Florida Senate - 2016 COMMITTEE AMENDMENT
Bill No. PCS (664560) for SB 1496
Senate . House
Comm: RCS .
The Committee on Appropriations (Gaetz) recommended the
1 Senate Amendment (with title amendment)
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 395.301, Florida Statutes, is amended to
7 395.301 Price transparency; itemized patient statement or
form and content prescribed by the agency; patient
9 admission status notification.—
10 (1) A facility licensed under this chapter shall provide
11 timely and accurate financial information and quality of service
12 measures to prospective and actual patients of the facility, or
13 to patients’ survivors or legal guardians, as appropriate. Such
14 information shall be provided in accordance with this section
15 and rules adopted by the agency pursuant to this chapter and s.
16 408.05. Licensed facilities operating exclusively as state
17 facilities are exempt from this subsection.
18 (a) Each licensed facility shall make available to the
19 public on its website information on payments made to that
20 facility for defined bundles of services and procedures. The
21 payment data must be presented and searchable in accordance
22 with, and through a hyperlink to, the system established by the
23 agency and its vendor using the descriptive service bundles
24 developed under s. 408.05(3)(c). At a minimum, the facility
25 shall provide the estimated average payment received from all
26 payors, excluding Medicaid and Medicare, for the descriptive
27 service bundles available at that facility and the estimated
28 payment range for such bundles. Using plain language,
29 comprehensible to an ordinary layperson, the facility must
30 disclose that the information on average payments and the
31 payment ranges is an estimate of costs that may be incurred by
32 the patient or prospective patient and that actual costs will be
33 based on the services actually provided to the patient. The
34 facility shall also assist the consumer in accessing his or her
35 health insurer’s or health maintenance organization’s website
36 for information on estimated copayments, deductibles, and other
37 cost-sharing responsibilities. The facility’s website must:
38 1. Identify and post the names and hyperlinks for direct
39 access to the websites of all health insurers and health
40 maintenance organizations for which the facility is a network
41 provider or preferred provider.
42 2. Provide information to uninsured patients and insured
43 patients whose health insurer or health maintenance organization
44 does not include the facility as a network provider or preferred
45 provider on the facility’s financial assistance policy,
46 including the application process, payment plans, and discounts,
47 and the facility’s charity care policy and collection
49 3. If applicable, notify patients and prospective patients
50 that services may be provided in the health care facility by the
51 facility as well as by other health care providers who may
52 separately bill the patient and that such health care providers
53 may or may not participate with the same health insurers or
54 health maintenance organizations as the facility does.
55 4. Inform patients and prospective patients that they may
56 request from the facility and other health care providers a more
57 personalized estimate of charges and other information, and
58 inform patients that they should contact each health care
59 practitioner who will provide services in the hospital to
60 determine with which health insurers and health maintenance
61 organizations he or she participates as a network provider or
62 preferred provider.
63 5. Provide the names, mailing addresses, and telephone
64 numbers of the health care practitioners and medical practice
65 groups with which it contracts to provide services in the
66 facility and instructions on how to contact the practitioners
67 and groups to determine the health insurers and health
68 maintenance organizations with which they participate as a
69 network provider or preferred provider.
70 (b)1. Upon request, and before providing any nonemergency
71 medical services, each licensed facility shall provide a
72 written, good faith estimate of reasonably anticipated charges
73 by the facility for the treatment of the patient’s or
74 prospective patient’s specific condition. The facility must
75 provide the estimate in writing to the patient or prospective
76 patient within 7 business days after the receipt of the request
77 and is not required to adjust the estimate for any potential
78 insurance coverage. The estimate may be based on the descriptive
79 service bundles developed by the agency under s. 408.05(3)(c)
80 unless the patient or prospective patient requests a more
81 personalized and specific estimate that accounts for the
82 specific condition and characteristics of the patient or
83 prospective patient. The facility shall inform the patient or
84 prospective patient that he or she may contact his or her health
85 insurer or health maintenance organization for additional
86 information concerning cost-sharing responsibilities.
87 2. In the estimate, the facility shall provide to the
88 patient or prospective patient information on the facility’s
89 financial assistance policy, including the application process,
90 payment plans, and discounts and the facility’s charity care
91 policy and collection procedures.
92 3. The estimate shall clearly identify any facility fees
93 and, if applicable, include a statement notifying the patient or
94 prospective patient that a facility fee is included in the
95 estimate, the purpose of the fee, and that the patient may pay
96 less for the procedure or service at another facility or in
97 another health care setting.
98 4. Upon request, the facility shall notify the patient or
99 prospective patient of any revision to the estimate.
100 5. In the estimate, the facility must notify the patient or
101 prospective patient that services may be provided in the health
102 care facility by the facility as well as by other health care
103 providers that may separately bill the patient, if applicable.
104 6. The facility shall take action to educate the public
105 that such estimates are available upon request.
106 7. Failure to timely provide the estimate pursuant to this
107 paragraph shall result in a daily fine of $1,000 until the
108 estimate is provided to the patient or prospective patient. The
109 total fine may not exceed $10,000.
111 The provision of an estimate does not preclude the actual
112 charges from exceeding the estimate.
113 (c) Each facility shall make available on its website a
114 hyperlink to the health-related data, including quality measures
115 and statistics that are disseminated by the agency pursuant to
116 s. 408.05. The facility shall also take action to notify the
117 public that such information is electronically available and
118 provide a hyperlink to the agency’s website.
119 (d)1. Upon request, and after the patient’s discharge or
120 release from a facility, the facility must provide A licensed
121 facility not operated by the state shall notify each patient
122 during admission and at discharge of his or her right to receive
123 an itemized bill upon request. Within 7 days following the
124 patient’s discharge or release from a licensed facility not
125 operated by the state, the licensed facility providing the
126 service shall, upon request, submit to the patient , or to the
127 patient’s survivor or legal guardian, as may be appropriate, an
128 itemized statement or bill detailing in plain language,
129 comprehensible to an ordinary layperson, the specific nature of
130 charges or expenses incurred by the patient. , which in The
131 initial statement or bill billing shall be provided within 7
132 days after the patient’s discharge or release or after a request
133 for such statement or bill, whichever is later. The initial
134 statement or bill must contain a statement of specific services
135 received and expenses incurred by date and provider for such
136 items of service, enumerating in detail as prescribed by the
137 agency the constituent components of the services received
138 within each department of the licensed facility and including
139 unit price data on rates charged by the licensed facility , as
140 prescribed by the agency. The statement or bill must also
141 clearly identify any facility fee and explain the purpose of the
142 fee. The statement or bill must identify each item as paid,
143 pending payment by a third party, or pending payment by the
144 patient and must include the amount due, if applicable. If an
145 amount is due from the patient, a due date must be included. The
146 initial statement or bill must direct the patient or the
147 patient’s survivor or legal guardian, as appropriate, to contact
148 the patient’s insurer or health maintenance organization
149 regarding the patient’s cost-sharing responsibilities.
150 2. Any subsequent statement or bill provided to a patient
151 or to the patient’s survivor or legal guardian, as appropriate,
152 relating to the episode of care must include all of the
153 information required by subparagraph 1., with any revisions
154 clearly delineated.
155 3. (2)(a) Each such statement or bill provided submitted
156 pursuant to this subsection section:
157 a. 1. Must May not include notice charges of hospital-based
158 physicians and other health care providers who bill if billed
160 b. 2. May not include any generalized category of expenses
161 such as “other” or “miscellaneous” or similar categories.
162 c. 3. Must Shall list drugs by brand or generic name and not
163 refer to drug code numbers when referring to drugs of any sort.
164 d. 4. Must Shall specifically identify physical,
165 occupational, or speech therapy treatment by as to the date,
166 type, and length of treatment when such therapy treatment is a
167 part of the statement or bill.
168 (b) Any person receiving a statement pursuant to this
169 section shall be fully and accurately informed as to each charge
170 and service provided by the institution preparing the statement.
171 (2) (3) On each itemized statement submitted pursuant to
172 subsection (1) there shall appear the words “A FOR-PROFIT (or
173 NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
174 CENTER) LICENSED BY THE STATE OF FLORIDA” or substantially
175 similar words sufficient to identify clearly and plainly the
176 ownership status of the licensed facility. Each itemized
177 statement or bill must prominently display the telephone phone
178 number of the medical facility’s patient liaison who is
179 responsible for expediting the resolution of any billing dispute
180 between the patient, or the patient’s survivor or legal guardian
181 his or her representative, and the billing department.
182 (4) An itemized bill shall be provided once to the
183 patient’s physician at the physician’s request, at no charge.
184 (5) In any billing for services subsequent to the initial
185 billing for such services, the patient, or the patient’s
186 survivor or legal guardian, may elect, at his or her option, to
187 receive a copy of the detailed statement of specific services
188 received and expenses incurred for each such item of service as
189 provided in subsection (1).
