HB 7073

1
A bill to be entitled
2An act relating to health care information; providing a
3short title; providing purpose; amending s. 408.05, F.S.;
4renaming the State Center for Health Statistics; revising
5criteria for collection and use of certain health-related
6data; providing responsibilities of the Agency for Health
7Care Administration; providing for agency consultation
8with the State Consumer Health Information and Policy
9Advisory Council for the dissemination of certain consumer
10information; requiring the Florida Center for Health
11Information and Policy Analysis to provide certain
12technical assistance services; authorizing the agency to
13monitor certain grants; removing a provision that
14establishes the Comprehensive Health Information System
15Trust Fund as the repository of certain funds; renaming
16the State Comprehensive Health Information System Advisory
17Council; providing for duties and responsibilities of the
18State Consumer Health Information and Policy Advisory
19Council; providing for membership, terms, officers, and
20meetings; amending s. 408.061, F.S.; providing for health
21care providers to submit additional data to the agency;
22correcting a reference; amending s. 408.062, F.S.;
23revising provisions relating to availability of specified
24information on the agency's Internet website; requiring a
25report; removing an obsolete provision; authorizing the
26agency to develop an electronic health information
27network; amending ss. 20.42, 381.001, 395.602, 395.6025,
28408.07, and 408.18, F.S.; conforming references to changes
29made by the act; amending ss. 381.026, 395.301, 465.0244,
30627.6499, and 641.54, F.S.; conforming a cross-reference;
31providing an effective date.
32
33Be It Enacted by the Legislature of the State of Florida:
34
35     Section 1.  This act may be cited as the "Coordinated
36Health Care Information and Transparency Act of 2006."
37     Section 2.  The purpose of this act is to provide better
38coordination of health information for purposes of public
39health, policy analysis, and transparency of consumer health
40care information.
41     Section 3.  Section 408.05, Florida Statutes, is amended to
42read:
43     408.05  Florida State Center for Health Information and
44Policy Analysis Statistics.--
45     (1)  ESTABLISHMENT.--The agency shall establish a Florida
46State Center for Health Information and Policy Analysis
47Statistics. The center shall establish a comprehensive health
48information system to provide for the collection, compilation,
49coordination, analysis, indexing, dissemination, and utilization
50of both purposefully collected and extant health-related data
51and statistics. The center shall be staffed with public health
52experts, biostatisticians, information system analysts, health
53policy experts, economists, and other staff necessary to carry
54out its functions.
55     (2)  HEALTH-RELATED DATA STATISTICS.--The comprehensive
56health information system operated by the Florida State Center
57for Health Information and Policy Analysis Statistics shall
58identify the best available data sources and coordinate the
59compilation of extant health-related data and statistics and
60purposefully collect data on:
61     (a)  The extent and nature of illness and disability of the
62state population, including life expectancy, the incidence of
63various acute and chronic illnesses, and infant and maternal
64morbidity and mortality.
65     (b)  The impact of illness and disability of the state
66population on the state economy and on other aspects of the
67well-being of the people in this state.
68     (c)  Environmental, social, and other health hazards.
69     (d)  Health knowledge and practices of the people in this
70state and determinants of health and nutritional practices and
71status.
72     (e)  Health resources, including physicians, dentists,
73nurses, and other health professionals, by specialty and type of
74practice and acute, long-term care and other institutional care
75facility supplies and specific services provided by hospitals,
76nursing homes, home health agencies, and other health care
77facilities.
78     (f)  Utilization of health care by type of provider.
79     (g)  Health care costs and financing, including trends in
80health care prices and costs, the sources of payment for health
81care services, and federal, state, and local expenditures for
82health care.
83     (h)  Family formation, growth, and dissolution.
84     (i)  The extent of public and private health insurance
85coverage in this state.
86     (j)  The quality of care provided by various health care
87providers.
88     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
89produce comparable and uniform health information and statistics
90for the development of policy recommendations, the agency shall
91perform the following functions:
92     (a)  Coordinate the activities of state agencies involved
93in the design and implementation of the comprehensive health
94information system.
95     (b)  Undertake research, development, and evaluation
96respecting the comprehensive health information system.
97     (c)  Review the statistical activities of state agencies to
98ensure the Department of Health to assure that they are
99consistent with the comprehensive health information system.
