HB 1435

1	A bill to be entitled
2	An act relating to disclosure of health care financial
3	information; providing a short title; amending s. 212.08,
4	F.S.; requiring a hospital to meet certain community
5	benefits requirements to retain tax-exempt status;
6	providing definitions; providing duties of tax-exempt
7	hospitals; providing reporting requirements; requiring
8	annual reports of community benefits plans to be available
9	to the public, upon request; requiring a hospital to
10	provide certain notice to health care consumers relating
11	to eligibility for charity care; authorizing the Chief
12	Financial Officer to revoke a hospital's tax-exempt status
13	under certain circumstances; providing that certain
14	disproportionate share hospitals are deemed in compliance
15	with such tax-exemption requirements; amending s. 381.026,
16	F.S.; revising provisions relating to notification of
17	financial disclosure to Medicaid eligible patients;
18	revising requirements for written estimate of charges;
19	revising requirements for submission of health care data;
20	amending s. 395.301, F.S.; revising billing requirements;
21	revising written estimate requirements; amending s.
22	408.05, F.S.; revising determination of patient charge
23	data disclosure; amending s. 408.061, F.S.; revising data
24	submission requirements; amending s. 409.911, F.S.;
25	providing applicability of the terms "charity care" and
26	"uncompensated charity care" to certain hospital reporting
27	requirements; providing an effective date.
28
29	Be It Enacted by the Legislature of the State of Florida:
30
31	Section 1.  This act may be cited as the "Health Care
32	Financial Information Act."
33	Section 2.  Paragraph (p) of subsection (7) of section
34	212.08, Florida Statutes, is amended to read:
35	212.08  Sales, rental, use, consumption, distribution, and
36	storage tax; specified exemptions.--The sale at retail, the
37	rental, the use, the consumption, the distribution, and the
38	storage to be used or consumed in this state of the following
39	are hereby specifically exempt from the tax imposed by this
40	chapter.
41	(7)  MISCELLANEOUS EXEMPTIONS.--Exemptions provided to any
42	entity by this chapter do not inure to any transaction that is
43	otherwise taxable under this chapter when payment is made by a
44	representative or employee of the entity by any means,
45	including, but not limited to, cash, check, or credit card, even
46	when that representative or employee is subsequently reimbursed
47	by the entity. In addition, exemptions provided to any entity by
48	this subsection do not inure to any transaction that is
49	otherwise taxable under this chapter unless the entity has
50	obtained a sales tax exemption certificate from the department
51	or the entity obtains or provides other documentation as
52	required by the department. Eligible purchases or leases made
53	with such a certificate must be in strict compliance with this
54	subsection and departmental rules, and any person who makes an
55	exempt purchase with a certificate that is not in strict
56	compliance with this subsection and the rules is liable for and
57	shall pay the tax. The department may adopt rules to administer
58	this subsection.
59	(p)  Section 501(c)(3) organizations.--Also exempt from the
60	tax imposed by this chapter are sales or leases to organizations
61	determined by the Internal Revenue Service to be currently
62	exempt from federal income tax pursuant to s. 501(c)(3) of the
63	Internal Revenue Code of 1986, as amended, when such leases or
64	purchases are used in carrying on their customary nonprofit
65	activities. To retain tax-exempt status under this paragraph, a
66	hospital must meet the community benefits requirements set forth
67	in this paragraph.
68	1.  As used in this paragraph:
69	a.  "Agency" means the Agency for Health Care
70	Administration.
71	b.  "Charity care" means that portion of hospital charges
72	reported to the agency for which there is no compensation, other
73	than restricted or unrestricted revenues provided to a hospital
74	by local governments or tax districts regardless of the method
75	of payment, for care provided to a patient whose family income
76	for the 12 months preceding the determination is equal to or
77	below 200 percent of the federal poverty level, unless the
78	amount of hospital charges due from the patient exceeds 25
79	percent of the patient's annual family income. However, in no
80	case shall the hospital charges for a patient whose family
81	income exceeds four times the federal poverty level for a family
82	of four be considered for charity care.