190 (6) No physician, dentist, podiatric physician, or licensed
191 facility may add to the price charged by any third party except
192 for a service or handling charge representing a cost actually
193 incurred as an item of expense; however, the physician, dentist,
194 podiatric physician, or licensed facility is entitled to fair
195 compensation for all professional services rendered. The amount
196 of the service or handling charge, if any, shall be set forth
197 clearly in the bill to the patient.
198 (7) Each licensed facility not operated by the state shall
199 provide, prior to provision of any nonemergency medical
200 services, a written good faith estimate of reasonably
201 anticipated charges for the facility to treat the patient’s
202 condition upon written request of a prospective patient. The
203 estimate shall be provided to the prospective patient within 7
204 business days after the receipt of the request. The estimate may
205 be the average charges for that diagnosis related group or the
206 average charges for that procedure. Upon request, the facility
207 shall notify the patient of any revision to the good faith
208 estimate. Such estimate shall not preclude the actual charges
209 from exceeding the estimate. The facility shall place a notice
210 in the reception area that such information is available.
211 Failure to provide the estimate within the provisions
212 established pursuant to this section shall result in a fine of
213 $500 for each instance of the facility’s failure to provide the
214 requested information.
215 (8) Each licensed facility that is not operated by the
216 state shall provide any uninsured person seeking planned
217 nonemergency elective admission a written good faith estimate of
218 reasonably anticipated charges for the facility to treat such
219 person. The estimate must be provided to the uninsured person
220 within 7 business days after the person notifies the facility
221 and the facility confirms that the person is uninsured. The
222 estimate may be the average charges for that diagnosis-related
223 group or the average charges for that procedure. Upon request,
224 the facility shall notify the person of any revision to the good
225 faith estimate. Such estimate does not preclude the actual
226 charges from exceeding the estimate. The facility shall also
227 provide to the uninsured person a copy of any facility discount
228 and charity care discount policies for which the uninsured
229 person may be eligible. The facility shall place a notice in the
230 reception area where such information is available. Failure to
231 provide the estimate as required by this subsection shall result
232 in a fine of $500 for each instance of the facility’s failure to
233 provide the requested information.
234 (3) (9) If a licensed facility places a patient on
235 observation status rather than inpatient status, observation
236 services shall be documented in the patient’s discharge papers.
237 The patient or the patient’s survivor or legal guardian proxy
238 shall be notified of observation services through discharge
239 papers, which may also include brochures, signage, or other
240 forms of communication for this purpose.
241 (4) (10) A licensed facility shall make available to a
242 patient all records necessary for verification of the accuracy
243 of the patient’s statement or bill within 10 30 business days
244 after the request for such records. The records verification
245 information must be made available in the facility’s offices and
246 through electronic means that comply with the Health Insurance
247 Portability and Accountability Act of 1996. Such records must
248 shall be available to the patient before prior to and after
249 payment of the statement or bill or claim. The facility may not
250 charge the patient for making such verification records
251 available; however, the facility may charge its usual fee for
252 providing copies of records as specified in s. 395.3025.
253 (5) (11) Each facility shall establish a method for
254 reviewing and responding to questions from patients concerning
255 the patient’s itemized statement or bill. Such response shall be
256 provided within 7 business 30 days after the date a question is
257 received. If the patient is not satisfied with the response, the
258 facility must provide the patient with the contact information
259 address of the consumer advocate as provided in s. 627.0613
260 agency to which the issue may be sent for review.
261 (12) Each licensed facility shall make available on its
262 Internet website a link to the performance outcome and financial
263 data that is published by the Agency for Health Care
264 Administration pursuant to s. 408.05(3)(k). The facility shall
265 place a notice in the reception area that the information is
266 available electronically and the facility’s Internet website
268 Section 2. Section 395.107, Florida Statutes, is amended to
270 395.107 Facilities Urgent care centers; publishing and
271 posting schedule of charges; penalties.—
272 (1) For purposes of this section, “facility” means:
273 (a) An urgent care center as defined in s. 395.002; or
274 (b) A diagnostic-imaging center operated by a hospital
275 licensed under this chapter which is not located on the
276 hospital’s premises.
277 (2) A facility An urgent care center must publish and post
278 a schedule of charges for the medical services offered to
280 (3) (2) The schedule of charges must describe the medical
281 services in language comprehensible to a layperson. The schedule
282 must include the prices charged to an uninsured person paying
283 for such services by cash, check, credit card, or debit card.
284 The schedule must be posted in a conspicuous place in the
285 reception area and must include, but is not limited to, the 50
286 services most frequently provided. The schedule may group
287 services by three price levels, listing services in each price
288 level. The posting may be a sign, which must be at least 15
289 square feet in size, or may be through an electronic messaging
290 board. If a facility an urgent care center is affiliated with a
291 facility licensed hospital under this chapter, the schedule must
292 include text that notifies the insured patients whether the
293 charges for medical services received at the center will be the
294 same as, or more than, charges for medical services received at
295 the affiliated hospital. The text notifying the patient of the
296 schedule of charges shall be in a font size equal to or greater
297 than the font size used for prices and must be in a contrasting
298 color. The text that notifies the insured patients whether the
299 charges for medical services received at the center will be the
300 same as, or more than, charges for medical services received at
301 the affiliated hospital shall be included in all media and
302 Internet advertisements for the center and in language
303 comprehensible to a layperson.
304 (4) (3) The posted text describing the medical services must
305 fill at least 12 square feet of the posting. A facility center
306 may use an electronic device or messaging board to post the
307 schedule of charges. Such a device must be at least 3 square
308 feet, and patients must be able to access the schedule during
309 all hours of operation of the facility urgent care center.
310 (5) (4) A facility An urgent care center that is operated
311 and used exclusively for employees and the dependents of
312 employees of the business that owns or contracts for the
313 facility urgent care center is exempt from this section.
314 (6) (5) The failure of a facility an urgent care center to
315 publish and post a schedule of charges as required by this
316 section shall result in a fine of not more than $1,000, per day,
317 until the schedule is published and posted.
318 Section 3. Section 395.3012, Florida Statutes, is created
319 to read:
320 395.3012 Penalties for unconscionable prices.—
321 (1) The agency may impose administrative fines based on the
322 findings of the consumer advocate’s investigation of billing
323 complaints pursuant to s. 627.0613(6).
324 (2) The administrative fines for noncompliance with s.
325 395.301 are the greater of $2,500 per violation or double the
326 amount of the original charges.
327 Section 4. Subsection (1) of section 400.487, Florida
328 Statutes, is amended to read:
329 400.487 Home health service agreements; physician’s,
330 physician assistant’s, and advanced registered nurse
331 practitioner’s treatment orders; patient assessment;
332 establishment and review of plan of care; provision of services;
333 orders not to resuscitate.—
334 (1)(a) Services provided by a home health agency must be
335 covered by an agreement between the home health agency and the
336 patient or the patient’s legal representative specifying the
337 home health services to be provided, the rates or charges for
338 services paid with private funds, and the sources of payment,
339 which may include Medicare, Medicaid, private insurance,
340 personal funds, or a combination thereof. A home health agency
341 providing skilled care must make an assessment of the patient’s
342 needs within 48 hours after the start of services.
343 (b) Every licensed home health agency shall provide upon
344 the request of a prospective patient or his or her legal
345 guardian a written, good faith estimate of reasonably
346 anticipated charges for the prospective patient for services
347 provided by the home health agency. The home health agency must
348 provide the estimate to the requestor within 7 business days
349 after receiving the request. The home health agency must inform
350 the prospective patient, or his or her legal guardian, that he
351 or she may contact the prospective patient’s health insurer or
352 health maintenance organization for additional information
353 concerning cost-sharing responsibilities. The home health agency
354 must also provide information disclosing the home health
355 agency’s payment plans, discounts, and other available
356 assistance and its collection procedures.
357 Section 5. Subsection (23) is added to section 400.934,
358 Florida Statutes, to read:
359 400.934 Minimum standards.—As a requirement of licensure,
360 home medical equipment providers shall:
361 (23) Provide upon the request of a prospective patient or
362 his or her legal guardian a written, good faith estimate of
363 reasonably anticipated charges for the prospective patient for
364 services provided by the home medical equipment provider. The
365 home medical equipment provider must provide the estimate to the
366 requestor within 7 business days after receiving the request.
367 The home medical equipment provider must inform the prospective
368 patient, or his or her legal guardian, that he or she may
369 contact the prospective patient’s health insurer or health
370 maintenance organization for additional information concerning
371 cost-sharing responsibilities. The home medical equipment
372 provider must also provide information disclosing the home
373 medical equipment provider’s payment plans, discounts, and other
374 available assistance and its collection procedures.
