Florida Senate - 2023                                     SB 268
       By Senator Brodeur
       10-00729-23                                            2023268__
    1                        A bill to be entitled                      
    2         An act relating to health care expenses; amending s.
    3         95.11, F.S.; establishing a 3-year statute of
    4         limitations for an action to collect medical debt for
    5         services rendered by a health care provider or
    6         facility; creating s. 222.26, F.S.; providing
    7         additional personal property exemptions from legal
    8         process for medical debts resulting from services
    9         provided in certain licensed facilities; amending s.
   10         395.301, F.S.; requiring a licensed facility to post
   11         on its website a consumer-friendly list of standard
   12         charges for a minimum number of shoppable health care
   13         services; defining the terms “shoppable health care
   14         service” and “standard charge”; requiring a licensed
   15         facility to provide an estimate to a patient or
   16         prospective patient and the patient’s health insurer
   17         within specified timeframes; requiring a licensed
   18         facility to establish an internal grievance process
   19         for patients to dispute charges; requiring a facility
   20         to make available information necessary for initiating
   21         a grievance; requiring a facility to respond to a
   22         patient grievance within a specified timeframe;
   23         creating s. 395.3011, F.S.; defining the term
   24         “extraordinary collection action”; prohibiting certain
   25         collection activities by a licensed facility; creating
   26         s. 627.445, F.S.; defining the term “health insurer”;
   27         requiring each health insurer to provide an insured
   28         with an advance explanation of benefits after
   29         receiving a patient estimate from a facility for
   30         scheduled services; providing requirements for the
   31         advance explanation of benefits; amending ss.
   32         627.6387, 627.6648, and 641.31076, F.S.; providing
   33         that a shared savings incentive offered by a health
   34         insurer or health maintenance organization constitutes
   35         a medical expense for rate development and rate filing
   36         purposes; amending ss. 475.01, 475.611, 517.191, and
   37         768.28, F.S.; conforming cross-references; providing
   38         an effective date.
   40  Be It Enacted by the Legislature of the State of Florida:
   42         Section 1. Present subsections (4) through (11) of section
   43  95.11, Florida Statutes, are redesignated as subsections (5)
   44  through (12), a new subsection (4) is added to that section, and
   45  paragraph (o) of subsection (3) and paragraphs (f) and (g) of
   46  present subsection (5) of that section are amended, to read:
   47         95.11 Limitations other than for the recovery of real
   48  property.—Actions other than for recovery of real property shall
   49  be commenced as follows:
   50         (3) WITHIN FOUR YEARS.—
   51         (o) An action for assault, battery, false arrest, malicious
   52  prosecution, malicious interference, false imprisonment, or any
   53  other intentional tort, except as provided in subsections (5),
   54  (6), and (8) (4), (5), and (7).
   55         (4)WITHIN THREE YEARS.—An action to collect medical debt
   56  for services rendered by a facility licensed under chapter 395,
   57  provided that the period of limitations shall run from the date
   58  on which the facility refers the medical debt to a third party
   59  for collection.
   60         (6)(5) WITHIN ONE YEAR.—
   61         (f) Except for actions described in subsection (9) (8), a
   62  petition for extraordinary writ, other than a petition
   63  challenging a criminal conviction, filed by or on behalf of a
   64  prisoner as defined in s. 57.085.
   65         (g) Except for actions described in subsection (9) (8), an
   66  action brought by or on behalf of a prisoner, as defined in s.
   67  57.085, relating to the conditions of the prisoner’s
   68  confinement.
   69         Section 2. Section 222.26, Florida Statutes, is created to
   70  read:
   71         222.26Additional exemptions from legal process concerning
   72  medical debt.—If a debt is owed for medical services provided by
   73  a facility licensed under chapter 395, the following property is
   74  exempt from attachment, garnishment, or other legal process in
   75  an action on such debt:
   76         (1)A debtor’s interest, not to exceed $10,000 in value, in
   77  a single motor vehicle as defined in s. 320.01(1).
   78         (2)A debtor’s interest in personal property, not to exceed
   79  $10,000 in value, if the debtor does not claim or receive the
   80  benefits of a homestead exemption under s. 4, Art. X of the
   81  State Constitution.
   82         Section 3. Present paragraphs (b), (c), and (d) of
   83  subsection (1) of section 395.301, Florida Statutes, are
   84  redesignated as paragraphs (c), (d), and (e), respectively,
   85  present subsection (6) of that section is redesignated as
   86  subsection (7), a new paragraph (b) is added to subsection (1)
   87  of that section, a new subsection (6) is added to that section,
   88  and present paragraph (b) of subsection (1) of that section is
   89  amended, to read:
   90         395.301 Price transparency; itemized patient statement or
   91  bill; patient admission status notification.—
   92         (1) A facility licensed under this chapter shall provide
   93  timely and accurate financial information and quality of service
   94  measures to patients and prospective patients of the facility,
   95  or to patients’ survivors or legal guardians, as appropriate.
