Bill Text: FL S1496 | 2016 | Regular Session | Comm Sub
Bill Title: Transparency in Health Care
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Introduced - Dead) 2016-03-08 - Laid on Table, companion bill(s) passed, see CS/CS/HB 1175 (Ch. 2016-234), CS/CS/CS/HB 221 (Ch. 2016-222) [S1496 Detail]
Download: Florida-2016-S1496-Comm_Sub.html
Florida Senate - 2016 CS for SB 1496 By the Committee on Appropriations; and Senators Bradley and Gaetz 576-04202-16 20161496c1 1 A bill to be entitled 2 An act relating to transparency in health care; 3 amending s. 395.301, F.S.; requiring a facility 4 licensed under ch. 395, F.S., to provide timely and 5 accurate financial information and quality of service 6 measures to certain individuals; providing an 7 exemption; requiring a licensed facility to make 8 available on its website certain information on 9 payments made to that facility for defined bundles of 10 services and procedures and other information for 11 consumers and patients; requiring that facility 12 websites provide specified information and notify and 13 inform patients or prospective patients of certain 14 information; requiring a facility to provide a 15 written, good faith estimate of charges to a patient 16 or prospective patient within a certain timeframe; 17 requiring a facility to provide information regarding 18 financial assistance from the facility which may be 19 available to a patient or a prospective patient; 20 providing a penalty for failing to provide an estimate 21 of charges to a patient; deleting a requirement that a 22 licensed facility not operated by the state provide 23 notice to a patient of his or her right to an itemized 24 statement or bill within a certain timeframe; revising 25 the information that must be included on a patient’s 26 statement or bill; requiring that certain records be 27 made available through electronic means that comply 28 with a specified law; reducing the response time for 29 certain patient requests for information; amending s. 30 395.107, F.S.; providing a definition; making 31 technical changes; creating s. 395.3012, F.S.; 32 authorizing the Agency for Health Care Administration 33 to impose penalties based on certain findings of an 34 investigation as determined by the consumer advocate; 35 amending ss. 400.487 and 400.934, F.S.; requiring home 36 health agencies and home medical equipment providers 37 to provide upon request certain written estimates of 38 charges within a certain timeframe; amending s. 39 408.05, F.S.; revising requirements for the collection 40 and use of health-related data by the agency; 41 requiring the agency to contract with a vendor to 42 provide an Internet-based platform with certain 43 attributes; requiring potential vendors to have 44 certain qualifications; prohibiting the agency from 45 establishing a certain database under certain 46 circumstances; amending s. 408.061, F.S.; revising 47 requirements for the submission of health care data to 48 the agency; requiring submitted information considered 49 a trade secret to be clearly designated; amending s. 50 456.0575, F.S.; requiring a health care practitioner 51 to provide a patient upon his or her request a 52 written, good faith estimate of anticipated charges 53 within a certain timeframe; setting a maximum amount 54 for total fines assessed in certain disciplinary 55 actions; amending s. 456.072, F.S.; providing that the 56 failure to comply with fair billing practices by a 57 health care practitioner is grounds for disciplinary 58 action; amending s. 627.0613, F.S.; providing that the 59 consumer advocate must represent the general public 60 before other state agencies; authorizing the consumer 61 advocate to report findings relating to certain 62 investigations to the agency and the Department of 63 Health; authorizing the consumer advocate to have 64 access to files, records, and data of the agency and 65 the department necessary for certain investigations; 66 authorizing the consumer advocate to maintain a 67 process to receive and investigate complaints from 68 patients relating to compliance with certain billing 69 and notice requirements by licensed health care 70 facilities and practitioners; defining a term; 71 authorizing the consumer advocate to provide mediation 72 between providers and consumers relating to certain 73 matters; creating s. 627.6385, F.S.; requiring a 74 health insurer to make available on its website 75 certain methods that a policyholder can use to make 76 estimates of certain costs and charges; providing that 77 an estimate does not preclude an actual cost from 78 exceeding the estimate; requiring a health insurer to 79 make available on its website a hyperlink to certain 80 health information; requiring a health insurer to 81 include certain notice; requiring a health insurer 82 that participates in the state group health insurance 83 plan or Medicaid managed care to provide all claims 84 data to a contracted vendor selected by the agency; 85 excluding from the contributed claims data certain 86 types of coverage; amending s. 641.54, F.S.; revising 87 a requirement that a health maintenance organization 88 make certain information available to its subscribers; 89 requiring a health maintenance organization that 90 participates in the state group health insurance plan 91 or Medicaid managed care to provide all claims data to 92 a contracted vendor selected by the agency; excluding 93 from the contributed claims data certain types of 94 coverage; amending s. 409.967, F.S.; requiring managed 95 care plans to provide all claims data to a contracted 96 vendor selected by the agency; amending s. 110.123, 97 F.S.; requiring the Department of Management Services 98 to provide certain data to the contracted vendor for 99 the price transparency database established by the 100 agency; requiring a contracted vendor for the state 101 group health insurance plan to provide claims data to 102 the vendor selected by the agency; amending ss. 20.42, 103 381.026, 395.602, 395.6025, 408.07, 408.18, and 104 465.0244, F.S.; conforming provisions to changes made 105 by the act; providing legislative intent; providing an 106 effective date. 107 108 Be It Enacted by the Legislature of the State of Florida: 109 110 Section 1. Section 395.301, Florida Statutes, is amended to 111 read: 112 395.301 Price transparency; itemized patient statement or 113 bill;form and content prescribed by the agency;patient 114 admission status notification.— 115 (1) A facility licensed under this chapter shall provide 116 timely and accurate financial information and quality of service 117 measures to prospective and actual patients of the facility, or 118 to patients’ survivors or legal guardians, as appropriate. Such 119 information shall be provided in accordance with this section 120 and rules adopted by the agency pursuant to this chapter and s. 121 408.05. Licensed facilities operating exclusively as state 122 facilities are exempt from this subsection. 123 (a) Each licensed facility shall make available to the 124 public on its website information on payments made to that 125 facility for defined bundles of services and procedures. The 126 payment data must be presented and searchable in accordance 127 with, and through a hyperlink to, the system established by the 128 agency and its vendor using the descriptive service bundles 129 developed under s. 408.05(3)(c). At a minimum, the facility 130 shall provide the estimated average payment received from all 131 payors, excluding Medicaid and Medicare, for the descriptive 132 service bundles available at that facility and the estimated 133 payment range for such bundles. Using plain language, 134 comprehensible to an ordinary layperson, the facility must 135 disclose that the information on average payments and the 136 payment ranges is an estimate of costs that may be incurred by 137 the patient or prospective patient and that actual costs will be 138 based on the services actually provided to the patient. The 139 facility shall also assist the consumer in accessing his or her 140 health insurer’s or health maintenance organization’s website 141 for information on estimated copayments, deductibles, and other 142 cost-sharing responsibilities. The facility’s website must: 143 1. Identify and post the names and hyperlinks for direct 144 access to the websites of all health insurers and health 145 maintenance organizations for which the facility is a network 146 provider or preferred provider. 147 2. Provide information to uninsured patients and insured 148 patients whose health insurer or health maintenance organization 149 does not include the facility as a network provider or preferred 150 provider on the facility’s financial assistance policy, 151 including the application process, payment plans, and discounts, 152 and the facility’s charity care policy and collection 153 procedures. 154 3. If applicable, notify patients and prospective patients 155 that services may be provided in the health care facility by the 156 facility as well as by other health care providers who may 157 separately bill the patient and that such health care providers 158 may or may not participate with the same health insurers or 159 health maintenance organizations as the facility does. 160 4. Inform patients and prospective patients that they may 161 request from the facility and other health care providers a more 162 personalized estimate of charges and other information, and 163 inform patients that they should contact each health care 164 practitioner who will provide services in the hospital to 165 determine with which health insurers and health maintenance 166 organizations he or she participates as a network provider or 167 preferred provider. 168 5. Provide the names, mailing addresses, and telephone 169 numbers of the health care practitioners and medical practice 170 groups with which it contracts to provide services in the 171 facility and instructions on how to contact the practitioners 172 and groups to determine the health insurers and health 173 maintenance organizations with which they participate as network 174 providers or preferred providers. 175 (b)1. Upon request, and before providing any nonemergency 176 medical services, each licensed facility shall provide a 177 written, good faith estimate of reasonably anticipated charges 178 by the facility for the treatment of the patient’s or 179 prospective patient’s specific condition. The facility must 180 provide the estimate in writing to the patient or prospective 181 patient within 7 business days after the receipt of the request 182 and is not required to adjust the estimate for any potential 183 insurance coverage. The estimate may be based on the descriptive 184 service bundles developed by the agency under s. 408.05(3)(c) 185 unless the patient or prospective patient requests a more 186 personalized and specific estimate that accounts for the 187 specific condition and characteristics of the patient or 188 prospective patient. The facility shall inform the patient or 189 prospective patient that he or she may contact his or her health 190 insurer or health maintenance organization for additional 191 information concerning cost-sharing responsibilities. 