Florida Senate - 2019 SB 1790
By Senator Perry
1 A bill to be entitled
2 An act relating to medical services and insurance;
3 creating s. 395.0176, F.S.; providing definitions;
4 requiring the Department of Health to adopt statewide
5 fee schedules for services, supplies, and care
6 provided in hospitals and ambulatory surgical centers;
7 providing requirements for diagnostic testing;
8 requiring the department to adopt rules; creating s.
9 456.0535, F.S.; providing definitions; providing
10 requirements for specified licensed medical
11 professionals for diagnostic testing and treatment
12 plans; providing disciplinary actions; requiring the
13 department to adopt rules; amending s. 456.072, F.S.;
14 providing additional grounds for disciplinary actions
15 in health professions and occupations; amending s.
16 627.736, F.S.; revising the medical benefits
17 requirements under personal injury protection
18 coverage; providing a definition; conforming
19 provisions to changes made by the act; revising
20 circumstances under which an insurer or insured is not
21 required to pay a claim or charges; providing
22 effective dates.
24 Be It Enacted by the Legislature of the State of Florida:
26 Section 1. Section 395.0176, Florida Statutes, is created
27 to read:
28 395.0176 Fee schedules and standards of care in licensed
30 (1) DEFINITIONS.—As used in this section, the term:
31 (a) “Dentist” means a dentist licensed under chapter 466.
32 (b) “Physician” means a physician licensed under chapter
33 458, an osteopathic physician licensed under chapter 459, or a
34 chiropractic physician licensed under chapter 460.
35 (2) FEE SCHEDULES.—
36 (a) Effective July 1, 2020, and each year thereafter, the
37 department shall adopt statewide fee schedules for services,
38 care, and supplies provided in a licensed facility as follows:
39 1. For emergency transport and treatment during transport
40 by providers licensed under chapter 401 or by the licensed
41 facility’s medical staff, 200 percent of Medicare.
42 2. For emergency services and care provided by the licensed
43 facility, 200 percent of the Medicare Part A prospective payment
44 applicable to the specific licensed facility providing the
45 emergency services and care.
46 3. For emergency services and care provided in the licensed
47 facility by a physician or dentist, and related inpatient
48 services provided in the licensed facility by a physician or
49 dentist, 200 percent of the participating physician’s fee
50 schedule of Medicare Part B.
51 4. For inpatient services other than emergency services and
52 care, 200 percent of the Medicare Part A prospective payment
53 applicable to the specific licensed facility providing the
54 inpatient services.
55 5. For outpatient services other than emergency services
56 and care, 200 percent of the Medicare Part A Ambulatory Payment
57 Classification applicable to the specific licensed facility
58 providing the outpatient services.
59 6. For all other services, supplies, and care, except for
61 a. Two-hundred percent of the allowable amount under:
62 (I) The participating physician’s fee schedule of Medicare
63 Part B, except as provided in sub-sub-subparagraphs (II) and
65 (II) Medicare Part B in the case of services, supplies, and
66 care provided by ambulatory surgical centers and clinical
68 (III) The Durable Medical Equipment Prosthetics/Orthotics
69 and Supplies fee schedule of Medicare Part B in the case of
70 durable medical equipment.
71 b. If services, supplies, or care in this subparagraph is
72 not reimbursable under Medicare Part A or Part B, 200 percent of
73 the maximum reimbursable allowance under workers’ compensation,
74 as determined under s. 440.13 and rules adopted thereunder that
75 are in effect at the time the services, supplies, or care is
76 provided. Services, supplies, or care that is not reimbursable
77 under Medicare or workers’ compensation is not reimbursable
78 under a no-fault insurance.
79 7. For medication dispensed in the licensed facility, 150
80 percent of the average wholesale price.
81 (b) For purposes of paragraph (a), the applicable fee
82 schedule or payment limitation under Medicare is the fee
83 schedule or payment limitation in effect on March 1 of the
84 service year in which the services, supplies, or care is
85 rendered and for the area in which such services, supplies, or
86 care is rendered, and the applicable fee schedule or payment
87 limitation applies to services, supplies, or care rendered
88 during that service year, notwithstanding any subsequent change
89 made to the fee schedule or payment limitation, except that it
90 may not be less than the allowable amount under the applicable
91 schedule of Medicare Part A for 2007 for inpatient admitted
92 hospital and skilled nursing coverage or Medicare Part B for
93 2007 for medical services, supplies, and care subject to
94 Medicare Part B. For purposes of this paragraph, the term
95 “service year” means the period from March 1 through the end of
96 February of the following year.
97 (3) DIAGNOSTIC TESTING.—The physician or dentist who orders
98 a diagnostic test must document the test results and the
99 clinical rationale for ordering the test.