375 Section 6. Section 408.05, Florida Statutes, is amended to
377 408.05 Florida Center for Health Information and
378 Transparency Policy Analysis.—
379 (1) ESTABLISHMENT.—The agency shall establish and maintain
380 a Florida Center for Health Information and Transparency to
381 collect, compile, coordinate, analyze, index, and disseminate
382 Policy Analysis. The center shall establish a comprehensive
383 health information system to provide for the collection,
384 compilation, coordination, analysis, indexing, dissemination,
385 and utilization of both purposefully collected and extant
386 health-related data and statistics. The center shall be staffed
387 as with public health experts, biostatisticians, information
388 system analysts, health policy experts, economists, and other
389 staff necessary to carry out its functions.
390 (2) HEALTH-RELATED DATA.—The comprehensive health
391 information system operated by the Florida Center for Health
392 Information and Transparency Policy Analysis shall identify the
393 best available data sets, compile new data when specifically
394 authorized, data sources and promote the use coordinate the
395 compilation of extant health-related data and statistics. The
396 center must maintain any data sets in existence before July 1,
397 2016, unless such data sets duplicate information that is
398 readily available from other credible sources, and may and
399 purposefully collect or compile data on:
400 (a) The extent and nature of illness and disability of the
401 state population, including life expectancy, the incidence of
402 various acute and chronic illnesses, and infant and maternal
403 morbidity and mortality.
404 (b) The impact of illness and disability of the state
405 population on the state economy and on other aspects of the
406 well-being of the people in this state.
407 (c) Environmental, social, and other health hazards.
408 (d) Health knowledge and practices of the people in this
409 state and determinants of health and nutritional practices and
411 (a) (e) Health resources, including licensed physicians,
412 dentists, nurses, and other health care practitioners
413 professionals, by specialty and type of practice. Such data
414 shall include information collected by the Department of Health
415 pursuant to ss. 458.3191 and 459.0081.
416 (b) Health service inventories, including and acute care,
417 long-term care, and other institutional care facilities facility
418 supplies and specific services provided by hospitals, nursing
419 homes, home health agencies, and other licensed health care
421 (c) (f) Service utilization for licensed health care
422 facilities of health care by type of provider.
423 (d) (g) Health care costs and financing, including trends in
424 health care prices and costs, the sources of payment for health
425 care services, and federal, state, and local expenditures for
426 health care.
427 (h) Family formation, growth, and dissolution.
428 (e) (i) The extent of public and private health insurance
429 coverage in this state.
430 (f) (j) Specific quality-of-care initiatives involving The
431 quality of care provided by various health care providers when
432 extant data is not adequate to achieve the objectives of the
434 (3) COMPREHENSIVE HEALTH INFORMATION TRANSPARENCY SYSTEM.
435 In order to disseminate and facilitate the availability of
436 produce comparable and uniform health information and statistics
437 for the development of policy recommendations, the agency shall
438 perform the following functions:
439 (a) Collect and compile information on and coordinate the
440 activities of state agencies involved in providing the design
441 and implementation of the comprehensive health information to
442 consumers system.
443 (b) Promote data sharing through dissemination of state
444 collected health data by making such data available,
445 transferable, and readily usable Undertake research,
446 development, and evaluation respecting the comprehensive health
447 information system.
448 (c) Contract with a vendor to provide a consumer-friendly,
449 Internet-based platform that allows a consumer to research the
450 cost of health care services and procedures and allows for price
451 comparison. The Internet-based platform must allow a consumer to
452 search by condition or service bundles that are comprehensible
453 to a layperson and may not require registration, a security
454 password, or user identification. The vendor shall also
455 establish and maintain a Florida-specific data set of health
456 care claims information available to the public and any
457 interested party. The agency shall actively oversee the vendor
458 to ensure compliance with state law. The agency shall select the
459 vendor through an invitation to negotiate. A responsive vendor
460 must be a nonprofit research institute that is qualified under
461 s. 1874 of the Social Security Act to receive Medicare claims
462 data and that receives claims, payment, and patient cost-share
463 data from multiple private insurers nationwide. By July 1, 2016,
464 a responsive vendor must have:
465 1. A national database consisting of at least 15 billion
466 claim lines of administrative claims data from multiple payors
467 capable of being expanded by adding third-party payors,
468 including employers with health plans covered by the Employee
469 Retirement Income Security Act of 1974.
470 2. A well-developed methodology for analyzing claims data
471 within defined service bundles.
472 3. A bundling methodology that is available in the public
473 domain to allow for consistency and comparison of state and
474 national benchmarks with local regions and specific providers.
475 (c) Review the statistical activities of state agencies to
476 ensure that they are consistent with the comprehensive health
477 information system.
478 (d) Develop written agreements with local, state, and
479 federal agencies to facilitate for the sharing of data related
480 to health care health-care-related data or using the facilities
481 and services of such agencies. State agencies, local health
482 councils, and other agencies under state contract shall assist
483 the center in obtaining, compiling, and transferring health
484 care-related data maintained by state and local agencies.
485 Written agreements must specify the types, methods, and
486 periodicity of data exchanges and specify the types of data that
487 will be transferred to the center.
488 (e) Establish by rule:
489 1. The types of data collected, compiled, processed, used,
490 or shared.
491 2. Requirements for implementation of the consumer
492 friendly, Internet-based platform created by the contracted
493 vendor under paragraph (c).
494 3. Requirements for the submission of data by insurers
495 pursuant to s. 627.6385 and health maintenance organizations
496 pursuant to s. 641.54 to the contracted vendor under paragraph
498 4. Requirements governing the collection of data by the
499 contracted vendor under paragraph (c).
500 5. How information is to be published on the consumer
501 friendly, Internet-based platform created under paragraph (c)
502 for public use. Decisions regarding center data sets should be
503 made based on consultation with the State Consumer Health
504 Information and Policy Advisory Council and other public and
505 private users regarding the types of data which should be
506 collected and their uses. The center shall establish
507 standardized means for collecting health information and
508 statistics under laws and rules administered by the agency.
509 (f) Consult with contracted vendors, the State Consumer
510 Health Information and Policy Advisory Council, and other public
511 and private users regarding the types of data that should be
512 collected and the use of such data.
513 (g) Monitor data collection procedures and test data
514 quality to facilitate the dissemination of data that is
515 accurate, valid, reliable, and complete.
516 (f) Establish minimum health-care-related data sets which
517 are necessary on a continuing basis to fulfill the collection
518 requirements of the center and which shall be used by state
519 agencies in collecting and compiling health-care-related data.
520 The agency shall periodically review ongoing health care data
521 collections of the Department of Health and other state agencies
522 to determine if the collections are being conducted in
523 accordance with the established minimum sets of data.
524 (g) Establish advisory standards to ensure the quality of
525 health statistical and epidemiological data collection,
526 processing, and analysis by local, state, and private
528 (h) Prescribe standards for the publication of health-care
529 related data reported pursuant to this section which ensure the
530 reporting of accurate, valid, reliable, complete, and comparable
531 data. Such standards should include advisory warnings to users
532 of the data regarding the status and quality of any data
533 reported by or available from the center.
534 (h) (i) Develop Prescribe standards for the maintenance and
535 preservation of the center’s data. This should include methods
536 for archiving data, retrieval of archived data, and data editing
537 and verification.
538 (j) Ensure that strict quality control measures are
539 maintained for the dissemination of data through publications,
540 studies, or user requests.
541 (i) (k) Make Develop, in conjunction with the State Consumer
542 Health Information and Policy Advisory Council, and implement a
543 long-range plan for making available health care quality
544 measures and financial data that will allow consumers to compare
545 outcomes and other performance measures for health care
546 services. The health care quality measures and financial data
547 the agency must make available include, but are not limited to,
548 pharmaceuticals, physicians, health care facilities, and health
549 plans and managed care entities. The agency shall update the
550 plan and report on the status of its implementation annually.
551 The agency shall also make the plan and status report available
552 to the public on its Internet website. As part of the plan, the
553 agency shall identify the process and timeframes for
554 implementation, barriers to implementation, and recommendations
555 of changes in the law that may be enacted by the Legislature to
556 eliminate the barriers. As preliminary elements of the plan, the
557 agency shall:
558 1. Make available patient-safety indicators, inpatient
559 quality indicators, and performance outcome and patient charge
560 data collected from health care facilities pursuant to s.
561 408.061(1)(a) and (2). The terms “patient-safety indicators” and
562 “inpatient quality indicators” have the same meaning as that
563 ascribed by the Centers for Medicare and Medicaid Services, an
564 accrediting organization whose standards incorporate comparable
565 regulations required by this state, or a national entity that
566 establishes standards to measure the performance of health care
567 providers, or by other states. The agency shall determine which
568 conditions, procedures, health care quality measures, and
569 patient charge data to disclose based upon input from the
570 council. When determining which conditions and procedures are to
571 be disclosed, the council and the agency shall consider
572 variation in costs, variation in outcomes, and magnitude of
573 variations and other relevant information. When determining
574 which health care quality measures to disclose, the agency:
575 a. Shall consider such factors as volume of cases; average
576 patient charges; average length of stay; complication rates;
577 mortality rates; and infection rates, among others, which shall
578 be adjusted for case mix and severity, if applicable.
