Florida Senate - 2013 SB 1258
By Senator Grimsley
1 A bill to be entitled
2 An act relating to a comprehensive health information
3 system; amending s. 408.05, F.S.; renaming the Florida
4 Center for Health Information and Policy Analysis as
5 the Florida Health Information Transparency
6 Initiative; providing a statement of purpose for the
7 initiative; providing the duties of the Agency for
8 Health Care Administration; revising the data and
9 information required to be included in the health
10 information system; revising the functions that the
11 agency must perform in order to collect and
12 disseminate health information and statistics;
13 deleting provisions that require the center to provide
14 technical assistance to persons and organizations
15 engaged in health planning activities; deleting
16 provisions that require the center to provide
17 widespread dissemination of data; requiring the agency
18 to implement the transparency initiative in a manner
19 that recognizes state-collected data as an asset and
20 rewards taxpayer investment in information collection
21 and management; authorizing the agency to apply for,
22 receive, and accept grants, gifts, and other payments,
23 including property and services, from a governmental
24 or other public or private entity or person; requiring
25 the agency to ensure that certain vendors do not
26 inhibit or impede consumer access to state-collected
27 health data and information; abolishing the State
28 Consumer Health Information and Policy Advisory
29 Council; amending ss. 381.026, 395.301, 465.0244,
30 627.6499, and 641.54, F.S.; conforming provisions to
31 changes made by the act; providing an effective date.
33 Be It Enacted by the Legislature of the State of Florida:
35 Section 1. Section 408.05, Florida Statutes, is amended to
37 408.05 Florida
Center for Health Information Transparency
38 Initiative and Policy Analysis.—
39 (1) PURPOSE ESTABLISHMENT.—The agency shall coordinate
40 establish a Florida Center for Health Information and Policy
41 Analysis. The center shall establish a comprehensive health
42 information system to promote accessibility, transparency, and
43 utility of state-collected data and information about health
44 providers, facilities, services, and payment sources provide for
45 the collection, compilation, coordination, analysis, indexing,
46 dissemination, and utilization of both purposefully collected
47 and extant health-related data and statistics. The agency center
48 shall be responsible for making data available in a manner that
49 allows for and encourages multiple and innovative uses of data
50 sets collected under the auspices of the state. Subject to the
51 General Appropriations Act, the agency shall contract with one
52 or more vendors to develop new methods of dissemination and to
53 convert data into easily useable electronic formats staffed with
54 public health experts, biostatisticians, information system
55 analysts, health policy experts, economists, and other staff
56 necessary to carry out its functions.
57 (2) HEALTH-RELATED DATA.—The comprehensive health
58 information system operated by the Florida Center for Health
59 Information and Policy Analysis shall include, but may not be
60 limited to, the following data and information identify the best
61 available data sources and coordinate the compilation of extant
62 health-related data and statistics and purposefully collect data
64 (a) The extent and nature of illness and disability of the
65 state population, including life expectancy, the incidence of
66 various acute and chronic illnesses, and infant and maternal
67 morbidity and mortality.
68 (b) The impact of illness and disability of the state
69 population on the state economy and on other aspects of the
70 well-being of the people in this state.
71 (c) Environmental, social, and other health hazards.
72 (d) Health knowledge and practices of the people in this
73 state and determinants of health and nutritional practices and
75 (a) (e) Health resources, including licensed physicians,
76 dentists, nurses, and other health professionals, licensed by
77 specialty and type of practice and acute, long-term care and
78 other institutional care facility supplies and specific services
79 provided by hospitals, nursing homes, home health agencies, and
80 other health care facilities, managed care organizations, and
81 other health services regulated or funded by the state.
82 (b) (f) Utilization of health resources care by type of
84 (c) (g) Health care costs and financing, including Medicaid
85 claims and encounter data and data from other public and private
86 payors trends in health care prices and costs, the sources of
87 payment for health care services, and federal, state, and local
88 expenditures for health care.
89 (h) Family formation, growth, and dissolution.
90 (d) (i) The extent, source, and type of public and private
91 health insurance coverage in this state.
