Florida Senate - 2019                                    SB 1320
       
       
        
       By Senator Stargel
       
       
       
       
       
       22-00908A-19                                          20191320__
    1                        A bill to be entitled                      
    2         An act relating to damages recoverable for health care
    3         costs; creating s. 768.755, F.S.; defining the terms
    4         “allowed amount benchmark” and “charge benchmark”;
    5         requiring that certain evidence of the usual and
    6         customary rates for health care services, procedures,
    7         or equipment be introduced at trial under specified
    8         circumstances in personal injury or wrongful death
    9         actions for certain claims of damages; providing
   10         requirements for certain organizations that maintain a
   11         benchmarking database; providing applicability;
   12         providing a directive to the Division of Law Revision;
   13         providing an effective date.
   14          
   15  Be It Enacted by the Legislature of the State of Florida:
   16  
   17         Section 1. Section 768.755, Florida Statutes, is created to
   18  read:
   19         768.755 Damages recoverable for costs of past health care
   20  services, procedures, or equipment; evidence of usual and
   21  customary rates; applicability.—
   22         (1) As used in this section, the term:
   23         (a) “Allowed amount benchmark,” for particular health care
   24  services, procedures, or equipment, means the value, at a
   25  specified percentile rank, corresponding to the distribution of
   26  the negotiated in-network rates authorized for payment by
   27  commercial insurance carriers, including any copays or
   28  deductibles payable by insureds, under the current official code
   29  for such services, procedures, or equipment provided by health
   30  care providers in the same or similar specialty in the same
   31  geographical area.
   32         (b) “Charge benchmark,” for particular health care
   33  services, procedures, or equipment, means the value, at a
   34  specified percentile rank, corresponding to the distribution of
   35  the full, nondiscounted standard rates charged by health care
   36  providers in the same or similar specialty under the current
   37  official code for such services, procedures, or equipment
   38  provided out-of-network, or to uninsured individuals, in the
   39  same geographical area.
   40         (2) In a personal injury or wrongful death action to which
   41  this part applies, for any claim of damages for the costs of
   42  health care services, procedures, or equipment provided to a
   43  claimant which are unpaid and remain due and payable, evidence
   44  of the usual and customary rates for such services, procedures,
   45  or equipment must be introduced at trial as follows:
   46         (a) If the claimant has coverage for such services,
   47  procedures, or equipment from a governmental program but, in
   48  lieu of such program coverage, chooses for those services,
   49  procedures, or equipment to be provided by a health care
   50  provider who contractually agrees to defer payment until
   51  recovery from the claimant’s damages award or settlement,
   52  evidence must be introduced at trial of the government program’s
   53  usual and customary rates for such services, procedures, or
   54  equipment, including any copay or deductible that would be owed
   55  by a claimant.
   56         (b) If the claimant has coverage for such services,
   57  procedures, or equipment from a commercial insurance carrier
   58  but, in lieu of such insurance coverage, chooses for those
   59  services, procedures, or equipment to be provided by a health
   60  care provider who contractually agrees to defer payment until
   61  recovery from the claimant’s damages award or settlement,
   62  evidence must be introduced at trial of the usual and customary
   63  rates for such services, procedures, or equipment equal to the
   64  range of allowed amount benchmarks available from the 50th
   65  through the 95th percentile ranks as reported in a statistically
   66  reliable benchmarking database maintained by an independent,
   67  nonprofit organization designated by the Commissioner of
   68  Insurance Regulation. The organization must be unaffiliated with
   69  any carrier, provider, or other stakeholder in the health care
   70  industry.
   71         (c) If the claimant does not have coverage for such
   72  services, procedures, or equipment, evidence must be introduced
   73  at trial of the usual and customary rates for such services,
   74  procedures, or equipment equal to the range of charge benchmarks
   75  available from the 50th through the 95th percentile ranks as
   76  reported in a statistically reliable benchmarking database
   77  maintained by an independent, nonprofit organization designated
   78  by the Commissioner of Insurance Regulation. The organization
   79  must be unaffiliated with any carrier, provider, or other
   80  stakeholder in the health care industry.
   81         (3) This section applies only to those actions for personal
   82  injury or wrongful death to which this part applies arising on
   83  or after the effective date of this act. This section has no
   84  other application or effect regarding compensation paid to
   85  providers of health care services.
   86         Section 2. The Division of Law Revision is directed to
   87  replace the phrase “the effective date of this act” wherever it
   88  occurs in this act with the date the act becomes a law.
   89         Section 3. This act shall take effect upon becoming a law.