579 b. May consider such additional measures that are adopted
580 by the Centers for Medicare and Medicaid Studies, an accrediting
581 organization whose standards incorporate comparable regulations
582 required by this state, the National Quality Forum, the Joint
583 Commission on Accreditation of Healthcare Organizations, the
584 Agency for Healthcare Research and Quality, the Centers for
585 Disease Control and Prevention, or a similar national entity
586 that establishes standards to measure the performance of health
587 care providers, or by other states.
589 When determining which patient charge data to disclose, the
590 agency shall include such measures as the average of
591 undiscounted charges on frequently performed procedures and
592 preventive diagnostic procedures, the range of procedure charges
593 from highest to lowest, average net revenue per adjusted patient
594 day, average cost per adjusted patient day, and average cost per
595 admission, among others.
596 2. Make available performance measures, benefit design, and
597 premium cost data from health plans licensed pursuant to chapter
598 627 or chapter 641. The agency shall determine which health care
599 quality measures and member and subscriber cost data to
600 disclose, based upon input from the council. When determining
601 which data to disclose, the agency shall consider information
602 that may be required by either individual or group purchasers to
603 assess the value of the product, which may include membership
604 satisfaction, quality of care, current enrollment or membership,
605 coverage areas, accreditation status, premium costs, plan costs,
606 premium increases, range of benefits, copayments and
607 deductibles, accuracy and speed of claims payment, credentials
608 of physicians, number of providers, names of network providers,
609 and hospitals in the network. Health plans shall make available
610 to the agency such data or information that is not currently
611 reported to the agency or the office.
612 3. Determine the method and format for public disclosure of
613 data reported pursuant to this paragraph. The agency shall make
614 its determination based upon input from the State Consumer
615 Health Information and Policy Advisory Council. At a minimum,
616 the data shall be made available on the agency’s Internet
617 website in a manner that allows consumers to conduct an
618 interactive search that allows them to view and compare the
619 information for specific providers. The website must include
620 such additional information as is determined necessary to ensure
621 that the website enhances informed decisionmaking among
622 consumers and health care purchasers, which shall include, at a
623 minimum, appropriate guidance on how to use the data and an
624 explanation of why the data may vary from provider to provider.
625 4. Publish on its website undiscounted charges for no fewer
626 than 150 of the most commonly performed adult and pediatric
627 procedures, including outpatient, inpatient, diagnostic, and
628 preventative procedures.
629 (4) TECHNICAL ASSISTANCE.—
630 (a) The center shall provide technical assistance to
631 persons or organizations engaged in health planning activities
632 in the effective use of statistics collected and compiled by the
633 center. The center shall also provide the following additional
634 technical assistance services:
635 1. Establish procedures identifying the circumstances under
636 which, the places at which, the persons from whom, and the
637 methods by which a person may secure data from the center,
638 including procedures governing requests, the ordering of
639 requests, timeframes for handling requests, and other procedures
640 necessary to facilitate the use of the center’s data. To the
641 extent possible, the center should provide current data timely
642 in response to requests from public or private agencies.
643 2. Provide assistance to data sources and users in the
644 areas of database design, survey design, sampling procedures,
645 statistical interpretation, and data access to promote improved
646 health-care-related data sets.
647 3. Identify health care data gaps and provide technical
648 assistance to other public or private organizations for meeting
649 documented health care data needs.
650 4. Assist other organizations in developing statistical
651 abstracts of their data sets that could be used by the center.
652 5. Provide statistical support to state agencies with
653 regard to the use of databases maintained by the center.
654 6. To the extent possible, respond to multiple requests for
655 information not currently collected by the center or available
656 from other sources by initiating data collection.
657 7. Maintain detailed information on data maintained by
658 other local, state, federal, and private agencies in order to
659 advise those who use the center of potential sources of data
660 which are requested but which are not available from the center.
661 8. Respond to requests for data which are not available in
662 published form by initiating special computer runs on data sets
663 available to the center.
664 9. Monitor innovations in health information technology,
665 informatics, and the exchange of health information and maintain
666 a repository of technical resources to support the development
667 of a health information network.
668 (b) The agency shall administer, manage, and monitor grants
669 to not-for-profit organizations, regional health information
670 organizations, public health departments, or state agencies that
671 submit proposals for planning, implementation, or training
672 projects to advance the development of a health information
673 network. Any grant contract shall be evaluated to ensure the
674 effective outcome of the health information project.
675 (c) The agency shall initiate, oversee, manage, and
676 evaluate the integration of health care data from each state
677 agency that collects, stores, and reports on health care issues
678 and make that data available to any health care practitioner
679 through a state health information network.
680 (5) PUBLICATIONS; REPORTS; SPECIAL STUDIES.—The center
681 shall provide for the widespread dissemination of data which it
682 collects and analyzes. The center shall have the following
683 publication, reporting, and special study functions:
684 (a) The center shall publish and make available
685 periodically to agencies and individuals health statistics
686 publications of general interest, including health plan consumer
687 reports and health maintenance organization member satisfaction
688 surveys; publications providing health statistics on topical
689 health policy issues; publications that provide health status
690 profiles of the people in this state; and other topical health
691 statistics publications.
692 (j) (b) The center shall publish, Make available , and
693 disseminate, promptly and as widely as practicable, the results
694 of special health surveys, health care research, and health care
695 evaluations conducted or supported under this section. Any
696 publication by the center must include a statement of the
697 limitations on the quality, accuracy, and completeness of the
699 (c) The center shall provide indexing, abstracting,
700 translation, publication, and other services leading to a more
701 effective and timely dissemination of health care statistics.
702 (d) The center shall be responsible for publishing and
703 disseminating an annual report on the center’s activities.
704 (e) The center shall be responsible, to the extent
705 resources are available, for conducting a variety of special
706 studies and surveys to expand the health care information and
707 statistics available for health policy analyses, particularly
708 for the review of public policy issues. The center shall develop
709 a process by which users of the center’s data are periodically
710 surveyed regarding critical data needs and the results of the
711 survey considered in determining which special surveys or
712 studies will be conducted. The center shall select problems in
713 health care for research, policy analyses, or special data
714 collections on the basis of their local, regional, or state
715 importance; the unique potential for definitive research on the
716 problem; and opportunities for application of the study
718 (4) (6) PROVIDER DATA REPORTING.—This section does not
719 confer on the agency the power to demand or require that a
720 health care provider or professional furnish information,
721 records of interviews, written reports, statements, notes,
722 memoranda, or data other than as expressly required by law. The
723 agency may not establish an all-payor claims database or a
724 comparable database without express legislative authority.
725 (5) (7) BUDGET; FEES.—
726 (a) The Legislature intends that funding for the Florida
727 Center for Health Information and Policy Analysis be
728 appropriated from the General Revenue Fund.
729 (b) The Florida Center for Health Information and
730 Transparency Policy Analysis may apply for and receive and
731 accept grants, gifts, and other payments, including property and
732 services, from any governmental or other public or private
733 entity or person and make arrangements as to the use of same,
734 including the undertaking of special studies and other projects
735 relating to health-care-related topics. Funds obtained pursuant
736 to this paragraph may not be used to offset annual
737 appropriations from the General Revenue Fund.
738 (b) (c) The center may charge such reasonable fees for
739 services as the agency prescribes by rule. The established fees
740 may not exceed the reasonable cost for such services. Fees
741 collected may not be used to offset annual appropriations from
742 the General Revenue Fund.
743 (6) (8) STATE CONSUMER HEALTH INFORMATION AND POLICY
744 ADVISORY COUNCIL.—
745 (a) There is established in the agency the State Consumer
746 Health Information and Policy Advisory Council to assist the
747 center in reviewing the comprehensive health information system,
748 including the identification, collection, standardization,
749 sharing, and coordination of health-related data, fraud and
750 abuse data, and professional and facility licensing data among
751 federal, state, local, and private entities and to recommend
752 improvements for purposes of public health, policy analysis, and
753 transparency of consumer health care information. The council
754 consists shall consist of the following members:
755 1. An employee of the Executive Office of the Governor, to
756 be appointed by the Governor.
757 2. An employee of the Office of Insurance Regulation, to be
758 appointed by the director of the office.
759 3. An employee of the Department of Education, to be
760 appointed by the Commissioner of Education.
761 4. Ten persons, to be appointed by the Secretary of Health
762 Care Administration, representing other state and local
763 agencies, state universities, business and health coalitions,
764 local health councils, professional health-care-related
765 associations, consumers, and purchasers.
766 (b) Each member of the council shall be appointed to serve
767 for a term of 2 years following the date of appointment , except
768 the term of appointment shall end 3 years following the date of
769 appointment for members appointed in 2003, 2004, and 2005. A
770 vacancy shall be filled by appointment for the remainder of the
771 term, and each appointing authority retains the right to
772 reappoint members whose terms of appointment have expired.
