.
  500         (7) DEPOSITORY ACCOUNT.—Any moneys received by the
  501  organization may be held in a separate depository account in the
  502  name of the organization and subject to the contract with the
  503  division.
  504         (8) DIVISION’S RECEIPT OF PROCEEDS.—Proceeds received by
  505  the division from the organization shall be deposited into the
  506  Insurance Regulatory Trust Fund.
  507         Section 7. Subsections (1), (4), (5), (6), (8), (9), (10),
  508  and (11) of section 627.736, Florida Statutes, are amended to
  509  read:
  510         627.736 Required personal injury protection benefits;
  511  exclusions; priority; claims.—
  512         (1) REQUIRED BENEFITS.—An Every insurance policy complying
  513  with the security requirements of s. 627.733 must shall provide
  514  personal injury protection to the named insured, relatives
  515  residing in the same household, persons operating the insured
  516  motor vehicle, passengers in the such motor vehicle, and other
  517  persons struck by the such motor vehicle and suffering bodily
  518  injury while not an occupant of a self-propelled vehicle,
  519  subject to the provisions of subsection (2) and paragraph
  520  (4)(e), to a limit of $10,000 for loss sustained by any such
  521  person as a result of bodily injury, sickness, disease, or death
  522  arising out of the ownership, maintenance, or use of a motor
  523  vehicle as follows:
  524         (a) Medical benefits.—Eighty percent of all reasonable
  525  expenses for medically necessary medical, surgical, X-ray,
  526  dental, and rehabilitative services, including prosthetic
  527  devices, and medically necessary ambulance, hospital, and
  528  nursing services. Medical benefits do not include massage as
  529  defined in s. 480.033 or acupuncture as defined in s. 457.102.
  530  However, The medical benefits shall provide reimbursement only
  531  for such services and care that are lawfully provided,
  532  supervised, ordered, or prescribed by a physician licensed under
  533  chapter 458 or chapter 459, a dentist licensed under chapter
  534  466, or a chiropractic physician licensed under chapter 460 or
  535  that are provided by any of the following persons or entities:
  536         1. A hospital or ambulatory surgical center licensed under
  537  chapter 395.
  538         2. A person or entity licensed under part III of chapter
  539  401 which ss. 401.2101-401.45 that provides emergency
  540  transportation and treatment.
  541         3. An entity wholly owned by one or more physicians
  542  licensed under chapter 458 or chapter 459, chiropractic
  543  physicians licensed under chapter 460, or dentists licensed
  544  under chapter 466 or by such practitioner or practitioners and
  545  the spouse, parent, child, or sibling of such that practitioner
  546  or those practitioners.
  547         4. An entity wholly owned, directly or indirectly, by a
  548  hospital or hospitals.
  549         5. A health care clinic licensed under part X of chapter
  550  400 which ss. 400.990-400.995 that is:
  551         a. A health care clinic accredited by the Joint Commission
  552  on Accreditation of Healthcare Organizations, the American
  553  Osteopathic Association, the Commission on Accreditation of
  554  Rehabilitation Facilities, or the Accreditation Association for
  555  Ambulatory Health Care, Inc.; or
  556         b. A health care clinic that:
  557         (I) Has a medical director licensed under chapter 458,
  558  chapter 459, or chapter 460;
  559         (II) Has been continuously licensed for more than 3 years
  560  or is a publicly traded corporation that issues securities
  561  traded on an exchange registered with the United States
  562  Securities and Exchange Commission as a national securities
  563  exchange; and
  564         (III) Provides at least four of the following medical
  565  specialties:
  566         (A) General medicine.
  567         (B) Radiography.
  568         (C) Orthopedic medicine.
  569         (D) Physical medicine.
  570         (E) Physical therapy.
  571         (F) Physical rehabilitation.
  572         (G) Prescribing or dispensing outpatient prescription
  573  medication.
  574         (H) Laboratory services.
  575  
  576  The Financial Services Commission shall adopt by rule the form
  577  that must be used by an insurer and a health care provider
  578  specified in subparagraph 3., subparagraph 4., or subparagraph
  579  5. to document that the health care provider meets the criteria
  580  of this paragraph, which rule must include a requirement for a
  581  sworn statement or affidavit.
  582         (b) Disability benefits.—Sixty percent of any loss of gross
  583  income and loss of earning capacity per individual from
  584  inability to work proximately caused by the injury sustained by
  585  the injured person, plus all expenses reasonably incurred in
  586  obtaining from others ordinary and necessary services in lieu of
  587  those that, but for the injury, the injured person would have
  588  performed without income for the benefit of his or her
  589  household. All disability benefits payable under this provision
  590  must shall be paid at least not less than every 2 weeks.
  591         (c) Death benefits.—Death benefits equal to the lesser of
  592  $5,000 or the remainder of unused personal injury protection
  593  benefits per individual. The insurer shall give priority to the
  594  payment of death benefits over the payment of other benefits of
  595  the deceased and, upon learning of the death of the individual,
  596  stop paying the other benefits until the death benefits are
  597  paid. The insurer may pay death such benefits to the executor or
  598  administrator of the deceased, to any of the deceased’s
  599  relatives by blood, or legal adoption, or connection by
  600  marriage, or to any person appearing to the insurer to be
  601  equitably entitled thereto.
  602  
  603  Only insurers writing motor vehicle liability insurance in this
  604  state may provide the required benefits of this section, and no
  605  such insurer may not shall require the purchase of any other
  606  motor vehicle coverage other than the purchase of property
  607  damage liability coverage as required by s. 627.7275 as a
  608  condition for providing such required benefits. Insurers may not
  609  require that property damage liability insurance in an amount
  610  greater than $10,000 be purchased in conjunction with personal
  611  injury protection. Such insurers shall make benefits and
  612  required property damage liability insurance coverage available
  613  through normal marketing channels. An Any insurer writing motor
  614  vehicle liability insurance in this state who fails to comply
  615  with such availability requirement as a general business
  616  practice violates shall be deemed to have violated part IX of
  617  chapter 626, and such violation constitutes shall constitute an
  618  unfair method of competition or an unfair or deceptive act or
  619  practice involving the business of insurance. An; and any such
  620  insurer committing such violation is shall be subject to the
  621  penalties provided under that afforded in such part, as well as
  622  those provided which may be afforded elsewhere in the insurance
  623  code.
  624         (4) PAYMENT OF BENEFITS; WHEN DUE.—Benefits due from an
  625  insurer under ss. 627.730-627.7405 are shall be primary, except
  626  that benefits received under any workers’ compensation law must
  627  shall be credited against the benefits provided by subsection
  628  (1) and are shall be due and payable as loss accrues, upon
  629  receipt of reasonable proof of such loss and the amount of
  630  expenses and loss incurred which are covered by the policy
  631  issued under ss. 627.730-627.7405. If When the Agency for Health
  632  Care Administration provides, pays, or becomes liable for
  633  medical assistance under the Medicaid program related to injury,
  634  sickness, disease, or death arising out of the ownership,
  635  maintenance, or use of a motor vehicle, the benefits under ss.
