Senate Bill sb2022
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Florida Senate - 2004 SB 2022
By Senator Alexander
17-1418-04
1 A bill to be entitled
2 An act relating to health care; amending s.
3 395.10973, F.S.; directing the Agency for
4 Health Care Administration to make data
5 concerning patient charges and performance
6 outcomes collected from health care facilities
7 available to the public; requiring the data to
8 be placed on the agency's website by a
9 specified date; directing the agency to select
10 100 medical conditions and treatments in order
11 to compare data from licensed facilities;
12 providing criteria for comparison procedures;
13 directing the agency to publicly disclose the
14 amount that each licensed facility charges for
15 its services; requiring the agency to evaluate
16 the benefit of disclosing comparative measures;
17 directing the agency to report its findings and
18 recommendations to the Governor, the President
19 of the Senate, and the Speaker of the House of
20 Representatives by a specified date and
21 annually thereafter; requiring the agency to
22 implement an audit program to examine a health
23 care facility's patient bills and payor claims
24 for charges of $20,000 or more; providing an
25 acceptable error rate; authorizing the agency
26 to impose a fine on licensed facilities that
27 exceed the error rate; amending s. 395.301,
28 F.S.; requiring that, in cases of nonemergency
29 services, a licensed facility give each patient
30 an estimate, in writing, of the anticipated
31 charges the facility typically bills to treat
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1 the patient's condition; requiring that the
2 estimate be given to the patient before
3 treatment is rendered or before the patient is
4 admitted to the facility; providing that, if a
5 licensed facility increases the estimated cost
6 by a specified amount, the patient or payor is
7 not required to pay more than the original
8 written estimate; providing an exception for
9 costs arising from unanticipated complications;
10 requiring a licensed facility to give a patient
11 access to the records necessary to verify the
12 accuracy of the patient's bill within a certain
13 time after the licensed facility receives the
14 request for the records; providing that a
15 patient or a patient's payor may appeal any
16 charge listed in a licensed facility's bill;
17 providing procedures for an appeal; requiring
18 each licensed facility to file its uniform
19 schedule of charges each year with the agency
20 by January 1; requiring each licensed facility
21 to notify the agency and the public of any
22 proposed change to its schedule of charges 30
23 days before implementing the change; amending
24 s. 408.061, F.S.; directing each licensed
25 facility to report certain data to the agency
26 each quarter; providing an effective date.
27
28 Be It Enacted by the Legislature of the State of Florida:
29
30 Section 1. Section 395.10973, Florida Statutes, is
31 amended to read:
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1 395.10973 Powers and duties of the agency.--It is the
2 function of the agency to:
3 (1) Adopt rules under pursuant to ss. 120.536(1) and
4 120.54 to implement the provisions of this part conferring
5 duties upon it.
6 (2) Develop, impose, and enforce specific standards
7 within the scope of the general qualifications established by
8 this part which must be met by individuals in order to receive
9 licenses as health care risk managers. These standards shall
10 be designed to ensure that health care risk managers are
11 individuals of good character and otherwise suitable and, by
12 training or experience in the field of health care risk
13 management, qualified in accordance with the provisions of
14 this part to serve as health care risk managers, within
15 statutory requirements.
16 (3) Develop a method for determining whether an
17 individual meets the standards set forth in s. 395.10974.
18 (4) Issue licenses to qualified individuals meeting
19 the standards set forth in s. 395.10974.
20 (5) Receive, investigate, and take appropriate action
21 with respect to any charge or complaint filed with the agency
22 to the effect that a certified health care risk manager has
23 failed to comply with the requirements or standards adopted by
24 rule by the agency or to comply with the provisions of this
25 part.
26 (6) Establish procedures for providing periodic
27 reports on persons certified or disciplined by the agency
28 under this part.
29 (7) Develop a model risk management program for health
30 care facilities which will satisfy the requirements of s.
31 395.0197.
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1 (8) Enforce the special-occupancy provisions of the
2 Florida Building Code which apply to hospitals, intermediate
3 residential treatment facilities, and ambulatory surgical
4 centers in conducting any inspection authorized by this
5 chapter.
6 (9)(a) Make available data concerning patient charges
7 and performance outcomes collected from health care facilities
8 under s. 408.061(1) and (2) for not less than 100 inpatient
9 and outpatient diagnostic and therapeutic conditions and
10 procedures. The data must be made available on the agency's
11 website by October 1, 2004. The agency shall make a hardcopy
12 format available upon requests. The data shall be updated
13 quarterly.