100     (d)  Develop written agreements with local, state, and
101federal agencies for the sharing of health-care-related data or
102using the facilities and services of such agencies. State
103agencies, local health councils, and other agencies under state
104contract with the Department of Health shall assist the center
105in obtaining, compiling, and transferring health-care-related
106data maintained by state and local agencies. Written agreements
107must specify the types, methods, and periodicity of data
108exchanges and specify the types of data that will be transferred
109to the center.
110     (e)  The agency shall Establish by rule the types of data
111collected, compiled, processed, used, or shared. Decisions
112regarding center data sets should be made based on consultation
113with the State Consumer Comprehensive Health Information and
114Policy System Advisory Council and other public and private
115users regarding the types of data which should be collected and
116their uses.
117     (f)  The center shall establish standardized means for
118collecting health information and statistics under laws and
119rules administered by the agency.
120     (f)(g)  Establish minimum health-care-related data sets
121which are necessary on a continuing basis to fulfill the
122collection requirements of the center and which shall be used by
123state agencies in collecting and compiling health-care-related
124data. The agency shall periodically review ongoing health care
125data collections of the Department of Health and other state
126agencies to determine if the collections are being conducted in
127accordance with the established minimum sets of data.
128     (g)(h)  Establish advisory standards to ensure assure the
129quality of health statistical and epidemiological data
130collection, processing, and analysis by local, state, and
131private organizations.
132     (h)(i)  Prescribe standards for the publication of health-
133care-related data reported pursuant to this section which ensure
134the reporting of accurate, valid, reliable, complete, and
135comparable data. Such standards should include advisory warnings
136to users of the data regarding the status and quality of any
137data reported by or available from the center.
138     (i)(j)  Prescribe standards for the maintenance and
139preservation of the center's data. This should include methods
140for archiving data, retrieval of archived data, and data editing
141and verification.
142     (j)(k)  Ensure that strict quality control measures are
143maintained for the dissemination of data through publications,
144studies, or user requests.
145     (k)(l)  Develop, in conjunction with the State Consumer
146Comprehensive Health Information and Policy System Advisory
147Council, and implement a long-range plan for making available
148health care quality measures performance outcome and financial
149data that will allow consumers to compare health care services.
150The health care quality measures performance outcomes and
151financial data the agency must make available shall include, but
152is not limited to, pharmaceuticals, physicians, health care
153facilities, and health plans and managed care entities. The
154agency shall submit the initial plan to the Governor, the
155President of the Senate, and the Speaker of the House of
156Representatives by January 1, 2006, and shall update the plan
157and report on the status of its implementation annually
158thereafter. The agency shall also make the plan and status
159report available to the public on its Internet website. As part
160of the plan, the agency shall identify the process and
161timeframes for implementation, any barriers to implementation,
162and recommendations of changes in the law that may be enacted by
163the Legislature to eliminate the barriers. As preliminary
164elements of the plan, the agency shall:
165     1.  Make available health care quality measures that
166include, but are not limited to, process measures, patient
167safety measures, inpatient quality indicators, performance
168measures, outcome and patient charge data collected from health
169care facilities pursuant to s. 408.061(1)(a) and (2). The agency
170shall determine which conditions, and procedures, health care
171quality measures performance outcomes, and patient charge data
172to disclose based upon input from the council. When determining
173which conditions and procedures are to be disclosed, the council
174and the agency shall consider variation in costs, variation in
175outcomes, and magnitude of variations and other relevant
176information. When determining which health care quality measures
177performance outcomes to disclose, the agency:
178     a.  Shall consider such factors as volume of cases; average
179patient charges; average length of stay; complication rates;
180mortality rates; and infection rates, among others, which shall
181be adjusted for case mix and severity, if applicable.
182     b.  May consider such additional measures that are adopted
183by the Centers for Medicare and Medicaid Studies, National
184Quality Forum, the Joint Commission on Accreditation of
185Healthcare Organizations, the Agency for Healthcare Research and
186Quality, Centers for Disease Control and Prevention, or a
187similar national entity that establishes standards to measure
188the performance of health care providers, or by other states.
189
190When determining which patient charge data to disclose, the
191agency shall consider such measures as average charge, average
192net revenue per adjusted patient day, average cost per adjusted
193patient day, and average cost per admission, among others.