  636  627.730-627.7405 are shall be subject to the provisions of the
  637  Medicaid program. However, within 30 days after receiving notice
  638  that the Medicaid program paid such benefits, the insurer shall
  639  repay the full amount of the benefits to the Medicaid program.
  640         (a) An insurer may require written notice to be given as
  641  soon as practicable after an accident involving a motor vehicle
  642  with respect to which the policy affords the security required
  643  by ss. 627.730-627.7405.
  644         (b) Personal injury protection insurance benefits paid
  645  pursuant to this section are shall be overdue if not paid within
  646  30 days after the insurer is furnished written notice of the
  647  fact of a covered loss and of the amount of same. However:
  648         1. If such written notice of the entire claim is not
  649  furnished to the insurer as to the entire claim, any partial
  650  amount supported by written notice is overdue if not paid within
  651  30 days after such written notice is furnished to the insurer.
  652  Any part or all of the remainder of the claim that is
  653  subsequently supported by written notice is overdue if not paid
  654  within 30 days after such written notice is furnished to the
  655  insurer.
  656         2. If When an insurer pays only a portion of a claim or
  657  rejects a claim, the insurer shall provide at the time of the
  658  partial payment or rejection an itemized specification of each
  659  item that the insurer had reduced, omitted, or declined to pay
  660  and any information that the insurer desires the claimant to
  661  consider related to the medical necessity of the denied
  662  treatment or to explain the reasonableness of the reduced charge
  663  if, provided that this does shall not limit the introduction of
  664  evidence at trial.; and The insurer must also shall include the
  665  name and address of the person to whom the claimant should
  666  respond and a claim number to be referenced in future
  667  correspondence.
  668         3. If an insurer pays only a portion of a claim or rejects
  669  a claim due to an alleged error in the claim, the insurer shall
  670  provide at the time of the partial payment or rejection an
  671  itemized specification or explanation of benefits of the
  672  specified error. Upon receiving the specification or
  673  explanation, the person making the claim has, at the person’s
  674  option and without waiving any other legal remedy for payment,
  675  15 days to submit a revised claim, and the revised claim shall
  676  be considered a timely submission of written notice of a claim.
  677  The insurer has 15 days after receipt of the resubmitted or
  678  revised claim to issue payment. If the claim is not paid,
  679  payment is overdue unless the insurer has reasonable proof
  680  establishing that it is not responsible for payment of the
  681  claim.
  682         4.However, Notwithstanding the fact that written notice
  683  has been furnished to the insurer, any payment is shall not be
  684  deemed overdue if when the insurer has reasonable proof to
  685  establish that the insurer is not responsible for the payment.
  686         5. For the purpose of calculating the extent to which any
  687  benefits are overdue, payment shall be treated as being made on
  688  the date a draft or other valid instrument that which is
  689  equivalent to payment was placed in the United States mail in a
  690  properly addressed, postpaid envelope or, if not so posted, on
  691  the date of delivery.
  692         6. This paragraph does not preclude or limit the ability of
  693  the insurer to assert that the claim was unrelated, was not
  694  medically necessary, or was unreasonable or that the amount of
  695  the charge was in excess of that permitted under, or in
  696  violation of, subsection (5). Such assertion by the insurer may
  697  be made at any time, including after payment of the claim or
  698  after the 30-day time period for payment set forth in this
  699  paragraph.
  700         (c) Upon receiving notice of an accident that is
  701  potentially covered by personal injury protection benefits, the
  702  insurer must reserve $5,000 of personal injury protection
  703  benefits for payment to:
  704         1. Physicians licensed under chapter 458 or chapter 459 or
  705  dentists licensed under chapter 466 who provide emergency
  706  services and care, as defined in s. 395.002(9), or who provide
  707  hospital inpatient care.
  708         2. Hospitals licensed under chapter 395.
  709  
  710  The amount required to be held in reserve may be used only to
  711  pay claims from such physicians, or dentists, or hospitals until
  712  30 days after the date the insurer receives notice of the
  713  accident. After the 30-day period, any amount of the reserve for
  714  which the insurer has not received notice of such claims a claim
  715  from a physician or dentist who provided emergency services and
  716  care or who provided hospital inpatient care may then be used by
  717  the insurer to pay other claims. The time periods specified in
  718  paragraph (b) for required payment of personal injury protection
  719  benefits are shall be tolled for the period of time that an
  720  insurer is required by this paragraph to hold payment of a claim
  721  that is not from such a physician, or dentist, or hospital who
  722  provided emergency services and care or who provided hospital
  723  inpatient care to the extent that the personal injury protection
  724  benefits not held in reserve are insufficient to pay the claim.
  725  This paragraph does not require an insurer to establish a claim
  726  reserve for insurance accounting purposes.
  727         (d) All overdue payments shall bear simple interest at the
  728  rate established under s. 55.03 or the rate established in the
  729  insurance contract, whichever is greater, for the year in which
  730  the payment became overdue, calculated from the date the insurer
  731  was furnished with written notice of the amount of covered loss.
  732  Interest is shall be due at the time payment of the overdue
  733  claim is made.
  734         (e) The insurer of the owner of a motor vehicle shall pay
  735  personal injury protection benefits for:
  736         1. Accidental bodily injury sustained in this state by the
  737  owner while occupying a motor vehicle, or while not an occupant
  738  of a self-propelled vehicle if the injury is caused by physical
  739  contact with a motor vehicle.
  740         2. Accidental bodily injury sustained outside this state,
  741  but within the United States of America or its territories or
  742  possessions or Canada, by the owner while occupying the owner’s
  743  motor vehicle.
  744         3. Accidental bodily injury sustained by a relative of the
  745  owner residing in the same household, under the circumstances
  746  described in subparagraph 1. or subparagraph 2., if provided the
  747  relative at the time of the accident is domiciled in the owner’s
  748  household and is not himself or herself the owner of a motor
  749  vehicle with respect to which security is required under ss.
  750  627.730-627.7405.
  751         4. Accidental bodily injury sustained in this state by any
  752  other person while occupying the owner’s motor vehicle or, if a
  753  resident of this state, while not an occupant of a self
  754  propelled vehicle, if the injury is caused by physical contact
  755  with such motor vehicle, if provided the injured person is not
  756  himself or herself:
  757         a. The owner of a motor vehicle with respect to which
  758  security is required under ss. 627.730-627.7405; or
  759         b. Entitled to personal injury benefits from the insurer of
  760  the owner or owners of such a motor vehicle.