92 (e) (j) The data necessary for measuring value and quality
93 of care provided by various health care providers, including
94 applicable credentials, accreditation status, utilization,
95 revenues and expenses, outcomes, site visits, and other
96 regulatory reports, and the results of administrative and civil
98 (3) COORDINATION COMPREHENSIVE HEALTH INFORMATION SYSTEM.
99 In order to collect and disseminate comprehensive produce
100 comparable and uniform health information and statistics for the
101 public as well as for development of policy recommendations, the
102 agency shall perform the following functions:
103 (a) Collect and compile data from all state agencies and
104 programs involved in providing, regulating, and paying for
105 health services Coordinate the activities of state agencies
106 involved in the design and implementation of the comprehensive
107 health information system.
108 (b) Promote data sharing through the Undertake research ,
109 development, dissemination, and evaluation of state-collected
110 health data and by making such data available, transferable, and
111 readily useable respecting the comprehensive health information
113 (c) Review the statistical activities of state agencies to
114 ensure that they are consistent with the comprehensive health
115 information system.
116 (c) (d) Develop written agreements with local, state, and
117 federal agencies for the sharing of health-care-related data or
118 using the facilities and services of such agencies. State
119 agencies, local health councils, and other agencies under state
120 contract shall assist the agency center in obtaining, compiling,
121 and transferring health-care-related data maintained by state
122 and local agencies. Written agreements must specify the types,
123 methods, and periodicity of data exchanges and specify the types
124 of data that will be transferred to the center.
125 (d) (e) Enable and facilitate the sharing and use of all
126 state-collected health data to the maximum extent allowed by law
127 Establish by rule the types of data collected, compiled,
128 processed, used, or shared. Decisions regarding center data sets
129 should be made based on consultation with the State Consumer
130 Health Information and Policy Advisory Council and other public
131 and private users regarding the types of data which should be
132 collected and their uses. The center shall establish
133 standardized means for collecting health information and
134 statistics under laws and rules administered by the agency.
135 (f) Establish minimum health-care-related data sets which
136 are necessary on a continuing basis to fulfill the collection
137 requirements of the center and which shall be used by state
138 agencies in collecting and compiling health-care-related data.
139 The agency shall periodically review ongoing health care data
140 collections of the Department of Health and other state agencies
141 to determine if the collections are being conducted in
142 accordance with the established minimum sets of data.
143 (g) Establish advisory standards to ensure the quality of
144 health statistical and epidemiological data collection,
145 processing, and analysis by local, state, and private
147 (e) (h) Monitor data collection procedures, test data
148 quality, and take such corrective actions as may be necessary to
149 ensure that data and information disseminated under the
150 initiative are accurate, valid, reliable, and complete Prescribe
151 standards for the publication of health-care-related data
152 reported pursuant to this section which ensure the reporting of
153 accurate, valid, reliable, complete, and comparable data. Such
154 standards should include advisory warnings to users of the data
155 regarding the status and quality of any data reported by or
156 available from the center.
157 (f) (i) Initiate and maintain activities necessary to
158 collect, edit, verify, archive, and retrieve Prescribe standards
159 for the maintenance and preservation of the center’s data. This
160 should include methods for archiving data, retrieval of archived
161 data , and data compiled pursuant to this section editing and
163 (j) Ensure that strict quality control measures are
164 maintained for the dissemination of data through publications,
165 studies, or user requests.
166 (k) Develop, in conjunction with the State Consumer Health
167 Information and Policy Advisory Council, and implement a long
168 range plan for making available health care quality measures and
169 financial data that will allow consumers to compare health care
170 services. The health care quality measures and financial data
171 the agency must make available shall include, but is not limited
172 to, pharmaceuticals, physicians, health care facilities, and
173 health plans and managed care entities. The agency shall update
174 the plan and report on the status of its implementation
175 annually. The agency shall also make the plan and status report
176 available to the public on its Internet website. As part of the
177 plan, the agency shall identify the process and timeframes for
178 implementation, any barriers to implementation, and
179 recommendations of changes in the law that may be enacted by the
180 Legislature to eliminate the barriers. As preliminary elements
181 of the plan, the agency shall:
182 1. Make available patient-safety indicators, inpatient
183 quality indicators, and performance outcome and patient charge
184 data collected from health care facilities pursuant to s.
