Florida Senate - 2016 SENATOR AMENDMENT
Bill No. CS/CS/HB 1175, 1st Eng.
Ì773730ÉÎ773730
LEGISLATIVE ACTION
Senate . House
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Floor: 1/AE/3R . Floor: SENAT/CA
03/10/2016 03:01 PM . 03/11/2016 10:36 AM
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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 may not be owned
397 or operated by any health plan, health insurer, health
398 maintenance organization, or any entity authorized to provide
399 health care coverage in any state or any director, employee, or
400 other person who has the ability to direct or control a health
401 plan, health insurer, health maintenance organization, or any
402 entity authorized to provide health care coverage in any state.
403 The vendor must be qualified under s. 1874 of the Social
404 Security Act, 42 U.S.C. 1395kk, to receive Medicare claims data
405 and receive claims, payment, and patient cost-share data from
406 multiple private insurers nationwide. The agency shall select
407 the vendor through a competitive procurement process. By October
408 1, 2016, a responsive vendor shall have:
409 1. A national database consisting of at least 15 billion
410 claim lines of administrative claims data from multiple payors
411 capable of being expanded by adding claims data, directly or
412 through arrangements with extant data sources, from other third
413 party payors, including employers with health plans covered by
414 the Employee Retirement Income Security Act of 1974 when those
415 employers choose to participate.
416 2. A well-developed methodology for analyzing claims data
417 within defined service bundles that are understandable by the
418 general public.
419 3. A bundling methodology that is available in the public
420 domain to allow for consistency and comparison of state and
421 national benchmarks with local regions and specific providers.
422 (c) Review the statistical activities of state agencies to
423 ensure that they are consistent with the comprehensive health
424 information system.
425 (d) Develop written agreements with local, state, and
426 federal agencies to facilitate for the sharing of data related
427 to health care health-care-related data or using the facilities
428 and services of such agencies. State agencies, local health
429 councils, and other agencies under state contract shall assist
430 the center in obtaining, compiling, and transferring health
431 care-related data maintained by state and local agencies.
432 Written agreements must specify the types, methods, and
433 periodicity of data exchanges and specify the types of data that
434 will be transferred to the center.
435 (e) Establish by rule:
436 1. The types of data collected, compiled, processed, used,
437 or shared.
438 2. Requirements for implementation of the consumer
439 friendly, Internet-based platform created by the contracted
440 vendor under paragraph (c).
441 3. Requirements for the submission of data by insurers
442 pursuant to s. 627.6385 and health maintenance organizations
443 pursuant to s. 641.54 to the contracted vendor under paragraph
444 (c).
445 4. Requirements governing the collection of data by the
446 contracted vendor under paragraph (c).
447 5. How information is to be published on the consumer
448 friendly, Internet-based platform created under paragraph (c)
449 for public use Decisions regarding center data sets should be
450 made based on consultation with the State Consumer Health
451 Information and Policy Advisory Council and other public and
452 private users regarding the types of data which should be
453 collected and their uses. The center shall establish
454 standardized means for collecting health information and
455 statistics under laws and rules administered by the agency.
456 (f) Consult with contracted vendors, the State Consumer
457 Health Information and Policy Advisory Council, and other public
458 and private users regarding the types of data that should be
459 collected and the use of such data.
460 (g) Monitor data collection procedures and test data
461 quality to facilitate the dissemination of data that is
462 accurate, valid, reliable, and complete.
463 (f) Establish minimum health-care-related data sets which
464 are necessary on a continuing basis to fulfill the collection
465 requirements of the center and which shall be used by state
466 agencies in collecting and compiling health-care-related data.
467 The agency shall periodically review ongoing health care data
468 collections of the Department of Health and other state agencies
469 to determine if the collections are being conducted in
470 accordance with the established minimum sets of data.
471 (g) Establish advisory standards to ensure the quality of
472 health statistical and epidemiological data collection,
473 processing, and analysis by local, state, and private
474 organizations.
475 (h) Prescribe standards for the publication of health-care
476 related data reported pursuant to this section which ensure the
477 reporting of accurate, valid, reliable, complete, and comparable
478 data. Such standards should include advisory warnings to users
479 of the data regarding the status and quality of any data
480 reported by or available from the center.
481 (h)(i) Develop Prescribe standards for the maintenance and
482 preservation of the center’s data. This should include methods
483 for archiving data, retrieval of archived data, and data editing
484 and verification.
485 (j) Ensure that strict quality control measures are
486 maintained for the dissemination of data through publications,
487 studies, or user requests.
488 (i)(k) Make Develop, in conjunction with the State Consumer
489 Health Information and Policy Advisory Council, and implement a
490 long-range plan for making available health care quality
491 measures and financial data that will allow consumers to compare
492 outcomes and other performance measures for health care
493 services. The health care quality measures and financial data
494 the agency must make available include, but are not limited to,
495 pharmaceuticals, physicians, health care facilities, and health
496 plans and managed care entities. The agency shall update the
497 plan and report on the status of its implementation annually.
498 The agency shall also make the plan and status report available
499 to the public on its Internet website. As part of the plan, the
500 agency shall identify the process and timeframes for
501 implementation, barriers to implementation, and recommendations
502 of changes in the law that may be enacted by the Legislature to
503 eliminate the barriers. As preliminary elements of the plan, the
504 agency shall:
505 1. Make available patient-safety indicators, inpatient
506 quality indicators, and performance outcome and patient charge
507 data collected from health care facilities pursuant to s.
508 408.061(1)(a) and (2). The terms “patient-safety indicators” and
509 “inpatient quality indicators” have the same meaning as that
510 ascribed by the Centers for Medicare and Medicaid Services, an
511 accrediting organization whose standards incorporate comparable
512 regulations required by this state, or a national entity that
513 establishes standards to measure the performance of health care
514 providers, or by other states. The agency shall determine which
515 conditions, procedures, health care quality measures, and
516 patient charge data to disclose based upon input from the
517 council. When determining which conditions and procedures are to
518 be disclosed, the council and the agency shall consider
519 variation in costs, variation in outcomes, and magnitude of
520 variations and other relevant information. When determining
521 which health care quality measures to disclose, the agency:
522 a. Shall consider such factors as volume of cases; average
523 patient charges; average length of stay; complication rates;
524 mortality rates; and infection rates, among others, which shall
525 be adjusted for case mix and severity, if applicable.