83	c.  "Community" means the primary geographic area and
84	patient categories for which a hospital provides health care
85	services.
86	d.  "Community benefits" means the unreimbursed cost to a
87	hospital of providing charity care, uncompensated government-
88	sponsored indigent health care, donations, education,
89	uncompensated government-sponsored program services, research,
90	and subsidized health services provided by the hospital.
91	Community benefits do not include the cost to the hospital of
92	paying any taxes or other governmental assessments.
93	e.  "Hospital " means a health care institution licensed by
94	the agency as a hospital under chapter 395.
95	f.  "Uncompensated government-sponsored indigent health
96	care" means the unreimbursed cost to a hospital of providing
97	health care services to recipients of Medicaid and other
98	federal, state, or local indigent health care programs,
99	eligibility for which is based on financial need.
100	g.  "Uncompensated government-sponsored program services"
101	means the unreimbursed cost to the hospital of providing health
102	care services to the beneficiaries of Medicare, the Civilian
103	Health and Medical Program of the Uniformed Services, and other
104	federal, state, or local government health care programs.
105	2.  Each exempt hospital shall:
106	a.  Develop an organization mission statement that
107	identifies the hospital's commitment to serving the health care
108	needs of the community; and
109	b.  Develop a community benefits plan. The plan shall be an
110	operational plan for serving the community's health care needs
111	that sets out goals and objectives for providing community
112	benefits that include charity care and government-sponsored
113	indigent health care and identifies the populations and
114	communities served by the hospital. In developing the community
115	benefits plan, the hospital shall consider the health care needs
116	of the community as determined by a communitywide needs
117	assessment. Elements of the plan shall include, but are not
118	limited to, the following:
119	(I)  A mechanism to evaluate the effectiveness of the plan,
120	including, but not limited to, a method for soliciting the views
121	of the individuals in the communities served by the hospital and
122	identification of community groups and other local government
123	officials consulted during the plan's development.
124	(II)  Measurable objectives to be achieved within a
125	specified timeframe.
126	(III)  A proposed budget.
127	3.  Each exempt hospital shall provide community benefits
128	on an annual basis as provided in its community benefits plan.
129	The provision of charity care and government-sponsored indigent
130	health care shall be guided by the prudent business judgment of
131	the hospital which shall determine the appropriate level of
132	charity care and government-sponsored indigent health care based
133	on the needs of the community, the available resources of the
134	hospital, the tax-exempt benefits received by the hospital, and
135	other factors that may be unique to the hospital, such as the
136	number of Medicare and Medicaid patients served by the hospital.
137	The standards provided in sub-subparagraphs b. and c. do not
138	determine the amount of charity care and government-sponsored
139	indigent health care that will be considered reasonable under
140	sub-subparagraph c. The hospital shall provide community
141	benefits according to any one of the following standards:
142	a.  Charity care and government-sponsored indigent health
143	care are provided at a level which is reasonable in relation to
144	the community's needs, as determined through the community needs
145	assessment, the available resources of the hospital, and the
146	tax-exempt benefits received by the hospital;
147	b.  Charity care and government-sponsored indigent health
148	care are provided in an amount equal to at least 100 percent of
149	the hospital's tax-exempt benefits, excluding federal income
150	tax; or
151	c.  Charity care and community benefits provided in a
152	combined amount equal to at least 5 percent of the hospital's
153	net patient revenue, provided that charity care and government-
154	sponsored indigent health care are provided in an amount equal
155	to at least 4 percent of the hospital's net patient revenue.
156
157	For hospitals, a parent corporation may elect to provide the
158	community benefits in order to satisfy the requirements of this
159	paragraph for each of the hospitals within the organization on a
160	consolidated basis.
161	4.  Reporting requirements are as follows:
162	a.  Each exempt hospital shall submit a community benefits
163	plan for the next fiscal year to the agency no later than April
164	30 of each year.
165	b.  Each exempt hospital shall submit a report to the
166	agency no later than 120 days after the end of the hospital's
167	fiscal year. The report shall document compliance with the
168	community benefits plan and shall include, but not be limited
169	to, the following information:
170	(I)  The hospital's mission statement.