185 408.061 (1)(a) and (2). The terms “patient-safety indicators” and
186 “inpatient quality indicators” shall be as defined by the
187 Centers for Medicare and Medicaid Services, the National Quality
188 Forum, the Joint Commission on Accreditation of Healthcare
189 Organizations, the Agency for Healthcare Research and Quality,
190 the Centers for Disease Control and Prevention, or a similar
191 national entity that establishes standards to measure the
192 performance of health care providers, or by other states. The
193 agency shall determine which conditions, procedures, health care
194 quality measures, and patient charge data to disclose based upon
195 input from the council. When determining which conditions and
196 procedures are to be disclosed, the council and the agency shall
197 consider variation in costs, variation in outcomes, and
198 magnitude of variations and other relevant information. When
199 determining which health care quality measures to disclose, the
201 a. Shall consider such factors as volume of cases; average
202 patient charges; average length of stay; complication rates;
203 mortality rates; and infection rates, among others, which shall
204 be adjusted for case mix and severity, if applicable.
205 b. May consider such additional measures that are adopted
206 by the Centers for Medicare and Medicaid Studies, National
207 Quality Forum, the Joint Commission on Accreditation of
208 Healthcare Organizations, the Agency for Healthcare Research and
209 Quality, Centers for Disease Control and Prevention, or a
210 similar national entity that establishes standards to measure
211 the performance of health care providers, or by other states.
213 When determining which patient charge data to disclose, the
214 agency shall include such measures as the average of
215 undiscounted charges on frequently performed procedures and
216 preventive diagnostic procedures, the range of procedure charges
217 from highest to lowest, average net revenue per adjusted patient
218 day, average cost per adjusted patient day, and average cost per
219 admission, among others.
220 2. Make available performance measures, benefit design, and
221 premium cost data from health plans licensed pursuant to chapter
222 627 or chapter 641. The agency shall determine which health care
223 quality measures and member and subscriber cost data to
224 disclose, based upon input from the council. When determining
225 which data to disclose, the agency shall consider information
226 that may be required by either individual or group purchasers to
227 assess the value of the product, which may include membership
228 satisfaction, quality of care, current enrollment or membership,
229 coverage areas, accreditation status, premium costs, plan costs,
230 premium increases, range of benefits, copayments and
231 deductibles, accuracy and speed of claims payment, credentials
232 of physicians, number of providers, names of network providers,
233 and hospitals in the network. Health plans shall make available
234 to the agency any such data or information that is not currently
235 reported to the agency or the office.
236 3. Determine the method and format for public disclosure of
237 data reported pursuant to this paragraph. The agency shall make
238 its determination based upon input from the State Consumer
239 Health Information and Policy Advisory Council. At a minimum,
240 the data shall be made available on the agency’s Internet
241 website in a manner that allows consumers to conduct an
242 interactive search that allows them to view and compare the
243 information for specific providers. The website must include
244 such additional information as is determined necessary to ensure
245 that the website enhances informed decisionmaking among
246 consumers and health care purchasers, which shall include, at a
247 minimum, appropriate guidance on how to use the data and an
248 explanation of why the data may vary from provider to provider.
249 4. Publish on its website undiscounted charges for no fewer
250 than 150 of the most commonly performed adult and pediatric
251 procedures, including outpatient, inpatient, diagnostic, and
252 preventative procedures.
253 (4) TECHNICAL ASSISTANCE.—
254 (a) The center shall provide technical assistance to
255 persons or organizations engaged in health planning activities
256 in the effective use of statistics collected and compiled by the
257 center. The center shall also provide the following additional
258 technical assistance services:
259 1. Establish procedures identifying the circumstances under
260 which, the places at which, the persons from whom, and the
261 methods by which a person may secure data from the center,
262 including procedures governing requests, the ordering of
263 requests, timeframes for handling requests, and other procedures
264 necessary to facilitate the use of the center’s data. To the
265 extent possible, the center should provide current data timely
266 in response to requests from public or private agencies.
267 2. Provide assistance to data sources and users in the
268 areas of database design, survey design, sampling procedures,
269 statistical interpretation, and data access to promote improved
270 health-care-related data sets.
271 3. Identify health care data gaps and provide technical
272 assistance to other public or private organizations for meeting
273 documented health care data needs.
274 4. Assist other organizations in developing statistical
275 abstracts of their data sets that could be used by the center.
