Florida Senate - 2021                             CS for SB 1976
       
       
        
       By the Committee on Appropriations; and Senator Brodeur
       
       
       
       
       
       576-04679-21                                          20211976c1
    1                        A bill to be entitled                      
    2         An act relating to freestanding emergency departments;
    3         amending s. 395.002, F.S.; defining and revising
    4         terms; amending s. 395.003, F.S.; deleting an obsolete
    5         provision relating to a prohibition on new emergency
    6         departments located off the premises of licensed
    7         hospitals; amending s. 395.1041, F.S.; prohibiting a
    8         freestanding emergency department from holding itself
    9         out to the public as an urgent care center; providing
   10         an exception; requiring a freestanding emergency
   11         department to clearly identify itself as a hospital
   12         emergency department using certain signage; requiring
   13         a freestanding emergency department to post signs in
   14         certain locations which contain specified statements;
   15         providing requirements for such signs; providing
   16         requirements for the advertisement of freestanding
   17         emergency departments; requiring the Agency for Health
   18         Care Administration to post information on its website
   19         describing the differences between a freestanding
   20         emergency department and an urgent care center;
   21         requiring the agency to update such information on its
   22         website at least annually; requiring hospitals to post
   23         a link to such information on their websites;
   24         requiring certain freestanding emergency departments
   25         to provide an emergency room billing acknowledgement
   26         form to patients under certain circumstances;
   27         requiring that the form contain a specified heading
   28         and statement; amending s. 627.6405, F.S.; deleting
   29         legislative findings and intent; requiring health
   30         insurers to post certain information regarding
   31         appropriate use of emergency care services on their
   32         websites and update such information at least
   33         annually; revising the definition of the term
   34         “emergency care”; amending ss. 385.211, 390.011,
   35         394.4787, 395.701, 400.9935, 409.905, 409.975,
   36         468.505, 627.64194, and 765.101, F.S.; conforming
   37         cross-references; providing an effective date.
   38          
   39  Be It Enacted by the Legislature of the State of Florida:
   40  
   41         Section 1. Present subsections (10) through (32) of section
   42  395.002, Florida Statutes, are redesignated as subsections (11)
   43  through (33), respectively, a new subsection (10) is added to
   44  that section, and present subsections (10), (27), and (29) are
   45  amended, to read:
   46         395.002 Definitions.—As used in this chapter:
   47         (10)“Freestanding emergency department” means a facility
   48  that:
   49         (a)Provides emergency services and care;
   50         (b)Is owned and operated by a licensed hospital and
   51  operates under the license of the hospital; and
   52         (c)Is located on separate premises from the hospital.
   53         (11)(10) “General hospital” means any facility which meets
   54  the provisions of subsection (13) (12) and which regularly makes
   55  its facilities and services available to the general population.
   56         (28)(27) “Specialty hospital” means any facility which
   57  meets the provisions of subsection (13) (12), and which
   58  regularly makes available either:
   59         (a) The range of medical services offered by general
   60  hospitals, but restricted to a defined age or gender group of
   61  the population;
   62         (b) A restricted range of services appropriate to the
   63  diagnosis, care, and treatment of patients with specific
   64  categories of medical or psychiatric illnesses or disorders; or
   65         (c) Intensive residential treatment programs for children
   66  and adolescents as defined in subsection (16) (15).
   67         (30)(29) “Urgent care center” means a facility or clinic
   68  that provides immediate but not emergent ambulatory medical care
   69  to patients. The term includes an offsite emergency department
   70  of a hospital that is presented to the general public in any
   71  manner as a department where immediate and not only emergent
   72  medical care is provided. The term also includes:
   73         (a) An offsite facility of a facility licensed under this
   74  chapter, or a joint venture between a facility licensed under
   75  this chapter and a provider licensed under chapter 458 or
   76  chapter 459, that does not require a patient to make an
   77  appointment and is presented to the general public in any manner
   78  as a facility where immediate but not emergent medical care is
   79  provided.
   80         (b) A clinic organization that is licensed under part X of
   81  chapter 400, maintains three or more locations using the same or
   82  a similar name, does not require a patient to make an
   83  appointment, and holds itself out to the general public in any
   84  manner as a facility or clinic where immediate but not emergent
   85  medical care is provided.
