Florida Senate - 2012 COMMITTEE AMENDMENT Bill No. SB 668 Barcode 115316 LEGISLATIVE ACTION Senate . House Comm: FAV . 02/23/2012 . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Health Regulation (Garcia) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete everything after the enacting clause 4 and insert: 5 Section 1. Paragraph (a) of subsection (3) and paragraph 6 (c) of subsection (12) of section 440.13, Florida Statutes, are 7 amended, paragraph (k) is added to subsection (3), paragraphs 8 (d) and (e) of subsection (12) are redesignated as paragraphs 9 (c) and (d), respectively, present subsections (15) through (17) 10 are renumbered as subsections (16) through (18), respectively, 11 and a new subsection (15) is added to that section, to read: 12 440.13 Medical services and supplies; penalty for 13 violations; limitations.— 14 (3) PROVIDER ELIGIBILITY; AUTHORIZATION.— 15 (a) As a condition for
toeligibility for payment under 16 this chapter, a health care provider who renders services must 17 be a certified health care provider and must receive 18 authorization from the carrier before providing treatment. This 19 paragraph does not apply to emergency care. An employer or a 20 carrier may not refuse to authorize a physician to treat an 21 injured employee solely because the physician is a dispensing 22 practitioner, as defined in s. 465.0276. The department shall 23 adopt rules to administer implementthe certification of health 24 care providers. 25 (k) If a physician who is a dispensing practitioner as 26 defined in s. 465.0276 receives authorization from an employer 27 or a carrier to treat a claimant pursuant to paragraph (a), the 28 physician may dispense and fill prescriptions for medicines 29 under this chapter. For purposes of dispensing and filling 30 prescriptions for medicines, the department, employer, or 31 carrier, or an agent or representative of the department, 32 employer, or carrier, may not select the pharmacy, pharmacist, 33 or dispensing practitioner that the claimant must use. 34 (12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM 35 REIMBURSEMENT ALLOWANCES.— 36 (c) As to reimbursement for a prescription medication, the37 reimbursement amount for a prescription shall be the average38 wholesale price plus $4.18 for the dispensing fee, except where39 the carrier has contracted for a lower amount. Fees for40 pharmaceuticals and pharmaceutical services shall be41 reimbursable at the applicable fee schedule amount. Where the42 employer or carrier has contracted for such services and the43 employee elects to obtain them through a provider not a party to44 the contract, the carrier shall reimburse at the schedule,45 negotiated, or contract price, whichever is lower. No such46 contract shall rely on a provider that is not reasonably47 accessible to the employee.48 (15) REIMBURSEMENT FOR PRESCRIPTION MEDICATION.—The 49 reimbursement amount for prescription medication shall be the 50 average wholesale price plus $4.18 for the dispensing fee, 51 unless the carrier and the provider seeking reimbursement have 52 directly contracted with each other for a lower reimbursement 53 amount. 54 (a) If a prescription has been repackaged or relabeled, the 55 provider shall give a $15 credit to the insurance carrier or 56 self-insured employer for each prescription that costs more than 57 $25. The credit shall be reflected in the Explanation of Bill 58 Review provided by the carrier or employer. The credit does not 59 apply if the carrier and the provider seeking reimbursement have 60 directly contracted with each other for a lower reimbursement 61 amount. Any credit to a self-insured employer shall be directly 62 deposited to the self-insurance fund of the entity. 63 (b) A physician or the physician’s assignee may not hold an 64 ownership interest in a licensed pharmaceutical repackaging 65 entity and may not set or cause to be set a repackaged 66 pharmaceutical average wholesale price. 67 (c) An insurance carrier or self-insured employer that 68 improperly denies or delays payment of a valid claim for 69 reimbursement of a prescription medication is subject to an 70 administrative fine of $250 per instance of improper 71 reimbursement. If the department determines that a carrier or 72 employer has improperly denied or delayed reimbursement claims 73 more than 15 times in any one calendar year, the administrative 74 penalty increases to $1,000 per instance of improper 75 reimbursement. If the department determines that a carrier or 76 employer has improperly denied or delayed reimbursement claims 77 more than 100 times in any one calendar year, the insurer or 78 employer must show cause to the department as to why its 79 certificate of authority to underwrite workers’ compensation 80 insurance should not be revoked or suspended. The penalties in 81 this paragraph are not exclusive and are in addition to remedies 82 provided under part IX of chapter 626. 83 (d) Pursuant to subsection (7), a provider may challenge a 84 disallowance, denial, or adjustment of payment by filing a 85 petition for dispute resolution with the department within 30 86 days after receiving the final Explanation of Bill Review issued 87 by the insurance carrier or self-insured employer. The carrier 88 or self-insured employer must clearly state on the face of the 89 final Explanation of Bill Review when the 30-day period for 90 filing a petition for dispute resolution with the department 91 commences. 92 Section 2. Effective July 1, 2012, the Office of Insurance 93 Regulation shall reduce the rates of workers’ compensation and 94 employer liability insurance carriers by 2.5 percent. 95 Section 3. Effective upon this act becoming a law and 96 before July 1, 2012, the Office of Insurance Regulation shall 97 conduct a retrospective review of any rate filing submitted by a 98 rating organization on behalf of workers’ compensation or 99 employer’s liability insurance carriers during the previous 12 100 months which resulted in a rate increase. The office’s review 101 must determine whether the information, data, and documentation 102 included in the rate filings include cost information 103 demonstrating that 2.5 percent of the overall rate increase that 104 was subsequently approved was directly attributable to the costs 105 of repackaging prescription medications. If the office 106 determines that such documentation or information was not 107 included in the rate filing, the office shall immediately reduce 108 the rates of workers’ compensation and employer liability 109 insurance carriers by 2.5 percent. The office shall also make 110 its review available to the Senate and the House of 111 Representatives by October 1, 2012. 112 Section 4. Except as otherwise expressly provided in this 113 act and except for this section, which shall take effect upon 114 this act becoming a law, this act shall take effect July 1, 115 2012. 116 117 ================= T I T L E A M E N D M E N T ================ 118 And the title is amended as follows: 119 Delete everything before the enacting clause 120 and insert: 121 A bill to be entitled 122 An act relating to workers’ compensation medical 123 services; amending s. 440.13, F.S.; prohibiting an 124 employer or carrier from refusing to authorize a 125 physician who is a prescribing physician; prohibiting 126 the Department of Financial Services, the employer, or 127 the carrier from selecting a claimant’s pharmacy; 128 revising requirements for determining the amount of a 129 reimbursement for prescription medications; 130 prohibiting a physician from having an ownership 131 interest in a pharmacy repackaging entity or setting 132 pharmaceutical wholesale prices; providing penalties 133 for an employer or carrier’s improper delay or denial 134 of payment and procedures for a provider to challenge 135 a disallowance, denial, or adjustment of payment; 136 requiring the Office of Insurance Regulation to reduce 137 rates for workers’ compensation and employer liability 138 insurance by a specified amount; requiring the Office 139 of Insurance Regulation to conduct a retrospective 140 review of certain rate filings to determine if the 141 filings were supported by documentation demonstrating 142 that a certain portion of the approved rate increase 143 was attributable to the costs of repackaging 144 prescription medications and to reduce rates if not so 145 supported; providing effective dates.