100 (4) RULEMAKING.—The department shall adopt rules necessary
101 to administer and enforce this section.
102 Section 2. Section 456.0535, Florida Statutes, is created
103 to read:
104 456.0535 Standards of care for medical services.—
105 (1) DEFINITIONS.—As used in this section, the term:
106 (a) “Evaluation and management CPT coding” or “E/M coding”
107 means the process by which an interaction between a patient and
108 a licensed medical professional is translated into a five-digit
109 Current Procedural Terminology (CPT) code. CPT code is a medical
110 code set maintained by the American Medical Association that is
111 used to report medical, surgical, and diagnostic procedures and
112 services. The E/M codes, a category of CPT codes, are used for
113 billing purposes and are categorized according to the site or
114 type of service provided, such as office, outpatient,
115 consultation, or emergency. Within these categories, the codes
116 are subdivided according to initial versus subsequent care.
117 (b) “Licensed medical professional” means:
118 1. A physician licensed under chapter 458, an osteopathic
119 physician licensed under chapter 459, or a chiropractic
120 physician licensed under chapter 460;
121 2. A physician assistant licensed under chapter 458 or
122 chapter 459;
123 3. An advanced practice registered nurse licensed under
124 chapter 464; or
125 4. A dentist licensed under chapter 466.
126 (c) “Treatment plan” means a documented course of treatment
127 based on a patient’s medical history and an examination or
128 diagnostic study of the patient.
129 (2) DIAGNOSTIC TESTING.—A licensed medical professional who
130 orders a diagnostic test must document the test results and the
131 clinical rationale for ordering the test and, if a treatment
132 plan is developed, use the test results in the formulation of
133 the patient’s treatment plan.
134 (3) TREATMENT PLANS.—A licensed medical professional’s
135 treatment plan must be supported by a written clinical rationale
136 that the treatment is reasonable and necessary and would be
137 considered appropriate for the patient’s condition by another
138 licensed medical professional of the same specialty and with
139 similar experience, education, and training.
140 (a) An initial treatment plan and all subsequent updates to
141 the treatment plan must include diagnostic codes from the most
142 recent International Classification of Diseases.
143 (b) An initial treatment plan may not exceed 6 weeks.
144 Subsequent treatment plans may not exceed 8 weeks between being
145 updated, changed, or extended via E/M coding.
146 (c) Interaction between the patient and a licensed medical
147 professional must occur at a minimum every 2 weeks or every
148 fourth patient visit, whichever occurs first, between treatment
149 plans. For each interaction, the patient’s medical record must
150 show that:
151 1. The licensed medical professional’s presence was
152 inherent to the service provided to the patient during the
153 interaction; or
154 2. The patient’s interaction with the licensed medical
155 professional was translated into an evaluation and management
156 CPT code.
157 (d) If a patient is insured under a no-fault insurance:
158 1. A licensed medical professional ordering a course of
159 treatment that extends to more than three patient interactions
160 must submit to the no-fault insurer the medical record of the
161 interaction during which the initial treatment plan was
162 developed. The medical record must include the details of the
163 proposed treatment plan.
164 2. In order for the licensed medical professional to be
165 reimbursed for additional treatment that goes beyond the
166 treatment specified in the initial treatment plan, the licensed
167 medical professional must update the patient’s treatment plan
168 pursuant to paragraph (c).
169 3. Any service or treatment that is reimbursable under the
170 no-fault insurance must be reasonable and necessary to the
171 extent that the service or treatment would be considered
172 appropriate for the patient’s condition by another licensed
173 medical provider of the same specialty and with similar
174 experience, education, and training.
175 4. Any medical benefits covered under a no-fault insurance
176 that are withdrawn, reduced, or denied by a licensed medical
177 professional based on this subsection must comply with s.
