Florida Senate - 2016 CS for SB 1496
By the Committee on Appropriations; and Senators Bradley and
Gaetz
576-04202-16 20161496c1
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; amending s.
30 395.107, F.S.; providing a definition; making
31 technical changes; creating s. 395.3012, F.S.;
32 authorizing the Agency for Health Care Administration
33 to impose penalties based on certain findings of an
34 investigation as determined by the consumer advocate;
35 amending ss. 400.487 and 400.934, F.S.; requiring home
36 health agencies and home medical equipment providers
37 to provide upon request certain written estimates of
38 charges within a certain timeframe; amending s.
39 408.05, F.S.; revising requirements for the collection
40 and use of health-related data by the agency;
41 requiring the agency to contract with a vendor to
42 provide an Internet-based platform with certain
43 attributes; requiring potential vendors to have
44 certain qualifications; prohibiting the agency from
45 establishing a certain database under certain
46 circumstances; amending s. 408.061, F.S.; revising
47 requirements for the submission of health care data to
48 the agency; requiring submitted information considered
49 a trade secret to be clearly designated; amending s.
50 456.0575, F.S.; requiring a health care practitioner
51 to provide a patient upon his or her request a
52 written, good faith estimate of anticipated charges
53 within a certain timeframe; setting a maximum amount
54 for total fines assessed in certain disciplinary
55 actions; amending s. 456.072, F.S.; providing that the
56 failure to comply with fair billing practices by a
57 health care practitioner is grounds for disciplinary
58 action; amending s. 627.0613, F.S.; providing that the
59 consumer advocate must represent the general public
60 before other state agencies; authorizing the consumer
61 advocate to report findings relating to certain
62 investigations to the agency and the Department of
63 Health; authorizing the consumer advocate to have
64 access to files, records, and data of the agency and
65 the department necessary for certain investigations;
66 authorizing the consumer advocate to maintain a
67 process to receive and investigate complaints from
68 patients relating to compliance with certain billing
69 and notice requirements by licensed health care
70 facilities and practitioners; defining a term;
71 authorizing the consumer advocate to provide mediation
72 between providers and consumers relating to certain
73 matters; creating s. 627.6385, F.S.; requiring a
74 health insurer to make available on its website
75 certain methods that a policyholder can use to make
76 estimates of certain costs and charges; providing that
77 an estimate does not preclude an actual cost from
78 exceeding the estimate; requiring a health insurer to
79 make available on its website a hyperlink to certain
80 health information; requiring a health insurer to
81 include certain notice; requiring a health insurer
82 that participates in the state group health insurance
83 plan or Medicaid managed care to provide all claims
84 data to a contracted vendor selected by the agency;
85 excluding from the contributed claims data certain
86 types of coverage; amending s. 641.54, F.S.; revising
87 a requirement that a health maintenance organization
88 make certain information available to its subscribers;
89 requiring a health maintenance organization that
90 participates in the state group health insurance plan
91 or Medicaid managed care to provide all claims data to
92 a contracted vendor selected by the agency; excluding
93 from the contributed claims data certain types of
94 coverage; amending s. 409.967, F.S.; requiring managed
95 care plans to provide all claims data to a contracted
96 vendor selected by the agency; amending s. 110.123,
97 F.S.; requiring the Department of Management Services
98 to provide certain data to the contracted vendor for
99 the price transparency database established by the
100 agency; requiring a contracted vendor for the state
101 group health insurance plan to provide claims data to
102 the vendor selected by the agency; amending ss. 20.42,
103 381.026, 395.602, 395.6025, 408.07, 408.18, and
104 465.0244, F.S.; conforming provisions to changes made
105 by the act; providing legislative intent; providing an
106 effective date.
107
108 Be It Enacted by the Legislature of the State of Florida:
109
110 Section 1. Section 395.301, Florida Statutes, is amended to
111 read:
112 395.301 Price transparency; itemized patient statement or
113 bill; form and content prescribed by the agency; patient
114 admission status notification.—
115 (1) A facility licensed under this chapter shall provide
116 timely and accurate financial information and quality of service
117 measures to prospective and actual patients of the facility, or
118 to patients’ survivors or legal guardians, as appropriate. Such
119 information shall be provided in accordance with this section
120 and rules adopted by the agency pursuant to this chapter and s.
121 408.05. Licensed facilities operating exclusively as state
122 facilities are exempt from this subsection.
123 (a) Each licensed facility shall make available to the
124 public on its website information on payments made to that
125 facility for defined bundles of services and procedures. The
126 payment data must be presented and searchable in accordance
127 with, and through a hyperlink to, the system established by the
128 agency and its vendor using the descriptive service bundles
129 developed under s. 408.05(3)(c). At a minimum, the facility
130 shall provide the estimated average payment received from all
131 payors, excluding Medicaid and Medicare, for the descriptive
132 service bundles available at that facility and the estimated
133 payment range for such bundles. Using plain language,
134 comprehensible to an ordinary layperson, the facility must
135 disclose that the information on average payments and the
136 payment ranges is an estimate of costs that may be incurred by
137 the patient or prospective patient and that actual costs will be
138 based on the services actually provided to the patient. The
139 facility shall also assist the consumer in accessing his or her
140 health insurer’s or health maintenance organization’s website
141 for information on estimated copayments, deductibles, and other
142 cost-sharing responsibilities. The facility’s website must:
143 1. Identify and post the names and hyperlinks for direct
144 access to the websites of all health insurers and health
145 maintenance organizations for which the facility is a network
146 provider or preferred provider.
147 2. Provide information to uninsured patients and insured
148 patients whose health insurer or health maintenance organization
149 does not include the facility as a network provider or preferred
150 provider on the facility’s financial assistance policy,
151 including the application process, payment plans, and discounts,
152 and the facility’s charity care policy and collection
153 procedures.
154 3. If applicable, notify patients and prospective patients
155 that services may be provided in the health care facility by the
156 facility as well as by other health care providers who may
157 separately bill the patient and that such health care providers
158 may or may not participate with the same health insurers or
159 health maintenance organizations as the facility does.
160 4. Inform patients and prospective patients that they may
161 request from the facility and other health care providers a more
162 personalized estimate of charges and other information, and
163 inform patients that they should contact each health care
164 practitioner who will provide services in the hospital to
165 determine with which health insurers and health maintenance
166 organizations he or she participates as a network provider or
167 preferred provider.
168 5. Provide the names, mailing addresses, and telephone
169 numbers of the health care practitioners and medical practice
170 groups with which it contracts to provide services in the
171 facility and instructions on how to contact the practitioners
172 and groups to determine the health insurers and health
173 maintenance organizations with which they participate as network
174 providers or preferred providers.
175 (b)1. Upon request, and before providing any nonemergency
176 medical services, each licensed facility shall provide a
177 written, good faith estimate of reasonably anticipated charges
178 by the facility for the treatment of the patient’s or
179 prospective patient’s specific condition. The facility must
180 provide the estimate in writing to the patient or prospective
181 patient within 7 business days after the receipt of the request
182 and is not required to adjust the estimate for any potential
183 insurance coverage. The estimate may be based on the descriptive
184 service bundles developed by the agency under s. 408.05(3)(c)
185 unless the patient or prospective patient requests a more
186 personalized and specific estimate that accounts for the
187 specific condition and characteristics of the patient or
188 prospective patient. The facility shall inform the patient or
189 prospective patient that he or she may contact his or her health
190 insurer or health maintenance organization for additional
191 information concerning cost-sharing responsibilities.
192 2. In the estimate, the facility shall provide to the
193 patient or prospective patient information on the facility’s
194 financial assistance policy, including the application process,
195 payment plans, and discounts and the facility’s charity care
196 policy and collection procedures.
197 3. The estimate shall clearly identify any facility fees
198 and, if applicable, include a statement notifying the patient or
199 prospective patient that a facility fee is included in the
200 estimate, the purpose of the fee, and that the patient may pay
201 less for the procedure or service at another facility or in
202 another health care setting.
203 4. Upon request, the facility shall notify the patient or
204 prospective patient of any revision to the estimate.
205 5. In the estimate, the facility must notify the patient or
206 prospective patient that services may be provided in the health
207 care facility by the facility as well as by other health care
208 providers that may separately bill the patient, if applicable.
209 6. The facility shall take action to educate the public
210 that such estimates are available upon request.
211 7. Failure to timely provide the estimate pursuant to this
212 paragraph shall result in a daily fine of $1,000 until the
213 estimate is provided to the patient or prospective patient. The
214 total fine may not exceed $10,000.
215
216 The provision of an estimate does not preclude the actual
217 charges from exceeding the estimate.
