Florida Senate - 2017                        COMMITTEE AMENDMENT
       Bill No. SB 1550
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/04/2017           .                                

       The Committee on Health Policy (Artiles) recommended the
    1         Senate Amendment (with title amendment)
    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.
  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.