194     2.  Make available performance measures, benefit design,
195and premium cost data from health plans licensed pursuant to
196chapter 627 or chapter 641. The agency shall determine which
197health care quality measures performance outcome and member and
198subscriber cost data to disclose, based upon input from the
199council. When determining which data to disclose, the agency
200shall consider information that may be required by either
201individual or group purchasers to assess the value of the
202product, which may include membership satisfaction, quality of
203care, current enrollment or membership, coverage areas,
204accreditation status, premium costs, plan costs, premium
205increases, range of benefits, copayments and deductibles,
206accuracy and speed of claims payment, credentials of physicians,
207number of providers, names of network providers, and hospitals
208in the network. Health plans shall make available to the agency
209any such data or information that is not currently reported to
210the agency or the office.
211     3.  Determine the method and format for public disclosure
212of data reported pursuant to this paragraph. The agency shall
213make its determination based upon input from the State Consumer
214Comprehensive Health Information and Policy System Advisory
215Council. At a minimum, the data shall be made available on the
216agency's Internet website in a manner that allows consumers to
217conduct an interactive search that allows them to view and
218compare the information for specific providers. The website must
219include such additional information as is determined necessary
220to ensure that the website enhances informed decisionmaking
221among consumers and health care purchasers, which shall include,
222at a minimum, appropriate guidance on how to use the data and an
223explanation of why the data may vary from provider to provider.
224The data specified in subparagraph 1. shall be released no later
225than January 1, 2006, for the reporting of infection rates, and
226no later than October 1, 2005, for mortality rates and
227complication rates. The data specified in subparagraph 2. shall
228be released no later than October 1, 2006.
229     (4)  TECHNICAL ASSISTANCE.--
230     (a)  The center shall provide technical assistance to
231persons or organizations engaged in health planning activities
232in the effective use of statistics collected and compiled by the
233center. The center shall also provide the following additional
234technical assistance services:
235     1.(a)  Establish procedures identifying the circumstances
236under which, the places at which, the persons from whom, and the
237methods by which a person may secure data from the center,
238including procedures governing requests, the ordering of
239requests, timeframes for handling requests, and other procedures
240necessary to facilitate the use of the center's data. To the
241extent possible, the center should provide current data timely
242in response to requests from public or private agencies.
243     2.(b)  Provide assistance to data sources and users in the
244areas of database design, survey design, sampling procedures,
245statistical interpretation, and data access to promote improved
246health-care-related data sets.
247     3.(c)  Identify health care data gaps and provide technical
248assistance to seek cooperative agreements with other public or
249private organizations for meeting documented health care data
250needs.
251     4.(d)  Assist other organizations in developing statistical
252abstracts of their data sets that could be used by the center.
253     5.(e)  Provide statistical support to state agencies with
254regard to the use of databases maintained by the center.
255     6.(f)  To the extent possible, respond to multiple requests
256for information not currently collected by the center or
257available from other sources by initiating data collection.
258     7.(g)  Maintain detailed information on data maintained by
259other local, state, federal, and private agencies in order to
260advise those who use the center of potential sources of data
261which are requested but which are not available from the center.
262     8.(h)  Respond to requests for data which are not available
263in published form by initiating special computer runs on data
264sets available to the center.
265     9.  Monitor innovations in health information technology,
266informatics, and the exchange of health information and maintain
267a repository of technical resources to support the development
268of a health information network.
269     (b)  The agency shall administer, manage, and monitor
270grants to not-for-profit organizations, regional health
271information organizations, public health departments, or state
272agencies that submit proposals for planning, implementation, or
273training projects to advance the development of a health
274information network. Any grant contract shall be evaluated to
275ensure the effective outcome of the health information project.
276     (c)  The agency shall initiate, oversee, manage, and
277evaluate the integration of health care data from each state
278agency that collects, stores, and reports on health care issues
279and make that data available to any health care practitioner
280through a state health information network.
281     (5)  PUBLICATIONS; REPORTS; SPECIAL STUDIES.--The center
282shall provide for the widespread dissemination of data which it
283collects and analyzes. The center shall have the following
284publication, reporting, and special study functions:
285     (a)  The center shall publish and make available
286periodically to agencies and individuals health statistics
287publications of general interest, including health plan consumer
288reports and health maintenance organization member satisfaction
289surveys HMO report cards; publications providing health
290statistics on topical health policy issues; publications that
291provide health status profiles of the people in this state; and
292other topical health statistics publications.