  761         (f) If two or more insurers are liable for paying to pay
  762  personal injury protection benefits for the same injury to any
  763  one person, the maximum payable is shall be as specified in
  764  subsection (1), and the any insurer paying the benefits is shall
  765  be entitled to recover from each of the other insurers an
  766  equitable pro rata share of the benefits paid and expenses
  767  incurred in processing the claim.
  768         (g) It is a violation of the insurance code for an insurer
  769  to fail to timely provide benefits as required by this section
  770  with such frequency as to constitute a general business
  771  practice.
  772         (h) Benefits are shall not be due or payable to or on the
  773  behalf of an insured person if that person has committed, by a
  774  material act or omission, any insurance fraud relating to
  775  personal injury protection coverage under his or her policy, if
  776  the fraud is admitted to in a sworn statement by the insured or
  777  if it is established in a court of competent jurisdiction. Any
  778  insurance fraud voids shall void all coverage arising from the
  779  claim related to such fraud under the personal injury protection
  780  coverage of the insured person who committed the fraud,
  781  irrespective of whether a portion of the insured person’s claim
  782  may be legitimate, and any benefits paid before prior to the
  783  discovery of the insured person’s insurance fraud is shall be
  784  recoverable by the insurer in its entirety from the person who
  785  committed insurance fraud in their entirety. The prevailing
  786  party is entitled to its costs and attorney attorney’s fees in
  787  any action in which it prevails in an insurer’s action to
  788  enforce its right of recovery under this paragraph.
  789         (i) An insurer shall create and maintain for each insured a
  790  log of personal injury protection benefits paid by the insurer
  791  on behalf of the insured. The insurer shall provide to the
  792  insured, or an assignee of the insured, a copy of the log within
  793  30 days after receiving a request for the log from the insured
  794  or the assignee.
  795         (5) CHARGES FOR TREATMENT OF INJURED PERSONS.—
  796         (a)1.A Any physician, hospital, clinic, or other person or
  797  institution lawfully rendering treatment to an injured person
  798  for a bodily injury covered by personal injury protection
  799  insurance may charge the insurer and injured party only a
  800  reasonable amount pursuant to this section for the services and
  801  supplies rendered, and the insurer providing such coverage may
  802  pay for such charges directly to such person or institution
  803  lawfully rendering such treatment, if the insured receiving such
  804  treatment or his or her guardian has countersigned the properly
  805  completed invoice, bill, or claim form approved by the office
  806  upon which such charges are to be paid for as having actually
  807  been rendered, to the best knowledge of the insured or his or
  808  her guardian. In no event, However, may such a charge may not
  809  exceed be in excess of the amount the person or institution
  810  customarily charges for like services or supplies. In
  811  determining With respect to a determination of whether a charge
  812  for a particular service, treatment, or otherwise is reasonable,
  813  consideration may be given to evidence of usual and customary
  814  charges and payments accepted by the provider involved in the
  815  dispute, and reimbursement levels in the community and various
  816  federal and state medical fee schedules applicable to motor
  817  vehicle automobile and other insurance coverages, and other
  818  information relevant to the reasonableness of the reimbursement
  819  for the service, treatment, or supply.
  820         1.2. The insurer may limit reimbursement to 80 percent of
  821  the following schedule of maximum charges:
  822         a. For emergency transport and treatment by providers
  823  licensed under chapter 401, 200 percent of Medicare.
  824         b. For emergency services and care provided by a hospital
  825  licensed under chapter 395, 75 percent of the hospital’s usual
  826  and customary charges.
  827         c. For emergency services and care as defined by s.
  828  395.002(9) provided in a facility licensed under chapter 395
  829  rendered by a physician or dentist, and related hospital
  830  inpatient services rendered by a physician or dentist, the usual
  831  and customary charges in the community.
  832         d. For hospital inpatient services, other than emergency
  833  services and care, 200 percent of the Medicare Part A
  834  prospective payment applicable to the specific hospital
  835  providing the inpatient services.
  836         e. For hospital outpatient services, other than emergency
  837  services and care, 200 percent of the Medicare Part A Ambulatory
  838  Payment Classification for the specific hospital providing the
  839  outpatient services.
  840         f. For all other medical services, supplies, and care, 200
  841  percent of the allowable amount under:
  842         (I) The participating physicians fee schedule of Medicare
  843  Part B, except as provided in sub-sub-subparagraphs (II) and
  844  (III).
  845         (II) Medicare Part B, in the case of services, supplies,
  846  and care provided by ambulatory surgical centers and clinical
  847  laboratories.
  848         (III) The Durable Medical Equipment Prosthetics/Orthotics
  849  and Supplies fee schedule of Medicare Part B, in the case of
  850  durable medical equipment.
  851  
  852  However, if such services, supplies, or care is not reimbursable
  853  under Medicare Part B, as provided in this sub-subparagraph, the
  854  insurer may limit reimbursement to 80 percent of the maximum
  855  reimbursable allowance under workers’ compensation, as
  856  determined under s. 440.13 and rules adopted thereunder which
  857  are in effect at the time such services, supplies, or care is
  858  provided. Services, supplies, or care that is not reimbursable
  859  under Medicare or workers’ compensation is not required to be
  860  reimbursed by the insurer.
  861         2.3. For purposes of subparagraph 1. 2., the applicable fee
  862  schedule or payment limitation under Medicare is the fee
  863  schedule or payment limitation in effect on January 1 of the
  864  year in which at the time the services, supplies, or care is was
  865  rendered and for the area in which such services, supplies, or
  866  care is were rendered, and the applicable fee schedule or
  867  payment limitation applies throughout the remainder of that
  868  year, notwithstanding any subsequent change made to the fee
  869  schedule or payment limitation, except that it may not be less
  870  than the allowable amount under the applicable participating
  871  physicians schedule of Medicare Part B for 2007 for medical
  872  services, supplies, and care subject to Medicare Part B.
  873         3.4. Subparagraph 1. 2. does not allow the insurer to apply
  874  any limitation on the number of treatments or other utilization
  875  limits that apply under Medicare or workers’ compensation. An
  876  insurer that applies the allowable payment limitations of
  877  subparagraph 1. 2. must reimburse a provider who lawfully
  878  provided care or treatment under the scope of his or her
  879  license, regardless of whether such provider is would be
  880  entitled to reimbursement under Medicare due to restrictions or
  881  limitations on the types or discipline of health care providers
  882  who may be reimbursed for particular procedures or procedure
  883  codes. However, subparagraph 1. does not prohibit an insurer
  884  from using the Medicare coding policies and payment
  885  methodologies of the federal Centers for Medicare and Medicaid
  886  Services, including applicable modifiers, to determine the
  887  appropriate amount of reimbursement for medical services,
  888  supplies, or care if the coding policy or payment methodology
  889  does not constitute a utilization limit.
