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A bill to be entitled

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An act relating to consumer information concerning health

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care; providing a short title; providing a purpose;

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amending s. 381.026, F.S.; revising requirements for

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health care providers and facilities in notifying patients

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of charges for health care services; requiring an

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itemized, comprehensible estimate of charges; requiring

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that a facility publish certain prices for current

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procedure terminology codes for the most commonly

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performed procedures, pharmaceuticals, and medical

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supplies; requiring the Agency for Health Care

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Administration to determine the codes; requiring that a

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patient receive a copy of an itemized bill; amending s.

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395.301, F.S.; revising requirements for billing and

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written estimates provided to patients by health care

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facilities; providing that an estimate does not preclude

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additional charges if the charges are itemized; amending

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s. 408.05, F.S.; revising the list of patient charge data

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that may be disclosed by the agency; amending s. 408.061,

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F.S.; requiring that the health care data submitted by

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health care facilities to the agency include information

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concerning prices for common procedures, pharmaceuticals,

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and supplies; providing an effective date.

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Be It Enacted by the Legislature of the State of Florida:

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     Section 1. This act may be cited as the "Health Care

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Consumer's Right to Information Act."

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     Section 2. The purpose of this act is to provide health

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care consumers with reliable and understandable information about

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facility charges to assist consumers in making informed decisions

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about health care.

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     Section 3.  Paragraph (c) of subsection (4) of section

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381.026, Florida Statutes, is amended to read:

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     381.026  Florida Patient's Bill of Rights and

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Responsibilities.--

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     (4)  RIGHTS OF PATIENTS.--Each health care facility or

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provider shall observe the following standards:

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     (c)  Financial information and disclosure.--

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     1.  A patient has the right to be given, upon request, by

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the responsible provider, his or her designee, or a

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representative of the health care facility full information and

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necessary counseling on the availability of known financial

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resources for the patient's health care.

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     2. A health care provider or a health care facility shall,

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upon request, disclose to each patient who is eligible for

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Medicare, in advance of treatment, whether the health care

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provider or the health care facility in which the patient is

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receiving medical services accepts assignment under Medicare

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reimbursement as payment in full for medical services and

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treatment rendered in the health care provider's office or health

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care facility.

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     3.  A health care provider or a health care facility shall,

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upon request, furnish a person, prior to provision of medical

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services, a reasonable, itemized estimate of charges for the

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provision of any medical such services in language that is

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comprehensible to an ordinary layperson. A health care provider

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or health care facility shall automatically furnish a reasonable,

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itemized estimate of charges in language that is comprehensible

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to an ordinary layperson to each patient who is uninsured or

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underinsured before providing any scheduled medical service. Such

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reasonable, itemized estimate does shall not preclude the health

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care provider or health care facility from exceeding the estimate

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or making additional charges based on changes in the patient's

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condition or treatment needs.

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     4.  Each licensed facility not operated by the state shall

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make available to the public on its Internet website or by other

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electronic means a description of and a link to the performance

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outcome and financial data that is published by the agency

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pursuant to s. 408.05(3)(k). The facility shall place a notice in

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the reception area that such information is available

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electronically and the website address. The licensed facility

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shall publish the undiscounted prices for the current procedure

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terminology codes for the 100 most commonly performed procedures,

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the 100 most commonly prescribed pharmaceuticals, and the 100

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most commonly provided medical supplies, and this information

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shall be provided to the Agency for Health Care Administration.

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The Agency for Health Care Administration shall determine the

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codes for the most commonly performed procedures,

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pharmaceuticals, and supplies. If a facility has a charity care

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discount policy, the policy shall be published and provided to

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the agency. The facility may indicate that the pricing

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information is based on a compilation of charges for the average

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patient and that each patient's bill may vary from the average

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depending upon the severity of illness and individual resources

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consumed. The licensed facility may also indicate that the price

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of service is negotiable for eligible patients based upon the

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patient's ability to pay.

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     5. A patient shall has the right to receive a copy of an

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itemized bill upon request. A patient has a right to be given an

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explanation of charges upon request.