179 (4) DISCIPLINARY ACTIONS.—The department shall review each
180 complaint of a violation of this section and determine whether
181 the incident involves conduct by a health care practitioner
182 which is subject to disciplinary action under s. 456.073.
183 Disciplinary action, if any, must be taken by the appropriate
184 regulatory board or by the department if no such board exists.
185 (5) RULEMAKING.—The department shall adopt rules to
186 administer this section.
187 Section 3. Paragraph (pp) is added to subsection (1) of
188 section 456.072, Florida Statutes, to read:
189 456.072 Grounds for discipline; penalties; enforcement.—
190 (1) The following acts shall constitute grounds for which
191 the disciplinary actions specified in subsection (2) may be
193 (pp) Violating any provision of s. 395.0176 or s. 456.0535.
194 Section 4. Effective July 1, 2020, paragraph (a) of
195 subsection (1) and paragraphs (a) and (b) of subsection (5) of
196 section 627.736, Florida Statutes, are amended to read:
197 627.736 Required personal injury protection benefits;
198 exclusions; priority; claims.—
199 (1) REQUIRED BENEFITS.—An insurance policy complying with
200 the security requirements of s. 627.733 must provide personal
201 injury protection to the named insured, relatives residing in
202 the same household, persons operating the insured motor vehicle,
203 passengers in the motor vehicle, and other persons struck by the
204 motor vehicle and suffering bodily injury while not an occupant
205 of a self-propelled vehicle, subject to subsection (2) and
206 paragraph (4)(e), to a limit of $10,000 in medical and
207 disability benefits and $5,000 in death benefits resulting from
208 bodily injury, sickness, disease, or death arising out of the
209 ownership, maintenance, or use of a motor vehicle as follows:
210 (a) Medical benefits.—
211 1. Eighty percent of all reasonable expenses for medically
212 necessary medical, surgical, X-ray, dental, and rehabilitative
213 services, including prosthetic devices and medically necessary
214 ambulance, hospital, and nursing services if the individual
215 receives initial services and care pursuant to sub-subparagraph
subparagraph 1. within 30 14 days after the motor vehicle
217 accident. The medical benefits provide reimbursement only for:
218 a. 1. Initial services and care that are lawfully provided,
219 supervised, ordered, or prescribed by a physician licensed under
220 chapter 458 or chapter 459, a dentist licensed under chapter
221 466, or a chiropractic physician licensed under chapter 460 or
222 that are provided in a hospital or in a facility that owns, or
223 is wholly owned by, a hospital. Initial services and care may
224 also be provided by a person or entity licensed under part III
225 of chapter 401 which provides emergency transportation and
227 b. 2. Upon referral by a provider described in sub
228 subparagraph a. subparagraph 1., followup services and care
229 consistent with the underlying medical diagnosis rendered
230 pursuant to sub-subparagraph a. subparagraph 1. which may be
231 provided, supervised, ordered, or prescribed only by a physician
232 licensed under chapter 458 or chapter 459, a chiropractic
233 physician licensed under chapter 460, a dentist licensed under
234 chapter 466, or, to the extent permitted by applicable law and
235 under the supervision of such physician, osteopathic physician,
236 chiropractic physician, or dentist, by a physician assistant
237 licensed under chapter 458 or chapter 459 or an advanced
238 practice registered nurse licensed under chapter 464. Followup
239 services and care may also be provided by the following persons
240 or entities:
241 (I) a. A hospital or ambulatory surgical center licensed
242 under chapter 395.
243 (II) b. An entity wholly owned by one or more physicians
244 licensed under chapter 458 or chapter 459, chiropractic
245 physicians licensed under chapter 460, or dentists licensed
246 under chapter 466 or by such practitioners and the spouse,
247 parent, child, or sibling of such practitioners.
248 (III) c. An entity that owns or is wholly owned, directly or
249 indirectly, by a hospital or hospitals.
250 (IV) d. A physical therapist licensed under chapter 486,
251 based upon a referral by a provider described in this sub
252 subparagraph subparagraph.
253 (V) e. A health care clinic licensed under part X of chapter
254 400 which is accredited by an accrediting organization whose
255 standards incorporate comparable regulations required by this
256 state, or
257 (A) (I) Has a medical director licensed under chapter 458,
258 chapter 459, or chapter 460;
259 (B) (II) Has been continuously licensed for more than 3
260 years or is a publicly traded corporation that issues securities
261 traded on an exchange registered with the United States
262 Securities and Exchange Commission as a national securities
263 exchange; and
264 (C) (III) Provides at least four of the following medical
266 (A) general medicine, .
