HB 9 — Damages

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 9 2020 A bill to be entitled An act relating to damages;

creatingamending s.

768.755,768.042, F.S.;

definingrequiring thethat termscertain "chargemedical benchmark"expenses andin "imputedpersonal allowedinjury amountclaims benchmark";be based on certain usual and customary amounts received;

providingspecifying forsituations thein calculationwhich of damages for certain health carecoverage services,must procedures,be orconsidered equipmentusual underand specifiedcustomary circumstances;amounts received;

specifyingdeleting thatan certainobsolete evidenceprovision; is inadmissible at trial;

providing applicability;

SectionSubsection 768.755,(2) of section 768.042, Florida Statutes, is createdamended to read:

768.755768.042 DamagesDamages.— recoverable(2) In any claim for costsdamages ofrelating pastto healthpersonal careinjury services,to procedures,a claimant, evidence regarding the past, present, or equipment;future medical expenses must be based on the usual and customary amounts received by a service provider for the same or similar services in the community in which the medical expenses are, or are reasonably probable to be, incurred.

evidenceEvidence of usual and customary rates;amounts received may not include evidence of increased or additional charges based on the outcome of litigation.

applicability.—If (1)the Asclaimant usedis inentitled thisto section,reimbursement through any public or private health insurance or governmental health coverage, the term:amounts paid or payable under the insurance or governmental Page 1 of 2 CODING:

(a) "Charge benchmarks" for particular health care service, procedure, or equipment, means the value, at a specified percentile rank within a range of benchmarks, which corresponds to the distribution of the full, nondiscounted standard rates charged by health care providers in the same or a similar specialty under the current official code for such services, procedures, or equipment provided out-of-network, or Page 1 of 5 CODING:

hb0009-00hb0009-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 9 2020 tohealth uninsuredcoverage individuals,must inbe considered the sameusual geographicaland area.customary amounts received for purposes of this subsection The provisions of this section shall not apply to any complaint filed prior to May 20, 1975.

(b) "Imputed allowed amount benchmark," for a particular health care service, procedure, or equipment, means the value, at a specified percentile rank within a range of imputed benchmarks, corresponding to the distribution of the negotiated in-network rates authorized for payment by commercial insurance carriers, including any copays or deductibles payable by insureds, under the current official code for such service, procedure, or equipment provided by health care providers in the same or a similar specialty in the same geographical area.

(2) In a personal injury or wrongful death action to which this part applies, for any claim of damages for the costs of health care services, procedures, or equipment provided to a claimant which are unpaid and remain due and payable, evidence of the usual and customary rates for such services, procedures, or equipment must be introduced at trial as follows:

(a) If the claimant has coverage for such service, procedure, or equipment from a government program but, in lieu of such coverage, chooses for those services, procedures, or equipment to be provided by a health care provider who contractually agrees to defer payment until recovery from the claimant's damages award or settlement, evidence must be introduced at trial of the usual and customary rates for such services, procedures, or equipment at the 50th percentile rank of the imputed allowed amount benchmark as reported in a Page 2 of 5 CODING:

Words stricken are deletions;

words underlined are additions.

hb0009-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 9 2020 statistically reliable benchmarking database maintained by an independent, nonprofit organization that, at least annually, reports a range of percentile ranks for imputed allowed amount benchmarks similar to the FAIR Health Database as it existed on July 1, 2020.

The organization must:

1.

Be designated by the commissioner of Insurance Regulation.

2.

Have reported a range of percentile benchmarks each year for at least 5 years using the official codes for such services, procedures, or equipment.

3.

Be unaffiliated with any carrier, provider, or other stakeholder in the health care industry.

Whether the claimant is a Medicare or Medicaid beneficiary is inadmissible at trial.

(b) If the claimant has coverage for such service, procedure, or equipment from a commercial insurance carrier or under a plan self-funded by the claimant's employer but, in lieu of such coverage, chooses for those services, procedures, or equipment to be provided by a health care provider who contractually agrees to defer payment until recovery from the claimant's damages award or settlement, evidence must be introduced at trial of the usual and customary rates for such services, procedures, or equipment at the 85th percentile rank of the imputed allowed amount benchmarks as reported in a Page 3 of 5 CODING:

Words stricken are deletions;

words underlined are additions.

hb0009-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 9 2020 statistically reliable benchmarking database maintained by an independent, nonprofit organization that, at least annually, reports a range of percentile ranks for imputed allowed amount benchmarks similar to the FAIR Health Database as it existed on July 1, 2020.

The organization must:

1.

Be designated by the commissioner of the Office of Insurance Regulation.

2.

Have reported a range of percentile benchmarks each year for at least 5 years using the official codes for such services, procedures, or equipment.

3.

Be unaffiliated with any carrier, provider, or other stakeholder in the health care industry.

(c) If the claimant does not have coverage for such services, procedures, or equipment, evidence must be introduced at trial of the usual and customary rates for such services, procedures, or equipment at the 85th percentile rank of the charge benchmarks as reported in a statistically reliable benchmarking database maintained by an independent, nonprofit organization that, at least annually, reports a range of percentile ranks for charge benchmarks similar to the FAIR Health Database as it existed on July 1, 2020.

The organization must: