Bill Text: FL H0935 | 2011 | Regular Session | Engrossed


Bill Title: Health Care Price Transparency

Spectrum: Bipartisan Bill

Status: (Engrossed - Dead) 2011-05-04 - Concurred in 1 amendment(s) (322804) -HJ 1140 [H0935 Detail]

Download: Florida-2011-H0935-Engrossed.html
CS/CS/HB 935

1
A bill to be entitled
2An act relating to health care price transparency;
3amending s. 381.026, F.S.; providing a definition;
4authorizing a primary care provider to publish and post a
5schedule of certain charges for medical services offered
6to patients; providing a minimum size for the posting;
7requiring a schedule of charges to include certain
8information regarding medical services offered; providing
9that the schedule may group the provider's services by
10price levels and list the services in each price level;
11providing an exemption from license fee and continuing
12education requirements for a provider who publishes and
13maintains a schedule of charges; requiring a primary care
14provider's estimates of charges for medical services to be
15consistent with the posted schedule; requiring a provider
16to post the schedule of charges for a certain time period;
17providing for repayment of license fees and compliance
18with continuing education requirements previously waived
19if the schedule of charges was not posted for a certain
20time period; amending s. 395.002, F.S.; providing a
21definition; creating s. 395.107, F.S.; requiring urgent
22care centers to publish and post a schedule of certain
23charges for medical services offered to patients;
24providing a minimum size for the posting; requiring a
25schedule of charges to include certain information
26regarding medical services offered; providing that the
27schedule may group the urgent care center's services by
28price levels and list the services in each price level;
29providing a fine for failure to publish and post a
30schedule of medical services; amending s. 400.9935, F.S.;
31requiring medical directors or clinic directors of health
32care clinics and entities with a certificate of exemption
33under the Health Care Clinic Act to publish and post a
34schedule of certain charges for medical services offered
35to patients; providing a minimum size for the posting;
36requiring a schedule of charges to include certain
37information regarding medical services offered; providing
38that the schedule may group the urgent care center's
39services by price levels and list the services in each
40price level; providing a fine for clinic failure to
41publish and post a schedule of medical services; providing
42an effective date.
43
44Be It Enacted by the Legislature of the State of Florida:
45
46     Section 1.  Subsection (2) and paragraph (c) of subsection
47(4) of section 381.026, Florida Statutes, are amended to read:
48     381.026  Florida Patient's Bill of Rights and
49Responsibilities.-
50     (2)  DEFINITIONS.-As used in this section and s. 381.0261,
51the term:
52     (a)  "Department" means the Department of Health.
53     (b)  "Health care facility" means a facility licensed under
54chapter 395.
55     (c)  "Health care provider" means a physician licensed
56under chapter 458, an osteopathic physician licensed under
57chapter 459, or a podiatric physician licensed under chapter
58461.
59     (d)  "Primary care provider" means a health care provider
60licensed under chapter 458, chapter 459, or chapter 464 who
61provides medical services to patients which are commonly
62provided without referral from another health care provider,
63including family and general practice, general pediatrics, and
64general internal medicine.
65     (e)(d)  "Responsible provider" means a health care provider
66who is primarily responsible for patient care in a health care
67facility or provider's office.
68     (4)  RIGHTS OF PATIENTS.-Each health care facility or
69provider shall observe the following standards:
70     (c)  Financial information and disclosure.-
71     1.  A patient has the right to be given, upon request, by
72the responsible provider, his or her designee, or a
73representative of the health care facility full information and
74necessary counseling on the availability of known financial
75resources for the patient's health care.
76     2.  A health care provider or a health care facility shall,
77upon request, disclose to each patient who is eligible for
78Medicare, before in advance of treatment, whether the health
79care provider or the health care facility in which the patient
80is receiving medical services accepts assignment under Medicare
81reimbursement as payment in full for medical services and
82treatment rendered in the health care provider's office or
83health care facility.
84     3.  A primary care provider may publish a schedule of
85charges for the medical services that the provider offers to
86patients. The schedule must include the prices charged to an
87uninsured person paying for such services by cash, check, credit
88card, or debit card. The schedule must be posted in a
89conspicuous place in the reception area of the provider's office