267 (B) radiography, .
268 (C) orthopedic medicine, .
269 (D) physical medicine, .
270 (E) physical therapy, .
271 (F) physical rehabilitation, .
272 (G) prescribing or dispensing outpatient prescription
273 medication, and .
274 (H) laboratory services.
275 c. 3. Reimbursement for Services and care provided in sub
276 subparagraph a. or sub-subparagraph b. subparagraph 1. or
277 subparagraph 2. up to $10,000 if a physician licensed under
278 chapter 458 or chapter 459, a dentist licensed under chapter
279 466, a physician assistant licensed under chapter 458 or chapter
280 459, or an advanced practice registered nurse licensed under
281 chapter 464 has determined that the injured person had an
282 emergency medical condition. Services and care rendered during
283 the interaction in which the emergency medical condition is
284 determined may occur in a traditional office or facility visit
285 or via telemedicine.
286 d. 4. Reimbursement for Services and care provided in sub
287 subparagraph a. or sub-subparagraph b. up subparagraph 1. or
288 subparagraph 2. is limited to $2,500 if a provider listed in
289 sub-subparagraph a. or sub-subparagraph b. subparagraph 1. or
290 subparagraph 2. determines that the injured person did not have
291 an emergency medical condition. Services and care rendered under
292 this sub-subparagraph may occur in a traditional office or
293 facility visit or via telemedicine.
294 e. Upon referral by a provider described in sub
295 subparagraph a.:
296 (I) A treatment plan, as defined in s. 456.0535, that is
297 submitted, along with the medical record of the interaction
298 during which the treatment plan was established, within 30 days
299 after the start date of the treatment plan.
300 (II) Diagnostic testing, the results of which are
301 documented by the ordering provider and, if a treatment plan is
302 developed, used in the formulation of the treatment plan.
303 (III) Additional treatment after the initial treatment plan
305 (A) The treatment plan is updated on a regular basis in
306 accordance with s. 456.0535.
307 (B) Interaction between the patient and the licensed
308 medical professional occurs between treatment plans at the
309 intervals specified in s. 456.0535. For each interaction, the
310 patient’s medical record must show that the licensed medical
311 professional’s encounter with the patient was translated into an
312 evaluation and management CPT code or that the licensed medical
313 professional’s presence was inherent to the service provided to
314 the patient during the interaction. As used in this section, the
315 term “licensed medical professional” has the same meaning as
316 provided in s. 456.0535.
317 (IV) Reasonable and necessary services and treatment that
318 conform with s. 456.0535.
319 2. 5. Medical benefits do not include massage as defined in
320 s. 480.033 or acupuncture as defined in s. 457.102, regardless
321 of the person, entity, or licensee providing massage or
322 acupuncture, and a licensed massage therapist or licensed
323 acupuncturist may not be reimbursed for medical benefits under
324 this section.
325 3. 6. The Financial Services commission shall adopt by rule
326 the form that must be used by an insurer and a health care
327 provider specified in sub-sub-subparagraph 1.b.(II), sub-sub
328 subparagraph 1.b.(III), or sub-sub-subparagraph 1.b.(V) sub
329 subparagraph 2.b., sub-subparagraph 2.c., or sub-subparagraph
330 2.e. to document that the health care provider meets the
331 criteria of this paragraph. Such rule must include a requirement
332 for a sworn statement or affidavit.
334 Only insurers writing motor vehicle liability insurance in this
335 state may provide the required benefits of this section, and
336 such insurer may not require the purchase of any other motor
337 vehicle coverage other than the purchase of property damage
338 liability coverage as required by s. 627.7275 as a condition for
339 providing such benefits. Insurers may not require that property
340 damage liability insurance in an amount greater than $10,000 be
341 purchased in conjunction with personal injury protection. Such
342 insurers shall make benefits and required property damage
343 liability insurance coverage available through normal marketing
344 channels. An insurer writing motor vehicle liability insurance
345 in this state who fails to comply with such availability
346 requirement as a general business practice violates part IX of
347 chapter 626, and such violation constitutes an unfair method of
348 competition or an unfair or deceptive act or practice involving
349 the business of insurance. An insurer committing such violation
350 is subject to the penalties provided under that part, as well as
351 those provided elsewhere in the insurance code.