526 b. May consider such additional measures that are adopted
527 by the Centers for Medicare and Medicaid Studies, an accrediting
528 organization whose standards incorporate comparable regulations
529 required by this state, the National Quality Forum, the Joint
530 Commission on Accreditation of Healthcare Organizations, the
531 Agency for Healthcare Research and Quality, the Centers for
532 Disease Control and Prevention, or a similar national entity
533 that establishes standards to measure the performance of health
534 care providers, or by other states.
535
536 When determining which patient charge data to disclose, the
537 agency shall include such measures as the average of
538 undiscounted charges on frequently performed procedures and
539 preventive diagnostic procedures, the range of procedure charges
540 from highest to lowest, average net revenue per adjusted patient
541 day, average cost per adjusted patient day, and average cost per
542 admission, among others.
543 2. Make available performance measures, benefit design, and
544 premium cost data from health plans licensed pursuant to chapter
545 627 or chapter 641. The agency shall determine which health care
546 quality measures and member and subscriber cost data to
547 disclose, based upon input from the council. When determining
548 which data to disclose, the agency shall consider information
549 that may be required by either individual or group purchasers to
550 assess the value of the product, which may include membership
551 satisfaction, quality of care, current enrollment or membership,
552 coverage areas, accreditation status, premium costs, plan costs,
553 premium increases, range of benefits, copayments and
554 deductibles, accuracy and speed of claims payment, credentials
555 of physicians, number of providers, names of network providers,
556 and hospitals in the network. Health plans shall make available
557 to the agency such data or information that is not currently
558 reported to the agency or the office.
559 3. Determine the method and format for public disclosure of
560 data reported pursuant to this paragraph. The agency shall make
561 its determination based upon input from the State Consumer
562 Health Information and Policy Advisory Council. At a minimum,
563 the data shall be made available on the agency’s Internet
564 website in a manner that allows consumers to conduct an
565 interactive search that allows them to view and compare the
566 information for specific providers. The website must include
567 such additional information as is determined necessary to ensure
568 that the website enhances informed decisionmaking among
569 consumers and health care purchasers, which shall include, at a
570 minimum, appropriate guidance on how to use the data and an
571 explanation of why the data may vary from provider to provider.
572 4. Publish on its website undiscounted charges for no fewer
573 than 150 of the most commonly performed adult and pediatric
574 procedures, including outpatient, inpatient, diagnostic, and
575 preventative procedures.
576 (4) TECHNICAL ASSISTANCE.—
577 (a) The center shall provide technical assistance to
578 persons or organizations engaged in health planning activities
579 in the effective use of statistics collected and compiled by the
580 center. The center shall also provide the following additional
581 technical assistance services:
582 1. Establish procedures identifying the circumstances under
583 which, the places at which, the persons from whom, and the
584 methods by which a person may secure data from the center,
585 including procedures governing requests, the ordering of
586 requests, timeframes for handling requests, and other procedures
587 necessary to facilitate the use of the center’s data. To the
588 extent possible, the center should provide current data timely
589 in response to requests from public or private agencies.
590 2. Provide assistance to data sources and users in the
591 areas of database design, survey design, sampling procedures,
592 statistical interpretation, and data access to promote improved
593 health-care-related data sets.
594 3. Identify health care data gaps and provide technical
595 assistance to other public or private organizations for meeting
596 documented health care data needs.
597 4. Assist other organizations in developing statistical
598 abstracts of their data sets that could be used by the center.
599 5. Provide statistical support to state agencies with
600 regard to the use of databases maintained by the center.
601 6. To the extent possible, respond to multiple requests for
602 information not currently collected by the center or available
603 from other sources by initiating data collection.
604 7. Maintain detailed information on data maintained by
605 other local, state, federal, and private agencies in order to
606 advise those who use the center of potential sources of data
607 which are requested but which are not available from the center.
608 8. Respond to requests for data which are not available in
609 published form by initiating special computer runs on data sets
610 available to the center.
611 9. Monitor innovations in health information technology,
612 informatics, and the exchange of health information and maintain
613 a repository of technical resources to support the development
614 of a health information network.
615 (b) The agency shall administer, manage, and monitor grants
616 to not-for-profit organizations, regional health information
617 organizations, public health departments, or state agencies that
618 submit proposals for planning, implementation, or training
619 projects to advance the development of a health information
620 network. Any grant contract shall be evaluated to ensure the
621 effective outcome of the health information project.
622 (c) The agency shall initiate, oversee, manage, and
623 evaluate the integration of health care data from each state
624 agency that collects, stores, and reports on health care issues
625 and make that data available to any health care practitioner
626 through a state health information network.
627 (5) PUBLICATIONS; REPORTS; SPECIAL STUDIES.—The center
628 shall provide for the widespread dissemination of data which it
629 collects and analyzes. The center shall have the following
630 publication, reporting, and special study functions:
631 (a) The center shall publish and make available
632 periodically to agencies and individuals health statistics
633 publications of general interest, including health plan consumer
634 reports and health maintenance organization member satisfaction
635 surveys; publications providing health statistics on topical
636 health policy issues; publications that provide health status
637 profiles of the people in this state; and other topical health
638 statistics publications.
639 (j)(b) Conduct and The center shall publish, make
640 available, and disseminate, promptly and as widely as
641 practicable, the results of special health surveys, health care
642 research, and health care evaluations conducted or supported
643 under this section. Each year the center shall select and
644 analyze one or more research topics that can be investigated
645 using the data available pursuant to paragraph (c). The selected
646 topics must focus on producing actionable information for
647 improving quality of care and reducing costs. The first topic
648 selected by the center must address preventable
649 hospitalizations. Any publication by the center must include a
650 statement of the limitations on the quality, accuracy, and
651 completeness of the data.
652 (c) The center shall provide indexing, abstracting,
653 translation, publication, and other services leading to a more
654 effective and timely dissemination of health care statistics.
655 (d) The center shall be responsible for publishing and
656 disseminating an annual report on the center’s activities.
657 (e) The center shall be responsible, to the extent
658 resources are available, for conducting a variety of special
659 studies and surveys to expand the health care information and
660 statistics available for health policy analyses, particularly
661 for the review of public policy issues. The center shall develop
662 a process by which users of the center’s data are periodically
663 surveyed regarding critical data needs and the results of the
664 survey considered in determining which special surveys or
665 studies will be conducted. The center shall select problems in
666 health care for research, policy analyses, or special data
667 collections on the basis of their local, regional, or state
668 importance; the unique potential for definitive research on the
669 problem; and opportunities for application of the study
670 findings.