218 (c) Each facility shall make available on its website a
219 hyperlink to the health-related data, including quality measures
220 and statistics that are disseminated by the agency pursuant to
221 s. 408.05. The facility shall also take action to notify the
222 public that such information is electronically available and
223 provide a hyperlink to the agency’s website.
224 (d)1. Upon request, and after the patient’s discharge or
225 release from a facility, the facility must provide A licensed
226 facility not operated by the state shall notify each patient
227 during admission and at discharge of his or her right to receive
228 an itemized bill upon request. Within 7 days following the
229 patient’s discharge or release from a licensed facility not
230 operated by the state, the licensed facility providing the
231 service shall, upon request, submit to the patient, or to the
232 patient’s survivor or legal guardian, as may be appropriate, an
233 itemized statement or a bill detailing in plain language,
234 comprehensible to an ordinary layperson, the specific nature of
235 charges or expenses incurred by the patient., which in The
236 initial statement or bill billing shall be provided within 7
237 days after the patient’s discharge or release or after a request
238 for such statement or bill, whichever is later. The initial
239 statement or bill must contain a statement of specific services
240 received and expenses incurred by date and provider for such
241 items of service, enumerating in detail as prescribed by the
242 agency the constituent components of the services received
243 within each department of the licensed facility and including
244 unit price data on rates charged by the licensed facility, as
245 prescribed by the agency. The statement or bill must also
246 clearly identify any facility fee and explain the purpose of the
247 fee. The statement or bill must identify each item as paid,
248 pending payment by a third party, or pending payment by the
249 patient, and must include the amount due, if applicable. If an
250 amount is due from the patient, a due date must be included. The
251 initial statement or bill must direct the patient or the
252 patient’s survivor or legal guardian, as appropriate, to contact
253 the patient’s insurer or health maintenance organization
254 regarding the patient’s cost-sharing responsibilities.
255 2. Any subsequent statement or bill provided to a patient
256 or to the patient’s survivor or legal guardian, as appropriate,
257 relating to the episode of care must include all of the
258 information required by subparagraph 1., with any revisions
259 clearly delineated.
260 3.(2)(a) Each such statement or bill provided submitted
261 pursuant to this subsection section:
262 a.1. Must May not include notice charges of hospital-based
263 physicians and other health care providers who bill if billed
264 separately.
265 b.2. May not include any generalized category of expenses
266 such as “other” or “miscellaneous” or similar categories.
267 c.3. Must Shall list drugs by brand or generic name and not
268 refer to drug code numbers when referring to drugs of any sort.
269 d.4. Must Shall specifically identify physical,
270 occupational, or speech therapy treatment by as to the date,
271 type, and length of treatment when such therapy treatment is a
272 part of the statement or bill.
273 (b) Any person receiving a statement pursuant to this
274 section shall be fully and accurately informed as to each charge
275 and service provided by the institution preparing the statement.
276 (2)(3) On each itemized statement submitted pursuant to
277 subsection (1) there shall appear the words “A FOR-PROFIT (or
278 NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
279 CENTER) LICENSED BY THE STATE OF FLORIDA” or substantially
280 similar words sufficient to identify clearly and plainly the
281 ownership status of the licensed facility. Each itemized
282 statement or bill must prominently display the telephone phone
283 number of the medical facility’s patient liaison who is
284 responsible for expediting the resolution of any billing dispute
285 between the patient, or the patient’s survivor or legal guardian
286 his or her representative, and the billing department.
287 (4) An itemized bill shall be provided once to the
288 patient’s physician at the physician’s request, at no charge.
289 (5) In any billing for services subsequent to the initial
290 billing for such services, the patient, or the patient’s
291 survivor or legal guardian, may elect, at his or her option, to
292 receive a copy of the detailed statement of specific services
293 received and expenses incurred for each such item of service as
294 provided in subsection (1).
295 (6) No physician, dentist, podiatric physician, or licensed
296 facility may add to the price charged by any third party except
297 for a service or handling charge representing a cost actually
298 incurred as an item of expense; however, the physician, dentist,
299 podiatric physician, or licensed facility is entitled to fair
300 compensation for all professional services rendered. The amount
301 of the service or handling charge, if any, shall be set forth
302 clearly in the bill to the patient.
303 (7) Each licensed facility not operated by the state shall
304 provide, prior to provision of any nonemergency medical
305 services, a written good faith estimate of reasonably
306 anticipated charges for the facility to treat the patient’s
307 condition upon written request of a prospective patient. The
308 estimate shall be provided to the prospective patient within 7
309 business days after the receipt of the request. The estimate may
310 be the average charges for that diagnosis related group or the
311 average charges for that procedure. Upon request, the facility
312 shall notify the patient of any revision to the good faith
313 estimate. Such estimate shall not preclude the actual charges
314 from exceeding the estimate. The facility shall place a notice
315 in the reception area that such information is available.
316 Failure to provide the estimate within the provisions
317 established pursuant to this section shall result in a fine of
318 $500 for each instance of the facility’s failure to provide the
319 requested information.
320 (8) Each licensed facility that is not operated by the
321 state shall provide any uninsured person seeking planned
322 nonemergency elective admission a written good faith estimate of
323 reasonably anticipated charges for the facility to treat such
324 person. The estimate must be provided to the uninsured person
325 within 7 business days after the person notifies the facility
326 and the facility confirms that the person is uninsured. The
327 estimate may be the average charges for that diagnosis-related
328 group or the average charges for that procedure. Upon request,
329 the facility shall notify the person of any revision to the good
330 faith estimate. Such estimate does not preclude the actual
331 charges from exceeding the estimate. The facility shall also
332 provide to the uninsured person a copy of any facility discount
333 and charity care discount policies for which the uninsured
334 person may be eligible. The facility shall place a notice in the
335 reception area where such information is available. Failure to
336 provide the estimate as required by this subsection shall result
337 in a fine of $500 for each instance of the facility’s failure to
338 provide the requested information.
339 (3)(9) If a licensed facility places a patient on
340 observation status rather than inpatient status, observation
341 services shall be documented in the patient’s discharge papers.
342 The patient or the patient’s survivor or legal guardian proxy
343 shall be notified of observation services through discharge
344 papers, which may also include brochures, signage, or other
345 forms of communication for this purpose.
346 (4)(10) A licensed facility shall make available to a
347 patient all records necessary for verification of the accuracy
348 of the patient’s statement or bill within 10 30 business days
349 after the request for such records. The records verification
350 information must be made available in the facility’s offices and
351 through electronic means that comply with the Health Insurance
352 Portability and Accountability Act of 1996, 42 U.S.C. s. 1320d,
353 as amended. Such records must shall be available to the patient
354 before prior to and after payment of the statement or bill or
355 claim. The facility may not charge the patient for making such
356 verification records available; however, the facility may charge
357 its usual fee for providing copies of records as specified in s.
358 395.3025.
359 (5)(11) Each facility shall establish a method for
360 reviewing and responding to questions from patients concerning
361 the patient’s itemized statement or bill. Such response shall be
362 provided within 7 business 30 days after the date a question is
363 received. If the patient is not satisfied with the response, the
364 facility must provide the patient with the contact information
365 address of the consumer advocate as provided in s. 627.0613
366 agency to which the issue may be sent for review.
367 (12) Each licensed facility shall make available on its
368 Internet website a link to the performance outcome and financial
369 data that is published by the Agency for Health Care
370 Administration pursuant to s. 408.05(3)(k). The facility shall
371 place a notice in the reception area that the information is
372 available electronically and the facility’s Internet website
373 address.
374 Section 2. Section 395.107, Florida Statutes, is amended to
375 read:
376 395.107 Facilities Urgent care centers; publishing and
377 posting schedule of charges; penalties.—
378 (1) For purposes of this section, the term “facility”
379 means:
380 (a) An urgent care center as defined in s. 395.002; or
381 (b) A diagnostic-imaging center operated by a hospital
382 licensed under this chapter which is not located on the
383 hospital’s premises.
384 (2) A facility An urgent care center must publish and post
385 a schedule of charges for the medical services offered to
386 patients.
387 (3)(2) The schedule of charges must describe the medical
388 services in language comprehensible to a layperson. The schedule
389 must include the prices charged to an uninsured person paying
390 for such services by cash, check, credit card, or debit card.
391 The schedule must be posted in a conspicuous place in the
392 reception area and must include, but is not limited to, the 50
393 services most frequently provided. The schedule may group
394 services by three price levels, listing services in each price
395 level. The posting may be a sign, which must be at least 15
396 square feet in size, or may be through an electronic messaging
397 board. If a facility an urgent care center is affiliated with a
398 facility licensed hospital under this chapter, the schedule must
399 include text that notifies the insured patients whether the
400 charges for medical services received at the center will be the
401 same as, or more than, charges for medical services received at
402 the affiliated hospital. The text notifying the patient of the
403 schedule of charges shall be in a font size equal to or greater
404 than the font size used for prices and must be in a contrasting
405 color. The text that notifies the insured patients whether the
406 charges for medical services received at the center will be the
407 same as, or more than, charges for medical services received at
408 the affiliated hospital shall be included in all media and
409 Internet advertisements for the center and in language
410 comprehensible to a layperson.