352 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.—
353 (a) A physician, hospital, clinic, or other person or
354 institution lawfully rendering treatment to an injured person
355 for a bodily injury covered by personal injury protection
356 insurance may charge the insurer and injured party only an a
357 reasonable amount pursuant to this section for the services and
358 supplies rendered, and the insurer providing such coverage may
359 pay for such charges directly to such person or institution
360 lawfully rendering such treatment if the insured receiving such
361 treatment or his or her guardian has countersigned the properly
362 completed invoice, bill, or claim form approved by the office
363 upon which such charges are to be paid for as having actually
364 been rendered, to the best knowledge of the insured or his or
365 her guardian. However, such a charge may not exceed the amount
366 specified in the fee schedules established by the Department of
367 Health in s. 395.0176 the person or institution customarily
368 charges for like services or supplies. In determining whether a
369 charge for a particular service, treatment, or otherwise is
370 reasonable, consideration may be given to evidence of usual and
371 customary charges and payments accepted by the provider involved
372 in the dispute, reimbursement levels in the community and
373 various federal and state medical fee schedules applicable to
374 motor vehicle and other insurance coverages, and other
375 information relevant to the reasonableness of the reimbursement
376 for the service, treatment, or supply.
377 1. The insurer may limit reimbursement to 80 percent of the
378 following schedule of maximum charges:
379 a. For emergency transport and treatment by providers
380 licensed under chapter 401, 200 percent of Medicare.
381 b. For emergency services and care provided by a hospital
382 licensed under chapter 395, 200 percent of Medicare Part A
383 prospective payment applicable to the hospital providing the
384 emergency services and care 75 percent of the hospital’s usual
385 and customary charges.
386 c. For emergency services and care as defined by s. 395.002
387 provided in a facility licensed under chapter 395 rendered by a
388 physician or dentist, and related hospital inpatient services
389 rendered by a physician or dentist, 200 percent of the
390 participating physician’s fee schedule of Medicare Part B the
391 usual and customary charges in the community.
392 d. For hospital inpatient services, other than emergency
393 services and care, 200 percent of the Medicare Part A
394 prospective payment applicable to the specific hospital
395 providing the inpatient services.
396 e. For hospital outpatient services, other than emergency
397 services and care, 200 percent of the Medicare Part A Ambulatory
398 Payment Classification for the specific hospital providing the
399 outpatient services.
400 f. For all other medical services, supplies, and care, 200
401 percent of the allowable amount under:
402 (I) The participating physician’s physicians fee schedule
403 of Medicare Part B, except as provided in sub-sub-subparagraphs
404 (II) and (III).
405 (II) Medicare Part B, in the case of services, supplies,
406 and care provided by ambulatory surgical centers and clinical
408 (III) The Durable Medical Equipment Prosthetics/Orthotics
409 and Supplies fee schedule of Medicare Part B, in the case of
410 durable medical equipment.
412 However, if such services, supplies, or care is not reimbursable
413 under Medicare Part B, as provided in this sub-subparagraph, the
414 insurer may limit reimbursement to 80 percent of 150 percent of
415 the maximum reimbursable allowance under workers’ compensation,
416 as determined under s. 440.13 and rules adopted thereunder which
417 are in effect at the time such services, supplies, or care is
418 provided. Services, supplies, or care that is not reimbursable
419 under Medicare or workers’ compensation is not required to be
420 reimbursed by the insurer.
