Florida Senate - 2013 CS for SB 1258
By the Committee on Appropriations; and 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 usable 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 the following data
60 and information identify the best available data sources and
61 coordinate the compilation of extant health-related data and
62 statistics and purposefully collect data on:
63 (a) The extent and nature of illness and disability of the
64 state population, including life expectancy, the incidence of
65 various acute and chronic illnesses, and infant and maternal
66 morbidity and mortality.
67 (b) The impact of illness and disability of the state
68 population on the state economy and on other aspects of the
69 well-being of the people in this state.
70 (c) Environmental, social, and other health hazards.
71 (d) Health knowledge and practices of the people in this
72 state and determinants of health and nutritional practices and
74 (a) (e) Health resources, including licensed physicians,
75 dentists, nurses, and other health professionals, licensed by
76 specialty and type of practice and acute, long-term care and
77 other institutional care facility supplies and specific services
78 provided by hospitals, nursing homes, home health agencies, and
79 other health care facilities, managed care organizations, and
80 other health services regulated or funded by the state.
81 (b) (f) Utilization of health resources care by type of
83 (c) (g) Health care costs and financing, including Medicaid
84 claims and encounter data and data from other public and private
85 payors trends in health care prices and costs, the sources of
86 payment for health care services, and federal, state, and local
87 expenditures for health care.
88 (h) Family formation, growth, and dissolution.
89 (d) (i) The extent, source, and type of public and private
90 health insurance coverage in this state.
91 (e) (j) The data necessary for measuring value and quality
92 of care provided by various health care providers, including
93 applicable credentials, accreditation status, utilization,
94 revenues and expenses, outcomes, site visits, and other
95 regulatory reports, and the results of administrative and civil
97 (3) COORDINATION COMPREHENSIVE HEALTH INFORMATION SYSTEM.
98 In order to collect and disseminate comprehensive produce
99 comparable and uniform health information and statistics for the
100 public as well as for the development of policy recommendations,
101 the agency shall perform the following functions:
102 (a) Collect and compile data from all state agencies and
103 programs involved in providing, regulating, and paying for
104 health services Coordinate the activities of state agencies
105 involved in the design and implementation of the comprehensive
106 health information system.
107 (b) Promote data sharing through the Undertake research ,
108 development, dissemination, and evaluation of state-collected
109 health data and by making such data available, transferable, and
110 readily usable respecting the comprehensive health information
112 (c) Review the statistical activities of state agencies to
113 ensure that they are consistent with the comprehensive health
114 information system.
115 (c) (d) Develop written agreements with local, state, and
116 federal agencies for the sharing of health-care-related data or
117 using the facilities and services of such agencies. State
118 agencies, local health councils, and other agencies under state
119 contract shall assist the agency center in obtaining, compiling,
120 and transferring health-care-related data maintained by state
121 and local agencies. Written agreements must specify the types,
122 methods, and periodicity of data exchanges and specify the types
123 of data that will be transferred to the center.
124 (d) (e) Enable and facilitate the sharing and use of all
125 state-collected health data to the maximum extent allowed by law
126 Establish by rule the types of data collected, compiled,
127 processed, used, or shared. Decisions regarding center data sets
128 should be made based on consultation with the State Consumer
129 Health Information and Policy Advisory Council and other public
130 and private users regarding the types of data which should be
131 collected and their uses. The center shall establish
132 standardized means for collecting health information and
133 statistics under laws and rules administered by the agency.
134 (f) Establish minimum health-care-related data sets which
135 are necessary on a continuing basis to fulfill the collection
136 requirements of the center and which shall be used by state
137 agencies in collecting and compiling health-care-related data.
138 The agency shall periodically review ongoing health care data
139 collections of the Department of Health and other state agencies
140 to determine if the collections are being conducted in
141 accordance with the established minimum sets of data.
142 (g) Establish advisory standards to ensure the quality of
143 health statistical and epidemiological data collection,
144 processing, and analysis by local, state, and private
146 (e) (h) Monitor data collection procedures, test data
147 quality, and take such corrective actions as may be necessary to
148 ensure that data and information disseminated under the
149 initiative are accurate, valid, reliable, and complete Prescribe
150 standards for the publication of health-care-related data
151 reported pursuant to this section which ensure the reporting of
152 accurate, valid, reliable, complete, and comparable data. Such
153 standards should include advisory warnings to users of the data
154 regarding the status and quality of any data reported by or
155 available from the center.