411 (4)(3) The posted text describing the medical services must
412 fill at least 12 square feet of the posting. A facility center
413 may use an electronic device or messaging board to post the
414 schedule of charges. Such a device must be at least 3 square
415 feet, and patients must be able to access the schedule during
416 all hours of operation of the facility urgent care center.
417 (5)(4) A facility An urgent care center that is operated
418 and used exclusively for employees and the dependents of
419 employees of the business that owns or contracts for the
420 facility urgent care center is exempt from this section.
421 (6)(5) The failure of a facility an urgent care center to
422 publish and post a schedule of charges as required by this
423 section shall result in a fine of not more than $1,000, per day,
424 until the schedule is published and posted.
425 Section 3. Section 395.3012, Florida Statutes, is created
426 to read:
427 395.3012 Penalties for unconscionable prices.—
428 (1) The agency may impose administrative fines based on the
429 findings of the consumer advocate’s investigation of billing
430 complaints pursuant to s. 627.0613(6).
431 (2) The administrative fines for noncompliance with s.
432 395.301 are the greater of $2,500 per violation or double the
433 amount of the original charges.
434 Section 4. Subsection (1) of section 400.487, Florida
435 Statutes, is amended to read:
436 400.487 Home health service agreements; physician’s,
437 physician assistant’s, and advanced registered nurse
438 practitioner’s treatment orders; patient assessment;
439 establishment and review of plan of care; provision of services;
440 orders not to resuscitate.—
441 (1)(a) Services provided by a home health agency must be
442 covered by an agreement between the home health agency and the
443 patient or the patient’s legal representative specifying the
444 home health services to be provided, the rates or charges for
445 services paid with private funds, and the sources of payment,
446 which may include Medicare, Medicaid, private insurance,
447 personal funds, or a combination thereof. A home health agency
448 providing skilled care must make an assessment of the patient’s
449 needs within 48 hours after the start of services.
450 (b) Every licensed home health agency shall provide upon
451 the request of a prospective patient or his or her legal
452 guardian a written, good faith estimate of reasonably
453 anticipated charges for the prospective patient for services
454 provided by the home health agency. The home health agency must
455 provide the estimate to the requestor within 7 business days
456 after receiving the request. The home health agency must inform
457 the prospective patient, or his or her legal guardian, that he
458 or she may contact the prospective patient’s health insurer or
459 health maintenance organization for additional information
460 concerning cost-sharing responsibilities. The home health agency
461 must also provide information disclosing the home health
462 agency’s payment plans, discounts, and other available
463 assistance and its collection procedures.
464 Section 5. Subsection (23) is added to section 400.934,
465 Florida Statutes, to read:
466 400.934 Minimum standards.—As a requirement of licensure,
467 home medical equipment providers shall:
468 (23) Provide upon the request of a prospective patient or
469 his or her legal guardian a written, good faith estimate of
470 reasonably anticipated charges for the prospective patient for
471 services provided by the home medical equipment providers. The
472 home medical equipment providers must provide the estimate to
473 the requestor within 7 business days after receiving the
474 request. The home medical equipment providers must inform the
475 prospective patient, or his or her legal guardian, that he or
476 she may contact the prospective patient’s health insurer or
477 health maintenance organization for additional information
478 concerning cost-sharing responsibilities. The home medical
479 equipment providers must also provide information disclosing the
480 home medical equipment providers’ payment plans, discounts, and
481 other available assistance and their collection procedures.
482 Section 6. Section 408.05, Florida Statutes, is amended to
483 read:
484 408.05 Florida Center for Health Information and
485 Transparency Policy Analysis.—
486 (1) ESTABLISHMENT.—The agency shall establish and maintain
487 a Florida Center for Health Information and Transparency to
488 collect, compile, coordinate, analyze, index, and disseminate
489 Policy Analysis. The center shall establish a comprehensive
490 health information system to provide for the collection,
491 compilation, coordination, analysis, indexing, dissemination,
492 and utilization of both purposefully collected and extant
493 health-related data and statistics. The center shall be staffed
494 as with public health experts, biostatisticians, information
495 system analysts, health policy experts, economists, and other
496 staff necessary to carry out its functions.
497 (2) HEALTH-RELATED DATA.—The comprehensive health
498 information system operated by the Florida Center for Health
499 Information and Transparency Policy Analysis shall identify the
500 best available data sets, compile new data when specifically
501 authorized, data sources and promote the use coordinate the
502 compilation of extant health-related data and statistics. The
503 center must maintain any data sets in existence before July 1,
504 2016, unless such data sets duplicate information that is
505 readily available from other credible sources, and may and
506 purposefully collect or compile data on:
507 (a) The extent and nature of illness and disability of the
508 state population, including life expectancy, the incidence of
509 various acute and chronic illnesses, and infant and maternal
510 morbidity and mortality.
511 (b) The impact of illness and disability of the state
512 population on the state economy and on other aspects of the
513 well-being of the people in this state.
514 (c) Environmental, social, and other health hazards.
515 (d) Health knowledge and practices of the people in this
516 state and determinants of health and nutritional practices and
517 status.
518 (a)(e) Health resources, including licensed physicians,
519 dentists, nurses, and other health care practitioners
520 professionals, by specialty and type of practice. Such data must
521 include information collected by the Department of Health
522 pursuant to ss. 458.3191 and 459.0081.
523 (b) Health service inventories, including and acute care,
524 long-term care, and other institutional care facilities facility
525 supplies and specific services provided by hospitals, nursing
526 homes, home health agencies, and other licensed health care
527 facilities.
528 (c)(f) Service utilization for licensed health care
529 facilities of health care by type of provider.
530 (d)(g) Health care costs and financing, including trends in
531 health care prices and costs, the sources of payment for health
532 care services, and federal, state, and local expenditures for
533 health care.
534 (h) Family formation, growth, and dissolution.
535 (e)(i) The extent of public and private health insurance
536 coverage in this state.
537 (f)(j) Specific quality-of-care initiatives involving The
538 quality of care provided by various health care providers when
539 extant data is not adequate to achieve the objectives of the
540 initiative.
541 (3) COMPREHENSIVE HEALTH INFORMATION TRANSPARENCY SYSTEM.
542 In order to disseminate and facilitate the availability of
543 produce comparable and uniform health information and statistics
544 for the development of policy recommendations, the agency shall
545 perform the following functions:
546 (a) Collect and compile information on and coordinate the
547 activities of state agencies involved in providing the design
548 and implementation of the comprehensive health information to
549 consumers system.
550 (b) Promote data sharing through dissemination of state
551 collected health data by making such data available,
552 transferable, and readily usable Undertake research,
553 development, and evaluation respecting the comprehensive health
554 information system.
555 (c) Contract with a vendor to provide a consumer-friendly,
556 Internet-based platform that allows a consumer to research the
557 cost of health care services and procedures and allows for price
558 comparison. The Internet-based platform must allow a consumer to
559 search by condition or service bundles that are comprehensible
560 to a layperson and may not require registration, a security
561 password, or user identification. The vendor shall also
562 establish and maintain a Florida-specific data set of health
563 care claims information available to the public and any
564 interested party. The agency shall actively oversee the vendor
565 to ensure compliance with state law. The agency shall select the
566 vendor through a competitive procurement process. By October 1,
567 2016, a responsive vendor must have:
568 1. A national database consisting of at least 15 billion
569 claim lines of administrative claims data from multiple payors
570 capable of being expanded by adding third-party payors,
571 including employers with health plans covered by the Employee
572 Retirement Income Security Act of 1974.
573 2. A well-developed methodology for analyzing claims data
574 within defined service bundles.
575 3. A bundling methodology that is available in the public
576 domain to allow for consistency and comparison of state and
577 national benchmarks with local regions and specific providers.
578 (c) Review the statistical activities of state agencies to
579 ensure that they are consistent with the comprehensive health
580 information system.
581 (d) Develop written agreements with local, state, and
582 federal agencies to facilitate for the sharing of data related
583 to health care health-care-related data or using the facilities
584 and services of such agencies. State agencies, local health
585 councils, and other agencies under state contract shall assist
586 the center in obtaining, compiling, and transferring health
587 care-related data maintained by state and local agencies.
588 Written agreements must specify the types, methods, and
589 periodicity of data exchanges and specify the types of data that
590 will be transferred to the center.
591 (e) Establish by rule:
592 1. The types of data collected, compiled, processed, used,
593 or shared.