14 (b) The agency, after consulting with the
15 Comprehensive Health Information Systems Advisory Council,
16 shall adopt by rule the conditions and procedures that must be
17 made publicly available. When determining which conditions and
18 procedures will be selected, the advisory council and the
19 agency shall consider the variation in costs and outcomes and
20 the magnitude of variations and other relevant information in
21 order that the list of conditions and procedures selected will
22 assist health care consumers to differentiate between health
23 care facilities when making decisions regarding health
24 treatment.
25 (c) For each medical condition and procedure chosen,
26 the agency shall report patient charges and performance
27 outcomes, adjusted for case mix and severity if applicable,
28 for each licensed facility. The agency shall report patient
29 charges that are stated on the hospital's most recently filed
30 charge master, as defined by s. 395.301(11). For each licensed
31 facility, the agency shall compare:
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1 1. Volume of cases;
2 2. Patient charges;
3 3. Length of stay;
4 4. Readmission rates;
5 5. Complication rates;
6 6. Mortality rates;
7 7. Infection rates; and
8 8. Use of computerized drug-order systems.
9 (d) The agency shall make available to the public
10 educational information relating to the 100 conditions and
11 procedures selected under this subsection, including, but not
12 limited to, an explanation of the medical condition or
13 procedure, potential side effects, alternative treatments,
14 costs, and the additional resources that may assist consumers
15 in making informed decisions. The information may be made
16 available by providing a link on the website to credible
17 national resources, such as, but not limited to, the National
18 Library of Medicine.
19 (10) Make available on its Internet website a copy of
20 each licensed facility's charge master for all services. The
21 charge-master information must include any change in the
22 facility's gross revenue due to a price increase or decrease
23 in its charge master, as filed under s. 395.301(11), during
24 the previous 12 months.
25 (11) Publicly disclose the information derived from
26 subsections (9) and (10) to allow for the comparison of
27 patient charges and performance outcomes between licensed
28 facilities in the state. When doing so, the agency must use
29 methods that are understandable to laypersons and accessible
30 to consumers using an interactive query system. The agency
31 must clearly state the age of the data and provide an
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1 explanation for the methodology used to adjust the data in
2 order to account for the applicable degree of risk. The agency
3 must provide guidance to consumers in this state on how to use
4 this information to make informed health care decisions.
5 (12)(a) Study and implement by October 1, 2005, the
6 most effective methods to publicly disclose comparative
7 patient charges and performance outcomes. The methods used to
8 deliver this information to consumers must enhance informed
9 decisionmaking choices among consumers and health care
10 purchasers.
11 (b) The agency shall evaluate the benefit of
12 disclosing additional comparative measures. Comparative
13 measures to be considered must include, but need not be
14 limited to, comparative measures that are adopted by the
15 National Quality Forum, the Joint Commission on Accreditation
16 of Healthcare Organizations, or similar national entities that
17 establish standards to measure the performance of health care
18 providers.
19 (13) Report its findings and recommendations under
20 subsection (12) to the Governor, the President of the Senate,
21 and the Speaker of the House of Representatives by October 1,
22 2005, and annually thereafter. The agency shall make this
23 annual report available to the public on its Internet website.
24 (14) Develop and implement by October 1, 2004, a
25 program to audit each health care facility's patient bills and
26 payor claims for charges by a provider of $20,000 or more.
27 Each licensed health care facility shall be audited at least
28 once every 3 years. The audit must establish a facility's
29 ratio of errors in billing and payor claims. An error ratio
30 under 5 percent is permissible. The error ratio shall be
31 determined by dividing the number of payor claims and bills
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1 containing errors from a statistically valid sample of claims
2 and payor bills for the audit period by the total number of
3 claims and bills in the sample. The agency may be assessed a
4 fine if the error ratio is 5 percent or higher. The fine may
5 be assessed in the amount of $500 per error. However, the
6 total fine may not exceed $100,000 for the audit period
7 examined. The agency shall require a facility to refund the
8 overpaid amount to any patient or payor who was overcharged
9 within 30 days after completion of the audit.
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11 The agency shall adopt rules to administer this section by
12 January 1, 2005.
13 Section 2. Section 395.301, Florida Statutes, is
14 amended to read:
15 395.301 Itemized patient bill; form and content
16 prescribed by the agency.--
17 (1)(a) In cases of nonemergency services, a licensed
18 facility shall give each patient a good faith estimate, in
19 writing, of the reasonably anticipated charges the facility
20 typically bills to treat the patient's condition. The estimate
21 must be given to the patient before treatment is rendered or
22 before the patient is admitted to the facility. The facility
23 shall also disclose other common, less costly methods to treat
24 the patient's medical condition, including, but not limited
25 to, outpatient services or drug therapies.
