Florida Senate - 2016 SENATOR AMENDMENT
Bill No. CS/CS/HB 1175, 1st Eng.
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LEGISLATIVE ACTION
Senate . House
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Floor: 1/RE/3R .
03/10/2016 03:00 PM .
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Senator Bradley moved the following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 395.301, Florida Statutes, is amended to
6 read:
7 395.301 Price transparency; itemized patient statement or
8 bill; form and content prescribed by the agency; patient
9 admission status notification.—
10 (1) A facility licensed under this chapter shall provide
11 timely and accurate financial information and quality of service
12 measures to patients and prospective patients of the facility,
13 or to patients’ survivors or legal guardians, as appropriate.
14 Such information shall be provided in accordance with this
15 section and rules adopted by the agency pursuant to this chapter
16 and s. 408.05. Licensed facilities operating exclusively as
17 state facilities are exempt from this subsection.
18 (a) Each licensed facility shall make available to the
19 public on its website information on payments made to that
20 facility for defined bundles of services and procedures. The
21 payment data must be presented and searchable in accordance
22 with, and through a hyperlink to, the system established by the
23 agency and its vendor using the descriptive service bundles
24 developed under s. 408.05(3)(c). At a minimum, the facility
25 shall provide the estimated average payment received from all
26 payors, excluding Medicaid and Medicare, for the descriptive
27 service bundles available at that facility and the estimated
28 payment range for such bundles. Using plain language,
29 comprehensible to an ordinary layperson, the facility must
30 disclose that the information on average payments and the
31 payment ranges is an estimate of costs that may be incurred by
32 the patient or prospective patient and that actual costs will be
33 based on the services actually provided to the patient. The
34 facility’s website must:
35 1. Provide information to prospective patients on the
36 facility’s financial assistance policy, including the
37 application process, payment plans, and discounts, and the
38 facility’s charity care policy and collection procedures.
39 2. If applicable, notify patients and prospective patients
40 that services may be provided in the health care facility by the
41 facility as well as by other health care providers who may
42 separately bill the patient and that such health care providers
43 may or may not participate with the same health insurers or
44 health maintenance organizations as the facility.
45 3. Inform patients and prospective patients that they may
46 request from the facility and other health care providers a more
47 personalized estimate of charges and other information, and
48 inform patients that they should contact each health care
49 practitioner who will provide services in the hospital to
50 determine the health insurers and health maintenance
51 organizations with which the health care practitioner
52 participates as a network provider or preferred provider.
53 4. Provide the names, mailing addresses, and telephone
54 numbers of the health care practitioners and medical practice
55 groups with which it contracts to provide services in the
56 facility and instructions on how to contact the practitioners
57 and groups to determine the health insurers and health
58 maintenance organizations with which they participate as network
59 providers or preferred providers.
60 (b)1. Upon request, and before providing any nonemergency
61 medical services, each licensed facility shall provide in
62 writing or by electronic means a good faith estimate of
63 reasonably anticipated charges by the facility for the treatment
64 of the patient’s or prospective patient’s specific condition.
65 The facility must provide the estimate to the patient or
66 prospective patient within 7 business days after the receipt of
67 the request and is not required to adjust the estimate for any
68 potential insurance coverage. The estimate may be based on the
69 descriptive service bundles developed by the agency under s.
70 408.05(3)(c) unless the patient or prospective patient requests
71 a more personalized and specific estimate that accounts for the
72 specific condition and characteristics of the patient or
73 prospective patient. The facility shall inform the patient or
74 prospective patient that he or she may contact his or her health
75 insurer or health maintenance organization for additional
76 information concerning cost-sharing responsibilities.
77 2. In the estimate, the facility shall provide to the
78 patient or prospective patient information on the facility’s
79 financial assistance policy, including the application process,
80 payment plans, and discounts and the facility’s charity care
81 policy and collection procedures.
82 3. The estimate shall clearly identify any facility fees
83 and, if applicable, include a statement notifying the patient or
84 prospective patient that a facility fee is included in the
85 estimate, the purpose of the fee, and that the patient may pay
86 less for the procedure or service at another facility or in
87 another health care setting.
88 4. Upon request, the facility shall notify the patient or
89 prospective patient of any revision to the estimate.
90 5. In the estimate, the facility must notify the patient or
91 prospective patient that services may be provided in the health
92 care facility by the facility as well as by other health care
93 providers that may separately bill the patient, if applicable.
94 6. The facility shall take action to educate the public
95 that such estimates are available upon request.
96 7. Failure to timely provide the estimate pursuant to this
97 paragraph shall result in a daily fine of $1,000 until the
98 estimate is provided to the patient or prospective patient. The
99 total fine may not exceed $10,000.
100
101 The provision of an estimate does not preclude the actual
102 charges from exceeding the estimate.
103 (c) Each facility shall make available on its website a
104 hyperlink to the health-related data, including quality measures
105 and statistics that are disseminated by the agency pursuant to
106 s. 408.05. The facility shall also take action to notify the
107 public that such information is electronically available and
108 provide a hyperlink to the agency’s website.
109 (d)1. Upon request, and after the patient’s discharge or
110 release from a facility, the facility must provide A licensed
111 facility not operated by the state shall notify each patient
112 during admission and at discharge of his or her right to receive
113 an itemized bill upon request. Within 7 days following the
114 patient’s discharge or release from a licensed facility not
115 operated by the state, the licensed facility providing the
116 service shall, upon request, submit to the patient, or to the
117 patient’s survivor or legal guardian, as may be appropriate, an
118 itemized statement or a bill detailing in plain language,
119 comprehensible to an ordinary layperson, the specific nature of
120 charges or expenses incurred by the patient., which in The
121 initial statement or bill billing shall be provided within 7
122 days after the patient’s discharge or release or after a request
123 for such statement or bill, whichever is later. The initial
124 statement or bill must contain a statement of specific services
125 received and expenses incurred by date and provider for such
126 items of service, enumerating in detail as prescribed by the
127 agency the constituent components of the services received
128 within each department of the licensed facility and including
129 unit price data on rates charged by the licensed facility, as
130 prescribed by the agency. The statement or bill must also
131 clearly identify any facility fee and explain the purpose of the
132 fee. The statement or bill must identify each item as paid,
133 pending payment by a third party, or pending payment by the
134 patient, and must include the amount due, if applicable. If an
135 amount is due from the patient, a due date must be included. The
136 initial statement or bill must direct the patient or the
137 patient’s survivor or legal guardian, as appropriate, to contact
138 the patient’s insurer or health maintenance organization
139 regarding the patient’s cost-sharing responsibilities.
140 2. Any subsequent statement or bill provided to a patient
141 or to the patient’s survivor or legal guardian, as appropriate,
142 relating to the episode of care must include all of the
143 information required by subparagraph 1., with any revisions
144 clearly delineated.
145 3.(2)(a) Each such statement or bill provided submitted
146 pursuant to this subsection section:
147 a.1. Must May not include notice charges of hospital-based
148 physicians and other health care providers who bill if billed
149 separately.
150 b.2. May not include any generalized category of expenses
151 such as “other” or “miscellaneous” or similar categories.
152 c.3. Must Shall list drugs by brand or generic name and not
153 refer to drug code numbers when referring to drugs of any sort.
154 d.4. Must Shall specifically identify physical,
155 occupational, or speech therapy treatment by as to the date,
156 type, and length of treatment when such therapy treatment is a
157 part of the statement or bill.
158 (b) Any person receiving a statement pursuant to this
159 section shall be fully and accurately informed as to each charge
160 and service provided by the institution preparing the statement.
161 (2)(3) On each itemized statement submitted pursuant to
162 subsection (1) there shall appear the words “A FOR-PROFIT (or
163 NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL
164 CENTER) LICENSED BY THE STATE OF FLORIDA” or substantially
165 similar words sufficient to identify clearly and plainly the
166 ownership status of the licensed facility. Each itemized
167 statement or bill must prominently display the telephone phone
168 number of the medical facility’s patient liaison who is
169 responsible for expediting the resolution of any billing dispute
170 between the patient, or the patient’s survivor or legal guardian
171 his or her representative, and the billing department.
172 (4) An itemized bill shall be provided once to the
173 patient’s physician at the physician’s request, at no charge.
174 (5) In any billing for services subsequent to the initial
175 billing for such services, the patient, or the patient’s
176 survivor or legal guardian, may elect, at his or her option, to
177 receive a copy of the detailed statement of specific services
178 received and expenses incurred for each such item of service as
179 provided in subsection (1).