156 (f) (i) Initiate and maintain activities necessary to
157 collect, edit, verify, archive, and retrieve Prescribe standards
158 for the maintenance and preservation of the center’s data. This
159 should include methods for archiving data, retrieval of archived
160 data , and data compiled pursuant to this section editing and
162 (j) Ensure that strict quality control measures are
163 maintained for the dissemination of data through publications,
164 studies, or user requests.
165 (k) Develop, in conjunction with the State Consumer Health
166 Information and Policy Advisory Council, and implement a long
167 range plan for making available health care quality measures and
168 financial data that will allow consumers to compare health care
169 services. The health care quality measures and financial data
170 the agency must make available shall include, but is not limited
171 to, pharmaceuticals, physicians, health care facilities, and
172 health plans and managed care entities. The agency shall update
173 the plan and report on the status of its implementation
174 annually. The agency shall also make the plan and status report
175 available to the public on its Internet website. As part of the
176 plan, the agency shall identify the process and timeframes for
177 implementation, any barriers to implementation, and
178 recommendations of changes in the law that may be enacted by the
179 Legislature to eliminate the barriers. As preliminary elements
180 of the plan, the agency shall:
181 1. Make available patient-safety indicators, inpatient
182 quality indicators, and performance outcome and patient charge
183 data collected from health care facilities pursuant to s.
184 408.061 (1)(a) and (2). The terms “patient-safety indicators” and
185 “inpatient quality indicators” shall be as defined by the
186 Centers for Medicare and Medicaid Services, the National Quality
187 Forum, the Joint Commission on Accreditation of Healthcare
188 Organizations, the Agency for Healthcare Research and Quality,
189 the Centers for Disease Control and Prevention, or a similar
190 national entity that establishes standards to measure the
191 performance of health care providers, or by other states. The
192 agency shall determine which conditions, procedures, health care
193 quality measures, and patient charge data to disclose based upon
194 input from the council. When determining which conditions and
195 procedures are to be disclosed, the council and the agency shall
196 consider variation in costs, variation in outcomes, and
197 magnitude of variations and other relevant information. When
198 determining which health care quality measures to disclose, the
200 a. Shall consider such factors as volume of cases; average
201 patient charges; average length of stay; complication rates;
202 mortality rates; and infection rates, among others, which shall
203 be adjusted for case mix and severity, if applicable.
204 b. May consider such additional measures that are adopted
205 by the Centers for Medicare and Medicaid Studies, National
206 Quality Forum, the Joint Commission on Accreditation of
207 Healthcare Organizations, the Agency for Healthcare Research and
208 Quality, Centers for Disease Control and Prevention, or a
209 similar national entity that establishes standards to measure
210 the performance of health care providers, or by other states.
212 When determining which patient charge data to disclose, the
213 agency shall include such measures as the average of
214 undiscounted charges on frequently performed procedures and
215 preventive diagnostic procedures, the range of procedure charges
216 from highest to lowest, average net revenue per adjusted patient
217 day, average cost per adjusted patient day, and average cost per
218 admission, among others.
219 2. Make available performance measures, benefit design, and
220 premium cost data from health plans licensed pursuant to chapter
221 627 or chapter 641. The agency shall determine which health care
222 quality measures and member and subscriber cost data to
223 disclose, based upon input from the council. When determining
224 which data to disclose, the agency shall consider information
225 that may be required by either individual or group purchasers to
226 assess the value of the product, which may include membership
227 satisfaction, quality of care, current enrollment or membership,
228 coverage areas, accreditation status, premium costs, plan costs,
229 premium increases, range of benefits, copayments and
230 deductibles, accuracy and speed of claims payment, credentials
231 of physicians, number of providers, names of network providers,
232 and hospitals in the network. Health plans shall make available
233 to the agency any such data or information that is not currently
234 reported to the agency or the office.
235 3. Determine the method and format for public disclosure of
236 data reported pursuant to this paragraph. The agency shall make
237 its determination based upon input from the State Consumer
238 Health Information and Policy Advisory Council. At a minimum,
239 the data shall be made available on the agency’s Internet
240 website in a manner that allows consumers to conduct an
241 interactive search that allows them to view and compare the
242 information for specific providers. The website must include
243 such additional information as is determined necessary to ensure
244 that the website enhances informed decisionmaking among
245 consumers and health care purchasers, which shall include, at a
246 minimum, appropriate guidance on how to use the data and an
247 explanation of why the data may vary from provider to provider.
248 4. Publish on its website undiscounted charges for no fewer
249 than 150 of the most commonly performed adult and pediatric
250 procedures, including outpatient, inpatient, diagnostic, and
251 preventative procedures.