293     (b)  The center shall publish, make available, and
294disseminate, promptly and as widely as practicable, the results
295of special health surveys, health care research, and health care
296evaluations conducted or supported under this section. Any
297publication by the center must include a statement of the
298limitations on the quality, accuracy, and completeness of the
299data.
300     (c)  The center shall provide indexing, abstracting,
301translation, publication, and other services leading to a more
302effective and timely dissemination of health care statistics.
303     (d)  The center shall be responsible for publishing and
304disseminating an annual report on the center's activities.
305     (e)  The center shall be responsible, to the extent
306resources are available, for conducting a variety of special
307studies and surveys to expand the health care information and
308statistics available for health policy analyses, particularly
309for the review of public policy issues. The center shall develop
310a process by which users of the center's data are periodically
311surveyed regarding critical data needs and the results of the
312survey considered in determining which special surveys or
313studies will be conducted. The center shall select problems in
314health care for research, policy analyses, or special data
315collections on the basis of their local, regional, or state
316importance; the unique potential for definitive research on the
317problem; and opportunities for application of the study
318findings.
319     (6)  PROVIDER DATA REPORTING.--This section does not confer
320on the agency the power to demand or require that a health care
321provider or professional furnish information, records of
322interviews, written reports, statements, notes, memoranda, or
323data other than as expressly required by law.
324     (7)  BUDGET; FEES; TRUST FUND.--
325     (a)  The Legislature intends that funding for the Florida
326State Center for Health Information and Policy Analysis
327Statistics be appropriated from the General Revenue Fund.
328     (b)  The Florida State Center for Health Information and
329Policy Analysis Statistics may apply for and receive and accept
330grants, gifts, and other payments, including property and
331services, from any governmental or other public or private
332entity or person and make arrangements as to the use of same,
333including the undertaking of special studies and other projects
334relating to health-care-related topics. Funds obtained pursuant
335to this paragraph may not be used to offset annual
336appropriations from the General Revenue Fund.
337     (c)  The center may charge such reasonable fees for
338services as the agency prescribes by rule. The established fees
339may not exceed the reasonable cost for such services. Fees
340collected may not be used to offset annual appropriations from
341the General Revenue Fund.
342     (d)  The agency shall establish a Comprehensive Health
343Information System Trust Fund as the repository of all funds
344appropriated to, and fees and grants collected for, services of
345the State Center for Health Statistics. Any funds, other than
346funds appropriated to the center from the General Revenue Fund,
347which are raised or collected by the agency for the operation of
348the center and which are not needed to meet the expenses of the
349center for its current fiscal year shall be available to the
350agency in succeeding years.
351     (8)  STATE CONSUMER COMPREHENSIVE HEALTH INFORMATION AND
352POLICY SYSTEM ADVISORY COUNCIL.--
353     (a)  There is established in the agency the State Consumer
354Comprehensive Health Information and Policy System Advisory
355Council to assist the center in reviewing the comprehensive
356health information system, including the identification,
357collection, standardization, sharing, and coordination of
358health-related data, fraud and abuse data, and professional and
359facility licensing data among federal, state, local, and private
360entities and to recommend improvements for purposes of public
361health, policy analysis, and transparency of consumer health
362care information such system. The council shall consist of the
363following members:
364     1.  An employee of the Executive Office of the Governor, to
365be appointed by the Governor.
366     2.  An employee of the Office of Insurance Regulation, to
367be appointed by the director of the office.
368     3.  An employee of the Department of Education, to be
369appointed by the Commissioner of Education.
370     4.  Ten persons, to be appointed by the Secretary of Health
371Care Administration, representing other state and local
372agencies, state universities, business and health the Florida
373Association of Business/Health coalitions, local health
374councils, professional health-care-related associations,
375consumers, and purchasers.
376     (b)  Each member of the council shall be appointed to serve
377for a term of 2 4 years following from the date of appointment,
378except the term of appointment shall end 3 years following the
379date of appointment for members appointed in 2003, 2004, and
3802005. that A vacancy shall be filled by appointment for the
381remainder of the term, and each appointing authority retains the
382right to reappoint members whose terms of appointment have
383expired. and except that:
384     1.  Three of the members initially appointed by the
385Director of Health Care Administration shall each be appointed
386for a term of 3 years.
387     2.  Two of the members initially appointed by the Director
388of Health Care Administration shall each be appointed for a term
389of 2 years.
390     3.  Two of the members initially appointed by the Director
391of Health Care Administration shall each be appointed for a term
392of 1 year.