   96  Such information shall be provided in accordance with this
   97  section and rules adopted by the agency pursuant to this chapter
   98  and s. 408.05. Licensed facilities operating exclusively as
   99  state facilities are exempt from this subsection.
  100         (b)Each licensed facility shall post on its website a
  101  consumer-friendly list of standard charges for at least 300
  102  shoppable health care services. If a facility provides fewer
  103  than 300 distinct shoppable health care services, it must make
  104  available on its website the standard charges for each service
  105  it provides. As used in this paragraph, the term:
  106         1.“Shoppable health care service” means a service that can
  107  be scheduled by a health care consumer in advance. The term
  108  includes, but is not limited to, the services described in s.
  109  627.6387(2)(e) and any services defined in regulations or
  110  guidance issued by the United States Department of Health and
  111  Human Services.
  112         2.“Standard charge” has the same meaning as that term is
  113  defined in regulations or guidance issued by the United States
  114  Department of Health and Human Services for purposes of hospital
  115  price transparency.
  116         (c)(b)1. Upon request, and Before providing any
  117  nonemergency medical services, each licensed facility shall
  118  provide in writing or by electronic means a good faith estimate
  119  of reasonably anticipated charges by the facility for the
  120  treatment of a the patient’s or prospective patient’s specific
  121  condition. Such estimate must be provided to the patient or
  122  prospective patient upon scheduling a medical service. The
  123  facility must provide the estimate to the patient or prospective
  124  patient within 7 business days after the receipt of the request
  125  and is not required to adjust the estimate for any potential
  126  insurance coverage. The facility shall provide the estimate to
  127  the patient’s health insurer, as defined in s. 627.445(1), and
  128  to the patient at least 3 business days before a service is to
  129  be furnished, but no later than 1 business day after the service
  130  is scheduled or, in the case of a service scheduled at least 10
  131  business days in advance, no later than 3 business days after
  132  the service is scheduled. The estimate may be based on the
  133  descriptive service bundles developed by the agency under s.
  134  408.05(3)(c) unless the patient or prospective patient requests
  135  a more personalized and specific estimate that accounts for the
  136  specific condition and characteristics of the patient or
  137  prospective patient. The facility shall inform the patient or
  138  prospective patient that he or she may contact his or her health
  139  insurer or health maintenance organization for additional
  140  information concerning cost-sharing responsibilities.
  141         2. In the estimate, the facility shall provide to the
  142  patient or prospective patient information on the facility’s
  143  financial assistance policy, including the application process,
  144  payment plans, and discounts and the facility’s charity care
  145  policy and collection procedures.
  146         3. The estimate must shall clearly identify any facility
  147  fees and, if applicable, include a statement notifying the
  148  patient or prospective patient that a facility fee is included
  149  in the estimate, the purpose of the fee, and that the patient
  150  may pay less for the procedure or service at another facility or
  151  in another health care setting.
  152         4. Upon request, The facility shall notify the patient or
  153  prospective patient of any revision to the estimate.
  154         5. In the estimate, the facility must notify the patient or
  155  prospective patient that services may be provided in the health
  156  care facility by the facility as well as by other health care
  157  providers that may separately bill the patient, if applicable.
  158         6. The facility shall take action to educate the public
  159  that such estimates are available upon request.
  160         7. Failure to timely provide the estimate pursuant to this
  161  paragraph shall result in a daily fine of $1,000 until the
  162  estimate is provided to the patient or prospective patient and
  163  the health insurer. The total fine per patient estimate may not
  164  exceed $10,000.
  166  The provision of an estimate does not preclude the actual
  167  charges from exceeding the estimate.
  168         (6)Each facility shall establish an internal process for
  169  reviewing and responding to grievances from patients. Such
  170  process must allow a patient to dispute charges that appear on
  171  the patient’s itemized statement or bill. The facility shall
  172  prominently post on its website and indicate in bold print on
  173  each itemized statement or bill the instructions for initiating
  174  a grievance and the direct contact information required to
  175  initiate the grievance process. The facility must provide an
  176  initial response to a patient grievance within 7 business days
  177  after the patient formally files a grievance disputing all or a
  178  portion of an itemized statement or bill.