421 2. For purposes of subparagraph 1., the applicable fee
422 schedule or payment limitation under Medicare is the fee
423 schedule or payment limitation in effect on March 1 of the
424 service year in which the services, supplies, or care is
425 rendered and for the area in which such services, supplies, or
426 care is rendered, and the applicable fee schedule or payment
427 limitation applies to services, supplies, or care rendered
428 during that service year, notwithstanding any subsequent change
429 made to the fee schedule or payment limitation, except that it
430 may not be less than the allowable amount under the applicable
431 schedule of Medicare Part B for 2007 for medical services,
432 supplies, and care subject to Medicare Part B. For purposes of
433 this subparagraph, the term “service year” means the period from
434 March 1 through the end of February of the following year.
435 3. Subparagraph 1. does not allow the insurer to apply any
436 limitation on the number of treatments or other utilization
437 limits that apply under Medicare or workers’ compensation. An
438 insurer that applies the allowable payment limitations of
439 subparagraph 1. must reimburse a provider who lawfully provided
440 care or treatment under the scope of his or her license,
441 regardless of whether such provider is entitled to reimbursement
442 under Medicare due to restrictions or limitations on the types
443 or discipline of health care providers who may be reimbursed for
444 particular procedures or procedure codes. However, subparagraph
445 1. does not prohibit an insurer from using the Medicare coding
446 policies and payment methodologies of the federal Centers for
447 Medicare and Medicaid Services, including applicable modifiers,
448 to determine the appropriate amount of reimbursement for medical
449 services, supplies, or care if the coding policy or payment
450 methodology does not constitute a utilization limit.
451 4. If an insurer limits payment as authorized by
452 subparagraph 1., the person providing such services, supplies,
453 or care may not bill or attempt to collect from the insured any
454 amount in excess of such limits, except for amounts that are not
455 covered by the insured’s personal injury protection coverage due
456 to the coinsurance amount or maximum policy limits.
457 5. An insurer may limit payment as authorized by this
458 paragraph only if the insurance policy includes a notice at the
459 time of issuance or renewal that the insurer may limit payment
460 pursuant to the schedule of charges specified in this paragraph.
461 A policy form approved by the office satisfies this requirement.
462 If a provider submits a charge for an amount less than the
463 amount allowed under subparagraph 1., the insurer may pay the
464 amount of the charge submitted.
465 (b)1. An insurer or insured is not required to pay a claim
466 or charges:
467 a. Made by a broker or by a person making a claim on behalf
468 of a broker;
469 b. For any service or treatment that was not lawful at the
470 time rendered;
471 c. To any person who knowingly submits a false or
472 misleading statement relating to the claim or charges;
473 d. With respect to a bill or statement that does not
474 substantially meet the applicable requirements of paragraph (d);
475 e. For any treatment or service that is upcoded, or that is
476 unbundled when such treatment or services should be bundled, in
477 accordance with paragraph (d). To facilitate prompt payment of
478 lawful services, an insurer may change codes that it determines
479 have been improperly or incorrectly upcoded or unbundled and may
480 make payment based on the changed codes, without affecting the
481 right of the provider to dispute the change by the insurer, if,
482 before doing so, the insurer contacts the health care provider
483 and discusses the reasons for the insurer’s change and the
484 health care provider’s reason for the coding, or makes a
485 reasonable good faith effort to do so, as documented in the
486 insurer’s file; and
487 f. For medical services or treatment billed by a physician
488 and not provided in a hospital unless such services are rendered
489 by the physician or are incident to his or her professional
490 services and are included on the physician’s bill, including
491 documentation verifying that the physician is responsible for
492 the medical services that were rendered and billed; .
493 g. For any service requiring a treatment plan, as defined
494 in s. 456.0535, and a treatment plan was not provided to;
495 h. For any additional treatment after the initial treatment
496 plan if:
497 (I) The treatment plan is not updated on a regular basis in
498 accordance with standards of care; or
499 (II) Interaction between the insured and a licensed medical
500 professional does not occur and is not properly documented
501 pursuant to s. 456.0535; and
502 i. For services and treatment that are not reasonable and
503 necessary under s. 456.0535.
504 2. The Department of Health, in consultation with the
505 appropriate professional licensing boards, shall adopt, by rule,
506 a list of diagnostic tests deemed not to be medically necessary
507 for use in the treatment of persons sustaining bodily injury
508 covered by personal injury protection benefits under this
509 section. The list shall be revised from time to time as
510 determined by the Department of Health, in consultation with the
511 respective professional licensing boards. Inclusion of a test on
512 the list shall be based on lack of demonstrated medical value
513 and a level of general acceptance by the relevant provider
514 community and may not be dependent for results entirely upon
515 subjective patient response. Notwithstanding its inclusion on a
516 fee schedule in this subsection, an insurer or insured is not
517 required to pay any charges or reimburse claims for an invalid
518 diagnostic test as determined by the Department of Health.
519 Section 5. Except as otherwise expressly provided in this
520 act, this act shall take effect January 1, 2020.