Florida Senate - 2016 SB 1496
By Senator Bradley
1 A bill to be entitled
2 An act relating to transparency in health care;
3 amending s. 395.301, F.S.; requiring a facility
4 licensed under ch. 395, F.S., to provide timely and
5 accurate financial information and quality of service
6 measures to certain individuals; providing an
7 exemption; requiring a licensed facility to make
8 available on its website certain information on
9 payments made to that facility for defined bundles of
10 services and procedures and other information for
11 consumers and patients; requiring that facility
12 websites provide specified information and notify and
13 inform patients or prospective patients of certain
14 information; requiring a facility to provide a
15 written, good faith estimate of charges to a patient
16 or prospective patient within a certain timeframe;
17 requiring a facility to provide information regarding
18 financial assistance from the facility which may be
19 available to a patient or a prospective patient;
20 providing a penalty for failing to provide an estimate
21 of charges to a patient; deleting a requirement that a
22 licensed facility not operated by the state provide
23 notice to a patient of his or her right to an itemized
24 statement or bill within a certain timeframe; revising
25 the information that must be included on a patient’s
26 statement or bill; requiring that certain records be
27 made available through electronic means that comply
28 with a specified law; reducing the response time for
29 certain patient requests for information; creating s.
30 395.3012, F.S.; authorizing the Agency for Health Care
31 Administration to impose penalties based on certain
32 findings of an investigation as determined by the
33 consumer advocate; amending ss. 400.165, 400.487, and
34 400.934, F.S.; requiring nursing homes, home health
35 agencies, and home medical equipment providers to
36 provide upon request certain written estimates of
37 charges within a certain timeframe; amending s.
38 408.05, F.S.; revising requirements for the collection
39 and use of health-related data by the agency;
40 requiring the agency to contract with a vendor to
41 provide an Internet-based platform with certain
42 attributes; requiring potential vendors to have
43 certain qualifications; prohibiting the agency from
44 establishing a certain database under certain
45 circumstances; amending s. 408.061, F.S.; revising
46 requirements for the submission of health care data to
47 the agency; amending s. 456.0575, F.S.; requiring a
48 health care practitioner to provide a patient upon his
49 or her request a written, good faith estimate of
50 anticipated charges within a certain timeframe;
51 amending s. 456.072, F.S.; providing that the failure
52 to comply with fair billing practices by a health care
53 practitioner is grounds for disciplinary action;
54 amending s. 627.0613, F.S.; providing that the
55 consumer advocate must represent the general public
56 before other state agencies; authorizing the consumer
57 advocate to report findings relating to certain
58 investigations to the agency and the Department of
59 Health; authorizing the consumer advocate to have
60 access to files, records, and data of the agency and
61 the department necessary for certain investigations;
62 authorizing the consumer advocate to maintain a
63 process to receive and investigate complaints from
64 patients relating to compliance with certain billing
65 and notice requirements by licensed health care
66 facilities and practitioners; defining a term;
67 authorizing the consumer advocate to provide mediation
68 between providers and consumers relating to certain
69 matters; creating s. 627.6385, F.S.; requiring a
70 health insurer to make available on its website
71 certain methods that a policyholder can use to make
72 estimates of certain costs and charges; providing that
73 an estimate does not preclude an actual cost from
74 exceeding the estimate; requiring a health insurer to
75 make available on its website a hyperlink to certain
76 health information; requiring a health insurer to
77 include certain notice; requiring a health insurer
78 that participates in the state group health insurance
79 plan or Medicaid managed care to provide all claims
80 data to a contracted vendor selected by the agency;
81 providing a credit against the premium tax to certain
82 health insurers; amending s. 641.54, F.S.; revising
83 the provision requiring a health maintenance
84 organization to make certain information available to
85 its subscribers; requiring a health maintenance
86 organization that participates in the state group
87 health insurance plan or Medicaid managed care to
88 provide all claims data to a contracted vendor
89 selected by the agency; providing a credit against
90 certain premium taxes to specified health maintenance
91 organizations; amending s. 409.967, F.S.; requiring
92 managed care plans to provide all claims data to a
93 contracted vendor selected by the agency; amending s.
94 110.123, F.S.; requiring the Department of Management
95 Services to provide certain data to the contracted
96 vendor for the price transparency database established
97 by the agency; requiring a contracted vendor for the
98 state group health insurance plan to provide claims
99 data to the vendor selected by the agency; creating s.
100 212.099, F.S.; defining terms; authorizing a credit
101 against sales and use tax for taxpayers that provide
102 health care claims information; providing a limitation
103 on credit amounts; providing penalties for
104 fraudulently claiming the credit; creating s. 220.197,
105 F.S.; defining terms; authorizing a credit against
106 corporate income tax for corporations that provide
107 health care claims information; providing a limitation
108 on credit amounts; providing penalties for
109 fraudulently claiming the credit; amending ss. 20.42,
110 381.026, 395.602, 395.6025, 408.07, 408.18, and
111 465.0244, F.S.; conforming provisions to changes made
112 by the act; providing effective dates.
114 Be It Enacted by the Legislature of the State of Florida:
116 Section 1. Section 395.301, Florida Statutes, is amended to
118 395.301 Price transparency; itemized patient statement or
form and content prescribed by the agency; patient
120 admission status notification.—
121 (1) A facility licensed under this chapter shall provide
122 timely and accurate financial information and quality of service
123 measures to prospective and actual patients of the facility, or
124 to patients’ survivors or legal guardians, as appropriate. Such
125 information shall be provided in accordance with this section
126 and rules adopted by the agency pursuant to this chapter and s.
127 408.05. Licensed facilities operating exclusively as state
128 mental health treatment facilities or as mobile surgical
129 facilities are exempt from the requirements of this subsection.
130 (a) Each licensed facility shall make available to the
131 public on its website information on payments made to that
132 facility for defined bundles of services and procedures. The
133 payment data must be presented and searchable in accordance with
134 the system established by the agency and its vendor using the
135 descriptive service bundles developed under s. 408.05(3)(c). At
136 a minimum, the facility shall provide the estimated average
137 payment received from all payors, excluding Medicaid and
138 Medicare, for the descriptive service bundles available at that
139 facility and the estimated payment range for such bundles. Using
140 plain language, comprehensible to an ordinary layperson, the
141 facility must disclose that the information on average payments
142 and the payment ranges is an estimate of costs that may be
143 incurred by the patient or prospective patient and that actual
144 costs will be based on the services actually provided to the
145 patient. The facility shall also assist the consumer in
146 accessing his or her health insurer’s or health maintenance
147 organization’s website for information on estimated copayments,
148 deductibles, and other cost-sharing responsibilities. The
149 facility’s website must:
150 1. Identify and post the names of all health insurers and
151 health maintenance organizations for which the facility is a
152 network provider or preferred provider and include a hyperlink
153 to the website of each.
154 2. Provide information to uninsured patients and insured
155 patients whose health insurer or health maintenance organization
156 does not include the facility as a network provider or preferred
157 provider on the facility’s financial assistance policy,
158 including the application process, payment plans, and discounts,
159 and the facility’s charity care policy and collection
161 3. Notify patients or prospective patients that services
162 may be provided in the health care facility by the facility as
163 well as by other health care providers who may separately bill
164 the patient.
165 4. Inform patients or prospective patients that they may
166 request from the facility and other health care providers a more
167 personalized estimate of charges and other information.
168 (b)1. Upon request, and before providing any nonemergency
169 medical services, each licensed facility shall provide a
170 written, good faith estimate of reasonably anticipated charges
171 by the facility for the treatment of the patient’s or
172 prospective patient’s specific condition. The facility must
173 provide the estimate in writing to the patient or prospective
174 patient within 7 business days after the receipt of the request
175 and is not required to adjust the estimate for any potential
176 insurance coverage. The estimate may be based on the descriptive
177 service bundles developed by the agency under s. 408.05(3)(c)
178 unless the patient or prospective patient requests a more
179 personalized and specific estimate that accounts for the
180 specific condition and characteristics of the patient or
181 prospective patient. The facility shall inform the patient or
182 prospective patient that he or she may contact his or her health
183 insurer or health maintenance organization for additional
184 information concerning cost-sharing responsibilities.
185 2. In the estimate, the facility shall provide to the
186 patient or prospective patient information on the facility’s
187 financial assistance policy, including the application process,
188 payment plans, and discounts and the facility’s charity care
189 policy and collection procedures.
190 3. Upon request, the facility shall notify the patient or
191 prospective patient of any revision to the estimate.
192 4. In the estimate, the facility must notify the patient or
193 prospective patient that services may be provided in the health
194 care facility by the facility as well as by other health care
195 providers that may separately bill the patient.
196 5. The facility shall take action to educate the public
197 that such estimates are available upon request.