671 (4)(6) PROVIDER DATA REPORTING.—This section does not
672 confer on the agency the power to demand or require that a
673 health care provider or professional furnish information,
674 records of interviews, written reports, statements, notes,
675 memoranda, or data other than as expressly required by law. The
676 agency may not establish an all-payor claims database or a
677 comparable database without express legislative authority.
678 (5)(7) BUDGET; FEES.—
679 (a) The Legislature intends that funding for the Florida
680 Center for Health Information and Policy Analysis be
681 appropriated from the General Revenue Fund.
682 (b) The Florida Center for Health Information and
683 Transparency Policy Analysis may apply for and receive and
684 accept grants, gifts, and other payments, including property and
685 services, from any governmental or other public or private
686 entity or person and make arrangements as to the use of same,
687 including the undertaking of special studies and other projects
688 relating to health-care-related topics. Funds obtained pursuant
689 to this paragraph may not be used to offset annual
690 appropriations from the General Revenue Fund.
691 (b)(c) The center may charge such reasonable fees for
692 services as the agency prescribes by rule. The established fees
693 may not exceed the reasonable cost for such services. Fees
694 collected may not be used to offset annual appropriations from
695 the General Revenue Fund.
696 (6)(8) STATE CONSUMER HEALTH INFORMATION AND POLICY
697 ADVISORY COUNCIL.—
698 (a) There is established in the agency the State Consumer
699 Health Information and Policy Advisory Council to assist the
700 center in reviewing the comprehensive health information system,
701 including the identification, collection, standardization,
702 sharing, and coordination of health-related data, fraud and
703 abuse data, and professional and facility licensing data among
704 federal, state, local, and private entities and to recommend
705 improvements for purposes of public health, policy analysis, and
706 transparency of consumer health care information. The council
707 consists shall consist of the following members:
708 1. An employee of the Executive Office of the Governor, to
709 be appointed by the Governor.
710 2. An employee of the Office of Insurance Regulation, to be
711 appointed by the director of the office.
712 3. An employee of the Department of Education, to be
713 appointed by the Commissioner of Education.
714 4. Ten persons, to be appointed by the Secretary of Health
715 Care Administration, representing other state and local
716 agencies, state universities, business and health coalitions,
717 local health councils, professional health-care-related
718 associations, consumers, and purchasers.
719 (b) Each member of the council shall be appointed to serve
720 for a term of 2 years following the date of appointment, except
721 the term of appointment shall end 3 years following the date of
722 appointment for members appointed in 2003, 2004, and 2005. A
723 vacancy shall be filled by appointment for the remainder of the
724 term, and each appointing authority retains the right to
725 reappoint members whose terms of appointment have expired.
726 (c) The council may meet at the call of its chair, at the
727 request of the agency, or at the request of a majority of its
728 membership, but the council must meet at least quarterly.
729 (d) Members shall elect a chair and vice chair annually.
730 (e) A majority of the members constitutes a quorum, and the
731 affirmative vote of a majority of a quorum is necessary to take
732 action.
733 (f) The council shall maintain minutes of each meeting and
734 shall make such minutes available to any person.
735 (g) Members of the council shall serve without compensation
736 but shall be entitled to receive reimbursement for per diem and
737 travel expenses as provided in s. 112.061.
738 (h) The council’s duties and responsibilities include, but
739 are not limited to, the following:
740 1. To develop a mission statement, goals, and a plan of
741 action for the identification, collection, standardization,
742 sharing, and coordination of health-related data across federal,
743 state, and local government and private sector entities.
744 2. To develop a review process to ensure cooperative
745 planning among agencies that collect or maintain health-related
746 data.
747 3. To create ad hoc issue-oriented technical workgroups on
748 an as-needed basis to make recommendations to the council.
749 (7)(9) APPLICATION TO OTHER AGENCIES.—Nothing in This
750 section does not shall limit, restrict, affect, or control the
751 collection, analysis, release, or publication of data by any
752 state agency pursuant to its statutory authority, duties, or
753 responsibilities.
754 Section 4. Subsection (1) of section 408.061, Florida
755 Statutes, is amended to read:
756 408.061 Data collection; uniform systems of financial
757 reporting; information relating to physician charges;
758 confidential information; immunity.—
759 (1) The agency shall require the submission by health care
760 facilities, health care providers, and health insurers of data
761 necessary to carry out the agency’s duties and to facilitate
762 transparency in health care pricing data and quality measures.
763 Specifications for data to be collected under this section shall
764 be developed by the agency and applicable contract vendors, with
765 the assistance of technical advisory panels including
766 representatives of affected entities, consumers, purchasers, and
767 such other interested parties as may be determined by the
768 agency.
769 (a) Data submitted by health care facilities, including the
770 facilities as defined in chapter 395, shall include, but are not
771 limited to: case-mix data, patient admission and discharge data,
772 hospital emergency department data which shall include the
773 number of patients treated in the emergency department of a
774 licensed hospital reported by patient acuity level, data on
775 hospital-acquired infections as specified by rule, data on
776 complications as specified by rule, data on readmissions as
777 specified by rule, with patient and provider-specific
778 identifiers included, actual charge data by diagnostic groups or
779 other bundled groupings as specified by rule, financial data,
780 accounting data, operating expenses, expenses incurred for
781 rendering services to patients who cannot or do not pay,
782 interest charges, depreciation expenses based on the expected
783 useful life of the property and equipment involved, and
784 demographic data. The agency shall adopt nationally recognized
785 risk adjustment methodologies or software consistent with the
786 standards of the Agency for Healthcare Research and Quality and
787 as selected by the agency for all data submitted as required by
788 this section. Data may be obtained from documents such as, but
789 not limited to: leases, contracts, debt instruments, itemized
790 patient statements or bills, medical record abstracts, and
791 related diagnostic information. Reported data elements shall be
792 reported electronically in accordance with rule 59E-7.012,
793 Florida Administrative Code. Data submitted shall be certified
794 by the chief executive officer or an appropriate and duly
795 authorized representative or employee of the licensed facility
796 that the information submitted is true and accurate.
797 (b) Data to be submitted by health care providers may
798 include, but are not limited to: professional organization and
799 specialty board affiliations, Medicare and Medicaid
800 participation, types of services offered to patients, actual
801 charges to patients as specified by rule, amount of revenue and
802 expenses of the health care provider, and such other data which
803 are reasonably necessary to study utilization patterns. Data
804 submitted shall be certified by the appropriate duly authorized
805 representative or employee of the health care provider that the
806 information submitted is true and accurate.
