HB 0701 2004
1	A bill to be entitled
2	An act relating to consumer health care spending
3	protection; providing a popular name; providing a purpose;
4	amending s. 408.061, F.S.; revising a requirement for
5	submission of health care data; amending s. 395.10973,
6	F.S.; revising powers and duties of the Agency for Health
7	Care Administration to include patient charge and
8	performance outcome reporting and reporting changes in
9	each facility's charge master; requiring the agency to
10	provide such information to the public and implement
11	effective methods for making public disclosure; requiring
12	the agency to annually report findings to the Governor and
13	Legislature; requiring the development of an auditing
14	program for patient bills and payor claims over a certain
15	dollar amount; providing for fines for billing errors
16	exceeding a specified threshold; requiring the agency to
17	adopt certain rules; amending s. 395.301, F.S.; requiring
18	disclosure to nonemergency patients of a good faith
19	estimate of anticipated charges; prohibiting a facility
20	from requiring that a patient sign certain forms as a
21	condition of admission or provision of service; providing
22	conditions under which a patient shall not be required to
23	pay amounts exceeding the original estimate; requiring
24	patient notification of right to appeal charges in an
25	itemized bill and of any interest applied to such charges;
26	requiring the facility to disclose information necessary
27	to verify the accuracy of the bill; requiring a method for
28	appealing charges on the bill; requiring the facility to
29	maintain a log of all such appeals; requiring the facility
30	to file annually with the agency a copy of its charge
31	master and to disclose to the agency and the public any
32	changes to the charge master; providing an effective date.
33
34	Be It Enacted by the Legislature of the State of Florida:
35
36	Section 1. This act shall be known by the popular name the
37	"Health Care Consumer's Right to Know Act."
38	Section 2. The purpose of this act is to provide health
39	care consumers with reliable and understandable information
40	about facility charges and performance outcomes to assist
41	consumers in making informed decisions about health care.
42	Section 3. Paragraph (a) of subsection (1) of section
43	408.061, Florida Statutes, is amended to read:
44	408.061 Data collection; uniform systems of financial
45	reporting; information relating to physician charges;
46	confidential information; immunity.--
47	(1) The agency may require the submission by health care
48	facilities, health care providers, and health insurers of data
49	necessary to carry out the agency's duties. Specifications for
50	data to be collected under this section shall be developed by
51	the agency with the assistance of technical advisory panels
52	including representatives of affected entities, consumers,
53	purchasers, and such other interested parties as may be
54	determined by the agency.
55	(a) Data shall to be submitted by health care facilities
56	quarterly for each preceding calendar quarter no later than
57	February 1, May 1, August 1, and November 1 of each year
58	commencing August 1, 2004. Such data shall mayinclude, but are
59	not limited to: case-mix data, patient admission or discharge
60	data with patient and provider-specific identifiers included,
61	actual charge data by diagnostic groups, financial data,
62	accounting data, operating expenses, expenses incurred for
63	rendering services to patients who cannot or do not pay,
64	interest charges, depreciation expenses based on the expected
65	useful life of the property and equipment involved, and
66	demographic data. Data may be obtained from documents such as,
67	but not limited to: leases, contracts, debt instruments,
68	itemized patient bills, medical record abstracts, and related
69	diagnostic information.
70	Section 4. Subsections (9) through (15) are added to
71	section 395.10973, Florida Statutes, to read:
72	395.10973 Powers and duties of the agency.--It is the
73	function of the agency to:
74	(9)(a) Make available on its Internet website no later
75	than October 1, 2004, and in a hard-copy format upon request,
76	patient charge and performance outcome data collected from
77	health care facilities pursuant to s. 408.061(1)(a) and (2) for
78	not less than 100 inpatient and outpatient diagnostic and
79	therapeutic conditions and procedures and the volume of
80	inpatient and outpatient procedures by Medicare discharge
81	referral experience. The website shall also provide an
82	interactive search that allows consumers to view and compare the
83	information for specific facilities, a map that allows consumers
84	to select a county or region, definitions of all of the data,
85	descriptions of each procedure, and an explanation about why the
86	data may differ from facility to facility. Such public data
87	shall be updated on a quarterly basis.
88	(b) The agency shall establish by rule the conditions and
89	procedures to be disclosed based upon input from the State
90	Comprehensive Health Information System Advisory Council. When
91	determining which conditions and procedures are to be disclosed,
92	the council and the agency shall consider their variation in
93	costs, variation in outcomes and magnitude of variations, and
94	other relevant information so that the disclosed list of
95	conditions and procedures will assist health care consumers in
96	differentiating between facilities when making health treatment
97	decisions. As to each medical condition and procedure, the
98	agency shall report current patient charges, as indicated on the
99	facility's charge master as defined by s. 395.301(11), and
100	performance outcomes for each licensed facility as defined in s.