198 6. Failure to timely provide the estimate pursuant to this
199 paragraph shall result in a fine of $500 for each instance of
200 the facility’s failure to provide the requested information.
202 The provision of an estimate does not preclude the actual
203 charges from exceeding the estimate.
204 (c) Each facility shall make available on its website a
205 hyperlink to the health-related data, including quality measures
206 and statistics that are disseminated by the agency pursuant to
207 s. 408.05. The facility shall also take action to notify the
208 public that such information is electronically available and
209 provide a hyperlink to the agency’s website.
210 (d)1. Upon request, and after the patient’s discharge or
211 release from the facility, the facility must provide A licensed
212 facility not operated by the state shall notify each patient
213 during admission and at discharge of his or her right to receive
214 an itemized bill upon request. Within 7 days following the
215 patient’s discharge or release from a licensed facility not
216 operated by the state, the licensed facility providing the
217 service shall, upon request, submit to the patient , or to the
218 patient’s survivor or legal guardian, as may be appropriate, an
219 itemized statement or bill detailing in plain language,
220 comprehensible to an ordinary layperson, the specific nature of
221 charges or expenses incurred by the patient. , which in The
222 initial statement or bill billing shall be provided within 7
223 days after the patient’s discharge or release from the facility
224 or after a request for such statement or bill, whichever is
225 later. The initial statement or bill must contain a statement of
226 specific services received and expenses incurred by date for
227 such items of service, enumerating in detail as prescribed by
228 the agency the constituent components of the services received
229 within each department of the licensed facility and including
230 unit price data on rates charged by the licensed facility , as
231 prescribed by the agency. The statement or bill must identify
232 each item as paid, pending payment by a third party, or pending
233 payment by the patient and must include the amount due, if
234 applicable. If an amount is due from the patient, a due date
235 must be included. The initial statement or bill must inform the
236 patient or the patient’s survivor or legal guardian, as
237 appropriate, to contact the patient’s insurer or health
238 maintenance organization regarding the patient’s cost-sharing
240 2. Any subsequent statement or bill provided to a patient
241 or to the patient’s survivor or legal guardian, as appropriate,
242 relating to the episode of care must include all of the
243 information required by subparagraph 1., with any revisions
244 clearly delineated.
245 3. (2)(a) Each such statement or bill provided submitted
246 pursuant to this subsection section:
247 a. 1 . Must May not include notice charges of hospital-based
248 physicians and other health care providers who bill if billed
250 b. 2 . May not include any generalized category of expenses
251 such as “other” or “miscellaneous” or similar categories.
252 c. 3 . Must Shall list drugs by brand or generic name and not
253 refer to drug code numbers when referring to drugs of any sort.
254 d. 4 . Must Shall specifically identify physical,
255 occupational, or speech therapy treatment as to the date, type,
256 and length of treatment when such therapy treatment is a part of
257 the statement or bill.
258 (b) Any person receiving a statement pursuant to this
259 section shall be fully and accurately informed as to each charge
260 and service provided by the institution preparing the statement.
261 (2) (3) On each itemized statement submitted pursuant to
262 subsection (1) there shall appear the words “A FOR-PROFIT (or
263 NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
264 CENTER) LICENSED BY THE STATE OF FLORIDA” or substantially
265 similar words sufficient to identify clearly and plainly the
266 ownership status of the licensed facility. Each itemized
267 statement or bill must prominently display the telephone phone
268 number of the medical facility’s patient liaison who is
269 responsible for expediting the resolution of any billing dispute
270 between the patient, or the patient’s survivor or legal guardian
271 his or her representative, and the billing department.
272 (4) An itemized bill shall be provided once to the
273 patient’s physician at the physician’s request, at no charge.
274 (5) In any billing for services subsequent to the initial
275 billing for such services, the patient, or the patient’s
276 survivor or legal guardian, may elect, at his or her option, to
277 receive a copy of the detailed statement of specific services
278 received and expenses incurred for each such item of service as
279 provided in subsection (1).
280 (6) No physician, dentist, podiatric physician, or licensed
281 facility may add to the price charged by any third party except
282 for a service or handling charge representing a cost actually
283 incurred as an item of expense; however, the physician, dentist,
284 podiatric physician, or licensed facility is entitled to fair
285 compensation for all professional services rendered. The amount
286 of the service or handling charge, if any, shall be set forth
287 clearly in the bill to the patient.
288 (7) Each licensed facility not operated by the state shall
289 provide, prior to provision of any nonemergency medical
290 services, a written good faith estimate of reasonably
291 anticipated charges for the facility to treat the patient’s
292 condition upon written request of a prospective patient. The
293 estimate shall be provided to the prospective patient within 7
294 business days after the receipt of the request. The estimate may
295 be the average charges for that diagnosis related group or the
296 average charges for that procedure. Upon request, the facility
297 shall notify the patient of any revision to the good faith
298 estimate. Such estimate shall not preclude the actual charges
299 from exceeding the estimate. The facility shall place a notice
300 in the reception area that such information is available.
301 Failure to provide the estimate within the provisions
302 established pursuant to this section shall result in a fine of
303 $500 for each instance of the facility’s failure to provide the
304 requested information.
305 (8) Each licensed facility that is not operated by the
306 state shall provide any uninsured person seeking planned
307 nonemergency elective admission a written good faith estimate of
308 reasonably anticipated charges for the facility to treat such
309 person. The estimate must be provided to the uninsured person
310 within 7 business days after the person notifies the facility
311 and the facility confirms that the person is uninsured. The
312 estimate may be the average charges for that diagnosis-related
313 group or the average charges for that procedure. Upon request,
314 the facility shall notify the person of any revision to the good
315 faith estimate. Such estimate does not preclude the actual
316 charges from exceeding the estimate. The facility shall also
317 provide to the uninsured person a copy of any facility discount
318 and charity care discount policies for which the uninsured
319 person may be eligible. The facility shall place a notice in the
320 reception area where such information is available. Failure to
321 provide the estimate as required by this subsection shall result
322 in a fine of $500 for each instance of the facility’s failure to
323 provide the requested information.
324 (3) (9) If a licensed facility places a patient on
325 observation status rather than inpatient status, observation
326 services shall be documented in the patient’s discharge papers.
327 The patient or the patient’s survivor or legal guardian proxy
328 shall be notified of observation services through discharge
329 papers, which may also include brochures, signage, or other
330 forms of communication for this purpose.
331 (4) (10) A licensed facility shall make available to a
332 patient all records necessary for verification of the accuracy
333 of the patient’s statement or bill within 10 30 business days
334 after the request for such records. The records verification
335 information must be made available in the facility’s offices and
336 through electronic means that comply with the Health Insurance
337 Portability and Accountability Act of 1996 (HIPAA). Such records
338 must shall be available to the patient before prior to and after
339 payment of the statement or bill or claim. The facility may not
340 charge the patient for making such verification records
341 available; however, the facility may charge its usual fee for
342 providing copies of records as specified in s. 395.3025.
343 (5) (11) Each facility shall establish a method for
344 reviewing and responding to questions from patients concerning
345 the patient’s itemized statement or bill. Such response shall be
346 provided within 7 business 30 days after the date a question is
347 received. If the patient is not satisfied with the response, the
348 facility must provide the patient with the address and contact
349 information of the consumer advocate as provided in s. 627.0613
350 agency to which the issue may be sent for review.
351 (12) Each licensed facility shall make available on its
352 Internet website a link to the performance outcome and financial
353 data that is published by the Agency for Health Care
354 Administration pursuant to s. 408.05(3)(k). The facility shall
355 place a notice in the reception area that the information is
356 available electronically and the facility’s Internet website
358 Section 2. Section 395.3012, Florida Statutes, is created
359 to read:
360 395.3012 Penalties for unconscionable prices.—
361 (1) The agency may impose administrative fines based on the
362 findings of the consumer advocate’s investigation of billing
363 complaints pursuant to s. 627.0613(6).
364 (2) The administrative fines for noncompliance with s.
365 395.301 are the greater of $2,500 per violation or double the
366 amount of the charges that exceed fair charges.
367 Section 3. Present subsections (1) through (5) of section
368 400.165, Florida Statutes, are redesignated as subsections (2)
369 through (6), respectively, a new subsection (1) is added to that
370 section, and present subsection (4) of that section is amended,
371 to read:
372 400.165 Itemized resident billing, form and content
373 prescribed by the agency.—
374 (1) Every licensed nursing home shall provide upon the
375 request of a resident or prospective resident or his or her
376 legal guardian a written, good faith estimate of reasonably
377 anticipated charges for the resident at the nursing home. The
378 nursing home must provide the estimate to the requestor within 7
379 business days after receiving the request. The nursing home must
380 also provide information disclosing the nursing home’s payment
381 plans, discounts, and other available assistance and its
382 collection procedures.
