Florida Senate - 2021                                    SB 1952
       
       
        
       By Senator Rodrigues
       
       
       
       
       
       27-01446-21                                           20211952__
    1                        A bill to be entitled                      
    2         An act relating to health care expenses; creating s.
    3         222.26, F.S.; providing additional personal property
    4         exemptions from legal process for medical debts
    5         resulting from services provided in certain licensed
    6         facilities; amending s. 395.301, F.S.; requiring a
    7         licensed facility to post on its website a consumer
    8         friendly list of standard charges for shoppable health
    9         care services; defining the term “shoppable health
   10         care service”; requiring a licensed facility to
   11         establish an internal grievance process for patients
   12         to dispute charges; requiring a facility to make
   13         available the information necessary for initiating a
   14         grievance; requiring a facility to respond to a
   15         patient grievance within a specified timeframe;
   16         revising a requirement that a licensed facility
   17         provide a cost estimate to a patient or prospective
   18         patient and the patient’s health insurer within
   19         specified timeframes; prohibiting a licensed facility
   20         from charging a patient an amount that exceeds such
   21         cost estimate by a set threshold; requiring a licensed
   22         facility to provide a patient with a written
   23         explanation of excess charges under certain
   24         circumstances; requiring a facility to notify a
   25         patient of revisions to a cost estimate; deleting a
   26         requirement that a facility educate the public on the
   27         availability of such estimates upon request; revising
   28         a penalty for failure to timely provide the estimate;
   29         prohibiting a facility from billing or collecting any
   30         amount of charges from the patient or the patient’s
   31         health insurer for treatment under certain
   32         circumstances; deleting a prohibition on charges that
   33         exceed a cost estimate; creating s. 395.3011, F.S.;
   34         defining the term “extraordinary collection action”;
   35         prohibiting a licensed facility from engaging in
   36         extraordinary collection actions to obtain certain
   37         payments; creating s. 627.445, F.S.; defining the term
   38         “health insurer”; requiring each health insurer to
   39         provide an insured with an advance explanation of
   40         benefits after receiving a patient estimate from a
   41         facility for scheduled services; providing
   42         requirements for the advanced explanation of benefits;
   43         amending ss. 627.6387, 627.6648, and 641.31076, F.S.;
   44         providing that a shared savings incentive offered by a
   45         health insurer or a health maintenance organization
   46         must be counted as a medical expense for rate
   47         development and rate filing purposes; providing
   48         effective dates.
   49          
   50  Be It Enacted by the Legislature of the State of Florida:
   51  
   52         Section 1. Section 222.26, Florida Statutes, is created to
   53  read:
   54         222.26Additional exemptions from legal process concerning
   55  medical debt.—If a debt is owed for medical services provided by
   56  a facility licensed under chapter 395, the following property is
   57  exempt from attachment, garnishment, or other legal process:
   58         (1)A debtor’s interest, not to exceed $10,000 in value, in
   59  a single motor vehicle as defined in s. 320.01(1).
   60         (2)A debtor’s interest in personal property, not to exceed
   61  $10,000 in value, if the debtor does not claim or receive the
   62  benefits of a homestead exemption under s. 4, Art. X of the
   63  State Constitution.
   64         Section 2. Present paragraphs (b), (c), and (d) of
   65  subsection (1) of section 395.301, Florida Statutes, are
   66  redesignated as paragraphs (c), (d), and (e), respectively,
   67  present subsection (6) of that section is redesignated as
   68  subsection (7), a new paragraph (b) is added to subsection (1)
   69  of that section, and a new subsection (6) is added to that
   70  section, to read:
   71         395.301 Price transparency; itemized patient statement or
   72  bill; patient admission status notification.—
   73         (1) A facility licensed under this chapter shall provide
   74  timely and accurate financial information and quality of service
   75  measures to patients and prospective patients of the facility,
   76  or to patients’ survivors or legal guardians, as appropriate.
   77  Such information shall be provided in accordance with this
   78  section and rules adopted by the agency pursuant to this chapter
   79  and s. 408.05. Licensed facilities operating exclusively as
   80  state facilities are exempt from this subsection.
   81         (b)Each licensed facility shall post on its website a
   82  consumer-friendly list of standard charges for at least 300
   83  shoppable health care services. If a facility provides fewer
   84  than 300 distinct shoppable health care services, it must make
   85  available on its website the standard charges for each service
   86  it provides. As used in this paragraph, the term “shoppable
   87  health care service” means a health care service that can be