773 (c) The council may meet at the call of its chair, at the
774 request of the agency, or at the request of a majority of its
775 membership, but the council must meet at least quarterly.
776 (d) Members shall elect a chair and vice chair annually.
777 (e) A majority of the members constitutes a quorum, and the
778 affirmative vote of a majority of a quorum is necessary to take
780 (f) The council shall maintain minutes of each meeting and
781 shall make such minutes available to any person.
782 (g) Members of the council shall serve without compensation
783 but shall be entitled to receive reimbursement for per diem and
784 travel expenses as provided in s. 112.061.
785 (h) The council’s duties and responsibilities include, but
786 are not limited to, the following:
787 1. To develop a mission statement, goals, and a plan of
788 action for the identification, collection, standardization,
789 sharing, and coordination of health-related data across federal,
790 state, and local government and private sector entities.
791 2. To develop a review process to ensure cooperative
792 planning among agencies that collect or maintain health-related
794 3. To create ad hoc issue-oriented technical workgroups on
795 an as-needed basis to make recommendations to the council.
796 (7) (9) APPLICATION TO OTHER AGENCIES.— Nothing in This
797 section does not shall limit, restrict, affect, or control the
798 collection, analysis, release, or publication of data by any
799 state agency pursuant to its statutory authority, duties, or
801 Section 7. Subsection (1) of section 408.061, Florida
802 Statutes, is amended to read:
803 408.061 Data collection; uniform systems of financial
804 reporting; information relating to physician charges;
805 confidential information; immunity.—
806 (1) The agency shall require the submission by health care
807 facilities, health care providers, and health insurers of data
808 necessary to carry out the agency’s duties and to facilitate
809 transparency in health care pricing data and quality measures.
810 Specifications for data to be collected under this section shall
811 be developed by the agency and applicable contract vendors, with
812 the assistance of technical advisory panels including
813 representatives of affected entities, consumers, purchasers, and
814 such other interested parties as may be determined by the
816 (a) Data submitted by health care facilities, including the
817 facilities as defined in chapter 395, shall include, but are not
818 limited to: case-mix data, patient admission and discharge data,
819 hospital emergency department data which shall include the
820 number of patients treated in the emergency department of a
821 licensed hospital reported by patient acuity level, data on
822 hospital-acquired infections as specified by rule, data on
823 complications as specified by rule, data on readmissions as
824 specified by rule, with patient and provider-specific
825 identifiers included, actual charge data by diagnostic groups or
826 other bundled groupings as specified by rule, financial data,
827 accounting data, operating expenses, expenses incurred for
828 rendering services to patients who cannot or do not pay,
829 interest charges, depreciation expenses based on the expected
830 useful life of the property and equipment involved, and
831 demographic data. The agency shall adopt nationally recognized
832 risk adjustment methodologies or software consistent with the
833 standards of the Agency for Healthcare Research and Quality and
834 as selected by the agency for all data submitted as required by
835 this section. Data may be obtained from documents such as, but
836 not limited to: leases, contracts, debt instruments, itemized
837 patient statements or bills, medical record abstracts, and
838 related diagnostic information. Reported data elements shall be
839 reported electronically in accordance with rule 59E-7.012,
840 Florida Administrative Code. Data submitted shall be certified
841 by the chief executive officer or an appropriate and duly
842 authorized representative or employee of the licensed facility
843 that the information submitted is true and accurate.
844 (b) Data to be submitted by health care providers may
845 include, but are not limited to: professional organization and
846 specialty board affiliations, Medicare and Medicaid
847 participation, types of services offered to patients, actual
848 charges to patients as specified by rule, amount of revenue and
849 expenses of the health care provider, and such other data which
850 are reasonably necessary to study utilization patterns. Data
851 submitted shall be certified by the appropriate duly authorized
852 representative or employee of the health care provider that the
853 information submitted is true and accurate.
854 (c) Data to be submitted by health insurers may include,
855 but are not limited to: claims, payments to health care
856 facilities and health care providers as specified by rule,
857 premium, administration, and financial information. Data
858 submitted shall be certified by the chief financial officer, an
859 appropriate and duly authorized representative, or an employee
860 of the insurer that the information submitted is true and
861 accurate. Information that is considered a trade secret under s.
862 812.081 shall be clearly designated.
863 (d) Data required to be submitted by health care
864 facilities, health care providers, or health insurers may shall
865 not include specific provider contract reimbursement
866 information. However, such specific provider reimbursement data
867 shall be reasonably available for onsite inspection by the
868 agency as is necessary to carry out the agency’s regulatory
869 duties. Any such data obtained by the agency as a result of
870 onsite inspections may not be used by the state for purposes of
871 direct provider contracting and are confidential and exempt from
872 the provisions of s. 119.07(1) and s. 24(a), Art. I of the State
874 (e) A requirement to submit data shall be adopted by rule
875 if the submission of data is being required of all members of
876 any type of health care facility, health care provider, or
877 health insurer. Rules are not required, however, for the
878 submission of data for a special study mandated by the
879 Legislature or when information is being requested for a single
880 health care facility, health care provider, or health insurer.
881 Section 8. Section 456.0575, Florida Statutes, is amended
882 to read:
883 456.0575 Duty to notify patients.—
884 (1) Every licensed health care practitioner shall inform
885 each patient, or an individual identified pursuant to s.
886 765.401(1), in person about adverse incidents that result in
887 serious harm to the patient. Notification of outcomes of care
888 that result in harm to the patient under this section does shall
889 not constitute an acknowledgment of admission of liability, nor
890 can such notifications be introduced as evidence.
891 (2) Every licensed health care practitioner must provide
892 upon request by a patient, before providing any nonemergency
893 medical services in a facility licensed under chapter 395, a
894 written, good faith estimate of reasonably anticipated charges
895 to treat the patient’s condition at the facility. The health
896 care practitioner must provide the estimate to the patient
897 within 7 business days after receiving the request and is not
898 required to adjust the estimate for any potential insurance
899 coverage. The health care practitioner must inform the patient
900 that he or she may contact his or her health insurer or health
901 maintenance organization for additional information concerning
902 cost-sharing responsibilities. The health care practitioner must
903 provide information to uninsured patients and insured patients
904 for whom the practitioner is not a network provider or preferred
905 provider which discloses the practitioner’s financial assistance
906 policy, including the application process, payment plans,
907 discounts, or other available assistance, and the practitioner’s
908 charity care policy and collection procedures. Such estimate
909 does not preclude the actual charges from exceeding the
910 estimate. Failure to provide the estimate in accordance with
911 this subsection, without good cause, shall result in
912 disciplinary action against the health care practitioner and a
913 daily fine of $500 until the estimate is provided to the
914 patient. The total fine may not exceed $5,000.
915 Section 9. Paragraph (oo) is added to subsection (1) of
916 section 456.072, Florida Statutes, to read:
917 456.072 Grounds for discipline; penalties; enforcement.—
918 (1) The following acts shall constitute grounds for which
919 the disciplinary actions specified in subsection (2) may be
921 (oo) Failure to comply with fair billing practices pursuant
922 to s. 627.0613(6).
923 Section 10. Section 627.0613, Florida Statutes, is amended
924 to read:
925 627.0613 Consumer advocate.—The Chief Financial Officer
926 must appoint a consumer advocate who must represent the general
927 public of the state before the department, and the office, and
928 other state agencies, as required by this section. The consumer
929 advocate must report directly to the Chief Financial Officer,
930 but is not otherwise under the authority of the department or of
931 any employee of the department. The consumer advocate has such
932 powers as are necessary to carry out the duties of the office of
933 consumer advocate, including, but not limited to, the powers to:
934 (1) Recommend to the department or office, by petition, the
935 commencement of any proceeding or action; appear in any
936 proceeding or action before the department or office; or appear
937 in any proceeding before the Division of Administrative Hearings
938 relating to subject matter under the jurisdiction of the
939 department or office.
940 (2) Report to the Agency for Health Care Administration and
941 to the Department of Health any findings resulting from
942 investigation of unresolved complaints concerning the billing
943 practices of any health care facility licensed under chapter 395
944 or any health care practitioner subject to chapter 456.
945 (3) (2) Have access to and use of all files, records, and
946 data of the department or office.
947 (4) Have access to any files, records, and data of the
948 Agency for Health Care Administration and the Department of
949 Health which are necessary for the investigations authorized by
950 subsection (6).
951 (5) (3) Examine rate and form filings submitted to the
952 office, hire consultants as necessary to aid in the review
953 process, and recommend to the department or office any position
954 deemed by the consumer advocate to be in the public interest.