594 2. Requirements for implementation of the consumer
595 friendly, Internet-based platform created by the contracted
596 vendor under paragraph (c).
597 3. Requirements for the submission of data by insurers
598 pursuant to s. 627.6385 and health maintenance organizations
599 pursuant to s. 641.54 to the contracted vendor under paragraph
600 (c).
601 4. Requirements governing the collection of data by the
602 contracted vendor under paragraph (c).
603 5. How information is to be published on the consumer
604 friendly, Internet-based platform created under paragraph (c)
605 for public use Decisions regarding center data sets should be
606 made based on consultation with the State Consumer Health
607 Information and Policy Advisory Council and other public and
608 private users regarding the types of data which should be
609 collected and their uses. The center shall establish
610 standardized means for collecting health information and
611 statistics under laws and rules administered by the agency.
612 (f) Consult with contracted vendors, the State Consumer
613 Health Information and Policy Advisory Council, and other public
614 and private users regarding the types of data that should be
615 collected and the use of such data.
616 (g) Monitor data collection procedures and test data
617 quality to facilitate the dissemination of data that is
618 accurate, valid, reliable, and complete.
619 (f) Establish minimum health-care-related data sets which
620 are necessary on a continuing basis to fulfill the collection
621 requirements of the center and which shall be used by state
622 agencies in collecting and compiling health-care-related data.
623 The agency shall periodically review ongoing health care data
624 collections of the Department of Health and other state agencies
625 to determine if the collections are being conducted in
626 accordance with the established minimum sets of data.
627 (g) Establish advisory standards to ensure the quality of
628 health statistical and epidemiological data collection,
629 processing, and analysis by local, state, and private
630 organizations.
631 (h) Prescribe standards for the publication of health-care
632 related data reported pursuant to this section which ensure the
633 reporting of accurate, valid, reliable, complete, and comparable
634 data. Such standards should include advisory warnings to users
635 of the data regarding the status and quality of any data
636 reported by or available from the center.
637 (h)(i) Develop Prescribe standards for the maintenance and
638 preservation of the center’s data. This should include methods
639 for archiving data, retrieval of archived data, and data editing
640 and verification.
641 (j) Ensure that strict quality control measures are
642 maintained for the dissemination of data through publications,
643 studies, or user requests.
644 (i)(k) Make Develop, in conjunction with the State Consumer
645 Health Information and Policy Advisory Council, and implement a
646 long-range plan for making available health care quality
647 measures and financial data that will allow consumers to compare
648 outcomes and other performance measures for health care
649 services. The health care quality measures and financial data
650 the agency must make available include, but are not limited to,
651 pharmaceuticals, physicians, health care facilities, and health
652 plans and managed care entities. The agency shall update the
653 plan and report on the status of its implementation annually.
654 The agency shall also make the plan and status report available
655 to the public on its Internet website. As part of the plan, the
656 agency shall identify the process and timeframes for
657 implementation, barriers to implementation, and recommendations
658 of changes in the law that may be enacted by the Legislature to
659 eliminate the barriers. As preliminary elements of the plan, the
660 agency shall:
661 1. Make available patient-safety indicators, inpatient
662 quality indicators, and performance outcome and patient charge
663 data collected from health care facilities pursuant to s.
664 408.061(1)(a) and (2). The terms “patient-safety indicators” and
665 “inpatient quality indicators” have the same meaning as that
666 ascribed by the Centers for Medicare and Medicaid Services, an
667 accrediting organization whose standards incorporate comparable
668 regulations required by this state, or a national entity that
669 establishes standards to measure the performance of health care
670 providers, or by other states. The agency shall determine which
671 conditions, procedures, health care quality measures, and
672 patient charge data to disclose based upon input from the
673 council. When determining which conditions and procedures are to
674 be disclosed, the council and the agency shall consider
675 variation in costs, variation in outcomes, and magnitude of
676 variations and other relevant information. When determining
677 which health care quality measures to disclose, the agency:
678 a. Shall consider such factors as volume of cases; average
679 patient charges; average length of stay; complication rates;
680 mortality rates; and infection rates, among others, which shall
681 be adjusted for case mix and severity, if applicable.
682 b. May consider such additional measures that are adopted
683 by the Centers for Medicare and Medicaid Studies, an accrediting
684 organization whose standards incorporate comparable regulations
685 required by this state, the National Quality Forum, the Joint
686 Commission on Accreditation of Healthcare Organizations, the
687 Agency for Healthcare Research and Quality, the Centers for
688 Disease Control and Prevention, or a similar national entity
689 that establishes standards to measure the performance of health
690 care providers, or by other states.
691
692 When determining which patient charge data to disclose, the
693 agency shall include such measures as the average of
694 undiscounted charges on frequently performed procedures and
695 preventive diagnostic procedures, the range of procedure charges
696 from highest to lowest, average net revenue per adjusted patient
697 day, average cost per adjusted patient day, and average cost per
698 admission, among others.
699 2. Make available performance measures, benefit design, and
700 premium cost data from health plans licensed pursuant to chapter
701 627 or chapter 641. The agency shall determine which health care
702 quality measures and member and subscriber cost data to
703 disclose, based upon input from the council. When determining
704 which data to disclose, the agency shall consider information
705 that may be required by either individual or group purchasers to
706 assess the value of the product, which may include membership
707 satisfaction, quality of care, current enrollment or membership,
708 coverage areas, accreditation status, premium costs, plan costs,
709 premium increases, range of benefits, copayments and
710 deductibles, accuracy and speed of claims payment, credentials
711 of physicians, number of providers, names of network providers,
712 and hospitals in the network. Health plans shall make available
713 to the agency such data or information that is not currently
714 reported to the agency or the office.
715 3. Determine the method and format for public disclosure of
716 data reported pursuant to this paragraph. The agency shall make
717 its determination based upon input from the State Consumer
718 Health Information and Policy Advisory Council. At a minimum,
719 the data shall be made available on the agency’s Internet
720 website in a manner that allows consumers to conduct an
721 interactive search that allows them to view and compare the
722 information for specific providers. The website must include
723 such additional information as is determined necessary to ensure
724 that the website enhances informed decisionmaking among
725 consumers and health care purchasers, which shall include, at a
726 minimum, appropriate guidance on how to use the data and an
727 explanation of why the data may vary from provider to provider.
728 4. Publish on its website undiscounted charges for no fewer
729 than 150 of the most commonly performed adult and pediatric
730 procedures, including outpatient, inpatient, diagnostic, and
731 preventative procedures.
732 (4) TECHNICAL ASSISTANCE.—
733 (a) The center shall provide technical assistance to
734 persons or organizations engaged in health planning activities
735 in the effective use of statistics collected and compiled by the
736 center. The center shall also provide the following additional
737 technical assistance services:
738 1. Establish procedures identifying the circumstances under
739 which, the places at which, the persons from whom, and the
740 methods by which a person may secure data from the center,
741 including procedures governing requests, the ordering of
742 requests, timeframes for handling requests, and other procedures
743 necessary to facilitate the use of the center’s data. To the
744 extent possible, the center should provide current data timely
745 in response to requests from public or private agencies.
746 2. Provide assistance to data sources and users in the
747 areas of database design, survey design, sampling procedures,
748 statistical interpretation, and data access to promote improved
749 health-care-related data sets.
750 3. Identify health care data gaps and provide technical
751 assistance to other public or private organizations for meeting
752 documented health care data needs.
753 4. Assist other organizations in developing statistical
754 abstracts of their data sets that could be used by the center.
755 5. Provide statistical support to state agencies with
756 regard to the use of databases maintained by the center.
757 6. To the extent possible, respond to multiple requests for
758 information not currently collected by the center or available
759 from other sources by initiating data collection.
760 7. Maintain detailed information on data maintained by
761 other local, state, federal, and private agencies in order to
762 advise those who use the center of potential sources of data
763 which are requested but which are not available from the center.
764 8. Respond to requests for data which are not available in
765 published form by initiating special computer runs on data sets
766 available to the center.
767 9. Monitor innovations in health information technology,
768 informatics, and the exchange of health information and maintain
769 a repository of technical resources to support the development
770 of a health information network.
771 (b) The agency shall administer, manage, and monitor grants
772 to not-for-profit organizations, regional health information
773 organizations, public health departments, or state agencies that
774 submit proposals for planning, implementation, or training
775 projects to advance the development of a health information
776 network. Any grant contract shall be evaluated to ensure the
777 effective outcome of the health information project.
778 (c) The agency shall initiate, oversee, manage, and
779 evaluate the integration of health care data from each state
780 agency that collects, stores, and reports on health care issues
781 and make that data available to any health care practitioner
782 through a state health information network.