101	395.002(17), adjusted for case mix and severity if applicable,
102	comparing volume of cases, patient charges, length of stay,
103	readmission rates, complication rates, mortality rates,
104	infection rates, and use of computerized drug order systems.
105	(c) The agency shall make available educational
106	information relevant to the disclosed 100 conditions and
107	procedures pursuant to this subsection, including, but not
108	limited to, an explanation of the medical condition or
109	procedure, potential side effects, alternative treatments and
110	costs, and additional resources that can assist consumers in
111	informed decisionmaking. Such information may be made available
112	by linking consumers to credible national resources such as, but
113	not limited to, the National Library of Medicine.
114	(10) Make available on its Internet website a copy of each
115	facility's charge master, as defined by s. 395.301(11), for all
116	services and information on any percentage increase in each
117	facility's gross revenue due to any price increase or decrease
118	in its charge master during the previous 12-month period.
119	(11) Publicly disclose comparison information pursuant to
120	subsections (9) and (10), including the age of the data and an
121	explanation of the methodology used to risk-adjust the data, in
122	language that is understandable to laypersons and accessible to
123	consumers using an interactive query system to allow for the
124	comparison of patient charge and performance outcome data among
125	all licensed facilities in the state. The agency shall provide
126	guidance to consumers on how to use this information to make
127	informed health care decisions.
128	(12) Study, and implement by October 1, 2005, the most
129	effective methods for public disclosure of patient charge and
130	performance outcome data pursuant to subsections (9) and (10),
131	including additional mechanisms to deliver this information to
132	consumers, that would enhance informed decisionmaking among
133	consumers and health care purchasers. The agency shall also
134	evaluate the value of disclosing additional measures that are
135	adopted by the National Quality Forum, the Joint Commission on
136	Accreditation of Healthcare Organizations, or a similar national
137	entity that establishes standards to measure the performance of
138	health care providers.
139	(13) Report its findings and recommendations pursuant to
140	subsection (12) to the Governor, the President of the Senate,
141	and the Speaker of the House of Representatives by October 1,
142	2005, and on an annual basis thereafter. The agency shall also
143	make this annual report available to the public on its Internet
144	website.
145	(14) Develop, and implement by October 1, 2004, a program
146	to audit the accuracy of health care facility patient bills and
147	payor claims for provider charges of $20,000 or more. Each
148	licensed health care facility shall be audited at least once
149	every 3 years. The audit shall establish a facility's error
150	ratio for bill or claim errors. An error ratio of up to 5
151	percent is permissible. The error ratio shall be determined by
152	dividing the number of claims and bills with violations found on
153	a statistically valid sample of claims and bills for provider
154	charges of $20,000 or more for the audit period by the total
155	number of claims and bills in the sample. If the error ratio
156	exceeds the permissible error ratio, a fine may be assessed for
157	those claims and bill errors which exceed the error ratio in the
158	amount of $500 per error, but not to exceed $100,000 for the
159	noted audit period. The agency shall require a facility to
160	refund the overpaid amount to any patient or payor who was
161	overcharged within 30 days after the completion of the audit
162	period.
163	(15) Adopt rules to implement the provisions of
164	subsections (9)-(14) no later than July 1, 2004.
165	Section 5. Section 395.301, Florida Statutes, is amended
166	to read:
167	395.301 Itemized patient bill; form and content prescribed
168	by the agency.--
169	(1) A licensed facility as defined in s. 395.002(17) shall
170	disclose to each patient, prior to treatment being rendered or
171	admission in a nonemergency situation, a written good faith
172	estimate of the reasonably anticipated charges generally
173	required for the facility to treat the patient's condition. Such
174	facility shall also disclose other common, less costly
175	treatments for the medical condition, including, but not limited
176	to, outpatient services or drug therapies. In the event of any
177	unanticipated complications, the licensed facility may charge
178	the patient, or a third-party payor acting on behalf of the
179	patient, for additional treatment, services, or supplies
180	rendered in connection with the complication if such charges are
181	itemized on the patient billing statement.
182	(2) A licensed facility shall not, as a condition of
183	admission or the provision of service, require a patient to sign
184	any form that requires or binds the patient or the patient's
185	third-party payor to make an unspecified or unlimited financial
186	payment to the facility or to waive the patient's right to
187	appeal charges billed. A facility may require a financial
188	commitment from a patient or the patient's payor only if the
189	facility provides a prior written good faith estimate pursuant
190	to this section. The facility shall notify the patient or payor
191	of any revision to the good faith estimate in a timely manner.
192	Except for unanticipated complications, if the facility makes a
193	revision to the estimate that exceeds the lesser of 20 percent
194	of the original estimate or $1,000, the patient or payor shall
195	not be required to pay any amount over the original estimate.
