HB 7073

1	A bill to be entitled
2	An act relating to health care information; providing a
3	short title; providing purpose; amending s. 408.05, F.S.;
4	renaming the State Center for Health Statistics; revising
5	criteria for collection and use of certain health-related
6	data; providing responsibilities of the Agency for Health
7	Care Administration; providing for agency consultation
8	with the State Consumer Health Information and Policy
9	Advisory Council for the dissemination of certain consumer
10	information; requiring the Florida Center for Health
11	Information and Policy Analysis to provide certain
12	technical assistance services; authorizing the agency to
13	monitor certain grants; removing a provision that
14	establishes the Comprehensive Health Information System
15	Trust Fund as the repository of certain funds; renaming
16	the State Comprehensive Health Information System Advisory
17	Council; providing for duties and responsibilities of the
18	State Consumer Health Information and Policy Advisory
19	Council; providing for membership, terms, officers, and
20	meetings; amending s. 408.061, F.S.; providing for health
21	care providers to submit additional data to the agency;
22	correcting a reference; amending s. 408.062, F.S.;
23	revising provisions relating to availability of specified
24	information on the agency's Internet website; requiring a
25	report; removing an obsolete provision; authorizing the
26	agency to develop an electronic health information
27	network; amending ss. 20.42, 381.001, 395.602, 395.6025,
28	408.07, and 408.18, F.S.; conforming references to changes
29	made by the act; amending ss. 381.026, 395.301, 627.6499,
30	and 641.54, F.S.; conforming a cross-reference; amending
31	s. 465.0244, F.S.; conforming a cross-reference;
32	prohibiting pharmacies from entering into contracts with
33	insurers and health maintenance organizations under
34	certain circumstances; providing communication criteria
35	for pharmacies, health insurers, health maintenance
36	organizations, and any agent, employee, administrator,
37	intermediary, assignee, or designee thereof; providing
38	responsibility of the Agency for Health Care
39	Administration for security of certain data and backup
40	systems; providing requirements for a secure storage
41	facility; providing an effective date.
42
43	Be It Enacted by the Legislature of the State of Florida:
44
45	Section 1.  This act may be cited as the "Coordinated
46	Health Care Information and Transparency Act of 2006."
47	Section 2.  The purpose of this act is to provide better
48	coordination of health information for purposes of public
49	health, policy analysis, and transparency of consumer health
50	care information.
51	Section 3.  Section 408.05, Florida Statutes, is amended to
52	read:
53	408.05  Florida State Center for Health Information and
54	Policy Analysis Statistics.--
55	(1)  ESTABLISHMENT.--The agency shall establish a Florida
56	State Center for Health Information and Policy Analysis
57	Statistics. The center shall establish a comprehensive health
58	information system to provide for the collection, compilation,
59	coordination, analysis, indexing, dissemination, and utilization
60	of both purposefully collected and extant health-related data
61	and statistics. The center shall be staffed with public health
62	experts, biostatisticians, information system analysts, health
63	policy experts, economists, and other staff necessary to carry
64	out its functions.
65	(2)  HEALTH-RELATED DATA STATISTICS.--The comprehensive
66	health information system operated by the Florida State Center
67	for Health Information and Policy Analysis Statistics shall
68	identify the best available data sources and coordinate the
69	compilation of extant health-related data and statistics and
70	purposefully collect data on:
71	(a)  The extent and nature of illness and disability of the
72	state population, including life expectancy, the incidence of
73	various acute and chronic illnesses, and infant and maternal
74	morbidity and mortality.
75	(b)  The impact of illness and disability of the state
76	population on the state economy and on other aspects of the
77	well-being of the people in this state.
78	(c)  Environmental, social, and other health hazards.
79	(d)  Health knowledge and practices of the people in this
80	state and determinants of health and nutritional practices and
81	status.
82	(e)  Health resources, including physicians, dentists,
83	nurses, and other health professionals, by specialty and type of
84	practice and acute, long-term care and other institutional care
85	facility supplies and specific services provided by hospitals,
86	nursing homes, home health agencies, and other health care
87	facilities.
88	(f)  Utilization of health care by type of provider.
89	(g)  Health care costs and financing, including trends in
90	health care prices and costs, the sources of payment for health
91	care services, and federal, state, and local expenditures for
92	health care.
93	(h)  Family formation, growth, and dissolution.
94	(i)  The extent of public and private health insurance
95	coverage in this state.
96	(j)  The quality of care provided by various health care
97	providers.
98	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
99	produce comparable and uniform health information and statistics
100	for the development of policy recommendations, the agency shall
101	perform the following functions:
102	(a)  Coordinate the activities of state agencies involved
103	in the design and implementation of the comprehensive health
104	information system.
105	(b)  Undertake research, development, and evaluation
106	respecting the comprehensive health information system.
107	(c)  Review the statistical activities of state agencies to
108	ensure the Department of Health to assure that they are
109	consistent with the comprehensive health information system.
