Florida Senate - 2024                          SENATOR AMENDMENT
       Bill No. HB 7089, 1st Eng.
       
       
       
       
       
       
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                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/WD/2R         .                                
             03/08/2024 10:59 AM       .                                
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       Senator Collins moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 149 - 424
    4  and insert:
    5  condition. The facility must provide the estimate to the patient
    6  or prospective patient within 7 business days after the receipt
    7  of the request and is not required to adjust the estimate for
    8  any potential insurance coverage. The facility must provide the
    9  estimate to the patient’s health insurer, as defined in s.
   10  627.446(1), and the patient at least 3 business days before the
   11  date such service is to be provided, but no later than 1
   12  business day after the date such service is scheduled or, in the
   13  case of a service scheduled at least 10 business days in
   14  advance, no later than 3 business days after the date the
   15  service is scheduled. The facility must provide the estimate to
   16  the patient no later than 3 business days after the date the
   17  patient requests an estimate. The estimate may be based on the
   18  descriptive service bundles developed by the agency under s.
   19  408.05(3)(c) unless the patient or prospective patient requests
   20  a more personalized and specific estimate that accounts for the
   21  specific condition and characteristics of the patient or
   22  prospective patient. The facility shall inform the patient or
   23  prospective patient that he or she may contact his or her health
   24  insurer or health maintenance organization for additional
   25  information concerning cost-sharing responsibilities.
   26         2. In the estimate, the facility shall provide to the
   27  patient or prospective patient information on the facility’s
   28  financial assistance policy, including the application process,
   29  payment plans, and discounts and the facility’s charity care
   30  policy and collection procedures.
   31         3. The estimate shall clearly identify any facility fees
   32  and, if applicable, include a statement notifying the patient or
   33  prospective patient that a facility fee is included in the
   34  estimate, the purpose of the fee, and that the patient may pay
   35  less for the procedure or service at another facility or in
   36  another health care setting.
   37         4. Upon request, The facility shall notify the patient or
   38  prospective patient of any revision to the estimate.
   39         5. In the estimate, the facility must notify the patient or
   40  prospective patient that services may be provided in the health
   41  care facility by the facility as well as by other health care
   42  providers that may separately bill the patient, if applicable.
   43         6.The facility shall take action to educate the public
   44  that such estimates are available upon request.
   45         6.7. Failure to timely provide the estimate pursuant to
   46  this paragraph shall result in a daily fine of $1,000 until the
   47  estimate is provided to the patient or prospective patient and
   48  the health insurer. The total fine per patient estimate may not
   49  exceed $10,000.
   50  
   51  The provision of an estimate does not preclude the actual
   52  charges from exceeding the estimate.
   53         (6)Each facility shall establish an internal process for
   54  reviewing and responding to grievances from patients. Such
   55  process must allow a patient to dispute charges that appear on
   56  the patient’s itemized statement or bill. The facility shall
   57  prominently post on its website and indicate in bold print on
   58  each itemized statement or bill the instructions for initiating
   59  a grievance and the direct contact information required to
   60  initiate the grievance process. The facility must provide an
   61  initial response to a patient grievance within 7 business days
   62  after the patient formally files a grievance disputing all or a
   63  portion of an itemized statement or bill.
   64         (7)Each licensed facility shall disclose to a patient, a
   65  prospective patient, or a patient’s legal guardian whether a
   66  cost-sharing obligation for a particular covered health care
   67  service or item exceeds the charge that applies to an individual
   68  who pays cash or the cash equivalent for the same health care
   69  service or item in the absence of health insurance coverage.
   70  Failure to provide a disclosure in compliance with this
   71  subsection may result in a fine not to exceed $500 per incident.
   72         Section 4. Section 395.3011, Florida Statutes, is created
   73  to read:
   74         395.3011Billing and collection activities.—
   75         (1)As used in this section, the term “extraordinary
   76  collection action” means any of the following actions taken by a
   77  licensed facility against an individual in relation to obtaining
   78  payment of a bill for care covered under the facility’s
   79  financial assistance policy:
   80         (a)Selling the individual’s debt to another party.
   81         (b)Reporting adverse information about the individual to
   82  consumer credit reporting agencies or credit bureaus.
   83         (c)Deferring, denying, or requiring a payment before
   84  providing medically necessary care because of the individual’s
   85  nonpayment of one or more bills for previously provided care
   86  covered under the facility’s financial assistance policy.