955 (6) Maintain a process for receiving and investigating
956 complaints from insured and uninsured patients of health care
957 facilities licensed under chapter 395 and health care
958 practitioners subject to chapter 456 concerning billing
959 practices. Investigations by the office of the consumer advocate
960 shall be limited to determining compliance with the following
962 (a) The patient was informed before a nonemergency
963 procedure of expected payments related to the procedure as
964 provided in s. 395.301, contact information for health insurers
965 or health maintenance organizations to determine specific cost
966 sharing responsibilities, and the expected involvement in the
967 procedure of other providers who may bill independently.
968 (b) The patient was informed of policies and procedures to
969 qualify for discounted charges.
970 (c) The patient was informed of collection procedures and
971 given the opportunity to participate in an extended payment
973 (d) The patient was given a written, personal, and itemized
974 estimate upon request as provided in ss. 395.301 and 456.0575.
975 (e) The statement or bill delivered to the patient was
976 accurate and included all information required pursuant to s.
978 (f) The billed amounts were fair charges. As used in this
979 paragraph, the term “fair charges” means the common and frequent
980 range of charges for patients who are similarly situated
981 requiring the same or similar medical services.
982 (7) Provide mediation between providers and patients to
983 resolve billing complaints and negotiate arrangements for
984 extended payment schedules.
985 (8) (4) Prepare an annual budget for presentation to the
986 Legislature by the department, which budget must be adequate to
987 carry out the duties of the office of consumer advocate.
988 Section 11. Section 627.6385, Florida Statutes, is created
989 to read:
990 627.6385 Disclosures to policyholders; calculations of cost
992 (1) Each health insurer shall make available on its
994 (a) A method for policyholders to estimate their
995 copayments, deductibles, and other cost-sharing responsibilities
996 for health care services and procedures. Such method of making
997 an estimate shall be based on service bundles established
998 pursuant to s. 408.05(3)(c). Estimates do not preclude the
999 actual copayment, coinsurance percentage, or deductible,
1000 whichever is applicable, from exceeding the estimate.
1001 1. Estimates shall be calculated according to the policy
1002 and known plan usage during the coverage period.
1003 2. Estimates shall be made available based on providers
1004 that are in-network and out-of-network.
1005 3. A policyholder must be able to create estimates by any
1006 combination of the service bundles established pursuant to s.
1007 408.05(3)(c), by a specified provider, or a comparison of
1009 (b) A method for policyholders to estimate their
1010 copayments, deductibles, and other cost-sharing responsibilities
1011 based on a personalized estimate of charges received from a
1012 facility pursuant to s. 395.301 or a practitioner pursuant to s.
1014 (c) A hyperlink to the health information, including, but
1015 not limited to, service bundles and quality of care information,
1016 which is disseminated by the Agency for Health Care
1017 Administration pursuant to s. 408.05(3).
1018 (2) Each health insurer shall include in every policy
1019 delivered or issued for delivery to any person in the state or
1020 in materials provided as required by s. 627.64725 notice that
1021 the information required by this section is available
1022 electronically and the address of the website where the
1023 information can be accessed.
1024 (3) Each health insurer that participates in the state
1025 group health insurance plan created under s. 110.123 or Medicaid
1026 managed care pursuant to part IV of chapter 409 shall contribute
1027 all claims data from Florida policyholders held by the insurer
1028 and its affiliates to the contracted vendor selected by the
1029 Agency for Health Care Administration under s. 408.05(3)(c).
1030 Each insurer and its affiliates may not contribute claims data
1031 to the contracted vendor which reflect the following types of
1033 (a) Coverage only for accident, or disability income
1034 insurance, or any combination thereof.
1035 (b) Coverage issued as a supplement to liability insurance.
1036 (c) Liability insurance, including general liability
1037 insurance and automobile liability insurance.
1038 (d) Workers’ compensation or similar insurance.
1039 (e) Automobile medical payment insurance.
1040 (f) Credit-only insurance.
1041 (g) Coverage for onsite medical clinics, including prepaid
1042 health clinics under part II of chapter 641.
1043 (h) Limited scope dental or vision benefits.
1044 (i) Benefits for long-term care, nursing home care, home
1045 health care, community-based care, or any combination thereof.
1046 (j) Coverage only for a specified disease or illness.
1047 (k) Hospital indemnity or other fixed indemnity insurance.
1048 (l) Medicare supplemental health insurance as defined under
1049 s. 1882(g)(1) of the Social Security Act, coverage supplemental
1050 to the coverage provided under chapter 55 of Title 10 U.S.C.,
1051 and similar supplemental coverage provided to supplement
1052 coverage under a group health plan.
1053 Section 12. Subsection (6) of section 641.54, Florida
1054 Statutes, is amended, present subsection (7) of that section is
1055 redesignated as subsection (8) and amended, and a new subsection
1056 (7) is added to that section, to read:
1057 641.54 Information disclosure.—
1058 (6) Each health maintenance organization shall make
1059 available to its subscribers on its website or by request the
1060 estimated copayment copay, coinsurance percentage, or
1061 deductible, whichever is applicable, for any covered services as
1062 described by the searchable bundles established on a consumer
1063 friendly, Internet-based platform pursuant to s. 408.05(3)(c) or
1064 as described by a personalized estimate received from a facility
1065 pursuant to s. 395.301 or a practitioner pursuant to s.
1066 456.0575, the status of the subscriber’s maximum annual out-of
1067 pocket payments for a covered individual or family, and the
1068 status of the subscriber’s maximum lifetime benefit. Such
1069 estimate does shall not preclude the actual copayment copay,
1070 coinsurance percentage, or deductible, whichever is applicable,
1071 from exceeding the estimate.
1072 (7) Each health maintenance organization that participates
1073 in the state group health insurance plan created under s.
1074 110.123 or Medicaid managed care pursuant to part IV of chapter
1075 409 shall contribute all claims data from Florida subscribers
1076 held by the organization and its affiliates to the contracted
1077 vendor selected by the Agency for Health Care Administration
1078 under s. 408.05(3)(c). Each health maintenance organization and
1079 its affiliates may not contribute claims data to the contracted
1080 vendor which reflect the following types of coverage:
1081 (a) Coverage only for accident, or disability income
1082 insurance, or any combination thereof.
1083 (b) Coverage issued as a supplement to liability insurance.
1084 (c) Liability insurance, including general liability
1085 insurance and automobile liability insurance.
1086 (d) Workers’ compensation or similar insurance.
1087 (e) Automobile medical payment insurance.
1088 (f) Credit-only insurance.
1089 (g) Coverage for onsite medical clinics, including prepaid
1090 health clinics under part II of chapter 641.
1091 (h) Limited scope dental or vision benefits.
1092 (i) Benefits for long-term care, nursing home care, home
1093 health care, community-based care, or any combination thereof.
1094 (j) Coverage only for a specified disease or illness.
1095 (k) Hospital indemnity or other fixed indemnity insurance.
1096 (l) Medicare supplemental health insurance as defined under
1097 s. 1882(g)(1) of the Social Security Act, coverage supplemental
1098 to the coverage provided under chapter 55 of Title 10 U.S.C.,
1099 and similar supplemental coverage provided to supplement
1100 coverage under a group health plan.
1101 (8) (7) Each health maintenance organization shall make
1102 available on its Internet website a hyperlink link to the health
1103 information performance outcome and financial data that is
1104 disseminated published by the Agency for Health Care
1105 Administration pursuant to s. 408.05(3) s. 408.05(3)(k) and
1106 shall include in every policy delivered or issued for delivery
1107 to any person in the state or in any materials provided as
1108 required by s. 627.64725 notice that such information is
1109 available electronically and the address of its Internet
1111 Section 13. Paragraph (n) is added to subsection (2) of
1112 section 409.967, Florida Statutes, to read:
1113 409.967 Managed care plan accountability.—
1114 (2) The agency shall establish such contract requirements
1115 as are necessary for the operation of the statewide managed care
1116 program. In addition to any other provisions the agency may deem
1117 necessary, the contract must require:
1118 (n) Transparency.—Managed care plans shall comply with ss.
1119 627.6385(3) and 641.54(7).
1120 Section 14. Paragraph (d) of subsection (3) of section
1121 110.123, Florida Statutes, is amended to read:
1122 110.123 State group insurance program.—
1123 (3) STATE GROUP INSURANCE PROGRAM.—
1124 (d)1. Notwithstanding the provisions of chapter 287 and the
1125 authority of the department, for the purpose of protecting the
1126 health of, and providing medical services to, state employees
1127 participating in the state group insurance program, the
1128 department may contract to retain the services of professional
1129 administrators for the state group insurance program. The agency
1130 shall follow good purchasing practices of state procurement to
1131 the extent practicable under the circumstances.
1132 2. Each vendor in a major procurement, and any other vendor
1133 if the department deems it necessary to protect the state’s
1134 financial interests, shall, at the time of executing any
1135 contract with the department, post an appropriate bond with the
1136 department in an amount determined by the department to be
1137 adequate to protect the state’s interests but not higher than
1138 the full amount estimated to be paid annually to the vendor
1139 under the contract.
