Florida Senate - 2015                                     SB 768
       By Senator Gaetz
       1-00728-15                                             2015768__
    1                        A bill to be entitled                      
    2         An act relating to patient observation status
    3         notification; amending s. 395.301, F.S.; requiring
    4         licensed facilities to notify patients if they place
    5         them in observation status rather than admitted
    6         status; requiring facilities to provide certain
    7         notice; providing an effective date.
    9  Be It Enacted by the Legislature of the State of Florida:
   11         Section 1. Section 395.301, Florida Statutes, is amended,
   12  to read:
   13         395.301 Itemized patient bill; form and content prescribed
   14  by the agency; patient observation status notification.—
   15         (1) A licensed facility not operated by the state shall
   16  notify each patient during admission and at discharge of his or
   17  her right to receive an itemized bill upon request. Within 7
   18  days following the patient’s discharge or release from a
   19  licensed facility not operated by the state, the licensed
   20  facility providing the service shall, upon request, submit to
   21  the patient, or to the patient’s survivor or legal guardian as
   22  may be appropriate, an itemized statement detailing in language
   23  comprehensible to an ordinary layperson the specific nature of
   24  charges or expenses incurred by the patient, which in the
   25  initial billing shall contain a statement of specific services
   26  received and expenses incurred for such items of service,
   27  enumerating in detail the constituent components of the services
   28  received within each department of the licensed facility and
   29  including unit price data on rates charged by the licensed
   30  facility, as prescribed by the agency.
   31         (2)(a) Each such statement submitted pursuant to this
   32  section:
   33         1. May not include charges of hospital-based physicians if
   34  billed separately.
   35         2. May not include any generalized category of expenses
   36  such as “other” or “miscellaneous” or similar categories.
   37         3. Shall list drugs by brand or generic name and not refer
   38  to drug code numbers when referring to drugs of any sort.
   39         4. Shall specifically identify therapy treatment as to the
   40  date, type, and length of treatment when therapy treatment is a
   41  part of the statement.
   42         (b) Any person receiving a statement pursuant to this
   43  section shall be fully and accurately informed as to each charge
   44  and service provided by the institution preparing the statement.
   45         (3) On each itemized statement submitted pursuant to
   46  subsection (1) there shall appear the words “A FOR-PROFIT (or
   49  similar words sufficient to identify clearly and plainly the
   50  ownership status of the licensed facility. Each itemized
   51  statement must prominently display the phone number of the
   52  medical facility’s patient liaison who is responsible for
   53  expediting the resolution of any billing dispute between the
   54  patient, or his or her representative, and the billing
   55  department.
   56         (4) An itemized bill shall be provided once to the
   57  patient’s physician at the physician’s request, at no charge.
   58         (5) In any billing for services subsequent to the initial
   59  billing for such services, the patient, or the patient’s
   60  survivor or legal guardian, may elect, at his or her option, to
   61  receive a copy of the detailed statement of specific services
   62  received and expenses incurred for each such item of service as
   63  provided in subsection (1).
   64         (6) No physician, dentist, podiatric physician, or licensed
   65  facility may add to the price charged by any third party except
   66  for a service or handling charge representing a cost actually
   67  incurred as an item of expense; however, the physician, dentist,
   68  podiatric physician, or licensed facility is entitled to fair
   69  compensation for all professional services rendered. The amount
   70  of the service or handling charge, if any, shall be set forth
   71  clearly in the bill to the patient.
   72         (7) Each licensed facility not operated by the state shall
   73  provide, prior to provision of any nonemergency medical
   74  services, a written good faith estimate of reasonably
   75  anticipated charges for the facility to treat the patient’s
   76  condition upon written request of a prospective patient. The
   77  estimate shall be provided to the prospective patient within 7
   78  business days after the receipt of the request. The estimate may
   79  be the average charges for that diagnosis related group or the
   80  average charges for that procedure. Upon request, the facility
   81  shall notify the patient of any revision to the good faith
   82  estimate. Such estimate shall not preclude the actual charges
   83  from exceeding the estimate. The facility shall place a notice
   84  in the reception area that such information is available.
   85  Failure to provide the estimate within the provisions
   86  established pursuant to this section shall result in a fine of
   87  $500 for each instance of the facility’s failure to provide the
   88  requested information.
   89         (8) Each licensed facility that is not operated by the
   90  state shall provide any uninsured person seeking planned
   91  nonemergency elective admission a written good faith estimate of
   92  reasonably anticipated charges for the facility to treat such
   93  person. The estimate must be provided to the uninsured person
   94  within 7 business days after the person notifies the facility
   95  and the facility confirms that the person is uninsured. The
   96  estimate may be the average charges for that diagnosis-related
   97  group or the average charges for that procedure. Upon request,
   98  the facility shall notify the person of any revision to the good
   99  faith estimate. Such estimate does not preclude the actual
  100  charges from exceeding the estimate. The facility shall also
  101  provide to the uninsured person a copy of any facility discount
  102  and charity care discount policies for which the uninsured
  103  person may be eligible. The facility shall place a notice in the
  104  reception area where such information is available. Failure to
  105  provide the estimate as required by this subsection shall result
  106  in a fine of $500 for each instance of the facility’s failure to
  107  provide the requested information.
  108         (9)(a) A licensed facility, upon placing a patient in an
  109  observation status rather than an admission status, shall
  110  immediately notify the patient orally and in writing of his or
  111  her observation status and include the written notice of such
  112  status in the patient’s record. Such oral and written notice
  113  shall include:
  114         1. A statement that the patient has not been or is no
  115  longer admitted to the facility but has been placed in an
  116  observation status;
  117         2. A statement that placement in an observation status may
  118  affect the patient’s Medicare, Medicaid, or private insurance
  119  coverage for:
  120         a. Hospital services, including medications and
  121  pharmaceutical supplies; and
  122         b. Home or community-based care or care at a skilled
  123  nursing facility, including rehabilitative services, upon the
  124  patient’s discharge.
  125         3. A statement recommending that the patient contact his or
  126  her health insurance provider to determine the implications of
  127  his or her placement in an observation status and his or her
  128  right to appeal the placement by the facility.
  129         (b) The patient or the patient’s legal guardian,
  130  conservator, or other authorized representative must sign and
  131  date the written notice to be placed in the patient’s record at
  132  the time of oral notification.
  133         (10)(9) A licensed facility shall make available to a
  134  patient all records necessary for verification of the accuracy
  135  of the patient’s bill within 30 business days after the request
  136  for such records. The verification information must be made
  137  available in the facility’s offices. Such records shall be
  138  available to the patient prior to and after payment of the bill
  139  or claim. The facility may not charge the patient for making
  140  such verification records available; however, the facility may
  141  charge its usual fee for providing copies of records as
  142  specified in s. 395.3025.
  143         (11)(10) Each facility shall establish a method for
  144  reviewing and responding to questions from patients concerning
  145  the patient’s itemized bill. Such response shall be provided
  146  within 30 days after the date a question is received. If the
  147  patient is not satisfied with the response, the facility must
  148  provide the patient with the address of the agency to which the
  149  issue may be sent for review.
  150         (12)(11) Each licensed facility shall make available on its
  151  Internet website a link to the performance outcome and financial
  152  data that is published by the Agency for Health Care
  153  Administration pursuant to s. 408.05(3)(k). The facility shall
  154  place a notice in the reception area that the information is
  155  available electronically and the facility’s Internet website
  156  address.
  157         Section 2. This act shall take effect July 1, 2015.