  890         4.5. If an insurer limits payment as authorized by
  891  subparagraph 1. 2., the person providing such services,
  892  supplies, or care may not bill or attempt to collect from the
  893  insured any amount in excess of such limits, except for amounts
  894  that are not covered by the insured’s personal injury protection
  895  coverage due to the coinsurance amount or maximum policy limits.
  896         5. Effective July 1, 2012, an insurer may limit payment as
  897  authorized by this paragraph only if the insurance policy
  898  includes a notice at the time of issuance or renewal that the
  899  insurer may limit payment pursuant to the schedule of charges
  900  specified in this paragraph. A policy form approved by the
  901  office satisfies this requirement. If a provider submits a
  902  charge for an amount less than the amount allowed under
  903  subparagraph 1., the insurer may pay the amount of the charge
  904  submitted.
  905         (b)1. An insurer or insured is not required to pay a claim
  906  or charges:
  907         a. Made by a broker or by a person making a claim on behalf
  908  of a broker;
  909         b. For any service or treatment that was not lawful at the
  910  time rendered;
  911         c. To any person who knowingly submits a false or
  912  misleading statement relating to the claim or charges;
  913         d. With respect to a bill or statement that does not
  914  substantially meet the applicable requirements of paragraph (d);
  915         e. For any treatment or service that is upcoded, or that is
  916  unbundled when such treatment or services should be bundled, in
  917  accordance with paragraph (d). To facilitate prompt payment of
  918  lawful services, an insurer may change codes that it determines
  919  to have been improperly or incorrectly upcoded or unbundled, and
  920  may make payment based on the changed codes, without affecting
  921  the right of the provider to dispute the change by the insurer,
  922  if, provided that before doing so, the insurer contacts must
  923  contact the health care provider and discusses discuss the
  924  reasons for the insurer’s change and the health care provider’s
  925  reason for the coding, or makes make a reasonable good faith
  926  effort to do so, as documented in the insurer’s file; and
  927         f. For medical services or treatment billed by a physician
  928  and not provided in a hospital unless such services are rendered
  929  by the physician or are incident to his or her professional
  930  services and are included on the physician’s bill, including
  931  documentation verifying that the physician is responsible for
  932  the medical services that were rendered and billed.
  933         2. The Department of Health, in consultation with the
  934  appropriate professional licensing boards, shall adopt, by rule,
  935  a list of diagnostic tests deemed not to be medically necessary
  936  for use in the treatment of persons sustaining bodily injury
  937  covered by personal injury protection benefits under this
  938  section. The initial list shall be adopted by January 1, 2004,
  939  and shall be revised from time to time as determined by the
  940  Department of Health, in consultation with the respective
  941  professional licensing boards. Inclusion of a test on the list
  942  of invalid diagnostic tests shall be based on lack of
  943  demonstrated medical value and a level of general acceptance by
  944  the relevant provider community and may shall not be dependent
  945  for results entirely upon subjective patient response.
  946  Notwithstanding its inclusion on a fee schedule in this
  947  subsection, an insurer or insured is not required to pay any
  948  charges or reimburse claims for an any invalid diagnostic test
  949  as determined by the Department of Health.
  950         (c)1. With respect to any treatment or service, other than
  951  medical services billed by a hospital or other provider for
  952  emergency services and care as defined in s. 395.002 or
  953  inpatient services rendered at a hospital-owned facility, the
  954  statement of charges must be furnished to the insurer by the
  955  provider and may not include, and the insurer is not required to
  956  pay, charges for treatment or services rendered more than 35
  957  days before the postmark date or electronic transmission date of
  958  the statement, except for past due amounts previously billed on
  959  a timely basis under this paragraph, and except that, if the
  960  provider submits to the insurer a notice of initiation of
  961  treatment within 21 days after its first examination or
  962  treatment of the claimant, the statement may include charges for
  963  treatment or services rendered up to, but not more than, 75 days
  964  before the postmark date of the statement. The injured party is
  965  not liable for, and the provider may shall not bill the injured
  966  party for, charges that are unpaid because of the provider’s
  967  failure to comply with this paragraph. Any agreement requiring
  968  the injured person or insured to pay for such charges is
  969  unenforceable.
  970         1.2. If, however, the insured fails to furnish the provider
  971  with the correct name and address of the insured’s personal
  972  injury protection insurer, the provider has 35 days from the
  973  date the provider obtains the correct information to furnish the
  974  insurer with a statement of the charges. The insurer is not
  975  required to pay for such charges unless the provider includes
  976  with the statement documentary evidence that was provided by the
  977  insured during the 35-day period demonstrating that the provider
  978  reasonably relied on erroneous information from the insured and
  979  either:
  980         a. A denial letter from the incorrect insurer; or
  981         b. Proof of mailing, which may include an affidavit under
  982  penalty of perjury, reflecting timely mailing to the incorrect
  983  address or insurer.
  984         2.3. For emergency services and care as defined in s.
  985  395.002 rendered in a hospital emergency department or for
  986  transport and treatment rendered by an ambulance provider
  987  licensed pursuant to part III of chapter 401, the provider is
  988  not required to furnish the statement of charges within the time
  989  periods established by this paragraph,; and the insurer is shall
  990  not be considered to have been furnished with notice of the
  991  amount of covered loss for purposes of paragraph (4)(b) until it
  992  receives a statement complying with paragraph (d), or copy
  993  thereof, which specifically identifies the place of service to
  994  be a hospital emergency department or an ambulance in accordance
  995  with billing standards recognized by the federal Centers for
  996  Medicare and Medicaid Services Health Care Finance
  997  Administration.
  998         3.4. Each notice of the insured’s rights under s. 627.7401
  999  must include the following statement in at least 12-point type
 1000  in type no smaller than 12 points:
 1001  
 1002         BILLING REQUIREMENTS.—Florida law provides Statutes
 1003         provide that with respect to any treatment or
 1004         services, other than certain hospital and emergency
 1005         services, the statement of charges furnished to the
 1006         insurer by the provider may not include, and the
 1007         insurer and the injured party are not required to pay,
 1008         charges for treatment or services rendered more than
 1009         35 days before the postmark date of the statement,
 1010         except for past due amounts previously billed on a
 1011         timely basis, and except that, if the provider submits
 1012         to the insurer a notice of initiation of treatment
 1013         within 21 days after its first examination or
 1014         treatment of the claimant, the statement may include
 1015         charges for treatment or services rendered up to, but
 1016         not more than, 75 days before the postmark date of the
 1017         statement.