192 2. In the estimate, the facility shall provide to the 193 patient or prospective patient information on the facility’s 194 financial assistance policy, including the application process, 195 payment plans, and discounts and the facility’s charity care 196 policy and collection procedures. 197 3. The estimate shall clearly identify any facility fees 198 and, if applicable, include a statement notifying the patient or 199 prospective patient that a facility fee is included in the 200 estimate, the purpose of the fee, and that the patient may pay 201 less for the procedure or service at another facility or in 202 another health care setting. 203 4. Upon request, the facility shall notify the patient or 204 prospective patient of any revision to the estimate. 205 5. In the estimate, the facility must notify the patient or 206 prospective patient that services may be provided in the health 207 care facility by the facility as well as by other health care 208 providers that may separately bill the patient, if applicable. 209 6. The facility shall take action to educate the public 210 that such estimates are available upon request. 211 7. Failure to timely provide the estimate pursuant to this 212 paragraph shall result in a daily fine of $1,000 until the 213 estimate is provided to the patient or prospective patient. The 214 total fine may not exceed $10,000. 215 216 The provision of an estimate does not preclude the actual 217 charges from exceeding the estimate. 218 (c) Each facility shall make available on its website a 219 hyperlink to the health-related data, including quality measures 220 and statistics that are disseminated by the agency pursuant to 221 s. 408.05. The facility shall also take action to notify the 222 public that such information is electronically available and 223 provide a hyperlink to the agency’s website. 224 (d)1. Upon request, and after the patient’s discharge or 225 release from a facility, the facility must provideA licensed226facility not operated by the state shall notify each patient227during admission and at discharge of his or her right to receive228an itemized bill upon request. Within 7 days following the229patient’s discharge or release from a licensed facility not230operated by the state, the licensed facility providing the231service shall, upon request, submitto the patient,or to the 232 patient’s survivor or legal guardian, asmay beappropriate, an 233 itemized statement or a bill detailing in plain language, 234 comprehensible to an ordinary layperson, the specific nature of 235 charges or expenses incurred by the patient., which inThe 236 initial statement or billbillingshall be provided within 7 237 days after the patient’s discharge or release or after a request 238 for such statement or bill, whichever is later. The initial 239 statement or bill must contain a statement of specific services 240 received and expenses incurred by date and provider for such 241 items of service, enumerating in detail as prescribed by the 242 agency the constituent components of the services received 243 within each department of the licensed facility and including 244 unit price data on rates charged by the licensed facility, as245prescribed by the agency. The statement or bill must also 246 clearly identify any facility fee and explain the purpose of the 247 fee. The statement or bill must identify each item as paid, 248 pending payment by a third party, or pending payment by the 249 patient, and must include the amount due, if applicable. If an 250 amount is due from the patient, a due date must be included. The 251 initial statement or bill must direct the patient or the 252 patient’s survivor or legal guardian, as appropriate, to contact 253 the patient’s insurer or health maintenance organization 254 regarding the patient’s cost-sharing responsibilities. 255 2. Any subsequent statement or bill provided to a patient 256 or to the patient’s survivor or legal guardian, as appropriate, 257 relating to the episode of care must include all of the 258 information required by subparagraph 1., with any revisions 259 clearly delineated. 260 3.(2)(a)Eachsuchstatement or bill providedsubmitted261 pursuant to this subsectionsection: 262 a.1.MustMay notinclude noticechargesof hospital-based 263 physicians and other health care providers who billif billed264 separately. 265 b.2.May not include any generalized category of expenses 266 such as “other” or “miscellaneous” or similar categories. 267 c.3.MustShalllist drugs by brand or generic name and not 268 refer to drug code numbers when referring to drugs of any sort. 269 d.4.MustShallspecifically identify physical, 270 occupational, or speech therapy treatment byas to thedate, 271 type, and length of treatment when suchtherapytreatment is a 272 part of the statement or bill. 273(b) Any person receiving a statement pursuant to this274section shall be fully and accurately informed as to each charge275and service provided by the institution preparing the statement.276 (2)(3)On each itemized statement submitted pursuant to277subsection (1) there shall appear the words “A FOR-PROFIT (or278NOT-FOR-PROFIT or PUBLIC) HOSPITAL (or AMBULATORY SURGICAL279CENTER) LICENSED BY THE STATE OF FLORIDA” or substantially280similar words sufficient to identify clearly and plainly the281ownership status of the licensed facility.Each itemized 282 statement or bill must prominently display the telephonephone283 number of the medical facility’s patient liaison who is 284 responsible for expediting the resolution of any billing dispute 285 between the patient, or the patient’s survivor or legal guardian 286his or her representative, and the billing department. 287(4) An itemized bill shall be provided once to the288patient’s physician at the physician’s request, at no charge.289(5) In any billing for services subsequent to the initial290billing for such services, the patient, or the patient’s291survivor or legal guardian, may elect, at his or her option, to292receive a copy of the detailed statement of specific services293received and expenses incurred for each such item of service as294provided in subsection (1).295(6) No physician, dentist, podiatric physician, or licensed296facility may add to the price charged by any third party except297for a service or handling charge representing a cost actually298incurred as an item of expense; however, the physician, dentist,299podiatric physician, or licensed facility is entitled to fair300compensation for all professional services rendered. The amount301of the service or handling charge, if any, shall be set forth302clearly in the bill to the patient.303(7) Each licensed facility not operated by the state shall304provide, prior to provision of any nonemergency medical305services, a written good faith estimate of reasonably306anticipated charges for the facility to treat the patient’s307condition upon written request of a prospective patient. The308estimate shall be provided to the prospective patient within 7309business days after the receipt of the request. The estimate may310be the average charges for that diagnosis related group or the311average charges for that procedure. Upon request, the facility312shall notify the patient of any revision to the good faith313estimate. Such estimate shall not preclude the actual charges314from exceeding the estimate. The facility shall place a notice315in the reception area that such information is available.316Failure to provide the estimate within the provisions317established pursuant to this section shall result in a fine of318$500 for each instance of the facility’s failure to provide the319requested information.320(8) Each licensed facility that is not operated by the321state shall provide any uninsured person seeking planned322nonemergency elective admission a written good faith estimate of323reasonably anticipated charges for the facility to treat such324person. The estimate must be provided to the uninsured person325within 7 business days after the person notifies the facility326and the facility confirms that the person is uninsured. The327estimate may be the average charges for that diagnosis-related328group or the average charges for that procedure. Upon request,329the facility shall notify the person of any revision to the good330faith estimate. Such estimate does not preclude the actual331charges from exceeding the estimate. The facility shall also332provide to the uninsured person a copy of any facility discount333and charity care discount policies for which the uninsured334person may be eligible. The facility shall place a notice in the335reception area where such information is available. Failure to336provide the estimate as required by this subsection shall result337in a fine of $500 for each instance of the facility’s failure to338provide the requested information.339 (3)(9)If a licensed facility places a patient on 340 observation status rather than inpatient status, observation 341 services shall be documented in the patient’s discharge papers. 342 The patient or the patient’s survivor or legal guardianproxy343 shall be notified of observation services through discharge 344 papers, which may also include brochures, signage, or other 345 forms of communication for this purpose. 346 (4)(10)A licensed facility shall make available to a 347 patient all records necessary for verification of the accuracy 348 of the patient’s statement or bill within 1030business days 349 after the request for such records. The recordsverification350informationmust be made available in the facility’s offices and 351 through electronic means that comply with the Health Insurance 352 Portability and Accountability Act of 1996, 42 U.S.C. s. 1320d, 353 as amended. Such records mustshallbe available to the patient 354 beforeprior toand after payment of the statement or billor355claim. The facility may not charge the patient for making such 356 verification records available; however, the facility may charge 357 its usual fee for providing copies of records as specified in s. 358 395.3025. 359 (5)(11)Each facility shall establish a method for 360 reviewing and responding to questions from patients concerning 361 the patient’s itemized statement or bill. Such response shall be 362 provided within 7 business30days after the date a question is 363 received. If the patient is not satisfied with the response, the 364 facility must provide the patient with the contact information 365addressof the consumer advocate as provided in s. 627.0613 366agencyto which the issue may be sent for review. 