393     (c)  The council may meet at the call of its chair, at the
394request of the agency department, or at the request of a
395majority of its membership, but the council must meet at least
396quarterly.
397     (d)  Members shall elect a chair and vice chair annually.
398     (e)  A majority of the members constitutes a quorum, and
399the affirmative vote of a majority of a quorum is necessary to
400take action.
401     (f)  The council shall maintain minutes of each meeting and
402shall make such minutes available to any person.
403     (g)  Members of the council shall serve without
404compensation but shall be entitled to receive reimbursement for
405per diem and travel expenses as provided in s. 112.061.
406     (h)  The council's duties and responsibilities include, but
407are not limited to, the following:
408     1.  To develop a mission statement, goals, and a plan of
409action based on the guiding principles specified in s. 282.3032
410for the identification, collection, standardization, sharing,
411and coordination of health-related data across federal, state,
412and local government and private-sector entities.
413     2.  To develop a review process to ensure cooperative
414planning among agencies that collect or maintain health-related
415data.
416     3.  To create ad hoc issue-oriented technical workgroups on
417an as-needed basis to make recommendations to the council.
418     (9)  APPLICATION TO OTHER AGENCIES.--Nothing in this
419section shall limit, restrict, affect, or control the
420collection, analysis, release, or publication of data by any
421state agency pursuant to its statutory authority, duties, or
422responsibilities.
423     Section 4.  Paragraph (b) of subsection (1) and subsection
424(10) of section 408.061, Florida Statutes, are amended to read:
425     408.061  Data collection; uniform systems of financial
426reporting; information relating to physician charges;
427confidential information; immunity.--
428     (1)  The agency shall require the submission by health care
429facilities, health care providers, and health insurers of data
430necessary to carry out the agency's duties. Specifications for
431data to be collected under this section shall be developed by
432the agency with the assistance of technical advisory panels
433including representatives of affected entities, consumers,
434purchasers, and such other interested parties as may be
435determined by the agency.
436     (b)  Data to be submitted by health care providers may
437include, but are not limited to: professional organization and
438specialty board affiliations, Medicare and Medicaid
439participation, types of services offered to patients, amount of
440revenue and expenses of the health care provider, and such other
441data which are reasonably necessary to study utilization
442patterns. Data submitted shall be certified by the appropriate
443duly authorized representative or employee of the health care
444provider that the information submitted is true and accurate.
445     (10)  The agency shall be the primary source for collection
446and dissemination of health care data. No other agency of state
447government may gather data from a health care provider licensed
448or regulated under this chapter without first determining if the
449data is currently being collected by the agency and
450affirmatively demonstrating that it would be more cost-effective
451for an agency of state government other than the agency to
452gather the health care data. The secretary director shall ensure
453that health care data collected by the divisions within the
454agency is coordinated. It is the express intent of the
455Legislature that all health care data be collected by a single
456source within the agency and that other divisions within the
457agency, and all other agencies of state government, obtain data
458for analysis, regulation, and public dissemination purposes from
459that single source. Confidential information may be released to
460other governmental entities or to parties contracting with the
461agency to perform agency duties or functions as needed in
462connection with the performance of the duties of the receiving
463entity. The receiving entity or party shall retain the
464confidentiality of such information as provided for herein.
465     Section 5.  Paragraphs (h) and (j) of subsection (1) and
466subsections (2) and (5) of section 408.062, Florida Statutes,
467are amended to read:
468     408.062  Research, analyses, studies, and reports.--
469     (1)  The agency shall conduct research, analyses, and
470studies relating to health care costs and access to and quality
471of health care services as access and quality are affected by
472changes in health care costs. Such research, analyses, and
473studies shall include, but not be limited to:
474     (h)  The collection of a statistically valid sample of data
475on the retail prices charged by pharmacies for the 100 50 most
476frequently prescribed medicines from any pharmacy licensed by
477this state as a special study authorized by the Legislature to
478be performed by the agency quarterly. If the drug is available
479generically, price data shall be reported for the generic drug
480and price data of a brand-named drug for which the generic drug
481is the equivalent shall be reported. The agency shall make
482available on its Internet website for each pharmacy, no later
483than October 1, 2006 2005, drug prices for a 30-day supply at a
484standard dose. The data collected shall be reported for each
485drug by pharmacy and by metropolitan statistical area or region
486and updated quarterly.