783 (5) PUBLICATIONS; REPORTS; SPECIAL STUDIES.—The center
784 shall provide for the widespread dissemination of data which it
785 collects and analyzes. The center shall have the following
786 publication, reporting, and special study functions:
787 (a) The center shall publish and make available
788 periodically to agencies and individuals health statistics
789 publications of general interest, including health plan consumer
790 reports and health maintenance organization member satisfaction
791 surveys; publications providing health statistics on topical
792 health policy issues; publications that provide health status
793 profiles of the people in this state; and other topical health
794 statistics publications.
795 (j)(b) The center shall publish, Make available, and
796 disseminate, promptly and as widely as practicable, the results
797 of special health surveys, health care research, and health care
798 evaluations conducted or supported under this section. Any
799 publication by the center must include a statement of the
800 limitations on the quality, accuracy, and completeness of the
801 data.
802 (c) The center shall provide indexing, abstracting,
803 translation, publication, and other services leading to a more
804 effective and timely dissemination of health care statistics.
805 (d) The center shall be responsible for publishing and
806 disseminating an annual report on the center’s activities.
807 (e) The center shall be responsible, to the extent
808 resources are available, for conducting a variety of special
809 studies and surveys to expand the health care information and
810 statistics available for health policy analyses, particularly
811 for the review of public policy issues. The center shall develop
812 a process by which users of the center’s data are periodically
813 surveyed regarding critical data needs and the results of the
814 survey considered in determining which special surveys or
815 studies will be conducted. The center shall select problems in
816 health care for research, policy analyses, or special data
817 collections on the basis of their local, regional, or state
818 importance; the unique potential for definitive research on the
819 problem; and opportunities for application of the study
820 findings.
821 (4)(6) PROVIDER DATA REPORTING.—This section does not
822 confer on the agency the power to demand or require that a
823 health care provider or professional furnish information,
824 records of interviews, written reports, statements, notes,
825 memoranda, or data other than as expressly required by law. The
826 agency may not establish an all-payor claims database or a
827 comparable database without express legislative authority.
828 (5)(7) BUDGET; FEES.—
829 (a) The Legislature intends that funding for the Florida
830 Center for Health Information and Policy Analysis be
831 appropriated from the General Revenue Fund.
832 (b) The Florida Center for Health Information and
833 Transparency Policy Analysis may apply for and receive and
834 accept grants, gifts, and other payments, including property and
835 services, from any governmental or other public or private
836 entity or person and make arrangements as to the use of same,
837 including the undertaking of special studies and other projects
838 relating to health-care-related topics. Funds obtained pursuant
839 to this paragraph may not be used to offset annual
840 appropriations from the General Revenue Fund.
841 (b)(c) The center may charge such reasonable fees for
842 services as the agency prescribes by rule. The established fees
843 may not exceed the reasonable cost for such services. Fees
844 collected may not be used to offset annual appropriations from
845 the General Revenue Fund.
846 (6)(8) STATE CONSUMER HEALTH INFORMATION AND POLICY
847 ADVISORY COUNCIL.—
848 (a) There is established in the agency the State Consumer
849 Health Information and Policy Advisory Council to assist the
850 center in reviewing the comprehensive health information system,
851 including the identification, collection, standardization,
852 sharing, and coordination of health-related data, fraud and
853 abuse data, and professional and facility licensing data among
854 federal, state, local, and private entities and to recommend
855 improvements for purposes of public health, policy analysis, and
856 transparency of consumer health care information. The council
857 consists shall consist of the following members:
858 1. An employee of the Executive Office of the Governor, to
859 be appointed by the Governor.
860 2. An employee of the Office of Insurance Regulation, to be
861 appointed by the director of the office.
862 3. An employee of the Department of Education, to be
863 appointed by the Commissioner of Education.
864 4. Ten persons, to be appointed by the Secretary of Health
865 Care Administration, representing other state and local
866 agencies, state universities, business and health coalitions,
867 local health councils, professional health-care-related
868 associations, consumers, and purchasers.
869 (b) Each member of the council shall be appointed to serve
870 for a term of 2 years following the date of appointment, except
871 the term of appointment shall end 3 years following the date of
872 appointment for members appointed in 2003, 2004, and 2005. A
873 vacancy shall be filled by appointment for the remainder of the
874 term, and each appointing authority retains the right to
875 reappoint members whose terms of appointment have expired.
876 (c) The council may meet at the call of its chair, at the
877 request of the agency, or at the request of a majority of its
878 membership, but the council must meet at least quarterly.
879 (d) Members shall elect a chair and vice chair annually.
880 (e) A majority of the members constitutes a quorum, and the
881 affirmative vote of a majority of a quorum is necessary to take
882 action.
883 (f) The council shall maintain minutes of each meeting and
884 shall make such minutes available to any person.
885 (g) Members of the council shall serve without compensation
886 but shall be entitled to receive reimbursement for per diem and
887 travel expenses as provided in s. 112.061.
888 (h) The council’s duties and responsibilities include, but
889 are not limited to, the following:
890 1. To develop a mission statement, goals, and a plan of
891 action for the identification, collection, standardization,
892 sharing, and coordination of health-related data across federal,
893 state, and local government and private sector entities.
894 2. To develop a review process to ensure cooperative
895 planning among agencies that collect or maintain health-related
896 data.
897 3. To create ad hoc issue-oriented technical workgroups on
898 an as-needed basis to make recommendations to the council.
899 (7)(9) APPLICATION TO OTHER AGENCIES.—Nothing in This
900 section does not shall limit, restrict, affect, or control the
901 collection, analysis, release, or publication of data by any
902 state agency pursuant to its statutory authority, duties, or
903 responsibilities.
904 Section 7. Subsection (1) of section 408.061, Florida
905 Statutes, is amended to read:
906 408.061 Data collection; uniform systems of financial
907 reporting; information relating to physician charges;
908 confidential information; immunity.—
909 (1) The agency shall require the submission by health care
910 facilities, health care providers, and health insurers of data
911 necessary to carry out the agency’s duties and to facilitate
912 transparency in health care pricing data and quality measures.
913 Specifications for data to be collected under this section shall
914 be developed by the agency and applicable contract vendors, with
915 the assistance of technical advisory panels including
916 representatives of affected entities, consumers, purchasers, and
917 such other interested parties as may be determined by the
918 agency.
919 (a) Data submitted by health care facilities, including the
920 facilities as defined in chapter 395, shall include, but are not
921 limited to: case-mix data, patient admission and discharge data,
922 hospital emergency department data which shall include the
923 number of patients treated in the emergency department of a
924 licensed hospital reported by patient acuity level, data on
925 hospital-acquired infections as specified by rule, data on
926 complications as specified by rule, data on readmissions as
927 specified by rule, with patient and provider-specific
928 identifiers included, actual charge data by diagnostic groups or
929 other bundled groupings as specified by rule, financial data,
930 accounting data, operating expenses, expenses incurred for
931 rendering services to patients who cannot or do not pay,
932 interest charges, depreciation expenses based on the expected
933 useful life of the property and equipment involved, and
934 demographic data. The agency shall adopt nationally recognized
935 risk adjustment methodologies or software consistent with the
936 standards of the Agency for Healthcare Research and Quality and
937 as selected by the agency for all data submitted as required by
938 this section. Data may be obtained from documents such as, but
939 not limited to: leases, contracts, debt instruments, itemized
940 patient statements or bills, medical record abstracts, and
941 related diagnostic information. Reported data elements shall be
942 reported electronically in accordance with rule 59E-7.012,
943 Florida Administrative Code. Data submitted shall be certified
944 by the chief executive officer or an appropriate and duly
945 authorized representative or employee of the licensed facility
946 that the information submitted is true and accurate.
947 (b) Data to be submitted by health care providers may
948 include, but are not limited to: professional organization and
949 specialty board affiliations, Medicare and Medicaid
950 participation, types of services offered to patients, actual
951 charges to patients as specified by rule, amount of revenue and
952 expenses of the health care provider, and such other data which
953 are reasonably necessary to study utilization patterns. Data
954 submitted shall be certified by the appropriate duly authorized
955 representative or employee of the health care provider that the
956 information submitted is true and accurate.
957 (c) Data to be submitted by health insurers may include,
958 but are not limited to: claims, payments to health care
959 facilities and health care providers as specified by rule,
960 premium, administration, and financial information. Data
961 submitted shall be certified by the chief financial officer, an
962 appropriate and duly authorized representative, or an employee
963 of the insurer that the information submitted is true and
964 accurate. Information that is considered a trade secret under s.
965 812.081 shall be clearly designated.