 1018  
 1019         (d) All statements and bills for medical services rendered
 1020  by a any physician, hospital, clinic, or other person or
 1021  institution shall be submitted to the insurer on a properly
 1022  completed Centers for Medicare and Medicaid Services (CMS) 1500
 1023  form, UB 92 forms, or any other standard form approved by the
 1024  office or adopted by the commission for purposes of this
 1025  paragraph. All billings for such services rendered by providers
 1026  must shall, to the extent applicable, follow the Physicians’
 1027  Current Procedural Terminology (CPT) or Healthcare Correct
 1028  Procedural Coding System (HCPCS), or ICD-9 in effect for the
 1029  year in which services are rendered and comply with the Centers
 1030  for Medicare and Medicaid Services (CMS) 1500 form instructions,
 1031  and the American Medical Association Current Procedural
 1032  Terminology (CPT) Editorial Panel, and the Healthcare Correct
 1033  Procedural Coding System (HCPCS). All providers, other than
 1034  hospitals, must shall include on the applicable claim form the
 1035  professional license number of the provider in the line or space
 1036  provided for “Signature of Physician or Supplier, Including
 1037  Degrees or Credentials.” In determining compliance with
 1038  applicable CPT and HCPCS coding, guidance shall be provided by
 1039  the Physicians’ Current Procedural Terminology (CPT) or the
 1040  Healthcare Correct Procedural Coding System (HCPCS) in effect
 1041  for the year in which services were rendered, the Office of the
 1042  Inspector General (OIG), Physicians Compliance Guidelines, and
 1043  other authoritative treatises designated by rule by the Agency
 1044  for Health Care Administration. A No statement of medical
 1045  services may not include charges for medical services of a
 1046  person or entity that performed such services without possessing
 1047  the valid licenses required to perform such services. For
 1048  purposes of paragraph (4)(b), an insurer is shall not be
 1049  considered to have been furnished with notice of the amount of
 1050  covered loss or medical bills due unless the statements or bills
 1051  comply with this paragraph, and unless the statements or bills
 1052  are properly completed in their entirety as to all material
 1053  provisions, with all relevant information being provided
 1054  therein.
 1055         (e)1. At the initial treatment or service provided, each
 1056  physician, other licensed professional, clinic, or other medical
 1057  institution providing medical services upon which a claim for
 1058  personal injury protection benefits is based shall require an
 1059  insured person, or his or her guardian, to execute a disclosure
 1060  and acknowledgment form, which reflects at a minimum that:
 1061         a. The insured, or his or her guardian, must countersign
 1062  the form attesting to the fact that the services set forth
 1063  therein were actually rendered;
 1064         b. The insured, or his or her guardian, has both the right
 1065  and affirmative duty to confirm that the services were actually
 1066  rendered;
 1067         c. The insured, or his or her guardian, was not solicited
 1068  by any person to seek any services from the medical provider;
 1069         d. The physician, other licensed professional, clinic, or
 1070  other medical institution rendering services for which payment
 1071  is being claimed explained the services to the insured or his or
 1072  her guardian; and
 1073         e. If the insured notifies the insurer in writing of a
 1074  billing error, the insured may be entitled to a certain
 1075  percentage of a reduction in the amounts paid by the insured’s
 1076  motor vehicle insurer.
 1077         2. The physician, other licensed professional, clinic, or
 1078  other medical institution rendering services for which payment
 1079  is being claimed has the affirmative duty to explain the
 1080  services rendered to the insured, or his or her guardian, so
 1081  that the insured, or his or her guardian, countersigns the form
 1082  with informed consent.
 1083         3. Countersignature by the insured, or his or her guardian,
 1084  is not required for the reading of diagnostic tests or other
 1085  services that are of such a nature that they are not required to
 1086  be performed in the presence of the insured.
 1087         4. The licensed medical professional rendering treatment
 1088  for which payment is being claimed must sign, by his or her own
 1089  hand, the form complying with this paragraph.
 1090         5. The original completed disclosure and acknowledgment
 1091  form shall be furnished to the insurer pursuant to paragraph
 1092  (4)(b) and may not be electronically furnished.
 1093         6. The This disclosure and acknowledgment form is not
 1094  required for services billed by a provider for emergency
 1095  services as defined in s. 395.002, for emergency services and
 1096  care as defined in s. 395.002 rendered in a hospital emergency
 1097  department, or for transport and treatment rendered by an
 1098  ambulance provider licensed pursuant to part III of chapter 401.
 1099         7. The Financial Services Commission shall adopt, by rule,
 1100  a standard disclosure and acknowledgment form to that shall be
 1101  used to fulfill the requirements of this paragraph, effective 90
 1102  days after such form is adopted and becomes final. The
 1103  commission shall adopt a proposed rule by October 1, 2003. Until
 1104  the rule is final, the provider may use a form of its own which
 1105  otherwise complies with the requirements of this paragraph.
 1106         8. As used in this paragraph, the term “countersign” or
 1107  “countersignature” “countersigned” means a second or verifying
 1108  signature, as on a previously signed document, and is not
 1109  satisfied by the statement “signature on file” or any similar
 1110  statement.
 1111         9. The requirements of this paragraph apply only with
 1112  respect to the initial treatment or service of the insured by a
 1113  provider. For subsequent treatments or service, the provider
 1114  must maintain a patient log signed by the patient, in
 1115  chronological order by date of service, which that is consistent
 1116  with the services being rendered to the patient as claimed. The
 1117  requirement to maintain requirements of this subparagraph for
 1118  maintaining a patient log signed by the patient may be met by a
 1119  hospital that maintains medical records as required by s.
 1120  395.3025 and applicable rules and makes such records available
 1121  to the insurer upon request.
 1122         (f) Upon written notification by any person, an insurer
 1123  shall investigate any claim of improper billing by a physician
 1124  or other medical provider. The insurer shall determine if the
 1125  insured was properly billed for only those services and
 1126  treatments that the insured actually received. If the insurer
 1127  determines that the insured has been improperly billed, the
 1128  insurer shall notify the insured, the person making the written
 1129  notification, and the provider of its findings and shall reduce
 1130  the amount of payment to the provider by the amount determined
 1131  to be improperly billed. If a reduction is made due to a such
 1132  written notification by any person, the insurer shall pay to the
 1133  person 20 percent of the amount of the reduction, up to $500. If
 1134  the provider is arrested due to the improper billing, then the
 1135  insurer shall pay to the person 40 percent of the amount of the
 1136  reduction, up to $500.
 1137         (g) An insurer may not systematically downcode with the
 1138  intent to deny reimbursement otherwise due. Such action
 1139  constitutes a material misrepresentation under s.