  179         Section 4. Section 395.3011, Florida Statutes, is created
  180  to read:
  181         395.3011Billing and collection activities.—
  182         (1)As used in this section, the term “extraordinary
  183  collection action” means any of the following actions taken by a
  184  licensed facility against an individual in relation to obtaining
  185  payment of a bill for care covered under the facility’s
  186  financial assistance policy:
  187         (a)Selling the individual’s debt to another party.
  188         (b)Reporting adverse information about the individual to
  189  consumer credit reporting agencies or credit bureaus.
  190         (c)Deferring, denying, or requiring a payment before
  191  providing medically necessary care because of the individual’s
  192  nonpayment of one or more bills for previously provided care
  193  covered under the facility’s financial assistance policy.
  194         (d)Actions that require a legal or judicial process,
  195  including, but not limited to:
  196         1.Placing a lien on the individual’s property;
  197         2.Foreclosing on the individual’s real property;
  198         3.Attaching or seizing the individual’s bank account or
  199  any other personal property;
  200         4.Commencing a civil action against the individual;
  201         5.Causing the individual’s arrest; or
  202         6.Garnishing the individual’s wages.
  203         (2)A facility may not engage in an extraordinary
  204  collection action against an individual to obtain payment for
  205  services:
  206         (a)Before the facility has made reasonable efforts to
  207  determine whether the individual is eligible for assistance
  208  under its financial assistance policy for the care provided and,
  209  if eligible, before a decision is made by the facility on the
  210  patient’s application for such financial assistance;
  211         (b)Before the facility has provided the individual with an
  212  itemized statement or bill;
  213         (c)During an ongoing grievance process as described in s.
  214  395.301(6) or an ongoing appeal of a claim adjudication;
  215         (d)Before billing any applicable insurer and allowing the
  216  insurer to adjudicate a claim;
  217         (e)For 30 days after notifying the patient in writing, by
  218  certified mail, or by other traceable delivery method, that a
  219  collection action will commence absent additional action by the
  220  patient; or
  221         (f)While the individual:
  222         1.Negotiates in good faith the final amount of a bill for
  223  services rendered; or
  224         2.Complies with all terms of a payment plan with the
  225  facility.
  226         Section 5. Section 627.445, Florida Statutes, is created to
  227  read:
  228         627.445Advance explanation of benefits.—
  229         (1)As used in this section, the term “health insurer”
  230  means a health insurer issuing individual or group coverage or a
  231  health maintenance organization issuing coverage through an
  232  individual or a group contract.
  233         (2)Each health insurer shall prepare an advance
  234  explanation of benefits upon receiving a patient estimate from a
  235  facility pursuant to s. 395.301(1). The health insurer must
  236  provide the advance explanation of benefits to the insured no
  237  later than 1 business day after receiving the patient estimate
  238  from the facility or, in the case of a service scheduled at
  239  least 10 business days in advance, no later than 3 business days
  240  after receiving such estimate.
  241         (3)At a minimum, the advance explanation of benefits must
  242  include detailed coverage and cost-sharing information pursuant
  243  to the No Surprises Act, Title I of Division BB, Pub. L. No.
  244  116-260.
  245         Section 6. Paragraph (a) of subsection (4) of section
  246  627.6387, Florida Statutes, is amended to read:
  247         627.6387 Shared savings incentive program.—
  248         (4)(a) A shared savings incentive offered by a health
  249  insurer in accordance with this section:
  250         1. Is not an administrative expense for rate development or
  251  rate filing purposes and must be counted as a medical expense
  252  for such purposes.
  253         2. Does not constitute an unfair method of competition or
  254  an unfair or deceptive act or practice under s. 626.9541 and is
  255  presumed to be appropriate unless credible data clearly
  256  demonstrates otherwise.
  257         Section 7. Paragraph (a) of subsection (4) of section
  258  627.6648, Florida Statutes, is amended to read:
  259         627.6648 Shared savings incentive program.—
  260         (4)(a) A shared savings incentive offered by a health
  261  insurer in accordance with this section:
  262         1. Is not an administrative expense for rate development or
  263  rate filing purposes and must be counted as a medical expense
  264  for such purposes.
  265         2. Does not constitute an unfair method of competition or
  266  an unfair or deceptive act or practice under s. 626.9541 and is
  267  presumed to be appropriate unless credible data clearly
  268  demonstrates otherwise.
  269         Section 8. Paragraph (a) of subsection (4) of section
  270  641.31076, Florida Statutes, is amended to read:
  271         641.31076 Shared savings incentive program.—
  272         (4) A shared savings incentive offered by a health
  273  maintenance organization in accordance with this section:
  274         (a) Is not an administrative expense for rate development
  275  or rate filing purposes and must be counted as a medical expense
  276  for such purposes.