966 (d) Data required to be submitted by health care
967 facilities, health care providers, or health insurers may shall
968 not include specific provider contract reimbursement
969 information. However, such specific provider reimbursement data
970 shall be reasonably available for onsite inspection by the
971 agency as is necessary to carry out the agency’s regulatory
972 duties. Any such data obtained by the agency as a result of
973 onsite inspections may not be used by the state for purposes of
974 direct provider contracting and are confidential and exempt from
975 the provisions of s. 119.07(1) and s. 24(a), Art. I of the State
976 Constitution.
977 (e) A requirement to submit data shall be adopted by rule
978 if the submission of data is being required of all members of
979 any type of health care facility, health care provider, or
980 health insurer. Rules are not required, however, for the
981 submission of data for a special study mandated by the
982 Legislature or when information is being requested for a single
983 health care facility, health care provider, or health insurer.
984 Section 8. Section 456.0575, Florida Statutes, is amended
985 to read:
986 456.0575 Duty to notify patients.—
987 (1) Every licensed health care practitioner shall inform
988 each patient, or an individual identified pursuant to s.
989 765.401(1), in person about adverse incidents that result in
990 serious harm to the patient. Notification of outcomes of care
991 that result in harm to the patient under this section does shall
992 not constitute an acknowledgment of admission of liability, nor
993 can such notifications be introduced as evidence.
994 (2) Every licensed health care practitioner must provide
995 upon request by a patient, before providing any nonemergency
996 medical services in a facility licensed under chapter 395, a
997 written, good faith estimate of reasonably anticipated charges
998 to treat the patient’s condition at the facility. The health
999 care practitioner must provide the estimate to the patient
1000 within 7 business days after receiving the request and is not
1001 required to adjust the estimate for any potential insurance
1002 coverage. The health care practitioner must inform the patient
1003 that the patient may contact his or her health insurer or health
1004 maintenance organization for additional information concerning
1005 cost-sharing responsibilities. The health care practitioner must
1006 provide information to uninsured patients and insured patients
1007 for whom the practitioner is not a network provider or preferred
1008 provider which discloses the practitioner’s financial assistance
1009 policy, including the application process, payment plans,
1010 discounts, or other available assistance, and the practitioner’s
1011 charity care policy and collection procedures. Such estimate
1012 does not preclude the actual charges from exceeding the
1013 estimate. Failure to provide the estimate in accordance with
1014 this subsection, without good cause, shall result in
1015 disciplinary action against the health care practitioner and a
1016 daily fine of $500 until the estimate is provided to the
1017 patient. The total fine may not exceed $5,000.
1018 Section 9. Paragraph (oo) is added to subsection (1) of
1019 section 456.072, Florida Statutes, to read:
1020 456.072 Grounds for discipline; penalties; enforcement.—
1021 (1) The following acts shall constitute grounds for which
1022 the disciplinary actions specified in subsection (2) may be
1023 taken:
1024 (oo) Failure to comply with fair billing practices pursuant
1025 to s. 627.0613(6).
1026 Section 10. Section 627.0613, Florida Statutes, is amended
1027 to read:
1028 627.0613 Consumer advocate.—The Chief Financial Officer
1029 must appoint a consumer advocate who must represent the general
1030 public of the state before the department, and the office, and
1031 other state agencies, as required by this section. The consumer
1032 advocate must report directly to the Chief Financial Officer,
1033 but is not otherwise under the authority of the department or of
1034 any employee of the department. The consumer advocate has such
1035 powers as are necessary to carry out the duties of the office of
1036 consumer advocate, including, but not limited to, the powers to:
1037 (1) Recommend to the department or office, by petition, the
1038 commencement of any proceeding or action; appear in any
1039 proceeding or action before the department or office; or appear
1040 in any proceeding before the Division of Administrative Hearings
1041 relating to subject matter under the jurisdiction of the
1042 department or office.
1043 (2) Report to the Agency for Health Care Administration and
1044 to the Department of Health any findings resulting from an
1045 investigation of unresolved complaints concerning the billing
1046 practices of any health care facility licensed under chapter 395
1047 or any health care practitioner subject to chapter 456.
1048 (3)(2) Have access to and use of all files, records, and
1049 data of the department or office.
1050 (4) Have access to any files, records, and data of the
1051 Agency for Health Care Administration and the Department of
1052 Health which are necessary for the investigations authorized
1053 under subsection (6).
1054 (5)(3) Examine rate and form filings submitted to the
1055 office, hire consultants as necessary to aid in the review
1056 process, and recommend to the department or office any position
1057 deemed by the consumer advocate to be in the public interest.
1058 (6) Maintain a process for receiving and investigating
1059 complaints from insured and uninsured patients of health care
1060 facilities licensed under chapter 395 and health care
1061 practitioners subject to chapter 456 concerning billing
1062 practices. Investigations by the office of the consumer advocate
1063 shall be limited to determining compliance with the following
1064 requirements:
1065 (a) The patient was informed before a nonemergency
1066 procedure of expected payments related to the procedure as
1067 provided in s. 395.301, contact information for health insurers
1068 or health maintenance organizations to determine specific cost
1069 sharing responsibilities, and the expected involvement in the
1070 procedure of other providers who may bill independently.
1071 (b) The patient was informed of policies and procedures to
1072 qualify for discounted charges.
1073 (c) The patient was informed of collection procedures and
1074 given the opportunity to participate in an extended payment
1075 schedule.
1076 (d) The patient was given a written, personal, and itemized
1077 estimate upon request as provided in ss. 395.301 and 456.0575.
1078 (e) The statement or bill delivered to the patient was
1079 accurate and included all information required pursuant to s.
1080 395.301.
1081 (f) The billed amounts were fair charges. As used in this
1082 paragraph, the term “fair charges” means the common and frequent
1083 range of charges for patients who are similarly situated
1084 requiring the same or similar medical services.
1085 (7) Provide mediation between providers and patients to
1086 resolve billing complaints and negotiate arrangements for
1087 extended payment schedules.
1088 (8)(4) Prepare an annual budget for presentation to the
1089 Legislature by the department, which budget must be adequate to
1090 carry out the duties of the office of consumer advocate.
1091 Section 11. Section 627.6385, Florida Statutes, is created
1092 to read:
1093 627.6385 Disclosures to policyholders; calculations of cost
1094 sharing.—
1095 (1) Each health insurer shall make available on its
1096 website:
1097 (a) A method for policyholders to estimate their
1098 copayments, deductibles, and other cost-sharing responsibilities
1099 for health care services and procedures. Such method of making
1100 an estimate shall be based on service bundles established
1101 pursuant to s. 408.05(3)(c). Estimates do not preclude the
1102 actual copayment, coinsurance percentage, or deductible,
1103 whichever is applicable, from exceeding the estimate.
1104 1. Estimates shall be calculated according to the policy
1105 and known plan usage during the coverage period.
1106 2. Estimates shall be made available based on providers
1107 that are in-network and out-of-network.
1108 3. A policyholder must be able to create estimates by any
1109 combination of the service bundles established pursuant to s.
1110 408.05(3)(c), a specified provider, or a comparison of
1111 providers.
1112 (b) A method for policyholders to estimate their
1113 copayments, deductibles, and other cost-sharing responsibilities
1114 based on a personalized estimate of charges received from a
1115 facility pursuant to s. 395.301 or a practitioner pursuant to s.
1116 456.0575.
1117 (c) A hyperlink to the health information, including, but
1118 not limited to, service bundles and quality of care information,
1119 which is disseminated by the Agency for Health Care
1120 Administration pursuant to s. 408.05(3).
1121 (2) Each health insurer shall include in every policy
1122 delivered or issued for delivery to any person in the state or
1123 in materials provided as required by s. 627.64725 notice that
1124 the information required by this section is available
1125 electronically and the address of the website where the
1126 information can be accessed.
1127 (3) Each health insurer that participates in the state
1128 group health insurance plan created under s. 110.123 or Medicaid
1129 managed care pursuant to part IV of chapter 409 shall contribute
1130 all claims data from Florida policyholders held by the insurer
1131 and its affiliates to the contracted vendor selected by the
1132 Agency for Health Care Administration under s. 408.05(3)(c).
1133 Each insurer and its affiliates may not contribute claims data
1134 to the contracted vendor which reflect the following types of
1135 coverage:
1136 (a) Coverage only for accident, or disability income
1137 insurance, or any combination thereof.
1138 (b) Coverage issued as a supplement to liability insurance.
1139 (c) Liability insurance, including general liability
1140 insurance and automobile liability insurance.
1141 (d) Workers’ compensation or similar insurance.
1142 (e) Automobile medical payment insurance.
1143 (f) Credit-only insurance.
1144 (g) Coverage for onsite medical clinics, including prepaid
1145 health clinics under part II of chapter 641.
1146 (h) Limited scope dental or vision benefits.
1147 (i) Benefits for long-term care, nursing home care, home
1148 health care, community-based care, or any combination thereof.
1149 (j) Coverage only for a specified disease or illness.
1150 (k) Hospital indemnity or other fixed indemnity insurance.