180 (6) No physician, dentist, podiatric physician, or licensed
181 facility may add to the price charged by any third party except
182 for a service or handling charge representing a cost actually
183 incurred as an item of expense; however, the physician, dentist,
184 podiatric physician, or licensed facility is entitled to fair
185 compensation for all professional services rendered. The amount
186 of the service or handling charge, if any, shall be set forth
187 clearly in the bill to the patient.
188 (7) Each licensed facility not operated by the state shall
189 provide, prior to provision of any nonemergency medical
190 services, a written good faith estimate of reasonably
191 anticipated charges for the facility to treat the patient’s
192 condition upon written request of a prospective patient. The
193 estimate shall be provided to the prospective patient within 7
194 business days after the receipt of the request. The estimate may
195 be the average charges for that diagnosis related group or the
196 average charges for that procedure. Upon request, the facility
197 shall notify the patient of any revision to the good faith
198 estimate. Such estimate shall not preclude the actual charges
199 from exceeding the estimate. The facility shall place a notice
200 in the reception area that such information is available.
201 Failure to provide the estimate within the provisions
202 established pursuant to this section shall result in a fine of
203 $500 for each instance of the facility’s failure to provide the
204 requested information.
205 (8) Each licensed facility that is not operated by the
206 state shall provide any uninsured person seeking planned
207 nonemergency elective admission a written good faith estimate of
208 reasonably anticipated charges for the facility to treat such
209 person. The estimate must be provided to the uninsured person
210 within 7 business days after the person notifies the facility
211 and the facility confirms that the person is uninsured. The
212 estimate may be the average charges for that diagnosis-related
213 group or the average charges for that procedure. Upon request,
214 the facility shall notify the person of any revision to the good
215 faith estimate. Such estimate does not preclude the actual
216 charges from exceeding the estimate. The facility shall also
217 provide to the uninsured person a copy of any facility discount
218 and charity care discount policies for which the uninsured
219 person may be eligible. The facility shall place a notice in the
220 reception area where such information is available. Failure to
221 provide the estimate as required by this subsection shall result
222 in a fine of $500 for each instance of the facility’s failure to
223 provide the requested information.
224 (3)(9) If a licensed facility places a patient on
225 observation status rather than inpatient status, observation
226 services shall be documented in the patient’s discharge papers.
227 The patient or the patient’s survivor or legal guardian proxy
228 shall be notified of observation services through discharge
229 papers, which may also include brochures, signage, or other
230 forms of communication for this purpose.
231 (4)(10) A licensed facility shall make available to a
232 patient all records necessary for verification of the accuracy
233 of the patient’s statement or bill within 10 30 business days
234 after the request for such records. The records verification
235 information must be made available in the facility’s offices and
236 through electronic means that comply with the Health Insurance
237 Portability and Accountability Act of 1996, 42 U.S.C. s. 1320d,
238 as amended. Such records must shall be available to the patient
239 before prior to and after payment of the statement or bill or
240 claim. The facility may not charge the patient for making such
241 verification records available; however, the facility may charge
242 its usual fee for providing copies of records as specified in s.
243 395.3025.
244 (5)(11) Each facility shall establish a method for
245 reviewing and responding to questions from patients concerning
246 the patient’s itemized statement or bill. Such response shall be
247 provided within 7 business 30 days after the date a question is
248 received. If the patient is not satisfied with the response, the
249 facility must provide the patient with the contact information
250 address of the consumer advocate as provided in s. 627.0613
251 agency to which the issue may be sent for review. The facility
252 shall cooperate with the consumer advocate and his or her
253 representative to support the consumer advocate in his or her
254 efforts as authorized under s. 627.0613(2) and (3).
255 (12) Each licensed facility shall make available on its
256 Internet website a link to the performance outcome and financial
257 data that is published by the Agency for Health Care
258 Administration pursuant to s. 408.05(3)(k). The facility shall
259 place a notice in the reception area that the information is
260 available electronically and the facility’s Internet website
261 address.
262 Section 2. Section 395.107, Florida Statutes, is amended to
263 read:
264 395.107 Facilities Urgent care centers; publishing and
265 posting schedule of charges; penalties.—
266 (1) For purposes of this section, the term “facility”
267 means:
268 (a) An urgent care center as defined in s. 395.002; or
269 (b) A diagnostic-imaging center operated by a hospital
270 licensed under this chapter which is not located on the
271 hospital’s premises.
272 (2) A facility An urgent care center must publish and post
273 a schedule of charges for the medical services offered to
274 patients.
275 (3)(2) The schedule of charges must describe the medical
276 services in language comprehensible to a layperson. The schedule
277 must include the prices charged to an uninsured person paying
278 for such services by cash, check, credit card, or debit card.
279 The schedule must be posted in a conspicuous place in the
280 reception area and must include, but is not limited to, the 50
281 services most frequently provided. The schedule may group
282 services by three price levels, listing services in each price
283 level. The posting may be a sign, which must be at least 15
284 square feet in size, or may be through an electronic messaging
285 board. If a facility an urgent care center is affiliated with a
286 facility licensed hospital under this chapter, the schedule must
287 include text that notifies the insured patients whether the
288 charges for medical services received at the center will be the
289 same as, or more than, charges for medical services received at
290 the affiliated hospital. The text notifying the patient of the
291 schedule of charges shall be in a font size equal to or greater
292 than the font size used for prices and must be in a contrasting
293 color. The text that notifies the insured patients whether the
294 charges for medical services received at the center will be the
295 same as, or more than, charges for medical services received at
296 the affiliated hospital shall be included in all media and
297 Internet advertisements for the center and in language
298 comprehensible to a layperson.
299 (4)(3) The posted text describing the medical services must
300 fill at least 12 square feet of the posting. A facility center
301 may use an electronic device or messaging board to post the
302 schedule of charges. Such a device must be at least 3 square
303 feet, and patients must be able to access the schedule during
304 all hours of operation of the facility urgent care center.
305 (5)(4) A facility An urgent care center that is operated
306 and used exclusively for employees and the dependents of
307 employees of the business that owns or contracts for the
308 facility urgent care center is exempt from this section.
309 (6)(5) The failure of a facility an urgent care center to
310 publish and post a schedule of charges as required by this
311 section shall result in a fine of not more than $1,000, per day,
312 until the schedule is published and posted.
313 Section 3. Section 408.05, Florida Statutes, is amended to
314 read:
315 408.05 Florida Center for Health Information and
316 Transparency Policy Analysis.—
317 (1) ESTABLISHMENT.—The agency shall establish and maintain
318 a Florida Center for Health Information and Transparency to
319 collect, compile, coordinate, analyze, index, and disseminate
320 Policy Analysis. The center shall establish a comprehensive
321 health information system to provide for the collection,
322 compilation, coordination, analysis, indexing, dissemination,
323 and utilization of both purposefully collected and extant
324 health-related data and statistics. The center shall be staffed
325 as with public health experts, biostatisticians, information
326 system analysts, health policy experts, economists, and other
327 staff necessary to carry out its functions.
328 (2) HEALTH-RELATED DATA.—The comprehensive health
329 information system operated by the Florida Center for Health
330 Information and Transparency Policy Analysis shall identify the
331 best available data sets, compile new data when specifically
332 authorized, data sources and promote the use coordinate the
333 compilation of extant health-related data and statistics. The
334 center must maintain any data sets in existence before July 1,
335 2016, unless such data sets duplicate information that is
336 readily available from other credible sources, and may and
337 purposefully collect or compile data on:
338 (a) The extent and nature of illness and disability of the
339 state population, including life expectancy, the incidence of
340 various acute and chronic illnesses, and infant and maternal
341 morbidity and mortality.
342 (b) The impact of illness and disability of the state
343 population on the state economy and on other aspects of the
344 well-being of the people in this state.
345 (c) Environmental, social, and other health hazards.
346 (d) Health knowledge and practices of the people in this
347 state and determinants of health and nutritional practices and
348 status.
349 (a)(e) Health resources, including licensed physicians,
350 dentists, nurses, and other health care practitioners
351 professionals, by specialty and type of practice. Such data must
352 include information collected by the Department of Health
353 pursuant to ss. 458.3191 and 459.0081.
354 (b) Health service inventories, including and acute care,
355 long-term care, and other institutional care facilities facility
356 supplies and specific services provided by hospitals, nursing
357 homes, home health agencies, and other licensed health care
358 facilities.
359 (c)(f) Service utilization for licensed health care
360 facilities of health care by type of provider.
361 (d)(g) Health care costs and financing, including trends in
362 health care prices and costs, the sources of payment for health
363 care services, and federal, state, and local expenditures for
364 health care.