367(12) Each licensed facility shall make available on its368Internet website a link to the performance outcome and financial369data that is published by the Agency for Health Care370Administration pursuant to s. 408.05(3)(k). The facility shall371place a notice in the reception area that the information is372available electronically and the facility’s Internet website373address.374 Section 2. Section 395.107, Florida Statutes, is amended to 375 read: 376 395.107 FacilitiesUrgent care centers; publishing and 377 posting schedule of charges; penalties.— 378 (1) For purposes of this section, the term “facility” 379 means: 380 (a) An urgent care center as defined in s. 395.002; or 381 (b) A diagnostic-imaging center operated by a hospital 382 licensed under this chapter which is not located on the 383 hospital’s premises. 384 (2) A facilityAn urgent care centermust publish and post 385 a schedule of charges for the medical services offered to 386 patients. 387 (3)(2)The schedule of charges must describe the medical 388 services in language comprehensible to a layperson. The schedule 389 must include the prices charged to an uninsured person paying 390 for such services by cash, check, credit card, or debit card. 391 The schedule must be posted in a conspicuous place in the 392 reception area and must include, but is not limited to, the 50 393 services most frequently provided. The schedule may group 394 services by three price levels, listing services in each price 395 level. The posting may be a sign, which must be at least 15 396 square feet in size, or may be through an electronic messaging 397 board. If a facilityan urgent care centeris affiliated with a 398facilitylicensed hospital under this chapter, the schedule must 399 include text that notifies the insured patients whether the 400 charges for medical services received at the center will be the 401 same as, or more than, charges for medical services received at 402 the affiliated hospital. The text notifying the patient of the 403 schedule of charges shall be in a font size equal to or greater 404 than the font size used for prices and must be in a contrasting 405 color. The text that notifies the insured patients whether the 406 charges for medical services received at the center will be the 407 same as, or more than, charges for medical services received at 408 the affiliated hospital shall be included in all media and 409 Internet advertisements for the center and in language 410 comprehensible to a layperson. 411 (4)(3)The posted text describing the medical services must 412 fill at least 12 square feet of the posting. A facilitycenter413 may use an electronic device or messaging board to post the 414 schedule of charges. Such a device must be at least 3 square 415 feet, and patients must be able to access the schedule during 416 all hours of operation of the facilityurgent care center. 417 (5)(4)A facilityAn urgent care centerthat is operated 418 and used exclusively for employees and the dependents of 419 employees of the business that owns or contracts for the 420 facilityurgent care centeris exempt from this section. 421 (6)(5)The failure of a facilityan urgent care centerto 422 publish and post a schedule of charges as required by this 423 section shall result in a fine of not more than $1,000, per day, 424 until the schedule is published and posted. 425 Section 3. Section 395.3012, Florida Statutes, is created 426 to read: 427 395.3012 Penalties for unconscionable prices.— 428 (1) The agency may impose administrative fines based on the 429 findings of the consumer advocate’s investigation of billing 430 complaints pursuant to s. 627.0613(6). 431 (2) The administrative fines for noncompliance with s. 432 395.301 are the greater of $2,500 per violation or double the 433 amount of the original charges. 434 Section 4. Subsection (1) of section 400.487, Florida 435 Statutes, is amended to read: 436 400.487 Home health service agreements; physician’s, 437 physician assistant’s, and advanced registered nurse 438 practitioner’s treatment orders; patient assessment; 439 establishment and review of plan of care; provision of services; 440 orders not to resuscitate.— 441 (1)(a) Services provided by a home health agency must be 442 covered by an agreement between the home health agency and the 443 patient or the patient’s legal representative specifying the 444 home health services to be provided, the rates or charges for 445 services paid with private funds, and the sources of payment, 446 which may include Medicare, Medicaid, private insurance, 447 personal funds, or a combination thereof. A home health agency 448 providing skilled care must make an assessment of the patient’s 449 needs within 48 hours after the start of services. 450 (b) Every licensed home health agency shall provide upon 451 the request of a prospective patient or his or her legal 452 guardian a written, good faith estimate of reasonably 453 anticipated charges for the prospective patient for services 454 provided by the home health agency. The home health agency must 455 provide the estimate to the requestor within 7 business days 456 after receiving the request. The home health agency must inform 457 the prospective patient, or his or her legal guardian, that he 458 or she may contact the prospective patient’s health insurer or 459 health maintenance organization for additional information 460 concerning cost-sharing responsibilities. The home health agency 461 must also provide information disclosing the home health 462 agency’s payment plans, discounts, and other available 463 assistance and its collection procedures. 464 Section 5. Subsection (23) is added to section 400.934, 465 Florida Statutes, to read: 466 400.934 Minimum standards.—As a requirement of licensure, 467 home medical equipment providers shall: 468 (23) Provide upon the request of a prospective patient or 469 his or her legal guardian a written, good faith estimate of 470 reasonably anticipated charges for the prospective patient for 471 services provided by the home medical equipment providers. The 472 home medical equipment providers must provide the estimate to 473 the requestor within 7 business days after receiving the 474 request. The home medical equipment providers must inform the 475 prospective patient, or his or her legal guardian, that he or 476 she may contact the prospective patient’s health insurer or 477 health maintenance organization for additional information 478 concerning cost-sharing responsibilities. The home medical 479 equipment providers must also provide information disclosing the 480 home medical equipment providers’ payment plans, discounts, and 481 other available assistance and their collection procedures. 482 Section 6. Section 408.05, Florida Statutes, is amended to 483 read: 484 408.05 Florida Center for Health Information and 485 TransparencyPolicy Analysis.— 486 (1) ESTABLISHMENT.—The agency shall establish and maintain 487 a Florida Center for Health Information and Transparency to 488 collect, compile, coordinate, analyze, index, and disseminate 489Policy Analysis. The center shall establish a comprehensive490health information system to provide for the collection,491compilation, coordination, analysis, indexing, dissemination,492and utilization of both purposefully collected and extant493 health-related data and statistics. The center shall be staffed 494 aswith public health experts, biostatisticians, information495system analysts, health policy experts, economists, and other496staffnecessary to carry out its functions. 497 (2) HEALTH-RELATED DATA.—Thecomprehensive health498information system operated by theFlorida Center for Health 499 Information and TransparencyPolicy Analysisshall identifythe500bestavailable data sets, compile new data when specifically 501 authorized,data sourcesand promote the usecoordinate the502compilationof extant health-related data and statistics. The 503 center must maintain any data sets in existence before July 1, 504 2016, unless such data sets duplicate information that is 505 readily available from other credible sources, and mayand506purposefullycollect or compile data on: 507(a) The extent and nature of illness and disability of the508state population, including life expectancy, the incidence of509various acute and chronic illnesses, and infant and maternal510morbidity and mortality.511(b) The impact of illness and disability of the state512population on the state economy and on other aspects of the513well-being of the people in this state.514(c) Environmental, social, and other health hazards.515(d) Health knowledge and practices of the people in this516state and determinants of health and nutritional practices and517status.518 (a)(e)Health resources, including licensedphysicians,519dentists, nurses, and otherhealth care practitioners 520professionals, by specialty and type of practice. Such data must 521 include information collected by the Department of Health 522 pursuant to ss. 458.3191 and 459.0081. 523 (b) Health service inventories, includingandacute care, 524 long-term care, and other institutional care facilitiesfacility525suppliesand specific services provided by hospitals, nursing 526 homes, home health agencies, and other licensed health care 527 facilities. 528 (c)(f)Service utilization for licensed health care 529 facilitiesof health care by type of provider. 530 (d)(g)Health care costs and financing, including trends in 531 health care prices and costs, the sources of payment for health 532 care services, and federal, state, and local expenditures for 533 health care. 534(h) Family formation, growth, and dissolution.535 (e)(i)The extent of public and private health insurance 536 coverage in this state. 537 (f)(j)Specific quality-of-care initiatives involvingThe538quality of care provided byvarious health care providers when 539 extant data is not adequate to achieve the objectives of the 540 initiative. 541 (3)COMPREHENSIVEHEALTH INFORMATION TRANSPARENCYSYSTEM. 542 In order to disseminate and facilitate the availability of 543producecomparable and uniform health informationand statistics544for the development of policy recommendations, the agency shall 545 perform the following functions: 546 (a) Collect and compile information on and coordinate the 547 activities of state agencies involved in providingthe design548and implementation of the comprehensivehealth information to 549 consumerssystem. 550 (b) Promote data sharing through dissemination of state 551 collected health data by making such data available, 552 transferable, and readily usableUndertake research,553development, and evaluation respecting the comprehensive health554information system. 