807 (c) Data to be submitted by health insurers may include,
808 but are not limited to: claims, payments to health care
809 facilities and health care providers as specified by rule,
810 premium, administration, and financial information. Data
811 submitted shall be certified by the chief financial officer, an
812 appropriate and duly authorized representative, or an employee
813 of the insurer that the information submitted is true and
814 accurate. Information that is considered a trade secret under s.
815 812.081 shall be clearly designated.
816 (d) Data required to be submitted by health care
817 facilities, health care providers, or health insurers may shall
818 not include specific provider contract reimbursement
819 information. However, such specific provider reimbursement data
820 shall be reasonably available for onsite inspection by the
821 agency as is necessary to carry out the agency’s regulatory
822 duties. Any such data obtained by the agency as a result of
823 onsite inspections may not be used by the state for purposes of
824 direct provider contracting and are confidential and exempt from
825 the provisions of s. 119.07(1) and s. 24(a), Art. I of the State
826 Constitution.
827 (e) A requirement to submit data shall be adopted by rule
828 if the submission of data is being required of all members of
829 any type of health care facility, health care provider, or
830 health insurer. Rules are not required, however, for the
831 submission of data for a special study mandated by the
832 Legislature or when information is being requested for a single
833 health care facility, health care provider, or health insurer.
834 Section 5. Section 456.0575, Florida Statutes, is amended
835 to read:
836 456.0575 Duty to notify patients.—
837 (1) Every licensed health care practitioner shall inform
838 each patient, or an individual identified pursuant to s.
839 765.401(1), in person about adverse incidents that result in
840 serious harm to the patient. Notification of outcomes of care
841 that result in harm to the patient under this section does shall
842 not constitute an acknowledgment of admission of liability, nor
843 can such notifications be introduced as evidence.
844 (2) Upon request by a patient, before providing
845 nonemergency medical services in a facility licensed under
846 chapter 395, a health care practitioner shall provide, in
847 writing or by electronic means, a good faith estimate of
848 reasonably anticipated charges to treat the patient’s condition
849 at the facility. The health care practitioner shall provide the
850 estimate to the patient within 7 business days after receiving
851 the request and is not required to adjust the estimate for any
852 potential insurance coverage. The health care practitioner shall
853 inform the patient that the patient may contact his or her
854 health insurer or health maintenance organization for additional
855 information concerning cost-sharing responsibilities. The health
856 care practitioner shall provide information to uninsured
857 patients and insured patients for whom the practitioner is not a
858 network provider or preferred provider which discloses the
859 practitioner’s financial assistance policy, including the
860 application process, payment plans, discounts, or other
861 available assistance, and the practitioner’s charity care policy
862 and collection procedures. Such estimate does not preclude the
863 actual charges from exceeding the estimate. Failure to provide
864 the estimate in accordance with this subsection, without good
865 cause, shall result in disciplinary action against the health
866 care practitioner and a daily fine of $500 until the estimate is
867 provided to the patient. The total fine may not exceed $5,000.
868 The practitioner shall cooperate with the consumer advocate and
869 his or her representative to support the consumer advocate in
870 his or her efforts as authorized under s. 627.0613(2) and (3).
871 Section 6. Section 627.0613, Florida Statutes, is amended
872 to read:
873 627.0613 Consumer advocate.—The Chief Financial Officer
874 shall must appoint a consumer advocate who shall must represent
875 the general public of the state before the department, and the
876 office, health care facilities licensed under chapter 395, and
877 health care practitioners subject to s. 456.0575(2), as required
878 by this section. The consumer advocate must report directly to
879 the Chief Financial Officer, but is not otherwise under the
880 authority of the department or of any employee of the
881 department. The consumer advocate has such powers as are
882 necessary to carry out the duties of the office of consumer
883 advocate, including, but not limited to, the powers to:
884 (1) Recommend to the department or office, by petition, the
885 commencement of any proceeding or action; appear in any
886 proceeding or action before the department or office; or appear
887 in any proceeding before the Division of Administrative Hearings
888 relating to subject matter under the jurisdiction of the
889 department or office.
890 (2) Assist uninsured patients in understanding statements
891 or bills received from facilities licensed under chapter 395 or
892 health care practitioners subject to s. 456.0575(2), relating to
893 nonemergency health care services provided in a facility
894 licensed under chapter 395.
895 (3) Advocate on behalf of uninsured patients when
896 negotiation between the patient or the patient’s representative
897 and the health care provider does not result in:
898 (a) Charges for the nonemergency health care services in a
899 range that is common and frequent for patients who are similarly
900 situated requiring the same or similar medical services; and
901 (b) Access to available financial assistance, including
902 reasonable payment plans, discounts, and the facility’s charity
903 care, if applicable, for these health care services.
904 (4)(2) Have access to and use of all files, records, and
905 data of the department or office.
906 (5) Have access to any files, records, and data of the
907 Agency for Health Care Administration and the Department of
908 Health which are necessary to perform the activities authorized
909 under subsections (2) and (3).
910 (6)(3) Examine rate and form filings submitted to the
911 office, hire consultants as necessary to aid in the review
912 process, and recommend to the department or office any position
913 deemed by the consumer advocate to be in the public interest.
914 (7) Maintain a process for receiving and investigating
915 complaints from uninsured patients of health care facilities
916 licensed under chapter 395 and health care practitioners subject
917 to chapter 456 concerning billings for nonemergency health care
918 services as described in s. 395.301 or s. 456.0575(2). The
919 consumer advocate is encouraged to use the infrastructure of the
920 Division of Consumer Services within the Department of Financial
921 Services to the fullest extent possible to fulfill the
922 responsibilities imposed by this subsection and subsections (2),
923 (3), and (5).
924 (8)(4) Prepare an annual budget for presentation to the
925 Legislature by the department, which budget must be adequate to
926 carry out the duties of the office of consumer advocate.
927 Section 7. Section 627.6385, Florida Statutes, is created
928 to read:
929 627.6385 Disclosures to policyholders; calculations of cost
930 sharing.—
931 (1) Each health insurer shall make available on its
932 website:
933 (a) A method for policyholders to estimate their
934 copayments, deductibles, and other cost-sharing responsibilities
935 for health care services and procedures. Such method of making
936 an estimate shall be based on service bundles established
937 pursuant to s. 408.05(3)(c). Estimates do not preclude the
938 actual copayment, coinsurance percentage, or deductible,
939 whichever is applicable, from exceeding the estimate.
