HB 0701

CS

CHAMBER ACTION

1	The Committee on Health Care recommends the following:
2
3	Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to consumer health care spending
7	protection; providing a popular name; providing a purpose;
8	amending s. 408.05, F.S.; revising membership of the State
9	Comprehensive Health Information System Advisory Council;
10	amending s. 408.061, F.S.; revising a requirement for
11	submission of health care data; requiring the council to
12	assist the Agency for Health Care Administration in
13	developing specifications for data collection; amending s.
14	408.08, F.S.; conforming provisions to changes made by the
15	act; amending s. 395.10973, F.S.; revising powers and
16	duties of the agency to include patient charge and
17	performance outcome reporting; requiring the agency to
18	provide such information to the public and implement
19	effective methods for making public disclosure; requiring
20	the agency to annually report findings to the Governor and
21	Legislature; requiring the agency to adopt certain rules;
22	amending s. 395.301, F.S.; requiring disclosure to
23	nonemergency patients of a good faith estimate of
24	anticipated charges; revising the timeframe in which to
25	provide a statement of itemized expenses to a patient;
26	requiring the facility to disclose information necessary
27	to verify the accuracy of the bill; requiring the facility
28	to establish a method for reviewing billing disputes;
29	requiring the facility to maintain a log of all such
30	disputes and report certain information annually to the
31	agency; providing an effective date.
32
33	Be It Enacted by the Legislature of the State of Florida:
34
35	Section 1.  This act may be referred to by the popular name
36	the "Health Care Consumer's Right to Know Act."
37	Section 2.  The purpose of this act is to provide health
38	care consumers with reliable and understandable information
39	about facility charges and performance outcomes to assist
40	consumers in making informed decisions about health care.
41	Section 3.  Paragraph (a) of subsection (8) of section
42	408.05, Florida Statutes, is amended to read:
43	408.05  State Center for Health Statistics.--
44	(8)  STATE COMPREHENSIVE HEALTH INFORMATION SYSTEM ADVISORY
45	COUNCIL.--
46	(a)  There is established in the agency the State
47	Comprehensive Health Information System Advisory Council to
48	assist the center in reviewing the comprehensive health
49	information system and to recommend improvements for such
50	system. The council shall consist of the following 13 members:
51	1.  An employee of the Executive Office of the Governor, a
52	representative of an insurer licensed under chapter 627, a
53	consumer advocate, a representative of a business/health
54	coalition, and two representatives of statewide business
55	associations, to be appointed by the Governor.
56	2.  An employee of the Office of Insurance Regulation
57	Department of Financial Services, to be appointed by the
58	director of the office Chief Financial Officer.
59	3.  Three physicians, to be appointed by the Secretary of
60	Health, one of whom is a general surgeon licensed under chapter
61	458 or chapter 459, one of whom is a general internist licensed
62	under chapter 458 or chapter 459, and one of whom is a
63	radiologist or pathologist licensed under chapter 458 or chapter
64	459 An employee of the Department of Education, to be appointed
65	by the Commissioner of Education.
66	4.  Three Ten persons, to be appointed by the Secretary of
67	Health Care Administration, one of whom is the chief executive
68	officer of a hospital, one of whom is the chief executive
69	officer of a teaching hospital, and one of whom is a hospital
70	nursing executive representing other state and local agencies,
71	state universities, the Florida Association of Business/Health
72	Coalitions, local health councils, professional health-care-
73	related associations, consumers, and purchasers.
74	Section 4.  Subsection (1) of section 408.061, Florida
75	Statutes, is amended to read:
76	408.061  Data collection; uniform systems of financial
77	reporting; information relating to physician charges;
78	confidential information; immunity.--
79	(1)  The agency may require the submission by health care
80	facilities, health care providers, and health insurers of data
81	necessary to carry out the agency's duties. Specifications for
82	data to be collected under this section shall be developed by
83	the agency with the assistance of the State Comprehensive Health
84	Information System Advisory Council technical advisory panels
85	including representatives of affected entities, consumers,
86	purchasers, and such other interested parties as may be
87	determined by the agency.