555 (c) Contract with a vendor to provide a consumer-friendly, 556 Internet-based platform that allows a consumer to research the 557 cost of health care services and procedures and allows for price 558 comparison. The Internet-based platform must allow a consumer to 559 search by condition or service bundles that are comprehensible 560 to a layperson and may not require registration, a security 561 password, or user identification. The vendor shall also 562 establish and maintain a Florida-specific data set of health 563 care claims information available to the public and any 564 interested party. The agency shall actively oversee the vendor 565 to ensure compliance with state law. The agency shall select the 566 vendor through a competitive procurement process. By October 1, 567 2016, a responsive vendor must have: 568 1. A national database consisting of at least 15 billion 569 claim lines of administrative claims data from multiple payors 570 capable of being expanded by adding third-party payors, 571 including employers with health plans covered by the Employee 572 Retirement Income Security Act of 1974. 573 2. A well-developed methodology for analyzing claims data 574 within defined service bundles. 575 3. A bundling methodology that is available in the public 576 domain to allow for consistency and comparison of state and 577 national benchmarks with local regions and specific providers. 578(c) Review the statistical activities of state agencies to579ensure that they are consistent with the comprehensive health580information system.581 (d) Develop written agreements with local, state, and 582 federal agencies to facilitateforthe sharing of data related 583 to health carehealth-care-related data or using the facilities584and services of such agencies. State agencies, local health585councils, and other agencies under state contract shall assist586the center in obtaining, compiling, and transferring health587care-related data maintained by state and local agencies.588Written agreements must specify the types, methods, and589periodicity of data exchanges and specify the types of data that590will be transferred to the center. 591 (e) Establish by rule: 592 1. The types of data collected, compiled, processed, used, 593 or shared. 594 2. Requirements for implementation of the consumer 595 friendly, Internet-based platform created by the contracted 596 vendor under paragraph (c). 597 3. Requirements for the submission of data by insurers 598 pursuant to s. 627.6385 and health maintenance organizations 599 pursuant to s. 641.54 to the contracted vendor under paragraph 600 (c). 601 4. Requirements governing the collection of data by the 602 contracted vendor under paragraph (c). 603 5. How information is to be published on the consumer 604 friendly, Internet-based platform created under paragraph (c) 605 for public useDecisions regarding center data sets should be606made based on consultation with the State Consumer Health607Information and Policy Advisory Council and other public and608private users regarding the types of data which should be609collected and their uses.The center shall establish610standardized means for collecting health information and611statistics under laws and rules administered by the agency.612 (f) Consult with contracted vendors, the State Consumer 613 Health Information and Policy Advisory Council, and other public 614 and private users regarding the types of data that should be 615 collected and the use of such data. 616 (g) Monitor data collection procedures and test data 617 quality to facilitate the dissemination of data that is 618 accurate, valid, reliable, and complete. 619(f) Establish minimum health-care-related data sets which620are necessary on a continuing basis to fulfill the collection621requirements of the center and which shall be used by state622agencies in collecting and compiling health-care-related data.623The agency shall periodically review ongoing health care data624collections of the Department of Health and other state agencies625to determine if the collections are being conducted in626accordance with the established minimum sets of data.627(g) Establish advisory standards to ensure the quality of628health statistical and epidemiological data collection,629processing, and analysis by local, state, and private630organizations.631(h) Prescribe standards for the publication of health-care632related data reported pursuant to this section which ensure the633reporting of accurate, valid, reliable, complete, and comparable634data. Such standards should include advisory warnings to users635of the data regarding the status and quality of any data636reported by or available from the center.637 (h)(i)DevelopPrescribe standards for the maintenance and638preservation of the center’s data. This should includemethods 639 for archiving data, retrieval of archived data, and data editing 640 and verification. 641(j) Ensure that strict quality control measures are642maintained for the dissemination of data through publications,643studies, or user requests.644 (i)(k)MakeDevelop, in conjunction with the State Consumer645Health Information and Policy Advisory Council, and implement a646long-range plan for makingavailable health care quality 647 measuresand financial datathat will allow consumers to compare 648 outcomes and other performance measures for health care 649 services.The health care quality measures and financial data650the agency must make available include, but are not limited to,651pharmaceuticals, physicians, health care facilities, and health652plans and managed care entities. The agency shall update the653plan and report on the status of its implementation annually.654The agency shall also make the plan and status report available655to the public on its Internet website. As part of the plan, the656agency shall identify the process and timeframes for657implementation, barriers to implementation, and recommendations658of changes in the law that may be enacted by the Legislature to659eliminate the barriers. As preliminary elements of the plan, the660agency shall:6611. Make available patient-safety indicators, inpatient662quality indicators, and performance outcome and patient charge663data collected from health care facilities pursuant to s.664408.061(1)(a) and (2). The terms “patient-safety indicators” and665“inpatient quality indicators” have the same meaning as that666ascribed by the Centers for Medicare and Medicaid Services, an667accrediting organization whose standards incorporate comparable668regulations required by this state, or a national entity that669establishes standards to measure the performance of health care670providers, or by other states. The agency shall determine which671conditions, procedures, health care quality measures, and672patient charge data to disclose based upon input from the673council. When determining which conditions and procedures are to674be disclosed, the council and the agency shall consider675variation in costs, variation in outcomes, and magnitude of676variations and other relevant information. When determining677which health care quality measures to disclose, the agency:678a. Shall consider such factors as volume of cases; average679patient charges; average length of stay; complication rates;680mortality rates; and infection rates, among others, which shall681be adjusted for case mix and severity, if applicable.682b. May consider such additional measures that are adopted683by the Centers for Medicare and Medicaid Studies, an accrediting684organization whose standards incorporate comparable regulations685required by this state, the National Quality Forum, the Joint686Commission on Accreditation of Healthcare Organizations, the687Agency for Healthcare Research and Quality, the Centers for688Disease Control and Prevention, or a similar national entity689that establishes standards to measure the performance of health690care providers, or by other states.691 692When determining which patient charge data to disclose, the693agency shall include such measures as the average of694undiscounted charges on frequently performed procedures and695preventive diagnostic procedures, the range of procedure charges696from highest to lowest, average net revenue per adjusted patient697day, average cost per adjusted patient day, and average cost per698admission, among others.6992. Make available performance measures, benefit design, and700premium cost data from health plans licensed pursuant to chapter701627 or chapter 641. The agency shall determine which health care702quality measures and member and subscriber cost data to703disclose, based upon input from the council. When determining704which data to disclose, the agency shall consider information705that may be required by either individual or group purchasers to706assess the value of the product, which may include membership707satisfaction, quality of care, current enrollment or membership,708coverage areas, accreditation status, premium costs, plan costs,709premium increases, range of benefits, copayments and710deductibles, accuracy and speed of claims payment, credentials711of physicians, number of providers, names of network providers,712and hospitals in the network. Health plans shall make available713to the agency such data or information that is not currently714reported to the agency or the office.7153. Determine the method and format for public disclosure of716data reported pursuant to this paragraph. The agency shall make717its determination based upon input from the State Consumer718Health Information and Policy Advisory Council. At a minimum,719the data shall be made available on the agency’s Internet720website in a manner that allows consumers to conduct an721interactive search that allows them to view and compare the722information for specific providers. The website must include723such additional information as is determined necessary to ensure724that the website enhances informed decisionmaking among725consumers and health care purchasers, which shall include, at a726minimum, appropriate guidance on how to use the data and an727explanation of why the data may vary from provider to provider.7284. Publish on its website undiscounted charges for no fewer729than 150 of the most commonly performed adult and pediatric730procedures, including outpatient, inpatient, diagnostic, and731preventative procedures.732(4) TECHNICAL ASSISTANCE.