HB 1657 2003
1	A bill to be entitled
2	An act relating to charges for health care services;
3	amending s. 641.513, F.S.; providing that the rate for
4	emergency care charged to a health maintenance
5	organization by a health care provider who does not have a
6	contract with the health maintenance organization may not
7	exceed the Medicare rate; providing maximum charges for
8	certain followup services; amending s. 627.6131, F.S.;
9	providing that certain unlawful actions with regard to
10	bill collecting by health care providers also constitutes
11	a violation of the Florida Deceptive and Unfair Trade
12	Practices Act; amending s. 641.3155, F.S.; providing that
13	certain unlawful actions with regard to bill collecting by
14	health care providers also constitutes a violation of the
15	Florida Deceptive and Unfair Trade Practices Act; amending
16	s. 395.301, F.S.; requiring that certain charges and
17	changes in charges for health care services must be made
18	available to the public; requiring certain health care
19	facilities to make records available to patients and those
20	paying on behalf of patients for the purpose of verifying
21	the accuracy of billings; amending s. 395.10973, F.S.;
22	requiring the Agency for Health Care Administration to
23	audit certain billings; establishing a permissible error
24	ratio for such billings; providing fines for facilities
25	that exceed the error ratio; providing an effective date.
26
27	Be It Enacted by the Legislature of the State of Florida:
28
29	Section 1. Subsection (5) of section 641.513, Florida
30	Statutes, is amended and subsection (7) is added to said
31	section, to read:
32	641.513 Requirements for providing emergency services and
33	care.--
34	(5) Reimbursement for services pursuant to this section by
35	a provider who does not have a contract with the health
36	maintenance organization shall be the lesser of:
37	(a) The provider's charges;
38	(b) The usual and customary provider charges for similar
39	services in the community where the services were provided; or
40	(c) The charge mutually agreed to by the health
41	maintenance organization and the provider within 60 days after
42	of the submittal of the claim; or
43	(d) The Medicare payment rate for the services in
44	accordance with the prevailing Medicare allowable fee schedule.
45
46	Such reimbursement shall be net of any applicable copayment
47	authorized pursuant to subsection (4).
48	(7) Reimbursement for any medically necessary followup
49	services provided to subscribers who are not Medicaid recipients
50	by a provider for whom no contract exists between the provider
51	and the health maintenance organization shall be the lesser of:
52	(a) The provider's charges;
53	(b) The usual and customary provider charges for similar
54	services in the community where the services were provided;
55	(c) The charge mutually agreed to by the health
56	maintenance organization and the provider within 60 days after
57	the submittal of the claim; or
58	(d) The Medicare payment rate for the services in
59	accordance with the prevailing Medicare allowable fee schedule.
60	Section 2. Subsection (9) of section 627.6131, Florida
61	Statutes, is amended to read:
62	627.6131 Payment of claims.--
63	(9) A provider or any representative of a provider,
64	regardless of whether the provider is under contract with the
65	health insurer, may not collect or attempt to collect money
66	from, maintain any action at law against, or report to a credit
67	agency an insured for payment of covered services for which the
68	health insurer contested or denied the provider's claim. This
69	prohibition applies during the pendency of any claim for payment
70	made by the provider to the health insurer for payment of the
71	services or internal dispute resolution process to determine
72	whether the health insurer is liable for the services. For a
73	claim, this pendency applies from the date the claim or a
74	portion of the claim is denied to the date of the completion of
75	the health insurer's internal dispute resolution process, not to
76	exceed 60 days. The failure of the provider to observe the
77	requirements of this subsection which constitute a violation of
78	this subsection also constitutes a deceptive and unfair trade
79	practice for the purposes of ss. 501.201-501.213, and
80	administrative rules adopted thereunder.This subsection does
81	not prohibit the collection by the provider of copayments,
82	coinsurance, or deductible amounts due the provider.
83	Section 3. Subsection (8) of section 641.3155, Florida
84	Statutes, is amended to read:
85	641.3155 Prompt payment of claims.--
86	(8) A provider or any representative of a provider,
87	regardless of whether the provider is under contract with the
88	health maintenance organization, may not collect or attempt to
89	collect money from, maintain any action at law against, or
90	report to a credit agency a subscriber for payment of covered
91	services for which the health maintenance organization contested
92	or denied the provider's claim. This prohibition applies during
93	the pendency of any claim for payment made by the provider to
94	the health maintenance organization for payment of the services
95	or internal dispute resolution process to determine whether the
96	health maintenance organization is liable for the services. For
97	a claim, this pendency applies from the date the claim or a
98	portion of the claim is denied to the date of the completion of
99	the health maintenance organization's internal dispute
100	resolution process, not to exceed 60 days. The failure of the
101	provider to observe the requirements of this subsection which
102	constitute a violation of this subsection also constitutes a
103	deceptive and unfair trade practice for the purposes of ss.
104	501.201-501.213, and administrative rules adopted thereunder.
105	This subsection does not prohibit collection by the provider of
106	copayments, coinsurance, or deductible amounts due the provider.
107	Section 4. Subsections (7) and (8) are added to section
108	395.301, Florida Statutes, to read:
109	395.301 Itemized patient bill; form and content prescribed
110	by the agency.--
111	(7) A licensed facility not operated by the state must
112	make available to the public on its internet website or by other
113	electronic means and in its reception areas open to the public a
114	listing of all of its charges or charge master and its average
115	length of stay associated with established diagnostic groups.
116	The facility’s list of charges, codes, and description of
117	services must be consistent with federal electronic transmission
118	uniform standards under the Health Insurance Portability and
119	Accountability Act. The facility must provide 30 days public
120	notice at all required posting areas, including by electronic
121	means, prior to implementing any changes to its list of charges
122	or charge master. The notice must separately identify the amount
123	and percent by which a charge is being reduced or increased. The
124	facility must include on such notice an explanation developed by
125	the agency as to how the public may use the information in the
126	selection of a health care facility.
127	(8) A licensed facility not operated by the state must
128	make available to a patient or a payor acting on behalf of the
129	patient records necessary for verification of the accuracy of
130	the patient’s bill or payor’s claim related to such patient’s
131	bill within a reasonable time after the request for such
132	records. The verification information must be made available in
133	the facility’s offices. Such records shall be available to the
134	patient or payor prior to and after payment of the bill or
135	claim. The facility may not charge the patient or payor for
136	making such verification records available, except that the
137	facility may charge its usual charge for providing copies of
138	records as specified in s. 395.3025.
139	Section 5. Subsection (9) is added to section 395.10973,
140	Florida Statutes, to read:
141	395.10973 Powers and duties of the agency.--It is the
142	function of the agency to:
143	(9) Develop a program to audit the accuracy of patient
144	bills and payor claims for provider charges of $20,000 or more.
145	The audit shall establish a facility’s error ratio for bill or
146	claim errors. An error ratio of up to 5 percent is permissible.
147	The error ratio shall be determined by dividing the number of
148	claims and bills with violations found on a statistically valid
149	sample of claims and bills for provider charges of $20,000 or
150	more for the audit period by the total number of claims and
151	bills in the sample. If the error ratio exceeds the permissible
152	error ratio of 5 percent, a fine may be assessed for those
153	claims and bill errors which exceed the error ratio in the
154	amount of $500 per error, but not to exceed $100,000 for the
155	noted audit period.
156	Section 6. This act shall take effect upon becoming a law.