110	(d)  Develop written agreements with local, state, and
111	federal agencies for the sharing of health-care-related data or
112	using the facilities and services of such agencies. State
113	agencies, local health councils, and other agencies under state
114	contract with the Department of Health shall assist the center
115	in obtaining, compiling, and transferring health-care-related
116	data maintained by state and local agencies. Written agreements
117	must specify the types, methods, and periodicity of data
118	exchanges and specify the types of data that will be transferred
119	to the center.
120	(e)  The agency shall Establish by rule the types of data
121	collected, compiled, processed, used, or shared. Decisions
122	regarding center data sets should be made based on consultation
123	with the State Consumer Comprehensive Health Information and
124	Policy System Advisory Council and other public and private
125	users regarding the types of data which should be collected and
126	their uses.
127	(f)  The center shall establish standardized means for
128	collecting health information and statistics under laws and
129	rules administered by the agency.
130	(f)(g)  Establish minimum health-care-related data sets
131	which are necessary on a continuing basis to fulfill the
132	collection requirements of the center and which shall be used by
133	state agencies in collecting and compiling health-care-related
134	data. The agency shall periodically review ongoing health care
135	data collections of the Department of Health and other state
136	agencies to determine if the collections are being conducted in
137	accordance with the established minimum sets of data.
138	(g)(h)  Establish advisory standards to ensure assure the
139	quality of health statistical and epidemiological data
140	collection, processing, and analysis by local, state, and
141	private organizations.
142	(h)(i)  Prescribe standards for the publication of health-
143	care-related data reported pursuant to this section which ensure
144	the reporting of accurate, valid, reliable, complete, and
145	comparable data. Such standards should include advisory warnings
146	to users of the data regarding the status and quality of any
147	data reported by or available from the center.
148	(i)(j)  Prescribe standards for the maintenance and
149	preservation of the center's data. This should include methods
150	for archiving data, retrieval of archived data, and data editing
151	and verification.
152	(j)(k)  Ensure that strict quality control measures are
153	maintained for the dissemination of data through publications,
154	studies, or user requests.
155	(k)(l)  Develop, in conjunction with the State Consumer
156	Comprehensive Health Information and Policy System Advisory
157	Council, and implement a long-range plan for making available
158	health care quality measures performance outcome and financial
159	data that will allow consumers to compare health care services.
160	The health care quality measures performance outcomes and
161	financial data the agency must make available shall include, but
162	is not limited to, pharmaceuticals, physicians, health care
163	facilities, and health plans and managed care entities. The
164	agency shall submit the initial plan to the Governor, the
165	President of the Senate, and the Speaker of the House of
166	Representatives by January 1, 2006, and shall update the plan
167	and report on the status of its implementation annually
168	thereafter. The agency shall also make the plan and status
169	report available to the public on its Internet website. As part
170	of the plan, the agency shall identify the process and
171	timeframes for implementation, any barriers to implementation,
172	and recommendations of changes in the law that may be enacted by
173	the Legislature to eliminate the barriers. As preliminary
174	elements of the plan, the agency shall:
175	1.  Make available patient-safety indicators, inpatient
176	quality indicators, and performance outcome and patient charge
177	data collected from health care facilities pursuant to s.
178	408.061(1)(a) and (2). The terms "patient-safety indicators" and
179	"inpatient quality indicators" shall be as defined by the
180	Centers for Medicare and Medicaid Services, the National Quality
181	Forum, the Joint Commission on Accreditation of Healthcare
182	Organizations, the Agency for Healthcare Research and Quality,
183	the Centers for Disease Control and Prevention, or a similar
184	national entity that establishes standards to measure the
185	performance of health care providers, or by other states. The
186	agency shall determine which conditions, and procedures, health
187	care quality measures performance outcomes, and patient charge
188	data to disclose based upon input from the council. When
189	determining which conditions and procedures are to be disclosed,
190	the council and the agency shall consider variation in costs,
191	variation in outcomes, and magnitude of variations and other
192	relevant information. When determining which health care quality
193	measures performance outcomes to disclose, the agency:
194	a.  Shall consider such factors as volume of cases; average
195	patient charges; average length of stay; complication rates;
196	mortality rates; and infection rates, among others, which shall
197	be adjusted for case mix and severity, if applicable.
198	b.  May consider such additional measures that are adopted
199	by the Centers for Medicare and Medicaid Studies, National
200	Quality Forum, the Joint Commission on Accreditation of
201	Healthcare Organizations, the Agency for Healthcare Research and
202	Quality, Centers for Disease Control and Prevention, or a
203	similar national entity that establishes standards to measure
204	the performance of health care providers, or by other states.
205
206	When determining which patient charge data to disclose, the
207	agency shall consider such measures as average charge, average
208	net revenue per adjusted patient day, average cost per adjusted
209	patient day, and average cost per admission, among others.