—733(a) The center shall provide technical assistance to734persons or organizations engaged in health planning activities735in the effective use of statistics collected and compiled by the736center. The center shall also provide the following additional737technical assistance services:7381. Establish procedures identifying the circumstances under739which, the places at which, the persons from whom, and the740methods by which a person may secure data from the center,741including procedures governing requests, the ordering of742requests, timeframes for handling requests, and other procedures743necessary to facilitate the use of the center’s data. To the744extent possible, the center should provide current data timely745in response to requests from public or private agencies.7462. Provide assistance to data sources and users in the747areas of database design, survey design, sampling procedures,748statistical interpretation, and data access to promote improved749health-care-related data sets.7503. Identify health care data gaps and provide technical751assistance to other public or private organizations for meeting752documented health care data needs.7534. Assist other organizations in developing statistical754abstracts of their data sets that could be used by the center.7555. Provide statistical support to state agencies with756regard to the use of databases maintained by the center.7576. To the extent possible, respond to multiple requests for758information not currently collected by the center or available759from other sources by initiating data collection.7607. Maintain detailed information on data maintained by761other local, state, federal, and private agencies in order to762advise those who use the center of potential sources of data763which are requested but which are not available from the center.7648. Respond to requests for data which are not available in765published form by initiating special computer runs on data sets766available to the center.7679. Monitor innovations in health information technology,768informatics, and the exchange of health information and maintain769a repository of technical resources to support the development770of a health information network.771(b) The agency shall administer, manage, and monitor grants772to not-for-profit organizations, regional health information773organizations, public health departments, or state agencies that774submit proposals for planning, implementation, or training775projects to advance the development of a health information776network. Any grant contract shall be evaluated to ensure the777effective outcome of the health information project.778(c) The agency shall initiate, oversee, manage, and779evaluate the integration of health care data from each state780agency that collects, stores, and reports on health care issues781and make that data available to any health care practitioner782through a state health information network.783(5) PUBLICATIONS; REPORTS; SPECIAL STUDIES.—The center784shall provide for the widespread dissemination of data which it785collects and analyzes. The center shall have the following786publication, reporting, and special study functions:787(a) The center shall publish and make available788periodically to agencies and individuals health statistics789publications of general interest, including health plan consumer790reports and health maintenance organization member satisfaction791surveys; publications providing health statistics on topical792health policy issues; publications that provide health status793profiles of the people in this state; and other topical health794statistics publications.795 (j)(b)The center shall publish,Make available, and796disseminate, promptly and as widely as practicable,the results 797 of special health surveys, health care research, and health care 798 evaluations conducted or supported under this section.Any799publication by the center must include a statement of the800limitations on the quality, accuracy, and completeness of the801data.802(c) The center shall provide indexing, abstracting,803translation, publication, and other services leading to a more804effective and timely dissemination of health care statistics.805(d) The center shall be responsible for publishing and806disseminating an annual report on the center’s activities.807(e) The center shall be responsible, to the extent808resources are available, for conducting a variety of special809studies and surveys to expand the health care information and810statistics available for health policy analyses, particularly811for the review of public policy issues. The center shall develop812a process by which users of the center’s data are periodically813surveyed regarding critical data needs and the results of the814survey considered in determining which special surveys or815studies will be conducted. The center shall select problems in816health care for research, policy analyses, or special data817collections on the basis of their local, regional, or state818importance; the unique potential for definitive research on the819problem; and opportunities for application of the study820findings.821 (4)(6)PROVIDER DATA REPORTING.—This section does not 822 confer on the agency the power to demand or require that a 823 health care provider or professional furnish information, 824 records of interviews, written reports, statements, notes, 825 memoranda, or data other than as expressly required by law. The 826 agency may not establish an all-payor claims database or a 827 comparable database without express legislative authority. 828 (5)(7)BUDGET; FEES.— 829 (a)The Legislature intends that funding for the Florida830Center for Health Information and Policy Analysis be831appropriated from the General Revenue Fund.832(b)The Florida Center for Health Information and 833 TransparencyPolicy Analysismay apply for and receive and 834 accept grants, gifts, and other payments, including property and 835 services, from any governmental or other public or private 836 entity or person and make arrangements as to the use of same, 837 including the undertaking of special studies and other projects 838 relating to health-care-related topics. Funds obtained pursuant 839 to this paragraph may not be used to offset annual 840 appropriations from the General Revenue Fund. 841 (b)(c)The center may charge such reasonable fees for 842 services as the agency prescribes by rule. The established fees 843 may not exceed the reasonable cost for such services. Fees 844 collected may not be used to offset annual appropriations from 845 the General Revenue Fund. 846 (6)(8)STATE CONSUMER HEALTH INFORMATION AND POLICY 847 ADVISORY COUNCIL.— 848 (a) There is established in the agency the State Consumer 849 Health Information and Policy Advisory Council to assist the 850 centerin reviewing the comprehensive health information system,851including the identification, collection, standardization,852sharing, and coordination of health-related data, fraud and853abuse data, and professional and facility licensing data among854federal, state, local, and private entities and to recommend855improvements for purposes of public health, policy analysis, and856transparency of consumer health care information. The council 857 consistsshall consistof the following members: 858 1. An employee of the Executive Office of the Governor, to 859 be appointed by the Governor. 860 2. An employee of the Office of Insurance Regulation, to be 861 appointed by the director of the office. 862 3. An employee of the Department of Education, to be 863 appointed by the Commissioner of Education. 864 4. Ten persons, to be appointed by the Secretary of Health 865 Care Administration, representing other state and local 866 agencies, state universities, business and health coalitions, 867 local health councils, professional health-care-related 868 associations, consumers, and purchasers. 869 (b) Each member of the council shall be appointed to serve 870 for a term of 2 years following the date of appointment, except871the term of appointment shall end 3 years following the date of872appointment for members appointed in 2003, 2004, and 2005. A 873 vacancy shall be filled by appointment for the remainder of the 874 term, and each appointing authority retains the right to 875 reappoint members whose terms of appointment have expired. 876 (c) The council may meet at the call of its chair, at the 877 request of the agency, or at the request of a majority of its 878 membership, but the council must meet at least quarterly. 879 (d) Members shall elect a chair and vice chair annually. 880 (e) A majority of the members constitutes a quorum, and the 881 affirmative vote of a majority of a quorum is necessary to take 882 action. 883 (f) The council shall maintain minutes of each meeting and 884 shall make such minutes available to any person. 885 (g) Members of the council shall serve without compensation 886 but shall be entitled to receive reimbursement for per diem and 887 travel expenses as provided in s. 112.061. 888 (h) The council’s duties and responsibilities include, but 889 are not limited to, the following: 890 1. To develop a mission statement, goals, and a plan of 891 action for the identification, collection, standardization, 892 sharing, and coordination of health-related data across federal, 893 state, and local government and private sector entities. 894 2. To develop a review process to ensure cooperative 895 planning among agencies that collect or maintain health-related 896 data. 897 3. To create ad hoc issue-oriented technical workgroups on 898 an as-needed basis to make recommendations to the council. 899 (7)(9)APPLICATION TO OTHER AGENCIES.—Nothing inThis 900 section does notshalllimit, restrict, affect, or control the 901 collection, analysis, release, or publication of data by any 902 state agency pursuant to its statutory authority, duties, or 903 responsibilities. 904 Section 7. Subsection (1) of section 408.061, Florida 905 Statutes, is amended to read: 906 408.061 Data collection; uniform systems of financial 907 reporting; information relating to physician charges; 908 confidential information; immunity.— 909 (1) The agency shall require the submission by health care 910 facilities, health care providers, and health insurers of data 911 necessary to carry out the agency’s duties and to facilitate 912 transparency in health care pricing data and quality measures. 913 Specifications for data to be collected under this section shall 914 be developed by the agency and applicable contract vendors, with 915 the assistance of technical advisory panels including 916 representatives of affected entities, consumers, purchasers, and 917 such other interested parties as may be determined by the 918 agency. 919 (a) Data submitted by health care facilities, including the 920 facilities as defined in chapter 395, shall include, but are not 921 limited to: case-mix data, patient admission and discharge data, 922 hospital emergency department data which shall include the 923 number of patients treated in the emergency department of a 924 licensed hospital reported by patient acuity level, data on 925 hospital-acquired infections as specified by rule, data on 926 complications as specified by rule, data on readmissions as 927 specified by rule, with patient and provider-specific 928 identifiers included, actual charge data by diagnostic groups or 929 other bundled groupings as specified by rule, financial data, 930 accounting data, operating expenses, expenses incurred for 931 rendering services to patients who cannot or do not pay, 932 interest charges, depreciation expenses based on the expected 933 useful life of the property and equipment involved, and 934 demographic data. The agency shall adopt nationally recognized 935 risk adjustment methodologies or software consistent with the 936 standards of the Agency for Healthcare Research and Quality and 937 as selected by the agency for all data submitted as required by 938 this section. Data may be obtained from documents such as, but 939 not limited to: leases, contracts, debt instruments, itemized 940 patient statements or bills, medical record abstracts, and 941 related diagnostic information. Reported data elements shall be 942 reported electronically in accordance with rule 59E-7.012, 943 Florida Administrative Code. Data submitted shall be certified 944 by the chief executive officer or an appropriate and duly 945 authorized representative or employee of the licensed facility 946 that the information submitted is true and accurate. 