2007 FCA Legislative Update  – Friday September 21, 2007- 2:00 p.m.

Tentative agreement on PIP/No-fault continuation announced
by Jack Hebert, Government Relations Director & Paul Lambert, General Counsel

Tallahassee– Moments ago, Chris Kise, special counsel to Gov. Charlie Crist announced that a tentative “deal” had been reached by both Senate and House leadership and the Governor which could lead to the continuation of the PIP/No-fault insurance requirement for Florida drivers.  Kise made the announcement shortly after convening the most recent meeting of the stakeholders over the last two weeks discussing possible common ground for a possible continuation of the program.

Though details are still being worked out and final language is not yet available, it is believed that the plan is to have something ready for lawmakers to consider soon, ideally in advance of the scheduled Oct. 1 sunset so a coverage gap could be averted. Lawmakers are already scheduled to return to the capitol on Oct. 3 for a special session devoted to budget cuts, however, to accomplish this goal yet another special session would have to be called, presumably by late next week.

At this moment it appears only House and Senate leaders are in agreement as to the basic concepts.  In the coming hours and days the task then becomes one of trying to sell the final bill language to a majority of House and Senate members in preparation for a final vote.

Though no final language is yet available, we were informed the earliest draft is expected to embrace the changes detailed below to the current no-fault law, most all of which were the result of the recent meetings hosted by the Governor’s office in which your FCA Lobby Team was an active participant.

Current PIP law will remain in effect until January 1, 2008 without change, then,
beginning on Jan. 1, the following changes will be implemented:

• Deductibles will no longer be collected.  The 20% co-pay requirement remains.
• Licensed clinics will not be eligible to file PIP claims unless they have been licensed for three years, or are owned by publicly-traded corporations.
• The $5,000 death benefit remains.
• The Office of Insurance Regulation will adopt standardized forms for documentation of medical necessity.
• Providers and hospitals will be paid at 200% of the Medicare fee schedule, regardless of Medicare regulations that otherwise discriminate among provider groups. All providers will use the Medicare codes that reflect the billed treatment and be paid at 200% of the value assigned to those codes.
• All providers will be paid at the Workers’ Comp fee schedule rate for services not listed in the Medicare fee schedule.
• ER facilities will be paid 75% of billed charges.
• Attorneys will be required to consolidate into a single suit all claims on behalf of an individual client/patient.
• Providers who choose to initiate PIP suits will be required to participate in a non-binding pre-suit mediation.
• The Florida Attorney General is authorized to investigate dishonest insurance practices.
• $2-million is appropriated to investigate and prosecute PIP fraud.
• PIP and property damage insurance coverage requirements remain in effect for drivers.
• Attempts by the insurance industry to invoke utilization reviews, force managed care arrangements and limit attorneys’ fees were rejected.

Please remember that at this point these are the concepts we speculate will be included in the initial work product.  We did not have the benefit of final language for this explanation.  As in any delicate negotiation, the devil is in the details.  Once a preliminary draft becomes public, we will provide a more comprehensive analysis.

Again, there are still a lot of “ifs” which must happen before any of this becomes official and we can clearly celebrate a victory.  Please stay closely tuned to your e-mails for further updates in the coming days.