252 (4) TECHNICAL ASSISTANCE.—
253 (a) The center shall provide technical assistance to
254 persons or organizations engaged in health planning activities
255 in the effective use of statistics collected and compiled by the
256 center. The center shall also provide the following additional
257 technical assistance services:
258 1. Establish procedures identifying the circumstances under
259 which, the places at which, the persons from whom, and the
260 methods by which a person may secure data from the center,
261 including procedures governing requests, the ordering of
262 requests, timeframes for handling requests, and other procedures
263 necessary to facilitate the use of the center’s data. To the
264 extent possible, the center should provide current data timely
265 in response to requests from public or private agencies.
266 2. Provide assistance to data sources and users in the
267 areas of database design, survey design, sampling procedures,
268 statistical interpretation, and data access to promote improved
269 health-care-related data sets.
270 3. Identify health care data gaps and provide technical
271 assistance to other public or private organizations for meeting
272 documented health care data needs.
273 4. Assist other organizations in developing statistical
274 abstracts of their data sets that could be used by the center.
275 5. Provide statistical support to state agencies with
276 regard to the use of databases maintained by the center.
277 6. To the extent possible, respond to multiple requests for
278 information not currently collected by the center or available
279 from other sources by initiating data collection.
280 7. Maintain detailed information on data maintained by
281 other local, state, federal, and private agencies in order to
282 advise those who use the center of potential sources of data
283 which are requested but which are not available from the center.
284 8. Respond to requests for data which are not available in
285 published form by initiating special computer runs on data sets
286 available to the center.
287 9. Monitor innovations in health information technology,
288 informatics, and the exchange of health information and maintain
289 a repository of technical resources to support the development
290 of a health information network.
291 (b) The agency shall administer, manage, and monitor grants
292 to not-for-profit organizations, regional health information
293 organizations, public health departments, or state agencies that
294 submit proposals for planning, implementation, or training
295 projects to advance the development of a health information
296 network. Any grant contract shall be evaluated to ensure the
297 effective outcome of the health information project.
298 (c) The agency shall initiate, oversee, manage, and
299 evaluate the integration of health care data from each state
300 agency that collects, stores, and reports on health care issues
301 and make that data available to any health care practitioner
302 through a state health information network.
303 (5) PUBLICATIONS; REPORTS; SPECIAL STUDIES.—The center
304 shall provide for the widespread dissemination of data which it
305 collects and analyzes. The center shall have the following
306 publication, reporting, and special study functions:
307 (a) The center shall publish and make available
308 periodically to agencies and individuals health statistics
309 publications of general interest, including health plan consumer
310 reports and health maintenance organization member satisfaction
311 surveys; publications providing health statistics on topical
312 health policy issues; publications that provide health status
313 profiles of the people in this state; and other topical health
314 statistics publications.
315 (b) The center shall publish, make available, and
316 disseminate, promptly and as widely as practicable, the results
317 of special health surveys, health care research, and health care
318 evaluations conducted or supported under this section. Any
319 publication by the center must include a statement of the
320 limitations on the quality, accuracy, and completeness of the
322 (c) The center shall provide indexing, abstracting,
323 translation, publication, and other services leading to a more
324 effective and timely dissemination of health care statistics.
325 (d) The center shall be responsible for publishing and
326 disseminating an annual report on the center’s activities.
327 (e) The center shall be responsible, to the extent
328 resources are available, for conducting a variety of special
329 studies and surveys to expand the health care information and
330 statistics available for health policy analyses, particularly
331 for the review of public policy issues. The center shall develop
332 a process by which users of the center’s data are periodically
333 surveyed regarding critical data needs and the results of the
334 survey considered in determining which special surveys or
335 studies will be conducted. The center shall select problems in
336 health care for research, policy analyses, or special data
337 collections on the basis of their local, regional, or state
338 importance; the unique potential for definitive research on the
339 problem; and opportunities for application of the study
341 (4) (6) PROVIDER DATA REPORTING.—This section does not
342 confer on the agency the power to demand or require that a
343 health care provider or professional furnish information,
344 records of interviews, written reports, statements, notes,
345 memoranda, or data other than as expressly required by law.
346 (5) (7) HEALTH INFORMATION ENTERPRISE BUDGET; FEES.—
347 (a) The agency shall implement the transparency initiative
348 in a manner that recognizes state-collected data as an asset and
349 rewards taxpayer investment in information collection and
350 management Legislature intends that funding for the Florida
351 Center for Health Information and Policy Analysis be
352 appropriated from the General Revenue Fund.