365 (h) Family formation, growth, and dissolution.
366 (e)(i) The extent of public and private health insurance
367 coverage in this state.
368 (f)(j) Specific quality-of-care initiatives involving The
369 quality of care provided by various health care providers when
370 extant data is not adequate to achieve the objectives of the
371 initiative.
372 (3) COMPREHENSIVE HEALTH INFORMATION TRANSPARENCY SYSTEM.
373 In order to disseminate and facilitate the availability of
374 produce comparable and uniform health information and statistics
375 for the development of policy recommendations, the agency shall
376 perform the following functions:
377 (a) Collect and compile information on and coordinate the
378 activities of state agencies involved in providing the design
379 and implementation of the comprehensive health information to
380 consumers system.
381 (b) Promote data sharing through dissemination of state
382 collected health data by making such data available,
383 transferable, and readily usable Undertake research,
384 development, and evaluation respecting the comprehensive health
385 information system.
386 (c) Contract with a vendor to provide a consumer-friendly,
387 Internet-based platform that allows a consumer to research the
388 cost of health care services and procedures and allows for price
389 comparison. The Internet-based platform must allow a consumer to
390 search by condition or service bundles that are comprehensible
391 to a layperson and may not require registration, a security
392 password, or user identification. The vendor shall also
393 establish and maintain a Florida-specific data set of health
394 care claims information available to the public and any
395 interested party. The agency shall actively oversee the vendor
396 to ensure compliance with state law. The vendor must be a
397 nonprofit research institute that is qualified under s. 1874 of
398 the Social Security Act, 42 U.S.C. 1395kk, to receive Medicare
399 claims data and that receives claims, payment, and patient cost
400 share data from multiple private insurers nationwide. The agency
401 shall select the vendor through a competitive procurement
402 process. By October 1, 2016, a responsive vendor shall have:
403 1. A national database consisting of at least 15 billion
404 claim lines of administrative claims data from multiple payors
405 capable of being expanded by adding claims data, directly or
406 through arrangements with extant data sources, from other third
407 party payors, including employers with health plans covered by
408 the Employee Retirement Income Security Act of 1974 when those
409 employers choose to participate.
410 2. A well-developed methodology for analyzing claims data
411 within defined service bundles that are understandable by the
412 general public.
413 3. A bundling methodology that is available in the public
414 domain to allow for consistency and comparison of state and
415 national benchmarks with local regions and specific providers.
416 (c) Review the statistical activities of state agencies to
417 ensure that they are consistent with the comprehensive health
418 information system.
419 (d) Develop written agreements with local, state, and
420 federal agencies to facilitate for the sharing of data related
421 to health care health-care-related data or using the facilities
422 and services of such agencies. State agencies, local health
423 councils, and other agencies under state contract shall assist
424 the center in obtaining, compiling, and transferring health
425 care-related data maintained by state and local agencies.
426 Written agreements must specify the types, methods, and
427 periodicity of data exchanges and specify the types of data that
428 will be transferred to the center.
429 (e) Establish by rule:
430 1. The types of data collected, compiled, processed, used,
431 or shared.
432 2. Requirements for implementation of the consumer
433 friendly, Internet-based platform created by the contracted
434 vendor under paragraph (c).
435 3. Requirements for the submission of data by insurers
436 pursuant to s. 627.6385 and health maintenance organizations
437 pursuant to s. 641.54 to the contracted vendor under paragraph
438 (c).
439 4. Requirements governing the collection of data by the
440 contracted vendor under paragraph (c).
441 5. How information is to be published on the consumer
442 friendly, Internet-based platform created under paragraph (c)
443 for public use Decisions regarding center data sets should be
444 made based on consultation with the State Consumer Health
445 Information and Policy Advisory Council and other public and
446 private users regarding the types of data which should be
447 collected and their uses. The center shall establish
448 standardized means for collecting health information and
449 statistics under laws and rules administered by the agency.
450 (f) Consult with contracted vendors, the State Consumer
451 Health Information and Policy Advisory Council, and other public
452 and private users regarding the types of data that should be
453 collected and the use of such data.
454 (g) Monitor data collection procedures and test data
455 quality to facilitate the dissemination of data that is
456 accurate, valid, reliable, and complete.
457 (f) Establish minimum health-care-related data sets which
458 are necessary on a continuing basis to fulfill the collection
459 requirements of the center and which shall be used by state
460 agencies in collecting and compiling health-care-related data.
461 The agency shall periodically review ongoing health care data
462 collections of the Department of Health and other state agencies
463 to determine if the collections are being conducted in
464 accordance with the established minimum sets of data.
465 (g) Establish advisory standards to ensure the quality of
466 health statistical and epidemiological data collection,
467 processing, and analysis by local, state, and private
468 organizations.
469 (h) Prescribe standards for the publication of health-care
470 related data reported pursuant to this section which ensure the
471 reporting of accurate, valid, reliable, complete, and comparable
472 data. Such standards should include advisory warnings to users
473 of the data regarding the status and quality of any data
474 reported by or available from the center.
475 (h)(i) Develop Prescribe standards for the maintenance and
476 preservation of the center’s data. This should include methods
477 for archiving data, retrieval of archived data, and data editing
478 and verification.
479 (j) Ensure that strict quality control measures are
480 maintained for the dissemination of data through publications,
481 studies, or user requests.
482 (i)(k) Make Develop, in conjunction with the State Consumer
483 Health Information and Policy Advisory Council, and implement a
484 long-range plan for making available health care quality
485 measures and financial data that will allow consumers to compare
486 outcomes and other performance measures for health care
487 services. The health care quality measures and financial data
488 the agency must make available include, but are not limited to,
489 pharmaceuticals, physicians, health care facilities, and health
490 plans and managed care entities. The agency shall update the
491 plan and report on the status of its implementation annually.
492 The agency shall also make the plan and status report available
493 to the public on its Internet website. As part of the plan, the
494 agency shall identify the process and timeframes for
495 implementation, barriers to implementation, and recommendations
496 of changes in the law that may be enacted by the Legislature to
497 eliminate the barriers. As preliminary elements of the plan, the
498 agency shall:
499 1. Make available patient-safety indicators, inpatient
500 quality indicators, and performance outcome and patient charge
501 data collected from health care facilities pursuant to s.
502 408.061(1)(a) and (2). The terms “patient-safety indicators” and
503 “inpatient quality indicators” have the same meaning as that
504 ascribed by the Centers for Medicare and Medicaid Services, an
505 accrediting organization whose standards incorporate comparable
506 regulations required by this state, or a national entity that
507 establishes standards to measure the performance of health care
508 providers, or by other states. The agency shall determine which
509 conditions, procedures, health care quality measures, and
510 patient charge data to disclose based upon input from the
511 council. When determining which conditions and procedures are to
512 be disclosed, the council and the agency shall consider
513 variation in costs, variation in outcomes, and magnitude of
514 variations and other relevant information. When determining
515 which health care quality measures to disclose, the agency:
516 a. Shall consider such factors as volume of cases; average
517 patient charges; average length of stay; complication rates;
518 mortality rates; and infection rates, among others, which shall
519 be adjusted for case mix and severity, if applicable.
520 b. May consider such additional measures that are adopted
521 by the Centers for Medicare and Medicaid Studies, an accrediting
522 organization whose standards incorporate comparable regulations
523 required by this state, the National Quality Forum, the Joint
524 Commission on Accreditation of Healthcare Organizations, the
525 Agency for Healthcare Research and Quality, the Centers for
526 Disease Control and Prevention, or a similar national entity
527 that establishes standards to measure the performance of health
528 care providers, or by other states.
529
530 When determining which patient charge data to disclose, the
531 agency shall include such measures as the average of
532 undiscounted charges on frequently performed procedures and
533 preventive diagnostic procedures, the range of procedure charges
534 from highest to lowest, average net revenue per adjusted patient
535 day, average cost per adjusted patient day, and average cost per
536 admission, among others.
537 2. Make available performance measures, benefit design, and
538 premium cost data from health plans licensed pursuant to chapter
539 627 or chapter 641. The agency shall determine which health care
540 quality measures and member and subscriber cost data to
541 disclose, based upon input from the council. When determining
542 which data to disclose, the agency shall consider information
543 that may be required by either individual or group purchasers to
544 assess the value of the product, which may include membership
545 satisfaction, quality of care, current enrollment or membership,
546 coverage areas, accreditation status, premium costs, plan costs,
547 premium increases, range of benefits, copayments and
548 deductibles, accuracy and speed of claims payment, credentials
549 of physicians, number of providers, names of network providers,
550 and hospitals in the network. Health plans shall make available
551 to the agency such data or information that is not currently
552 reported to the agency or the office.