   87         (d)Actions that require a legal or judicial process,
   88  including, but not limited to:
   89         1.Placing a lien on the individual’s property;
   90         2.Foreclosing on the individual’s real property;
   91         3.Attaching or seizing the individual’s bank account or
   92  any other personal property;
   93         4.Commencing a civil action against the individual;
   94         5.Causing the individual’s arrest; or
   95         6.Garnishing the individual’s wages.
   96         (2)A facility may not engage in an extraordinary
   97  collection action against an individual to obtain payment for
   98  services:
   99         (a)Before the facility has made reasonable efforts to
  100  determine whether the individual is eligible for assistance
  101  under its financial assistance policy for the care provided and,
  102  if eligible, before a decision is made by the facility on the
  103  patient’s application for such financial assistance.
  104         (b)Before the facility has provided the individual with an
  105  itemized statement or bill.
  106         (c)During an ongoing grievance process as described in s.
  107  395.301(6) or an ongoing appeal of a claim adjudication.
  108         (d)Before billing any applicable insurer and allowing the
  109  insurer to adjudicate a claim.
  110         (e)For 30 days after notifying the patient in writing, by
  111  certified mail, or by other traceable delivery method, that a
  112  collection action will commence absent additional action by the
  113  patient.
  114         (f)While the individual:
  115         1. Negotiates in good faith the final amount of a bill for
  116  services rendered; or
  117         2. Complies with all terms of a payment plan with the
  118  facility.
  119         Section 5. Paragraph (b) of subsection (1) of section
  120  624.27, Florida Statutes, is amended to read:
  121         624.27 Direct health care agreements; exemption from code.—
  122         (1) As used in this section, the term:
  123         (b) “Health care provider” means a health care provider
  124  licensed under chapter 458, chapter 459, chapter 460, chapter
  125  461, chapter 464, or chapter 466, chapter 490, or chapter 491,
  126  or a health care group practice, who provides health care
  127  services to patients.
  128         Section 6. Section 627.446, Florida Statutes, is created to
  129  read:
  130         627.446Advanced explanation of benefits.—
  131         (1)As used in this section, the term “health insurer”
  132  means a health insurer issuing individual or group coverage or a
  133  health maintenance organization issuing coverage through an
  134  individual or a group contract.
  135         (2)Each health insurer shall prepare an advanced
  136  explanation of benefits upon receiving a patient estimate from a
  137  facility pursuant to s. 395.301(1). The health insurer must
  138  provide the advanced explanation of benefits to the insured no
  139  later than 1 business day after receiving the patient estimate
  140  from the facility or, in the case of a service scheduled at
  141  least 10 business days in advance, no later than 3 business days
  142  after receiving such estimate. The health insurer must provide
  143  an advanced explanation of benefits to the insured no later than
  144  3 business days after the date on which the health insurer
  145  receives a request from the insured.
  146         (3)At a minimum, the advanced explanation of benefits must
  147  include detailed coverage and cost-sharing information pursuant
  148  to the No Surprises Act, Title I of Division BB of the
  149  Consolidated Appropriations Act, 2021, Pub. L. No. 116-260.
  150         Section 7. Paragraph (b) of subsection (2) and paragraph
  151  (a) of subsection (4) of section 627.6387, Florida Statutes, are
  152  amended to read:
  153         627.6387 Shared savings incentive program.—
  154         (2) As used in this section, the term:
  155         (b) “Health insurer” means an authorized insurer issuing
  156  major medical or other comprehensive coverage through an
  157  individual policy offering health insurance as defined in s.
  158  624.603.
  159         (4)(a) A shared savings incentive offered by a health
  160  insurer in accordance with this section:
  161         1. Is not an administrative expense for rate development or
  162  rate filing purposes and shall be counted as a medical expense
  163  for such purposes.
  164         2. Does not constitute an unfair method of competition or
  165  an unfair or deceptive act or practice under s. 626.9541 and is
  166  presumed to be appropriate unless credible data clearly
  167  demonstrates otherwise.
  168         Section 8. Paragraph (b) of subsection (2) and paragraph
  169  (a) of subsection (4) of section 627.6648, Florida Statutes, are
  170  amended to read:
  171         627.6648 Shared savings incentive program.—
  172         (2) As used in this section, the term:
  173         (b) “Health insurer” means an authorized insurer issuing
  174  major medical or other comprehensive coverage through a group
  175  policy offering health insurance as defined in s. 624.603. The
  176  term does not include the state group health insurance program
  177  provided under s. 110.123.