947 (b) Data to be submitted by health care providers may 948 include, but are not limited to: professional organization and 949 specialty board affiliations, Medicare and Medicaid 950 participation, types of services offered to patients, actual 951 charges to patients as specified by rule, amount of revenue and 952 expenses of the health care provider, and such other data which 953 are reasonably necessary to study utilization patterns. Data 954 submitted shall be certified by the appropriate duly authorized 955 representative or employee of the health care provider that the 956 information submitted is true and accurate. 957 (c) Data to be submitted by health insurers may include, 958 but are not limited to: claims, payments to health care 959 facilities and health care providers as specified by rule, 960 premium, administration, and financial information. Data 961 submitted shall be certified by the chief financial officer, an 962 appropriate and duly authorized representative, or an employee 963 of the insurer that the information submitted is true and 964 accurate. Information that is considered a trade secret under s. 965 812.081 shall be clearly designated. 966 (d) Data required to be submitted by health care 967 facilities, health care providers, or health insurers mayshall968 not include specific provider contract reimbursement 969 information. However, such specific provider reimbursement data 970 shall be reasonably available for onsite inspection by the 971 agency as is necessary to carry out the agency’s regulatory 972 duties. Any such data obtained by the agency as a result of 973 onsite inspections may not be used by the state for purposes of 974 direct provider contracting and are confidential and exempt from 975the provisions ofs. 119.07(1) and s. 24(a), Art. I of the State 976 Constitution. 977 (e) A requirement to submit data shall be adopted by rule 978 if the submission of data is being required of all members of 979 any type of health care facility, health care provider, or 980 health insurer. Rules are not required, however, for the 981 submission of data for a special study mandated by the 982 Legislature or when information is being requested for a single 983 health care facility, health care provider, or health insurer. 984 Section 8. Section 456.0575, Florida Statutes, is amended 985 to read: 986 456.0575 Duty to notify patients.— 987 (1) Every licensed health care practitioner shall inform 988 each patient, or an individual identified pursuant to s. 989 765.401(1), in person about adverse incidents that result in 990 serious harm to the patient. Notification of outcomes of care 991 that result in harm to the patient under this section doesshall992 not constitute an acknowledgment of admission of liability, nor 993 can such notifications be introduced as evidence. 994 (2) Every licensed health care practitioner must provide 995 upon request by a patient, before providing any nonemergency 996 medical services in a facility licensed under chapter 395, a 997 written, good faith estimate of reasonably anticipated charges 998 to treat the patient’s condition at the facility. The health 999 care practitioner must provide the estimate to the patient 1000 within 7 business days after receiving the request and is not 1001 required to adjust the estimate for any potential insurance 1002 coverage. The health care practitioner must inform the patient 1003 that the patient may contact his or her health insurer or health 1004 maintenance organization for additional information concerning 1005 cost-sharing responsibilities. The health care practitioner must 1006 provide information to uninsured patients and insured patients 1007 for whom the practitioner is not a network provider or preferred 1008 provider which discloses the practitioner’s financial assistance 1009 policy, including the application process, payment plans, 1010 discounts, or other available assistance, and the practitioner’s 1011 charity care policy and collection procedures. Such estimate 1012 does not preclude the actual charges from exceeding the 1013 estimate. Failure to provide the estimate in accordance with 1014 this subsection, without good cause, shall result in 1015 disciplinary action against the health care practitioner and a 1016 daily fine of $500 until the estimate is provided to the 1017 patient. The total fine may not exceed $5,000. 1018 Section 9. Paragraph (oo) is added to subsection (1) of 1019 section 456.072, Florida Statutes, to read: 1020 456.072 Grounds for discipline; penalties; enforcement.— 1021 (1) The following acts shall constitute grounds for which 1022 the disciplinary actions specified in subsection (2) may be 1023 taken: 1024 (oo) Failure to comply with fair billing practices pursuant 1025 to s. 627.0613(6). 1026 Section 10. Section 627.0613, Florida Statutes, is amended 1027 to read: 1028 627.0613 Consumer advocate.—The Chief Financial Officer 1029 must appoint a consumer advocate who must represent the general 1030 public of the state before the department,andthe office, and 1031 other state agencies, as required by this section. The consumer 1032 advocate must report directly to the Chief Financial Officer, 1033 but is not otherwise under the authority of the department or of 1034 any employee of the department. The consumer advocate has such 1035 powers as are necessary to carry out the duties of the office of 1036 consumer advocate, including, but not limited to, the powers to: 1037 (1) Recommend to the department or office, by petition, the 1038 commencement of any proceeding or action; appear in any 1039 proceeding or action before the department or office; or appear 1040 in any proceeding before the Division of Administrative Hearings 1041 relating to subject matter under the jurisdiction of the 1042 department or office. 1043 (2) Report to the Agency for Health Care Administration and 1044 to the Department of Health any findings resulting from an 1045 investigation of unresolved complaints concerning the billing 1046 practices of any health care facility licensed under chapter 395 1047 or any health care practitioner subject to chapter 456. 1048 (3)(2)Have access to and use of all files, records, and 1049 data of the department or office. 1050 (4) Have access to any files, records, and data of the 1051 Agency for Health Care Administration and the Department of 1052 Health which are necessary for the investigations authorized 1053 under subsection (6). 1054 (5)(3)Examine rate and form filings submitted to the 1055 office, hire consultants as necessary to aid in the review 1056 process, and recommend to the department or office any position 1057 deemed by the consumer advocate to be in the public interest. 1058 (6) Maintain a process for receiving and investigating 1059 complaints from insured and uninsured patients of health care 1060 facilities licensed under chapter 395 and health care 1061 practitioners subject to chapter 456 concerning billing 1062 practices. Investigations by the office of the consumer advocate 1063 shall be limited to determining compliance with the following 1064 requirements: 1065 (a) The patient was informed before a nonemergency 1066 procedure of expected payments related to the procedure as 1067 provided in s. 395.301, contact information for health insurers 1068 or health maintenance organizations to determine specific cost 1069 sharing responsibilities, and the expected involvement in the 1070 procedure of other providers who may bill independently. 1071 (b) The patient was informed of policies and procedures to 1072 qualify for discounted charges. 1073 (c) The patient was informed of collection procedures and 1074 given the opportunity to participate in an extended payment 1075 schedule. 1076 (d) The patient was given a written, personal, and itemized 1077 estimate upon request as provided in ss. 395.301 and 456.0575. 1078 (e) The statement or bill delivered to the patient was 1079 accurate and included all information required pursuant to s. 1080 395.301. 1081 (f) The billed amounts were fair charges. As used in this 1082 paragraph, the term “fair charges” means the common and frequent 1083 range of charges for patients who are similarly situated 1084 requiring the same or similar medical services. 1085 (7) Provide mediation between providers and patients to 1086 resolve billing complaints and negotiate arrangements for 1087 extended payment schedules. 1088 (8)(4)Prepare an annual budget for presentation to the 1089 Legislature by the department, which budget must be adequate to 1090 carry out the duties of the office of consumer advocate. 1091 Section 11. Section 627.6385, Florida Statutes, is created 1092 to read: 1093 627.6385 Disclosures to policyholders; calculations of cost 1094 sharing.— 1095 (1) Each health insurer shall make available on its 1096 website: 1097 (a) A method for policyholders to estimate their 1098 copayments, deductibles, and other cost-sharing responsibilities 1099 for health care services and procedures. Such method of making 1100 an estimate shall be based on service bundles established 1101 pursuant to s. 408.05(3)(c). Estimates do not preclude the 1102 actual copayment, coinsurance percentage, or deductible, 1103 whichever is applicable, from exceeding the estimate. 1104 1. Estimates shall be calculated according to the policy 1105 and known plan usage during the coverage period. 1106 2. Estimates shall be made available based on providers 1107 that are in-network and out-of-network. 1108 3. A policyholder must be able to create estimates by any 1109 combination of the service bundles established pursuant to s. 1110 408.05(3)(c), a specified provider, or a comparison of 1111 providers. 1112 (b) A method for policyholders to estimate their 1113 copayments, deductibles, and other cost-sharing responsibilities 1114 based on a personalized estimate of charges received from a 1115 facility pursuant to s. 395.301 or a practitioner pursuant to s. 1116 456.0575. 1117 (c) A hyperlink to the health information, including, but 1118 not limited to, service bundles and quality of care information, 1119 which is disseminated by the Agency for Health Care 1120 Administration pursuant to s. 408.05(3). 1121 (2) Each health insurer shall include in every policy 1122 delivered or issued for delivery to any person in the state or 1123 in materials provided as required by s. 627.64725 notice that 1124 the information required by this section is available 1125 electronically and the address of the website where the 1126 information can be accessed. 