940 1. Estimates shall be calculated according to the policy
941 and known plan usage during the coverage period.
942 2. Estimates shall be made available based on providers
943 that are in-network and out-of-network.
944 3. A policyholder must be able to create estimates by any
945 combination of the service bundles established pursuant to s.
946 408.05(3)(c), a specified provider, or a comparison of
947 providers.
948 (b) A method for policyholders to estimate their
949 copayments, deductibles, and other cost-sharing responsibilities
950 based on a personalized estimate of charges received from a
951 facility pursuant to s. 395.301 or a practitioner pursuant to s.
952 456.0575.
953 (c) A hyperlink to the health information, including, but
954 not limited to, service bundles and quality of care information,
955 which is disseminated by the Agency for Health Care
956 Administration pursuant to s. 408.05(3).
957 (2) Each health insurer shall include in every policy
958 delivered or issued for delivery to any person in the state or
959 in materials provided as required by s. 627.64725 notice that
960 the information required by this section is available
961 electronically and the address of the website where the
962 information can be accessed.
963 (3) Each health insurer that participates in the state
964 group health insurance plan created under s. 110.123 or Medicaid
965 managed care pursuant to part IV of chapter 409 shall contribute
966 all claims data from Florida policyholders held by the insurer
967 and its affiliates to the contracted vendor selected by the
968 Agency for Health Care Administration under s. 408.05(3)(c).
969 Health insurers shall submit Medicaid managed care claims data
970 to the vendor beginning July 1, 2017, and may submit data before
971 that date. However, each insurer and its affiliates may not
972 contribute claims data to the contracted vendor which reflect
973 the following types of coverage:
974 (a) Coverage only for accident, or disability income
975 insurance, or any combination thereof.
976 (b) Coverage issued as a supplement to liability insurance.
977 (c) Liability insurance, including general liability
978 insurance and automobile liability insurance.
979 (d) Workers’ compensation or similar insurance.
980 (e) Automobile medical payment insurance.
981 (f) Credit-only insurance.
982 (g) Coverage for onsite medical clinics, including prepaid
983 health clinics under part II of chapter 641.
984 (h) Limited scope dental or vision benefits.
985 (i) Benefits for long-term care, nursing home care, home
986 health care, community-based care, or any combination thereof.
987 (j) Coverage only for a specified disease or illness.
988 (k) Hospital indemnity or other fixed indemnity insurance.
989 (l) Medicare supplemental health insurance as defined under
990 s. 1882(g)(1) of the Social Security Act, coverage supplemental
991 to the coverage provided under chapter 55 of Title 10, U.S.C.,
992 and similar supplemental coverage provided to supplement
993 coverage under a group health plan.
994 Section 8. Subsection (6) of section 641.54, Florida
995 Statutes, is amended, present subsection (7) of that section is
996 redesignated as subsection (8) and amended, and a new subsection
997 (7) is added to that section, to read:
998 641.54 Information disclosure.—
999 (6) Each health maintenance organization shall make
1000 available to its subscribers on its website or by request the
1001 estimated copayment copay, coinsurance percentage, or
1002 deductible, whichever is applicable, for any covered services as
1003 described by the searchable bundles established on a consumer
1004 friendly, Internet-based platform pursuant to s. 408.05(3)(c) or
1005 as described by a personalized estimate received from a facility
1006 pursuant to s. 395.301 or a practitioner pursuant to s.
1007 456.0575, the status of the subscriber’s maximum annual out-of
1008 pocket payments for a covered individual or family, and the
1009 status of the subscriber’s maximum lifetime benefit. Such
1010 estimate does shall not preclude the actual copayment copay,
1011 coinsurance percentage, or deductible, whichever is applicable,
1012 from exceeding the estimate.
1013 (7) Each health maintenance organization that participates
1014 in the state group health insurance plan created under s.
1015 110.123 or Medicaid managed care pursuant to part IV of chapter
1016 409 shall contribute all claims data from Florida subscribers
1017 held by the organization and its affiliates to the contracted
1018 vendor selected by the Agency for Health Care Administration
1019 under s. 408.05(3)(c). Health maintenance organizations shall
1020 submit Medicaid managed care claims data to the vendor beginning
1021 July 1, 2017, and may submit data before that date. However,
1022 each health maintenance organization and its affiliates may not
1023 contribute claims data to the contracted vendor which reflect
1024 the following types of coverage:
1025 (a) Coverage only for accident, or disability income
1026 insurance, or any combination thereof.
1027 (b) Coverage issued as a supplement to liability insurance.
1028 (c) Liability insurance, including general liability
1029 insurance and automobile liability insurance.
1030 (d) Workers’ compensation or similar insurance.
1031 (e) Automobile medical payment insurance.
1032 (f) Credit-only insurance.
1033 (g) Coverage for onsite medical clinics, including prepaid
1034 health clinics under part II of chapter 641.
1035 (h) Limited scope dental or vision benefits.
1036 (i) Benefits for long-term care, nursing home care, home
1037 health care, community-based care, or any combination thereof.
1038 (j) Coverage only for a specified disease or illness.
1039 (k) Hospital indemnity or other fixed indemnity insurance.
1040 (l) Medicare supplemental health insurance as defined under
1041 s. 1882(g)(1) of the Social Security Act, coverage supplemental
1042 to the coverage provided under chapter 55 of Title 10, U.S.C.,
1043 and similar supplemental coverage provided to supplement
1044 coverage under a group health plan.
1045 (8)(7) Each health maintenance organization shall make
1046 available on its Internet website a hyperlink link to the health
1047 information performance outcome and financial data that is
1048 disseminated published by the Agency for Health Care
1049 Administration pursuant to s. 408.05(3) s. 408.05(3)(k) and
1050 shall include in every policy delivered or issued for delivery
1051 to any person in the state or in any materials provided as
1052 required by s. 627.64725 notice that such information is
1053 available electronically and the address of its Internet
1054 website.
1055 Section 9. Paragraph (n) is added to subsection (2) of
1056 section 409.967, Florida Statutes, to read:
1057 409.967 Managed care plan accountability.—
1058 (2) The agency shall establish such contract requirements
1059 as are necessary for the operation of the statewide managed care
1060 program. In addition to any other provisions the agency may deem
1061 necessary, the contract must require:
1062 (n) Transparency.—Managed care plans shall comply with ss.
1063 627.6385(3) and 641.54(7).
