| 1 | Representative Galvano offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Between lines 117-118 and insert: |
| 5 | Section 3. Paragraph (a) of subsection (5) of section |
| 6 | 627.736, Florida Statutes, is amended to read: |
| 7 | 627.736 Required personal injury protection benefits; |
| 8 | exclusions; priority; claims.-- |
| 9 | (5) CHARGES FOR TREATMENT OF INJURED PERSONS.-- |
| 10 | (a)1. Any physician, hospital, clinic, or other person or |
| 11 | institution lawfully rendering treatment to an injured person |
| 12 | for a bodily injury covered by personal injury protection |
| 13 | insurance may charge the insurer and injured party only a |
| 14 | reasonable amount pursuant to this section for the services and |
| 15 | supplies rendered, and the insurer providing such coverage may |
| 16 | pay for such charges directly to such person or institution |
| 17 | lawfully rendering such treatment, if the insured receiving such |
| 18 | treatment or his or her guardian has countersigned the properly |
| 19 | completed invoice, bill, or claim form approved by the office |
| 20 | upon which such charges are to be paid for as having actually |
| 21 | been rendered, to the best knowledge of the insured or his or |
| 22 | her guardian. In no event, however, may such a charge be in |
| 23 | excess of the amount the person or institution customarily |
| 24 | charges for like services or supplies. With respect to a |
| 25 | determination of whether a charge for a particular service, |
| 26 | treatment, or otherwise is reasonable, consideration may be |
| 27 | given to evidence of usual and customary charges and payments |
| 28 | accepted by the provider involved in the dispute, and |
| 29 | reimbursement levels in the community and various federal and |
| 30 | state medical fee schedules applicable to automobile and other |
| 31 | insurance coverages, and other information relevant to the |
| 32 | reasonableness of the reimbursement for the service, treatment, |
| 33 | or supply. |
| 34 | 2. The insurer may limit reimbursement to 80 percent of |
| 35 | the following schedule of maximum charges: |
| 36 | a. For emergency transport and treatment by providers |
| 37 | licensed under chapter 401, 200 percent of Medicare. |
| 38 | b. For emergency services and care provided by a hospital |
| 39 | licensed under chapter 395, 75 percent of the hospital's usual |
| 40 | and customary charges. |
| 41 | c. For emergency services and care as defined by s. |
| 42 | 395.002(10) provided in a facility licensed under chapter 395 |
| 43 | rendered by a physician or dentist, and related hospital |
| 44 | inpatient services rendered by a physician or dentist, the usual |
| 45 | and customary charges in the community. |
| 46 | d. For hospital inpatient services, other than emergency |
| 47 | services and care, 200 percent of the Medicare Part A |
| 48 | prospective payment applicable to the specific hospital |
| 49 | providing the inpatient services. |
| 50 | e. For hospital outpatient services, other than emergency |
| 51 | services and care, 200 percent of the Medicare Part A Ambulatory |
| 52 | Payment Classification for the specific hospital providing the |
| 53 | outpatient services. |
| 54 | f. For all other medical services, supplies, and care, 200 |
| 55 | percent of the allowable amount under the participating |
| 56 | physicians schedule of applicable Medicare Part B fee schedule. |
| 57 | However, if such services, supplies, or care is not reimbursable |
| 58 | under Medicare Part B, the insurer may limit reimbursement to 80 |
| 59 | percent of the maximum reimbursable allowance under workers' |
| 60 | compensation, as determined under s. 440.13 and rules adopted |
| 61 | thereunder which are in effect at the time such services, |
| 62 | supplies, or care is provided. Services, supplies, or care that |
| 63 | is not reimbursable under Medicare or workers' compensation is |
| 64 | not required to be reimbursed by the insurer. |
| 65 | 3. For purposes of subparagraph 2., the applicable fee |
| 66 | schedule or payment limitation under Medicare is the fee |
| 67 | schedule or payment limitation in effect at the time the |
| 68 | services, supplies, or care was rendered and for the area in |
| 69 | which such services were rendered, except that it may not be |
| 70 | less than the allowable amount under the participating |
| 71 | physicians schedule applicable 2007 Medicare Part B for 2007 fee |
| 72 | schedule for medical services, supplies, and care subject to |
| 73 | Medicare Part B. |
| 74 | 4. Subparagraph 2. does not allow the insurer to apply any |
| 75 | limitation on the number of treatments or other utilization |
| 76 | limits that apply under Medicare or workers' compensation. An |
| 77 | insurer that applies the allowable payment limitations of |
| 78 | subparagraph 2. must reimburse a provider who lawfully provided |
| 79 | care or treatment under the scope of his or her license, |
| 80 | regardless of whether such provider would be entitled to |
| 81 | reimbursement under Medicare due to restrictions or limitations |
| 82 | on the types or discipline of health care providers who may be |
| 83 | reimbursed for particular procedures or procedure codes. |
| 84 | 5. If an insurer limits payment as authorized by |
| 85 | subparagraph 2., the person providing such services, supplies, |
| 86 | or care may not bill or attempt to collect from the insured any |
| 87 | amount in excess of such limits, except for amounts that are not |
| 88 | covered by the insured's personal injury protection coverage due |
| 89 | to the coinsurance amount or maximum policy limits. |
| 90 |
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| 91 | ----------------------------------------------------- |
| 92 | T I T L E A M E N D M E N T |
| 93 | Remove line 17 and insert: |
| 94 | dismissed; amending s. 627.736, F.S.; revising the schedule of |
| 95 | maximum charges on which an insurer may base a limited |
| 96 | reimbursement for certain medical services, supplies, and care |
| 97 | for injured persons covered by personal injury protection; |
| 98 | specifying a minimum amount for the applicable fee schedule or |
| 99 | payment limitation under Medicare for such reimbursements; |
| 100 | providing effective dates. |