CS/HB 1435

1
A bill to be entitled
2An act relating to consumer information concerning health
3care; providing a short title; providing a purpose;
4amending s. 381.026, F.S.; requiring a health care
5provider or a health care facility to provide an uninsured
6person with a reasonable estimate of charges for planned
7nonemergency medical services before such services are
8provided; requiring that the provider or the facility
9provide the uninsured person with information regarding
10such provider's or facility's discount or charity
11policies; requiring that the estimate be in writing and in
12a language comprehensible to an ordinary layperson;
13amending s. 395.301, F.S.; requiring certain licensed
14facilities to provide a written estimate within a certain
15period of time to an uninsured person seeking planned
16nonemergency elective admission; requiring the facility to
17notify the person if the estimate is revised; requiring
18the facility to provide the person with a copy of any
19discount or charity care discount policies for which such
20person may be eligible; requiring the facility to place a
21notice in the reception area where such information is
22available; imposing a monetary penalty if the facility
23fails to provide the requested information; amending s.
24408.05, F.S.; revising the list of patient charge data
25that may be disclosed by the Agency for Health Care
26Administration; requiring the agency to publish on its
27website information concerning prices for the most
28commonly performed adult and pediatric procedures;
29requiring the Agency for Health Care Administration to
30conduct a study of community benefits programs in other
31states; requiring the agency to submit a report to the
32relevant committees of the Senate and the House of
33Representatives by January 1, 2009; requiring the Office
34of Program Policy Analysis and Government Accountability
35to conduct a study of certain charitable hospitals;
36requiring the office to submit a report to the relevant
37committees of the Senate and the House of Representatives
38by January 1, 2009; providing an effective date.
39
40Be It Enacted by the Legislature of the State of Florida:
41
42     Section 1.  This act may be cited as the "Health Care
43Consumer's Right to Information Act."
44     Section 2.  The purpose of this act is to provide health
45care consumers with reliable and understandable information
46about facility charges to assist consumers in making informed
47decisions about health care.
48     Section 3.  Paragraph (c) of subsection (4) of section
49381.026, Florida Statutes, is amended to read:
50     381.026  Florida Patient's Bill of Rights and
51Responsibilities.--
52     (4)  RIGHTS OF PATIENTS.--Each health care facility or
53provider shall observe the following standards:
54     (c)  Financial information and disclosure.--
55     1.  A patient has the right to be given, upon request, by
56the responsible provider, his or her designee, or a
57representative of the health care facility full information and
58necessary counseling on the availability of known financial
59resources for the patient's health care.
60     2.  A health care provider or a health care facility shall,
61upon request, disclose to each patient who is eligible for
62Medicare, in advance of treatment, whether the health care
63provider or the health care facility in which the patient is
64receiving medical services accepts assignment under Medicare
65reimbursement as payment in full for medical services and
66treatment rendered in the health care provider's office or
67health care facility.
68     3.  A health care provider or a health care facility shall,
69upon request, furnish a person, prior to provision of medical
70services, a reasonable estimate of charges for such services.
71The health care provider or the health care facility shall
72provide an uninsured person, prior to the provision of a planned
73nonemergency medical service, a reasonable estimate of charges
74for such service and information regarding the provider's or
75facility's discount or charity policies for which the uninsured
76person may be eligible. Estimates shall, to the extent possible,
77be written in a language comprehensible to an ordinary
78layperson. Such reasonable estimate shall not preclude the
79health care provider or health care facility from exceeding the
80estimate or making additional charges based on changes in the
81patient's condition or treatment needs.
82     4.  Each licensed facility not operated by the state shall
83make available to the public on its Internet website or by other
84electronic means a description of and a link to the performance
85outcome and financial data that is published by the agency
86pursuant to s. 408.05(3)(k). The facility shall place a notice
87in the reception area that such information is available
88electronically and the website address. The licensed facility
89may indicate that the pricing information is based on a
90compilation of charges for the average patient and that each
91patient's bill may vary from the average depending upon the
92severity of illness and individual resources consumed. The
93licensed facility may also indicate that the price of service is
94negotiable for eligible patients based upon the patient's
95ability to pay.