   88  scheduled by a health care consumer in advance. The term
   89  includes, but is not limited to, the services described in s.
   90  627.6387(2)(e) and any services defined in regulations or
   91  guidance issued by the United States Department of Health and
   92  Human Services.
   93         (6)Each facility shall establish an internal process for
   94  reviewing and responding to grievances from patients. Such
   95  process must allow patients to dispute charges that appear on
   96  the patient’s itemized statement or bill. The facility shall
   97  prominently post on its website and indicate in bold print on
   98  each itemized statement or bill the instructions for initiating
   99  a grievance and the direct contact information required to
  100  initiate the grievance process. The facility must provide an
  101  initial response to a patient grievance within 7 business days
  102  after the patient formally files a grievance disputing all or a
  103  portion of an itemized statement or bill.
  104         Section 3. Effective July 1, 2022, paragraph (c) of
  105  subsection (1) of section 395.301, Florida Statutes, as amended
  106  by this act, is amended to read:
  107         395.301 Price transparency; itemized patient statement or
  108  bill; patient admission status notification.—
  109         (1) A facility licensed under this chapter shall provide
  110  timely and accurate financial information and quality of service
  111  measures to patients and prospective patients of the facility,
  112  or to patients’ survivors or legal guardians, as appropriate.
  113  Such information shall be provided in accordance with this
  114  section and rules adopted by the agency pursuant to this chapter
  115  and s. 408.05. Licensed facilities operating exclusively as
  116  state facilities are exempt from this subsection.
  117         (c)1. Upon request, and before providing any nonemergency
  118  medical services, Each licensed facility shall provide in
  119  writing or by electronic means a good faith estimate of
  120  reasonably anticipated charges by the facility for the treatment
  121  of a the patient’s or prospective patient’s specific condition.
  122  Such estimate must be provided to the patient or prospective
  123  patient after scheduling a medical service. The facility must
  124  provide the estimate to the patient or prospective patient
  125  within 7 business days after the receipt of the request and is
  126  not required to adjust the estimate for any potential insurance
  127  coverage. However, the facility must provide the estimate to the
  128  patient’s health insurer, as defined in s. 627.445(1), and the
  129  patient at least 3 business days before a service is to be
  130  furnished, but no later than 1 business day after the service is
  131  scheduled, or, in the case of a service scheduled at least 10
  132  business days in advance, no later than 3 business days after
  133  the service is scheduled. The estimate may be based on the
  134  descriptive service bundles developed by the agency under s.
  135  408.05(3)(c) unless the patient or prospective patient requests
  136  a more personalized and specific estimate that accounts for the
  137  specific condition and characteristics of the patient or
  138  prospective patient. The facility shall inform the patient or
  139  prospective patient that he or she may contact his or her health
  140  insurer or health maintenance organization for additional
  141  information concerning cost-sharing responsibilities. The
  142  facility may not charge the patient more than 110 percent of the
  143  estimate. However, if the facility determines that such charges
  144  are warranted due to unforeseen circumstances or the provision
  145  of additional services, the facility must provide the patient
  146  with a written explanation of the excess charges as part of the
  147  detailed, itemized statement or bill to the patient.
  148         2. In the estimate, the facility shall provide to the
  149  patient or prospective patient information on the facility’s
  150  financial assistance policy, including the application process,
  151  payment plans, and discounts and the facility’s charity care
  152  policy and collection procedures.
  153         3. The estimate shall clearly identify any facility fees
  154  and, if applicable, include a statement notifying the patient or
  155  prospective patient that a facility fee is included in the
  156  estimate, the purpose of the fee, and that the patient may pay
  157  less for the procedure or service at another facility or in
  158  another health care setting.
  159         4. Upon request, The facility shall notify the patient or
  160  prospective patient of any revision to the estimate.
  161         5. In the estimate, the facility must notify the patient or
  162  prospective patient that services may be provided in the health
  163  care facility by the facility as well as by other health care
  164  providers that may separately bill the patient, if applicable.
  165         6.The facility shall take action to educate the public
  166  that such estimates are available upon request.
  167         6.7. Failure to timely provide the estimate pursuant to
  168  this paragraph shall result in a daily fine of $1,000 until the
  169  estimate is provided to the patient or prospective patient and
  170  the health insurer. The total fine per patient estimate may not
  171  exceed $10,000.
  172         7.If the facility fails to provide the estimate more than
  173  24 hours before beginning the treatment that is the subject of
  174  the estimate required by this section, the facility may not bill