   86         Section 2. Paragraph (c) of subsection (1) of section
   87  395.003, Florida Statutes, is amended to read:
   88         395.003 Licensure; denial, suspension, and revocation.—
   89         (1)
   90         (c)Until July 1, 2006, additional emergency departments
   91  located off the premises of licensed hospitals may not be
   92  authorized by the agency.
   93         Section 3. Paragraph (m) is added to subsection (3) of
   94  section 395.1041, Florida Statutes, to read:
   95         395.1041 Access to emergency services and care.—
   96         (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
   97  FACILITY OR HEALTH CARE PERSONNEL.—
   98         (m)1.A freestanding emergency department may not hold
   99  itself out to the public as an urgent care center, unless that
  100  site is operating in accordance with s. 395.107 and provides
  101  urgent care services that are not billed at emergency department
  102  rates, and must clearly identify itself as a hospital emergency
  103  department using, at a minimum, prominent lighted external
  104  signage that includes the word “EMERGENCY” in conjunction with
  105  the name of the hospital.
  106         2.A freestanding emergency department shall conspicuously
  107  post signs at locations that are readily accessible to and
  108  visible by patients outside the entrance to the facility and in
  109  patient waiting areas which state the following: “THIS IS A
  110  HOSPITAL EMERGENCY DEPARTMENT.” Unless the freestanding
  111  emergency department shares a location and a public entrance
  112  with an urgent care center, the signs must also state the
  113  following: “THIS IS NOT AN URGENT CARE CENTER. HOSPITAL
  114  EMERGENCY DEPARTMENT RATES ARE BILLED FOR OUR SERVICES.” The
  115  signs must also specify the facility’s average facility fee, if
  116  any, and notify the public that the facility or a physician
  117  providing medical care at the facility may be an out-of-network
  118  provider. The signs must be at least 2 square feet in size and
  119  the text must be in at least 36-point type. A freestanding
  120  emergency department that shares a location and public entrance
  121  with an urgent care center that operates in accordance with s.
  122  395.107 and does not bill patients at emergency department rates
  123  may also state “AND URGENT CARE SERVICES” in addition to any
  124  signage requirements required by this paragraph.
  125         3.Except as provided in this paragraph, any advertisement
  126  for a freestanding emergency department that does not provide
  127  and bill for urgent care services in accordance with s. 395.107
  128  must include the following statement: “This emergency department
  129  is not an urgent care center. It is part of (insert hospital
  130  name) and its services and care are billed at hospital emergency
  131  department rates.” Any billboard advertising a freestanding
  132  emergency department that does not provide and bill for urgent
  133  care services in accordance with s. 395.107 which measures at
  134  least 200 square feet must include the following statement in
  135  clearly legible contrasting color text at least 15 inches high:
  136  “(INSERT NAME OF HOSPITAL) EMERGENCY DEPARTMENT. THIS IS NOT AN
  137  URGENT CARE CENTER.”
  138         4.a.The agency shall post information on its website which
  139  provides a description of the differences between a freestanding
  140  emergency department and an urgent care center. Such description
  141  must include:
  142         (I)At least two examples illustrating the impact on both
  143  insured and insurer paid amounts from the inappropriate use of
  144  nonemergent services and care in a hospital emergency department
  145  setting compared to the use of nonemergent services and care in
  146  an urgent care center;
  147         (II)An interactive tool to locate local urgent care
  148  centers; and
  149         (III)What to do in the event of a true emergency.
  150         b.The agency shall update the information required in sub
  151  subparagraph a. at least annually. Each hospital shall post a
  152  link to such information in a prominent location on its website.