487     (j)  The making available on its Internet website beginning
488no later than October 1, 2004, and in a hard-copy format upon
489request, of patient charge, volumes, length of stay, and
490performance outcome indicators collected from health care
491facilities pursuant to s. 408.061(1)(a) for specific medical
492conditions, surgeries, and procedures provided in inpatient and
493outpatient facilities as determined by the agency. In making the
494determination of specific medical conditions, surgeries, and
495procedures to include, the agency shall consider such factors as
496volume, severity of the illness, urgency of admission,
497individual and societal costs, and whether the condition is
498acute or chronic. Performance outcome indicators shall be risk
499adjusted or severity adjusted, as applicable, using nationally
500recognized risk adjustment methodologies or software consistent
501with the standards of the Agency for Healthcare Research and
502Quality and as selected by the agency. The website shall also
503provide an interactive search that allows consumers to view and
504compare the information for specific facilities, a map that
505allows consumers to select a county or region, definitions of
506all of the data, descriptions of each procedure, and an
507explanation about why the data may differ from facility to
508facility. Such public data shall be updated quarterly. The
509agency shall submit an annual status report on the collection of
510data and publication of health care quality measures performance
511outcome indicators to the Governor, the Speaker of the House of
512Representatives, the President of the Senate, and the
513substantive legislative committees with the first status report
514due January 1, 2005.
515     (2)  The agency may assess annually the caesarean section
516rate in Florida hospitals using the analysis methodology that
517the agency determines most appropriate. The data from this
518assessment shall be published periodically on the agency's
519Internet website. To assist the agency in determining the impact
520of this chapter on Florida hospitals' caesarean section rates,
521each provider hospital, as defined in s. 383.336, shall notify
522the agency of the date of implementation of the practice
523parameters and the date of the first meeting of the hospital
524peer review board created pursuant to this chapter. The agency
525shall use these dates in monitoring any change in provider
526hospital caesarean section rates. An annual report based on this
527monitoring and assessment shall be submitted to the Governor,
528the Speaker of the House of Representatives, and the President
529of the Senate by the agency, with the first annual report due
530January 1, 1993.
531     (5)  The agency shall develop and implement a strategy for
532the adoption and use of electronic health records, including the
533development of an electronic health information network for the
534sharing of electronic health records among health care
535facilities, health care providers, and health insurers. The
536agency may develop rules to facilitate the functionality and
537protect the confidentiality of electronic health records. The
538agency shall report to the Governor, the Speaker of the House of
539Representatives, and the President of the Senate on legislative
540recommendations to protect the confidentiality of electronic
541health records.
542     Section 6.  Subsection (3) of section 20.42, Florida
543Statutes, is amended to read:
544     20.42  Agency for Health Care Administration.--
545     (3)  The department shall be the chief health policy and
546planning entity for the state. The department is responsible for
547health facility licensure, inspection, and regulatory
548enforcement; investigation of consumer complaints related to
549health care facilities and managed care plans; the
550implementation of the certificate of need program; the operation
551of the Florida State Center for Health Information and Policy
552Analysis Statistics; the administration of the Medicaid program;
553the administration of the contracts with the Florida Healthy
554Kids Corporation; the certification of health maintenance
555organizations and prepaid health clinics as set forth in part
556III of chapter 641; and any other duties prescribed by statute
557or agreement.
558     Section 7.  Subsection (3) of section 381.001, Florida
559Statutes, is amended to read:
560     381.001  Legislative intent; public health system.--
561     (3)  It is, furthermore, the intent of the Legislature that
562the public health system include comprehensive planning, data
563collection, technical support, and health resource development
564functions. These functions include, but are not limited to,
565state laboratory and pharmacy services, the state vital
566statistics system, the Florida State Center for Health
567Information and Policy Analysis Statistics, emergency medical
568services coordination and support, and recruitment, retention,
569and development of preventive and primary health care
570professionals and managers.