553 3. Determine the method and format for public disclosure of
554 data reported pursuant to this paragraph. The agency shall make
555 its determination based upon input from the State Consumer
556 Health Information and Policy Advisory Council. At a minimum,
557 the data shall be made available on the agency’s Internet
558 website in a manner that allows consumers to conduct an
559 interactive search that allows them to view and compare the
560 information for specific providers. The website must include
561 such additional information as is determined necessary to ensure
562 that the website enhances informed decisionmaking among
563 consumers and health care purchasers, which shall include, at a
564 minimum, appropriate guidance on how to use the data and an
565 explanation of why the data may vary from provider to provider.
566 4. Publish on its website undiscounted charges for no fewer
567 than 150 of the most commonly performed adult and pediatric
568 procedures, including outpatient, inpatient, diagnostic, and
569 preventative procedures.
570 (4) TECHNICAL ASSISTANCE.—
571 (a) The center shall provide technical assistance to
572 persons or organizations engaged in health planning activities
573 in the effective use of statistics collected and compiled by the
574 center. The center shall also provide the following additional
575 technical assistance services:
576 1. Establish procedures identifying the circumstances under
577 which, the places at which, the persons from whom, and the
578 methods by which a person may secure data from the center,
579 including procedures governing requests, the ordering of
580 requests, timeframes for handling requests, and other procedures
581 necessary to facilitate the use of the center’s data. To the
582 extent possible, the center should provide current data timely
583 in response to requests from public or private agencies.
584 2. Provide assistance to data sources and users in the
585 areas of database design, survey design, sampling procedures,
586 statistical interpretation, and data access to promote improved
587 health-care-related data sets.
588 3. Identify health care data gaps and provide technical
589 assistance to other public or private organizations for meeting
590 documented health care data needs.
591 4. Assist other organizations in developing statistical
592 abstracts of their data sets that could be used by the center.
593 5. Provide statistical support to state agencies with
594 regard to the use of databases maintained by the center.
595 6. To the extent possible, respond to multiple requests for
596 information not currently collected by the center or available
597 from other sources by initiating data collection.
598 7. Maintain detailed information on data maintained by
599 other local, state, federal, and private agencies in order to
600 advise those who use the center of potential sources of data
601 which are requested but which are not available from the center.
602 8. Respond to requests for data which are not available in
603 published form by initiating special computer runs on data sets
604 available to the center.
605 9. Monitor innovations in health information technology,
606 informatics, and the exchange of health information and maintain
607 a repository of technical resources to support the development
608 of a health information network.
609 (b) The agency shall administer, manage, and monitor grants
610 to not-for-profit organizations, regional health information
611 organizations, public health departments, or state agencies that
612 submit proposals for planning, implementation, or training
613 projects to advance the development of a health information
614 network. Any grant contract shall be evaluated to ensure the
615 effective outcome of the health information project.
616 (c) The agency shall initiate, oversee, manage, and
617 evaluate the integration of health care data from each state
618 agency that collects, stores, and reports on health care issues
619 and make that data available to any health care practitioner
620 through a state health information network.
621 (5) PUBLICATIONS; REPORTS; SPECIAL STUDIES.—The center
622 shall provide for the widespread dissemination of data which it
623 collects and analyzes. The center shall have the following
624 publication, reporting, and special study functions:
625 (a) The center shall publish and make available
626 periodically to agencies and individuals health statistics
627 publications of general interest, including health plan consumer
628 reports and health maintenance organization member satisfaction
629 surveys; publications providing health statistics on topical
630 health policy issues; publications that provide health status
631 profiles of the people in this state; and other topical health
632 statistics publications.
633 (j)(b) Conduct and The center shall publish, make
634 available, and disseminate, promptly and as widely as
635 practicable, the results of special health surveys, health care
636 research, and health care evaluations conducted or supported
637 under this section. Each year the center shall select and
638 analyze one or more research topics that can be investigated
639 using the data available pursuant to paragraph (c). The selected
640 topics must focus on producing actionable information for
641 improving quality of care and reducing costs. The first topic
642 selected by the center must address preventable
643 hospitalizations. Any publication by the center must include a
644 statement of the limitations on the quality, accuracy, and
645 completeness of the data.
646 (c) The center shall provide indexing, abstracting,
647 translation, publication, and other services leading to a more
648 effective and timely dissemination of health care statistics.
649 (d) The center shall be responsible for publishing and
650 disseminating an annual report on the center’s activities.
651 (e) The center shall be responsible, to the extent
652 resources are available, for conducting a variety of special
653 studies and surveys to expand the health care information and
654 statistics available for health policy analyses, particularly
655 for the review of public policy issues. The center shall develop
656 a process by which users of the center’s data are periodically
657 surveyed regarding critical data needs and the results of the
658 survey considered in determining which special surveys or
659 studies will be conducted. The center shall select problems in
660 health care for research, policy analyses, or special data
661 collections on the basis of their local, regional, or state
662 importance; the unique potential for definitive research on the
663 problem; and opportunities for application of the study
664 findings.
665 (4)(6) PROVIDER DATA REPORTING.—This section does not
666 confer on the agency the power to demand or require that a
667 health care provider or professional furnish information,
668 records of interviews, written reports, statements, notes,
669 memoranda, or data other than as expressly required by law. The
670 agency may not establish an all-payor claims database or a
671 comparable database without express legislative authority.
672 (5)(7) BUDGET; FEES.—
673 (a) The Legislature intends that funding for the Florida
674 Center for Health Information and Policy Analysis be
675 appropriated from the General Revenue Fund.
676 (b) The Florida Center for Health Information and
677 Transparency Policy Analysis may apply for and receive and
678 accept grants, gifts, and other payments, including property and
679 services, from any governmental or other public or private
680 entity or person and make arrangements as to the use of same,
681 including the undertaking of special studies and other projects
682 relating to health-care-related topics. Funds obtained pursuant
683 to this paragraph may not be used to offset annual
684 appropriations from the General Revenue Fund.
685 (b)(c) The center may charge such reasonable fees for
686 services as the agency prescribes by rule. The established fees
687 may not exceed the reasonable cost for such services. Fees
688 collected may not be used to offset annual appropriations from
689 the General Revenue Fund.
690 (6)(8) STATE CONSUMER HEALTH INFORMATION AND POLICY
691 ADVISORY COUNCIL.—
692 (a) There is established in the agency the State Consumer
693 Health Information and Policy Advisory Council to assist the
694 center in reviewing the comprehensive health information system,
695 including the identification, collection, standardization,
696 sharing, and coordination of health-related data, fraud and
697 abuse data, and professional and facility licensing data among
698 federal, state, local, and private entities and to recommend
699 improvements for purposes of public health, policy analysis, and
700 transparency of consumer health care information. The council
701 consists shall consist of the following members:
702 1. An employee of the Executive Office of the Governor, to
703 be appointed by the Governor.
704 2. An employee of the Office of Insurance Regulation, to be
705 appointed by the director of the office.
706 3. An employee of the Department of Education, to be
707 appointed by the Commissioner of Education.
708 4. Ten persons, to be appointed by the Secretary of Health
709 Care Administration, representing other state and local
710 agencies, state universities, business and health coalitions,
711 local health councils, professional health-care-related
712 associations, consumers, and purchasers.
713 (b) Each member of the council shall be appointed to serve
714 for a term of 2 years following the date of appointment, except
715 the term of appointment shall end 3 years following the date of
716 appointment for members appointed in 2003, 2004, and 2005. A
717 vacancy shall be filled by appointment for the remainder of the
718 term, and each appointing authority retains the right to
719 reappoint members whose terms of appointment have expired.
720 (c) The council may meet at the call of its chair, at the
721 request of the agency, or at the request of a majority of its
722 membership, but the council must meet at least quarterly.
723 (d) Members shall elect a chair and vice chair annually.
724 (e) A majority of the members constitutes a quorum, and the
725 affirmative vote of a majority of a quorum is necessary to take
726 action.
727 (f) The council shall maintain minutes of each meeting and
728 shall make such minutes available to any person.
729 (g) Members of the council shall serve without compensation
730 but shall be entitled to receive reimbursement for per diem and
731 travel expenses as provided in s. 112.061.
732 (h) The council’s duties and responsibilities include, but
733 are not limited to, the following:
734 1. To develop a mission statement, goals, and a plan of
735 action for the identification, collection, standardization,
736 sharing, and coordination of health-related data across federal,
737 state, and local government and private sector entities.