383 (5) (4) In any billing for services subsequent to the
384 initial billing for such services, the resident, or the
385 resident’s survivor or legal guardian, may elect, at his or her
386 option, to receive a copy of the detailed statement of specific
387 services received and expenses incurred for each such item of
388 service as provided in subsection (2) subsection (1).
389 Section 4. Subsection (1) of section 400.487, Florida
390 Statutes, is amended to read:
391 400.487 Home health service agreements; physician’s,
392 physician assistant’s, and advanced registered nurse
393 practitioner’s treatment orders; patient assessment;
394 establishment and review of plan of care; provision of services;
395 orders not to resuscitate.—
396 (1)(a) Services provided by a home health agency must be
397 covered by an agreement between the home health agency and the
398 patient or the patient’s legal representative specifying the
399 home health services to be provided, the rates or charges for
400 services paid with private funds, and the sources of payment,
401 which may include Medicare, Medicaid, private insurance,
402 personal funds, or a combination thereof. A home health agency
403 providing skilled care must make an assessment of the patient’s
404 needs within 48 hours after the start of services.
405 (b) Every licensed home health agency shall provide upon
406 the request of a prospective patient or his or her legal
407 guardian a written, good faith estimate of reasonably
408 anticipated charges for the prospective patient for services
409 provided by the home health agency. The home health agency must
410 provide the estimate to the requestor within 7 business days
411 after receiving the request. The home health agency must inform
412 the prospective patient, or his or her legal guardian, that he
413 or she may contact the prospective patient’s health insurer or
414 health maintenance organization for additional information
415 concerning cost-sharing responsibilities. The home health agency
416 must also provide information disclosing the home health
417 agency’s payment plans, discounts, and other available
418 assistance and its collection procedures.
419 Section 5. Subsection (23) is added to section 400.934,
420 Florida Statutes, to read:
421 400.934 Minimum standards.—As a requirement of licensure,
422 home medical equipment providers shall:
423 (23) Provide upon the request of a prospective patient or
424 his or her legal guardian a written, good faith estimate of
425 reasonably anticipated charges for the prospective patient for
426 services provided by the home medical equipment provider. The
427 home medical equipment provider must provide the estimate to the
428 requestor within 7 business days after receiving the request.
429 The home medical equipment provider must inform the prospective
430 patient, or his or her legal guardian, that he or she may
431 contact the prospective patient’s health insurer or health
432 maintenance organization for additional information concerning
433 cost-sharing responsibilities. The home medical equipment
434 provider must also provide information disclosing the home
435 medical equipment provider’s payment plans, discounts, and other
436 available assistance and its collection procedures.
437 Section 6. Section 408.05, Florida Statutes, is amended to
439 408.05 Florida Center for Health Information and
440 Transparency Policy Analysis.—
441 (1) ESTABLISHMENT.—The agency shall establish and maintain
442 a Florida Center for Health Information and Transparency to
443 collect, compile, coordinate, analyze, index, and disseminate
444 Policy Analysis. The center shall establish a comprehensive
445 health information system to provide for the collection,
446 compilation, coordination, analysis, indexing, dissemination,
447 and utilization of both purposefully collected and extant
448 health-related data and statistics. The center shall be staffed
449 as necessary with public health experts, biostatisticians,
450 information system analysts, health policy experts, economists,
451 and other staff necessary to carry out its functions.
452 (2) HEALTH-RELATED DATA.—The comprehensive health
453 information system operated by the Florida Center for Health
454 Information and Transparency Policy Analysis shall identify the
455 best available data sets, compile new data when specifically
456 authorized, data sources and promote the use coordinate the
457 compilation of extant health-related data and statistics. The
458 center must maintain any data sets in existence before July 1,
459 2016, unless such data sets duplicate information that is
460 readily available from other credible sources, and may and
461 purposefully collect or compile data on the following:
462 (a) The extent and nature of illness and disability of the
463 state population, including life expectancy, the incidence of
464 various acute and chronic illnesses, and infant and maternal
465 morbidity and mortality.
466 (b) The impact of illness and disability of the state
467 population on the state economy and on other aspects of the
468 well-being of the people in this state.
469 (c) Environmental, social, and other health hazards.
470 (d) Health knowledge and practices of the people in this
471 state and determinants of health and nutritional practices and
473 (a) (e) Health resources, including licensed physicians,
474 dentists, nurses, and other health care practitioners
475 professionals, by specialty and type of practice. Such data
476 shall include information collected by the Department of Health
477 pursuant to ss. 458.3191 and 459.0081.
478 (b) Health service inventories, including and acute care,
479 long-term care, and other institutional care facilities facility
480 supplies and specific services provided by hospitals, nursing
481 homes, home health agencies, and other licensed health care
483 (c) (f) Service utilization for licensed health care
484 facilities of health care by type of provider.
485 (d) (g) Health care costs and financing, including trends in
486 health care prices and costs, the sources of payment for health
487 care services, and federal, state, and local expenditures for
488 health care.
489 (h) Family formation, growth, and dissolution.
490 (e) (i) The extent of public and private health insurance
491 coverage in this state.
492 (f) (j) Specific quality-of-care initiatives involving The
493 quality of care provided by various health care providers when
494 extant data is not adequate to achieve the objectives of the
496 (3) COMPREHENSIVE HEALTH INFORMATION TRANSPARENCY SYSTEM.
497 In order to disseminate and facilitate the availability of
498 produce comparable and uniform health information and statistics
499 for the development of policy recommendations, the agency shall
500 perform the following functions:
501 (a) Collect and compile information on and coordinate the
502 activities of state agencies involved in providing the design
503 and implementation of the comprehensive health information to
504 consumers system.
505 (b) Promote data sharing through dissemination of state
506 collected health data by making such data available,
507 transferable, and readily usable Undertake research,
508 development, and evaluation respecting the comprehensive health
509 information system.
510 (c) Contract with a vendor to provide a consumer-friendly,
511 Internet-based platform that allows a consumer to research the
512 cost of health care services and procedures and allows for price
513 comparison. The Internet-based platform must allow a consumer to
514 search by condition or service bundles that are comprehensible
515 to an ordinary layperson and may not require registration, a
516 security password, or user identification. The vendor must be a
517 nonprofit research institute that is qualified under s. 1874 of
518 the Social Security Act to receive Medicare claims data and that
519 receives claims data from multiple private insurers nationwide.
520 The vendor must have:
521 1. A national database consisting of at least 15 billion
522 claim lines of administrative claims data from multiple payors
523 capable of being expanded by adding third-party payors,
524 including employers with health plans covered by the Employee
525 Retirement Income Security Act of 1974 (ERISA).
526 2. A well-developed methodology for analyzing claims data
527 within defined service bundles.
528 3. A bundling methodology that is available in the public
529 domain to allow for consistency and comparison of state and
530 national benchmarks with local regions and specific providers.
531 (c) Review the statistical activities of state agencies to
532 ensure that they are consistent with the comprehensive health
533 information system.
534 (d) Develop written agreements with local, state, and
535 federal agencies to facilitate for the sharing of data related
536 to health care health-care-related data or using the facilities
537 and services of such agencies. State agencies, local health
538 councils, and other agencies under state contract shall assist
539 the center in obtaining, compiling, and transferring health
540 care-related data maintained by state and local agencies.
541 Written agreements must specify the types, methods, and
542 periodicity of data exchanges and specify the types of data that
543 will be transferred to the center.
544 (e) Establish by rule the types of data collected,
545 compiled, processed, used, or shared. Decisions regarding center
546 data sets should be made based on consultation with the State
547 Consumer Health Information and Policy Advisory Council and
548 other public and private users regarding the types of data which
549 should be collected and their uses. The center shall establish
550 standardized means for collecting health information and
551 statistics under laws and rules administered by the agency.
552 (f) Consult with contracted vendors, the State Consumer
553 Health Information and Policy Advisory Council, and other public
554 and private users regarding the types of data that should be
555 collected and the use of such data.
556 (g) Monitor data collection procedures and test data
557 quality to facilitate the dissemination of data that is
558 accurate, valid, reliable, and complete.
559 (f) Establish minimum health-care-related data sets which
560 are necessary on a continuing basis to fulfill the collection
561 requirements of the center and which shall be used by state
562 agencies in collecting and compiling health-care-related data.
563 The agency shall periodically review ongoing health care data
564 collections of the Department of Health and other state agencies
565 to determine if the collections are being conducted in
566 accordance with the established minimum sets of data.