276 5. Provide statistical support to state agencies with
277 regard to the use of databases maintained by the center.
278 6. To the extent possible, respond to multiple requests for
279 information not currently collected by the center or available
280 from other sources by initiating data collection.
281 7. Maintain detailed information on data maintained by
282 other local, state, federal, and private agencies in order to
283 advise those who use the center of potential sources of data
284 which are requested but which are not available from the center.
285 8. Respond to requests for data which are not available in
286 published form by initiating special computer runs on data sets
287 available to the center.
288 9. Monitor innovations in health information technology,
289 informatics, and the exchange of health information and maintain
290 a repository of technical resources to support the development
291 of a health information network.
292 (b) The agency shall administer, manage, and monitor grants
293 to not-for-profit organizations, regional health information
294 organizations, public health departments, or state agencies that
295 submit proposals for planning, implementation, or training
296 projects to advance the development of a health information
297 network. Any grant contract shall be evaluated to ensure the
298 effective outcome of the health information project.
299 (c) The agency shall initiate, oversee, manage, and
300 evaluate the integration of health care data from each state
301 agency that collects, stores, and reports on health care issues
302 and make that data available to any health care practitioner
303 through a state health information network.
304 (5) PUBLICATIONS; REPORTS; SPECIAL STUDIES.—The center
305 shall provide for the widespread dissemination of data which it
306 collects and analyzes. The center shall have the following
307 publication, reporting, and special study functions:
308 (a) The center shall publish and make available
309 periodically to agencies and individuals health statistics
310 publications of general interest, including health plan consumer
311 reports and health maintenance organization member satisfaction
312 surveys; publications providing health statistics on topical
313 health policy issues; publications that provide health status
314 profiles of the people in this state; and other topical health
315 statistics publications.
316 (b) The center shall publish, make available, and
317 disseminate, promptly and as widely as practicable, the results
318 of special health surveys, health care research, and health care
319 evaluations conducted or supported under this section. Any
320 publication by the center must include a statement of the
321 limitations on the quality, accuracy, and completeness of the
323 (c) The center shall provide indexing, abstracting,
324 translation, publication, and other services leading to a more
325 effective and timely dissemination of health care statistics.
326 (d) The center shall be responsible for publishing and
327 disseminating an annual report on the center’s activities.
328 (e) The center shall be responsible, to the extent
329 resources are available, for conducting a variety of special
330 studies and surveys to expand the health care information and
331 statistics available for health policy analyses, particularly
332 for the review of public policy issues. The center shall develop
333 a process by which users of the center’s data are periodically
334 surveyed regarding critical data needs and the results of the
335 survey considered in determining which special surveys or
336 studies will be conducted. The center shall select problems in
337 health care for research, policy analyses, or special data
338 collections on the basis of their local, regional, or state
339 importance; the unique potential for definitive research on the
340 problem; and opportunities for application of the study
342 (4) (6) PROVIDER DATA REPORTING.—This section does not
343 confer on the agency the power to demand or require that a
344 health care provider or professional furnish information,
345 records of interviews, written reports, statements, notes,
346 memoranda, or data other than as expressly required by law.
347 (5) (7) HEALTH INFORMATION ENTERPRISE BUDGET; FEES.—
348 (a) The agency shall implement the transparency initiative
349 in a manner that recognizes state-collected data as an asset and
350 rewards taxpayer investment in information collection and
351 management Legislature intends that funding for the Florida
352 Center for Health Information and Policy Analysis be
353 appropriated from the General Revenue Fund.
354 (b) The agency Florida Center for Health Information and
355 Policy Analysis may apply for, and receive, and accept grants,
356 gifts, and other payments, including property and services, from
357 a any governmental or other public or private entity or person
358 and make arrangements for as to the use of such funds same,
359 including the undertaking of special studies and other projects
360 relating to health-care-related topics. Funds obtained pursuant
361 to this paragraph may not be used to offset annual
362 appropriations from the General Revenue Fund.