738 2. To develop a review process to ensure cooperative
739 planning among agencies that collect or maintain health-related
740 data.
741 3. To create ad hoc issue-oriented technical workgroups on
742 an as-needed basis to make recommendations to the council.
743 (7)(9) APPLICATION TO OTHER AGENCIES.—Nothing in This
744 section does not shall limit, restrict, affect, or control the
745 collection, analysis, release, or publication of data by any
746 state agency pursuant to its statutory authority, duties, or
747 responsibilities.
748 Section 4. Subsection (1) of section 408.061, Florida
749 Statutes, is amended to read:
750 408.061 Data collection; uniform systems of financial
751 reporting; information relating to physician charges;
752 confidential information; immunity.—
753 (1) The agency shall require the submission by health care
754 facilities, health care providers, and health insurers of data
755 necessary to carry out the agency’s duties and to facilitate
756 transparency in health care pricing data and quality measures.
757 Specifications for data to be collected under this section shall
758 be developed by the agency and applicable contract vendors, with
759 the assistance of technical advisory panels including
760 representatives of affected entities, consumers, purchasers, and
761 such other interested parties as may be determined by the
762 agency.
763 (a) Data submitted by health care facilities, including the
764 facilities as defined in chapter 395, shall include, but are not
765 limited to: case-mix data, patient admission and discharge data,
766 hospital emergency department data which shall include the
767 number of patients treated in the emergency department of a
768 licensed hospital reported by patient acuity level, data on
769 hospital-acquired infections as specified by rule, data on
770 complications as specified by rule, data on readmissions as
771 specified by rule, with patient and provider-specific
772 identifiers included, actual charge data by diagnostic groups or
773 other bundled groupings as specified by rule, financial data,
774 accounting data, operating expenses, expenses incurred for
775 rendering services to patients who cannot or do not pay,
776 interest charges, depreciation expenses based on the expected
777 useful life of the property and equipment involved, and
778 demographic data. The agency shall adopt nationally recognized
779 risk adjustment methodologies or software consistent with the
780 standards of the Agency for Healthcare Research and Quality and
781 as selected by the agency for all data submitted as required by
782 this section. Data may be obtained from documents such as, but
783 not limited to: leases, contracts, debt instruments, itemized
784 patient statements or bills, medical record abstracts, and
785 related diagnostic information. Reported data elements shall be
786 reported electronically in accordance with rule 59E-7.012,
787 Florida Administrative Code. Data submitted shall be certified
788 by the chief executive officer or an appropriate and duly
789 authorized representative or employee of the licensed facility
790 that the information submitted is true and accurate.
791 (b) Data to be submitted by health care providers may
792 include, but are not limited to: professional organization and
793 specialty board affiliations, Medicare and Medicaid
794 participation, types of services offered to patients, actual
795 charges to patients as specified by rule, amount of revenue and
796 expenses of the health care provider, and such other data which
797 are reasonably necessary to study utilization patterns. Data
798 submitted shall be certified by the appropriate duly authorized
799 representative or employee of the health care provider that the
800 information submitted is true and accurate.
801 (c) Data to be submitted by health insurers may include,
802 but are not limited to: claims, payments to health care
803 facilities and health care providers as specified by rule,
804 premium, administration, and financial information. Data
805 submitted shall be certified by the chief financial officer, an
806 appropriate and duly authorized representative, or an employee
807 of the insurer that the information submitted is true and
808 accurate. Information that is considered a trade secret under s.
809 812.081 shall be clearly designated.
810 (d) Data required to be submitted by health care
811 facilities, health care providers, or health insurers may shall
812 not include specific provider contract reimbursement
813 information. However, such specific provider reimbursement data
814 shall be reasonably available for onsite inspection by the
815 agency as is necessary to carry out the agency’s regulatory
816 duties. Any such data obtained by the agency as a result of
817 onsite inspections may not be used by the state for purposes of
818 direct provider contracting and are confidential and exempt from
819 the provisions of s. 119.07(1) and s. 24(a), Art. I of the State
820 Constitution.
821 (e) A requirement to submit data shall be adopted by rule
822 if the submission of data is being required of all members of
823 any type of health care facility, health care provider, or
824 health insurer. Rules are not required, however, for the
825 submission of data for a special study mandated by the
826 Legislature or when information is being requested for a single
827 health care facility, health care provider, or health insurer.
828 Section 5. Section 456.0575, Florida Statutes, is amended
829 to read:
830 456.0575 Duty to notify patients.—
831 (1) Every licensed health care practitioner shall inform
832 each patient, or an individual identified pursuant to s.
833 765.401(1), in person about adverse incidents that result in
834 serious harm to the patient. Notification of outcomes of care
835 that result in harm to the patient under this section does shall
836 not constitute an acknowledgment of admission of liability, nor
837 can such notifications be introduced as evidence.
838 (2) Upon request by a patient, before providing
839 nonemergency medical services in a facility licensed under
840 chapter 395, a health care practitioner shall provide, in
841 writing or by electronic means, a good faith estimate of
842 reasonably anticipated charges to treat the patient’s condition
843 at the facility. The health care practitioner shall provide the
844 estimate to the patient within 7 business days after receiving
845 the request and is not required to adjust the estimate for any
846 potential insurance coverage. The health care practitioner shall
847 inform the patient that the patient may contact his or her
848 health insurer or health maintenance organization for additional
849 information concerning cost-sharing responsibilities. The health
850 care practitioner shall provide information to uninsured
851 patients and insured patients for whom the practitioner is not a
852 network provider or preferred provider which discloses the
853 practitioner’s financial assistance policy, including the
854 application process, payment plans, discounts, or other
855 available assistance, and the practitioner’s charity care policy
856 and collection procedures. Such estimate does not preclude the
857 actual charges from exceeding the estimate. Failure to provide
858 the estimate in accordance with this subsection, without good
859 cause, shall result in disciplinary action against the health
860 care practitioner and a daily fine of $500 until the estimate is
861 provided to the patient. The total fine may not exceed $5,000.
862 The practitioner shall cooperate with the consumer advocate and
863 his or her representative to support the consumer advocate in
864 his or her efforts as authorized under s. 627.0613(2) and (3).
865 Section 6. Section 627.0613, Florida Statutes, is amended
866 to read:
867 627.0613 Consumer advocate.—The Chief Financial Officer
868 shall must appoint a consumer advocate who shall must represent
869 the general public of the state before the department, and the
870 office, health care facilities licensed under chapter 395, and
871 health care practitioners subject to s. 456.0575(2), as required
872 by this section. The consumer advocate must report directly to
873 the Chief Financial Officer, but is not otherwise under the
874 authority of the department or of any employee of the
875 department. The consumer advocate has such powers as are
876 necessary to carry out the duties of the office of consumer
877 advocate, including, but not limited to, the powers to:
878 (1) Recommend to the department or office, by petition, the
879 commencement of any proceeding or action; appear in any
880 proceeding or action before the department or office; or appear
881 in any proceeding before the Division of Administrative Hearings
882 relating to subject matter under the jurisdiction of the
883 department or office.
884 (2) Assist uninsured patients in understanding statements
885 or bills received from facilities licensed under chapter 395 or
886 health care practitioners subject to s. 456.0575(2), relating to
887 nonemergency health care services provided in a facility
888 licensed under chapter 395.
889 (3) Advocate on behalf of uninsured patients when
890 negotiation between the patient or the patient’s representative
891 and the health care provider does not result in:
892 (a) Charges for the nonemergency health care services in a
893 range that is common and frequent for patients who are similarly
894 situated requiring the same or similar medical services; and
895 (b) Access to available financial assistance, including
896 reasonable payment plans, discounts, and the facility’s charity
897 care, if applicable, for these health care services.
898 (4)(2) Have access to and use of all files, records, and
899 data of the department or office.
900 (5) Have access to any files, records, and data of the
901 Agency for Health Care Administration and the Department of
902 Health which are necessary to perform the activities authorized
903 under subsections (2) and (3).
904 (6)(3) Examine rate and form filings submitted to the
905 office, hire consultants as necessary to aid in the review
906 process, and recommend to the department or office any position
907 deemed by the consumer advocate to be in the public interest.
908 (7) Maintain a process for receiving and investigating
909 complaints from uninsured patients of health care facilities
910 licensed under chapter 395 and health care practitioners subject
911 to chapter 456 concerning billings for nonemergency health care
912 services as described in s. 395.301 or s. 456.0575(2). The
913 consumer advocate is encouraged to use the infrastructure of the
914 Division of Consumer Services within the Department of Financial
915 Services to the fullest extent possible to fulfill the
916 responsibilities imposed by this subsection and subsections (2),
917 (3), and (5).