  178         (4)(a) A shared savings incentive offered by a health
  179  insurer in accordance with this section:
  180         1. Is not an administrative expense for rate development or
  181  rate filing purposes and shall be counted as a medical expense
  182  for such purposes.
  183         2. Does not constitute an unfair method of competition or
  184  an unfair or deceptive act or practice under s. 626.9541 and is
  185  presumed to be appropriate unless credible data clearly
  186  demonstrates otherwise.
  187         Section 9. Paragraph (b) of subsection (2) and paragraph
  188  (a) of subsection (4) of section 641.31076, Florida Statutes,
  189  are amended to read:
  190         641.31076 Shared savings incentive program.—
  191         (2) As used in this section, the term:
  192         (b) “Health maintenance organization” means an authorized
  193  health maintenance organization issuing major medical or other
  194  comprehensive coverage through individual or group contract has
  195  the same meaning as provided in s. 641.19. The term does not
  196  include the state group health insurance program provided under
  197  s. 110.123.
  198         (4) A shared savings incentive offered by a health
  199  maintenance organization in accordance with this section:
  200         (a) Is not an administrative expense for rate development
  201  or rate filing purposes and shall be counted as a medical
  202  expense for such purposes.
  203         Section 10. Paragraphs (a) and (j) of subsection (1) of
  204  section 475.01, Florida Statutes, are amended to read:
  205         475.01 Definitions.—
  206         (1) As used in this part:
  207         (a) “Broker” means a person who, for another, and for a
  208  compensation or valuable consideration directly or indirectly
  209  paid or promised, expressly or impliedly, or with an intent to
  210  collect or receive a compensation or valuable consideration
  211  therefor, appraises, auctions, sells, exchanges, buys, rents, or
  212  offers, attempts or agrees to appraise, auction, or negotiate
  213  the sale, exchange, purchase, or rental of business enterprises
  214  or business opportunities or any real property or any interest
  215  in or concerning the same, including mineral rights or leases,
  216  or who advertises or holds out to the public by any oral or
  217  printed solicitation or representation that she or he is engaged
  218  in the business of appraising, auctioning, buying, selling,
  219  exchanging, leasing, or renting business enterprises or business
  220  opportunities or real property of others or interests therein,
  221  including mineral rights, or who takes any part in the procuring
  222  of sellers, purchasers, lessors, or lessees of business
  223  enterprises or business opportunities or the real property of
  224  another, or leases, or interest therein, including mineral
  225  rights, or who directs or assists in the procuring of prospects
  226  or in the negotiation or closing of any transaction which does,
  227  or is calculated to, result in a sale, exchange, or leasing
  228  thereof, and who receives, expects, or is promised any
  229  compensation or valuable consideration, directly or indirectly
  230  therefor; and all persons who advertise rental property
  231  information or lists. A broker renders a professional service
  232  and is a professional within the meaning of s. 95.11(5)(b) s.
  233  95.11(4)(b). Where the term “appraise” or “appraising” appears
  234  in the definition of the term “broker,” it specifically excludes
  235  those appraisal services which must be performed only by a
  236  state-licensed or state-certified appraiser, and those appraisal
  237  services which may be performed by a registered trainee
  238  appraiser as defined in part II. The term “broker” also includes
  239  any person who is a general partner, officer, or director of a
  240  partnership or corporation which acts as a broker. The term
  241  “broker” also includes any person or entity who undertakes to
  242  list or sell one or more timeshare periods per year in one or
  243  more timeshare plans on behalf of any number of persons, except
  244  as provided in ss. 475.011 and 721.20.
  245         (j) “Sales associate” means a person who performs any act
  246  specified in the definition of “broker,” but who performs such
  247  act under the direction, control, or management of another
  248  person. A sales associate renders a professional service and is
  249  a professional within the meaning of s. 95.11(5)(b) s.
  250  95.11(4)(b).
  251         Section 11. Paragraph (h) of subsection (1) of section
  252  475.611, Florida Statutes, is amended to read:
  253         475.611 Definitions.—
  254         (1) As used in this part, the term:
  255         (h) “Appraiser” means any person who is a registered
  256  trainee real estate appraiser, a licensed real estate appraiser,
  257  or a certified real estate appraiser. An appraiser renders a
  258  professional service and is a professional within the meaning of
  259  s. 95.11(5)(b) s. 95.11(4)(b).