 1140  626.9541(1)(i)2.
 1141         (h) As provided in s. 400.9905, an entity excluded from the
 1142  definition of a clinic shall be deemed a clinic and must be
 1143  licensed under part X of chapter 400 in order to receive
 1144  reimbursement under ss. 627.730-627.7405. However, this
 1145  licensing requirement does not apply to:
 1146         1. An entity wholly owned by a physician licensed under
 1147  chapter 458 or chapter 459, or by the physician and the spouse,
 1148  parent, child, or sibling of the physician;
 1149         2. An entity wholly owned by a dentist licensed under
 1150  chapter 466, or by the dentist and the spouse, parent, child, or
 1151  sibling of the dentist;
 1152         3. An entity wholly owned by a chiropractic physician
 1153  licensed under chapter 460, or by the chiropractic physician and
 1154  the spouse, parent, child, or sibling of the chiropractic
 1155  physician;
 1156         4. A hospital or ambulatory surgical center licensed under
 1157  chapter 395; or
 1158         5. An entity wholly owned, directly or indirectly, by a
 1159  hospital or hospitals licensed under chapter 395.
 1160         (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON; DISPUTES.—
 1161         (a) Every employer shall, If a request is made by an
 1162  insurer providing personal injury protection benefits under ss.
 1163  627.730-627.7405 against whom a claim has been made, an employer
 1164  must furnish forthwith, in a form approved by the office, a
 1165  sworn statement of the earnings, since the time of the bodily
 1166  injury and for a reasonable period before the injury, of the
 1167  person upon whose injury the claim is based.
 1168         (b) Every physician, hospital, clinic, or other medical
 1169  institution providing, before or after bodily injury upon which
 1170  a claim for personal injury protection insurance benefits is
 1171  based, any products, services, or accommodations in relation to
 1172  that or any other injury, or in relation to a condition claimed
 1173  to be connected with that or any other injury, shall, if
 1174  requested to do so by the insurer against whom the claim has
 1175  been made, furnish forthwith a written report of the history,
 1176  condition, treatment, dates, and costs of such treatment of the
 1177  injured person and why the items identified by the insurer were
 1178  reasonable in amount and medically necessary, together with a
 1179  sworn statement that the treatment or services rendered were
 1180  reasonable and necessary with respect to the bodily injury
 1181  sustained and identifying which portion of the expenses for such
 1182  treatment or services was incurred as a result of such bodily
 1183  injury, and produce forthwith, and allow permit the inspection
 1184  and copying of, his or her or its records regarding such
 1185  history, condition, treatment, dates, and costs of treatment if;
 1186  provided that this does shall not limit the introduction of
 1187  evidence at trial. Such sworn statement must shall read as
 1188  follows: “Under penalty of perjury, I declare that I have read
 1189  the foregoing, and the facts alleged are true, to the best of my
 1190  knowledge and belief.” A No cause of action for violation of the
 1191  physician-patient privilege or invasion of the right of privacy
 1192  may not be brought shall be permitted against any physician,
 1193  hospital, clinic, or other medical institution complying with
 1194  the provisions of this section. The person requesting such
 1195  records and such sworn statement shall pay all reasonable costs
 1196  connected therewith. If an insurer makes a written request for
 1197  documentation or information under this paragraph within 30 days
 1198  after having received notice of the amount of a covered loss
 1199  under paragraph (4)(a), the amount or the partial amount that
 1200  which is the subject of the insurer’s inquiry is shall become
 1201  overdue if the insurer does not pay in accordance with paragraph
 1202  (4)(b) or within 10 days after the insurer’s receipt of the
 1203  requested documentation or information, whichever occurs later.
 1204  As used in For purposes of this paragraph, the term “receipt”
 1205  includes, but is not limited to, inspection and copying pursuant
 1206  to this paragraph. An Any insurer that requests documentation or
 1207  information pertaining to reasonableness of charges or medical
 1208  necessity under this paragraph without a reasonable basis for
 1209  such requests as a general business practice is engaging in an
 1210  unfair trade practice under the insurance code.
 1211         (c) In the event of a any dispute regarding an insurer’s
 1212  right to discovery of facts under this section, the insurer may
 1213  petition a court of competent jurisdiction to enter an order
 1214  permitting such discovery. The order may be made only on motion
 1215  for good cause shown and upon notice to all persons having an
 1216  interest, and must it shall specify the time, place, manner,
 1217  conditions, and scope of the discovery. Such court may, In order
 1218  to protect against annoyance, embarrassment, or oppression, as
 1219  justice requires, the court may enter an order refusing
 1220  discovery or specifying conditions of discovery and may order
 1221  payments of costs and expenses of the proceeding, including
 1222  reasonable fees for the appearance of attorneys at the
 1223  proceedings, as justice requires.
 1224         (d) The injured person shall be furnished, upon request, a
 1225  copy of all information obtained by the insurer under the
 1226  provisions of this section, and shall pay a reasonable charge,
 1227  if required by the insurer.
 1228         (e) Notice to an insurer of the existence of a claim may
 1229  shall not be unreasonably withheld by an insured.
 1230         (f) In a dispute between the insured and the insurer, or
 1231  between an assignee of the insured’s rights and the insurer, the
 1232  insurer must notify the insured or the assignee that the policy
 1233  limits under this section have been reached within 15 days after
 1234  the limits have been reached.
 1235         (8) APPLICABILITY OF PROVISION REGULATING ATTORNEY
 1236  ATTORNEY’S FEES.—With respect to any dispute under the
 1237  provisions of ss. 627.730-627.7405 between the insured and the
 1238  insurer, or between an assignee of an insured’s rights and the
 1239  insurer, the provisions of ss. s. 627.428 and 768.79 shall
 1240  apply, except as provided in subsections (10) and (15).
 1241         (9) PREFERRED PROVIDERS.—An insurer may negotiate and
 1242  contract enter into contracts with preferred licensed health
 1243  care providers for the benefits described in this section,
 1244  referred to in this section as “preferred providers,” which
 1245  shall include health care providers licensed under chapter
 1246  chapters 458, chapter 459, chapter 460, chapter 461, or chapter
 1247  and 463. The insurer may provide an option to an insured to use
 1248  a preferred provider at the time of purchasing purchase of the
 1249  policy for personal injury protection benefits, if the
 1250  requirements of this subsection are met. If the insured elects
 1251  to use a provider who is not a preferred provider, whether the
 1252  insured purchased a preferred provider policy or a nonpreferred
 1253  provider policy, the medical benefits provided by the insurer
 1254  shall be as required by this section. If the insured elects to
 1255  use a provider who is a preferred provider, the insurer may pay
 1256  medical benefits in excess of the benefits required by this
 1257  section and may waive or lower the amount of any deductible that
 1258  applies to such medical benefits. If the insurer offers a
 1259  preferred provider policy to a policyholder or applicant, it
 1260  must also offer a nonpreferred provider policy. The insurer
 1261  shall provide each insured policyholder with a current roster of
 1262  preferred providers in the county in which the insured resides
 1263  at the time of purchase of such policy, and shall make such list
 1264  available for public inspection during regular business hours at
 1265  the insurer’s principal office of the insurer within the state.