26 (b) If unanticipated complications arise, the licensed
27 facility may charge the patient, or a third-party payor acting
28 on behalf of the patient, for the additional treatment,
29 services, or supplies resulting from the unanticipated
30 complications, if these charges are itemized on the patient's
31 billing statement.
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1 (2)(a) A licensed facility may not, as a condition of
2 admission or providing services, require a patient to sign any
3 form that requires or binds the patient, or the patient's
4 third-party payor, to make an unspecified or unlimited
5 financial payment to the facility or to waive the patient's
6 right to appeal the charges billed.
7 (b) A licensed facility may require a commitment for
8 payment from a patient or the patient's third-party payor only
9 if the licensed facility provides a good faith estimate, in
10 writing, of the reasonably anticipated charges the facility
11 typically bills to treat the patient's condition. The licensed
12 facility shall notify the patient or payor of any revision to
13 the estimate in a timely manner. If the facility makes a
14 revision to the estimate which exceeds the lesser of 20
15 percent of the original estimate or $1,000, the patient or
16 payor is not required to pay any amount over the original
17 written estimate. This limitation does not apply to additional
18 treatment, services, or supplies resulting from unanticipated
19 complications.
20 (3)(1) A licensed facility not operated by the state
21 shall notify each patient during admission and at discharge of
22 his or her right to receive an itemized bill upon request.
23 Within 7 days following discharge or release from a licensed
24 facility not operated by the state, or within 7 days after the
25 earliest date at which the loss or expense from the service
26 may be determined, the licensed facility providing the service
27 shall, upon request, submit to the patient, or to the
28 patient's survivor or legal guardian as may be appropriate, an
29 itemized statement detailing in language comprehensible to an
30 ordinary layperson the specific nature of charges or expenses
31 incurred by the patient, which in the initial billing shall
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1 contain a statement of specific services received and expenses
2 incurred for the such items of service, enumerating in detail
3 the constituent components of the services received within
4 each department of the licensed facility and including unit
5 price data on rates charged by the licensed facility, as
6 prescribed by the agency.
7 (4)(2) Each such statement:
8 (a) May not include charges of hospital-based
9 physicians if billed separately.
10 (b) May not include any generalized category of
11 expenses such as "other" or "miscellaneous" or similar
12 categories.
13 (c) Shall list drugs by brand or generic name and not
14 refer to drug code numbers when referring to drugs of any
15 sort.
16 (d) Shall specifically identify therapy treatment as
17 to the date, type, and length of treatment when therapy
18 treatment is a part of the statement. Any person receiving a
19 statement under pursuant to this section shall be fully and
20 accurately informed as to each charge and service provided by
21 the institution preparing the statement.
22 (e) Shall conspicuously display notice of the
23 patient's or a third-party payor's right to appeal any of the
24 charges in the bill. The patient must also be notified whether
25 interest will be applied to any billing charge not covered by
26 a third-party payor and, if so, the rate of interest which
27 will be charged.
28 (5)(3) On each such itemized statement there shall
29 appear the words "A FOR-PROFIT (or NOT-FOR-PROFIT or PUBLIC)
30 HOSPITAL (or AMBULATORY SURGICAL CENTER) LICENSED BY THE STATE
31 OF FLORIDA" or substantially similar words sufficient to
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1 identify clearly and plainly the ownership status of the
2 licensed facility. Each itemized statement must prominently
3 display the phone number of the medical facility's patient
4 liaison who is responsible for expediting the resolution of
5 any billing dispute between the patient, or his or her
6 representative, and the billing department.
7 (6)(4) An itemized bill shall be provided once to the
8 patient's physician at the physician's request, at no charge.
9 (7)(5) In any billing for services subsequent to the
10 initial billing for such services, the patient, or the
11 patient's survivor or legal guardian, may elect, at his or her
12 option, to receive a copy of the detailed statement of
13 specific services received and expenses incurred for each such
14 item of service as provided in subsection (1).
15 (8)(6) No physician, dentist, podiatric physician, or
16 licensed facility may add to the price charged by any third
17 party except for a service or handling charge representing a
18 cost actually incurred as an item of expense; however, the
19 physician, dentist, podiatric physician, or licensed facility
20 is entitled to fair compensation for all professional services
21 rendered. The amount of the service or handling charge, if
22 any, shall be set forth clearly in the bill to the patient.
23 (9) A licensed facility must make available to a
24 patient, or a payor acting on behalf of the patient, the
25 records necessary to verify the accuracy of the patient's bill
26 or payor's claim relating to the patient's bill. The records
27 must be provided within 3 business days after the licensed
28 facility receives the request for the records. The records
29 shall be made available at the licensed facility's offices.