210	2.  Make available performance measures, benefit design,
211	and premium cost data from health plans licensed pursuant to
212	chapter 627 or chapter 641. The agency shall determine which
213	health care quality measures performance outcome and member and
214	subscriber cost data to disclose, based upon input from the
215	council. When determining which data to disclose, the agency
216	shall consider information that may be required by either
217	individual or group purchasers to assess the value of the
218	product, which may include membership satisfaction, quality of
219	care, current enrollment or membership, coverage areas,
220	accreditation status, premium costs, plan costs, premium
221	increases, range of benefits, copayments and deductibles,
222	accuracy and speed of claims payment, credentials of physicians,
223	number of providers, names of network providers, and hospitals
224	in the network. Health plans shall make available to the agency
225	any such data or information that is not currently reported to
226	the agency or the office.
227	3.  Determine the method and format for public disclosure
228	of data reported pursuant to this paragraph. The agency shall
229	make its determination based upon input from the State Consumer
230	Comprehensive Health Information and Policy System Advisory
231	Council. At a minimum, the data shall be made available on the
232	agency's Internet website in a manner that allows consumers to
233	conduct an interactive search that allows them to view and
234	compare the information for specific providers. The website must
235	include such additional information as is determined necessary
236	to ensure that the website enhances informed decisionmaking
237	among consumers and health care purchasers, which shall include,
238	at a minimum, appropriate guidance on how to use the data and an
239	explanation of why the data may vary from provider to provider.
240	The data specified in subparagraph 1. shall be released no later
241	than January 1, 2006, for the reporting of infection rates, and
242	no later than October 1, 2005, for mortality rates and
243	complication rates. The data specified in subparagraph 2. shall
244	be released no later than October 1, 2006.
245	(4)  TECHNICAL ASSISTANCE.--
246	(a)  The center shall provide technical assistance to
247	persons or organizations engaged in health planning activities
248	in the effective use of statistics collected and compiled by the
249	center. The center shall also provide the following additional
250	technical assistance services:
251	1.(a)  Establish procedures identifying the circumstances
252	under which, the places at which, the persons from whom, and the
253	methods by which a person may secure data from the center,
254	including procedures governing requests, the ordering of
255	requests, timeframes for handling requests, and other procedures
256	necessary to facilitate the use of the center's data. To the
257	extent possible, the center should provide current data timely
258	in response to requests from public or private agencies.
259	2.(b)  Provide assistance to data sources and users in the
260	areas of database design, survey design, sampling procedures,
261	statistical interpretation, and data access to promote improved
262	health-care-related data sets.
263	3.(c)  Identify health care data gaps and provide technical
264	assistance to seek cooperative agreements with other public or
265	private organizations for meeting documented health care data
266	needs.
267	4.(d)  Assist other organizations in developing statistical
268	abstracts of their data sets that could be used by the center.
269	5.(e)  Provide statistical support to state agencies with
270	regard to the use of databases maintained by the center.
271	6.(f)  To the extent possible, respond to multiple requests
272	for information not currently collected by the center or
273	available from other sources by initiating data collection.
274	7.(g)  Maintain detailed information on data maintained by
275	other local, state, federal, and private agencies in order to
276	advise those who use the center of potential sources of data
277	which are requested but which are not available from the center.
278	8.(h)  Respond to requests for data which are not available
279	in published form by initiating special computer runs on data
280	sets available to the center.
281	9.  Monitor innovations in health information technology,
282	informatics, and the exchange of health information and maintain
283	a repository of technical resources to support the development
284	of a health information network.
285	(b)  The agency shall administer, manage, and monitor
286	grants to not-for-profit organizations, regional health
287	information organizations, public health departments, or state
288	agencies that submit proposals for planning, implementation, or
289	training projects to advance the development of a health
290	information network. Any grant contract shall be evaluated to
291	ensure the effective outcome of the health information project.
292	(c)  The agency shall initiate, oversee, manage, and
293	evaluate the integration of health care data from each state
294	agency that collects, stores, and reports on health care issues
295	and make that data available to any health care practitioner
296	through a state health information network.
297	(5)  PUBLICATIONS; REPORTS; SPECIAL STUDIES.--The center
298	shall provide for the widespread dissemination of data which it
299	collects and analyzes. The center shall have the following
300	publication, reporting, and special study functions:
301	(a)  The center shall publish and make available
302	periodically to agencies and individuals health statistics
303	publications of general interest, including health plan consumer
304	reports and health maintenance organization member satisfaction
305	surveys HMO report cards; publications providing health
306	statistics on topical health policy issues; publications that
307	provide health status profiles of the people in this state; and
308	other topical health statistics publications.
309	(b)  The center shall publish, make available, and
310	disseminate, promptly and as widely as practicable, the results
311	of special health surveys, health care research, and health care
312	evaluations conducted or supported under this section. Any
313	publication by the center must include a statement of the
314	limitations on the quality, accuracy, and completeness of the
315	data.