88	(a)  Data to be submitted by health care facilities may
89	include, but are not limited to: case-mix data, patient
90	admission or discharge data with patient and provider-specific
91	identifiers included, actual charge data by diagnostic groups,
92	financial data, accounting data, operating expenses, expenses
93	incurred for rendering services to patients who cannot or do not
94	pay, interest charges, depreciation expenses based on the
95	expected useful life of the property and equipment involved, and
96	demographic data. Data may be obtained from documents such as,
97	but not limited to: leases, contracts, debt instruments,
98	itemized patient bills, medical record abstracts, and related
99	diagnostic information. All discharge data shall be submitted
100	quarterly as prescribed by rule.
101	(b)  Data to be submitted by health care providers may
102	include, but are not limited to: Medicare and Medicaid
103	participation, types of services offered to patients, amount of
104	revenue and expenses of the health care provider, and such other
105	data which are reasonably necessary to study utilization
106	patterns.
107	(c)  Data to be submitted by health insurers may include,
108	but are not limited to: claims, premium, administration, and
109	financial information.
110	(b)(d)  Data required to be submitted by health care
111	facilities, health care providers, or health insurers shall not
112	include specific provider contract reimbursement information.
113	However, such specific provider reimbursement data shall be
114	reasonably available for onsite inspection by the agency as is
115	necessary to carry out the agency's regulatory duties. Any such
116	data obtained by the agency as a result of onsite inspections
117	may not be used by the state for purposes of direct provider
118	contracting and are confidential and exempt from the provisions
119	of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
120	(c)(e)  A requirement to submit data shall be adopted by
121	rule if the submission of data is being required of all members
122	of any type of health care facility, health care provider, or
123	health insurer. Rules are not required, however, for the
124	submission of data for a special study mandated by the
125	Legislature or when information is being requested for a single
126	health care facility, health care provider, or health insurer.
127	Section 5.  Subsections (5) and (6) of section 408.08,
128	Florida Statutes, are renumbered as subsections (4) and (5),
129	respectively, and present subsections (3) and (4) of said
130	section are amended to read:
131	408.08  Inspections and audits; violations; penalties;
132	fines; enforcement.--
133	(3)  Any health care provider that refuses to file a
134	report, fails to timely file a report, files a false report, or
135	files an incomplete report and upon notification fails to timely
136	file a complete report required under s. 408.061; that violates
137	this section, s. 408.061, or s. 408.20, or rule adopted
138	thereunder; or that fails to provide documents or records
139	requested by the agency under this chapter shall be referred to
140	the appropriate licensing board which shall take appropriate
141	action against the health care provider.
142	(4)  If a health insurer does not comply with the
143	requirements of s. 408.061, the agency shall report a health
144	insurer's failure to comply to the Office of Insurance
145	Regulation of the Financial Services Commission, which shall
146	take into account the failure by the health insurer to comply in
147	conjunction with its approval authority under s. 627.410. The
148	agency shall adopt any rules necessary to carry out its
149	responsibilities required by this subsection.
150	Section 6.  Subsections (9) through (13) are added to
151	section 395.10973, Florida Statutes, to read:
152	395.10973  Powers and duties of the agency.--It is the
153	function of the agency to:
154	(9)(a)  Make available on its Internet website no later
155	than October 1, 2004, and in a hard-copy format upon request,
156	patient charge and performance outcome data collected from
157	licensed facilities pursuant to s. 408.061(1)(a) and (2) for not
158	less than 100 conditions or procedures and the volume of
159	inpatient hospitalizations or procedures by the appropriate
160	Medicare diagnostic-related groups International Classification
161	of Diseases 9 or Common Procedural Terminology code. Procedures
162	performed 50 or fewer times shall not be included. The Internet
163	website shall also provide an interactive search that allows
164	consumers to view and compare the information for specific
165	facilities, a map that allows consumers to select a county or
166	region, definitions of all of the data, descriptions of each
167	procedure, and an explanation about why the data may differ from
168	facility to facility. Such public data shall be updated on a
169	quarterly basis.