1140 3. Each major contract entered into by the department
1141 pursuant to this section shall contain a provision for payment
1142 of liquidated damages to the department for material
1143 noncompliance by a vendor with a contract provision. The
1144 department may require a liquidated damages provision in any
1145 contract if the department deems it necessary to protect the
1146 state’s financial interests.
1147 4. Section The provisions of s. 120.57(3) applies apply to
1148 the department’s contracting process, except:
1149 a. A formal written protest of any decision, intended
1150 decision, or other action subject to protest shall be filed
1151 within 72 hours after receipt of notice of the decision,
1152 intended decision, or other action.
1153 b. As an alternative to any provision of s. 120.57(3), the
1154 department may proceed with the bid selection or contract award
1155 process if the director of the department sets forth, in
1156 writing, particular facts and circumstances that which
1157 demonstrate the necessity of continuing the procurement process
1158 or the contract award process in order to avoid a substantial
1159 disruption to the provision of any scheduled insurance services.
1160 5. The department shall make arrangements as necessary to
1161 contribute claims data of the state group health insurance plan
1162 to the contracted vendor selected by the Agency for Health Care
1163 Administration pursuant to s. 408.05(3)(c).
1164 6. Each contracted vendor for the state group health
1165 insurance plan shall contribute Florida claims data to the
1166 contracted vendor selected by the Agency for Health Care
1167 Administration pursuant to s. 408.05(3)(c).
1168 Section 15. Subsection (3) of section 20.42, Florida
1169 Statutes, is amended to read:
1170 20.42 Agency for Health Care Administration.—
1171 (3) The department shall be the chief health policy and
1172 planning entity for the state. The department is responsible for
1173 health facility licensure, inspection, and regulatory
1174 enforcement; investigation of consumer complaints related to
1175 health care facilities and managed care plans; the
1176 implementation of the certificate of need program; the operation
1177 of the Florida Center for Health Information and Transparency
1178 Policy Analysis; the administration of the Medicaid program; the
1179 administration of the contracts with the Florida Healthy Kids
1180 Corporation; the certification of health maintenance
1181 organizations and prepaid health clinics as set forth in part
1182 III of chapter 641; and any other duties prescribed by statute
1183 or agreement.
1184 Section 16. Paragraph (c) of subsection (4) of section
1185 381.026, Florida Statutes, is amended to read:
1186 381.026 Florida Patient’s Bill of Rights and
1188 (4) RIGHTS OF PATIENTS.—Each health care facility or
1189 provider shall observe the following standards:
1190 (c) Financial information and disclosure.—
1191 1. A patient has the right to be given, upon request, by
1192 the responsible provider, his or her designee, or a
1193 representative of the health care facility full information and
1194 necessary counseling on the availability of known financial
1195 resources for the patient’s health care.
1196 2. A health care provider or a health care facility shall,
1197 upon request, disclose to each patient who is eligible for
1198 Medicare, before treatment, whether the health care provider or
1199 the health care facility in which the patient is receiving
1200 medical services accepts assignment under Medicare reimbursement
1201 as payment in full for medical services and treatment rendered
1202 in the health care provider’s office or health care facility.
1203 3. A primary care provider may publish a schedule of
1204 charges for the medical services that the provider offers to
1205 patients. The schedule must include the prices charged to an
1206 uninsured person paying for such services by cash, check, credit
1207 card, or debit card. The schedule must be posted in a
1208 conspicuous place in the reception area of the provider’s office
1209 and must include, but is not limited to, the 50 services most
1210 frequently provided by the primary care provider. The schedule
1211 may group services by three price levels, listing services in
1212 each price level. The posting must be at least 15 square feet in
1213 size. A primary care provider who publishes and maintains a
1214 schedule of charges for medical services is exempt from the
1215 license fee requirements for a single period of renewal of a
1216 professional license under chapter 456 for that licensure term
1217 and is exempt from the continuing education requirements of
1218 chapter 456 and the rules implementing those requirements for a
1219 single 2-year period.
1220 4. If a primary care provider publishes a schedule of
1221 charges pursuant to subparagraph 3., he or she must continually
1222 post it at all times for the duration of active licensure in
1223 this state when primary care services are provided to patients.
1224 If a primary care provider fails to post the schedule of charges
1225 in accordance with this subparagraph, the provider shall be
1226 required to pay any license fee and comply with any continuing
1227 education requirements for which an exemption was received.
1228 5. A health care provider or a health care facility shall,
1229 upon request, furnish a person, before the provision of medical
1230 services, a reasonable estimate of charges for such services.
1231 The health care provider or the health care facility shall
1232 provide an uninsured person, before the provision of a planned
1233 nonemergency medical service, a reasonable estimate of charges
1234 for such service and information regarding the provider’s or
1235 facility’s discount or charity policies for which the uninsured
1236 person may be eligible. Such estimates by a primary care
1237 provider must be consistent with the schedule posted under
1238 subparagraph 3. Estimates shall, to the extent possible, be
1239 written in language comprehensible to an ordinary layperson.
1240 Such reasonable estimate does not preclude the health care
1241 provider or health care facility from exceeding the estimate or
1242 making additional charges based on changes in the patient’s
1243 condition or treatment needs.
1244 6. Each licensed facility, except a facility operating
1245 exclusively as a state facility, not operated by the state shall
1246 make available to the public on its Internet website or by other
1247 electronic means a description of and a hyperlink link to the
1248 health information performance outcome and financial data that
1249 is disseminated published by the agency pursuant to s. 408.05(3)
1250 s. 408.05(3)(k). The facility shall place a notice in the
1251 reception area that such information is available electronically
1252 and the website address. The licensed facility may indicate that
1253 the pricing information is based on a compilation of charges for
1254 the average patient and that each patient’s statement or bill
1255 may vary from the average depending upon the severity of illness
1256 and individual resources consumed. The licensed facility may
1257 also indicate that the price of service is negotiable for
1258 eligible patients based upon the patient’s ability to pay.
1259 7. A patient has the right to receive a copy of an itemized
1260 statement or bill upon request. A patient has a right to be
1261 given an explanation of charges upon request.
1262 Section 17. Paragraph (e) of subsection (2) of section
1263 395.602, Florida Statutes, is amended to read:
1264 395.602 Rural hospitals.—
1265 (2) DEFINITIONS.—As used in this part, the term:
1266 (e) “Rural hospital” means an acute care hospital licensed
1267 under this chapter, having 100 or fewer licensed beds and an
1268 emergency room, which is:
1269 1. The sole provider within a county with a population
1270 density of up to 100 persons per square mile;
1271 2. An acute care hospital, in a county with a population
1272 density of up to 100 persons per square mile, which is at least
1273 30 minutes of travel time, on normally traveled roads under
1274 normal traffic conditions, from any other acute care hospital
1275 within the same county;
1276 3. A hospital supported by a tax district or subdistrict
1277 whose boundaries encompass a population of up to 100 persons per
1278 square mile;
1279 4. A hospital with a service area that has a population of
1280 up to 100 persons per square mile. As used in this subparagraph,
1281 the term “service area” means the fewest number of zip codes
1282 that account for 75 percent of the hospital’s discharges for the
1283 most recent 5-year period, based on information available from
1284 the hospital inpatient discharge database in the Florida Center
1285 for Health Information and Transparency Policy Analysis at the
1286 agency; or
1287 5. A hospital designated as a critical access hospital, as
1288 defined in s. 408.07.
1290 Population densities used in this paragraph must be based upon
1291 the most recently completed United States census. A hospital
1292 that received funds under s. 409.9116 for a quarter beginning no
1293 later than July 1, 2002, is deemed to have been and shall
1294 continue to be a rural hospital from that date through June 30,
1295 2021, if the hospital continues to have up to 100 licensed beds
1296 and an emergency room. An acute care hospital that has not
1297 previously been designated as a rural hospital and that meets
1298 the criteria of this paragraph shall be granted such designation
1299 upon application, including supporting documentation, to the
1300 agency. A hospital that was licensed as a rural hospital during
1301 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
1302 rural hospital from the date of designation through June 30,
1303 2021, if the hospital continues to have up to 100 licensed beds
1304 and an emergency room.
1305 Section 18. Section 395.6025, Florida Statutes, is amended
1306 to read:
1307 395.6025 Rural hospital replacement facilities.