  260         Section 12. Subsection (7) of section 517.191, Florida
  261  Statutes, is amended to read:
  262         517.191 Injunction to restrain violations; civil penalties;
  263  enforcement by Attorney General.—
  264         (7) Notwithstanding s. 95.11(5)(f) s. 95.11(4)(f), an
  265  enforcement action brought under this section based on a
  266  violation of any provision of this chapter or any rule or order
  267  issued under this chapter shall be brought within 6 years after
  268  the facts giving rise to the cause of action were discovered or
  269  should have been discovered with the exercise of due diligence,
  270  but not more than 8 years after the date such violation
  271  occurred.
  272         Section 13. Subsection (14) of section 768.28, Florida
  273  Statutes, is amended to read:
  274         768.28 Waiver of sovereign immunity in tort actions;
  275  recovery limits; civil liability for damages caused during a
  276  riot; limitation on attorney fees; statute of limitations;
  277  exclusions; indemnification; risk management programs.—
  278         (14) Every claim against the state or one of its agencies
  279  or subdivisions for damages for a negligent or wrongful act or
  280  omission pursuant to this section shall be forever barred unless
  281  the civil action is commenced by filing a complaint in the court
  282  of appropriate jurisdiction within 4 years after such claim
  283  accrues; except that an action for contribution must be
  284  commenced within the limitations provided in s. 768.31(4), and
  285  an action for damages arising from medical malpractice or
  286  wrongful death must be commenced within the limitations for such
  287  actions in s. 95.11(5) s. 95.11(4).
  288         Section 14. Subsection (4) of section 787.061, Florida
  289  Statutes, is amended to read:
  290         787.061 Civil actions by victims of human trafficking.—
  291         (4) STATUTE OF LIMITATIONS.—The statute of limitations as
  292  specified in s. 95.11(8) or (10) s. 95.11(7) or (9), as
  293  applicable, governs an action brought under this section.
  294         Section 15. The requirements of s. 395.301(1)(b), Florida
  295  Statutes, as created by this act, relating to shoppable health
  296  care services, do not apply to ambulatory surgical centers as
  297  defined in s. 395.002, Florida Statutes, until January 1, 2026.
  298         Section 16. The changes made by this act to s. 395.301,
  299  Florida Statutes, relating to good faith estimates, are not
  300  effective until the United States Department of Health and Human
  301  Services, the United States Department of Labor, and the United
  302  States Department of the Treasury issue a final rule pertaining
  303  to good faith estimates required by section 2799B-6 of the
  304  Public Health Services Act. The Agency for Health Care
  305  Administration shall notify the Division of Law Revision upon
  306  the promulgation of the final rule.
  307         Section 17. The changes made by this act to s. 627.446,
  308  Florida Statutes, relating to advanced explanation of benefits,
  309  are not effective until the United States Department of Health
  310  and Human Services, the United States Department of Labor, and
  311  the United States Department of the Treasury issue final rules
  312  pertaining to advanced explanation of benefits required by
  313  section 2799A-1(f) of the Public Health Services and good faith
  314  estimates required by section 2799B-6 of the Public Health
  315  Services Act. The Office of Insurance Regulation shall notify
  316  the Division of Law Revision upon the promulgation of the final
  317  rule pertaining to advanced explanation of benefits.
  318         Section 18. This act shall take effect July 1, 2024.
  319  
  320  ================= T I T L E  A M E N D M E N T ================
  321  And the title is amended as follows:
  322         Delete lines 33 - 46
  323  and insert:
  324         explanation of benefits within specified timeframes;
  325         providing requirements for the advanced explanation of
  326         benefits; amending ss. 627.6387 and 627.6648, F.S.;
  327         revising the definition of the term “health insurer”;
  328         providing that a shared savings incentive offered by a
  329         health insurer constitutes a medical expense for rate
  330         development and rate filing purposes for individual
  331         and group health insurance policies, respectively;
  332         amending s. 641.31076, F.S.; revising the definition
  333         of the term “health maintenance organization”;
  334         providing that a shared savings incentive offered by a
  335         health maintenance organization constitutes a medical
  336         expense for rate development and rate filing purposes
  337         for individual or group health maintenance contracts;
  338         amending ss. 475.01, 475.611, 517.191, 768.28, and
  339         787.061, F.S.; conforming provisions to changes made
  340         by the act; providing applicability; requiring the
  341         Agency for Health Care Administration and the Office
  342         of Insurance Regulation to notify the Division of Law
  343         Revision upon the promulgation of certain federal
  344         rules; providing an