170	(b)  Analyze and trend for comparison by and between
171	facilities the gross charges for the 100 conditions or
172	procedures following an adjustment to reflect changes in patient
173	acuity, case mix, and severity of illness. This information
174	shall be posted annually on the agency's Internet website.
175	(c)  Establish by rule the conditions and procedures to be
176	disclosed based upon input from the State Comprehensive Health
177	Information System Advisory Council. When determining which
178	conditions and procedures are to be disclosed, the council and
179	the agency shall consider their variation in costs, variation in
180	outcomes and magnitude of variations, and other relevant
181	information so that the disclosed list of conditions and
182	procedures will assist health care consumers in differentiating
183	between facilities when making health treatment decisions. This
184	data shall be adjusted for case mix and severity, if applicable,
185	comparing volume of cases, patient charges, length of stay,
186	readmission rates, complication rates, mortality rates,
187	infection rates, and use of computerized drug order systems.
188	(d)  Make available educational information relevant to the
189	disclosed 100 conditions and procedures pursuant to this
190	subsection, including, but not limited to, an explanation of the
191	medical condition or procedure, potential side effects,
192	alternative treatments and costs, and additional resources that
193	can assist consumers in informed decisionmaking. Such
194	information may be made available by linking consumers to
195	credible national resources such as, but not limited to, the
196	National Library of Medicine.
197	(10)  Publicly disclose comparison information as to each
198	medical condition or procedure pursuant to subsection (9),
199	including the age of the data and an explanation of the
200	methodology used to adjust the data, in language that is
201	understandable to laypersons and accessible to consumers using
202	an interactive query system to allow for the comparison of the
203	latest reported patient charge and performance outcome data
204	among all licensed facilities in the state. The agency shall
205	provide guidance to consumers on how to use this information to
206	make informed health care decisions.
207	(11)  Study and implement by October 1, 2005, the most
208	effective methods for public disclosure of patient charge and
209	performance outcome data pursuant to subsection (9), including
210	additional mechanisms to deliver this information to consumers,
211	that would enhance informed decisionmaking among consumers and
212	health care purchasers. The agency shall also evaluate the value
213	of disclosing additional measures that are adopted by the
214	National Quality Forum, the Joint Commission on Accreditation of
215	Healthcare Organizations, The Leapfrog Group, or a similar
216	national entity that establishes standards to measure the
217	performance of health care providers.
218	(12)  Report its findings and recommendations pursuant to
219	subsection (11) to the Governor, the President of the Senate,
220	and the Speaker of the House of Representatives by October 1,
221	2005, and on an annual basis thereafter. The agency shall also
222	make this annual report available to the public on its Internet
223	website.
224	(13)  Adopt rules to implement the provisions of
225	subsections (9)-(12) no later than July 1, 2004.
226	Section 7.  Section 395.301, Florida Statutes, is amended
227	to read:
228	395.301  Itemized patient bill; form and content prescribed
229	by the agency.--
230	(1)  A licensed facility as defined in s. 395.002(17) shall
231	disclose to a prospective patient upon request, prior to
232	treatment being rendered or admission in a nonemergency
233	situation, a written good faith estimate of the reasonably
234	anticipated charges generally required for the facility to treat
235	the patient's condition. In order to comply with this
236	subsection, the facility may provide, upon request, the median
237	charges for its top 100 conditions or procedures by the
238	appropriate Medicare diagnostic-related group International
239	Classification of Diseases 9 or Common Procedural Terminology
240	code. The facility shall notify the patient or patient-
241	designated next of kin or designated health care surrogate of
242	any revision to the good faith estimate in a timely manner if
243	the good faith estimate represented one of the top 100
244	procedures. Such estimate shall not prohibit the actual charges
245	from exceeding the estimate.