171	(II)  Disclosure of the health care needs of the community
172	considered by the hospital in developing the community benefits
173	plan.
174	(III)  Disclosure of the amount and types of community
175	benefits provided, including charity care. Charity care shall be
176	reported as a separate item from other community benefits.
177	(IV)  A statement of total operating expenses computed in
178	accordance with generally accepted accounting principles for
179	hospitals, including a completed worksheet that computes the
180	ratio of cost-to-charge for the fiscal year, from the most
181	recent completed and audited prior fiscal year of the hospital.
182	(V)  Disclosure of the amount of tax-exempt benefits for
183	that fiscal year if the hospital provides community benefits
184	according to the standards provided in sub-subparagraph 3.a. or
185	sub-subparagraph 3.b.
186	c.  The agency shall publish and submit to the Attorney
187	General and the Chief Financial Officer, no later than January 1
188	of each year, a report listing each exempt hospital that did not
189	meet the requirements of this paragraph during the previous
190	fiscal year and delineating the manner of noncompliance.
191	d.  The agency shall publish and submit to the Attorney
192	General and the Chief Financial Officer, no later than January 1
193	of each year, a report containing the following information for
194	each exempt hospital during the preceding fiscal year:
195	(I)  The amount of charity care provided.
196	(II)  The amount of government-sponsored indigent health
197	care provided.
198	(III)  The amount of community benefits provided.
199	(IV)  The amount of net patient revenue and the amount
200	constituting 4 percent of the net patient revenue.
201	(V)  The dollar amount of the hospital's charity care and
202	community benefits requirements met.
203	(VI)  The amount of tax-exempt benefits if the hospital
204	provides community benefits according to the standards provided
205	in sub-subparagraph 3.a. or sub-subparagraph 3.b.
206	(VII)  The amount of charity care expenses reported to the
207	hospital's audited financial statement.
208	5.  Each exempt hospital shall notify the public that the
209	annual report of the community benefits plan is public
210	information, that it is filed with the agency, and that it is
211	available to the public by request to the hospital. The
212	statement shall be posted in prominent places throughout the
213	hospital, including, but not limited to, the emergency room
214	waiting area and the admissions office waiting area. The
215	statement shall also be printed in the hospital patient guide or
216	other material that provides the patient with information about
217	the admissions criteria of the hospital.
218	6.  Each exempt hospital shall provide notice to each
219	person who seeks any health care, in appropriate languages,
220	about the availability of charity care in that hospital,
221	including the charity care and eligibility policies of the
222	program, and how to apply for charity care. Such notice shall
223	also be conspicuously posted in the general waiting area, in the
224	waiting area for emergency services, in the business office, and
225	in such other locations as the hospital deems likely to give
226	notice of the charity care program and policies. Each hospital
227	shall annually publish notice of the hospital's charity care
228	program and polices in a local newspaper of general circulation
229	in the county. Each notice under this paragraph must be written
230	in language readily understandable by the average reader.
231	7.  The Chief Financial Officer shall revoke the tax-exempt
232	status of a hospital that fails to comply with any provision of
233	this paragraph. Any hospital facing revocation of the hospital's
234	tax-exempt status may apply for a grace period of 1 fiscal year
235	in order to meet the provisions in this paragraph. During such
236	time, the hospital in question must provide an additional amount
237	of charity care and government-sponsored indigent health care
238	that is equal to the shortfall from the previous fiscal year. A
239	hospital may apply for such grace period one time in a 5-year
240	period.
241	8.  An exempt hospital that has been designated as a
242	disproportionate share hospital under the state Medicaid program
243	in the current fiscal year or in either of the previous 2 fiscal
244	years shall be deemed in compliance with the requirements of
245	this paragraph.
246	Section 3.  Paragraph (c) of subsection (4) of section
247	381.026, Florida Statutes, is amended to read:
248	381.026  Florida Patient's Bill of Rights and
249	Responsibilities.--
250	(4)  RIGHTS OF PATIENTS.--Each health care facility or
251	provider shall observe the following standards:
252	(c)  Financial information and disclosure.--
253	1.  A patient has the right to be given, upon request, by
254	the responsible provider, his or her designee, or a
255	representative of the health care facility full information and
256	necessary counseling on the availability of known financial
257	resources for the patient's health care.