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     Section 4.  Subsections (1) and (7) of section 395.301,

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Florida Statutes, are amended to read:

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     395.301  Itemized patient bill; form and content prescribed

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by the agency.--

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     (1)  A licensed facility not operated by the state shall

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notify each patient during admission and at discharge of his or

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her right to receive an itemized bill upon request. Within 7 days

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following the patient's discharge or release from a licensed

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facility not operated by the state, the licensed facility

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providing the service shall, upon request, submit to the patient,

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or to the patient's survivor or legal guardian as may be

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appropriate, an itemized statement detailing in language

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comprehensible to an ordinary layperson the specific nature of

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charges or expenses incurred by the patient, which in the initial

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billing shall contain a statement of specific services received

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and expenses incurred for such items of service, enumerating in

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detail the constituent components of the services received within

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each department of the licensed facility and including unit price

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data on rates charged by the licensed facility, as prescribed by

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the agency.

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     (7)  Each licensed facility not operated by the state shall

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provide in writing, prior to provision of any nonemergency

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medical services, an itemized, a written good faith estimate of

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reasonably anticipated charges for the facility to treat the

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patient's condition upon written request of a prospective

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patient. The estimate shall be provided to the prospective

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patient within 7 business days after the receipt of the request.

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The estimate may be the average charges for that diagnosis

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related group or the average charges for that procedure. Upon

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request, The facility shall notify the patient of any revision to

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the good faith estimate. Such estimate does shall not preclude

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the licensed facility actual charges from exceeding the estimate

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or making additional charges based on changes in the patient's

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condition or treatment needs if the charges are itemized on the

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patient billing statement. The facility shall place a notice in

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the reception area that such information is available. Failure to

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provide the estimate within the provisions established pursuant

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to this section shall result in a fine of $500 for each instance

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of the facility's failure to provide the requested information.

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     Section 5.  Paragraph (k) of subsection (3) of section

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408.05, Florida Statutes, is amended to read:

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     408.05  Florida Center for Health Information and Policy

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Analysis.--

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     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to

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produce comparable and uniform health information and statistics

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for the development of policy recommendations, the agency shall

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perform the following functions:

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     (k)  Develop, in conjunction with the State Consumer Health

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Information and Policy Advisory Council, and implement a long-

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range plan for making available health care quality measures and

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financial data that will allow consumers to compare health care

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services. The health care quality measures and financial data the

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agency must make available shall include, but is not limited to,

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pharmaceuticals, physicians, health care facilities, and health

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plans and managed care entities. The agency shall submit the

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initial plan to the Governor, the President of the Senate, and

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the Speaker of the House of Representatives by January 1, 2006,

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and shall update the plan and report on the status of its

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implementation annually thereafter. The agency shall also make

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the plan and status report available to the public on its

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Internet website. As part of the plan, the agency shall identify

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the process and timeframes for implementation, any barriers to

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implementation, and recommendations of changes in the law that

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may be enacted by the Legislature to eliminate the barriers. As

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preliminary elements of the plan, the agency shall:

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     1.  Make available patient-safety indicators, inpatient

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quality indicators, and performance outcome and patient charge

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data collected from health care facilities pursuant to s.

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408.061(1)(a) and (2). The terms "patient-safety indicators" and

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"inpatient quality indicators" shall be as defined by the Centers

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for Medicare and Medicaid Services, the National Quality Forum,

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the Joint Commission on Accreditation of Healthcare

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Organizations, the Agency for Healthcare Research and Quality,

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the Centers for Disease Control and Prevention, or a similar

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national entity that establishes standards to measure the

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performance of health care providers, or by other states. The

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agency shall determine which conditions, procedures, health care

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quality measures, and patient charge data to disclose based upon

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input from the council. When determining which conditions and

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procedures are to be disclosed, the council and the agency shall

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consider variation in costs, variation in outcomes, and magnitude

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of variations and other relevant information. When determining

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which health care quality measures to disclose, the agency:

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     a.  Shall consider such factors as volume of cases; average

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patient charges; average length of stay; complication rates;

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mortality rates; and infection rates, among others, which shall

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be adjusted for case mix and severity, if applicable.

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     b.  May consider such additional measures that are adopted

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by the Centers for Medicare and Medicaid Studies, National

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Quality Forum, the Joint Commission on Accreditation of

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Healthcare Organizations, the Agency for Healthcare Research and

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Quality, Centers for Disease Control and Prevention, or a similar

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national entity that establishes standards to measure the

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performance of health care providers, or by other states.