  277         Section 9. Paragraphs (a) and (j) of subsection (1) of
  278  section 475.01, Florida Statutes, are amended to read:
  279         475.01 Definitions.—
  280         (1) As used in this part:
  281         (a) “Broker” means a person who, for another, and for a
  282  compensation or valuable consideration directly or indirectly
  283  paid or promised, expressly or impliedly, or with an intent to
  284  collect or receive a compensation or valuable consideration
  285  therefor, appraises, auctions, sells, exchanges, buys, rents, or
  286  offers, attempts or agrees to appraise, auction, or negotiate
  287  the sale, exchange, purchase, or rental of business enterprises
  288  or business opportunities or any real property or any interest
  289  in or concerning the same, including mineral rights or leases,
  290  or who advertises or holds out to the public by any oral or
  291  printed solicitation or representation that she or he is engaged
  292  in the business of appraising, auctioning, buying, selling,
  293  exchanging, leasing, or renting business enterprises or business
  294  opportunities or real property of others or interests therein,
  295  including mineral rights, or who takes any part in the procuring
  296  of sellers, purchasers, lessors, or lessees of business
  297  enterprises or business opportunities or the real property of
  298  another, or leases, or interest therein, including mineral
  299  rights, or who directs or assists in the procuring of prospects
  300  or in the negotiation or closing of any transaction which does,
  301  or is calculated to, result in a sale, exchange, or leasing
  302  thereof, and who receives, expects, or is promised any
  303  compensation or valuable consideration, directly or indirectly
  304  therefor; and all persons who advertise rental property
  305  information or lists. A broker renders a professional service
  306  and is a professional within the meaning of s. 95.11(5)(a) s.
  307  95.11(4)(a). Where the term “appraise” or “appraising” appears
  308  in the definition of the term “broker,” it specifically excludes
  309  those appraisal services which must be performed only by a
  310  state-licensed or state-certified appraiser, and those appraisal
  311  services which may be performed by a registered trainee
  312  appraiser as defined in part II. The term “broker” also includes
  313  any person who is a general partner, officer, or director of a
  314  partnership or corporation which acts as a broker. The term
  315  “broker” also includes any person or entity who undertakes to
  316  list or sell one or more timeshare periods per year in one or
  317  more timeshare plans on behalf of any number of persons, except
  318  as provided in ss. 475.011 and 721.20.
  319         (j) “Sales associate” means a person who performs any act
  320  specified in the definition of “broker,” but who performs such
  321  act under the direction, control, or management of another
  322  person. A sales associate renders a professional service and is
  323  a professional within the meaning of s. 95.11(5)(a) s.
  324  95.11(4)(a).
  325         Section 10. Paragraph (h) of subsection (1) of section
  326  475.611, Florida Statutes, is amended to read:
  327         475.611 Definitions.—
  328         (1) As used in this part, the term:
  329         (h) “Appraiser” means any person who is a registered
  330  trainee real estate appraiser, a licensed real estate appraiser,
  331  or a certified real estate appraiser. An appraiser renders a
  332  professional service and is a professional within the meaning of
  333  s. 95.11(5)(a) s. 95.11(4)(a).
  334         Section 11. Subsection (7) of section 517.191, Florida
  335  Statutes, is amended to read:
  336         517.191 Injunction to restrain violations; civil penalties;
  337  enforcement by Attorney General.—
  338         (7) Notwithstanding s. 95.11(5)(e) s. 95.11(4)(e), an
  339  enforcement action brought under this section based on a
  340  violation of any provision of this chapter or any rule or order
  341  issued under this chapter shall be brought within 6 years after
  342  the facts giving rise to the cause of action were discovered or
  343  should have been discovered with the exercise of due diligence,
  344  but not more than 8 years after the date such violation
  345  occurred.
  346         Section 12. Subsection (14) of section 768.28, Florida
  347  Statutes, is amended to read:
  348         768.28 Waiver of sovereign immunity in tort actions;
  349  recovery limits; civil liability for damages caused during a
  350  riot; limitation on attorney fees; statute of limitations;
  351  exclusions; indemnification; risk management programs.—
  352         (14) Every claim against the state or one of its agencies
  353  or subdivisions for damages for a negligent or wrongful act or
  354  omission pursuant to this section shall be forever barred unless
  355  the civil action is commenced by filing a complaint in the court
  356  of appropriate jurisdiction within 4 years after such claim
  357  accrues; except that an action for contribution must be
  358  commenced within the limitations provided in s. 768.31(4), and
  359  an action for damages arising from medical malpractice or
  360  wrongful death must be commenced within the limitations for such
  361  actions in s. 95.11(5) s. 95.11(4).
  362         Section 13. This act shall take effect July 1, 2023.