  153         5.A freestanding emergency department that provides and
  154  bills for urgent care services in accordance with s. 395.107
  155  shall provide an emergency room billing acknowledgement form to
  156  a patient receiving emergency medical treatment from the
  157  emergency department after a medical screening examination is
  158  conducted and stabilizing care is provided to the patient. The
  159  form must have a heading that reads, Your visit today will be
  160  billed as an emergency room visit” and must contain the
  161  following statement: I, (insert patient’s name), understand
  162  that today’s visit will be BILLED AS AN EMERGENCY ROOM VISIT. I
  163  certify that the (insert hospital name) has not withheld,
  164  delayed, or conditioned a medical screening examination or
  165  stabilizing care based upon me signing or refusing to sign this
  166  form or based upon any payment related concerns. I understand
  167  that I may qualify for financial assistance if I am unable to
  168  pay for my care today.
  169         Section 4. Section 627.6405, Florida Statutes, is amended
  170  to read:
  171         627.6405 Decreasing inappropriate utilization of emergency
  172  care.—
  173         (1) The Legislature finds and declares it to be of vital
  174  importance that emergency services and care be provided by
  175  hospitals and physicians to every person in need of such care,
  176  but with the double-digit increases in health insurance
  177  premiums, health care providers and insurers should encourage
  178  patients and the insured to assume responsibility for their
  179  treatment, including emergency care. The Legislature finds that
  180  inappropriate utilization of emergency department services
  181  increases the overall cost of providing health care and these
  182  costs are ultimately borne by the hospital, the insured
  183  patients, and, many times, by the taxpayers of this state.
  184  Finally, the Legislature declares that the providers and
  185  insurers must share the responsibility of providing alternative
  186  treatment options to urgent care patients outside of the
  187  emergency department. Therefore, it is the intent of the
  188  Legislature to place the obligation for educating consumers and
  189  creating mechanisms for delivery of care that will decrease the
  190  overutilization of emergency service on health insurers and
  191  providers.
  192         (2)A health insurer insurers shall post provide on its
  193  website their websites information regarding appropriate
  194  utilization of emergency care services which shall include, but
  195  need not be limited to:,
  196         (a) A list of alternative urgent care contracted
  197  providers;,
  198         (b) The types of services offered by these providers;,
  199         (c)A comparison of statewide average in-network and out
  200  of-network urgent care center and freestanding emergency
  201  department charges for the 30 most common urgent care center
  202  services;
  203         (d)At least two examples illustrating the impact on
  204  insured and insurer paid amounts of inappropriate utilization of
  205  nonemergent services and care in a hospital emergency department
  206  setting compared to utilization of nonemergent services and care
  207  in an urgent care center;
  208         (e)An interactive tool to locate local in-network and out
  209  of-network urgent care centers; and
  210         (f) What to do in the event of a true emergency.
  211  
  212  Health insurers shall update the information required in this
  213  subsection on its website at least annually.
  214         (2)(3) Health insurers shall develop community emergency
  215  department diversion programs. Such programs may include, at the
  216  discretion of the insurer, but not be limited to, enlisting
  217  providers to be on call to insurers after hours, coordinating
  218  care through local community resources, and providing incentives
  219  to providers for case management.
  220         (3)(4) As a disincentive for insureds to inappropriately
  221  use emergency department services for nonemergency care, health
  222  insurers may require higher copayments for urgent care or
  223  primary care provided in an emergency department and higher
  224  copayments for use of out-of-network emergency departments.
  225  Higher copayments may not be charged for the utilization of the
  226  emergency department for emergency care. For the purposes of
  227  this section, the term “emergency care” has the same meaning as
  228  the term “emergency services and care” as defined provided in s.
  229  395.002(9) s. 395.002 and includes shall include services
  230  provided to rule out an emergency medical condition.
  231         Section 5. Subsection (2) of section 385.211, Florida
  232  Statutes, is amended to read:
  233         385.211 Refractory and intractable epilepsy treatment and
  234  research at recognized medical centers.—
  235         (2) Notwithstanding chapter 893, medical centers recognized
  236  pursuant to s. 381.925, or an academic medical research
  237  institution legally affiliated with a licensed children’s
  238  specialty hospital as defined in s. 395.002(28) s. 395.002(27)
  239  that contracts with the Department of Health, may conduct
  240  research on cannabidiol and low-THC cannabis. This research may
  241  include, but is not limited to, the agricultural development,
  242  production, clinical research, and use of liquid medical
  243  derivatives of cannabidiol and low-THC cannabis for the
  244  treatment for refractory or intractable epilepsy. The authority
  245  for recognized medical centers to conduct this research is
  246  derived from 21 C.F.R. parts 312 and 316. Current state or
  247  privately obtained research funds may be used to support the
  248  activities described in this section.