363 (c) The agency shall ensure that a vendor who enters into a
364 contract with the state under this section does not inhibit or
365 impede consumer access to state-collected health data and
366 information center may charge such reasonable fees for services
367 as the agency prescribes by rule. The established fees may not
368 exceed the reasonable cost for such services. Fees collected may
369 not be used to offset annual appropriations from the General
370 Revenue Fund .
371 (8) STATE CONSUMER HEALTH INFORMATION AND POLICY ADVISORY
373 (a) There is established in the agency the State Consumer
374 Health Information and Policy Advisory Council to assist the
375 center in reviewing the comprehensive health information system,
376 including the identification, collection, standardization,
377 sharing, and coordination of health-related data, fraud and
378 abuse data, and professional and facility licensing data among
379 federal, state, local, and private entities and to recommend
380 improvements for purposes of public health, policy analysis, and
381 transparency of consumer health care information. The council
382 shall consist of the following members:
383 1. An employee of the Executive Office of the Governor, to
384 be appointed by the Governor.
385 2. An employee of the Office of Insurance Regulation, to be
386 appointed by the director of the office.
387 3. An employee of the Department of Education, to be
388 appointed by the Commissioner of Education.
389 4. Ten persons, to be appointed by the Secretary of Health
390 Care Administration, representing other state and local
391 agencies, state universities, business and health coalitions,
392 local health councils, professional health-care-related
393 associations, consumers, and purchasers.
394 (b) Each member of the council shall be appointed to serve
395 for a term of 2 years following the date of appointment, except
396 the term of appointment shall end 3 years following the date of
397 appointment for members appointed in 2003, 2004, and 2005. A
398 vacancy shall be filled by appointment for the remainder of the
399 term, and each appointing authority retains the right to
400 reappoint members whose terms of appointment have expired.
401 (c) The council may meet at the call of its chair, at the
402 request of the agency, or at the request of a majority of its
403 membership, but the council must meet at least quarterly.
404 (d) Members shall elect a chair and vice chair annually.
405 (e) A majority of the members constitutes a quorum, and the
406 affirmative vote of a majority of a quorum is necessary to take
408 (f) The council shall maintain minutes of each meeting and
409 shall make such minutes available to any person.
410 (g) Members of the council shall serve without compensation
411 but shall be entitled to receive reimbursement for per diem and
412 travel expenses as provided in s. 112.061 .
413 (h) The council’s duties and responsibilities include, but
414 are not limited to, the following:
415 1. To develop a mission statement, goals, and a plan of
416 action for the identification, collection, standardization,
417 sharing, and coordination of health-related data across federal,
418 state, and local government and private sector entities.
419 2. To develop a review process to ensure cooperative
420 planning among agencies that collect or maintain health-related
422 3. To create ad hoc issue-oriented technical workgroups on
423 an as-needed basis to make recommendations to the council.
424 (9) APPLICATION TO OTHER AGENCIES.—Nothing in this section
425 shall limit, restrict, affect, or control the collection,
426 analysis, release, or publication of data by any state agency
427 pursuant to its statutory authority, duties, or
429 Section 2. Paragraph (c) of subsection (4) of section
430 381.026, Florida Statutes, is amended to read:
431 381.026 Florida Patient’s Bill of Rights and
433 (4) RIGHTS OF PATIENTS.—Each health care facility or
434 provider shall observe the following standards:
435 (c) Financial information and disclosure.—
436 1. A patient has the right to be given, upon request, by
437 the responsible provider, his or her designee, or a
438 representative of the health care facility full information and
439 necessary counseling on the availability of known financial
440 resources for the patient’s health care.
441 2. A health care provider or a health care facility shall,
442 upon request, disclose to each patient who is eligible for
443 Medicare, before treatment, whether the health care provider or
444 the health care facility in which the patient is receiving
445 medical services accepts assignment under Medicare reimbursement
446 as payment in full for medical services and treatment rendered
447 in the health care provider’s office or health care facility.
448 3. A primary care provider may publish a schedule of
449 charges for the medical services that the provider offers to
450 patients. The schedule must include the prices charged to an
451 uninsured person paying for such services by cash, check, credit
452 card, or debit card. The schedule must be posted in a
453 conspicuous place in the reception area of the provider’s office
454 and must include, but is not limited to, the 50 services most
455 frequently provided by the primary care provider. The schedule
456 may group services by three price levels, listing services in
457 each price level. The posting must be at least 15 square feet in
458 size. A primary care provider who publishes and maintains a
459 schedule of charges for medical services is exempt from the
460 license fee requirements for a single period of renewal of a
461 professional license under chapter 456 for that licensure term
462 and is exempt from the continuing education requirements of
463 chapter 456 and the rules implementing those requirements for a
464 single 2-year period.