246	(2)(1)  A licensed facility not operated by the state shall
247	notify each patient during admission and at discharge of his or
248	her right to receive an itemized bill upon request. Within 7
249	days following the patient's discharge or release from a
250	licensed facility not operated by the state, or within 7 days
251	after the earliest date at which the loss or expense from the
252	service may be determined, the licensed facility providing the
253	service shall, upon request, submit to the patient, or to the
254	patient's survivor or legal guardian, as may be appropriate, an
255	itemized statement detailing in language comprehensible to an
256	ordinary layperson the specific nature of charges or expenses
257	incurred by the patient, which in the initial billing shall
258	contain a statement of specific services received and expenses
259	incurred for such items of service, enumerating in detail the
260	constituent components of the services received within each
261	department of the licensed facility and including unit price
262	data on rates charged by the licensed facility, as prescribed by
263	the agency.
264	(3)(2)  Each such statement submitted pursuant to
265	subsection (2):
266	(a)  May not include charges of hospital-based physicians
267	if billed separately.
268	(b)  May not include any generalized category of expenses
269	such as "other" or "miscellaneous" or similar categories.
270	(c)  Shall list drugs by brand or generic name and not
271	refer to drug code numbers when referring to drugs of any sort.
272	(d)  Shall specifically identify therapy treatment as to
273	the date, type, and length of treatment when therapy treatment
274	is a part of the statement. Any person receiving a statement
275	pursuant to this section shall be fully and accurately informed
276	as to each charge and service provided by the institution
277	preparing the statement.
278	(4)(3)  On each such itemized statement submitted pursuant
279	to subsection (2), there shall appear the words "A FOR-PROFIT
280	(or NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
281	CENTER) LICENSED BY THE STATE OF FLORIDA" or substantially
282	similar words sufficient to identify clearly and plainly the
283	ownership status of the licensed facility. Each itemized
284	statement must prominently display the phone number of the
285	medical facility's patient liaison who is responsible for
286	expediting the resolution of any billing dispute between the
287	patient, or his or her representative, and the billing
288	department.
289	(5)(4)  An itemized bill shall be provided once to the
290	patient's physician at the physician's request, at no charge.
291	(6)(5)  In any billing for services subsequent to the
292	initial billing for such services, the patient, or the patient's
293	survivor or legal guardian, may elect, at his or her option, to
294	receive a copy of the detailed statement of specific services
295	received and expenses incurred for each such item of service as
296	provided in subsection (2)(1).
297	(7)(6)  No physician, dentist, podiatric physician, or
298	licensed facility may add to the price charged by any third
299	party except for a service or handling charge representing a
300	cost actually incurred as an item of expense; however, the
301	physician, dentist, podiatric physician, or licensed facility is
302	entitled to fair compensation for all professional services
303	rendered. The amount of the service or handling charge, if any,
304	shall be set forth clearly in the bill to the patient.
305	(8)  A licensed facility shall make available to a patient
306	all records necessary for verification of the accuracy of the
307	patient's bill within 7 business days after the request for such
308	records. The verification information must be made available in
309	the facility's offices. Such records shall be available to the
310	patient prior to and after payment of the bill or claim. The
311	facility may not charge the patient for making such verification
312	records available; however, the facility may charge its usual
313	fee for providing copies of records as specified in s. 395.3025.
314	(9)  Each facility shall establish an impartial method for
315	reviewing billing disputes of patients and provide a written
316	response, with a clear explanation of the grounds for the
317	response, to the patient making the dispute within 30 days after
318	the receipt of the dispute. A facility shall maintain a complete
319	and accurate log of all disputes and shall report to the agency
320	the number of disputes, the total of the charges subject to
321	dispute, and a summary of the dispositions of the disputes no
322	later than January 1 of each year.
323	Section 8.  This act shall take effect July 1, 2004.

CODING: Words stricken are deletions; words underlined are additions.