90and must include, but is not limited to, the 50 services most
91frequently provided by the primary care provider. The schedule
92may group services by three price levels, listing services in
93each price level. The posting must be at least 15 square feet in
94size. A primary care provider who publishes and maintains a
95schedule of charges for medical services is exempt from the
96license fee requirements for a single period of renewal of a
97professional license under chapter 456 for that licensure term
98and is exempt from the continuing education requirements of
99chapter 456 and the rules implementing those requirements for a
100single 2-year period.
101     4.  If a primary care provider publishes a schedule of
102charges pursuant to subparagraph 3., he or she must continually
103post it at all times for the duration of active licensure in
104this state when primary care services are provided to patients.
105If a primary care provider fails to post the schedule of charges
106in accordance with this subparagraph, the provider shall be
107required to pay any license fee and comply with any continuing
108education requirements for which an exemption was received.
109     5.3.  A health care provider or a health care facility
110shall, upon request, furnish a person, before the prior to
111provision of medical services, a reasonable estimate of charges
112for such services. The health care provider or the health care
113facility shall provide an uninsured person, before prior to the
114provision of a planned nonemergency medical service, a
115reasonable estimate of charges for such service and information
116regarding the provider's or facility's discount or charity
117policies for which the uninsured person may be eligible. Such
118estimates by a primary care provider must be consistent with the
119schedule posted under subparagraph 3. Estimates shall, to the
120extent possible, be written in a language comprehensible to an
121ordinary layperson. Such reasonable estimate does shall not
122preclude the health care provider or health care facility from
123exceeding the estimate or making additional charges based on
124changes in the patient's condition or treatment needs.
125     6.4.  Each licensed facility not operated by the state
126shall make available to the public on its Internet website or by
127other electronic means a description of and a link to the
128performance outcome and financial data that is published by the
129agency pursuant to s. 408.05(3)(k). The facility shall place a
130notice in the reception area that such information is available
131electronically and the website address. The licensed facility
132may indicate that the pricing information is based on a
133compilation of charges for the average patient and that each
134patient's bill may vary from the average depending upon the
135severity of illness and individual resources consumed. The
136licensed facility may also indicate that the price of service is
137negotiable for eligible patients based upon the patient's
138ability to pay.
139     7.5.  A patient has the right to receive a copy of an
140itemized bill upon request. A patient has a right to be given an
141explanation of charges upon request.
142     Section 2.  Subsections (30) through (32) of section
143395.002, Florida Statutes, are renumbered as subsections (31)
144through (33), respectively, and a new subsection (30) is added
145to that section to read:
146     395.002  Definitions.-As used in this chapter:
147     (30)  "Urgent care center" means a facility or clinic that
148provides immediate but not emergent ambulatory medical care to
149patients with or without an appointment. It does not include the
150emergency department of a hospital.
151     Section 3.  Section 395.107, Florida Statutes, is created
152to read:
153     395.107  Urgent care centers; publishing and posting
154schedule of charges.-An urgent care center must publish a
155schedule of charges for the medical services offered to
156patients. The schedule must include the prices charged to an
157uninsured person paying for such services by cash, check, credit
158card, or debit card. The schedule must be posted in a
159conspicuous place in the reception area of the urgent care
160center and must include, but is not limited to, the 50 services
161most frequently provided by the urgent care center. The schedule
162may group services by three price levels, listing services in
163each price level. The posting must be at least 15 square feet in
164size. The failure of an urgent care center to publish and post a
165schedule of charges as required by this section shall result in
166a fine of not more than $1,000, per day, until the schedule is
167published and posted.
168     Section 4.  Subsections (1) and (6) of section 400.9935,
169Florida Statutes, are amended to read:
170     400.9935  Clinic responsibilities.-
171     (1)  Each clinic shall appoint a medical director or clinic
172director who shall agree in writing to accept legal
173responsibility for the following activities on behalf of the