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When determining which patient charge data to disclose, the

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agency shall include consider such measures as the undiscounted

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price list of procedures, pharmaceuticals, and supplies, the

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average charge, Medicare reimbursement payment, average net

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revenue per adjusted patient day, average cost per adjusted

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patient day, and average cost per admission, among others.

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     2.  Make available performance measures, benefit design, and

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premium cost data from health plans licensed pursuant to chapter

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627 or chapter 641. The agency shall determine which health care

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quality measures and member and subscriber cost data to disclose,

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based upon input from the council. When determining which data to

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disclose, the agency shall consider information that may be

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required by either individual or group purchasers to assess the

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value of the product, which may include membership satisfaction,

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quality of care, current enrollment or membership, coverage

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areas, accreditation status, premium costs, plan costs, premium

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increases, range of benefits, copayments and deductibles,

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accuracy and speed of claims payment, credentials of physicians,

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number of providers, names of network providers, and hospitals in

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the network. Health plans shall make available to the agency any

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such data or information that is not currently reported to the

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agency or the office.

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     3.  Determine the method and format for public disclosure of

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data reported pursuant to this paragraph. The agency shall make

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its determination based upon input from the State Consumer Health

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Information and Policy Advisory Council. At a minimum, the data

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shall be made available on the agency's Internet website in a

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manner that allows consumers to conduct an interactive search

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that allows them to view and compare the information for specific

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providers. The website must include such additional information

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as is determined necessary to ensure that the website enhances

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informed decisionmaking among consumers and health care

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purchasers, which shall include, at a minimum, appropriate

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guidance on how to use the data and an explanation of why the

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data may vary from provider to provider. The data specified in

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subparagraph 1. shall be released no later than January 1, 2006,

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for the reporting of infection rates, and no later than October

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1, 2005, for mortality rates and complication rates. The data

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specified in subparagraph 2. shall be released no later than

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October 1, 2006.

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     Section 6.  Paragraph (a) of subsection (1) of section

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408.061, Florida Statutes, is amended to read:

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     408.061  Data collection; uniform systems of financial

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reporting; information relating to physician charges;

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confidential information; immunity.--

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     (1)  The agency shall require the submission by health care

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facilities, health care providers, and health insurers of data

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necessary to carry out the agency's duties. Specifications for

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data to be collected under this section shall be developed by the

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agency with the assistance of technical advisory panels including

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representatives of affected entities, consumers, purchasers, and

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such other interested parties as may be determined by the agency.

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     (a)  Data submitted by health care facilities, including the

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facilities as defined in chapter 395, shall include, but are not

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limited to: case-mix data, patient admission and discharge data,

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hospital emergency department data which shall include the number

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of patients treated in the emergency department of a licensed

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hospital reported by patient acuity level, data on hospital-

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acquired infections as specified by rule, data on complications

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as specified by rule, data on readmissions as specified by rule,

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with patient and provider-specific identifiers included, actual

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charge data by diagnostic groups, an undiscounted price list for

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no fewer than the 100 most commonly performed procedures, the 100

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most commonly prescribed pharmaceuticals, and the 100 most

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commonly provided medical supplies based on a statewide average

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as determined by the agency, financial data, accounting data,

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operating expenses, expenses incurred for rendering services to

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patients who cannot or do not pay, interest charges, depreciation

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expenses based on the expected useful life of the property and

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equipment involved, and demographic data. The agency shall adopt

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nationally recognized risk adjustment methodologies or software

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consistent with the standards of the Agency for Healthcare

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Research and Quality and as selected by the agency for all data

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submitted as required by this section. Data may be obtained from

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documents such as, but not limited to: leases, contracts, debt

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instruments, itemized patient bills, medical record abstracts,

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and related diagnostic information. Reported data elements shall

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be reported electronically in accordance with rule 59E-7.012,

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Florida Administrative Code. Data submitted shall be certified by

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the chief executive officer or an appropriate and duly authorized

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representative or employee of the licensed facility that the

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information submitted is true and accurate.

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     Section 7.  This act shall take effect July 1, 2008.