316	(c)  The center shall provide indexing, abstracting,
317	translation, publication, and other services leading to a more
318	effective and timely dissemination of health care statistics.
319	(d)  The center shall be responsible for publishing and
320	disseminating an annual report on the center's activities.
321	(e)  The center shall be responsible, to the extent
322	resources are available, for conducting a variety of special
323	studies and surveys to expand the health care information and
324	statistics available for health policy analyses, particularly
325	for the review of public policy issues. The center shall develop
326	a process by which users of the center's data are periodically
327	surveyed regarding critical data needs and the results of the
328	survey considered in determining which special surveys or
329	studies will be conducted. The center shall select problems in
330	health care for research, policy analyses, or special data
331	collections on the basis of their local, regional, or state
332	importance; the unique potential for definitive research on the
333	problem; and opportunities for application of the study
334	findings.
335	(6)  PROVIDER DATA REPORTING.--This section does not confer
336	on the agency the power to demand or require that a health care
337	provider or professional furnish information, records of
338	interviews, written reports, statements, notes, memoranda, or
339	data other than as expressly required by law.
340	(7)  BUDGET; FEES; TRUST FUND.--
341	(a)  The Legislature intends that funding for the Florida
342	State Center for Health Information and Policy Analysis
343	Statistics be appropriated from the General Revenue Fund.
344	(b)  The Florida State Center for Health Information and
345	Policy Analysis Statistics may apply for and receive and accept
346	grants, gifts, and other payments, including property and
347	services, from any governmental or other public or private
348	entity or person and make arrangements as to the use of same,
349	including the undertaking of special studies and other projects
350	relating to health-care-related topics. Funds obtained pursuant
351	to this paragraph may not be used to offset annual
352	appropriations from the General Revenue Fund.
353	(c)  The center may charge such reasonable fees for
354	services as the agency prescribes by rule. The established fees
355	may not exceed the reasonable cost for such services. Fees
356	collected may not be used to offset annual appropriations from
357	the General Revenue Fund.
358	(d)  The agency shall establish a Comprehensive Health
359	Information System Trust Fund as the repository of all funds
360	appropriated to, and fees and grants collected for, services of
361	the State Center for Health Statistics. Any funds, other than
362	funds appropriated to the center from the General Revenue Fund,
363	which are raised or collected by the agency for the operation of
364	the center and which are not needed to meet the expenses of the
365	center for its current fiscal year shall be available to the
366	agency in succeeding years.
367	(8)  STATE CONSUMER COMPREHENSIVE HEALTH INFORMATION AND
368	POLICY SYSTEM ADVISORY COUNCIL.--
369	(a)  There is established in the agency the State Consumer
370	Comprehensive Health Information and Policy System Advisory
371	Council to assist the center in reviewing the comprehensive
372	health information system, including the identification,
373	collection, standardization, sharing, and coordination of
374	health-related data, fraud and abuse data, and professional and
375	facility licensing data among federal, state, local, and private
376	entities and to recommend improvements for purposes of public
377	health, policy analysis, and transparency of consumer health
378	care information such system. The council shall consist of the
379	following members:
380	1.  An employee of the Executive Office of the Governor, to
381	be appointed by the Governor.
382	2.  An employee of the Office of Insurance Regulation, to
383	be appointed by the director of the office.
384	3.  An employee of the Department of Education, to be
385	appointed by the Commissioner of Education.
386	4.  Ten persons, to be appointed by the Secretary of Health
387	Care Administration, representing other state and local
388	agencies, state universities, business and health the Florida
389	Association of Business/Health coalitions, local health
390	councils, professional health-care-related associations,
391	consumers, and purchasers.
392	(b)  Each member of the council shall be appointed to serve
393	for a term of 2 4 years following from the date of appointment,
394	except the term of appointment shall end 3 years following the
395	date of appointment for members appointed in 2003, 2004, and
396	2005. that A vacancy shall be filled by appointment for the
397	remainder of the term, and each appointing authority retains the
398	right to reappoint members whose terms of appointment have
399	expired. and except that:
400	1.  Three of the members initially appointed by the
401	Director of Health Care Administration shall each be appointed
402	for a term of 3 years.
403	2.  Two of the members initially appointed by the Director
404	of Health Care Administration shall each be appointed for a term
405	of 2 years.
406	3.  Two of the members initially appointed by the Director
407	of Health Care Administration shall each be appointed for a term
408	of 1 year.
409	(c)  The council may meet at the call of its chair, at the
410	request of the agency department, or at the request of a
411	majority of its membership, but the council must meet at least
412	quarterly.
413	(d)  Members shall elect a chair and vice chair annually.
414	(e)  A majority of the members constitutes a quorum, and
415	the affirmative vote of a majority of a quorum is necessary to
416	take action.
417	(f)  The council shall maintain minutes of each meeting and
418	shall make such minutes available to any person.
