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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.; requiring a health care

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provider or a health care facility to provide an uninsured

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person with a reasonable estimate of charges for planned

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nonemergency medical services before such services are

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provided; requiring that the provider or the facility

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provide the uninsured person with information regarding

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such provider's or facility's discount or charity

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policies; requiring that the estimate be in writing and in

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a language comprehensible to an ordinary layperson;

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amending s. 395.301, F.S.; requiring certain licensed

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facilities to provide a written estimate within a certain

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period of time to an uninsured person seeking planned

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nonemergency elective admission; requiring the facility to

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notify the person if the estimate is revised; requiring

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the facility to provide the person with a copy of any

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discount or charity care discount policies for which such

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person may be eligible; requiring the facility to place a

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notice in the reception area where such information is

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available; imposing a monetary penalty if the facility

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fails to provide the requested information; amending s.

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

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that may be disclosed by the Agency for Health Care

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Administration; requiring the agency to publish on its

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website information concerning prices for the most

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commonly performed adult and pediatric procedures;

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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 estimate of charges for such services. The

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health care provider or the health care facility shall provide an

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uninsured person, prior to the provision of a planned

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nonemergency medical service, a reasonable estimate of charges

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for such service and information regarding the provider's or

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facility's discount or charity policies for which the uninsured

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person may be eligible. Estimates shall, to the extent possible,

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be written in a language comprehensible to an ordinary layperson.

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Such reasonable estimate shall not preclude the health care

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provider or health care facility from exceeding the estimate or

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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 may

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indicate that the pricing information is based on a compilation

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of charges for the average patient and that each patient's bill

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may vary from the average depending upon the severity of illness

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and individual resources consumed. The licensed facility may also

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indicate that the price of service is negotiable for eligible

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patients based upon the patient's ability to pay.

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

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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.  Present subsections (8), (9), and (10) of

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section 395.301, Florida Statutes, are redesignated as

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subsections (9), (10), and (11), respectively, and a new

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subsection (8) is added to that section, 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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     (8) Each licensed facility that is not operated by the

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state shall provide any uninsured person seeking planned

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nonemergency elective admission a written good faith estimate of

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reasonably anticipated charges for the facility to treat such

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person. The estimate must be provided to the uninsured person

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within 7 business days after the person notifies the facility and

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the facility confirms that the person is uninsured. The estimate

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may be the average charges for that diagnosis-related group or

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the average charges for that procedure. Upon request, the

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facility shall notify the person of any revision to the good

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faith estimate. Such estimate does not preclude the actual

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charges from exceeding the estimate. The facility shall also

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provide to the uninsured person a copy of any facility discount

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and charity care discount policies for which the uninsured person

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may be eligible. The facility shall place a notice in the

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reception area where such information is available. Failure to

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provide the estimate as required by this subsection shall result

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in a fine of $500 for each instance of the facility's failure to

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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 average of

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undiscounted charges on frequently performed procedures and

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preventive diagnostic procedures, the range of procedure charges

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from highest to lowest average charge, average net revenue per

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adjusted patient day, average cost per adjusted patient day, and

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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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     4. Publish on its website undiscounted charges for no fewer

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than 150 of the most commonly performed adult and pediatric

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procedures, including outpatient, inpatient, diagnostic, and

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preventative procedures.

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     Section 6.  This act shall take effect January 1, 2009.