30 The records must be available to the patient or patient's
31 payor before and after payment of the bill or claim. A
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1 licensed facility may not charge the patient or the patient's
2 payor for making the records available, except that the
3 facility may charge its usual charge for providing copies of
4 records as specified in s. 395.3025.
5 (10) A patient or a patient's payor may appeal any
6 charge listed in a licensed facility's bill. A licensed
7 facility shall establish an impartial method for reviewing
8 billing appeals. The licensed facility must provide its
9 written decision to the patient or the patient's payor making
10 the appeal and to the agency within 30 days after the licensed
11 facility receives the appeal. The decision must include a
12 clear explanation of the grounds for the decision. A facility
13 shall maintain a complete and accurate log of all appeals and
14 shall report to the agency the number of appeals, the total
15 amount of the charges subject to appeal, and a summary of the
16 dispositions of the appeals by January 1 of each year.
17 (11) A licensed facility shall file each year with the
18 agency by January 1 a copy of its charge master. A facility
19 must include an estimate of the percentage increase in its
20 gross revenue due to any price increase or decrease in its
21 charge master during the previous 12 months. As used in this
22 section, the term "charge master" means a uniform schedule of
23 charges represented by the facility as its gross billed charge
24 for a given service or item, regardless of payer type.
25 (12) A licensed facility shall report to the agency
26 and provide public notice on its Internet website or by other
27 electronic means, and in its reception areas open to the
28 public, any proposed change to its charge master 30 days
29 before implementing the change. The notice must separately
30 identify the amount and percent by which a charge is being
31 reduced or increased. The licensed facility must include in
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1 the notice an explanation developed by the agency as to how
2 the public may use the information in selecting a health care
3 facility.
4 Section 3. Paragraph (a) of subsection (1) of section
5 408.061, Florida Statutes, is amended to read:
6 408.061 Data collection; uniform systems of financial
7 reporting; information relating to physician charges;
8 confidential information; immunity.--
9 (1) The agency may require the submission by health
10 care facilities, health care providers, and health insurers of
11 data necessary to carry out the agency's duties.
12 Specifications for data to be collected under this section
13 shall be developed by the agency with the assistance of
14 technical advisory panels including representatives of
15 affected entities, consumers, purchasers, and such other
16 interested parties as may be determined by the agency.
17 (a) Data shall to be submitted by health care
18 facilities quarterly for each preceding calendar quarter no
19 later than February 1, May 1, August 1, and November 1 of each
20 year beginning on August 1, 2004. The data shall may include,
21 but are not limited to: case-mix data, patient admission or
22 discharge data with patient and provider-specific identifiers
23 included, actual charge data by diagnostic groups, financial
24 data, accounting data, operating expenses, expenses incurred
25 for rendering services to patients who cannot or do not pay,
26 interest charges, depreciation expenses based on the expected
27 useful life of the property and equipment involved, and
28 demographic data. Data may be obtained from documents such as,
29 but not limited to: leases, contracts, debt instruments,
30 itemized patient bills, medical record abstracts, and related
31 diagnostic information.
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1 Section 4. This act shall take effect upon becoming a
2 law.
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5 SENATE SUMMARY
6 Directs the Agency for Health Care Administration to make
data concerning patient charges and performance outcomes
7 available to the public. Requires the data to be placed
on the agency's website. Directs the agency to select 100
8 medical conditions and treatments to compare data from
licensed facilities. Directs the agency to disclose what
9 each licensed facility charges for its services. Directs
the agency to report its findings and recommendations to
10 the Governor and Legislature. Requires the agency to
implement an audit program to examine health care
11 facility patient bills and payor claims for charges of
$20,000 or more. Provides an acceptable error rate.
12 Authorizes the agency to impose a fine on licensed
facilities that exceed the error rate. Requires that, in
13 cases of nonemergency services, a licensed facility give
each patient a good faith estimate, in writing, of the
14 reasonably anticipated charges. Requires that the
estimate be given to the patient before treatment is
15 rendered or before the patient is admitted to the
facility. Provides an exception for costs arising from
16 unanticipated complications. Requires a licensed facility
to give a patient access to the records necessary to
17 verify the accuracy of the patient's bill. Provides that
a patient or a patient's payor may appeal any charge.
18 Requires each licensed facility to file its uniform
schedule of charges with the agency. Requires each
19 licensed facility to notify the agency and the public of
any proposed change to its schedule. (See bill for
20 details.)
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