1064 Section 10. Paragraph (d) of subsection (3) of section
1065 110.123, Florida Statutes, is amended to read:
1066 110.123 State group insurance program.—
1067 (3) STATE GROUP INSURANCE PROGRAM.—
1068 (d)1. Notwithstanding the provisions of chapter 287 and the
1069 authority of the department, for the purpose of protecting the
1070 health of, and providing medical services to, state employees
1071 participating in the state group insurance program, the
1072 department may contract to retain the services of professional
1073 administrators for the state group insurance program. The agency
1074 shall follow good purchasing practices of state procurement to
1075 the extent practicable under the circumstances.
1076 2. Each vendor in a major procurement, and any other vendor
1077 if the department deems it necessary to protect the state’s
1078 financial interests, shall, at the time of executing any
1079 contract with the department, post an appropriate bond with the
1080 department in an amount determined by the department to be
1081 adequate to protect the state’s interests but not higher than
1082 the full amount estimated to be paid annually to the vendor
1083 under the contract.
1084 3. Each major contract entered into by the department
1085 pursuant to this section shall contain a provision for payment
1086 of liquidated damages to the department for material
1087 noncompliance by a vendor with a contract provision. The
1088 department may require a liquidated damages provision in any
1089 contract if the department deems it necessary to protect the
1090 state’s financial interests.
1091 4. Section The provisions of s. 120.57(3) applies apply to
1092 the department’s contracting process, except:
1093 a. A formal written protest of any decision, intended
1094 decision, or other action subject to protest shall be filed
1095 within 72 hours after receipt of notice of the decision,
1096 intended decision, or other action.
1097 b. As an alternative to any provision of s. 120.57(3), the
1098 department may proceed with the bid selection or contract award
1099 process if the director of the department sets forth, in
1100 writing, particular facts and circumstances that which
1101 demonstrate the necessity of continuing the procurement process
1102 or the contract award process in order to avoid a substantial
1103 disruption to the provision of any scheduled insurance services.
1104 5. The department shall make arrangements as necessary to
1105 contribute claims data of the state group health insurance plan
1106 to the contracted vendor selected by the Agency for Health Care
1107 Administration pursuant to s. 408.05(3)(c).
1108 6. Each contracted vendor for the state group health
1109 insurance plan shall contribute Florida claims data to the
1110 contracted vendor selected by the Agency for Health Care
1111 Administration pursuant to s. 408.05(3)(c).
1112 Section 11. Subsection (3) of section 20.42, Florida
1113 Statutes, is amended to read:
1114 20.42 Agency for Health Care Administration.—
1115 (3) The department shall be the chief health policy and
1116 planning entity for the state. The department is responsible for
1117 health facility licensure, inspection, and regulatory
1118 enforcement; investigation of consumer complaints related to
1119 health care facilities and managed care plans; the
1120 implementation of the certificate of need program; the operation
1121 of the Florida Center for Health Information and Transparency
1122 Policy Analysis; the administration of the Medicaid program; the
1123 administration of the contracts with the Florida Healthy Kids
1124 Corporation; the certification of health maintenance
1125 organizations and prepaid health clinics as set forth in part
1126 III of chapter 641; and any other duties prescribed by statute
1127 or agreement.
1128 Section 12. Paragraph (c) of subsection (4) of section
1129 381.026, Florida Statutes, is amended to read:
1130 381.026 Florida Patient’s Bill of Rights and
1131 Responsibilities.—
1132 (4) RIGHTS OF PATIENTS.—Each health care facility or
1133 provider shall observe the following standards:
1134 (c) Financial information and disclosure.—
1135 1. A patient has the right to be given, upon request, by
1136 the responsible provider, his or her designee, or a
1137 representative of the health care facility full information and
1138 necessary counseling on the availability of known financial
1139 resources for the patient’s health care.
1140 2. A health care provider or a health care facility shall,
1141 upon request, disclose to each patient who is eligible for
1142 Medicare, before treatment, whether the health care provider or
1143 the health care facility in which the patient is receiving
1144 medical services accepts assignment under Medicare reimbursement
1145 as payment in full for medical services and treatment rendered
1146 in the health care provider’s office or health care facility.
1147 3. A primary care provider may publish a schedule of
1148 charges for the medical services that the provider offers to
1149 patients. The schedule must include the prices charged to an
1150 uninsured person paying for such services by cash, check, credit
1151 card, or debit card. The schedule must be posted in a
1152 conspicuous place in the reception area of the provider’s office
1153 and must include, but is not limited to, the 50 services most
1154 frequently provided by the primary care provider. The schedule
1155 may group services by three price levels, listing services in
1156 each price level. The posting must be at least 15 square feet in
1157 size. A primary care provider who publishes and maintains a
1158 schedule of charges for medical services is exempt from the
1159 license fee requirements for a single period of renewal of a
1160 professional license under chapter 456 for that licensure term
1161 and is exempt from the continuing education requirements of
1162 chapter 456 and the rules implementing those requirements for a
1163 single 2-year period.
1164 4. If a primary care provider publishes a schedule of
1165 charges pursuant to subparagraph 3., he or she must continually
1166 post it at all times for the duration of active licensure in
1167 this state when primary care services are provided to patients.
1168 If a primary care provider fails to post the schedule of charges
1169 in accordance with this subparagraph, the provider shall be
1170 required to pay any license fee and comply with any continuing
1171 education requirements for which an exemption was received.
1172 5. A health care provider or a health care facility shall,
1173 upon request, furnish a person, before the provision of medical
1174 services, a reasonable estimate of charges for such services.
1175 The health care provider or the health care facility shall
1176 provide an uninsured person, before the provision of a planned
1177 nonemergency medical service, a reasonable estimate of charges
1178 for such service and information regarding the provider’s or
1179 facility’s discount or charity policies for which the uninsured
1180 person may be eligible. Such estimates by a primary care
1181 provider must be consistent with the schedule posted under
1182 subparagraph 3. Estimates shall, to the extent possible, be
1183 written in language comprehensible to an ordinary layperson.
1184 Such reasonable estimate does not preclude the health care
1185 provider or health care facility from exceeding the estimate or
1186 making additional charges based on changes in the patient’s
1187 condition or treatment needs.