96     5.  A patient has the right to receive a copy of an
97itemized bill upon request. A patient has a right to be given an
98explanation of charges upon request.
99     Section 4.  Present subsections (8), (9), and (10) of
100section 395.301, Florida Statutes, are redesignated as
101subsections (9), (10), and (11), respectively, and a new
102subsection (8) is added to that section to read:
103     395.301  Itemized patient bill; form and content prescribed
104by the agency.--
105     (8)  Each licensed facility that is not operated by the
106state shall provide any uninsured person seeking planned
107nonemergency elective admission a written good faith estimate of
108reasonably anticipated charges for the facility to treat such
109person. The estimate must be provided to the uninsured person
110within 7 business days after the person notifies the facility
111and the facility confirms that the person is uninsured. The
112estimate may be the average charges for that diagnosis-related
113group or the average charges for that procedure. Upon request,
114the facility shall notify the person of any revision to the good
115faith estimate. Such estimate does not preclude the actual
116charges from exceeding the estimate. The facility shall also
117provide to the uninsured person a copy of any facility discount
118and charity care discount policies for which the uninsured
119person may be eligible. The facility shall place a notice in the
120reception area where such information is available. Failure to
121provide the estimate as required by this subsection shall result
122in a fine of $500 for each instance of the facility's failure to
123provide the requested information.
124     Section 5.  Paragraph (k) of subsection (3) of section
125408.05, Florida Statutes, is amended to read:
126     408.05  Florida Center for Health Information and Policy
127Analysis.--
128     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
129produce comparable and uniform health information and statistics
130for the development of policy recommendations, the agency shall
131perform the following functions:
132     (k)  Develop, in conjunction with the State Consumer Health
133Information and Policy Advisory Council, and implement a long-
134range plan for making available health care quality measures and
135financial data that will allow consumers to compare health care
136services. The health care quality measures and financial data
137the agency must make available shall include, but is not limited
138to, pharmaceuticals, physicians, health care facilities, and
139health plans and managed care entities. The agency shall submit
140the initial plan to the Governor, the President of the Senate,
141and the Speaker of the House of Representatives by January 1,
1422006, and shall update the plan and report on the status of its
143implementation annually thereafter. The agency shall also make
144the plan and status report available to the public on its
145Internet website. As part of the plan, the agency shall identify
146the process and timeframes for implementation, any barriers to
147implementation, and recommendations of changes in the law that
148may be enacted by the Legislature to eliminate the barriers. As
149preliminary elements of the plan, the agency shall:
150     1.  Make available patient-safety indicators, inpatient
151quality indicators, and performance outcome and patient charge
152data collected from health care facilities pursuant to s.
153408.061(1)(a) and (2). The terms "patient-safety indicators" and
154"inpatient quality indicators" shall be as defined by the
155Centers for Medicare and Medicaid Services, the National Quality
156Forum, the Joint Commission on Accreditation of Healthcare
157Organizations, the Agency for Healthcare Research and Quality,
158the Centers for Disease Control and Prevention, or a similar
159national entity that establishes standards to measure the
160performance of health care providers, or by other states. The
161agency shall determine which conditions, procedures, health care
162quality measures, and patient charge data to disclose based upon
163input from the council. When determining which conditions and
164procedures are to be disclosed, the council and the agency shall
165consider variation in costs, variation in outcomes, and
166magnitude of variations and other relevant information. When
167determining which health care quality measures to disclose, the
168agency:
169     a.  Shall consider such factors as volume of cases; average
170patient charges; average length of stay; complication rates;
171mortality rates; and infection rates, among others, which shall
172be adjusted for case mix and severity, if applicable.
173     b.  May consider such additional measures that are adopted
174by the Centers for Medicare and Medicaid Studies, National
175Quality Forum, the Joint Commission on Accreditation of
176Healthcare Organizations, the Agency for Healthcare Research and
177Quality, Centers for Disease Control and Prevention, or a
178similar national entity that establishes standards to measure
179the performance of health care providers, or by other states.