567 (g) Establish advisory standards to ensure the quality of
568 health statistical and epidemiological data collection,
569 processing, and analysis by local, state, and private
571 (h) Prescribe standards for the publication of health-care
572 related data reported pursuant to this section which ensure the
573 reporting of accurate, valid, reliable, complete, and comparable
574 data. Such standards should include advisory warnings to users
575 of the data regarding the status and quality of any data
576 reported by or available from the center.
577 (h) (i) Develop Prescribe standards for the maintenance and
578 preservation of the center’s data. This should include methods
579 for archiving data, retrieval of archived data, and data editing
580 and verification.
581 (j) Ensure that strict quality control measures are
582 maintained for the dissemination of data through publications,
583 studies, or user requests.
584 (i) (k) Make Develop, in conjunction with the State Consumer
585 Health Information and Policy Advisory Council, and implement a
586 long-range plan for making available health care quality
587 measures and financial data that will allow consumers to compare
588 outcomes and other performance measures for health care
589 services. The health care quality measures and financial data
590 the agency must make available include, but are not limited to,
591 pharmaceuticals, physicians, health care facilities, and health
592 plans and managed care entities. The agency shall update the
593 plan and report on the status of its implementation annually.
594 The agency shall also make the plan and status report available
595 to the public on its Internet website. As part of the plan, the
596 agency shall identify the process and timeframes for
597 implementation, barriers to implementation, and recommendations
598 of changes in the law that may be enacted by the Legislature to
599 eliminate the barriers. As preliminary elements of the plan, the
600 agency shall:
601 1. Make available patient-safety indicators, inpatient
602 quality indicators, and performance outcome and patient charge
603 data collected from health care facilities pursuant to s.
604 408.061(1)(a) and (2). The terms “patient-safety indicators” and
605 “inpatient quality indicators” have the same meaning as that
606 ascribed by the Centers for Medicare and Medicaid Services, an
607 accrediting organization whose standards incorporate comparable
608 regulations required by this state, or a national entity that
609 establishes standards to measure the performance of health care
610 providers, or by other states. The agency shall determine which
611 conditions, procedures, health care quality measures, and
612 patient charge data to disclose based upon input from the
613 council. When determining which conditions and procedures are to
614 be disclosed, the council and the agency shall consider
615 variation in costs, variation in outcomes, and magnitude of
616 variations and other relevant information. When determining
617 which health care quality measures to disclose, the agency:
618 a. Shall consider such factors as volume of cases; average
619 patient charges; average length of stay; complication rates;
620 mortality rates; and infection rates, among others, which shall
621 be adjusted for case mix and severity, if applicable.
622 b. May consider such additional measures that are adopted
623 by the Centers for Medicare and Medicaid Studies, an accrediting
624 organization whose standards incorporate comparable regulations
625 required by this state, the National Quality Forum, the Joint
626 Commission on Accreditation of Healthcare Organizations, the
627 Agency for Healthcare Research and Quality, the Centers for
628 Disease Control and Prevention, or a similar national entity
629 that establishes standards to measure the performance of health
630 care providers, or by other states.
632 When determining which patient charge data to disclose, the
633 agency shall include such measures as the average of
634 undiscounted charges on frequently performed procedures and
635 preventive diagnostic procedures, the range of procedure charges
636 from highest to lowest, average net revenue per adjusted patient
637 day, average cost per adjusted patient day, and average cost per
638 admission, among others.
639 2. Make available performance measures, benefit design, and
640 premium cost data from health plans licensed pursuant to chapter
641 627 or chapter 641. The agency shall determine which health care
642 quality measures and member and subscriber cost data to
643 disclose, based upon input from the council. When determining
644 which data to disclose, the agency shall consider information
645 that may be required by either individual or group purchasers to
646 assess the value of the product, which may include membership
647 satisfaction, quality of care, current enrollment or membership,
648 coverage areas, accreditation status, premium costs, plan costs,
649 premium increases, range of benefits, copayments and
650 deductibles, accuracy and speed of claims payment, credentials
651 of physicians, number of providers, names of network providers,
652 and hospitals in the network. Health plans shall make available
653 to the agency such data or information that is not currently
654 reported to the agency or the office.
655 3. Determine the method and format for public disclosure of
656 data reported pursuant to this paragraph. The agency shall make
657 its determination based upon input from the State Consumer
658 Health Information and Policy Advisory Council. At a minimum,
659 the data shall be made available on the agency’s Internet
660 website in a manner that allows consumers to conduct an
661 interactive search that allows them to view and compare the
662 information for specific providers. The website must include
663 such additional information as is determined necessary to ensure
664 that the website enhances informed decisionmaking among
665 consumers and health care purchasers, which shall include, at a
666 minimum, appropriate guidance on how to use the data and an
667 explanation of why the data may vary from provider to provider.
668 4. Publish on its website undiscounted charges for no fewer
669 than 150 of the most commonly performed adult and pediatric
670 procedures, including outpatient, inpatient, diagnostic, and
671 preventative procedures.
672 (4) TECHNICAL ASSISTANCE.—
673 (a) The center shall provide technical assistance to
674 persons or organizations engaged in health planning activities
675 in the effective use of statistics collected and compiled by the
676 center. The center shall also provide the following additional
677 technical assistance services:
678 1. Establish procedures identifying the circumstances under
679 which, the places at which, the persons from whom, and the
680 methods by which a person may secure data from the center,
681 including procedures governing requests, the ordering of
682 requests, timeframes for handling requests, and other procedures
683 necessary to facilitate the use of the center’s data. To the
684 extent possible, the center should provide current data timely
685 in response to requests from public or private agencies.
686 2. Provide assistance to data sources and users in the
687 areas of database design, survey design, sampling procedures,
688 statistical interpretation, and data access to promote improved
689 health-care-related data sets.
690 3. Identify health care data gaps and provide technical
691 assistance to other public or private organizations for meeting
692 documented health care data needs.
693 4. Assist other organizations in developing statistical
694 abstracts of their data sets that could be used by the center.
695 5. Provide statistical support to state agencies with
696 regard to the use of databases maintained by the center.
697 6. To the extent possible, respond to multiple requests for
698 information not currently collected by the center or available
699 from other sources by initiating data collection.
700 7. Maintain detailed information on data maintained by
701 other local, state, federal, and private agencies in order to
702 advise those who use the center of potential sources of data
703 which are requested but which are not available from the center.
704 8. Respond to requests for data which are not available in
705 published form by initiating special computer runs on data sets
706 available to the center.
707 9. Monitor innovations in health information technology,
708 informatics, and the exchange of health information and maintain
709 a repository of technical resources to support the development
710 of a health information network.
711 (b) The agency shall administer, manage, and monitor grants
712 to not-for-profit organizations, regional health information
713 organizations, public health departments, or state agencies that
714 submit proposals for planning, implementation, or training
715 projects to advance the development of a health information
716 network. Any grant contract shall be evaluated to ensure the
717 effective outcome of the health information project.
718 (c) The agency shall initiate, oversee, manage, and
719 evaluate the integration of health care data from each state
720 agency that collects, stores, and reports on health care issues
721 and make that data available to any health care practitioner
722 through a state health information network.
723 (5) PUBLICATIONS; REPORTS; SPECIAL STUDIES.—The center
724 shall provide for the widespread dissemination of data which it
725 collects and analyzes. The center shall have the following
726 publication, reporting, and special study functions:
727 (a) The center shall publish and make available
728 periodically to agencies and individuals health statistics
729 publications of general interest, including health plan consumer
730 reports and health maintenance organization member satisfaction
731 surveys; publications providing health statistics on topical
732 health policy issues; publications that provide health status
733 profiles of the people in this state; and other topical health
734 statistics publications.
735 (j) (b) The center shall publish, Make available , and
736 disseminate, promptly and as widely as practicable, the results
737 of special health surveys, health care research, and health care
738 evaluations conducted or supported under this section. Any
739 publication by the center must include a statement of the
740 limitations on the quality, accuracy, and completeness of the
742 (c) The center shall provide indexing, abstracting,
743 translation, publication, and other services leading to a more
744 effective and timely dissemination of health care statistics.
745 (d) The center shall be responsible for publishing and
746 disseminating an annual report on the center’s activities.
747 (e) The center shall be responsible, to the extent
748 resources are available, for conducting a variety of special
749 studies and surveys to expand the health care information and
750 statistics available for health policy analyses, particularly
751 for the review of public policy issues. The center shall develop
752 a process by which users of the center’s data are periodically
753 surveyed regarding critical data needs and the results of the
754 survey considered in determining which special surveys or
755 studies will be conducted. The center shall select problems in
756 health care for research, policy analyses, or special data
757 collections on the basis of their local, regional, or state
758 importance; the unique potential for definitive research on the
759 problem; and opportunities for application of the study
761 (4) (6) PROVIDER DATA REPORTING.—This section does not
762 confer on the agency the power to demand or require that a
763 health care provider or professional furnish information,
764 records of interviews, written reports, statements, notes,
765 memoranda, or data other than as expressly required by law. The
766 agency may not establish an all-payor claims database or a
767 comparable database without express legislative authority.