  249         Section 6. Subsection (7) of section 390.011, Florida
  250  Statutes, is amended to read:
  251         390.011 Definitions.—As used in this chapter, the term:
  252         (7) “Hospital” means a facility as defined in s.
  253  395.002(13) s. 395.002(12) and licensed under chapter 395 and
  254  part II of chapter 408.
  255         Section 7. Subsection (7) of section 394.4787, Florida
  256  Statutes, is amended to read:
  257         394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
  258  394.4789.—As used in this section and ss. 394.4786, 394.4788,
  259  and 394.4789:
  260         (7) “Specialty psychiatric hospital” means a hospital
  261  licensed by the agency pursuant to s. 395.002(28) s. 395.002(27)
  262  and part II of chapter 408 as a specialty psychiatric hospital.
  263         Section 8. Paragraph (c) of subsection (1) of section
  264  395.701, Florida Statutes, is amended to read:
  265         395.701 Annual assessments on net operating revenues for
  266  inpatient and outpatient services to fund public medical
  267  assistance; administrative fines for failure to pay assessments
  268  when due; exemption.—
  269         (1) For the purposes of this section, the term:
  270         (c) “Hospital” means a health care institution as defined
  271  in s. 395.002(13) s. 395.002(12), but does not include any
  272  hospital operated by a state agency.
  273         Section 9. Paragraph (i) of subsection (1) of section
  274  400.9935, Florida Statutes, is amended to read:
  275         400.9935 Clinic responsibilities.—
  276         (1) Each clinic shall appoint a medical director or clinic
  277  director who shall agree in writing to accept legal
  278  responsibility for the following activities on behalf of the
  279  clinic. The medical director or the clinic director shall:
  280         (i) Ensure that the clinic publishes a schedule of charges
  281  for the medical services offered to patients. The schedule must
  282  include the prices charged to an uninsured person paying for
  283  such services by cash, check, credit card, or debit card. The
  284  schedule may group services by price levels, listing services in
  285  each price level. The schedule must be posted in a conspicuous
  286  place in the reception area of any clinic that is considered an
  287  urgent care center as defined in s. 395.002(30)(b) s.
  288  395.002(29)(b) and must include, but is not limited to, the 50
  289  services most frequently provided by the clinic. The posting may
  290  be a sign that must be at least 15 square feet in size or
  291  through an electronic messaging board that is at least 3 square
  292  feet in size. The failure of a clinic, including a clinic that
  293  is considered an urgent care center, to publish and post a
  294  schedule of charges as required by this section shall result in
  295  a fine of not more than $1,000, per day, until the schedule is
  296  published and posted.
  297         Section 10. Subsection (8) of section 409.905, Florida
  298  Statutes, is amended to read:
  299         409.905 Mandatory Medicaid services.—The agency may make
  300  payments for the following services, which are required of the
  301  state by Title XIX of the Social Security Act, furnished by
  302  Medicaid providers to recipients who are determined to be
  303  eligible on the dates on which the services were provided. Any
  304  service under this section shall be provided only when medically
  305  necessary and in accordance with state and federal law.