353 (b) The agency Florida Center for Health Information and
354 Policy Analysis may apply for, and receive, and accept grants,
355 gifts, and other payments, including property and services, from
356 a any governmental or other public or private entity or person
357 and make arrangements for as to the use of such funds same,
358 including the undertaking of special studies and other projects
359 relating to health-care-related topics. Funds obtained pursuant
360 to this paragraph may not be used to offset annual
361 appropriations from the General Revenue Fund.
362 (c) The agency shall ensure that a vendor who enters into a
363 contract with the state under this section does not inhibit or
364 impede consumer access to state-collected health data and
365 information center may charge such reasonable fees for services
366 as the agency prescribes by rule. The established fees may not
367 exceed the reasonable cost for such services. Fees collected may
368 not be used to offset annual appropriations from the General
369 Revenue Fund .
370 (8) STATE CONSUMER HEALTH INFORMATION AND POLICY ADVISORY
372 (a) There is established in the agency the State Consumer
373 Health Information and Policy Advisory Council to assist the
374 center in reviewing the comprehensive health information system,
375 including the identification, collection, standardization,
376 sharing, and coordination of health-related data, fraud and
377 abuse data, and professional and facility licensing data among
378 federal, state, local, and private entities and to recommend
379 improvements for purposes of public health, policy analysis, and
380 transparency of consumer health care information. The council
381 shall consist of the following members:
382 1. An employee of the Executive Office of the Governor, to
383 be appointed by the Governor.
384 2. An employee of the Office of Insurance Regulation, to be
385 appointed by the director of the office.
386 3. An employee of the Department of Education, to be
387 appointed by the Commissioner of Education.
388 4. Ten persons, to be appointed by the Secretary of Health
389 Care Administration, representing other state and local
390 agencies, state universities, business and health coalitions,
391 local health councils, professional health-care-related
392 associations, consumers, and purchasers.
393 (b) Each member of the council shall be appointed to serve
394 for a term of 2 years following the date of appointment, except
395 the term of appointment shall end 3 years following the date of
396 appointment for members appointed in 2003, 2004, and 2005. A
397 vacancy shall be filled by appointment for the remainder of the
398 term, and each appointing authority retains the right to
399 reappoint members whose terms of appointment have expired.
400 (c) The council may meet at the call of its chair, at the
401 request of the agency, or at the request of a majority of its
402 membership, but the council must meet at least quarterly.
403 (d) Members shall elect a chair and vice chair annually.
404 (e) A majority of the members constitutes a quorum, and the
405 affirmative vote of a majority of a quorum is necessary to take
407 (f) The council shall maintain minutes of each meeting and
408 shall make such minutes available to any person.
409 (g) Members of the council shall serve without compensation
410 but shall be entitled to receive reimbursement for per diem and
411 travel expenses as provided in s. 112.061 .
412 (h) The council’s duties and responsibilities include, but
413 are not limited to, the following:
414 1. To develop a mission statement, goals, and a plan of
415 action for the identification, collection, standardization,
416 sharing, and coordination of health-related data across federal,
417 state, and local government and private sector entities.
418 2. To develop a review process to ensure cooperative
419 planning among agencies that collect or maintain health-related
421 3. To create ad hoc issue-oriented technical workgroups on
422 an as-needed basis to make recommendations to the council.
423 (9) APPLICATION TO OTHER AGENCIES.—Nothing in this section
424 shall limit, restrict, affect, or control the collection,
425 analysis, release, or publication of data by any state agency
426 pursuant to its statutory authority, duties, or
428 Section 2. Paragraph (c) of subsection (4) of section
429 381.026, Florida Statutes, is amended to read:
430 381.026 Florida Patient’s Bill of Rights and
432 (4) RIGHTS OF PATIENTS.—Each health care facility or
433 provider shall observe the following standards:
434 (c) Financial information and disclosure.—
435 1. A patient has the right to be given, upon request, by
436 the responsible provider, his or her designee, or a
437 representative of the health care facility full information and
438 necessary counseling on the availability of known financial
439 resources for the patient’s health care.
440 2. A health care provider or a health care facility shall,
441 upon request, disclose to each patient who is eligible for
442 Medicare, before treatment, whether the health care provider or
443 the health care facility in which the patient is receiving
444 medical services accepts assignment under Medicare reimbursement
445 as payment in full for medical services and treatment rendered
446 in the health care provider’s office or health care facility.