419	(g)  Members of the council shall serve without
420	compensation but shall be entitled to receive reimbursement for
421	per diem and travel expenses as provided in s. 112.061.
422	(h)  The council's duties and responsibilities include, but
423	are not limited to, the following:
424	1.  To develop a mission statement, goals, and a plan of
425	action based on the guiding principles specified in s. 282.3032
426	for the identification, collection, standardization, sharing,
427	and coordination of health-related data across federal, state,
428	and local government and private-sector entities.
429	2.  To develop a review process to ensure cooperative
430	planning among agencies that collect or maintain health-related
431	data.
432	3.  To create ad hoc issue-oriented technical workgroups on
433	an as-needed basis to make recommendations to the council.
434	(9)  APPLICATION TO OTHER AGENCIES.--Nothing in this
435	section shall limit, restrict, affect, or control the
436	collection, analysis, release, or publication of data by any
437	state agency pursuant to its statutory authority, duties, or
438	responsibilities.
439	Section 4.  Paragraph (b) of subsection (1) and subsection
440	(10) of section 408.061, Florida Statutes, are amended to read:
441	408.061  Data collection; uniform systems of financial
442	reporting; information relating to physician charges;
443	confidential information; immunity.--
444	(1)  The agency shall require the submission by health care
445	facilities, health care providers, and health insurers of data
446	necessary to carry out the agency's duties. Specifications for
447	data to be collected under this section shall be developed by
448	the agency with the assistance of technical advisory panels
449	including representatives of affected entities, consumers,
450	purchasers, and such other interested parties as may be
451	determined by the agency.
452	(b)  Data to be submitted by health care providers may
453	include, but are not limited to: professional organization and
454	specialty board affiliations, Medicare and Medicaid
455	participation, types of services offered to patients, amount of
456	revenue and expenses of the health care provider, and such other
457	data which are reasonably necessary to study utilization
458	patterns. Data submitted shall be certified by the appropriate
459	duly authorized representative or employee of the health care
460	provider that the information submitted is true and accurate.
461	(10)  The agency shall be the primary source for collection
462	and dissemination of health care data. No other agency of state
463	government may gather data from a health care provider licensed
464	or regulated under this chapter without first determining if the
465	data is currently being collected by the agency and
466	affirmatively demonstrating that it would be more cost-effective
467	for an agency of state government other than the agency to
468	gather the health care data. The secretary director shall ensure
469	that health care data collected by the divisions within the
470	agency is coordinated. It is the express intent of the
471	Legislature that all health care data be collected by a single
472	source within the agency and that other divisions within the
473	agency, and all other agencies of state government, obtain data
474	for analysis, regulation, and public dissemination purposes from
475	that single source. Confidential information may be released to
476	other governmental entities or to parties contracting with the
477	agency to perform agency duties or functions as needed in
478	connection with the performance of the duties of the receiving
479	entity. The receiving entity or party shall retain the
480	confidentiality of such information as provided for herein.
481	Section 5.  Paragraphs (h) and (j) of subsection (1) and
482	subsections (2) and (5) of section 408.062, Florida Statutes,
483	are amended to read:
484	408.062  Research, analyses, studies, and reports.--
485	(1)  The agency shall conduct research, analyses, and
486	studies relating to health care costs and access to and quality
487	of health care services as access and quality are affected by
488	changes in health care costs. Such research, analyses, and
489	studies shall include, but not be limited to:
490	(h)  The collection of a statistically valid sample of data
491	on the retail prices charged by pharmacies for the 100 50 most
492	frequently prescribed medicines from any pharmacy licensed by
493	this state as a special study authorized by the Legislature to
494	be performed by the agency quarterly. If the drug is available
495	generically, price data shall be reported for the generic drug
496	and price data of a brand-named drug for which the generic drug
497	is the equivalent shall be reported. The agency shall make
498	available on its Internet website for each pharmacy, no later
499	than October 1, 2006 2005, drug prices for a 30-day supply at a
500	standard dose. The data collected shall be reported for each
501	drug by pharmacy and by metropolitan statistical area or region
502	and updated quarterly.
503	(j)  The making available on its Internet website beginning
504	no later than October 1, 2004, and in a hard-copy format upon
505	request, of patient charge, volumes, length of stay, and
506	performance outcome indicators collected from health care
507	facilities pursuant to s. 408.061(1)(a) for specific medical
508	conditions, surgeries, and procedures provided in inpatient and
509	outpatient facilities as determined by the agency. In making the
510	determination of specific medical conditions, surgeries, and
511	procedures to include, the agency shall consider such factors as
512	volume, severity of the illness, urgency of admission,
513	individual and societal costs, and whether the condition is
514	acute or chronic. Performance outcome indicators shall be risk
515	adjusted or severity adjusted, as applicable, using nationally
516	recognized risk adjustment methodologies or software consistent
517	with the standards of the Agency for Healthcare Research and
518	Quality and as selected by the agency. The website shall also
519	provide an interactive search that allows consumers to view and
520	compare the information for specific facilities, a map that
521	allows consumers to select a county or region, definitions of
522	all of the data, descriptions of each procedure, and an
523	explanation about why the data may differ from facility to
524	facility. Such public data shall be updated quarterly. The
525	agency shall submit an annual status report on the collection of
526	data and publication of health care quality measures performance
527	outcome indicators to the Governor, the Speaker of the House of
528	Representatives, the President of the Senate, and the
529	substantive legislative committees with the first status report
530	due January 1, 2005.