196	(3)(1)A licensed facility not operated by the state shall
197	notify each patient during admission and at discharge of his or
198	her right to receive an itemized bill upon request. Within 7
199	days following the patient'sdischarge or release from a
200	licensed facility not operated by the state, or within 7 days
201	after the earliest date on atwhich the loss or expense from the
202	service may be determined, the licensed facility providing the
203	service shall, upon request, submit to the patient, or to the
204	patient's survivor or legal guardian,as may be appropriate, an
205	itemized statement detailing in language comprehensible to an
206	ordinary layperson the specific nature of charges or expenses
207	incurred by the patient, which in the initial billing shall
208	contain a statement of specific services received and expenses
209	incurred for such items of service, enumerating in detail the
210	constituent components of the services received within each
211	department of the licensed facility and including unit price
212	data on rates charged by the licensed facility, as prescribed by
213	the agency.
214	(4)(2) Each such statement submitted pursuant to
215	subsection (3):
216	(a) May not include charges of hospital-based physicians
217	if billed separately.
218	(b) May not include any generalized category of expenses
219	such as "other" or "miscellaneous" or similar categories.
220	(c) Shall list drugs by brand or generic name and not
221	refer to drug code numbers when referring to drugs of any sort.
222	(d) Shall specifically identify therapy treatment as to
223	the date, type, and length of treatment when therapy treatment
224	is a part of the statement. Any person receiving a statement
225	pursuant to this section shall be fully and accurately informed
226	as to each charge and service provided by the institution
227	preparing the statement.
228	(e) Shall conspicuously display notice of the right of a
229	patient, or a third-party payor acting on behalf of the patient,
230	to appeal any of the charges in the bill and whether interest
231	will be charged on the amount not covered by a third-party payor
232	and the interest rate charged, if applicable.
233	(5)(3) On each such itemized statement submitted pursuant
234	to subsection (3),there shall appear the words "A FOR-PROFIT
235	(or NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
236	CENTER) LICENSED BY THE STATE OF FLORIDA" or substantially
237	similar words sufficient to identify clearly and plainly the
238	ownership status of the licensed facility. Each itemized
239	statement must prominently display the phone number of the
240	medical facility's patient liaison who is responsible for
241	expediting the resolution of any billing dispute between the
242	patient, or his or her representative, and the billing
243	department.
244	(6)(4)An itemized bill shall be provided once to the
245	patient's physician at the physician's request, at no charge.
246	(7)(5)In any billing for services subsequent to the
247	initial billing for such services, the patient, or the patient's
248	survivor or legal guardian, may elect, at his or her option, to
249	receive a copy of the detailed statement of specific services
250	received and expenses incurred for each such item of service as
251	provided in subsection (3)(1).
252	(8)(6)No physician, dentist, podiatric physician, or
253	licensed facility may add to the price charged by any third
254	party except for a service or handling charge representing a
255	cost actually incurred as an item of expense; however, the
256	physician, dentist, podiatric physician, or licensed facility is
257	entitled to fair compensation for all professional services
258	rendered. The amount of the service or handling charge, if any,
259	shall be set forth clearly in the bill to the patient.
260	(9) A licensed facility shall make available to a patient,
261	or a third-party payor acting on behalf of the patient, records
262	necessary for verification of the accuracy of the patient's bill
263	or payor's claim related to such patient's bill within 3
264	business days after the request for such records. The
265	verification information must be made available in the
266	facility's offices. Such records shall be available to the
267	patient or payor prior to and after payment of the bill or
268	claim. The facility may not charge the patient or payor for
269	making such verification records available; however, the
270	facility may charge its usual fee for providing copies of
271	records as specified in s. 395.3025.
272	(10) A patient, or a third-party payor acting on behalf of
273	the patient, has the right to appeal any charges in a facility's
274	bill. A facility shall establish an impartial method for
275	reviewing billing appeals and provide a written decision, with a
276	clear explanation of the grounds for the decision, to the
277	patient or payor making the appeal and to the agency within 30
278	days after the receipt of the appeal. A facility shall maintain
279	a complete and accurate log of all appeals and shall report to
280	the agency the number of appeals, the total of the charges
281	subject to appeal, and a summary of the dispositions of the
282	appeals no later than January 1 of each year.
283	(11) A licensed facility shall file with the agency no
284	later than January 1 of each year a copy of its charge master. A
285	facility must include an estimate of the percentage increase in
286	its gross revenue due to any price increase or decrease in its
287	charge master during the previous 12-month period. For purposes
288	of this section, the term "charge master" means a uniform
289	schedule of charges represented by the facility as its gross
290	billed charge for a given service or item, regardless of payor
291	type.
292	(12) A licensed facility shall report to the agency and
293	provide public notice on its Internet website, or by other
294	electronic means, and in its public reception areas any proposed
295	change to its charge master 30 days prior to implementing such
296	changes. The notice must separately identify the amount and
297	percent by which a charge is being reduced or increased. The
298	licensed facility must include on such notice an explanation
299	developed by the agency as to how the public may use the
300	information in the selection of a health care facility.
301	Section 6. This act shall take effect July 1, 2004.