465 4. If a primary care provider publishes a schedule of
466 charges pursuant to subparagraph 3., he or she must continually
467 post it at all times for the duration of active licensure in
468 this state when primary care services are provided to patients.
469 If a primary care provider fails to post the schedule of charges
470 in accordance with this subparagraph, the provider must shall be
471 required to pay any license fee and comply with any continuing
472 education requirements for which an exemption was received.
473 5. A health care provider or a health care facility shall,
474 upon request, furnish a person, before the provision of medical
475 services, a reasonable estimate of charges for such services.
476 The health care provider or the health care facility shall
477 provide an uninsured person, before the provision of a planned
478 nonemergency medical service, a reasonable estimate of charges
479 for such service and information regarding the provider’s or
480 facility’s discount or charity policies for which the uninsured
481 person may be eligible. Such estimates by a primary care
482 provider must be consistent with the schedule posted under
483 subparagraph 3. To the extent possible, estimates shall , to the
484 extent possible, be written in language comprehensible to an
485 ordinary layperson. Such reasonable estimate does not preclude
486 the health care provider or health care facility from exceeding
487 the estimate or making additional charges based on changes in
488 the patient’s condition or treatment needs.
489 6. Each licensed facility not operated by the state shall
490 make available to the public on its Internet website or by other
491 electronic means a description of and a link to the performance
492 outcome and financial data that is published by the agency
493 pursuant to s. 408.05 (3)(k). The facility shall place a notice
494 in the reception area that such information is available
495 electronically and the website address. The licensed facility
496 may indicate that the pricing information is based on a
497 compilation of charges for the average patient and that each
498 patient’s bill may vary from the average depending upon the
499 severity of illness and individual resources consumed. The
500 licensed facility may also indicate that the price of service is
501 negotiable for eligible patients based upon the patient’s
502 ability to pay.
503 7. A patient has the right to receive a copy of an itemized
504 bill upon request. A patient has a right to be given an
505 explanation of charges upon request.
506 Section 3. Subsection (11) of section 395.301, Florida
507 Statutes, is amended to read:
508 395.301 Itemized patient bill; form and content prescribed
509 by the agency.—
510 (11) Each licensed facility shall make available on its
511 Internet website a link to the performance outcome and financial
512 data that is published by the Agency for Health Care
513 Administration pursuant to s. 408.05 (3)(k). The facility shall
514 place a notice in the reception area that the information is
515 available electronically and the facility’s Internet website
517 Section 4. Section 465.0244, Florida Statutes, is amended
518 to read:
519 465.0244 Information disclosure.—Every pharmacy shall make
520 available on its Internet website a link to the performance
521 outcome and financial data that is published by the Agency for
522 Health Care Administration pursuant to s. 408.05 (3)(k) and shall
523 place in the area where customers receive filled prescriptions
524 notice that such information is available electronically and the
525 address of its Internet website.
526 Section 5. Subsection (2) of section 627.6499, Florida
527 Statutes, is amended to read:
528 627.6499 Reporting by insurers and third-party
530 (2) Each health insurance issuer shall make available on
531 its Internet website a link to the performance outcome and
532 financial data that is published by the Agency for Health Care
533 Administration pursuant to s. 408.05 (3)(k) and shall include in
534 every policy delivered or issued for delivery to any person in
535 the state or any materials provided as required by s. 627.64725
536 notice that such information is available electronically and the
537 address of its Internet website.
538 Section 6. Subsection (7) of section 641.54, Florida
539 Statutes, is amended to read:
540 641.54 Information disclosure.—
541 (7) Each health maintenance organization shall make
542 available on its Internet website a link to the performance
543 outcome and financial data that is published by the Agency for
544 Health Care Administration pursuant to s. 408.05 (3)(k) and shall
545 include in every policy delivered or issued for delivery to any
546 person in the state or any materials provided as required by s.
547 627.64725 notice that such information is available
548 electronically and the address of its Internet website.
549 Section 7. This act shall take effect July 1, 2013.