174clinic. The medical director or the clinic director shall:
175     (a)  Have signs identifying the medical director or clinic
176director posted in a conspicuous location within the clinic
177readily visible to all patients.
178     (b)  Ensure that all practitioners providing health care
179services or supplies to patients maintain a current active and
180unencumbered Florida license.
181     (c)  Review any patient referral contracts or agreements
182executed by the clinic.
183     (d)  Ensure that all health care practitioners at the
184clinic have active appropriate certification or licensure for
185the level of care being provided.
186     (e)  Serve as the clinic records owner as defined in s.
187456.057.
188     (f)  Ensure compliance with the recordkeeping, office
189surgery, and adverse incident reporting requirements of chapter
190456, the respective practice acts, and rules adopted under this
191part and part II of chapter 408.
192     (g)  Conduct systematic reviews of clinic billings to
193ensure that the billings are not fraudulent or unlawful. Upon
194discovery of an unlawful charge, the medical director or clinic
195director shall take immediate corrective action. If the clinic
196performs only the technical component of magnetic resonance
197imaging, static radiographs, computed tomography, or positron
198emission tomography, and provides the professional
199interpretation of such services, in a fixed facility that is
200accredited by the Joint Commission on Accreditation of
201Healthcare Organizations or the Accreditation Association for
202Ambulatory Health Care, and the American College of Radiology;
203and if, in the preceding quarter, the percentage of scans
204performed by that clinic which was billed to all personal injury
205protection insurance carriers was less than 15 percent, the
206chief financial officer of the clinic may, in a written
207acknowledgment provided to the agency, assume the responsibility
208for the conduct of the systematic reviews of clinic billings to
209ensure that the billings are not fraudulent or unlawful.
210     (h)  Not refer a patient to the clinic if the clinic
211performs magnetic resonance imaging, static radiographs,
212computed tomography, or positron emission tomography. The term
213"refer a patient" means the referral of one or more patients of
214the medical or clinical director or a member of the medical or
215clinical director's group practice to the clinic for magnetic
216resonance imaging, static radiographs, computed tomography, or
217positron emission tomography. A medical director who is found to
218violate this paragraph commits a felony of the third degree,
219punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
220     (i)  Ensure that the clinic publishes a schedule of charges
221for the medical services offered to patients. The schedule must
222include the prices charged to an uninsured person paying for
223such services by cash, check, credit card, or debit card. The
224schedule must be posted in a conspicuous place in the reception
225area of the urgent care center and must include, but is not
226limited to, the 50 services most frequently provided by the
227clinic. The schedule may group services by three price levels,
228listing services in each price level. The posting must be at
229least 15 square feet in size. The failure of a clinic to publish
230and post a schedule of charges as required by this section shall
231result in a fine of not more than $1,000, per day, until the
232schedule is published and posted.
233     (6)  Any person or entity providing health care services
234which is not a clinic, as defined under s. 400.9905, may
235voluntarily apply for a certificate of exemption from licensure
236under its exempt status with the agency on a form that sets
237forth its name or names and addresses, a statement of the
238reasons why it cannot be defined as a clinic, and other
239information deemed necessary by the agency. An exemption is not
240transferable. The agency may charge an applicant for a
241certificate of exemption in an amount equal to $100 or the
242actual cost of processing the certificate, whichever is less. An
243entity seeking a certificate of exemption must publish and
244maintain a schedule of charges for the medical services offered
245to patients. The schedule must include the prices charged to an
246uninsured person paying for such services by cash, check, credit
247card, or debit card. The schedule must be posted in a
248conspicuous place in the reception area of the entity and must
249include, but is not limited to, the 50 services most frequently
250provided by the entity. The schedule may group services by three
251price levels, listing services in each price level. The posting
252must be at least 15 square feet in size. As a condition
253precedent to receiving a certificate of exemption, an applicant
254must provide to the agency documentation of compliance with
255these requirements.
256     Section 5.  This act shall take effect July 1, 2011.


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