Florida Senate - 2017 COMMITTEE AMENDMENT
Bill No. SB 1550
Ì944284:Î944284
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/04/2017 .
.
.
.
—————————————————————————————————————————————————————————————————
—————————————————————————————————————————————————————————————————
The Committee on Health Policy (Artiles) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Present paragraphs (d) through (j) of subsection
6 (3) of section 408.05, Florida Statutes, are redesignated as
7 paragraphs (e) through (k), respectively, and a new paragraph
8 (d) is added to that subsection, to read:
9 408.05 Florida Center for Health Information and
10 Transparency.—
11 (3) HEALTH INFORMATION TRANSPARENCY.—In order to
12 disseminate and facilitate the availability of comparable and
13 uniform health information, the agency shall perform the
14 following functions:
15 (d) Contract with a vendor to evaluate health information
16 technology activities within the state. The vendor shall
17 identify best practices for developing data systems which will
18 leverage existing public and private health care data sources to
19 provide health care providers with real-time access to their
20 patients’ health records. The evaluation shall identify methods
21 to increase interoperability across delivery systems regardless
22 of geographic location and include a review of eligibility for
23 public programs or private insurance to ensure that health care
24 services, including Medicaid services, are clinically
25 appropriate. The evaluation shall address cost-avoidance through
26 the elimination of duplicative services or overutilization of
27 services. The agency shall submit a report of the vendor’s
28 findings and recommendations to the President of the Senate and
29 the Speaker of the House of Representatives by December 31,
30 2017.
31 Section 2. Subsection (27) of section 409.901, Florida
32 Statutes, is amended to read:
33 409.901 Definitions; ss. 409.901-409.920.—As used in ss.
34 409.901-409.920, except as otherwise specifically provided, the
35 term:
36 (27) “Third party” means an individual, entity, or program,
37 excluding Medicaid, that is, may be, could be, should be, or has
38 been liable for all or part of the cost of medical services
39 related to any medical assistance covered by Medicaid. A third
40 party includes a third-party administrator; or a pharmacy
41 benefits manager; health insurer; self-insured plan; group
42 health plan, as defined in s. 607(1) of the Employee Retirement
43 Income Security Act of 1974; service benefit plan; managed care
44 organization; liability insurance, including self-insurance; no
45 fault insurance; workers’ compensation laws or plans; or other
46 parties that are, by statute, contract, or agreement, legally
47 responsible for payment of a claim for a health care item or
48 service.
49 Section 3. Subsection (4), paragraph (c) of subsection (6),
50 paragraph (h) of subsection (11), subsection (16), paragraph (b)
51 of subsection (17), and subsection (20) of section 409.910,
52 Florida Statutes, are amended to read:
53 409.910 Responsibility for payments on behalf of Medicaid
54 eligible persons when other parties are liable.—
55 (4) After the agency has provided medical assistance under
56 the Medicaid program, it shall seek recovery of reimbursement
57 from third-party benefits to the limit of legal liability and
58 for the full amount of third-party benefits, but not in excess
59 of the amount of medical assistance paid by Medicaid, as to:
60 (a) Claims for which the agency has a waiver pursuant to
61 federal law; or
62 (b) Situations in which the agency learns of the existence
63 of a liable third party or in which third-party benefits are
64 discovered or become available after medical assistance has been
65 provided by Medicaid.
66 (6) When the agency provides, pays for, or becomes liable
67 for medical care under the Medicaid program, it has the
68 following rights, as to which the agency may assert independent
69 principles of law, which shall nevertheless be construed
70 together to provide the greatest recovery from third-party
71 benefits:
72 (c) The agency is entitled to, and has, an automatic lien
73 for the full amount of medical assistance provided by Medicaid
74 to or on behalf of the recipient for medical care furnished as a
75 result of any covered injury or illness for which a third party
76 is or may be liable, upon the collateral, as defined in s.
77 409.901.
