Bill Text: FL S1790 | 2019 | Regular Session | Introduced


Bill Title: Medical Services and Insurance

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2019-05-03 - Died in Health Policy [S1790 Detail]

Download: Florida-2019-S1790-Introduced.html
       Florida Senate - 2019                                    SB 1790
       
       
        
       By Senator Perry
       
       
       
       
       
       8-01378A-19                                           20191790__
    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.
   23          
   24  Be It Enacted by the Legislature of the State of Florida:
   25  
   26         Section 1. Section 395.0176, Florida Statutes, is created
   27  to read:
   28         395.0176Fee schedules and standards of care in licensed
   29  facilities.—
   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
   60  medication:
   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
   64  (III).
   65         (II)Medicare Part B in the case of services, supplies, and
   66  care provided by ambulatory surgical centers and clinical
   67  laboratories.
   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         456.0535Standards 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.
  178  627.736(7).
  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
  192  taken:
  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
  216  a. 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
  226  treatment.
  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
  265  specialties:
  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
  304  if:
  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.
  333  
  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
  407  laboratories.
  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.
  411  
  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.

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