Florida Senate - 2019                                    SB 1514
       By Senator Albritton
       26-01633-19                                           20191514__
    1                        A bill to be entitled                      
    2         An act relating to medical billing; creating s.
    3         222.26, F.S.; providing additional personal property
    4         exemptions from legal process for medical debts
    5         resulting from services provided in certain licensed
    6         facilities; amending s. 395.301, F.S.; requiring a
    7         licensed facility to provide a cost estimate to a
    8         patient within a specified timeframe after
    9         recommending a specific course of treatment or set of
   10         services; prohibiting a licensed facility from
   11         charging a patient an amount that exceeds such cost
   12         estimate by a set threshold; requiring a licensed
   13         facility to provide a patient with a written
   14         explanation of excess charges under certain
   15         circumstances; requiring a licensed facility to
   16         establish an appeal process for patients to dispute
   17         charges; requiring a facility to make available
   18         information necessary for initiating an appeal;
   19         requiring a facility to respond to a patient appeal
   20         within a specified timeframe; creating s. 395.3011,
   21         F.S.; defining the term “extraordinary collection
   22         action”; prohibiting licensed facilities, under
   23         certain circumstances, from engaging in extraordinary
   24         collection actions against individuals; providing an
   25         effective date.
   27  Be It Enacted by the Legislature of the State of Florida:
   29         Section 1. Section 222.26, Florida Statutes, is created to
   30  read:
   31         222.26Additional exemptions from legal process concerning
   32  medical debt.—If a debt is owed for medical services provided by
   33  a facility licensed under chapter 395, the following property is
   34  exempt from attachment, garnishment, or other legal process:
   35         (1)A debtor’s interest, not to exceed $10,000 in value, in
   36  a single motor vehicle as defined in s. 320.01.
   37         (2)A debtor’s interest in personal property, not to exceed
   38  $10,000, if the debtor does not claim or receive the benefits of
   39  a homestead exemption under s. 4, Art. X of the State
   40  Constitution.
   41         Section 2. Present subsection (6) of section 395.301,
   42  Florida Statutes, is redesignated as subsection (7), paragraph
   43  (b) of subsection (1) is amended, and a new subsection (6) is
   44  added to that section, to read:
   45         395.301 Price transparency; itemized patient statement or
   46  bill; patient admission status notification.—
   47         (1) A facility licensed under this chapter shall provide
   48  timely and accurate financial information and quality of service
   49  measures to patients and prospective patients of the facility,
   50  or to patients’ survivors or legal guardians, as appropriate.
   51  Such information shall be provided in accordance with this
   52  section and rules adopted by the agency pursuant to this chapter
   53  and s. 408.05. Licensed facilities operating exclusively as
   54  state facilities are exempt from this subsection.
   55         (b)1. Upon request, and Before providing any nonemergency
   56  medical services, each licensed facility shall provide in
   57  writing or by electronic means a good faith estimate of
   58  reasonably anticipated charges by the facility for the treatment
   59  of the patient’s or prospective patient’s specific condition.
   60  The facility must provide the estimate to the patient or
   61  prospective patient within 7 business days after recommending a
   62  specific course of treatment or set of services the receipt of
   63  the request and is not required to adjust the estimate for any
   64  potential insurance coverage. The estimate may be based on the
   65  descriptive service bundles developed by the agency under s.
   66  408.05(3)(c) unless the patient or prospective patient requests
   67  a more personalized and specific estimate that accounts for the
   68  specific condition and characteristics of the patient or
   69  prospective patient. The facility shall inform the patient or
   70  prospective patient that he or she may contact his or her health
   71  insurer or health maintenance organization for additional
   72  information concerning cost-sharing responsibilities. The
   73  facility may not charge the patient more than 110 percent of the
   74  estimate. However, if the facility determines that such charges
   75  are warranted due to unforeseen circumstances or the provision
   76  of additional services, the facility must provide the patient
   77  with a written explanation of the excess charges as part of the
   78  detailed, itemized statement or bill.
   79         2. In the estimate, the facility shall provide to the
   80  patient or prospective patient information on the facility’s
   81  financial assistance policy, including the application process,
   82  payment plans, and discounts and the facility’s charity care
   83  policy and collection procedures.
   84         3. The estimate shall clearly identify any facility fees
   85  and, if applicable, include a statement notifying the patient or
   86  prospective patient that a facility fee is included in the
   87  estimate, the purpose of the fee, and that the patient may pay
   88  less for the procedure or service at another facility or in
   89  another health care setting.
   90         4. Upon request, The facility shall notify the patient or
   91  prospective patient of any revision to the estimate.
   92         5. In the estimate, the facility must notify the patient or
   93  prospective patient that services may be provided in the health
   94  care facility by the facility as well as by other health care
   95  providers that may separately bill the patient, if applicable.
   96         6.The facility shall take action to educate the public
   97  that such estimates are available upon request.
   98         6.7. Failure to timely provide the estimate within the
   99  timeframe required in subparagraph 1. pursuant to this paragraph
  100  shall result in a daily fine of $1,000 until the estimate is
  101  provided to the patient or prospective patient. The total fine
  102  may not exceed $10,000.
  104  The provision of an estimate does not preclude the actual
  105  charges from exceeding the estimate.
  106         (6)Each facility shall establish an appeal process
  107  designed to allow patients to dispute charges that appear on the
  108  patient’s itemized statement or bill. The facility shall
  109  prominently post on its website, and indicate in bold print on
  110  each itemized statement or bill, the instructions for initiating
  111  an appeal and the direct contact information needed to initiate
  112  the appeal process. The facility must provide an initial
  113  response to a patient appeal within 7 business days after the
  114  patient formally files an appeal disputing all or a portion of
  115  an itemized statement or bill.
  116         Section 3. Section 395.3011, Florida Statutes, is created
  117  to read:
  118         395.3011Billing and collection activities.—
  119         (1)As used in this section, the term “extraordinary
  120  collection action” means any of the following actions taken by a
  121  licensed facility against an individual in relation to obtaining
  122  payment of a bill for care covered under the facility’s
  123  financial assistance policy:
  124         (a)Selling the individual’s debt to another party.
  125         (b)Reporting adverse information about the individual to
  126  consumer credit reporting agencies or credit bureaus.
  127         (c)Deferring, denying, or requiring a payment before
  128  providing medically necessary care because of the individual’s
  129  nonpayment of one or more bills for previously provided care
  130  covered under the facility’s financial assistance policy.
  131         (d)Actions that require a legal or judicial process,
  132  including, but not limited to:
  133         1.Placing a lien on the individual’s property;
  134         2.Foreclosing on the individual’s real property;
  135         3.Attaching or seizing the individual’s bank account or
  136  any other personal property;
  137         4.Commencing a civil action against the individual;
  138         5.Causing the individual’s arrest; or
  139         6.Garnishing the individual’s wages.
  140         (2)A facility shall not engage in an extraordinary
  141  collection action against an individual to obtain payment for
  142  services:
  143         (a)Before the facility has made reasonable efforts to
  144  determine whether the individual is eligible for assistance
  145  under its financial assistance policy for the care;
  146         (b)Before the facility has provided the individual with a
  147  requested itemized statement or bill;
  148         (c)During an ongoing appeal process as described in s.
  149  395.301(6); or
  150         (d)For 30 days after notifying the patient in writing, by
  151  certified mail or other traceable delivery method, that a
  152  collection action will commence absent additional action by the
  153  patient.
  154         Section 4. This act shall take effect July 1, 2019.