1151 (l) Medicare supplemental health insurance as defined under
1152 s. 1882(g)(1) of the Social Security Act, coverage supplemental
1153 to the coverage provided under chapter 55 of Title 10 U.S.C.,
1154 and similar supplemental coverage provided to supplement
1155 coverage under a group health plan.
1156 Section 12. Subsection (6) of section 641.54, Florida
1157 Statutes, is amended, present subsection (7) of that section is
1158 redesignated as subsection (8) and amended, and a new subsection
1159 (7) is added to that section, to read:
1160 641.54 Information disclosure.—
1161 (6) Each health maintenance organization shall make
1162 available to its subscribers on its website or by request the
1163 estimated copayment copay, coinsurance percentage, or
1164 deductible, whichever is applicable, for any covered services as
1165 described by the searchable bundles established on a consumer
1166 friendly, Internet-based platform pursuant to s. 408.05(3)(c) or
1167 as described by a personalized estimate received from a facility
1168 pursuant to s. 395.301 or a practitioner pursuant to s.
1169 456.0575, the status of the subscriber’s maximum annual out-of
1170 pocket payments for a covered individual or family, and the
1171 status of the subscriber’s maximum lifetime benefit. Such
1172 estimate does shall not preclude the actual copayment copay,
1173 coinsurance percentage, or deductible, whichever is applicable,
1174 from exceeding the estimate.
1175 (7) Each health maintenance organization that participates
1176 in the state group health insurance plan created under s.
1177 110.123 or Medicaid managed care pursuant to part IV of chapter
1178 409 shall contribute all claims data from Florida subscribers
1179 held by the organization and its affiliates to the contracted
1180 vendor selected by the Agency for Health Care Administration
1181 under s. 408.05(3)(c). Each health maintenance organization and
1182 its affiliates may not contribute claims data to the contracted
1183 vendor which reflect the following types of coverage:
1184 (a) Coverage only for accident, or disability income
1185 insurance, or any combination thereof.
1186 (b) Coverage issued as a supplement to liability insurance.
1187 (c) Liability insurance, including general liability
1188 insurance and automobile liability insurance.
1189 (d) Workers’ compensation or similar insurance.
1190 (e) Automobile medical payment insurance.
1191 (f) Credit-only insurance.
1192 (g) Coverage for onsite medical clinics, including prepaid
1193 health clinics under part II of chapter 641.
1194 (h) Limited scope dental or vision benefits.
1195 (i) Benefits for long-term care, nursing home care, home
1196 health care, community-based care, or any combination thereof.
1197 (j) Coverage only for a specified disease or illness.
1198 (k) Hospital indemnity or other fixed indemnity insurance.
1199 (l) Medicare supplemental health insurance as defined under
1200 s. 1882(g)(1) of the Social Security Act, coverage supplemental
1201 to the coverage provided under chapter 55 of Title 10 U.S.C.,
1202 and similar supplemental coverage provided to supplement
1203 coverage under a group health plan.
1204 (8)(7) Each health maintenance organization shall make
1205 available on its Internet website a hyperlink link to the health
1206 information performance outcome and financial data that is
1207 disseminated published by the Agency for Health Care
1208 Administration pursuant to s. 408.05(3) s. 408.05(3)(k) and
1209 shall include in every policy delivered or issued for delivery
1210 to any person in the state or in any materials provided as
1211 required by s. 627.64725 notice that such information is
1212 available electronically and the address of its Internet
1213 website.
1214 Section 13. Paragraph (n) is added to subsection (2) of
1215 section 409.967, Florida Statutes, to read:
1216 409.967 Managed care plan accountability.—
1217 (2) The agency shall establish such contract requirements
1218 as are necessary for the operation of the statewide managed care
1219 program. In addition to any other provisions the agency may deem
1220 necessary, the contract must require:
1221 (n) Transparency.—Managed care plans shall comply with ss.
1222 627.6385(3) and 641.54(7).
1223 Section 14. Paragraph (d) of subsection (3) of section
1224 110.123, Florida Statutes, is amended to read:
1225 110.123 State group insurance program.—
1226 (3) STATE GROUP INSURANCE PROGRAM.—
1227 (d)1. Notwithstanding the provisions of chapter 287 and the
1228 authority of the department, for the purpose of protecting the
1229 health of, and providing medical services to, state employees
1230 participating in the state group insurance program, the
1231 department may contract to retain the services of professional
1232 administrators for the state group insurance program. The agency
1233 shall follow good purchasing practices of state procurement to
1234 the extent practicable under the circumstances.
1235 2. Each vendor in a major procurement, and any other vendor
1236 if the department deems it necessary to protect the state’s
1237 financial interests, shall, at the time of executing any
1238 contract with the department, post an appropriate bond with the
1239 department in an amount determined by the department to be
1240 adequate to protect the state’s interests but not higher than
1241 the full amount estimated to be paid annually to the vendor
1242 under the contract.
1243 3. Each major contract entered into by the department
1244 pursuant to this section shall contain a provision for payment
1245 of liquidated damages to the department for material
1246 noncompliance by a vendor with a contract provision. The
1247 department may require a liquidated damages provision in any
1248 contract if the department deems it necessary to protect the
1249 state’s financial interests.
1250 4. Section The provisions of s. 120.57(3) applies apply to
1251 the department’s contracting process, except:
1252 a. A formal written protest of any decision, intended
1253 decision, or other action subject to protest shall be filed
1254 within 72 hours after receipt of notice of the decision,
1255 intended decision, or other action.
1256 b. As an alternative to any provision of s. 120.57(3), the
1257 department may proceed with the bid selection or contract award
1258 process if the director of the department sets forth, in
1259 writing, particular facts and circumstances that which
1260 demonstrate the necessity of continuing the procurement process
1261 or the contract award process in order to avoid a substantial
1262 disruption to the provision of any scheduled insurance services.
1263 5. The department shall make arrangements as necessary to
1264 contribute claims data of the state group health insurance plan
1265 to the contracted vendor selected by the Agency for Health Care
1266 Administration pursuant to s. 408.05(3)(c).
1267 6. Each contracted vendor for the state group health
1268 insurance plan shall contribute Florida claims data to the
1269 contracted vendor selected by the Agency for Health Care
1270 Administration pursuant to s. 408.05(3)(c).
1271 Section 15. Subsection (3) of section 20.42, Florida
1272 Statutes, is amended to read:
1273 20.42 Agency for Health Care Administration.—
1274 (3) The department shall be the chief health policy and
1275 planning entity for the state. The department is responsible for
1276 health facility licensure, inspection, and regulatory
1277 enforcement; investigation of consumer complaints related to
1278 health care facilities and managed care plans; the
1279 implementation of the certificate of need program; the operation
1280 of the Florida Center for Health Information and Transparency
1281 Policy Analysis; the administration of the Medicaid program; the
1282 administration of the contracts with the Florida Healthy Kids
1283 Corporation; the certification of health maintenance
1284 organizations and prepaid health clinics as set forth in part
1285 III of chapter 641; and any other duties prescribed by statute
1286 or agreement.
1287 Section 16. Paragraph (c) of subsection (4) of section
1288 381.026, Florida Statutes, is amended to read:
1289 381.026 Florida Patient’s Bill of Rights and
1290 Responsibilities.—
1291 (4) RIGHTS OF PATIENTS.—Each health care facility or
1292 provider shall observe the following standards:
1293 (c) Financial information and disclosure.—
1294 1. A patient has the right to be given, upon request, by
1295 the responsible provider, his or her designee, or a
1296 representative of the health care facility full information and
1297 necessary counseling on the availability of known financial
1298 resources for the patient’s health care.
1299 2. A health care provider or a health care facility shall,
1300 upon request, disclose to each patient who is eligible for
1301 Medicare, before treatment, whether the health care provider or
1302 the health care facility in which the patient is receiving
1303 medical services accepts assignment under Medicare reimbursement
1304 as payment in full for medical services and treatment rendered
1305 in the health care provider’s office or health care facility.
1306 3. A primary care provider may publish a schedule of
1307 charges for the medical services that the provider offers to
1308 patients. The schedule must include the prices charged to an
1309 uninsured person paying for such services by cash, check, credit
1310 card, or debit card. The schedule must be posted in a
1311 conspicuous place in the reception area of the provider’s office
1312 and must include, but is not limited to, the 50 services most
1313 frequently provided by the primary care provider. The schedule
1314 may group services by three price levels, listing services in
1315 each price level. The posting must be at least 15 square feet in
1316 size. A primary care provider who publishes and maintains a
1317 schedule of charges for medical services is exempt from the
1318 license fee requirements for a single period of renewal of a
1319 professional license under chapter 456 for that licensure term
1320 and is exempt from the continuing education requirements of
1321 chapter 456 and the rules implementing those requirements for a
1322 single 2-year period.