447 3. A primary care provider may publish a schedule of
448 charges for the medical services that the provider offers to
449 patients. The schedule must include the prices charged to an
450 uninsured person paying for such services by cash, check, credit
451 card, or debit card. The schedule must be posted in a
452 conspicuous place in the reception area of the provider’s office
453 and must include, but is not limited to, the 50 services most
454 frequently provided by the primary care provider. The schedule
455 may group services by three price levels, listing services in
456 each price level. The posting must be at least 15 square feet in
457 size. A primary care provider who publishes and maintains a
458 schedule of charges for medical services is exempt from the
459 license fee requirements for a single period of renewal of a
460 professional license under chapter 456 for that licensure term
461 and is exempt from the continuing education requirements of
462 chapter 456 and the rules implementing those requirements for a
463 single 2-year period.
464 4. If a primary care provider publishes a schedule of
465 charges pursuant to subparagraph 3., he or she must continually
466 post it at all times for the duration of active licensure in
467 this state when primary care services are provided to patients.
468 If a primary care provider fails to post the schedule of charges
469 in accordance with this subparagraph, the provider must shall be
470 required to pay any license fee and comply with any continuing
471 education requirements for which an exemption was received.
472 5. A health care provider or a health care facility shall,
473 upon request, furnish a person, before the provision of medical
474 services, a reasonable estimate of charges for such services.
475 The health care provider or the health care facility shall
476 provide an uninsured person, before the provision of a planned
477 nonemergency medical service, a reasonable estimate of charges
478 for such service and information regarding the provider’s or
479 facility’s discount or charity policies for which the uninsured
480 person may be eligible. Such estimates by a primary care
481 provider must be consistent with the schedule posted under
482 subparagraph 3. To the extent possible, estimates shall , to the
483 extent possible, be written in language comprehensible to an
484 ordinary layperson. Such reasonable estimate does not preclude
485 the health care provider or health care facility from exceeding
486 the estimate or making additional charges based on changes in
487 the patient’s condition or treatment needs.
488 6. Each licensed facility not operated by the state shall
489 make available to the public on its Internet website or by other
490 electronic means a description of and a link to the performance
491 outcome and financial data that is published by the agency
492 pursuant to s. 408.05 (3)(k). The facility shall place a notice
493 in the reception area that such information is available
494 electronically and the website address. The licensed facility
495 may indicate that the pricing information is based on a
496 compilation of charges for the average patient and that each
497 patient’s bill may vary from the average depending upon the
498 severity of illness and individual resources consumed. The
499 licensed facility may also indicate that the price of service is
500 negotiable for eligible patients based upon the patient’s
501 ability to pay.
502 7. A patient has the right to receive a copy of an itemized
503 bill upon request. A patient has a right to be given an
504 explanation of charges upon request.
505 Section 3. Subsection (11) of section 395.301, Florida
506 Statutes, is amended to read:
507 395.301 Itemized patient bill; form and content prescribed
508 by the agency.—
509 (11) Each licensed facility shall make available on its
510 Internet website a link to the performance outcome and financial
511 data that is published by the Agency for Health Care
512 Administration pursuant to s. 408.05 (3)(k). The facility shall
513 place a notice in the reception area that the information is
514 available electronically and the facility’s Internet website
516 Section 4. Section 465.0244, Florida Statutes, is amended
517 to read:
518 465.0244 Information disclosure.—Every pharmacy shall make
519 available on its Internet website a link to the performance
520 outcome and financial data that is published by the Agency for
521 Health Care Administration pursuant to s. 408.05 (3)(k) and shall
522 place in the area where customers receive filled prescriptions
523 notice that such information is available electronically and the
524 address of its Internet website.
525 Section 5. Subsection (2) of section 627.6499, Florida
526 Statutes, is amended to read:
527 627.6499 Reporting by insurers and third-party
529 (2) Each health insurance issuer shall make available on
530 its Internet website a link to the performance outcome and
531 financial data that is published by the Agency for Health Care
532 Administration pursuant to s. 408.05 (3)(k) and shall include in
533 every policy delivered or issued for delivery to any person in
534 the state or any materials provided as required by s. 627.64725
535 notice that such information is available electronically and the
536 address of its Internet website.
537 Section 6. Subsection (7) of section 641.54, Florida
538 Statutes, is amended to read:
539 641.54 Information disclosure.—
540 (7) Each health maintenance organization shall make
541 available on its Internet website a link to the performance
542 outcome and financial data that is published by the Agency for
543 Health Care Administration pursuant to s. 408.05 (3)(k) and shall
544 include in every policy delivered or issued for delivery to any
545 person in the state or any materials provided as required by s.
546 627.64725 notice that such information is available
547 electronically and the address of its Internet website.
548 Section 7. This act shall take effect July 1, 2013.