258	2.  A health care provider or a health care facility shall,
259	upon request, disclose to each patient who is eligible for
260	Medicare, in advance of treatment, whether the health care
261	provider or the health care facility in which the patient is
262	receiving medical services accepts assignment under Medicare
263	reimbursement as payment in full for medical services and
264	treatment rendered in the health care provider's office or
265	health care facility.
266	3.  A health care provider or a health care facility shall,
267	upon request, furnish a person, prior to provision of medical
268	services, a reasonable itemized estimate of charges for such
269	services. Such reasonable itemized estimate shall not preclude
270	the health care provider or health care facility from exceeding
271	the estimate or making additional charges based on changes in
272	the patient's condition or treatment needs.
273	4.  Each licensed facility not operated by the state shall
274	make available to the public on its Internet website or by other
275	electronic means a description of and a link to the performance
276	outcome and financial data that is published by the agency
277	pursuant to s. 408.05(3)(k). The facility shall place a notice
278	in the reception area that such information is available
279	electronically and the website address. The licensed facility
280	shall publish pricing information, including the lowest charge,
281	the average charge, and the highest charge. The facility may
282	indicate that the pricing information is based on a compilation
283	of charges for the average patient and that each patient's bill
284	may vary from the average depending upon the severity of illness
285	and individual resources consumed. The licensed facility may
286	also indicate that the price of service is negotiable for
287	eligible patients based upon the patient's ability to pay.
288	5.  A patient has the right to receive a copy of an
289	itemized bill upon request. A patient has a right to be given an
290	explanation of charges upon request.
291	Section 4.  Subsections (1) and (7) of section 395.301,
292	Florida Statutes, are amended to read:
293	395.301  Itemized patient bill; form and content prescribed
294	by the agency.--
295	(1)  A licensed facility not operated by the state shall
296	notify each patient during admission and at discharge of his or
297	her right to receive an itemized bill upon request. Within 7
298	days following the patient's discharge or release from a
299	licensed facility not operated by the state, the licensed
300	facility providing the service shall, upon request, submit to
301	the patient, or to the patient's survivor or legal guardian as
302	may be appropriate, an itemized statement detailing in language
303	comprehensible to an ordinary layperson the specific nature of
304	charges or expenses incurred by the patient, which in the
305	initial billing shall contain a statement of specific services
306	received and expenses incurred for such items of service,
307	enumerating in detail the constituent components of the services
308	received within each department of the licensed facility and
309	including unit price data on rates charged by the licensed
310	facility, as prescribed by the agency.
311	(7)  Each licensed facility not operated by the state shall
312	provide in writing, prior to provision of any nonemergency
313	medical services, an itemized a written good faith estimate of
314	reasonably anticipated charges for the facility to treat the
315	patient's condition upon written request of a prospective
316	patient. The estimate shall be provided to the prospective
317	patient within 7 business days after the receipt of the request.
318	The estimate may be the average charges for that diagnosis
319	related group or the average charges for that procedure. Upon
320	request, The facility shall notify the patient of any revision
321	to the good faith estimate. Such estimate shall not preclude the
322	health care provider or health care facility actual charges from
323	exceeding the estimate or making additional charges based on
324	changes in the patient's condition or treatment needs if such
325	charges are itemized on the patient's billing statement. The
326	facility shall place a notice in the reception area that such
327	information is available. Failure to provide the estimate within
328	the provisions established pursuant to this section shall result
329	in a fine of $500 for each instance of the facility's failure to
330	provide the requested information.