571     Section 8.  Paragraph (e) of subsection (2) of section
572395.602, Florida Statutes, is amended to read:
573     395.602  Rural hospitals.--
574     (2)  DEFINITIONS.--As used in this part:
575     (e)  "Rural hospital" means an acute care hospital licensed
576under this chapter, having 100 or fewer licensed beds and an
577emergency room, which is:
578     1.  The sole provider within a county with a population
579density of no greater than 100 persons per square mile;
580     2.  An acute care hospital, in a county with a population
581density of no greater than 100 persons per square mile, which is
582at least 30 minutes of travel time, on normally traveled roads
583under normal traffic conditions, from any other acute care
584hospital within the same county;
585     3.  A hospital supported by a tax district or subdistrict
586whose boundaries encompass a population of 100 persons or fewer
587per square mile;
588     4.  A hospital in a constitutional charter county with a
589population of over 1 million persons that has imposed a local
590option health service tax pursuant to law and in an area that
591was directly impacted by a catastrophic event on August 24,
5921992, for which the Governor of Florida declared a state of
593emergency pursuant to chapter 125, and has 120 beds or less that
594serves an agricultural community with an emergency room
595utilization of no less than 20,000 visits and a Medicaid
596inpatient utilization rate greater than 15 percent;
597     5.  A hospital with a service area that has a population of
598100 persons or fewer per square mile. As used in this
599subparagraph, the term "service area" means the fewest number of
600zip codes that account for 75 percent of the hospital's
601discharges for the most recent 5-year period, based on
602information available from the hospital inpatient discharge
603database in the Florida State Center for Health Information and
604Policy Analysis Statistics at the Agency for Health Care
605Administration; or
606     6.  A hospital designated as a critical access hospital, as
607defined in s. 408.07(15).
608
609Population densities used in this paragraph must be based upon
610the most recently completed United States census. A hospital
611that received funds under s. 409.9116 for a quarter beginning no
612later than July 1, 2002, is deemed to have been and shall
613continue to be a rural hospital from that date through June 30,
6142012, if the hospital continues to have 100 or fewer licensed
615beds and an emergency room, or meets the criteria of
616subparagraph 4. An acute care hospital that has not previously
617been designated as a rural hospital and that meets the criteria
618of this paragraph shall be granted such designation upon
619application, including supporting documentation to the Agency
620for Health Care Administration.
621     Section 9.  Section 395.6025, Florida Statutes, is amended
622to read:
623     395.6025  Rural hospital replacement
624facilities.--Notwithstanding the provisions of s. 408.036, a
625hospital defined as a statutory rural hospital in accordance
626with s. 395.602, or a not-for-profit operator of rural
627hospitals, is not required to obtain a certificate of need for
628the construction of a new hospital located in a county with a
629population of at least 15,000 but no more than 18,000 and a
630density of less than 30 persons per square mile, or a
631replacement facility, provided that the replacement, or new,
632facility is located within 10 miles of the site of the currently
633licensed rural hospital and within the current primary service
634area. As used in this section, the term "service area" means the
635fewest number of zip codes that account for 75 percent of the
636hospital's discharges for the most recent 5-year period, based
637on information available from the hospital inpatient discharge
638database in the Florida State Center for Health Information and
639Policy Analysis Statistics at the Agency for Health Care
640Administration.
641     Section 10.  Paragraph (d) of subsection (43) of section
642408.07, Florida Statutes, is amended to read:
643     408.07  Definitions.--As used in this chapter, with the
644exception of ss. 408.031-408.045, the term:
645     (43)  "Rural hospital" means an acute care hospital
646licensed under chapter 395, having 100 or fewer licensed beds
647and an emergency room, and which is:
648     (d)  A hospital with a service area that has a population
649of 100 persons or fewer per square mile. As used in this
650paragraph, the term "service area" means the fewest number of
651zip codes that account for 75 percent of the hospital's
652discharges for the most recent 5-year period, based on
653information available from the hospital inpatient discharge
654database in the Florida State Center for Health Information and
655Policy Analysis Statistics at the Agency for Health Care
656Administration; or
657
658Population densities used in this subsection must be based upon
659the most recently completed United States census. A hospital
660that received funds under s. 409.9116 for a quarter beginning no
661later than July 1, 2002, is deemed to have been and shall
662continue to be a rural hospital from that date through June 30,
6632012, if the hospital continues to have 100 or fewer licensed
664beds and an emergency room, or meets the criteria of s.
665395.602(2)(e)4. An acute care hospital that has not previously
666been designated as a rural hospital and that meets the criteria
667of this subsection shall be granted such designation upon
668application, including supporting documentation, to the Agency
669for Health Care Administration.