  175  the patient or the patient’s health insurer or collect any
  176  amount of charges from any source for such treatment.
  177  
  178  The provision of an estimate does not preclude the actual
  179  charges from exceeding the estimate.
  180         Section 4. Section 395.3011, Florida Statutes, is created
  181  to read:
  182         395.3011Billing and collection activities.—
  183         (1)As used in this section, the term “extraordinary
  184  collection action” means any of the following actions taken by a
  185  licensed facility against an individual in relation to obtaining
  186  payment of a bill for care covered under the facility’s
  187  financial assistance policy:
  188         (a)Selling the individual’s debt to another party.
  189         (b)Reporting adverse information about the individual to
  190  consumer credit reporting agencies or credit bureaus.
  191         (c)Deferring, denying, or requiring a payment before
  192  providing medically necessary care because of the individual’s
  193  nonpayment of one or more bills for previously provided care
  194  covered under the facility’s financial assistance policy.
  195         (d)Actions that require a legal or judicial process,
  196  including, but not limited to:
  197         1.Placing a lien on the individual’s property;
  198         2.Foreclosing on the individual’s real property;
  199         3.Attaching or seizing the individual’s bank account or
  200  any other personal property;
  201         4.Commencing a civil action against the individual;
  202         5.Causing the individual’s arrest; or
  203         6.Garnishing the individual’s wages.
  204         (2)A facility may not engage in an extraordinary
  205  collection action against an individual to obtain payment for
  206  services:
  207         (a)Before the facility has made reasonable efforts to
  208  determine whether the individual is eligible for assistance
  209  under its financial assistance policy for the care provided.
  210         (b)Before the facility has provided the individual with an
  211  itemized statement or bill.
  212         (c)During an ongoing grievance process as described in s.
  213  395.301(6).
  214         (d)Before billing any applicable insurer and allowing the
  215  insurer to adjudicate a claim.
  216         (e)For 30 days after notifying the patient in writing, by
  217  certified mail or other traceable delivery method, that a
  218  collection action will commence absent additional action by the
  219  patient.
  220         Section 5. Effective July 1, 2022, section 627.445, Florida
  221  Statutes, is created to read:
  222         627.445Advanced explanation of benefits.—
  223         (1)As used in this section, the term “health insurer”
  224  means a health insurer issuing individual or group coverage or a
  225  health maintenance organization issuing coverage through an
  226  individual or group contract.
  227         (2)Each health insurer shall prepare an advanced
  228  explanation of benefits upon receiving a patient estimate from a
  229  facility pursuant to s. 395.301(1). The health insurer must
  230  provide the advanced explanation of benefits to the insured no
  231  later than 1 business day after receiving the patient estimate
  232  from the facility, or, in the case of a service scheduled at
  233  least 10 business days in advance, no later than 3 business days
  234  after receiving such estimate.
  235         (3)At a minimum, the advanced explanation of benefits must
  236  include detailed coverage and cost-sharing information pursuant
  237  to the No Surprises Act, Title I of Division BB, Pub. L. No.
  238  116-260.
  239         Section 6. Paragraph (a) of subsection (4) of section
  240  627.6387, Florida Statutes, is amended to read:
  241         627.6387 Shared savings incentive program.—
  242         (4)(a) A shared savings incentive offered by a health
  243  insurer in accordance with this section:
  244         1. Is not an administrative expense for rate development or
  245  rate filing purposes and must be counted as a medical expense
  246  for such purposes.
  247         2. Does not constitute an unfair method of competition or
  248  an unfair or deceptive act or practice under s. 626.9541 and is
  249  presumed to be appropriate unless credible data clearly
  250  demonstrates otherwise.
  251         Section 7. Paragraph (a) of subsection (4) of section
  252  627.6648, Florida Statutes, is amended to read:
  253         627.6648 Shared savings incentive program.—
  254         (4)(a) A shared savings incentive offered by a health
  255  insurer in accordance with this section:
  256         1. Is not an administrative expense for rate development or
  257  rate filing purposes and must be counted as a medical expense
  258  for such purposes.
  259         2. Does not constitute an unfair method of competition or
  260  an unfair or deceptive act or practice under s. 626.9541 and is
  261  presumed to be appropriate unless credible data clearly
  262  demonstrates otherwise.
  263         Section 8. Paragraph (a) of subsection (4) of section
  264  641.31076, Florida Statutes, is amended to read:
  265         641.31076 Shared savings incentive program.—
  266         (4) A shared savings incentive offered by a health
  267  maintenance organization in accordance with this section:
  268         (a) Is not an administrative expense for rate development
  269  or rate filing purposes and must be counted as a medical expense
  270  for such purposes.
  271         Section 9. Except as otherwise expressly provided in this
  272  act, this act shall take effect July 1, 2021.