Florida Senate - 2014                                     SB 436
       
       
        
       By Senator Altman
       
       
       
       
       
       16-00288-14                                            2014436__
    1                        A bill to be entitled                      
    2         An act relating to payment for services provided by
    3         licensed psychologists; amending ss. 627.6131 and
    4         641.3155, F.S.; adding licensed psychologists to the
    5         list of health care providers who are protected by a
    6         limitations period from claims for overpayment being
    7         sought by health insurers or health maintenance
    8         organizations; adding licensed psychologists to the
    9         list of health care providers who are subject to a
   10         limitations period for submitting claims to health
   11         insurers or health maintenance organizations for
   12         underpayment; amending s. 627.638, F.S.; adding
   13         licensed psychologists to the list of health care
   14         providers who are eligible for direct payment for
   15         medical services by a health insurer under certain
   16         circumstances; making technical and grammatical
   17         changes; providing an effective date.
   18          
   19  Be It Enacted by the Legislature of the State of Florida:
   20  
   21         Section 1. Subsections (18) and (19) of section 627.6131,
   22  Florida Statutes, are amended to read:
   23         627.6131 Payment of claims.—
   24         (18) Notwithstanding the 30-month period provided in
   25  subsection (6), all claims for overpayment submitted to a
   26  provider licensed under chapter 458, chapter 459, chapter 460,
   27  chapter 461, or chapter 466, or chapter 490 must be submitted to
   28  the provider within 12 months after the health insurer’s payment
   29  of the claim. A claim for overpayment is may not be permitted
   30  beyond 12 months after the health insurer’s payment of a claim,
   31  except that claims for overpayment may be sought after beyond
   32  that time from providers convicted of fraud pursuant to s.
   33  817.234.
   34         (19) Notwithstanding any other provision of this section,
   35  all claims for underpayment from a provider licensed under
   36  chapter 458, chapter 459, chapter 460, chapter 461, or chapter
   37  466, or chapter 490 must be submitted to the insurer within 12
   38  months after the health insurer’s payment of the claim. A claim
   39  for underpayment is may not be permitted beyond 12 months after
   40  the health insurer’s payment of a claim.
   41         Section 2. Subsections (16) and (17) of section 641.3155,
   42  Florida Statutes, are amended to read:
   43         641.3155 Prompt payment of claims.—
   44         (16) Notwithstanding the 30-month period provided in
   45  subsection (5), all claims for overpayment submitted to a
   46  provider licensed under chapter 458, chapter 459, chapter 460,
   47  chapter 461, or chapter 466, or chapter 490 must be submitted to
   48  the provider within 12 months after the health maintenance
   49  organization’s payment of the claim. A claim for overpayment is
   50  may not be permitted beyond 12 months after the health
   51  maintenance organization’s payment of a claim, except that
   52  claims for overpayment may be sought after beyond that time from
   53  providers convicted of fraud pursuant to s. 817.234.
   54         (17) Notwithstanding any other provision of this section,
   55  all claims for underpayment from a provider licensed under
   56  chapter 458, chapter 459, chapter 460, chapter 461, or chapter
   57  466, or chapter 490 must be submitted to the health maintenance
   58  organization within 12 months after the health maintenance
   59  organization’s payment of the claim. A claim for underpayment is
   60  may not be permitted beyond 12 months after the health
   61  maintenance organization’s payment of a claim.
   62         Section 3. Subsection (2) of section 627.638, Florida
   63  Statutes, is amended to read:
   64         627.638 Direct payment for hospital, medical services.—
   65         (2) If Whenever, in any health insurance claim form, an
   66  insured specifically authorizes payment of benefits directly to
   67  a any recognized hospital, licensed ambulance provider,
   68  physician, dentist, psychologist, or other person who provided
   69  the services in accordance with the provisions of the policy,
   70  the insurer shall make such payment to the designated provider
   71  of such services. The insurance contract may not prohibit, and
   72  claims forms must provide an option for, the payment of benefits
   73  directly to a licensed hospital, licensed ambulance provider,
   74  physician, dentist, psychologist, or other person who provided
   75  the services in accordance with the provisions of the policy for
   76  care provided. The insurer may require written attestation of
   77  assignment of benefits. Payment to the provider from the insurer
   78  may not be more than the amount that the insurer would otherwise
   79  have paid without the assignment.
   80         Section 4. This act shall take effect July 1, 2014.