House says goodbye to Personal Injury Protection

Jan 11, 2012

The following article was published in The Florida Current on January 11, 2012:

House says goodbye to PIP

By Christine Jordan Sexton

A House committee on Wednesday scrapped the personal injury protection (PIP) no-fault program by passing a bill that establishes Emergency Care Coverage instead.

Like PIP, ECC will provide $10,000 in benefits but care would be limited to emergency transport and treatment by licensed ambulance providers; emergency services and care rendered at a hospital within 72 hours of an accident; and inpatient hospital admissions within 72 hours of an accident.

Care can be rendered after the 72-hour cutoff so long as it is for an emergency medical condition related to a diagnosis arising from a motor vehicle accident. Care also must be administered by a licensed physician, a licensed dentist, a licensed physician’s assistant or a licensed nurse practitioner. Chiropractors and massage therapists would be precluded from providing care to injured drivers and passengers.

The ECC language appeared in a proposed committee bill that was deliberated by members of the House Insurance and Banking Subcommittee on Wednesday. It was passed by a 10-5 vote and along party lines.

Several Republicans who voted in favor of the measure warned that they had concerns about limitations on access to care and the 72-hour time frame, noting that soft tissue damage or whiplash could take more than 72 hours to develop. Other criticisms came from Democrats on the committee who expressed concerns with limitations on attorneys’ fees as well as limiting access to health care providers. Rep. Evan Jenne, a Fort Lauderdale Democrat, asked bill sponsor Rep. Jim Boyd, R-Bradenton, why the bill would preclude an injured driver from obtaining care from their primary physician.

“Why would we want to limit somebody’s choice of doctor,” It seems a little Romney-ish,” Jenne said, referring to presidential candidate Mitt Romney’s Massachusetts health care plan, which was used as a model in part for the federal health care reform bill. 

Jenne and others also expressed concerns that hospital emergency room costs generally are some of the highest in the health care delivery system and that the requirement drivers seek care there could actually increase PIP costs for Florida drivers.

Jacksonville lawyer Christopher Nuland said directing people to a hospital ER and not to their primary care doctor is counterintuitive to what the state has been encouraging for years: to stay away from emergency rooms. Nuland represents the Florida Chapter of the American College of Physicians.

Boyd said after the meeting that he wanted to maintain the hospital-owned requirement because he thinks it’s a good way to crack down on PIP fraud. Gov. Rick Scott says fraudulent activity amounts to a $900 million annual tax on Florida drivers.

“I  am assuming the true medical providers, doctors, hospitals and the like, are not the ones committing the fraud. It’s these sham clinics. If you go to the hospital ER with a staged accident it’s not going to take them long to decide you are not really hurt. Professional providers, I would have to assume, are not  causing the problem.”

Under the new ECC no-fault system, attorneys’  fees would be capped and an attorney could not received more than $15,000 per case. The caps under the new ECC program are the same caps that the underlying bill, HB 119, put in place for PIP.

The PCB places reimbursement schedules. Emergency transport is set at 200 percent of Medicare levels, while reimbursement for emergency services provided by a hospital is set at 75 percent of the facility’s usual and customary charges. For emergency care provided in a facility licensed under a hospital and provided by a physician or dentist, rates are set at the usual and customary charge for a community. Hospital inpatient services would be capped at 200 percent of the Medicare Part A prospective payment.

Bill sponsor Boyd successfully beat back a series of amendments that he considered unfriendly. The amendments would have extended the length of time for someone to receive care from 72 hours to 14 days.

Monte Stevens,  government affairs director for the Office of Insurance Regulation, said the OIR was 110 percent behind the bill.

Florida Gov.Rick Scott said requiring injured drivers and passengers to go to the emergency room is one way to prevent fraud in the system. Requiring all clinics to be licensed is another potential route, he said, adding that he thinks the House bill is good and he’s supportive of it.

“There’s lot of different ways to solve the problem, but one of the ways is to do that,” Scott said of referring patients to hospitals. “But we got to figure it out. This is costing us a significant amount of money every year. Costing consumers that amount of money.”

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