 1266         (10) DEMAND LETTER.—
 1267         (a) As a condition precedent to filing any action for
 1268  benefits under this section, the insurer must be provided with
 1269  written notice of an intent to initiate litigation must be
 1270  provided to the insurer. Such notice may not be sent until the
 1271  claim is overdue, including any additional time the insurer has
 1272  to pay the claim pursuant to paragraph (4)(b). However, the
 1273  requirements of this subsection do not apply to physicians
 1274  licensed under chapter 458 or chapter 459, dentists licensed
 1275  under chapter 466 who provide emergency services or care as
 1276  defined in s. 395.002 or hospital inpatient care, hospitals, or
 1277  an insured claiming lost wages.
 1278         (b) The notice must required shall state that it is a
 1279  “demand letter under s. 627.736(10)” and shall state with
 1280  specificity:
 1281         1. The name of the insured upon which such benefits are
 1282  being sought, including a copy of the assignment giving rights
 1283  to the claimant if the claimant is not the insured.
 1284         2. The claim number or policy number upon which such claim
 1285  was originally submitted to the insurer.
 1286         3. To the extent applicable, the name of any medical
 1287  provider who rendered to an insured the treatment, services,
 1288  accommodations, or supplies that form the basis of such claim;
 1289  and an itemized statement specifying each exact amount, the date
 1290  of treatment, service, or accommodation, and the type of benefit
 1291  claimed to be due. A completed form satisfying the requirements
 1292  of paragraph (5)(d) or the lost-wage statement previously
 1293  submitted may be used as the itemized statement. To the extent
 1294  that the demand involves an insurer’s withdrawal of payment
 1295  under paragraph (7)(a) for future treatment not yet rendered,
 1296  the claimant shall attach a copy of the insurer’s notice
 1297  withdrawing such payment and an itemized statement of the type,
 1298  frequency, and duration of future treatment claimed to be
 1299  reasonable and medically necessary.
 1300         (c) A notice is not deficient merely because there are
 1301  calculation errors or payments not taken into account in the
 1302  demand letter. In determining compliance with this subsection,
 1303  the courts shall adhere to the standard of substantial
 1304  compliance and consider the purpose of the notice, which is to
 1305  provide notice of the overdue claim and to allow the insurer
 1306  time to pay the overdue bills before litigation is initiated. If
 1307  a demand is found to be deficient for any reason and suit has
 1308  commenced, the insured or the insured’s assignee may abate the
 1309  action to allow for compliance with this section. If the insurer
 1310  is asserting that the notice is deficient, the insurer must
 1311  respond to the notice by specifying each deficiency that the
 1312  insurer is claiming pursuant to the notice. If the insurer fails
 1313  to so specify, the insurer waives any deficiencies found in the
 1314  notice.
 1315         (d)(c) Each notice required by this subsection must be
 1316  delivered to the insurer by United States certified or
 1317  registered mail, return receipt requested. Such postal costs
 1318  shall be reimbursed by the insurer if so requested by the
 1319  claimant in the notice, when the insurer pays the claim. Such
 1320  notice must be sent to the person and address specified by the
 1321  insurer for the purposes of receiving notices under this
 1322  subsection. Each licensed insurer, whether domestic, foreign, or
 1323  alien, shall file with the office designation of the name and
 1324  address of the person to whom notices must pursuant to this
 1325  subsection shall be sent which the office shall make available
 1326  on its Internet website. The name and address on file with the
 1327  office pursuant to s. 624.422 are shall be deemed the authorized
 1328  representative to accept notice pursuant to this subsection if
 1329  in the event no other designation has been made.
 1330         (e)(d) If, within 30 days after receipt of notice by the
 1331  insurer, the overdue claim specified in the notice is paid by
 1332  the insurer together with applicable interest and a penalty of
 1333  10 percent of the overdue amount paid by the insurer, subject to
 1334  a maximum penalty of $250, no action may be brought against the
 1335  insurer. If the demand involves an insurer’s withdrawal of
 1336  payment under paragraph (7)(a) for future treatment not yet
 1337  rendered, no action may be brought against the insurer if,
 1338  within 30 days after its receipt of the notice, the insurer
 1339  mails to the person filing the notice a written statement of the
 1340  insurer’s agreement to pay for such treatment in accordance with
 1341  the notice and to pay a penalty of 10 percent, subject to a
 1342  maximum penalty of $250, when it pays for such future treatment
 1343  in accordance with the requirements of this section. To the
 1344  extent the insurer determines not to pay any amount demanded,
 1345  the penalty is shall not be payable in any subsequent action.
 1346  For purposes of this subsection, payment or the insurer’s
 1347  agreement shall be treated as being made on the date a draft or
 1348  other valid instrument that is equivalent to payment, or the
 1349  insurer’s written statement of agreement, is placed in the
 1350  United States mail in a properly addressed, postpaid envelope,
 1351  or if not so posted, on the date of delivery. The insurer is not
 1352  obligated to pay any attorney attorney’s fees if the insurer
 1353  pays the claim or mails its agreement to pay for future
 1354  treatment within the time prescribed by this subsection.
 1355         (f)(e) The applicable statute of limitation for an action
 1356  under this section shall be tolled for a period of 30 business
 1357  days by the mailing of the notice required by this subsection.
 1358         (f) Any insurer making a general business practice of not
 1359  paying valid claims until receipt of the notice required by this
 1360  subsection is engaging in an unfair trade practice under the
 1361  insurance code.
 1362         (11) FAILURE TO PAY VALID CLAIMS; UNFAIR OR DECEPTIVE
 1363  PRACTICE.—
 1364         (a) If An insurer fails to pay valid claims for personal
 1365  injury protection with such frequency so as to indicate a
 1366  general business practice, the insurer is engaging in a
 1367  prohibited unfair or deceptive practice that is subject to the
 1368  penalties provided in s. 626.9521 and the office has the powers
 1369  and duties specified in ss. 626.9561-626.9601 if the insurer,
 1370  with such frequency so as to indicate a general business
 1371  practice: with respect thereto
 1372         1. Fails to pay valid claims for personal injury
 1373  protection; or
 1374         2. Fails to pay valid claims until receipt of the notice
 1375  required by subsection (10).
