HB 1039

1	A bill to be entitled
2	An act relating to access to emergency services and care;
3	amending s. 395.1041, F.S.; authorizing a hospital to
4	require payment from a person not suffering from an
5	emergency medical condition and authorizing discharge if
6	payment cannot be made, under certain circumstances;
7	directing the Department of Health Services Research,
8	Management and Policy at the University of Florida to
9	conduct an Uninsured Noncitizen Care Study and providing
10	purposes thereof; providing an appropriation; requiring a
11	report; providing an effective date.
12
13	WHEREAS, Florida hospitals are serving a growing number of
14	uninsured non-United States citizens, including undocumented
15	immigrants as well as legal noncitizens who are in the United
16	States on a tourist, work, or student visa, and
17	WHEREAS, there is no requirement, legal or otherwise, for
18	those visitors on tourist, work, or student visas to have health
19	insurance, and
20	WHEREAS, approximately 8 million people from other
21	countries visit Florida each year and, in 2001, approximately
22	800,000 uninsured legal noncitizens lived in Florida, and
23	WHEREAS, data from the United States Census Current
24	Population Survey shows that about half of the legal noncitizens
25	in Florida lack health insurance coverage, and
26	WHEREAS, because many of these patients have limited or
27	nonexistent resources to pay for health care, they place a huge
28	financial burden on Florida hospitals with the sickest patients
29	requiring lengthy hospital stays, expensive treatment, and long-
30	term followup care, and
31	WHEREAS, federal laws that require hospitals to treat
32	anyone who requests emergency care regardless of ability to pay
33	create an unfunded mandate to treat these patients despite the
34	fact that they are not United States citizens, and
35	WHEREAS, data from the Agency for Health Care
36	Administration shows that 70 percent of patients who are not
37	citizens of the United States are admitted through the emergency
38	room, and
39	WHEREAS, significant nonreimbursed costs associated with
40	caring for these individuals threaten the stability of the
41	already fragile safety net of Florida's health care system and
42	some of these nonreimbursed costs are shifted to those with
43	health insurance, thereby indirectly impacting health care costs
44	for all Florida citizens, NOW, THEREFORE,
45
46	Be It Enacted by the Legislature of the State of Florida:
47
48	Section 1.  Paragraph (h) of subsection (3) of section
49	395.1041, Florida Statutes, is amended to read:
50	395.1041  Access to emergency services and care.--
51	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
52	FACILITY OR HEALTH CARE PERSONNEL.--
53	(h)  A hospital may request and collect insurance
54	information and other financial information from a patient, in
55	accordance with federal law, if emergency services and care are
56	not delayed. No hospital to which another hospital is
57	transferring a person in need of emergency services and care may
58	require the transferring hospital or any person or entity to
59	guarantee payment for the person as a condition of receiving the
60	transfer. In addition, a hospital may not require any
61	contractual agreement, any type of preplanned transfer
62	agreement, or any other arrangement to be made prior to or at
63	the time of transfer as a condition of receiving an individual
64	patient being transferred. However, the patient or the patient's
65	legally responsible relative or guardian shall execute an
66	agreement to pay for emergency services or care or otherwise
67	supply insurance or credit information promptly after the
68	services and care are rendered. If, after examining and
69	evaluating the patient, it is determined by a physician or other
70	qualified medical person that the patient is not suffering from
71	an emergency medical condition, the hospital may require payment
72	before proceeding with nonemergency treatment and may discharge
73	the patient if payment cannot be obtained.
74	Section 2.  The Department of Health Services Research,
75	Management and Policy at the University of Florida shall conduct
76	a study entitled the Uninsured Noncitizen Care Study to
77	determine the extent to which:
78	(1)  Legal noncitizens, such as persons in the state on
79	tourist, student, or work visas, use the hospital emergency
80	departments for everything from basic to complex care.
81	(2)  Undocumented or illegal aliens involved in major auto
82	accidents are transported to trauma centers or emergency rooms
83	and may remain in hospitals for months.
84	(3)  Patient families refuse to authorize transfers back to
85	the home country, and deportation and appeals may take years.
86	(4)  Noncitizens or their children with severe diseases
87	obtain tourist visas, either legally or illegally, and take
88	taxis directly from airports to hospital emergency rooms.
89	(5)  Hospitals typically assume the costs associated with
90	the patient's trip home, such as the costs of airline tickets or
91	air ambulances.
92	(6)  When patients cannot be sent back to their country of
93	origin, hospitals assume considerable costs for continued care,
94	such as the costs of prescription drugs, oxygen, dialysis
95	treatments, and skilled nursing or rehabilitative care.
96	(7)  Federal and state emergency service laws need to be
97	clarified as to the extent of a hospital's obligation for
98	continuing care after stabilization of an emergency.
99	(8)  Tourist visas need to be issued on the condition of
100	documented health status and financial responsibility for health
101	care services and to clearly declare on all visas that
102	applicants, if they have to use health care facilities in the
103	United States, must accept transfer back to their home country
104	after they are stabilized.
105	(9)  More resources and better coordination for sick or
106	injured immigrants are needed among the federal Immigration and
107	Naturalization Service, international embassies, immigration
108	attorneys, and patient families.
109	(10)  More funding is needed for patients either through
110	federal and state programs or through diversion of United States
111	foreign aid to these countries.
112	Section 3.  The Legislature shall appropriate an amount
113	sufficient for the Department of Health Services Research,
114	Management and Policy at the University of Florida to complete
115	this study.
116	Section 4.  The Department of Health Services Research,
117	Management and Policy at the University of Florida shall submit
118	a report of its findings to the President of the Senate and the
119	Speaker of the House of Representatives by January 1, 2006.
120	Section 5.  This act shall take effect July 1, 2005.

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