331	Section 5.  Paragraph (k) of subsection (3) of section
332	408.05, Florida Statutes, is amended to read:
333	408.05  Florida Center for Health Information and Policy
334	Analysis.--
335	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order to
336	produce comparable and uniform health information and statistics
337	for the development of policy recommendations, the agency shall
338	perform the following functions:
339	(k)  Develop, in conjunction with the State Consumer Health
340	Information and Policy Advisory Council, and implement a long-
341	range plan for making available health care quality measures and
342	financial data that will allow consumers to compare health care
343	services. The health care quality measures and financial data
344	the agency must make available shall include, but is not limited
345	to, pharmaceuticals, physicians, health care facilities, and
346	health plans and managed care entities. The agency shall submit
347	the initial plan to the Governor, the President of the Senate,
348	and the Speaker of the House of Representatives by January 1,
349	2006, and shall update the plan and report on the status of its
350	implementation annually thereafter. The agency shall also make
351	the plan and status report available to the public on its
352	Internet website. As part of the plan, the agency shall identify
353	the process and timeframes for implementation, any barriers to
354	implementation, and recommendations of changes in the law that
355	may be enacted by the Legislature to eliminate the barriers. As
356	preliminary elements of the plan, the agency shall:
357	1.  Make available patient-safety indicators, inpatient
358	quality indicators, and performance outcome and patient charge
359	data collected from health care facilities pursuant to s.
360	408.061(1)(a) and (2). The terms "patient-safety indicators" and
361	"inpatient quality indicators" shall be as defined by the
362	Centers for Medicare and Medicaid Services, the National Quality
363	Forum, the Joint Commission on Accreditation of Healthcare
364	Organizations, the Agency for Healthcare Research and Quality,
365	the Centers for Disease Control and Prevention, or a similar
366	national entity that establishes standards to measure the
367	performance of health care providers, or by other states. The
368	agency shall determine which conditions, procedures, health care
369	quality measures, and patient charge data to disclose based upon
370	input from the council. When determining which conditions and
371	procedures are to be disclosed, the council and the agency shall
372	consider variation in costs, variation in outcomes, and
373	magnitude of variations and other relevant information. When
374	determining which health care quality measures to disclose, the
375	agency:
376	a.  Shall consider such factors as volume of cases; average
377	patient charges; average length of stay; complication rates;
378	mortality rates; and infection rates, among others, which shall
379	be adjusted for case mix and severity, if applicable.
380	b.  May consider such additional measures that are adopted
381	by the Centers for Medicare and Medicaid Studies, National
382	Quality Forum, the Joint Commission on Accreditation of
383	Healthcare Organizations, the Agency for Healthcare Research and
384	Quality, Centers for Disease Control and Prevention, or a
385	similar national entity that establishes standards to measure
386	the performance of health care providers, or by other states.
387
388	When determining which patient charge data to disclose, the
389	agency shall consider such measures as a price list of
390	procedures, supplies, and services; average charge;, range of
391	charges from lowest charge to highest charge; average net
392	revenue per adjusted patient day;, average cost per adjusted
393	patient day;, and average cost per admission, among other
394	measures others.
395	2.  Make available performance measures, benefit design,
396	and premium cost data from health plans licensed pursuant to
397	chapter 627 or chapter 641. The agency shall determine which
398	health care quality measures and member and subscriber cost data
399	to disclose, based upon input from the council. When determining
400	which data to disclose, the agency shall consider information
401	that may be required by either individual or group purchasers to
402	assess the value of the product, which may include membership
403	satisfaction, quality of care, current enrollment or membership,
404	coverage areas, accreditation status, premium costs, plan costs,
405	premium increases, range of benefits, copayments and
406	deductibles, accuracy and speed of claims payment, credentials
407	of physicians, number of providers, names of network providers,
408	and hospitals in the network. Health plans shall make available
409	to the agency any such data or information that is not currently
410	reported to the agency or the office.
411	3.  Determine the method and format for public disclosure
412	of data reported pursuant to this paragraph. The agency shall
413	make its determination based upon input from the State Consumer
414	Health Information and Policy Advisory Council. At a minimum,
415	the data shall be made available on the agency's Internet
416	website in a manner that allows consumers to conduct an
417	interactive search that allows them to view and compare the
418	information for specific providers. The website must include
419	such additional information as is determined necessary to ensure
420	that the website enhances informed decisionmaking among
421	consumers and health care purchasers, which shall include, at a
422	minimum, appropriate guidance on how to use the data and an
423	explanation of why the data may vary from provider to provider.