 1376         (b) Notwithstanding s. 501.212, the Department of Legal
 1377  Affairs may investigate and initiate actions for a violation of
 1378  this subsection, including, but not limited to, the powers and
 1379  duties specified in part II of chapter 501.
 1380         Section 8. Effective December 1, 2012, subsection (16) of
 1381  section 627.736, Florida Statutes, is amended to read:
 1382         627.736 Required personal injury protection benefits;
 1383  exclusions; priority; claims.—
 1384         (16) SECURE ELECTRONIC DATA TRANSFER.—If all parties
 1385  mutually and expressly agree, A notice, documentation,
 1386  transmission, or communication of any kind required or
 1387  authorized under ss. 627.730-627.7405 may be transmitted
 1388  electronically if it is transmitted by secure electronic data
 1389  transfer that is consistent with state and federal privacy and
 1390  security laws.
 1391         Section 9. Subsections (1), (10), and (13) of section
 1392  817.234, Florida Statutes, are amended to read:
 1393         817.234 False and fraudulent insurance claims.—
 1394         (1)(a) A person commits insurance fraud punishable as
 1395  provided in subsection (11) if that person, with the intent to
 1396  injure, defraud, or deceive any insurer:
 1397         1. Presents or causes to be presented any written or oral
 1398  statement as part of, or in support of, a claim for payment or
 1399  other benefit pursuant to an insurance policy or a health
 1400  maintenance organization subscriber or provider contract,
 1401  knowing that such statement contains any false, incomplete, or
 1402  misleading information concerning any fact or thing material to
 1403  such claim;
 1404         2. Prepares or makes any written or oral statement that is
 1405  intended to be presented to any insurer in connection with, or
 1406  in support of, any claim for payment or other benefit pursuant
 1407  to an insurance policy or a health maintenance organization
 1408  subscriber or provider contract, knowing that such statement
 1409  contains any false, incomplete, or misleading information
 1410  concerning any fact or thing material to such claim; or
 1411         3.a. Knowingly presents, causes to be presented, or
 1412  prepares or makes with knowledge or belief that it will be
 1413  presented to any insurer, purported insurer, servicing
 1414  corporation, insurance broker, or insurance agent, or any
 1415  employee or agent thereof, any false, incomplete, or misleading
 1416  information or written or oral statement as part of, or in
 1417  support of, an application for the issuance of, or the rating
 1418  of, any insurance policy, or a health maintenance organization
 1419  subscriber or provider contract; or
 1420         b. Who Knowingly conceals information concerning any fact
 1421  material to such application; or.
 1422         4. Knowingly presents, causes to be presented, or prepares
 1423  or makes with knowledge or belief that it will be presented to
 1424  any insurer a claim for payment or other benefit under a
 1425  personal injury protection insurance policy if the person knows
 1426  that the payee knowingly submitted a false, misleading, or
 1427  fraudulent application or other document when applying for
 1428  licensure as a health care clinic, seeking an exemption from
 1429  licensure as a health care clinic, or demonstrating compliance
 1430  with part X of chapter 400.
 1431         (b) All claims and application forms must shall contain a
 1432  statement that is approved by the Office of Insurance Regulation
 1433  of the Financial Services Commission which clearly states in
 1434  substance the following: “Any person who knowingly and with
 1435  intent to injure, defraud, or deceive any insurer files a
 1436  statement of claim or an application containing any false,
 1437  incomplete, or misleading information is guilty of a felony of
 1438  the third degree.” This paragraph does shall not apply to
 1439  reinsurance contracts, reinsurance agreements, or reinsurance
 1440  claims transactions.
 1441         (10) A licensed health care practitioner who is found
 1442  guilty of insurance fraud under this section for an act relating
 1443  to a personal injury protection insurance policy loses his or
 1444  her license to practice for 5 years and may not receive
 1445  reimbursement for personal injury protection benefits for 10
 1446  years. As used in this section, the term “insurer” means any
 1447  insurer, health maintenance organization, self-insurer, self
 1448  insurance fund, or other similar entity or person regulated
 1449  under chapter 440 or chapter 641 or by the Office of Insurance
 1450  Regulation under the Florida Insurance Code.
 1451         (13) As used in this section, the term:
 1452         (a) “Insurer” means any insurer, health maintenance
 1453  organization, self-insurer, self-insurance fund, or similar
 1454  entity or person regulated under chapter 440 or chapter 641 or
 1455  by the Office of Insurance Regulation under the Florida
 1456  Insurance Code.
 1457         (b)(a) “Property” means property as defined in s. 812.012.
 1458         (c)(b) “Value” means value as defined in s. 812.012.
 1459         Section 10. Subsection (4) of section 316.065, Florida
 1460  Statutes, is amended to read:
 1461         316.065 Crashes; reports; penalties.—
 1462         (4) Any person who knowingly repairs a motor vehicle
 1463  without having made a report as required by subsection (3) is
 1464  guilty of a misdemeanor of the first degree, punishable as
 1465  provided in s. 775.082 or s. 775.083. The owner and driver of a
 1466  vehicle involved in a crash who makes a report thereof in
 1467  accordance with subsection (1) or s. 316.066(1) is not liable
 1468  under this section.
 1469         Section 11. The Office of Insurance Regulation shall
 1470  perform a comprehensive personal injury protection data call and
 1471  publish the results by January 1, 2015. It is the intent of the
 1472  Legislature that the office design the data call with the
 1473  expectation that the Legislature will use the data to help
 1474  evaluate market conditions relating to the Florida Motor Vehicle
 1475  No-Fault Law and the impact on the market of reforms to the law
 1476  made by this act. The elements of the data call must address,
 1477  but need not be limited to, the following components of the
 1478  Florida Motor Vehicle No-Fault Law:
 1479         (1) Quantity of personal injury protection claims.
 1480         (2) Type or nature of claimants.
 1481         (3) Amount and type of personal injury protection benefits
 1482  paid and expenses incurred.
 1483         (4) Type and quantity of, and charges for, medical
 1484  benefits.
 1485         (5)Attorney fees related to bringing and defending actions
 1486  for benefits.
 1487         (6) Direct earned premiums for personal injury protection
 1488  coverage, pure loss ratios, pure premiums, and other information
 1489  related to premiums and losses.
 1490         (7) Licensed drivers and accidents.
 1491         (8) Fraud and enforcement.
 1492         Section 12. If any provision of this act or its application
 1493  to any person or circumstance is held invalid, the invalidity
 1494  does not affect other provisions or applications of the act
 1495  which can be given effect without the invalid provision or
 1496  application, and to this end the provisions of this act are
 1497  severable.
 1498         Section 13. Except as otherwise expressly provided in this
 1499  act, this act shall take effect July 1, 2012.