180
181When determining which patient charge data to disclose, the
182agency shall include consider such measures as the average of
183undiscounted charges on frequently performed procedures and
184preventive diagnostic procedures, the range of procedure charges
185from highest to lowest average charge, average net revenue per
186adjusted patient day, average cost per adjusted patient day, and
187average cost per admission, among others.
188     2.  Make available performance measures, benefit design,
189and premium cost data from health plans licensed pursuant to
190chapter 627 or chapter 641. The agency shall determine which
191health care quality measures and member and subscriber cost data
192to disclose, based upon input from the council. When determining
193which data to disclose, the agency shall consider information
194that may be required by either individual or group purchasers to
195assess the value of the product, which may include membership
196satisfaction, quality of care, current enrollment or membership,
197coverage areas, accreditation status, premium costs, plan costs,
198premium increases, range of benefits, copayments and
199deductibles, accuracy and speed of claims payment, credentials
200of physicians, number of providers, names of network providers,
201and hospitals in the network. Health plans shall make available
202to the agency any such data or information that is not currently
203reported to the agency or the office.
204     3.  Determine the method and format for public disclosure
205of data reported pursuant to this paragraph. The agency shall
206make its determination based upon input from the State Consumer
207Health Information and Policy Advisory Council. At a minimum,
208the data shall be made available on the agency's Internet
209website in a manner that allows consumers to conduct an
210interactive search that allows them to view and compare the
211information for specific providers. The website must include
212such additional information as is determined necessary to ensure
213that the website enhances informed decisionmaking among
214consumers and health care purchasers, which shall include, at a
215minimum, appropriate guidance on how to use the data and an
216explanation of why the data may vary from provider to provider.
217The data specified in subparagraph 1. shall be released no later
218than January 1, 2006, for the reporting of infection rates, and
219no later than October 1, 2005, for mortality rates and
220complication rates. The data specified in subparagraph 2. shall
221be released no later than October 1, 2006.
222     4.  Publish on its website undiscounted charges for no
223fewer than 150 of the most commonly performed adult and
224pediatric procedures, including outpatient, inpatient,
225diagnostic, and preventative procedures.
226     Section 6.  The Agency for Health Care Administration shall
227conduct a study of the use of community benefits programs in
228other states. The agency shall submit a report of its study to
229the relevant committees of the Senate and the House of
230Representatives by January 1, 2009. The report shall include
231recommendations for community benefits requirements in the
232state, including standards and guidelines for not-for-profit
233charitable hospitals that are exempt from taxation under s.
234501(c)(3) of the Internal Revenue Code. The Office of Program
235Policy Analysis and Government Accountability shall conduct a
236study of not-for-profit charitable hospitals that are exempt
237from taxation under s. 501(c)(3) of the Internal Revenue Code
238and the benefits received by not-for-profit hospitals from sales
239and lease tax exemption certificates obtained pursuant to s.
240212.08(7)(p), Florida Statutes, and from property tax and
241federal income tax exemptions. The study shall determine the
242dollar value of those exemptions for each hospital for the last
2433 fiscal years and shall assess the actual cost of charity care
244provided by each hospital for the last 3 fiscal years. The study
245shall include an evaluation of the profitability of not-for-
246profit hospitals and the allocation of hospital resources to
247provide community benefits and executive compensation and shall
248provide a comparison of those results with comparable data from
249other states. The study shall analyze and recommend a state
250standard that would provide accurate and measurable figures
251relating to the reporting of expenditures for charity care and
252uncompensated care. The office shall submit a report to the
253relevant committees of the Senate and the House of
254Representatives by January 1, 2009. For the purposes of the
255studies and reports required under this section, "community
256benefits" means the unreimbursed cost to a hospital of providing
257charity care, uncompensated government-sponsored indigent health
258care, donations, uncompensated government-sponsored program
259services, free screening, testing services, and subsidized
260health services provided by the hospital.
261     Section 7.  This act shall take effect January 1, 2009.


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