768 (5) (7) BUDGET; FEES.—
769 (a) The Legislature intends that funding for the Florida
770 Center for Health Information and Transparency Policy Analysis
771 be appropriated from the General Revenue Fund.
772 (b) The Florida Center for Health Information and
773 Transparency Policy Analysis may apply for and receive and
774 accept grants, gifts, and other payments, including property and
775 services, from any governmental or other public or private
776 entity or person and make arrangements as to the use of same,
777 including the undertaking of special studies and other projects
778 relating to health-care-related topics. Funds obtained pursuant
779 to this paragraph may not be used to offset annual
780 appropriations from the General Revenue Fund.
781 (c) The center may charge such reasonable fees for services
782 as the agency prescribes by rule. The established fees may not
783 exceed the reasonable cost for such services. Fees collected may
784 not be used to offset annual appropriations from the General
785 Revenue Fund.
786 (6) (8) STATE CONSUMER HEALTH INFORMATION AND POLICY
787 ADVISORY COUNCIL.—
788 (a) There is established in the agency the State Consumer
789 Health Information and Policy Advisory Council to assist the
790 center in reviewing the comprehensive health information system,
791 including the identification, collection, standardization,
792 sharing, and coordination of health-related data, fraud and
793 abuse data, and professional and facility licensing data among
794 federal, state, local, and private entities and to recommend
795 improvements for purposes of public health, policy analysis, and
796 transparency of consumer health care information. The council
797 consists shall consist of the following members:
798 1. An employee of the Executive Office of the Governor, to
799 be appointed by the Governor.
800 2. An employee of the Office of Insurance Regulation, to be
801 appointed by the director of the office.
802 3. An employee of the Department of Education, to be
803 appointed by the Commissioner of Education.
804 4. Ten persons, to be appointed by the Secretary of Health
805 Care Administration, representing other state and local
806 agencies, state universities, business and health coalitions,
807 local health councils, professional health-care-related
808 associations, consumers, and purchasers.
809 (b) Each member of the council shall be appointed to serve
810 for a term of 2 years following the date of appointment , except
811 the term of appointment shall end 3 years following the date of
812 appointment for members appointed in 2003, 2004, and 2005. A
813 vacancy shall be filled by appointment for the remainder of the
814 term, and each appointing authority retains the right to
815 reappoint members whose terms of appointment have expired.
816 (c) The council may meet at the call of its chair, at the
817 request of the agency, or at the request of a majority of its
818 membership, but the council must meet at least quarterly.
819 (d) Members shall elect a chair and vice chair annually.
820 (e) A majority of the members constitutes a quorum, and the
821 affirmative vote of a majority of a quorum is necessary to take
823 (f) The council shall maintain minutes of each meeting and
824 shall make such minutes available to any person.
825 (g) Members of the council shall serve without compensation
826 but shall be entitled to receive reimbursement for per diem and
827 travel expenses as provided in s. 112.061.
828 (h) The council’s duties and responsibilities include, but
829 are not limited to, the following:
830 1. To develop a mission statement, goals, and a plan of
831 action for the identification, collection, standardization,
832 sharing, and coordination of health-related data across federal,
833 state, and local government and private sector entities.
834 2. To develop a review process to ensure cooperative
835 planning among agencies that collect or maintain health-related
837 3. To create ad hoc issue-oriented technical workgroups on
838 an as-needed basis to make recommendations to the council.
839 (7) (9) APPLICATION TO OTHER AGENCIES.— Nothing in This
840 section does not shall limit, restrict, affect, or control the
841 collection, analysis, release, or publication of data by any
842 state agency pursuant to its statutory authority, duties, or
844 Section 7. Subsection (1) of section 408.061, Florida
845 Statutes, is amended to read:
846 408.061 Data collection; uniform systems of financial
847 reporting; information relating to physician charges;
848 confidential information; immunity.—
849 (1) The agency shall require the submission by health care
850 facilities, health care providers, and health insurers of data
851 necessary to carry out the agency’s duties and to facilitate
852 transparency in health care pricing data and quality measures.
853 Specifications for data to be collected under this section shall
854 be developed by the agency and applicable contract vendors, with
855 the assistance of technical advisory panels including
856 representatives of affected entities, consumers, purchasers, and
857 such other interested parties as may be determined by the
859 (a) Data submitted by health care facilities, including the
860 facilities as defined in chapter 395, shall include, but are not
861 limited to: case-mix data, patient admission and discharge data,
862 hospital emergency department data which shall include the
863 number of patients treated in the emergency department of a
864 licensed hospital reported by patient acuity level, data on
865 hospital-acquired infections as specified by rule, data on
866 complications as specified by rule, data on readmissions as
867 specified by rule, with patient and provider-specific
868 identifiers included, actual charge data by diagnostic groups or
869 other bundled groupings as specified by rule, financial data,
870 accounting data, operating expenses, expenses incurred for
871 rendering services to patients who cannot or do not pay,
872 interest charges, depreciation expenses based on the expected
873 useful life of the property and equipment involved, and
874 demographic data. The agency shall adopt nationally recognized
875 risk adjustment methodologies or software consistent with the
876 standards of the Agency for Healthcare Research and Quality and
877 as selected by the agency for all data submitted as required by
878 this section. Data may be obtained from documents such as, but
879 not limited to: leases, contracts, debt instruments, itemized
880 patient statements or bills, medical record abstracts, and
881 related diagnostic information. Reported data elements shall be
882 reported electronically in accordance with rule 59E-7.012,
883 Florida Administrative Code. Data submitted shall be certified
884 by the chief executive officer or an appropriate and duly
885 authorized representative or employee of the licensed facility
886 that the information submitted is true and accurate.
887 (b) Data to be submitted by health care providers may
888 include, but are not limited to: professional organization and
889 specialty board affiliations, Medicare and Medicaid
890 participation, types of services offered to patients, actual
891 charges to patients as specified by rule, amount of revenue and
892 expenses of the health care provider, and such other data which
893 are reasonably necessary to study utilization patterns. Data
894 submitted shall be certified by the appropriate duly authorized
895 representative or employee of the health care provider that the
896 information submitted is true and accurate.
897 (c) Data to be submitted by health insurers may include,
898 but are not limited to: claims, payments to health care
899 facilities and health care providers as specified by rule,
900 premium, administration, and financial information. Data
901 submitted shall be certified by the chief financial officer, an
902 appropriate and duly authorized representative, or an employee
903 of the insurer that the information submitted is true and
905 (d) Data required to be submitted by health care
906 facilities, health care providers, or health insurers may shall
907 not include specific provider contract reimbursement
908 information. However, such specific provider reimbursement data
909 shall be reasonably available for onsite inspection by the
910 agency as is necessary to carry out the agency’s regulatory
911 duties. Any such data obtained by the agency as a result of
912 onsite inspections may not be used by the state for purposes of
913 direct provider contracting and are confidential and exempt from
914 the provisions of s. 119.07(1) and s. 24(a), Art. I of the State
916 (e) A requirement to submit data shall be adopted by rule
917 if the submission of data is being required of all members of
918 any type of health care facility, health care provider, or
919 health insurer. Rules are not required, however, for the
920 submission of data for a special study mandated by the
921 Legislature or when information is being requested for a single
922 health care facility, health care provider, or health insurer.
923 Section 8. Section 456.0575, Florida Statutes, is amended
924 to read:
925 456.0575 Duty to notify patients.—
926 (1) Every licensed health care practitioner shall inform
927 each patient, or an individual identified pursuant to s.
928 765.401(1), in person about adverse incidents that result in
929 serious harm to the patient. Notification of outcomes of care
930 that result in harm to the patient under this section shall not
931 constitute an acknowledgment of admission of liability, nor can
932 such notifications be introduced as evidence.
933 (2) Every licensed health care practitioner must provide
934 upon request by a patient, before providing any nonemergency
935 medical services in a facility licensed under chapter 395, a
936 written, good faith estimate of reasonably anticipated charges
937 to treat the patient’s condition at the licensed facility. The
938 health care practitioner must provide the estimate to the
939 patient within 7 business days after receiving the request and
940 is not required to adjust the estimate for any potential
941 insurance coverage. The health care practitioner must inform the
942 patient that he or she may contact his or her health insurer or
943 health maintenance organization for additional information
944 concerning cost-sharing responsibilities. The health care
945 practitioner must provide information to uninsured patients and
946 insured patients for whom the practitioner is not a network
947 provider or preferred provider which discloses the
948 practitioner’s financial assistance policy, including the
949 application process, payment plans, discounts, and other
950 available assistance; the practitioner’s charity care policy;
951 and the practitioner’s collection procedures. Such estimate does
952 not preclude the actual charges from exceeding the estimate.