531	(2)  The agency may assess annually the caesarean section
532	rate in Florida hospitals using the analysis methodology that
533	the agency determines most appropriate. The data from this
534	assessment shall be published periodically on the agency's
535	Internet website. To assist the agency in determining the impact
536	of this chapter on Florida hospitals' caesarean section rates,
537	each provider hospital, as defined in s. 383.336, shall notify
538	the agency of the date of implementation of the practice
539	parameters and the date of the first meeting of the hospital
540	peer review board created pursuant to this chapter. The agency
541	shall use these dates in monitoring any change in provider
542	hospital caesarean section rates. An annual report based on this
543	monitoring and assessment shall be submitted to the Governor,
544	the Speaker of the House of Representatives, and the President
545	of the Senate by the agency, with the first annual report due
546	January 1, 1993.
547	(5)  The agency shall develop and implement a strategy for
548	the adoption and use of electronic health records, including the
549	development of an electronic health information network for the
550	sharing of electronic health records among health care
551	facilities, health care providers, and health insurers. The
552	agency may develop rules to facilitate the functionality and
553	protect the confidentiality of electronic health records. The
554	agency shall report to the Governor, the Speaker of the House of
555	Representatives, and the President of the Senate on legislative
556	recommendations to protect the confidentiality of electronic
557	health records.
558	Section 6.  Subsection (3) of section 20.42, Florida
559	Statutes, is amended to read:
560	20.42  Agency for Health Care Administration.--
561	(3)  The department shall be the chief health policy and
562	planning entity for the state. The department is responsible for
563	health facility licensure, inspection, and regulatory
564	enforcement; investigation of consumer complaints related to
565	health care facilities and managed care plans; the
566	implementation of the certificate of need program; the operation
567	of the Florida State Center for Health Information and Policy
568	Analysis Statistics; the administration of the Medicaid program;
569	the administration of the contracts with the Florida Healthy
570	Kids Corporation; the certification of health maintenance
571	organizations and prepaid health clinics as set forth in part
572	III of chapter 641; and any other duties prescribed by statute
573	or agreement.
574	Section 7.  Subsection (3) of section 381.001, Florida
575	Statutes, is amended to read:
576	381.001  Legislative intent; public health system.--
577	(3)  It is, furthermore, the intent of the Legislature that
578	the public health system include comprehensive planning, data
579	collection, technical support, and health resource development
580	functions. These functions include, but are not limited to,
581	state laboratory and pharmacy services, the state vital
582	statistics system, the Florida State Center for Health
583	Information and Policy Analysis Statistics, emergency medical
584	services coordination and support, and recruitment, retention,
585	and development of preventive and primary health care
586	professionals and managers.
587	Section 8.  Paragraph (e) of subsection (2) of section
588	395.602, Florida Statutes, is amended to read:
589	395.602  Rural hospitals.--
590	(2)  DEFINITIONS.--As used in this part:
591	(e)  "Rural hospital" means an acute care hospital licensed
592	under this chapter, having 100 or fewer licensed beds and an
593	emergency room, which is:
594	1.  The sole provider within a county with a population
595	density of no greater than 100 persons per square mile;
596	2.  An acute care hospital, in a county with a population
597	density of no greater than 100 persons per square mile, which is
598	at least 30 minutes of travel time, on normally traveled roads
599	under normal traffic conditions, from any other acute care
600	hospital within the same county;
601	3.  A hospital supported by a tax district or subdistrict
602	whose boundaries encompass a population of 100 persons or fewer
603	per square mile;
604	4.  A hospital in a constitutional charter county with a
605	population of over 1 million persons that has imposed a local
606	option health service tax pursuant to law and in an area that
607	was directly impacted by a catastrophic event on August 24,
608	1992, for which the Governor of Florida declared a state of
609	emergency pursuant to chapter 125, and has 120 beds or less that
610	serves an agricultural community with an emergency room
611	utilization of no less than 20,000 visits and a Medicaid
612	inpatient utilization rate greater than 15 percent;
613	5.  A hospital with a service area that has a population of
614	100 persons or fewer per square mile. As used in this
615	subparagraph, the term "service area" means the fewest number of
616	zip codes that account for 75 percent of the hospital's
617	discharges for the most recent 5-year period, based on
618	information available from the hospital inpatient discharge
619	database in the Florida State Center for Health Information and
620	Policy Analysis Statistics at the Agency for Health Care
621	Administration; or
622	6.  A hospital designated as a critical access hospital, as
623	defined in s. 408.07(15).