918 (8)(4) Prepare an annual budget for presentation to the
919 Legislature by the department, which budget must be adequate to
920 carry out the duties of the office of consumer advocate.
921 Section 7. Section 627.6385, Florida Statutes, is created
922 to read:
923 627.6385 Disclosures to policyholders; calculations of cost
924 sharing.—
925 (1) Each health insurer shall make available on its
926 website:
927 (a) A method for policyholders to estimate their
928 copayments, deductibles, and other cost-sharing responsibilities
929 for health care services and procedures. Such method of making
930 an estimate shall be based on service bundles established
931 pursuant to s. 408.05(3)(c). Estimates do not preclude the
932 actual copayment, coinsurance percentage, or deductible,
933 whichever is applicable, from exceeding the estimate.
934 1. Estimates shall be calculated according to the policy
935 and known plan usage during the coverage period.
936 2. Estimates shall be made available based on providers
937 that are in-network and out-of-network.
938 3. A policyholder must be able to create estimates by any
939 combination of the service bundles established pursuant to s.
940 408.05(3)(c), a specified provider, or a comparison of
941 providers.
942 (b) A method for policyholders to estimate their
943 copayments, deductibles, and other cost-sharing responsibilities
944 based on a personalized estimate of charges received from a
945 facility pursuant to s. 395.301 or a practitioner pursuant to s.
946 456.0575.
947 (c) A hyperlink to the health information, including, but
948 not limited to, service bundles and quality of care information,
949 which is disseminated by the Agency for Health Care
950 Administration pursuant to s. 408.05(3).
951 (2) Each health insurer shall include in every policy
952 delivered or issued for delivery to any person in the state or
953 in materials provided as required by s. 627.64725 notice that
954 the information required by this section is available
955 electronically and the address of the website where the
956 information can be accessed.
957 (3) Each health insurer that participates in the state
958 group health insurance plan created under s. 110.123 or Medicaid
959 managed care pursuant to part IV of chapter 409 shall contribute
960 all claims data from Florida policyholders held by the insurer
961 and its affiliates to the contracted vendor selected by the
962 Agency for Health Care Administration under s. 408.05(3)(c).
963 Health insurers shall submit Medicaid managed care claims data
964 to the vendor beginning July 1, 2017, and may submit data before
965 that date. However, each insurer and its affiliates may not
966 contribute claims data to the contracted vendor which reflect
967 the following types of coverage:
968 (a) Coverage only for accident, or disability income
969 insurance, or any combination thereof.
970 (b) Coverage issued as a supplement to liability insurance.
971 (c) Liability insurance, including general liability
972 insurance and automobile liability insurance.
973 (d) Workers’ compensation or similar insurance.
974 (e) Automobile medical payment insurance.
975 (f) Credit-only insurance.
976 (g) Coverage for onsite medical clinics, including prepaid
977 health clinics under part II of chapter 641.
978 (h) Limited scope dental or vision benefits.
979 (i) Benefits for long-term care, nursing home care, home
980 health care, community-based care, or any combination thereof.
981 (j) Coverage only for a specified disease or illness.
982 (k) Hospital indemnity or other fixed indemnity insurance.
983 (l) Medicare supplemental health insurance as defined under
984 s. 1882(g)(1) of the Social Security Act, coverage supplemental
985 to the coverage provided under chapter 55 of Title 10, U.S.C.,
986 and similar supplemental coverage provided to supplement
987 coverage under a group health plan.
988 Section 8. Subsection (6) of section 641.54, Florida
989 Statutes, is amended, present subsection (7) of that section is
990 redesignated as subsection (8) and amended, and a new subsection
991 (7) is added to that section, to read:
992 641.54 Information disclosure.—
993 (6) Each health maintenance organization shall make
994 available to its subscribers on its website or by request the
995 estimated copayment copay, coinsurance percentage, or
996 deductible, whichever is applicable, for any covered services as
997 described by the searchable bundles established on a consumer
998 friendly, Internet-based platform pursuant to s. 408.05(3)(c) or
999 as described by a personalized estimate received from a facility
1000 pursuant to s. 395.301 or a practitioner pursuant to s.
1001 456.0575, the status of the subscriber’s maximum annual out-of
1002 pocket payments for a covered individual or family, and the
1003 status of the subscriber’s maximum lifetime benefit. Such
1004 estimate does shall not preclude the actual copayment copay,
1005 coinsurance percentage, or deductible, whichever is applicable,
1006 from exceeding the estimate.
1007 (7) Each health maintenance organization that participates
1008 in the state group health insurance plan created under s.
1009 110.123 or Medicaid managed care pursuant to part IV of chapter
1010 409 shall contribute all claims data from Florida subscribers
1011 held by the organization and its affiliates to the contracted
1012 vendor selected by the Agency for Health Care Administration
1013 under s. 408.05(3)(c). Health maintenance organizations shall
1014 submit Medicaid managed care claims data to the vendor beginning
1015 July 1, 2017, and may submit data before that date. However,
1016 each health maintenance organization and its affiliates may not
1017 contribute claims data to the contracted vendor which reflect
1018 the following types of coverage:
1019 (a) Coverage only for accident, or disability income
1020 insurance, or any combination thereof.
1021 (b) Coverage issued as a supplement to liability insurance.
1022 (c) Liability insurance, including general liability
1023 insurance and automobile liability insurance.
1024 (d) Workers’ compensation or similar insurance.
1025 (e) Automobile medical payment insurance.
1026 (f) Credit-only insurance.
1027 (g) Coverage for onsite medical clinics, including prepaid
1028 health clinics under part II of chapter 641.
1029 (h) Limited scope dental or vision benefits.
1030 (i) Benefits for long-term care, nursing home care, home
1031 health care, community-based care, or any combination thereof.
1032 (j) Coverage only for a specified disease or illness.
1033 (k) Hospital indemnity or other fixed indemnity insurance.
1034 (l) Medicare supplemental health insurance as defined under
1035 s. 1882(g)(1) of the Social Security Act, coverage supplemental
1036 to the coverage provided under chapter 55 of Title 10, U.S.C.,
1037 and similar supplemental coverage provided to supplement
1038 coverage under a group health plan.
1039 (8)(7) Each health maintenance organization shall make
1040 available on its Internet website a hyperlink link to the health
1041 information performance outcome and financial data that is
1042 disseminated published by the Agency for Health Care
1043 Administration pursuant to s. 408.05(3) s. 408.05(3)(k) and
1044 shall include in every policy delivered or issued for delivery
1045 to any person in the state or in any materials provided as
1046 required by s. 627.64725 notice that such information is
1047 available electronically and the address of its Internet
1048 website.
1049 Section 9. Paragraph (n) is added to subsection (2) of
1050 section 409.967, Florida Statutes, to read:
1051 409.967 Managed care plan accountability.—
1052 (2) The agency shall establish such contract requirements
1053 as are necessary for the operation of the statewide managed care
1054 program. In addition to any other provisions the agency may deem
1055 necessary, the contract must require:
1056 (n) Transparency.—Managed care plans shall comply with ss.
1057 627.6385(3) and 641.54(7).
1058 Section 10. Paragraph (d) of subsection (3) of section
1059 110.123, Florida Statutes, is amended to read:
1060 110.123 State group insurance program.—
1061 (3) STATE GROUP INSURANCE PROGRAM.—
1062 (d)1. Notwithstanding the provisions of chapter 287 and the
1063 authority of the department, for the purpose of protecting the
1064 health of, and providing medical services to, state employees
1065 participating in the state group insurance program, the
1066 department may contract to retain the services of professional
1067 administrators for the state group insurance program. The agency
1068 shall follow good purchasing practices of state procurement to
1069 the extent practicable under the circumstances.
1070 2. Each vendor in a major procurement, and any other vendor
1071 if the department deems it necessary to protect the state’s
1072 financial interests, shall, at the time of executing any
1073 contract with the department, post an appropriate bond with the
1074 department in an amount determined by the department to be
1075 adequate to protect the state’s interests but not higher than
1076 the full amount estimated to be paid annually to the vendor
1077 under the contract.
1078 3. Each major contract entered into by the department
1079 pursuant to this section shall contain a provision for payment
1080 of liquidated damages to the department for material
1081 noncompliance by a vendor with a contract provision. The
1082 department may require a liquidated damages provision in any
1083 contract if the department deems it necessary to protect the
1084 state’s financial interests.