953 Failure to provide the estimate in accordance with this
954 subsection, without good cause, within the 7 business days shall
955 result in disciplinary action against the health care
956 practitioner and a fine of $500 for each instance of the
957 practitioner’s failure to provide the requested estimate.
958 Section 9. Paragraph (oo) is added to subsection (1) of
959 section 456.072, Florida Statutes, to read:
960 456.072 Grounds for discipline; penalties; enforcement.—
961 (1) The following acts shall constitute grounds for which
962 the disciplinary actions specified in subsection (2) may be
964 (oo) Failure to comply with fair billing practices pursuant
965 to s. 627.0613(6).
966 Section 10. Section 627.0613, Florida Statutes, is amended
967 to read:
968 627.0613 Consumer advocate.—The Chief Financial Officer
969 must appoint a consumer advocate who must represent the general
970 public of the state before the department, and the office, and
971 other state agencies, as required by this section. The consumer
972 advocate must report directly to the Chief Financial Officer,
973 but is not otherwise under the authority of the department or of
974 any employee of the department. The consumer advocate has such
975 powers as are necessary to carry out the duties of the office of
976 consumer advocate, including, but not limited to, the powers to:
977 (1) Recommend to the department or office, by petition, the
978 commencement of any proceeding or action; appear in any
979 proceeding or action before the department or office; or appear
980 in any proceeding before the Division of Administrative Hearings
981 relating to subject matter under the jurisdiction of the
982 department or office.
983 (2) Report to the Agency for Health Care Administration and
984 to the Department of Health any findings resulting from
985 investigation of unresolved complaints concerning the billing
986 practices of any health care facility licensed under chapter 395
987 or any health care practitioner subject to chapter 456.
988 (3) (2) Have access to and use of all files, records, and
989 data of the department or office.
990 (4) Have access to any files, records, and data of the
991 Agency for Health Care Administration and the Department of
992 Health which are necessary for the investigations authorized by
993 subsection (6).
994 (5) (3) Examine rate and form filings submitted to the
995 office, hire consultants as necessary to aid in the review
996 process, and recommend to the department or office any position
997 deemed by the consumer advocate to be in the public interest.
998 (6) Maintain a process for receiving and investigating
999 complaints from insured and uninsured patients of health care
1000 facilities licensed under chapter 395 and health care
1001 practitioners subject to chapter 456 concerning billing
1002 practices. Investigations by the office of the consumer advocate
1003 shall be limited to determining compliance with the following
1005 (a) The patient was informed before a nonemergency
1006 procedure of expected payments related to the procedure as
1007 provided in s. 395.301, contact information for health insurers
1008 or health maintenance organizations to determine specific cost
1009 sharing responsibilities, and the expected involvement in the
1010 procedure of other providers who may bill independently.
1011 (b) The patient was informed of policies and procedures to
1012 qualify for discounted charges.
1013 (c) The patient was informed of collection procedures and
1014 given the opportunity to participate in an extended payment
1016 (d) The patient was given a written, personal, and itemized
1017 estimate upon request as provided in ss. 395.301 and 456.0575.
1018 (e) The statement or bill delivered to the patient was
1019 accurate and included all information required pursuant to s.
1021 (f) The billed amounts were fair charges. As used in this
1022 paragraph, the term “fair charges” means the common and frequent
1023 range of charges for patients who are similarly situated
1024 requiring the same or similar medical services.
1025 (7) Provide mediation between providers and patients to
1026 resolve billing complaints and negotiate arrangements for
1027 extended payment schedules.
1028 (8) (4) Prepare an annual budget for presentation to the
1029 Legislature by the department, which budget must be adequate to
1030 carry out the duties of the office of consumer advocate.
1031 Section 11. Section 627.6385, Florida Statutes, is created
1032 to read:
1033 627.6385 Disclosures to policyholders; calculations of cost
1035 (1) Each health insurer shall make available on its
1037 (a) A method for policyholders to estimate their
1038 copayments, deductibles, and other cost-sharing responsibilities
1039 for health care services and procedures. Such method of making
1040 an estimate shall be based on service bundles established
1041 pursuant to s. 408.05(3)(c). Estimates do not preclude the
1042 actual copayment, coinsurance percentage, or deductible,
1043 whichever is applicable, from exceeding the estimate.
1044 1. Estimates shall be calculated according to the policy
1045 and known plan usage during the coverage period.
1046 2. Estimates shall be made available based on providers
1047 that are in-network or out-of-network.
1048 3. A policyholder must be able to create estimates by any
1049 combination of the service bundles established pursuant to s.
1050 408.05(3)(c) or by a specified provider or a comparison of
1052 (b) A method for policyholders to estimate their
1053 copayments, deductibles, and other cost-sharing responsibilities
1054 based on a personalized estimate of charges received from a
1055 facility pursuant to s. 395.301 or a practitioner pursuant to s.
1057 (c) A hyperlink to the health information, including, but
1058 not limited to, service bundles and quality of care information,
1059 which is disseminated by the Agency for Health Care
1060 Administration pursuant to s. 408.05(3).
1061 (2) Each health insurer shall include in every policy
1062 delivered or issued for delivery to any person in the state or
1063 in materials provided as required by s. 627.64725 notice that
1064 the information required by this section is available
1065 electronically and the address of the website where the
1066 information can be accessed.
1067 (3) Each health insurer that participates in the state
1068 group health insurance plan created pursuant to s. 110.123 or
1069 Medicaid managed care pursuant to part IV of chapter 409 shall
1070 provide all claims data to the fullest extent possible to the
1071 contracted vendor selected by the Agency for Health Care
1072 Administration under s. 408.05(3)(c).
1073 (4) Each health insurer that provides all claims data to
1074 the fullest extent possible to the contracted vendor under s.
1075 408.05(3)(c) is entitled to a 0.05 percent credit against the
1076 premium tax established pursuant to s. 624.509, notwithstanding
1077 any premium tax credit limitation imposed by s. 624.509.
1078 Section 12. Subsection (6) and present subsection (7) of
1079 section 641.54, Florida Statutes, are amended, present
1080 subsection (7) of that section is redesignated as subsection
1081 (9), and a new subsection (7) and subsection (8) are added to
1082 that section, to read:
1083 641.54 Information disclosure.—
1084 (6) Each health maintenance organization shall make
1085 available to its subscribers on its website or by request the
1086 estimated copayment copay, coinsurance percentage, or
1087 deductible, whichever is applicable, for any covered services as
1088 described by the searchable bundles established on a consumer
1089 friendly, Internet-based platform pursuant to s. 408.05(3)(c) or
1090 as described in a personalized estimate received from a facility
1091 pursuant to s. 395.301 or a practitioner pursuant to s.
1092 456.0575, the status of the subscriber’s maximum annual out-of
1093 pocket payments for a covered individual or family, and the
1094 status of the subscriber’s maximum lifetime benefit. Such
1095 estimate does shall not preclude the actual copayment copay,
1096 coinsurance percentage, or deductible, whichever is applicable,
1097 from exceeding the estimate.
1098 (7) Each health maintenance organization that participates
1099 in the state group health insurance plan created pursuant to s.
1100 110.123 or Medicaid managed care pursuant to part IV of chapter
1101 409 shall provide all claims data to the fullest extent possible
1102 to the contracted vendor selected by the Agency for Health Care
1103 Administration under s. 408.05(3)(c).
1104 (8) Each health maintenance organization that provides all
1105 claims data to the fullest extent possible to the contracted
1106 vendor under s. 408.05(3)(c) is entitled to a 0.05 percent
1107 credit against the premium tax established pursuant to s.
1108 624.509, notwithstanding any premium tax credit limitation
1109 imposed by s. 624.509.
1110 (9) (7) Each health maintenance organization shall make
1111 available on its Internet website a hyperlink link to the health
1112 information performance outcome and financial data that is
1113 disseminated published by the Agency for Health Care
1114 Administration pursuant to s. 408.05(3) s. 408.05(3) (k) and
1115 shall include in every policy delivered or issued for delivery
1116 to any person in the state or any materials provided as required
1117 by s. 627.64725 notice that such information is available
1118 electronically and the address of its Internet website.
1119 Section 13. Paragraph (n) is added to subsection (2) of
1120 section 409.967, Florida Statutes, to read:
1121 409.967 Managed care plan accountability.—
1122 (2) The agency shall establish such contract requirements
1123 as are necessary for the operation of the statewide managed care
1124 program. In addition to any other provisions the agency may deem
1125 necessary, the contract must require:
1126 (n) Transparency.—Managed care plans shall comply with ss.