1188 6. Each licensed facility, except a facility operating
1189 exclusively as a state facility, not operated by the state shall
1190 make available to the public on its Internet website or by other
1191 electronic means a description of and a hyperlink link to the
1192 health information performance outcome and financial data that
1193 is disseminated published by the agency pursuant to s. 408.05(3)
1194 s. 408.05(3)(k). The facility shall place a notice in the
1195 reception area that such information is available electronically
1196 and the website address. The licensed facility may indicate that
1197 the pricing information is based on a compilation of charges for
1198 the average patient and that each patient’s statement or bill
1199 may vary from the average depending upon the severity of illness
1200 and individual resources consumed. The licensed facility may
1201 also indicate that the price of service is negotiable for
1202 eligible patients based upon the patient’s ability to pay.
1203 7. A patient has the right to receive a copy of an itemized
1204 statement or bill upon request. A patient has a right to be
1205 given an explanation of charges upon request.
1206 Section 13. Paragraph (e) of subsection (2) of section
1207 395.602, Florida Statutes, is amended to read:
1208 395.602 Rural hospitals.—
1209 (2) DEFINITIONS.—As used in this part, the term:
1210 (e) “Rural hospital” means an acute care hospital licensed
1211 under this chapter, having 100 or fewer licensed beds and an
1212 emergency room, which is:
1213 1. The sole provider within a county with a population
1214 density of up to 100 persons per square mile;
1215 2. An acute care hospital, in a county with a population
1216 density of up to 100 persons per square mile, which is at least
1217 30 minutes of travel time, on normally traveled roads under
1218 normal traffic conditions, from any other acute care hospital
1219 within the same county;
1220 3. A hospital supported by a tax district or subdistrict
1221 whose boundaries encompass a population of up to 100 persons per
1222 square mile;
1223 4. A hospital with a service area that has a population of
1224 up to 100 persons per square mile. As used in this subparagraph,
1225 the term “service area” means the fewest number of zip codes
1226 that account for 75 percent of the hospital’s discharges for the
1227 most recent 5-year period, based on information available from
1228 the hospital inpatient discharge database in the Florida Center
1229 for Health Information and Transparency Policy Analysis at the
1230 agency; or
1231 5. A hospital designated as a critical access hospital, as
1232 defined in s. 408.07.
1233
1234 Population densities used in this paragraph must be based upon
1235 the most recently completed United States census. A hospital
1236 that received funds under s. 409.9116 for a quarter beginning no
1237 later than July 1, 2002, is deemed to have been and shall
1238 continue to be a rural hospital from that date through June 30,
1239 2021, if the hospital continues to have up to 100 licensed beds
1240 and an emergency room. An acute care hospital that has not
1241 previously been designated as a rural hospital and that meets
1242 the criteria of this paragraph shall be granted such designation
1243 upon application, including supporting documentation, to the
1244 agency. A hospital that was licensed as a rural hospital during
1245 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
1246 rural hospital from the date of designation through June 30,
1247 2021, if the hospital continues to have up to 100 licensed beds
1248 and an emergency room.
1249 Section 14. Section 395.6025, Florida Statutes, is amended
1250 to read:
1251 395.6025 Rural hospital replacement facilities.
1252 Notwithstanding the provisions of s. 408.036, a hospital defined
1253 as a statutory rural hospital in accordance with s. 395.602, or
1254 a not-for-profit operator of rural hospitals, is not required to
1255 obtain a certificate of need for the construction of a new
1256 hospital located in a county with a population of at least
1257 15,000 but no more than 18,000 and a density of fewer less than
1258 30 persons per square mile, or a replacement facility, provided
1259 that the replacement, or new, facility is located within 10
1260 miles of the site of the currently licensed rural hospital and
1261 within the current primary service area. As used in this
1262 section, the term “service area” means the fewest number of zip
1263 codes that account for 75 percent of the hospital’s discharges
1264 for the most recent 5-year period, based on information
1265 available from the hospital inpatient discharge database in the
1266 Florida Center for Health Information and Transparency Policy
1267 Analysis at the Agency for Health Care Administration.
1268 Section 15. Subsection (43) of section 408.07, Florida
1269 Statutes, is amended to read:
1270 408.07 Definitions.—As used in this chapter, with the
1271 exception of ss. 408.031-408.045, the term:
1272 (43) “Rural hospital” means an acute care hospital licensed
1273 under chapter 395, having 100 or fewer licensed beds and an
1274 emergency room, and which is:
1275 (a) The sole provider within a county with a population
1276 density of no greater than 100 persons per square mile;
1277 (b) An acute care hospital, in a county with a population
1278 density of no greater than 100 persons per square mile, which is
1279 at least 30 minutes of travel time, on normally traveled roads
1280 under normal traffic conditions, from another acute care
1281 hospital within the same county;
1282 (c) A hospital supported by a tax district or subdistrict
1283 whose boundaries encompass a population of 100 persons or fewer
1284 per square mile;
1285 (d) A hospital with a service area that has a population of
1286 100 persons or fewer per square mile. As used in this paragraph,
1287 the term “service area” means the fewest number of zip codes
1288 that account for 75 percent of the hospital’s discharges for the
1289 most recent 5-year period, based on information available from
1290 the hospital inpatient discharge database in the Florida Center
1291 for Health Information and Transparency Policy Analysis at the
1292 Agency for Health Care Administration; or
1293 (e) A critical access hospital.
1294
1295 Population densities used in this subsection must be based upon
1296 the most recently completed United States census. A hospital
1297 that received funds under s. 409.9116 for a quarter beginning no
1298 later than July 1, 2002, is deemed to have been and shall
1299 continue to be a rural hospital from that date through June 30,
1300 2015, if the hospital continues to have 100 or fewer licensed
1301 beds and an emergency room. An acute care hospital that has not
1302 previously been designated as a rural hospital and that meets
1303 the criteria of this subsection shall be granted such
1304 designation upon application, including supporting
1305 documentation, to the Agency for Health Care Administration.
1306 Section 16. Paragraph (a) of subsection (4) of section
1307 408.18, Florida Statutes, is amended to read:
1308 408.18 Health Care Community Antitrust Guidance Act;
1309 antitrust no-action letter; market-information collection and
1310 education.—
1311 (4)(a) Members of the health care community who seek
1312 antitrust guidance may request a review of their proposed
1313 business activity by the Attorney General’s office. In
1314 conducting its review, the Attorney General’s office may seek
1315 whatever documentation, data, or other material it deems
1316 necessary from the Agency for Health Care Administration, the
1317 Florida Center for Health Information and Transparency Policy
1318 Analysis, and the Office of Insurance Regulation of the
1319 Financial Services Commission.
1320 Section 17. Section 465.0244, Florida Statutes, is amended
1321 to read:
1322 465.0244 Information disclosure.—Every pharmacy shall make
1323 available on its Internet website a hyperlink link to the health
1324 information performance outcome and financial data that is
1325 disseminated published by the Agency for Health Care
1326 Administration pursuant to s. 408.05(3) s. 408.05(3)(k) and
1327 shall place in the area where customers receive filled
1328 prescriptions notice that such information is available
1329 electronically and the address of its Internet website.