  306  Mandatory services rendered by providers in mobile units to
  307  Medicaid recipients may be restricted by the agency. Nothing in
  308  this section shall be construed to prevent or limit the agency
  309  from adjusting fees, reimbursement rates, lengths of stay,
  310  number of visits, number of services, or any other adjustments
  311  necessary to comply with the availability of moneys and any
  312  limitations or directions provided for in the General
  313  Appropriations Act or chapter 216.
  314         (8) NURSING FACILITY SERVICES.—The agency shall pay for 24
  315  hour-a-day nursing and rehabilitative services for a recipient
  316  in a nursing facility licensed under part II of chapter 400 or
  317  in a rural hospital, as defined in s. 395.602, or in a Medicare
  318  certified skilled nursing facility operated by a hospital, as
  319  defined by s. 395.002(11) s. 395.002(10), that is licensed under
  320  part I of chapter 395, and in accordance with provisions set
  321  forth in s. 409.908(2)(a), which services are ordered by and
  322  provided under the direction of a licensed physician. However,
  323  if a nursing facility has been destroyed or otherwise made
  324  uninhabitable by natural disaster or other emergency and another
  325  nursing facility is not available, the agency must pay for
  326  similar services temporarily in a hospital licensed under part I
  327  of chapter 395 provided federal funding is approved and
  328  available. The agency shall pay only for bed-hold days if the
  329  facility has an occupancy rate of 95 percent or greater. The
  330  agency is authorized to seek any federal waivers to implement
  331  this policy.
  332         Section 11. Paragraph (b) of subsection (1) of section
  333  409.975, Florida Statutes, is amended to read:
  334         409.975 Managed care plan accountability.—In addition to
  335  the requirements of s. 409.967, plans and providers
  336  participating in the managed medical assistance program shall
  337  comply with the requirements of this section.
  338         (1) PROVIDER NETWORKS.—Managed care plans must develop and
  339  maintain provider networks that meet the medical needs of their
  340  enrollees in accordance with standards established pursuant to
  341  s. 409.967(2)(c). Except as provided in this section, managed
  342  care plans may limit the providers in their networks based on
  343  credentials, quality indicators, and price.
  344         (b) Certain providers are statewide resources and essential
  345  providers for all managed care plans in all regions. All managed
  346  care plans must include these essential providers in their
  347  networks. Statewide essential providers include:
  348         1. Faculty plans of Florida medical schools.
  349         2. Regional perinatal intensive care centers as defined in
  350  s. 383.16(2).
  351         3. Hospitals licensed as specialty children’s hospitals as
  352  defined in s. 395.002(28) s. 395.002(27).
  353         4. Accredited and integrated systems serving medically
  354  complex children which comprise separately licensed, but
  355  commonly owned, health care providers delivering at least the
  356  following services: medical group home, in-home and outpatient
  357  nursing care and therapies, pharmacy services, durable medical
  358  equipment, and Prescribed Pediatric Extended Care.
  359  
  360  Managed care plans that have not contracted with all statewide
  361  essential providers in all regions as of the first date of
  362  recipient enrollment must continue to negotiate in good faith.
  363  Payments to physicians on the faculty of nonparticipating
  364  Florida medical schools shall be made at the applicable Medicaid
  365  rate. Payments for services rendered by regional perinatal
  366  intensive care centers shall be made at the applicable Medicaid
  367  rate as of the first day of the contract between the agency and
  368  the plan. Except for payments for emergency services, payments
  369  to nonparticipating specialty children’s hospitals shall equal
  370  the highest rate established by contract between that provider
  371  and any other Medicaid managed care plan.
  372         Section 12. Paragraph (l) of subsection (1) of section
  373  468.505, Florida Statutes, is amended to read:
  374         468.505 Exemptions; exceptions.—
  375         (1) Nothing in this part may be construed as prohibiting or
  376  restricting the practice, services, or activities of:
  377         (l) A person employed by a nursing facility exempt from
  378  licensing under s. 395.002(13) s. 395.002(12), or a person
  379  exempt from licensing under s. 464.022.
  380         Section 13. Paragraph (b) of subsection (1) of section
  381  627.64194, Florida Statutes, is amended to read:
  382         627.64194 Coverage requirements for services provided by
  383  nonparticipating providers; payment collection limitations.—
  384         (1) As used in this section, the term:
  385         (b) “Facility” means a licensed facility as defined in s.
  386  395.002(17) s. 395.002(16) and an urgent care center as defined
  387  in s. 395.002.
  388         Section 14. Subsection (2) of section 765.101, Florida
  389  Statutes, is amended to read:
  390         765.101 Definitions.—As used in this chapter:
  391         (2) “Attending physician” means the physician who has
  392  primary responsibility for the treatment and care of the patient
  393  while the patient receives such treatment or care in a hospital
  394  as defined in s. 395.002(13) s. 395.002(12).
  395         Section 15. This act shall take effect July 1, 2021.