1085 4. Section The provisions of s. 120.57(3) applies apply to
1086 the department’s contracting process, except:
1087 a. A formal written protest of any decision, intended
1088 decision, or other action subject to protest shall be filed
1089 within 72 hours after receipt of notice of the decision,
1090 intended decision, or other action.
1091 b. As an alternative to any provision of s. 120.57(3), the
1092 department may proceed with the bid selection or contract award
1093 process if the director of the department sets forth, in
1094 writing, particular facts and circumstances that which
1095 demonstrate the necessity of continuing the procurement process
1096 or the contract award process in order to avoid a substantial
1097 disruption to the provision of any scheduled insurance services.
1098 5. The department shall make arrangements as necessary to
1099 contribute claims data of the state group health insurance plan
1100 to the contracted vendor selected by the Agency for Health Care
1101 Administration pursuant to s. 408.05(3)(c).
1102 6. Each contracted vendor for the state group health
1103 insurance plan shall contribute Florida claims data to the
1104 contracted vendor selected by the Agency for Health Care
1105 Administration pursuant to s. 408.05(3)(c).
1106 Section 11. Subsection (3) of section 20.42, Florida
1107 Statutes, is amended to read:
1108 20.42 Agency for Health Care Administration.—
1109 (3) The department shall be the chief health policy and
1110 planning entity for the state. The department is responsible for
1111 health facility licensure, inspection, and regulatory
1112 enforcement; investigation of consumer complaints related to
1113 health care facilities and managed care plans; the
1114 implementation of the certificate of need program; the operation
1115 of the Florida Center for Health Information and Transparency
1116 Policy Analysis; the administration of the Medicaid program; the
1117 administration of the contracts with the Florida Healthy Kids
1118 Corporation; the certification of health maintenance
1119 organizations and prepaid health clinics as set forth in part
1120 III of chapter 641; and any other duties prescribed by statute
1121 or agreement.
1122 Section 12. Paragraph (c) of subsection (4) of section
1123 381.026, Florida Statutes, is amended to read:
1124 381.026 Florida Patient’s Bill of Rights and
1125 Responsibilities.—
1126 (4) RIGHTS OF PATIENTS.—Each health care facility or
1127 provider shall observe the following standards:
1128 (c) Financial information and disclosure.—
1129 1. A patient has the right to be given, upon request, by
1130 the responsible provider, his or her designee, or a
1131 representative of the health care facility full information and
1132 necessary counseling on the availability of known financial
1133 resources for the patient’s health care.
1134 2. A health care provider or a health care facility shall,
1135 upon request, disclose to each patient who is eligible for
1136 Medicare, before treatment, whether the health care provider or
1137 the health care facility in which the patient is receiving
1138 medical services accepts assignment under Medicare reimbursement
1139 as payment in full for medical services and treatment rendered
1140 in the health care provider’s office or health care facility.
1141 3. A primary care provider may publish a schedule of
1142 charges for the medical services that the provider offers to
1143 patients. The schedule must include the prices charged to an
1144 uninsured person paying for such services by cash, check, credit
1145 card, or debit card. The schedule must be posted in a
1146 conspicuous place in the reception area of the provider’s office
1147 and must include, but is not limited to, the 50 services most
1148 frequently provided by the primary care provider. The schedule
1149 may group services by three price levels, listing services in
1150 each price level. The posting must be at least 15 square feet in
1151 size. A primary care provider who publishes and maintains a
1152 schedule of charges for medical services is exempt from the
1153 license fee requirements for a single period of renewal of a
1154 professional license under chapter 456 for that licensure term
1155 and is exempt from the continuing education requirements of
1156 chapter 456 and the rules implementing those requirements for a
1157 single 2-year period.
1158 4. If a primary care provider publishes a schedule of
1159 charges pursuant to subparagraph 3., he or she must continually
1160 post it at all times for the duration of active licensure in
1161 this state when primary care services are provided to patients.
1162 If a primary care provider fails to post the schedule of charges
1163 in accordance with this subparagraph, the provider shall be
1164 required to pay any license fee and comply with any continuing
1165 education requirements for which an exemption was received.
1166 5. A health care provider or a health care facility shall,
1167 upon request, furnish a person, before the provision of medical
1168 services, a reasonable estimate of charges for such services.
1169 The health care provider or the health care facility shall
1170 provide an uninsured person, before the provision of a planned
1171 nonemergency medical service, a reasonable estimate of charges
1172 for such service and information regarding the provider’s or
1173 facility’s discount or charity policies for which the uninsured
1174 person may be eligible. Such estimates by a primary care
1175 provider must be consistent with the schedule posted under
1176 subparagraph 3. Estimates shall, to the extent possible, be
1177 written in language comprehensible to an ordinary layperson.
1178 Such reasonable estimate does not preclude the health care
1179 provider or health care facility from exceeding the estimate or
1180 making additional charges based on changes in the patient’s
1181 condition or treatment needs.
1182 6. Each licensed facility, except a facility operating
1183 exclusively as a state facility, not operated by the state shall
1184 make available to the public on its Internet website or by other
1185 electronic means a description of and a hyperlink link to the
1186 health information performance outcome and financial data that
1187 is disseminated published by the agency pursuant to s. 408.05(3)
1188 s. 408.05(3)(k). The facility shall place a notice in the
1189 reception area that such information is available electronically
1190 and the website address. The licensed facility may indicate that
1191 the pricing information is based on a compilation of charges for
1192 the average patient and that each patient’s statement or bill
1193 may vary from the average depending upon the severity of illness
1194 and individual resources consumed. The licensed facility may
1195 also indicate that the price of service is negotiable for
1196 eligible patients based upon the patient’s ability to pay.
1197 7. A patient has the right to receive a copy of an itemized
1198 statement or bill upon request. A patient has a right to be
1199 given an explanation of charges upon request.
1200 Section 13. Paragraph (e) of subsection (2) of section
1201 395.602, Florida Statutes, is amended to read:
1202 395.602 Rural hospitals.—
1203 (2) DEFINITIONS.—As used in this part, the term:
1204 (e) “Rural hospital” means an acute care hospital licensed
1205 under this chapter, having 100 or fewer licensed beds and an
1206 emergency room, which is:
1207 1. The sole provider within a county with a population
1208 density of up to 100 persons per square mile;
1209 2. An acute care hospital, in a county with a population
1210 density of up to 100 persons per square mile, which is at least
1211 30 minutes of travel time, on normally traveled roads under
1212 normal traffic conditions, from any other acute care hospital
1213 within the same county;
1214 3. A hospital supported by a tax district or subdistrict
1215 whose boundaries encompass a population of up to 100 persons per
1216 square mile;
1217 4. A hospital with a service area that has a population of
1218 up to 100 persons per square mile. As used in this subparagraph,
1219 the term “service area” means the fewest number of zip codes
1220 that account for 75 percent of the hospital’s discharges for the
1221 most recent 5-year period, based on information available from
1222 the hospital inpatient discharge database in the Florida Center
1223 for Health Information and Transparency Policy Analysis at the
1224 agency; or
1225 5. A hospital designated as a critical access hospital, as
1226 defined in s. 408.07.
1227
1228 Population densities used in this paragraph must be based upon
1229 the most recently completed United States census. A hospital
1230 that received funds under s. 409.9116 for a quarter beginning no
1231 later than July 1, 2002, is deemed to have been and shall
1232 continue to be a rural hospital from that date through June 30,
1233 2021, if the hospital continues to have up to 100 licensed beds
1234 and an emergency room. An acute care hospital that has not
1235 previously been designated as a rural hospital and that meets
1236 the criteria of this paragraph shall be granted such designation
1237 upon application, including supporting documentation, to the
1238 agency. A hospital that was licensed as a rural hospital during
1239 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
1240 rural hospital from the date of designation through June 30,
1241 2021, if the hospital continues to have up to 100 licensed beds
1242 and an emergency room.
1243 Section 14. Section 395.6025, Florida Statutes, is amended
1244 to read:
1245 395.6025 Rural hospital replacement facilities.