1330 Section 18. This act is intended to promote health care
1331 price and quality transparency to enable consumers to make
1332 informed choices regarding health care treatment and improve
1333 competition in the health care market. Persons or entities
1334 required to submit, receive, or publish data under this act are
1335 acting pursuant to state requirements contained therein and are
1336 exempt from state antitrust laws.
1337 Section 19. For the 2016-2017 fiscal year, the sums of
1338 $952,919 in recurring funds and $3.1 million in nonrecurring
1339 funds from the Health Care Trust Fund are appropriated to the
1340 Agency for Health Care Administration, and one full-time
1341 equivalent position with associated salary rate of 41,106 is
1342 authorized, for the purpose of implementing this act.
1343 Section 20. For the 2016-2017 fiscal year, the sums of
1344 $893,994 in recurring funds and $402,560 in nonrecurring funds
1345 from the Insurance Regulatory Trust Fund are appropriated to the
1346 Department of Financial Services and 11 positions with
1347 associated salary rate of 820,176 are authorized for the purpose
1348 of implementing this act.
1349 Section 21. This act shall take effect July 1, 2016.
1350
1351 ================= T I T L E A M E N D M E N T ================
1352 And the title is amended as follows:
1353 Delete everything before the enacting clause
1354 and insert:
1355 A bill to be entitled
1356 An act relating to transparency in health care;
1357 amending s. 395.301, F.S.; requiring a facility
1358 licensed under ch. 395, F.S., to provide timely and
1359 accurate financial information and quality of service
1360 measures to certain individuals; providing an
1361 exemption; requiring a licensed facility to make
1362 available on its website certain information on
1363 payments made to that facility for defined bundles of
1364 services and procedures and other information for
1365 consumers and patients; requiring that facility
1366 websites provide specified information and notify and
1367 inform patients or prospective patients of certain
1368 information; requiring a facility to provide a written
1369 or electronic good faith estimate of charges to a
1370 patient or prospective patient within a certain
1371 timeframe; requiring a facility to provide information
1372 regarding financial assistance from the facility which
1373 may be available to a patient or a prospective
1374 patient; providing a penalty for failing to provide an
1375 estimate of charges to a patient; deleting a
1376 requirement that a licensed facility not operated by
1377 the state provide notice to a patient of his or her
1378 right to an itemized statement or bill within a
1379 certain timeframe; revising the information that must
1380 be included on a patient’s statement or bill;
1381 requiring that certain records be made available
1382 through electronic means that comply with a specified
1383 law; reducing the amount of time afforded to
1384 facilities to respond to certain patient requests for
1385 information; requiring the facility to cooperate with
1386 the consumer advocate under certain circumstances;
1387 amending s. 395.107, F.S.; providing a definition;
1388 making technical changes; amending s. 408.05, F.S.;
1389 revising requirements for the collection and use of
1390 health-related data by the agency; requiring the
1391 agency to contract with a vendor to provide an
1392 Internet-based platform with certain attributes;
1393 requiring potential vendors to have certain
1394 qualifications; prohibiting the agency from
1395 establishing a certain database under certain
1396 circumstances; amending s. 408.061, F.S.; revising
1397 requirements for the submission of health care data to
1398 the agency; requiring submitted information considered
1399 a trade secret to be clearly designated; amending s.
1400 456.0575, F.S.; requiring a health care practitioner
1401 to provide a patient upon his or her request a written
1402 or electronic good faith estimate of anticipated
1403 charges within a certain timeframe; setting a maximum
1404 amount for total fines assessed in certain
1405 disciplinary actions; requiring the practitioner to
1406 cooperate with the consumer advocate under certain
1407 circumstances; amending s. 627.0613, F.S.; providing
1408 that the consumer advocate has the power to assist
1409 certain uninsured patients in understanding certain
1410 bills for nonemergency medical services and advocate
1411 for favorable terms for payment; authorizing the
1412 consumer advocate to have access to files, records,
1413 and data of the agency and the department necessary
1414 for certain investigations; authorizing the consumer
1415 advocate to maintain a process to receive and
1416 investigate complaints from uninsured patients
1417 relating to certain billings and notice requirements
1418 by licensed health care facilities and practitioners;
1419 defining a term; authorizing the consumer advocate to
1420 negotiate between providers and consumers relating to
1421 certain matters; creating s. 627.6385, F.S.; requiring
1422 a health insurer to make available on its website
1423 certain methods that a policyholder can use to make
1424 estimates of certain costs and charges; providing that
1425 an estimate does not preclude an actual cost from
1426 exceeding the estimate; requiring a health insurer to
1427 make available on its website a hyperlink to certain
1428 health information; requiring a health insurer to
1429 include certain notice; requiring a health insurer
1430 that participates in the state group health insurance
1431 plan or Medicaid managed care to provide all claims
1432 data to a contracted vendor selected by the agency by
1433 a specified date; excluding from the contributed
1434 claims data certain types of coverage; amending s.
1435 641.54, F.S.; revising a requirement that a health
1436 maintenance organization make certain information
1437 available to its subscribers; requiring a health
1438 maintenance organization that participates in the
1439 state group health insurance plan or Medicaid managed
1440 care to provide all claims data to a contracted vendor
1441 selected by the agency by a specified date; excluding
1442 from the contributed claims data certain types of
1443 coverage; amending s. 409.967, F.S.; requiring managed
1444 care plans to provide all claims data to a contracted
1445 vendor selected by the agency; amending s. 110.123,
1446 F.S.; requiring the Department of Management Services
1447 to provide certain data to the contracted vendor for
1448 the price transparency database established by the
1449 agency; requiring a contracted vendor for the state
1450 group health insurance plan to provide claims data to
1451 the vendor selected by the agency; amending ss. 20.42,
1452 381.026, 395.602, 395.6025, 408.07, 408.18, and
1453 465.0244, F.S.; conforming provisions to changes made
1454 by the act; providing legislative intent; providing
1455 appropriations; authorizing the creation of positions
1456 with associated salary rate; providing an effective
1457 date.