670     Section 11.  Paragraph (a) of subsection (4) of section
671408.18, Florida Statutes, is amended to read:
672     408.18  Health Care Community Antitrust Guidance Act;
673antitrust no-action letter; market-information collection and
674education.--
675     (4)(a)  Members of the health care community who seek
676antitrust guidance may request a review of their proposed
677business activity by the Attorney General's office. In
678conducting its review, the Attorney General's office may seek
679whatever documentation, data, or other material it deems
680necessary from the Agency for Health Care Administration, the
681Florida State Center for Health Information and Policy Analysis
682Statistics, and the Office of Insurance Regulation of the
683Financial Services Commission.
684     Section 12.  Paragraph (c) of subsection (4) of section
685381.026, Florida Statutes, is amended to read:
686     381.026  Florida Patient's Bill of Rights and
687Responsibilities.--
688     (4)  RIGHTS OF PATIENTS.--Each health care facility or
689provider shall observe the following standards:
690     (c)  Financial information and disclosure.--
691     1.  A patient has the right to be given, upon request, by
692the responsible provider, his or her designee, or a
693representative of the health care facility full information and
694necessary counseling on the availability of known financial
695resources for the patient's health care.
696     2.  A health care provider or a health care facility shall,
697upon request, disclose to each patient who is eligible for
698Medicare, in advance of treatment, whether the health care
699provider or the health care facility in which the patient is
700receiving medical services accepts assignment under Medicare
701reimbursement as payment in full for medical services and
702treatment rendered in the health care provider's office or
703health care facility.
704     3.  A health care provider or a health care facility shall,
705upon request, furnish a person, prior to provision of medical
706services, a reasonable estimate of charges for such services.
707Such reasonable estimate shall not preclude the health care
708provider or health care facility from exceeding the estimate or
709making additional charges based on changes in the patient's
710condition or treatment needs.
711     4.  Each licensed facility not operated by the state shall
712make available to the public on its Internet website or by other
713electronic means a description of and a link to the performance
714outcome and financial data that is published by the agency
715pursuant to s. 408.05(3)(k)(l). The facility shall place a
716notice in the reception area that such information is available
717electronically and the website address. The licensed facility
718may indicate that the pricing information is based on a
719compilation of charges for the average patient and that each
720patient's bill may vary from the average depending upon the
721severity of illness and individual resources consumed. The
722licensed facility may also indicate that the price of service is
723negotiable for eligible patients based upon the patient's
724ability to pay.
725     5.  A patient has the right to receive a copy of an
726itemized bill upon request. A patient has a right to be given an
727explanation of charges upon request.
728     Section 13.  Subsection (10) of section 395.301, Florida
729Statutes, is amended to read:
730     395.301  Itemized patient bill; form and content prescribed
731by the agency.--
732     (10)  Each licensed facility shall make available on its
733Internet website a link to the performance outcome and financial
734data that is published by the Agency for Health Care
735Administration pursuant to s. 408.05(3)(k)(l). The facility
736shall place a notice in the reception area that the information
737is available electronically and the facility's Internet website
738address.
739     Section 14.  Section 465.0244, Florida Statutes, is amended
740to read:
741     465.0244  Information disclosure.--Every pharmacy shall
742make available on its Internet website a link to the performance
743outcome and financial data that is published by the Agency for
744Health Care Administration pursuant to s. 408.05(3)(k)(l) and
745shall place in the area where customers receive filled
746prescriptions notice that such information is available
747electronically and the address of its Internet website.
748     Section 15.  Subsection (2) of section 627.6499, Florida
749Statutes, is amended to read:
750     627.6499  Reporting by insurers and third-party
751administrators.--
752     (2)  Each health insurance issuer shall make available on
753its Internet website a link to the performance outcome and
754financial data that is published by the Agency for Health Care
755Administration pursuant to s. 408.05(3)(k)(l) and shall include
756in every policy delivered or issued for delivery to any person
757in the state or any materials provided as required by s.
758627.64725 notice that such information is available
759electronically and the address of its Internet website.
760     Section 16.  Subsection (7) of section 641.54, Florida
761Statutes, is amended to read:
762     641.54  Information disclosure.--
763     (7)  Each health maintenance organization shall make
764available on its Internet website a link to the performance
765outcome and financial data that is published by the Agency for
766Health Care Administration pursuant to s. 408.05(3)(k)(l) and
767shall include in every policy delivered or issued for delivery
768to any person in the state or any materials provided as required
769by s. 627.64725 notice that such information is available
770electronically and the address of its Internet website.
771     Section 17.  This act shall take effect upon becoming a
772law.


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