424	The data specified in subparagraph 1. shall be released no later
425	than January 1, 2006, for the reporting of infection rates, and
426	no later than October 1, 2005, for mortality rates and
427	complication rates. The data specified in subparagraph 2. shall
428	be released no later than October 1, 2006.
429	Section 6.  Paragraph (a) of subsection (1) of section
430	408.061, Florida Statutes, is amended to read:
431	408.061  Data collection; uniform systems of financial
432	reporting; information relating to physician charges;
433	confidential information; immunity.--
434	(1)  The agency shall require the submission by health care
435	facilities, health care providers, and health insurers of data
436	necessary to carry out the agency's duties. Specifications for
437	data to be collected under this section shall be developed by
438	the agency with the assistance of technical advisory panels
439	including representatives of affected entities, consumers,
440	purchasers, and such other interested parties as may be
441	determined by the agency.
442	(a)  Data submitted by health care facilities, including
443	the facilities as defined in chapter 395, shall include, but are
444	not limited to: case-mix data, patient admission and discharge
445	data, hospital emergency department data which shall include the
446	number of patients treated in the emergency department of a
447	licensed hospital reported by patient acuity level, data on
448	hospital-acquired infections as specified by rule, data on
449	complications as specified by rule, data on readmissions as
450	specified by rule, with patient and provider-specific
451	identifiers included, actual charge data by diagnostic groups, a
452	price list for not fewer than the 100 most commonly performed
453	procedures, based on a statewide average of procedures, and the
454	500 most commonly used supplies, financial data, accounting
455	data, operating expenses, expenses incurred for rendering
456	services to patients who cannot or do not pay, interest charges,
457	depreciation expenses based on the expected useful life of the
458	property and equipment involved, and demographic data. The
459	agency shall adopt nationally recognized risk adjustment
460	methodologies or software consistent with the standards of the
461	Agency for Healthcare Research and Quality and as selected by
462	the agency for all data submitted as required by this section.
463	Data may be obtained from documents such as, but not limited to:
464	leases, contracts, debt instruments, itemized patient bills,
465	medical record abstracts, and related diagnostic information.
466	Reported data elements shall be reported electronically in
467	accordance with rule 59E-7.012, Florida Administrative Code.
468	Data submitted shall be certified by the chief executive officer
469	or an appropriate and duly authorized representative or employee
470	of the licensed facility that the information submitted is true
471	and accurate.
472	Section 7.  Paragraph (c) of subsection (1) of section
473	409.911, Florida Statutes, is amended to read:
474	409.911  Disproportionate share program.--Subject to
475	specific allocations established within the General
476	Appropriations Act and any limitations established pursuant to
477	chapter 216, the agency shall distribute, pursuant to this
478	section, moneys to hospitals providing a disproportionate share
479	of Medicaid or charity care services by making quarterly
480	Medicaid payments as required. Notwithstanding the provisions of
481	s. 409.915, counties are exempt from contributing toward the
482	cost of this special reimbursement for hospitals serving a
483	disproportionate share of low-income patients.
484	(1)  DEFINITIONS.--As used in this section, s. 409.9112,
485	and the Florida Hospital Uniform Reporting System manual:
486	(c)  "Charity care" or "uncompensated charity care" means
487	that portion of hospital charges reported to the Agency for
488	Health Care Administration for which there is no compensation,
489	other than restricted or unrestricted revenues provided to a
490	hospital by local governments or tax districts regardless of the
491	method of payment, for care provided to a patient whose family
492	income for the 12 months preceding the determination is less
493	than or equal to 200 percent of the federal poverty level,
494	unless the amount of hospital charges due from the patient
495	exceeds 25 percent of the annual family income. However, in no
496	case shall the hospital charges for a patient whose family
497	income exceeds four times the federal poverty level for a family
498	of four be considered charity. The amount of charity care or
499	uncompensated charity care shall only be valued and reported at
500	Medicaid rates.
501	Section 8.  This act shall take effect July 1, 2008.

CODING: Words stricken are deletions; words underlined are additions.