1127 627.6385(3) and 641.54(7).
1128 Section 14. Paragraph (d) of subsection (3) of section
1129 110.123, Florida Statutes, is amended to read:
1130 110.123 State group insurance program.—
1131 (3) STATE GROUP INSURANCE PROGRAM.—
1132 (d)1. Notwithstanding the provisions of chapter 287 and the
1133 authority of the department, for the purpose of protecting the
1134 health of, and providing medical services to, state employees
1135 participating in the state group insurance program, the
1136 department may contract to retain the services of professional
1137 administrators for the state group insurance program. The agency
1138 shall follow good purchasing practices of state procurement to
1139 the extent practicable under the circumstances.
1140 2. Each vendor in a major procurement, and any other vendor
1141 if the department deems it necessary to protect the state’s
1142 financial interests, shall, at the time of executing any
1143 contract with the department, post an appropriate bond with the
1144 department in an amount determined by the department to be
1145 adequate to protect the state’s interests but not higher than
1146 the full amount estimated to be paid annually to the vendor
1147 under the contract.
1148 3. Each major contract entered into by the department
1149 pursuant to this section shall contain a provision for payment
1150 of liquidated damages to the department for material
1151 noncompliance by a vendor with a contract provision. The
1152 department may require a liquidated damages provision in any
1153 contract if the department deems it necessary to protect the
1154 state’s financial interests.
1155 4. Section The provisions of s. 120.57(3) applies apply to
1156 the department’s contracting process, except:
1157 a. A formal written protest of any decision, intended
1158 decision, or other action subject to protest shall be filed
1159 within 72 hours after receipt of notice of the decision,
1160 intended decision, or other action.
1161 b. As an alternative to any provision of s. 120.57(3), the
1162 department may proceed with the bid selection or contract award
1163 process if the director of the department sets forth, in
1164 writing, particular facts and circumstances which demonstrate
1165 the necessity of continuing the procurement process or the
1166 contract award process in order to avoid a substantial
1167 disruption to the provision of any scheduled insurance services.
1168 5. The department shall make arrangements as necessary to
1169 provide claims data of the state group health insurance plan to
1170 the contracted vendor selected by the Agency for Health Care
1171 Administration pursuant to s. 408.05(3)(c).
1172 6. Each contracted vendor for the state group health
1173 insurance plan shall provide claims data to the fullest extent
1174 possible to the vendor selected by the Agency for Health Care
1175 Administration pursuant to s. 408.05(3)(c).
1176 Section 15. Effective January 1, 2017, section 212.099,
1177 Florida Statutes, is created to read:
1178 212.099 Health information and transparency tax credit.—
1179 (1) As used in this section, the term:
1180 (a) “Eligible employee” means an employee who is employed
1181 in this state by an eligible employer and is covered under the
1182 eligible employer’s health plan covered by the Employee
1183 Retirement Income Security Act of 1974.
1184 (b) “Eligible employer” means an employer that provides a
1185 health plan covered by the Employee Retirement Income Security
1186 Act of 1974 to eligible employees and provides qualifying health
1187 care claims information submissions on a quarterly basis.
1188 (c) “Qualifying health care claims information submission”
1189 means the submission of health care claims information on
1190 eligible employees to the contract vendor selected by the Agency
1191 for Health Care Administration pursuant to s. 408.05(3)(c).
1192 (2) A credit against the tax imposed by this chapter is
1193 authorized for qualifying health care claims information
1194 submissions made by an eligible employer. The credit is equal to
1195 the number of eligible employees included on each qualifying
1196 health care claims information submission multiplied by $50. The
1197 total credit that may be claimed by an eligible employer under
1198 this section is $500,000 annually.
1199 (3) If the credit under this section is greater than can be
1200 taken on a single tax return, excess amounts may be taken as
1201 credits on any return submitted within 12 months after the
1202 submission of the qualifying health care claims information.
1203 (4) A corporation may take the credit under this section
1204 against its corporate income tax liability, as provided in s.
1205 220.197; however, a corporation that uses its credit against the
1206 tax imposed by chapter 220 may not receive the credit provided
1207 in this section. A credit may be taken against only one tax.
1208 (5) Any person who fraudulently claims this credit is
1209 liable for repayment of the credit plus a mandatory penalty of
1210 100 percent of the credit and commits a misdemeanor of the
1211 second degree, punishable as provided in s. 775.082 or s.
1213 Section 16. Effective January 1, 2017, section 220.197,
1214 Florida Statutes, is created to read:
1215 220.197 Health information and transparency tax credit.—
1216 (1) As used in this section, the term:
1217 (a) “Eligible employee” means an employee who is employed
1218 in this state by an eligible employer and is covered under the
1219 eligible employer’s health plan covered by the Employee
1220 Retirement Income Security Act of 1974.
1221 (b) “Eligible employer” means an employer that provides a
1222 health plan covered by the Employee Retirement Income Security
1223 Act of 1974 to eligible employees and provides qualifying health
1224 care claims information submissions on a quarterly basis.
1225 (c) “Qualifying health care claims information submission”
1226 means the submission of health care claims information on
1227 eligible employees to the contract vendor selected by the Agency
1228 for Health Care Administration pursuant to s. 408.05(3)(c).
1229 (2) A credit against the tax imposed by this chapter is
1230 authorized for quarterly qualifying health care claims
1231 information submissions made by an eligible employer. The credit
1232 is equal to the number of eligible employees included on each
1233 qualifying health care claims information submission multiplied
1234 by $50. The credit must be claimed on the next annual return
1235 filed by the corporation under this chapter. The total credit
1236 that may be claimed by a corporation under this section is
1237 $500,000 annually.
1238 (3) If the credit under this section is greater than can be
1239 taken on a single tax return, excess amounts may be carried
1240 forward for a period not to exceed 5 years.
1241 (4) The credit provided for in this section may be taken on
1242 a consolidated return; however, the total credit taken by the
1243 affiliated group is subject to the limitation established under
1244 subsection (2).
1245 (5) A corporation may take the credit under this section
1246 against its sales tax liability, as provided in s. 212.099;
1247 however, a corporation that uses its credit against the tax
1248 imposed by chapter 212 may not receive the credit provided in
1249 this section. A credit may be taken against only one tax.
1250 (6) Any person who fraudulently claims this credit is
1251 liable for repayment of the credit plus a mandatory penalty of
1252 100 percent of the credit and commits a misdemeanor of the
1253 second degree, punishable as provided in s. 775.082 or s.
1255 Section 17. Subsection (3) of section 20.42, Florida
1256 Statutes, is amended to read:
1257 20.42 Agency for Health Care Administration.—
1258 (3) The department shall be the chief health policy and
1259 planning entity for the state. The department is responsible for
1260 health facility licensure, inspection, and regulatory
1261 enforcement; investigation of consumer complaints related to
1262 health care facilities and managed care plans; the
1263 implementation of the certificate of need program; the operation
1264 of the Florida Center for Health Information and Transparency
1265 Policy Analysis; the administration of the Medicaid program; the
1266 administration of the contracts with the Florida Healthy Kids
1267 Corporation; the certification of health maintenance
1268 organizations and prepaid health clinics as set forth in part
1269 III of chapter 641; and any other duties prescribed by statute
1270 or agreement.
1271 Section 18. Paragraph (c) of subsection (4) of section
1272 381.026, Florida Statutes, is amended to read:
1273 381.026 Florida Patient’s Bill of Rights and
1275 (4) RIGHTS OF PATIENTS.—Each health care facility or
1276 provider shall observe the following standards:
1277 (c) Financial information and disclosure.—
1278 1. A patient has the right to be given, upon request, by
1279 the responsible provider, his or her designee, or a
1280 representative of the health care facility full information and
1281 necessary counseling on the availability of known financial
1282 resources for the patient’s health care.
1283 2. A health care provider or a health care facility shall,
1284 upon request, disclose to each patient who is eligible for
1285 Medicare, before treatment, whether the health care provider or
1286 the health care facility in which the patient is receiving
1287 medical services accepts assignment under Medicare reimbursement
1288 as payment in full for medical services and treatment rendered
1289 in the health care provider’s office or health care facility.
1290 3. A primary care provider may publish a schedule of
1291 charges for the medical services that the provider offers to
1292 patients. The schedule must include the prices charged to an
1293 uninsured person paying for such services by cash, check, credit
1294 card, or debit card. The schedule must be posted in a
1295 conspicuous place in the reception area of the provider’s office
1296 and must include, but is not limited to, the 50 services most
1297 frequently provided by the primary care provider. The schedule
1298 may group services by three price levels, listing services in
1299 each price level. The posting must be at least 15 square feet in
1300 size. A primary care provider who publishes and maintains a
1301 schedule of charges for medical services is exempt from the
1302 license fee requirements for a single period of renewal of a
1303 professional license under chapter 456 for that licensure term
1304 and is exempt from the continuing education requirements of
1305 chapter 456 and the rules implementing those requirements for a
1306 single 2-year period.