1127 (3) Each health insurer that participates in the state 1128 group health insurance plan created under s. 110.123 or Medicaid 1129 managed care pursuant to part IV of chapter 409 shall contribute 1130 all claims data from Florida policyholders held by the insurer 1131 and its affiliates to the contracted vendor selected by the 1132 Agency for Health Care Administration under s. 408.05(3)(c). 1133 Each insurer and its affiliates may not contribute claims data 1134 to the contracted vendor which reflect the following types of 1135 coverage: 1136 (a) Coverage only for accident, or disability income 1137 insurance, or any combination thereof. 1138 (b) Coverage issued as a supplement to liability insurance. 1139 (c) Liability insurance, including general liability 1140 insurance and automobile liability insurance. 1141 (d) Workers’ compensation or similar insurance. 1142 (e) Automobile medical payment insurance. 1143 (f) Credit-only insurance. 1144 (g) Coverage for onsite medical clinics, including prepaid 1145 health clinics under part II of chapter 641. 1146 (h) Limited scope dental or vision benefits. 1147 (i) Benefits for long-term care, nursing home care, home 1148 health care, community-based care, or any combination thereof. 1149 (j) Coverage only for a specified disease or illness. 1150 (k) Hospital indemnity or other fixed indemnity insurance. 1151 (l) Medicare supplemental health insurance as defined under 1152 s. 1882(g)(1) of the Social Security Act, coverage supplemental 1153 to the coverage provided under chapter 55 of Title 10 U.S.C., 1154 and similar supplemental coverage provided to supplement 1155 coverage under a group health plan. 1156 Section 12. Subsection (6) of section 641.54, Florida 1157 Statutes, is amended, present subsection (7) of that section is 1158 redesignated as subsection (8) and amended, and a new subsection 1159 (7) is added to that section, to read: 1160 641.54 Information disclosure.— 1161 (6) Each health maintenance organization shall make 1162 available to its subscribers on its website or by request the 1163 estimated copaymentcopay, coinsurance percentage, or 1164 deductible, whichever is applicable, for any covered services as 1165 described by the searchable bundles established on a consumer 1166 friendly, Internet-based platform pursuant to s. 408.05(3)(c) or 1167 as described by a personalized estimate received from a facility 1168 pursuant to s. 395.301 or a practitioner pursuant to s. 1169 456.0575, the status of the subscriber’s maximum annual out-of 1170 pocket payments for a covered individual or family, and the 1171 status of the subscriber’s maximum lifetime benefit. Such 1172 estimate doesshallnot preclude the actual copaymentcopay, 1173 coinsurance percentage, or deductible, whichever is applicable, 1174 from exceeding the estimate. 1175 (7) Each health maintenance organization that participates 1176 in the state group health insurance plan created under s. 1177 110.123 or Medicaid managed care pursuant to part IV of chapter 1178 409 shall contribute all claims data from Florida subscribers 1179 held by the organization and its affiliates to the contracted 1180 vendor selected by the Agency for Health Care Administration 1181 under s. 408.05(3)(c). Each health maintenance organization and 1182 its affiliates may not contribute claims data to the contracted 1183 vendor which reflect the following types of coverage: 1184 (a) Coverage only for accident, or disability income 1185 insurance, or any combination thereof. 1186 (b) Coverage issued as a supplement to liability insurance. 1187 (c) Liability insurance, including general liability 1188 insurance and automobile liability insurance. 1189 (d) Workers’ compensation or similar insurance. 1190 (e) Automobile medical payment insurance. 1191 (f) Credit-only insurance. 1192 (g) Coverage for onsite medical clinics, including prepaid 1193 health clinics under part II of chapter 641. 1194 (h) Limited scope dental or vision benefits. 1195 (i) Benefits for long-term care, nursing home care, home 1196 health care, community-based care, or any combination thereof. 1197 (j) Coverage only for a specified disease or illness. 1198 (k) Hospital indemnity or other fixed indemnity insurance. 1199 (l) Medicare supplemental health insurance as defined under 1200 s. 1882(g)(1) of the Social Security Act, coverage supplemental 1201 to the coverage provided under chapter 55 of Title 10 U.S.C., 1202 and similar supplemental coverage provided to supplement 1203 coverage under a group health plan. 1204 (8)(7)Each health maintenance organization shall make 1205 available on itsInternetwebsite a hyperlinklinkto the health 1206 informationperformance outcome and financial datathat is 1207 disseminatedpublishedby the Agency for Health Care 1208 Administration pursuant to s. 408.05(3)s. 408.05(3)(k)and 1209 shall include in every policy delivered or issued for delivery 1210 to any person in the state or inanymaterials provided as 1211 required by s. 627.64725 notice that such information is 1212 available electronically and the address of itsInternet1213 website. 1214 Section 13. Paragraph (n) is added to subsection (2) of 1215 section 409.967, Florida Statutes, to read: 1216 409.967 Managed care plan accountability.— 1217 (2) The agency shall establish such contract requirements 1218 as are necessary for the operation of the statewide managed care 1219 program. In addition to any other provisions the agency may deem 1220 necessary, the contract must require: 1221 (n) Transparency.—Managed care plans shall comply with ss. 1222 627.6385(3) and 641.54(7). 1223 Section 14. Paragraph (d) of subsection (3) of section 1224 110.123, Florida Statutes, is amended to read: 1225 110.123 State group insurance program.— 1226 (3) STATE GROUP INSURANCE PROGRAM.— 1227 (d)1. Notwithstandingthe provisions ofchapter 287 and the 1228 authority of the department, for the purpose of protecting the 1229 health of, and providing medical services to, state employees 1230 participating in the state group insurance program, the 1231 department may contract to retain the services of professional 1232 administrators for the state group insurance program. The agency 1233 shall follow good purchasing practices of state procurement to 1234 the extent practicable under the circumstances. 1235 2. Each vendor in a major procurement, and any other vendor 1236 if the department deems it necessary to protect the state’s 1237 financial interests, shall, at the time of executing any 1238 contract with the department, post an appropriate bond with the 1239 department in an amount determined by the department to be 1240 adequate to protect the state’s interests but not higher than 1241 the full amount estimated to be paid annually to the vendor 1242 under the contract. 1243 3. Each major contract entered into by the department 1244 pursuant to this section shall contain a provision for payment 1245 of liquidated damages to the department for material 1246 noncompliance by a vendor with a contract provision. The 1247 department may require a liquidated damages provision in any 1248 contract if the department deems it necessary to protect the 1249 state’s financial interests. 1250 4. SectionThe provisions of s.120.57(3) appliesapplyto 1251 the department’s contracting process, except: 1252 a. A formal written protest of any decision, intended 1253 decision, or other action subject to protest shall be filed 1254 within 72 hours after receipt of notice of the decision, 1255 intended decision, or other action. 1256 b. As an alternative to any provision of s. 120.57(3), the 1257 department may proceed with the bid selection or contract award 1258 process if the director of the department sets forth, in 1259 writing, particular facts and circumstances thatwhich1260 demonstrate the necessity of continuing the procurement process 1261 or the contract award process in order to avoid a substantial 1262 disruption to the provision of any scheduled insurance services. 1263 5. The department shall make arrangements as necessary to 1264 contribute claims data of the state group health insurance plan 1265 to the contracted vendor selected by the Agency for Health Care 1266 Administration pursuant to s. 408.05(3)(c). 1267 6. Each contracted vendor for the state group health 1268 insurance plan shall contribute Florida claims data to the 1269 contracted vendor selected by the Agency for Health Care 1270 Administration pursuant to s. 408.05(3)(c). 1271 Section 15. Subsection (3) of section 20.42, Florida 1272 Statutes, is amended to read: 1273 20.42 Agency for Health Care Administration.— 1274 (3) The department shall be the chief health policy and 1275 planning entity for the state. The department is responsible for 1276 health facility licensure, inspection, and regulatory 1277 enforcement; investigation of consumer complaints related to 1278 health care facilities and managed care plans; the 1279 implementation of the certificate of need program; the operation 1280 of the Florida Center for Health Information and Transparency 1281Policy Analysis; the administration of the Medicaid program; the 1282 administration of the contracts with the Florida Healthy Kids 1283 Corporation; the certification of health maintenance 1284 organizations and prepaid health clinics as set forth in part 1285 III of chapter 641; and any other duties prescribed by statute 1286 or agreement. 1287 Section 16. Paragraph (c) of subsection (4) of section 1288 381.026, Florida Statutes, is amended to read: 1289 381.026 Florida Patient’s Bill of Rights and 1290 Responsibilities.— 1291 (4) RIGHTS OF PATIENTS.—Each health care facility or 1292 provider shall observe the following standards: 1293 (c) Financial information and disclosure.— 1294 1. A patient has the right to be given, upon request, by 1295 the responsible provider, his or her designee, or a 1296 representative of the health care facility full information and 1297 necessary counseling on the availability of known financial 1298 resources for the patient’s health care. 1299 2. A health care provider or a health care facility shall, 1300 upon request, disclose to each patient who is eligible for 1301 Medicare, before treatment, whether the health care provider or 1302 the health care facility in which the patient is receiving 1303 medical services accepts assignment under Medicare reimbursement 1304 as payment in full for medical services and treatment rendered 1305 in the health care provider’s office or health care facility. 