78 1. The lien attaches automatically when a recipient first
79 receives treatment for which the agency may be obligated to
80 provide medical assistance under the Medicaid program. The lien
81 is perfected automatically at the time of attachment.
82 2. The agency is authorized to file a verified claim of
83 lien. The claim of lien shall be signed by an authorized
84 employee of the agency, and shall be verified as to the
85 employee’s knowledge and belief. The claim of lien may be filed
86 and recorded with the clerk of the circuit court in the
87 recipient’s last known county of residence or in any county
88 deemed appropriate by the agency. The claim of lien, to the
89 extent known by the agency, shall contain:
90 a. The name and last known address of the person to whom
91 medical care was furnished.
92 b. The date of injury.
93 c. The period for which medical assistance was provided.
94 d. The amount of medical assistance provided or paid, or
95 for which Medicaid is otherwise liable.
96 e. The names and addresses of all persons claimed by the
97 recipient to be liable for the covered injuries or illness.
98 3. The filing of the claim of lien pursuant to this section
99 shall be notice thereof to all persons.
100 4. If the claim of lien is filed within 3 years 1 year
101 after the later of the date when the last item of medical care
102 relative to a specific covered injury or illness was paid, or
103 the date of discovery by the agency of the liability of any
104 third party, or the date of discovery of a cause of action
105 against a third party brought by a recipient or his or her legal
106 representative, record notice shall relate back to the time of
107 attachment of the lien.
108 5. If the claim of lien is filed after 3 years 1 year after
109 the later of the events specified in subparagraph 4., notice
110 shall be effective as of the date of filing.
111 6. Only one claim of lien need be filed to provide notice
112 as set forth in this paragraph and shall provide sufficient
113 notice as to any additional or after-paid amount of medical
114 assistance provided by Medicaid for any specific covered injury
115 or illness. The agency may, in its discretion, file additional,
116 amended, or substitute claims of lien at any time after the
117 initial filing, until the agency has been repaid the full amount
118 of medical assistance provided by Medicaid or otherwise has
119 released the liable parties and recipient.
120 7. No release or satisfaction of any cause of action, suit,
121 claim, counterclaim, demand, judgment, settlement, or settlement
122 agreement shall be valid or effectual as against a lien created
123 under this paragraph, unless the agency joins in the release or
124 satisfaction or executes a release of the lien. An acceptance of
125 a release or satisfaction of any cause of action, suit, claim,
126 counterclaim, demand, or judgment and any settlement of any of
127 the foregoing in the absence of a release or satisfaction of a
128 lien created under this paragraph shall prima facie constitute
129 an impairment of the lien, and the agency is entitled to recover
130 damages on account of such impairment. In an action on account
131 of impairment of a lien, the agency may recover from the person
132 accepting the release or satisfaction or making the settlement
133 the full amount of medical assistance provided by Medicaid.
134 Nothing in this section shall be construed as creating a lien or
135 other obligation on the part of an insurer which in good faith
136 has paid a claim pursuant to its contract without knowledge or
137 actual notice that the agency has provided medical assistance
138 for the recipient related to a particular covered injury or
139 illness. However, notice or knowledge that an insured is, or has
140 been a Medicaid recipient within 1 year from the date of service
141 for which a claim is being paid creates a duty to inquire on the
142 part of the insurer as to any injury or illness for which the
143 insurer intends or is otherwise required to pay benefits.
144 8. The lack of a properly filed claim of lien shall not
145 affect the agency’s assignment or subrogation rights provided in
146 this subsection, nor shall it affect the existence of the lien,
147 but only the effective date of notice as provided in
148 subparagraph 5.
149 9. The lien created by this paragraph is a first lien and
150 superior to the liens and charges of any provider, and shall
151 exist for a period of 7 years, if recorded, after the date of
152 recording; and shall exist for a period of 7 years after the
153 date of attachment, if not recorded. If recorded, the lien may
154 be extended for one additional period of 7 years by rerecording
155 the claim of lien within the 90-day period preceding the
156 expiration of the lien.