624
625	Population densities used in this paragraph must be based upon
626	the most recently completed United States census. A hospital
627	that received funds under s. 409.9116 for a quarter beginning no
628	later than July 1, 2002, is deemed to have been and shall
629	continue to be a rural hospital from that date through June 30,
630	2012, if the hospital continues to have 100 or fewer licensed
631	beds and an emergency room, or meets the criteria of
632	subparagraph 4. An acute care hospital that has not previously
633	been designated as a rural hospital and that meets the criteria
634	of this paragraph shall be granted such designation upon
635	application, including supporting documentation to the Agency
636	for Health Care Administration.
637	Section 9.  Section 395.6025, Florida Statutes, is amended
638	to read:
639	395.6025  Rural hospital replacement
640	facilities.--Notwithstanding the provisions of s. 408.036, a
641	hospital defined as a statutory rural hospital in accordance
642	with s. 395.602, or a not-for-profit operator of rural
643	hospitals, is not required to obtain a certificate of need for
644	the construction of a new hospital located in a county with a
645	population of at least 15,000 but no more than 18,000 and a
646	density of less than 30 persons per square mile, or a
647	replacement facility, provided that the replacement, or new,
648	facility is located within 10 miles of the site of the currently
649	licensed rural hospital and within the current primary service
650	area. As used in this section, the term "service area" means the
651	fewest number of zip codes that account for 75 percent of the
652	hospital's discharges for the most recent 5-year period, based
653	on information available from the hospital inpatient discharge
654	database in the Florida State Center for Health Information and
655	Policy Analysis Statistics at the Agency for Health Care
656	Administration.
657	Section 10.  Paragraph (d) of subsection (43) of section
658	408.07, Florida Statutes, is amended to read:
659	408.07  Definitions.--As used in this chapter, with the
660	exception of ss. 408.031-408.045, the term:
661	(43)  "Rural hospital" means an acute care hospital
662	licensed under chapter 395, having 100 or fewer licensed beds
663	and an emergency room, and which is:
664	(d)  A hospital with a service area that has a population
665	of 100 persons or fewer per square mile. As used in this
666	paragraph, the term "service area" means the fewest number of
667	zip codes that account for 75 percent of the hospital's
668	discharges for the most recent 5-year period, based on
669	information available from the hospital inpatient discharge
670	database in the Florida State Center for Health Information and
671	Policy Analysis Statistics at the Agency for Health Care
672	Administration; or
673
674	Population densities used in this subsection must be based upon
675	the most recently completed United States census. A hospital
676	that received funds under s. 409.9116 for a quarter beginning no
677	later than July 1, 2002, is deemed to have been and shall
678	continue to be a rural hospital from that date through June 30,
679	2012, if the hospital continues to have 100 or fewer licensed
680	beds and an emergency room, or meets the criteria of s.
681	395.602(2)(e)4. An acute care hospital that has not previously
682	been designated as a rural hospital and that meets the criteria
683	of this subsection shall be granted such designation upon
684	application, including supporting documentation, to the Agency
685	for Health Care Administration.
686	Section 11.  Paragraph (a) of subsection (4) of section
687	408.18, Florida Statutes, is amended to read:
688	408.18  Health Care Community Antitrust Guidance Act;
689	antitrust no-action letter; market-information collection and
690	education.--
691	(4)(a)  Members of the health care community who seek
692	antitrust guidance may request a review of their proposed
693	business activity by the Attorney General's office. In
694	conducting its review, the Attorney General's office may seek
695	whatever documentation, data, or other material it deems
696	necessary from the Agency for Health Care Administration, the
697	Florida State Center for Health Information and Policy Analysis
698	Statistics, and the Office of Insurance Regulation of the
699	Financial Services Commission.
700	Section 12.  Paragraph (c) of subsection (4) of section
701	381.026, Florida Statutes, is amended to read:
702	381.026  Florida Patient's Bill of Rights and
703	Responsibilities.--
704	(4)  RIGHTS OF PATIENTS.--Each health care facility or
705	provider shall observe the following standards:
706	(c)  Financial information and disclosure.--
707	1.  A patient has the right to be given, upon request, by
708	the responsible provider, his or her designee, or a
709	representative of the health care facility full information and
710	necessary counseling on the availability of known financial
711	resources for the patient's health care.
712	2.  A health care provider or a health care facility shall,
713	upon request, disclose to each patient who is eligible for
714	Medicare, in advance of treatment, whether the health care
715	provider or the health care facility in which the patient is
716	receiving medical services accepts assignment under Medicare
717	reimbursement as payment in full for medical services and
718	treatment rendered in the health care provider's office or
719	health care facility.
720	3.  A health care provider or a health care facility shall,
721	upon request, furnish a person, prior to provision of medical
722	services, a reasonable estimate of charges for such services.