1306 3. A primary care provider may publish a schedule of 1307 charges for the medical services that the provider offers to 1308 patients. The schedule must include the prices charged to an 1309 uninsured person paying for such services by cash, check, credit 1310 card, or debit card. The schedule must be posted in a 1311 conspicuous place in the reception area of the provider’s office 1312 and must include, but is not limited to, the 50 services most 1313 frequently provided by the primary care provider. The schedule 1314 may group services by three price levels, listing services in 1315 each price level. The posting must be at least 15 square feet in 1316 size. A primary care provider who publishes and maintains a 1317 schedule of charges for medical services is exempt from the 1318 license fee requirements for a single period of renewal of a 1319 professional license under chapter 456 for that licensure term 1320 and is exempt from the continuing education requirements of 1321 chapter 456 and the rules implementing those requirements for a 1322 single 2-year period. 1323 4. If a primary care provider publishes a schedule of 1324 charges pursuant to subparagraph 3., he or she must continually 1325 post it at all times for the duration of active licensure in 1326 this state when primary care services are provided to patients. 1327 If a primary care provider fails to post the schedule of charges 1328 in accordance with this subparagraph, the provider shall be 1329 required to pay any license fee and comply with any continuing 1330 education requirements for which an exemption was received. 1331 5. A health care provider or a health care facility shall, 1332 upon request, furnish a person, before the provision of medical 1333 services, a reasonable estimate of charges for such services. 1334 The health care provider or the health care facility shall 1335 provide an uninsured person, before the provision of a planned 1336 nonemergency medical service, a reasonable estimate of charges 1337 for such service and information regarding the provider’s or 1338 facility’s discount or charity policies for which the uninsured 1339 person may be eligible. Such estimates by a primary care 1340 provider must be consistent with the schedule posted under 1341 subparagraph 3. Estimates shall, to the extent possible, be 1342 written in language comprehensible to an ordinary layperson. 1343 Such reasonable estimate does not preclude the health care 1344 provider or health care facility from exceeding the estimate or 1345 making additional charges based on changes in the patient’s 1346 condition or treatment needs. 1347 6. Each licensed facility, except a facility operating 1348 exclusively as a state facility,not operated by the stateshall 1349 make available to the public on itsInternetwebsite or by other 1350 electronic means a description of and a hyperlinklinkto the 1351 health informationperformance outcome and financial datathat 1352 is disseminatedpublishedby the agency pursuant to s. 408.05(3) 1353s. 408.05(3)(k). The facility shall place a notice in the 1354 reception area that such information is available electronically 1355 and the website address. The licensed facility may indicate that 1356 the pricing information is based on a compilation of charges for 1357 the average patient and that each patient’s statement or bill 1358 may vary from the average depending upon the severity of illness 1359 and individual resources consumed. The licensed facility may 1360 also indicate that the price of service is negotiable for 1361 eligible patients based upon the patient’s ability to pay. 1362 7. A patient has the right to receive a copy of an itemized 1363 statement or bill upon request. A patient has a right to be 1364 given an explanation of charges upon request. 1365 Section 17. Paragraph (e) of subsection (2) of section 1366 395.602, Florida Statutes, is amended to read: 1367 395.602 Rural hospitals.— 1368 (2) DEFINITIONS.—As used in this part, the term: 1369 (e) “Rural hospital” means an acute care hospital licensed 1370 under this chapter, having 100 or fewer licensed beds and an 1371 emergency room, which is: 1372 1. The sole provider within a county with a population 1373 density of up to 100 persons per square mile; 1374 2. An acute care hospital, in a county with a population 1375 density of up to 100 persons per square mile, which is at least 1376 30 minutes of travel time, on normally traveled roads under 1377 normal traffic conditions, from any other acute care hospital 1378 within the same county; 1379 3. A hospital supported by a tax district or subdistrict 1380 whose boundaries encompass a population of up to 100 persons per 1381 square mile; 1382 4. A hospital with a service area that has a population of 1383 up to 100 persons per square mile. As used in this subparagraph, 1384 the term “service area” means the fewest number of zip codes 1385 that account for 75 percent of the hospital’s discharges for the 1386 most recent 5-year period, based on information available from 1387 the hospital inpatient discharge database in the Florida Center 1388 for Health Information and TransparencyPolicy Analysisat the 1389 agency; or 1390 5. A hospital designated as a critical access hospital, as 1391 defined in s. 408.07. 1392 1393 Population densities used in this paragraph must be based upon 1394 the most recently completed United States census. A hospital 1395 that received funds under s. 409.9116 for a quarter beginning no 1396 later than July 1, 2002, is deemed to have been and shall 1397 continue to be a rural hospital from that date through June 30, 1398 2021, if the hospital continues to have up to 100 licensed beds 1399 and an emergency room. An acute care hospital that has not 1400 previously been designated as a rural hospital and that meets 1401 the criteria of this paragraph shall be granted such designation 1402 upon application, including supporting documentation, to the 1403 agency. A hospital that was licensed as a rural hospital during 1404 the 2010-2011 or 2011-2012 fiscal year shall continue to be a 1405 rural hospital from the date of designation through June 30, 1406 2021, if the hospital continues to have up to 100 licensed beds 1407 and an emergency room. 1408 Section 18. Section 395.6025, Florida Statutes, is amended 1409 to read: 1410 395.6025 Rural hospital replacement facilities. 1411 Notwithstandingthe provisions ofs. 408.036, a hospital defined 1412 as a statutory rural hospital in accordance with s. 395.602, or 1413 a not-for-profit operator of rural hospitals, is not required to 1414 obtain a certificate of need for the construction of a new 1415 hospital located in a county with a population of at least 1416 15,000 but no more than 18,000 and a density of fewerlessthan 1417 30 persons per square mile, or a replacement facility, provided 1418 that the replacement, or new, facility is located within 10 1419 miles of the site of the currently licensed rural hospital and 1420 within the current primary service area. As used in this 1421 section, the term “service area” means the fewest number of zip 1422 codes that account for 75 percent of the hospital’s discharges 1423 for the most recent 5-year period, based on information 1424 available from the hospital inpatient discharge database in the 1425 Florida Center for Health Information and TransparencyPolicy1426Analysisat the Agency for Health Care Administration. 1427 Section 19. Subsection (43) of section 408.07, Florida 1428 Statutes, is amended to read: 1429 408.07 Definitions.—As used in this chapter, with the 1430 exception of ss. 408.031-408.045, the term: 1431 (43) “Rural hospital” means an acute care hospital licensed 1432 under chapter 395, having 100 or fewer licensed beds and an 1433 emergency room, and which is: 1434 (a) The sole provider within a county with a population 1435 density of no greater than 100 persons per square mile; 1436 (b) An acute care hospital, in a county with a population 1437 density of no greater than 100 persons per square mile, which is 1438 at least 30 minutes of travel time, on normally traveled roads 1439 under normal traffic conditions, from another acute care 1440 hospital within the same county; 1441 (c) A hospital supported by a tax district or subdistrict 1442 whose boundaries encompass a population of 100 persons or fewer 1443 per square mile; 1444 (d) A hospital with a service area that has a population of 1445 100 persons or fewer per square mile. As used in this paragraph, 1446 the term “service area” means the fewest number of zip codes 1447 that account for 75 percent of the hospital’s discharges for the 1448 most recent 5-year period, based on information available from 1449 the hospital inpatient discharge database in the Florida Center 1450 for Health Information and TransparencyPolicy Analysisat the 1451 Agency for Health Care Administration; or 1452 (e) A critical access hospital. 1453 1454 Population densities used in this subsection must be based upon 1455 the most recently completed United States census. A hospital 1456 that received funds under s. 409.9116 for a quarter beginning no 1457 later than July 1, 2002, is deemed to have been and shall 1458 continue to be a rural hospital from that date through June 30, 1459 2015, if the hospital continues to have 100 or fewer licensed 1460 beds and an emergency room. An acute care hospital that has not 1461 previously been designated as a rural hospital and that meets 1462 the criteria of this subsection shall be granted such 1463 designation upon application, including supporting 1464 documentation, to the Agency for Health Care Administration. 1465 Section 20. Paragraph (a) of subsection (4) of section 1466 408.18, Florida Statutes, is amended to read: 1467 408.18 Health Care Community Antitrust Guidance Act; 1468 antitrust no-action letter; market-information collection and 1469 education.— 1470 (4)(a) Members of the health care community who seek 1471 antitrust guidance may request a review of their proposed 1472 business activity by the Attorney General’s office. In 1473 conducting its review, the Attorney General’s office may seek 1474 whatever documentation, data, or other material it deems 1475 necessary from the Agency for Health Care Administration, the 1476 Florida Center for Health Information and TransparencyPolicy1477Analysis, and the Office of Insurance Regulation of the 1478 Financial Services Commission. 1479 Section 21. Section 465.0244, Florida Statutes, is amended 1480 to read: 1481 465.0244 Information disclosure.—Every pharmacy shall make 1482 available on itsInternetwebsite a hyperlinklinkto the health 1483 informationperformance outcome and financial datathat is 1484 disseminatedpublishedby the Agency for Health Care 1485 Administration pursuant to s. 408.05(3)s. 408.05(3)(k)and 1486 shall place in the area where customers receive filled 1487 prescriptions notice that such information is available 1488 electronically and the address of its Internet website. 1489 Section 22. This act is intended to promote health care 1490 price and quality transparency to enable consumers to make 1491 informed choices on health care treatment and improve 1492 competition in the health care market. Persons or entities 1493 required to submit, receive, or publish data under this act are 1494 acting pursuant to state requirements contained therein and are 1495 exempt from state antitrust laws. 1496 Section 23. This act shall take effect July 1, 2016.