1246 Notwithstanding the provisions of s. 408.036, a hospital defined
1247 as a statutory rural hospital in accordance with s. 395.602, or
1248 a not-for-profit operator of rural hospitals, is not required to
1249 obtain a certificate of need for the construction of a new
1250 hospital located in a county with a population of at least
1251 15,000 but no more than 18,000 and a density of fewer less than
1252 30 persons per square mile, or a replacement facility, provided
1253 that the replacement, or new, facility is located within 10
1254 miles of the site of the currently licensed rural hospital and
1255 within the current primary service area. As used in this
1256 section, the term “service area” means the fewest number of zip
1257 codes that account for 75 percent of the hospital’s discharges
1258 for the most recent 5-year period, based on information
1259 available from the hospital inpatient discharge database in the
1260 Florida Center for Health Information and Transparency Policy
1261 Analysis at the Agency for Health Care Administration.
1262 Section 15. Subsection (43) of section 408.07, Florida
1263 Statutes, is amended to read:
1264 408.07 Definitions.—As used in this chapter, with the
1265 exception of ss. 408.031-408.045, the term:
1266 (43) “Rural hospital” means an acute care hospital licensed
1267 under chapter 395, having 100 or fewer licensed beds and an
1268 emergency room, and which is:
1269 (a) The sole provider within a county with a population
1270 density of no greater than 100 persons per square mile;
1271 (b) An acute care hospital, in a county with a population
1272 density of no greater than 100 persons per square mile, which is
1273 at least 30 minutes of travel time, on normally traveled roads
1274 under normal traffic conditions, from another acute care
1275 hospital within the same county;
1276 (c) A hospital supported by a tax district or subdistrict
1277 whose boundaries encompass a population of 100 persons or fewer
1278 per square mile;
1279 (d) A hospital with a service area that has a population of
1280 100 persons or fewer per square mile. As used in this paragraph,
1281 the term “service area” means the fewest number of zip codes
1282 that account for 75 percent of the hospital’s discharges for the
1283 most recent 5-year period, based on information available from
1284 the hospital inpatient discharge database in the Florida Center
1285 for Health Information and Transparency Policy Analysis at the
1286 Agency for Health Care Administration; or
1287 (e) A critical access hospital.
1288
1289 Population densities used in this subsection must be based upon
1290 the most recently completed United States census. A hospital
1291 that received funds under s. 409.9116 for a quarter beginning no
1292 later than July 1, 2002, is deemed to have been and shall
1293 continue to be a rural hospital from that date through June 30,
1294 2015, if the hospital continues to have 100 or fewer licensed
1295 beds and an emergency room. An acute care hospital that has not
1296 previously been designated as a rural hospital and that meets
1297 the criteria of this subsection shall be granted such
1298 designation upon application, including supporting
1299 documentation, to the Agency for Health Care Administration.
1300 Section 16. Paragraph (a) of subsection (4) of section
1301 408.18, Florida Statutes, is amended to read:
1302 408.18 Health Care Community Antitrust Guidance Act;
1303 antitrust no-action letter; market-information collection and
1304 education.—
1305 (4)(a) Members of the health care community who seek
1306 antitrust guidance may request a review of their proposed
1307 business activity by the Attorney General’s office. In
1308 conducting its review, the Attorney General’s office may seek
1309 whatever documentation, data, or other material it deems
1310 necessary from the Agency for Health Care Administration, the
1311 Florida Center for Health Information and Transparency Policy
1312 Analysis, and the Office of Insurance Regulation of the
1313 Financial Services Commission.
1314 Section 17. Section 465.0244, Florida Statutes, is amended
1315 to read:
1316 465.0244 Information disclosure.—Every pharmacy shall make
1317 available on its Internet website a hyperlink link to the health
1318 information performance outcome and financial data that is
1319 disseminated published by the Agency for Health Care
1320 Administration pursuant to s. 408.05(3) s. 408.05(3)(k) and
1321 shall place in the area where customers receive filled
1322 prescriptions notice that such information is available
1323 electronically and the address of its Internet website.
1324 Section 18. This act is intended to promote health care
1325 price and quality transparency to enable consumers to make
1326 informed choices regarding health care treatment and improve
1327 competition in the health care market. Persons or entities
1328 required to submit, receive, or publish data under this act are
1329 acting pursuant to state requirements contained therein and are
1330 exempt from state antitrust laws.
1331 Section 19. This act shall take effect July 1, 2016.
1332
1333 ================= T I T L E A M E N D M E N T ================
1334 And the title is amended as follows:
1335 Delete everything before the enacting clause
1336 and insert:
1337 A bill to be entitled
1338 An act relating to transparency in health care;
1339 amending s. 395.301, F.S.; requiring a facility
1340 licensed under ch. 395, F.S., to provide timely and
1341 accurate financial information and quality of service
1342 measures to certain individuals; providing an
1343 exemption; requiring a licensed facility to make
1344 available on its website certain information on
1345 payments made to that facility for defined bundles of
1346 services and procedures and other information for
1347 consumers and patients; requiring that facility
1348 websites provide specified information and notify and
1349 inform patients or prospective patients of certain
1350 information; requiring a facility to provide a written
1351 or electronic good faith estimate of charges to a
1352 patient or prospective patient within a certain
1353 timeframe; requiring a facility to provide information
1354 regarding financial assistance from the facility which
1355 may be available to a patient or a prospective
1356 patient; providing a penalty for failing to provide an
1357 estimate of charges to a patient; deleting a
1358 requirement that a licensed facility not operated by
1359 the state provide notice to a patient of his or her
1360 right to an itemized statement or bill within a
1361 certain timeframe; revising the information that must
1362 be included on a patient’s statement or bill;
1363 requiring that certain records be made available
1364 through electronic means that comply with a specified
1365 law; reducing the amount of time afforded to
1366 facilities to respond to certain patient requests for
1367 information; requiring the facility to cooperate with
1368 the consumer advocate under certain circumstances;
1369 amending s. 395.107, F.S.; providing a definition;
1370 making technical changes; amending s. 408.05, F.S.;
1371 revising requirements for the collection and use of
1372 health-related data by the agency; requiring the
1373 agency to contract with a vendor to provide an
1374 Internet-based platform with certain attributes;
1375 requiring potential vendors to have certain
1376 qualifications; prohibiting the agency from
1377 establishing a certain database under certain
1378 circumstances; amending s. 408.061, F.S.; revising
1379 requirements for the submission of health care data to
1380 the agency; requiring submitted information considered
1381 a trade secret to be clearly designated; amending s.
1382 456.0575, F.S.; requiring a health care practitioner
1383 to provide a patient upon his or her request a written
1384 or electronic good faith estimate of anticipated
1385 charges within a certain timeframe; setting a maximum
1386 amount for total fines assessed in certain
1387 disciplinary actions; requiring the practitioner to
1388 cooperate with the consumer advocate under certain
1389 circumstances; amending s. 627.0613, F.S.; providing
1390 that the consumer advocate has the power to assist
1391 certain uninsured patients in understanding certain
1392 bills for nonemergency medical services and advocate
1393 for favorable terms for payment; authorizing the
1394 consumer advocate to have access to files, records,
1395 and data of the agency and the department necessary
1396 for certain investigations; authorizing the consumer
1397 advocate to maintain a process to receive and
1398 investigate complaints from uninsured patients
1399 relating to certain billings and notice requirements
1400 by licensed health care facilities and practitioners;
1401 defining a term; authorizing the consumer advocate to
1402 negotiate between providers and consumers relating to
1403 certain matters; creating s. 627.6385, F.S.; requiring
1404 a health insurer to make available on its website
1405 certain methods that a policyholder can use to make
1406 estimates of certain costs and charges; providing that
1407 an estimate does not preclude an actual cost from
1408 exceeding the estimate; requiring a health insurer to
1409 make available on its website a hyperlink to certain
1410 health information; requiring a health insurer to
1411 include certain notice; requiring a health insurer
1412 that participates in the state group health insurance
1413 plan or Medicaid managed care to provide all claims
1414 data to a contracted vendor selected by the agency by
1415 a specified date; excluding from the contributed
1416 claims data certain types of coverage; amending s.
1417 641.54, F.S.; revising a requirement that a health
1418 maintenance organization make certain information
1419 available to its subscribers; requiring a health
1420 maintenance organization that participates in the
1421 state group health insurance plan or Medicaid managed
1422 care to provide all claims data to a contracted vendor
1423 selected by the agency by a specified date; excluding
1424 from the contributed claims data certain types of
1425 coverage; amending s. 409.967, F.S.; requiring managed
1426 care plans to provide all claims data to a contracted
1427 vendor selected by the agency; amending s. 110.123,
1428 F.S.; requiring the Department of Management Services
1429 to provide certain data to the contracted vendor for
1430 the price transparency database established by the
1431 agency; requiring a contracted vendor for the state
1432 group health insurance plan to provide claims data to
1433 the vendor selected by the agency; amending ss. 20.42,
1434 381.026, 395.602, 395.6025, 408.07, 408.18, and
1435 465.0244, F.S.; conforming provisions to changes made
1436 by the act; providing legislative intent; providing an
1437 effective date.