157 10. The clerk of the circuit court for each county in the
158 state shall endorse on a claim of lien filed under this
159 paragraph the date and hour of filing and shall record the claim
160 of lien in the official records of the county as for other
161 records received for filing. The clerk shall receive as his or
162 her fee for filing and recording any claim of lien or release of
163 lien under this paragraph the total sum of $2. Any fee required
164 to be paid by the agency shall not be required to be paid in
165 advance of filing and recording, but may be billed to the agency
166 after filing and recording of the claim of lien or release of
167 lien.
168 11. After satisfaction of any lien recorded under this
169 paragraph, the agency shall, within 60 days after satisfaction,
170 either file with the appropriate clerk of the circuit court or
171 mail to any appropriate party, or counsel representing such
172 party, if represented, a satisfaction of lien in a form
173 acceptable for filing in Florida.
174 (11) The agency may, as a matter of right, in order to
175 enforce its rights under this section, institute, intervene in,
176 or join any legal or administrative proceeding in its own name
177 in one or more of the following capacities: individually, as
178 subrogee of the recipient, as assignee of the recipient, or as
179 lienholder of the collateral.
180 (h) Except as otherwise provided in this section, actions
181 to enforce the rights of the agency under this section shall be
182 commenced within 6 5 years after the date a cause of action
183 accrues, with the period running from the later of the date of
184 discovery by the agency of a case filed by a recipient or his or
185 her legal representative, or of discovery of any judgment,
186 award, or settlement contemplated in this section, or of
187 discovery of facts giving rise to a cause of action under this
188 section. Nothing in this paragraph affects or prevents a
189 proceeding to enforce a lien during the existence of the lien as
190 set forth in subparagraph (6)(c)9.
191 (16) Any transfer or encumbrance of any right, title, or
192 interest to which the agency has a right pursuant to this
193 section, with the intent, likelihood, or practical effect of
194 defeating, hindering, or reducing reimbursement to recovery by
195 the agency for reimbursement of medical assistance provided by
196 Medicaid, shall be deemed to be a fraudulent conveyance, and
197 such transfer or encumbrance shall be void and of no effect
198 against the claim of the agency, unless the transfer was for
199 adequate consideration and the proceeds of the transfer are
200 reimbursed in full to the agency, but not in excess of the
201 amount of medical assistance provided by Medicaid.
202 (17)
203 (b) If federal law limits the agency to reimbursement from
204 the recovered medical expense damages, a recipient, or his or
205 her legal representative, may contest the amount designated as
206 recovered medical expense damages payable to the agency pursuant
207 to the formula specified in paragraph (11)(f) by filing a
208 petition under chapter 120 within 21 days after the date of
209 payment of funds to the agency or after the date of placing the
210 full amount of the third-party benefits in the trust account for
211 the benefit of the agency pursuant to paragraph (a). The
212 petition shall be filed with the Division of Administrative
213 Hearings. For purposes of chapter 120, the payment of funds to
214 the agency or the placement of the full amount of the third
215 party benefits in the trust account for the benefit of the
216 agency constitutes final agency action and notice thereof. Final
217 order authority for the proceedings specified in this subsection
218 rests with the Division of Administrative Hearings. This
219 procedure is the exclusive method for challenging the amount of
220 third-party benefits payable to the agency. In order to
221 successfully challenge the amount designated as recovered
222 medical expenses payable to the agency, the recipient must
223 prove, by clear and convincing evidence, that the a lesser
224 portion of the total recovery that should be allocated as
225 reimbursement for past and future medical expenses is less than
226 the amount calculated by the agency pursuant to the formula set
227 forth in paragraph (11)(f). Alternatively, the recipient must
228 prove by clear and convincing evidence or that Medicaid provided
229 a lesser amount of medical assistance than that asserted by the
230 agency.