723	Such reasonable estimate shall not preclude the health care
724	provider or health care facility from exceeding the estimate or
725	making additional charges based on changes in the patient's
726	condition or treatment needs.
727	4.  Each licensed facility not operated by the state shall
728	make available to the public on its Internet website or by other
729	electronic means a description of and a link to the performance
730	outcome and financial data that is published by the agency
731	pursuant to s. 408.05(3)(k)(l). The facility shall place a
732	notice in the reception area that such information is available
733	electronically and the website address. The licensed facility
734	may indicate that the pricing information is based on a
735	compilation of charges for the average patient and that each
736	patient's bill may vary from the average depending upon the
737	severity of illness and individual resources consumed. The
738	licensed facility may also indicate that the price of service is
739	negotiable for eligible patients based upon the patient's
740	ability to pay.
741	5.  A patient has the right to receive a copy of an
742	itemized bill upon request. A patient has a right to be given an
743	explanation of charges upon request.
744	Section 13.  Subsection (10) of section 395.301, Florida
745	Statutes, is amended to read:
746	395.301  Itemized patient bill; form and content prescribed
747	by the agency.--
748	(10)  Each licensed facility shall make available on its
749	Internet website a link to the performance outcome and financial
750	data that is published by the Agency for Health Care
751	Administration pursuant to s. 408.05(3)(k)(l). The facility
752	shall place a notice in the reception area that the information
753	is available electronically and the facility's Internet website
754	address.
755	Section 14.  Section 465.0244, Florida Statutes, is amended
756	to read:
757	465.0244  Information disclosure.--
758	(1)  Every pharmacy shall make available on its Internet
759	website a link to the performance outcome and financial data
760	that is published by the Agency for Health Care Administration
761	pursuant to s. 408.05(3)(k)(l) and shall place in the area where
762	customers receive filled prescriptions notice that such
763	information is available electronically and the address of its
764	Internet website.
765	(2)  An agreement among any of the following:
766	(a)  The holder of a pharmacy permit issued under this
767	chapter;
768	(b)  A health maintenance organization licensed under part
769	I of chapter 641;
770	(c)  A health insurer licensed under chapter 624; or
771	(d)  An agent, employee, administrator, intermediary,
772	assignee, or designee of any of the entities specified in this
773	subsection,
774
775	shall not contain any term or condition that prohibits,
776	restricts, or discourages the communication of information
777	relating to prescription drug pricing, including, but not
778	limited to, reimbursement formulas, dispensing fees, discounts,
779	exclusive buying arrangements, guarantees, or rebates.
780	Section 15.  Subsection (2) of section 627.6499, Florida
781	Statutes, is amended to read:
782	627.6499  Reporting by insurers and third-party
783	administrators.--
784	(2)  Each health insurance issuer shall make available on
785	its Internet website a link to the performance outcome and
786	financial data that is published by the Agency for Health Care
787	Administration pursuant to s. 408.05(3)(k)(l) and shall include
788	in every policy delivered or issued for delivery to any person
789	in the state or any materials provided as required by s.
790	627.64725 notice that such information is available
791	electronically and the address of its Internet website.
792	Section 16.  Subsection (7) of section 641.54, Florida
793	Statutes, is amended to read:
794	641.54  Information disclosure.--
795	(7)  Each health maintenance organization shall make
796	available on its Internet website a link to the performance
797	outcome and financial data that is published by the Agency for
798	Health Care Administration pursuant to s. 408.05(3)(k)(l) and
799	shall include in every policy delivered or issued for delivery
800	to any person in the state or any materials provided as required
801	by s. 627.64725 notice that such information is available
802	electronically and the address of its Internet website.
803	Section 17.  For the purpose of protecting and ensuring the
804	safety and security of the data held by the Agency for Health
805	Care Administration, as described in s. 408.061, Florida
806	Statutes, the agency shall be responsible for ensuring that data
807	and data backup systems are housed at a secure facility that
808	meets or exceeds the following requirements:
809	(a)  The facility must be located in the state;
810	(b)  The facility must be designated as a critical facility
811	by the county emergency management agency, under s. 252.38,
812	Florida Statutes, in the county where the facility is located;
813	(c)  The facility must be designed to withstand a category
814	5 hurricane and be outside the 500-year flood zone established
815	by the Federal Emergency Management Agency;
816	(d)  The facility must have six or more tier?one
817	telecommunication carriers deployed at the facility;
818	(e)  The facility must have commercial power supplied by at
819	least two separate substation feeders and must be able to
820	operate continuously for at least 5 days on its own power
821	generation systems without refueling should such commercial
822	power be interrupted; and
823	(f)  The facility has successfully undergone a Statement on
824	Auditing Standards (SAS) No. 70 review, representing that the
825	facility has been through an in-depth review of the security and
826	information technology control process relating to its
827	operation.
828	Section 18.  This act shall take effect upon becoming a
829	law.

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