1308 Notwithstanding the provisions of s. 408.036, a hospital defined
1309 as a statutory rural hospital in accordance with s. 395.602, or
1310 a not-for-profit operator of rural hospitals, is not required to
1311 obtain a certificate of need for the construction of a new
1312 hospital located in a county with a population of at least
1313 15,000 but no more than 18,000 and a density of fewer less than
1314 30 persons per square mile, or a replacement facility, provided
1315 that the replacement, or new, facility is located within 10
1316 miles of the site of the currently licensed rural hospital and
1317 within the current primary service area. As used in this
1318 section, the term “service area” means the fewest number of zip
1319 codes that account for 75 percent of the hospital’s discharges
1320 for the most recent 5-year period, based on information
1321 available from the hospital inpatient discharge database in the
1322 Florida Center for Health Information and Transparency Policy
1323 Analysis at the Agency for Health Care Administration.
1324 Section 19. Subsection (43) of section 408.07, Florida
1325 Statutes, is amended to read:
1326 408.07 Definitions.—As used in this chapter, with the
1327 exception of ss. 408.031-408.045, the term:
1328 (43) “Rural hospital” means an acute care hospital licensed
1329 under chapter 395, having 100 or fewer licensed beds and an
1330 emergency room, and which is:
1331 (a) The sole provider within a county with a population
1332 density of no greater than 100 persons per square mile;
1333 (b) An acute care hospital, in a county with a population
1334 density of no greater than 100 persons per square mile, which is
1335 at least 30 minutes of travel time, on normally traveled roads
1336 under normal traffic conditions, from another acute care
1337 hospital within the same county;
1338 (c) A hospital supported by a tax district or subdistrict
1339 whose boundaries encompass a population of 100 persons or fewer
1340 per square mile;
1341 (d) A hospital with a service area that has a population of
1342 100 persons or fewer per square mile. As used in this paragraph,
1343 the term “service area” means the fewest number of zip codes
1344 that account for 75 percent of the hospital’s discharges for the
1345 most recent 5-year period, based on information available from
1346 the hospital inpatient discharge database in the Florida Center
1347 for Health Information and Transparency Policy Analysis at the
1348 Agency for Health Care Administration; or
1349 (e) A critical access hospital.
1351 Population densities used in this subsection must be based upon
1352 the most recently completed United States census. A hospital
1353 that received funds under s. 409.9116 for a quarter beginning no
1354 later than July 1, 2002, is deemed to have been and shall
1355 continue to be a rural hospital from that date through June 30,
1356 2015, if the hospital continues to have 100 or fewer licensed
1357 beds and an emergency room. An acute care hospital that has not
1358 previously been designated as a rural hospital and that meets
1359 the criteria of this subsection shall be granted such
1360 designation upon application, including supporting
1361 documentation, to the Agency for Health Care Administration.
1362 Section 20. Paragraph (a) of subsection (4) of section
1363 408.18, Florida Statutes, is amended to read:
1364 408.18 Health Care Community Antitrust Guidance Act;
1365 antitrust no-action letter; market-information collection and
1367 (4)(a) Members of the health care community who seek
1368 antitrust guidance may request a review of their proposed
1369 business activity by the Attorney General’s office. In
1370 conducting its review, the Attorney General’s office may seek
1371 whatever documentation, data, or other material it deems
1372 necessary from the Agency for Health Care Administration, the
1373 Florida Center for Health Information and Transparency Policy
1374 Analysis, and the Office of Insurance Regulation of the
1375 Financial Services Commission.
1376 Section 21. Section 465.0244, Florida Statutes, is amended
1377 to read:
1378 465.0244 Information disclosure.—Every pharmacy shall make
1379 available on its Internet website a hyperlink link to the health
1380 information performance outcome and financial data that is
1381 disseminated published by the Agency for Health Care
1382 Administration pursuant to s. 408.05(3) s. 408.05(3)(k) and
1383 shall place in the area where customers receive filled
1384 prescriptions notice that such information is available
1385 electronically and the address of its Internet website.
1386 Section 22. This act is intended to promote health care
1387 price and quality transparency to enable consumers to make
1388 informed choices on health care treatment and improve
1389 competition in the health care market. Persons or entities
1390 required to submit, receive, or publish data under this act are
1391 acting pursuant to state requirements contained therein and are
1392 exempt from state antitrust laws.
1393 Section 23. This act shall take effect July 1, 2016.
1395 ================= T I T L E A M E N D M E N T ================
1396 And the title is amended as follows:
1397 Delete everything before the enacting clause
1398 and insert:
1399 A bill to be entitled
1400 An act relating to transparency in health care;
1401 amending s. 395.301, F.S.; requiring a facility
1402 licensed under ch. 395, F.S., to provide timely and
1403 accurate financial information and quality of service
1404 measures to certain individuals; providing an
1405 exemption; requiring a licensed facility to make
1406 available on its website certain information on
1407 payments made to that facility for defined bundles of
1408 services and procedures and other information for
1409 consumers and patients; requiring that facility
1410 websites provide specified information and notify and
1411 inform patients or prospective patients of certain
1412 information; requiring a facility to provide a
1413 written, good faith estimate of charges to a patient
1414 or prospective patient within a certain timeframe;
1415 requiring a facility to provide information regarding
1416 financial assistance from the facility which may be
1417 available to a patient or a prospective patient;
1418 providing a penalty for failing to provide an estimate
1419 of charges to a patient; deleting a requirement that a
1420 licensed facility not operated by the state provide
1421 notice to a patient of his or her right to an itemized
1422 statement or bill within a certain timeframe; revising
1423 the information that must be included on a patient’s
1424 statement or bill; requiring that certain records be
1425 made available through electronic means that comply
1426 with a specified law; reducing the response time for
1427 certain patient requests for information; amending s.
1428 395.107, F.S.; providing a definition; making
1429 technical changes; creating s. 395.3012, F.S.;
1430 authorizing the Agency for Health Care Administration
1431 to impose penalties based on certain findings of an
1432 investigation as determined by the consumer advocate;
1433 amending ss. 400.487 and 400.934, F.S.; requiring home
1434 health agencies and home medical equipment providers
1435 to provide upon request certain written estimates of
1436 charges within a certain timeframe; amending s.
1437 408.05, F.S.; revising requirements for the collection
1438 and use of health-related data by the agency;
1439 requiring the agency to contract with a vendor to
1440 provide an Internet-based platform with certain
1441 attributes; requiring potential vendors to have
1442 certain qualifications; prohibiting the agency from
1443 establishing a certain database under certain
1444 circumstances; amending s. 408.061, F.S.; revising
1445 requirements for the submission of health care data to
1446 the agency; requiring submitted information considered
1447 a trade secret to be clearly designated; amending s.
1448 456.0575, F.S.; requiring a health care practitioner
1449 to provide a patient upon his or her request a
1450 written, good faith estimate of anticipated charges
1451 within a certain timeframe; setting a maximum amount
1452 for total fines assessed in certain disciplinary
1453 actions; amending s. 456.072, F.S.; providing that the
1454 failure to comply with fair billing practices by a
1455 health care practitioner is grounds for disciplinary
1456 action; amending s. 627.0613, F.S.; providing that the
1457 consumer advocate must represent the general public
1458 before other state agencies; authorizing the consumer
1459 advocate to report findings relating to certain
1460 investigations to the agency and the Department of
1461 Health; authorizing the consumer advocate to have
1462 access to files, records, and data of the agency and
1463 the department necessary for certain investigations;
1464 authorizing the consumer advocate to maintain a
1465 process to receive and investigate complaints from
1466 patients relating to compliance with certain billing
1467 and notice requirements by licensed health care
1468 facilities and practitioners; defining a term;
1469 authorizing the consumer advocate to provide mediation
1470 between providers and consumers relating to certain
1471 matters; creating s. 627.6385, F.S.; requiring a
1472 health insurer to make available on its website
1473 certain methods that a policyholder can use to make
1474 estimates of certain costs and charges; providing that
1475 an estimate does not preclude an actual cost from
1476 exceeding the estimate; requiring a health insurer to
1477 make available on its website a hyperlink to certain
1478 health information; requiring a health insurer to
1479 include certain notice; requiring a health insurer
1480 that participates in the state group health insurance
1481 plan or Medicaid managed care to provide all claims
1482 data to a contracted vendor selected by the agency;
1483 excluding from the contributed claims data certain
1484 types of coverage; amending s. 641.54, F.S.; revising
1485 a requirement that a health maintenance organization
1486 make certain information available to its subscribers;
1487 requiring a health maintenance organization that
1488 participates in the state group health insurance plan
1489 or Medicaid managed care to provide all claims data to
1490 a contracted vendor selected by the agency; excluding
1491 from the contributed claims data certain types of
1492 coverage;; amending s. 409.967, F.S.; requiring
1493 managed care plans to provide all claims data to a
1494 contracted vendor selected by the agency; amending s.
1495 110.123, F.S.; requiring the Department of Management
1496 Services to provide certain data to the contracted
1497 vendor for the price transparency database established
1498 by the agency; requiring a contracted vendor for the
1499 state group health insurance plan to provide claims
1500 data to the vendor selected by the agency; amending
1501 ss. 20.42, 381.026, 395.602, 395.6025, 408.07, 408.18,
1502 and 465.0244, F.S.; conforming provisions to changes
1503 made by the act; providing legislative intent;
1504 providing an effective date.