231 (20)(a) Entities providing health insurance as defined in
232 s. 624.603, health maintenance organizations and prepaid health
233 clinics as defined in chapter 641, and, on behalf of their
234 clients, third-party administrators, and pharmacy benefits
235 managers, and any other third parties, as defined in s.
236 409.901(27), which are legally responsible for payment of a
237 claim for a health care item or service as a condition of doing
238 business in the state or providing coverage to residents of this
239 state, shall provide such records and information as are
240 necessary to accomplish the purpose of this section, unless such
241 requirement results in an unreasonable burden.
242 (b) An entity must respond to a request for payment with
243 payment on the claim, a written request for additional
244 information with which to process the claim, or a written reason
245 for denial of the claim within 90 working days after receipt of
246 written proof of loss or claim for payment for a health care
247 item or service provided to a Medicaid recipient who is covered
248 by the entity. Failure to pay or deny a claim within 140 days
249 after receipt of the claim creates an uncontestable obligation
250 to pay the claim.
251 (a) The director of the agency and the Director of the
252 Office of Insurance Regulation of the Financial Services
253 Commission shall enter into a cooperative agreement for
254 requesting and obtaining information necessary to effect the
255 purpose and objective of this section.
256 1. The agency shall request only that information necessary
257 to determine whether health insurance as defined pursuant to s.
258 624.603, or those health services provided pursuant to chapter
259 641, could be, should be, or have been claimed and paid with
260 respect to items of medical care and services furnished to any
261 person eligible for services under this section.
262 2. All information obtained pursuant to subparagraph 1. is
263 confidential and exempt from s. 119.07(1). The agency shall
264 provide the information obtained pursuant to subparagraph 1. to
265 the Department of Revenue for purposes of administering the
266 state Title IV-D program. The agency and the Department of
267 Revenue shall enter into a cooperative agreement for purposes of
268 implementing this requirement.
269 3. The cooperative agreement or rules adopted under this
270 subsection may include financial arrangements to reimburse the
271 reporting entities for reasonable costs or a portion thereof
272 incurred in furnishing the requested information. Neither the
273 cooperative agreement nor the rules shall require the automation
274 of manual processes to provide the requested information.
275 (b) The agency and the Financial Services Commission
276 jointly shall adopt rules for the development and administration
277 of the cooperative agreement. The rules shall include the
278 following:
279 1. A method for identifying those entities subject to
280 furnishing information under the cooperative agreement.
281 2. A method for furnishing requested information.
282 3. Procedures for requesting exemption from the cooperative
283 agreement based on an unreasonable burden to the reporting
284 entity.
285 Section 4. This act shall take effect July 1, 2017.
286
287 ================= T I T L E A M E N D M E N T ================
288 And the title is amended as follows:
289 Delete everything before the enacting clause
290 and insert:
291 A bill to be entitled
292 An act relating to health information transparency;
293 amending s. 408.05, F.S.; requiring the Agency for
294 Health Care Administration to contract with a vendor
295 to evaluate health information technology activities
296 to identify best practices and methods to increase
297 interoperability; requiring a report to the
298 Legislature by a specified date; amending s. 409.901,
299 F.S.; revising the definition of the term “third
300 party” for purposes of liability for payment of
301 certain medical services covered by Medicaid; amending
302 s. 409.910, F.S.; revising provisions relating to
303 responsibility for Medicaid payments in settlement
304 proceedings; extending the period of time for filing a
305 claim of lien filed for purposes of third-party
306 liability; extending the period of time within which
307 the agency is authorized to pursue certain causes of
308 action; revising procedures for a recipient to contest
309 the amount payable to the agency when federal law
310 limits reimbursement under certain circumstances;
311 requiring certain entities responsible for payment of
312 claims to provide certain records and information and
313 respond to requests for payment of claims within a
314 specified timeframe as a condition of doing business
315 in the state; providing circumstances under which such
316 parties are obligated to pay claims; deleting
317 provisions relating to cooperative agreements between
318 the agency, the Office of Insurance Regulation, and
319 the Department of Revenue; providing an effective
320 date.