1307 4. If a primary care provider publishes a schedule of
1308 charges pursuant to subparagraph 3., he or she must continually
1309 post it at all times for the duration of active licensure in
1310 this state when primary care services are provided to patients.
1311 If a primary care provider fails to post the schedule of charges
1312 in accordance with this subparagraph, the provider shall be
1313 required to pay any license fee and comply with any continuing
1314 education requirements for which an exemption was received.
1315 5. A health care provider or a health care facility shall,
1316 upon request, furnish a person, before the provision of medical
1317 services, a reasonable estimate of charges for such services.
1318 The health care provider or the health care facility shall
1319 provide an uninsured person, before the provision of a planned
1320 nonemergency medical service, a reasonable estimate of charges
1321 for such service and information regarding the provider’s or
1322 facility’s discount or charity policies for which the uninsured
1323 person may be eligible. Such estimates by a primary care
1324 provider must be consistent with the schedule posted under
1325 subparagraph 3. Estimates shall, to the extent possible, be
1326 written in language comprehensible to an ordinary layperson.
1327 Such reasonable estimate does not preclude the health care
1328 provider or health care facility from exceeding the estimate or
1329 making additional charges based on changes in the patient’s
1330 condition or treatment needs.
1331 6. Each licensed facility, except a facility operating
1332 exclusively as a state mental health treatment facility or as a
1333 mobile surgical facility, not operated by the state shall make
1334 available to the public on its Internet website or by other
1335 electronic means a description of and a hyperlink link to the
1336 health information performance outcome and financial data that
1337 is disseminated published by the agency pursuant to s. 408.05(3)
1338 s. 408.05(3)(k). The facility shall place a notice in the
1339 reception area that such information is available electronically
1340 and the website address. The licensed facility may indicate that
1341 the pricing information is based on a compilation of charges for
1342 the average patient and that each patient’s statement or bill
1343 may vary from the average depending upon the severity of illness
1344 and individual resources consumed. The licensed facility may
1345 also indicate that the price of service is negotiable for
1346 eligible patients based upon the patient’s ability to pay.
1347 7. A patient has the right to receive a copy of an itemized
1348 statement or bill upon request. A patient has a right to be
1349 given an explanation of charges upon request.
1350 Section 19. Paragraph (e) of subsection (2) of section
1351 395.602, Florida Statutes, is amended to read:
1352 395.602 Rural hospitals.—
1353 (2) DEFINITIONS.—As used in this part, the term:
1354 (e) “Rural hospital” means an acute care hospital licensed
1355 under this chapter, having 100 or fewer licensed beds and an
1356 emergency room, which is:
1357 1. The sole provider within a county with a population
1358 density of up to 100 persons per square mile;
1359 2. An acute care hospital, in a county with a population
1360 density of up to 100 persons per square mile, which is at least
1361 30 minutes of travel time, on normally traveled roads under
1362 normal traffic conditions, from any other acute care hospital
1363 within the same county;
1364 3. A hospital supported by a tax district or subdistrict
1365 whose boundaries encompass a population of up to 100 persons per
1366 square mile;
1367 4. A hospital with a service area that has a population of
1368 up to 100 persons per square mile. As used in this subparagraph,
1369 the term “service area” means the fewest number of zip codes
1370 that account for 75 percent of the hospital’s discharges for the
1371 most recent 5-year period, based on information available from
1372 the hospital inpatient discharge database in the Florida Center
1373 for Health Information and Transparency Policy Analysis at the
1374 agency; or
1375 5. A hospital designated as a critical access hospital, as
1376 defined in s. 408.07.
1378 Population densities used in this paragraph must be based upon
1379 the most recently completed United States census. A hospital
1380 that received funds under s. 409.9116 for a quarter beginning no
1381 later than July 1, 2002, is deemed to have been and shall
1382 continue to be a rural hospital from that date through June 30,
1383 2021, if the hospital continues to have up to 100 licensed beds
1384 and an emergency room. An acute care hospital that has not
1385 previously been designated as a rural hospital and that meets
1386 the criteria of this paragraph shall be granted such designation
1387 upon application, including supporting documentation, to the
1388 agency. A hospital that was licensed as a rural hospital during
1389 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
1390 rural hospital from the date of designation through June 30,
1391 2021, if the hospital continues to have up to 100 licensed beds
1392 and an emergency room.
1393 Section 20. Section 395.6025, Florida Statutes, is amended
1394 to read:
1395 395.6025 Rural hospital replacement facilities.
1396 Notwithstanding the provisions of s. 408.036, a hospital defined
1397 as a statutory rural hospital in accordance with s. 395.602, or
1398 a not-for-profit operator of rural hospitals, is not required to
1399 obtain a certificate of need for the construction of a new
1400 hospital located in a county with a population of at least
1401 15,000 but no more than 18,000 and a density of fewer less than
1402 30 persons per square mile, or a replacement facility, provided
1403 that the replacement, or new, facility is located within 10
1404 miles of the site of the currently licensed rural hospital and
1405 within the current primary service area. As used in this
1406 section, the term “service area” means the fewest number of zip
1407 codes that account for 75 percent of the hospital’s discharges
1408 for the most recent 5-year period, based on information
1409 available from the hospital inpatient discharge database in the
1410 Florida Center for Health Information and Transparency Policy
1411 Analysis at the Agency for Health Care Administration.
1412 Section 21. Subsection (43) of section 408.07, Florida
1413 Statutes, is amended to read:
1414 408.07 Definitions.—As used in this chapter, with the
1415 exception of ss. 408.031-408.045, the term:
1416 (43) “Rural hospital” means an acute care hospital licensed
1417 under chapter 395, having 100 or fewer licensed beds and an
1418 emergency room, and which is:
1419 (a) The sole provider within a county with a population
1420 density of no greater than 100 persons per square mile;
1421 (b) An acute care hospital, in a county with a population
1422 density of no greater than 100 persons per square mile, which is
1423 at least 30 minutes of travel time, on normally traveled roads
1424 under normal traffic conditions, from another acute care
1425 hospital within the same county;
1426 (c) A hospital supported by a tax district or subdistrict
1427 whose boundaries encompass a population of 100 persons or fewer
1428 per square mile;
1429 (d) A hospital with a service area that has a population of
1430 100 persons or fewer per square mile. As used in this paragraph,
1431 the term “service area” means the fewest number of zip codes
1432 that account for 75 percent of the hospital’s discharges for the
1433 most recent 5-year period, based on information available from
1434 the hospital inpatient discharge database in the Florida Center
1435 for Health Information and Transparency Policy Analysis at the
1436 Agency for Health Care Administration; or
1437 (e) A critical access hospital.
1439 Population densities used in this subsection must be based upon
1440 the most recently completed United States census. A hospital
1441 that received funds under s. 409.9116 for a quarter beginning no
1442 later than July 1, 2002, is deemed to have been and shall
1443 continue to be a rural hospital from that date through June 30,
1444 2015, if the hospital continues to have 100 or fewer licensed
1445 beds and an emergency room. An acute care hospital that has not
1446 previously been designated as a rural hospital and that meets
1447 the criteria of this subsection shall be granted such
1448 designation upon application, including supporting
1449 documentation, to the Agency for Health Care Administration.
1450 Section 22. Paragraph (a) of subsection (4) of section
1451 408.18, Florida Statutes, is amended to read:
1452 408.18 Health Care Community Antitrust Guidance Act;
1453 antitrust no-action letter; market-information collection and
1455 (4)(a) Members of the health care community who seek
1456 antitrust guidance may request a review of their proposed
1457 business activity by the Attorney General’s office. In
1458 conducting its review, the Attorney General’s office may seek
1459 whatever documentation, data, or other material it deems
1460 necessary from the Agency for Health Care Administration, the
1461 Florida Center for Health Information and Transparency Policy
1462 Analysis, and the Office of Insurance Regulation of the
1463 Financial Services Commission.
1464 Section 23. Section 465.0244, Florida Statutes, is amended
1465 to read:
1466 465.0244 Information disclosure.—Every pharmacy shall make
1467 available on its Internet website a hyperlink link to the health
1468 information performance outcome and financial data that is
1469 disseminated published by the Agency for Health Care
1470 Administration pursuant to s. 408.05(3) s. 408.05(3)(k) and
1471 shall place in the area where customers receive filled
1472 prescriptions notice that such information is available
1473 electronically and the address of its Internet website.
1474 Section 24. Except as otherwise expressly provided in this
1475 act, this act shall take effect July 1, 2016.