1323 4. If a primary care provider publishes a schedule of
1324 charges pursuant to subparagraph 3., he or she must continually
1325 post it at all times for the duration of active licensure in
1326 this state when primary care services are provided to patients.
1327 If a primary care provider fails to post the schedule of charges
1328 in accordance with this subparagraph, the provider shall be
1329 required to pay any license fee and comply with any continuing
1330 education requirements for which an exemption was received.
1331 5. A health care provider or a health care facility shall,
1332 upon request, furnish a person, before the provision of medical
1333 services, a reasonable estimate of charges for such services.
1334 The health care provider or the health care facility shall
1335 provide an uninsured person, before the provision of a planned
1336 nonemergency medical service, a reasonable estimate of charges
1337 for such service and information regarding the provider’s or
1338 facility’s discount or charity policies for which the uninsured
1339 person may be eligible. Such estimates by a primary care
1340 provider must be consistent with the schedule posted under
1341 subparagraph 3. Estimates shall, to the extent possible, be
1342 written in language comprehensible to an ordinary layperson.
1343 Such reasonable estimate does not preclude the health care
1344 provider or health care facility from exceeding the estimate or
1345 making additional charges based on changes in the patient’s
1346 condition or treatment needs.
1347 6. Each licensed facility, except a facility operating
1348 exclusively as a state facility, not operated by the state shall
1349 make available to the public on its Internet website or by other
1350 electronic means a description of and a hyperlink link to the
1351 health information performance outcome and financial data that
1352 is disseminated published by the agency pursuant to s. 408.05(3)
1353 s. 408.05(3)(k). The facility shall place a notice in the
1354 reception area that such information is available electronically
1355 and the website address. The licensed facility may indicate that
1356 the pricing information is based on a compilation of charges for
1357 the average patient and that each patient’s statement or bill
1358 may vary from the average depending upon the severity of illness
1359 and individual resources consumed. The licensed facility may
1360 also indicate that the price of service is negotiable for
1361 eligible patients based upon the patient’s ability to pay.
1362 7. A patient has the right to receive a copy of an itemized
1363 statement or bill upon request. A patient has a right to be
1364 given an explanation of charges upon request.
1365 Section 17. Paragraph (e) of subsection (2) of section
1366 395.602, Florida Statutes, is amended to read:
1367 395.602 Rural hospitals.—
1368 (2) DEFINITIONS.—As used in this part, the term:
1369 (e) “Rural hospital” means an acute care hospital licensed
1370 under this chapter, having 100 or fewer licensed beds and an
1371 emergency room, which is:
1372 1. The sole provider within a county with a population
1373 density of up to 100 persons per square mile;
1374 2. An acute care hospital, in a county with a population
1375 density of up to 100 persons per square mile, which is at least
1376 30 minutes of travel time, on normally traveled roads under
1377 normal traffic conditions, from any other acute care hospital
1378 within the same county;
1379 3. A hospital supported by a tax district or subdistrict
1380 whose boundaries encompass a population of up to 100 persons per
1381 square mile;
1382 4. A hospital with a service area that has a population of
1383 up to 100 persons per square mile. As used in this subparagraph,
1384 the term “service area” means the fewest number of zip codes
1385 that account for 75 percent of the hospital’s discharges for the
1386 most recent 5-year period, based on information available from
1387 the hospital inpatient discharge database in the Florida Center
1388 for Health Information and Transparency Policy Analysis at the
1389 agency; or
1390 5. A hospital designated as a critical access hospital, as
1391 defined in s. 408.07.
1392
1393 Population densities used in this paragraph must be based upon
1394 the most recently completed United States census. A hospital
1395 that received funds under s. 409.9116 for a quarter beginning no
1396 later than July 1, 2002, is deemed to have been and shall
1397 continue to be a rural hospital from that date through June 30,
1398 2021, if the hospital continues to have up to 100 licensed beds
1399 and an emergency room. An acute care hospital that has not
1400 previously been designated as a rural hospital and that meets
1401 the criteria of this paragraph shall be granted such designation
1402 upon application, including supporting documentation, to the
1403 agency. A hospital that was licensed as a rural hospital during
1404 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
1405 rural hospital from the date of designation through June 30,
1406 2021, if the hospital continues to have up to 100 licensed beds
1407 and an emergency room.
1408 Section 18. Section 395.6025, Florida Statutes, is amended
1409 to read:
1410 395.6025 Rural hospital replacement facilities.
1411 Notwithstanding the provisions of s. 408.036, a hospital defined
1412 as a statutory rural hospital in accordance with s. 395.602, or
1413 a not-for-profit operator of rural hospitals, is not required to
1414 obtain a certificate of need for the construction of a new
1415 hospital located in a county with a population of at least
1416 15,000 but no more than 18,000 and a density of fewer less than
1417 30 persons per square mile, or a replacement facility, provided
1418 that the replacement, or new, facility is located within 10
1419 miles of the site of the currently licensed rural hospital and
1420 within the current primary service area. As used in this
1421 section, the term “service area” means the fewest number of zip
1422 codes that account for 75 percent of the hospital’s discharges
1423 for the most recent 5-year period, based on information
1424 available from the hospital inpatient discharge database in the
1425 Florida Center for Health Information and Transparency Policy
1426 Analysis at the Agency for Health Care Administration.
1427 Section 19. Subsection (43) of section 408.07, Florida
1428 Statutes, is amended to read:
1429 408.07 Definitions.—As used in this chapter, with the
1430 exception of ss. 408.031-408.045, the term:
1431 (43) “Rural hospital” means an acute care hospital licensed
1432 under chapter 395, having 100 or fewer licensed beds and an
1433 emergency room, and which is:
1434 (a) The sole provider within a county with a population
1435 density of no greater than 100 persons per square mile;
1436 (b) An acute care hospital, in a county with a population
1437 density of no greater than 100 persons per square mile, which is
1438 at least 30 minutes of travel time, on normally traveled roads
1439 under normal traffic conditions, from another acute care
1440 hospital within the same county;
1441 (c) A hospital supported by a tax district or subdistrict
1442 whose boundaries encompass a population of 100 persons or fewer
1443 per square mile;
1444 (d) A hospital with a service area that has a population of
1445 100 persons or fewer per square mile. As used in this paragraph,
1446 the term “service area” means the fewest number of zip codes
1447 that account for 75 percent of the hospital’s discharges for the
1448 most recent 5-year period, based on information available from
1449 the hospital inpatient discharge database in the Florida Center
1450 for Health Information and Transparency Policy Analysis at the
1451 Agency for Health Care Administration; or
1452 (e) A critical access hospital.
1453
1454 Population densities used in this subsection must be based upon
1455 the most recently completed United States census. A hospital
1456 that received funds under s. 409.9116 for a quarter beginning no
1457 later than July 1, 2002, is deemed to have been and shall
1458 continue to be a rural hospital from that date through June 30,
1459 2015, if the hospital continues to have 100 or fewer licensed
1460 beds and an emergency room. An acute care hospital that has not
1461 previously been designated as a rural hospital and that meets
1462 the criteria of this subsection shall be granted such
1463 designation upon application, including supporting
1464 documentation, to the Agency for Health Care Administration.
1465 Section 20. Paragraph (a) of subsection (4) of section
1466 408.18, Florida Statutes, is amended to read:
1467 408.18 Health Care Community Antitrust Guidance Act;
1468 antitrust no-action letter; market-information collection and
1469 education.—
1470 (4)(a) Members of the health care community who seek
1471 antitrust guidance may request a review of their proposed
1472 business activity by the Attorney General’s office. In
1473 conducting its review, the Attorney General’s office may seek
1474 whatever documentation, data, or other material it deems
1475 necessary from the Agency for Health Care Administration, the
1476 Florida Center for Health Information and Transparency Policy
1477 Analysis, and the Office of Insurance Regulation of the
1478 Financial Services Commission.
1479 Section 21. Section 465.0244, Florida Statutes, is amended
1480 to read:
1481 465.0244 Information disclosure.—Every pharmacy shall make
1482 available on its Internet website a hyperlink link to the health
1483 information performance outcome and financial data that is
1484 disseminated published by the Agency for Health Care
1485 Administration pursuant to s. 408.05(3) s. 408.05(3)(k) and
1486 shall place in the area where customers receive filled
1487 prescriptions notice that such information is available
1488 electronically and the address of its Internet website.
1489 Section 22. This act is intended to promote health care
1490 price and quality transparency to enable consumers to make
1491 informed choices on health care treatment and improve
1492 competition in the health care market. Persons or entities
1493 required to submit, receive, or publish data under this act are
1494 acting pursuant to state requirements contained therein and are
1495 exempt from state antitrust laws.
1496 Section 23. This act shall take effect July 1, 2016.