Bill Text: FL S1612 | 2017 | Regular Session | Introduced


Bill Title: Health Care Consumer Protection

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2017-05-05 - Died in Health Policy [S1612 Detail]

Download: Florida-2017-S1612-Introduced.html
       Florida Senate - 2017                                    SB 1612
       
       
        
       By Senator Garcia
       
       
       
       
       
       36-00646-17                                           20171612__
    1                        A bill to be entitled                      
    2         An act relating to health care consumer protection;
    3         amending s. 395.301, F.S.; revising the requirements
    4         for a good faith itemized estimate provided to a
    5         patient or prospective patient by a licensed facility
    6         for nonemergency medical services; providing that a
    7         facility and its contracted health care providers may
    8         bill a patient for certain medical services only if
    9         the patient consents in writing; providing a penalty
   10         for violations; amending s. 456.0575, F.S.; requiring
   11         written patient consent for certain health care
   12         practitioners to bill a patient for services listed on
   13         the itemized estimate which are not covered by the
   14         patient’s health insurance; providing a penalty for
   15         violations; amending s. 627.6385, F.S.; requiring
   16         health insurers to provide certain information
   17         available on their websites or by request, rather than
   18         only on their websites; requiring a health insurer to
   19         provide a certain response to the policyholder and
   20         facility within a specified time after receiving an
   21         itemized estimate; providing construction and
   22         applicability; amending s. 627.64194, F.S.; providing
   23         that an insurer is solely liable for payment of
   24         certain fees for certain requested services under
   25         certain circumstances; providing applicability;
   26         conforming cross-references; amending s. 641.54, F.S.;
   27         requiring a health maintenance organization to provide
   28         a certain response to the subscriber and facility
   29         within a specified time after receiving an itemized
   30         estimate; providing applicability; providing an
   31         effective date.
   32          
   33  Be It Enacted by the Legislature of the State of Florida:
   34  
   35         Section 1. Paragraph (b) of subsection (1) of section
   36  395.301, Florida Statutes, is amended, present subsections (2)
   37  through (6) of that section are redesignated as subsections (3)
   38  through (7), respectively, and a new subsection (2) is added to
   39  that section, to read:
   40         395.301 Price transparency; itemized patient statement or
   41  bill; patient admission status notification.—
   42         (1) A facility licensed under this chapter shall provide
   43  timely and accurate financial information and quality of service
   44  measures to patients and prospective patients of the facility,
   45  or to patients’ survivors or legal guardians, as appropriate.
   46  Such information shall be provided in accordance with this
   47  section and rules adopted by the agency pursuant to this chapter
   48  and s. 408.05. Licensed facilities operating exclusively as
   49  state facilities are exempt from this subsection.
   50         (b)1. Upon request or preregistration, and before providing
   51  any nonemergency medical services, each licensed facility shall
   52  provide in writing or by electronic means an itemized a good
   53  faith estimate of reasonably anticipated charges by the facility
   54  for the treatment of the patient’s or prospective patient’s
   55  specific condition, including services provided for such
   56  treatment in the facility by other health care providers under
   57  contract with the hospital who may bill the patient separately.
   58  The facility must provide the estimate to the patient or
   59  prospective patient and the patient’s health insurer within 7
   60  business days after the receipt of the request and is not
   61  required to adjust the estimate for any potential insurance
   62  coverage. The estimate may be based on the descriptive service
   63  bundles developed by the agency under s. 408.05(3)(c) unless the
   64  patient or prospective patient requests a more personalized and
   65  specific estimate that accounts for the specific condition and
   66  characteristics of the patient or prospective patient. The
   67  facility shall inform the patient or prospective patient that he
   68  or she may contact his or her health insurer or health
   69  maintenance organization for additional information concerning
   70  cost-sharing responsibilities.
   71         2. In the estimate, the facility shall provide to the
   72  patient or prospective patient information on the facility’s
   73  financial assistance policy, including the application process,
   74  payment plans, and discounts and the facility’s charity care
   75  policy and collection procedures.
   76         3. The estimate shall clearly identify any facility fees
   77  and, if applicable, include a statement notifying the patient or
   78  prospective patient that a facility fee is included in the
   79  estimate, the purpose of the fee, and that the patient may pay
   80  less for the procedure or service at another facility or in
   81  another health care setting.
   82         4. Upon request, The facility shall notify the patient or
   83  prospective patient of any revision to the estimate.
   84         5. In the estimate, the facility must notify the patient or
   85  prospective patient that services may be provided in the health
   86  care facility by the facility as well as by other health care
   87  providers that may separately bill the patient, if applicable.
   88         6. The facility shall take action to educate the public
   89  that such estimates are available upon request.
   90         7. Failure to timely provide the estimate pursuant to this
   91  paragraph shall result in a daily fine of $1,000 until the
   92  estimate is provided to the patient or prospective patient. The
   93  total fine may not exceed $10,000.
   94  
   95  The provision of an estimate does not preclude the actual
   96  charges from exceeding the estimate.
   97         (2) The facility and health care providers under contract
   98  with the facility may bill the patient for a medical service
   99  that is on the itemized estimate and that is not covered by the
  100  patient’s health insurance only if the patient has provided
  101  specific written consent for the service. A violation of this
  102  subsection is punishable by a fine of $1,000 per occurrence.
  103         Section 2. Subsection (2) of section 456.0575, Florida
  104  Statutes, is amended to read:
  105         456.0575 Duty to notify patients.—
  106         (2) Upon request by a patient, before providing
  107  nonemergency medical services in a facility licensed under
  108  chapter 395, a health care practitioner shall provide, in
  109  writing or by electronic means, a good faith estimate of
  110  reasonably anticipated charges to treat the patient’s condition
  111  at the facility. The health care practitioner shall provide the
  112  estimate to the patient within 7 business days after receiving
  113  the request and is not required to adjust the estimate for any
  114  potential insurance coverage. The health care practitioner shall
  115  inform the patient that the patient may contact his or her
  116  health insurer or health maintenance organization for additional
  117  information concerning cost-sharing responsibilities. The health
  118  care practitioner shall provide information to uninsured
  119  patients and insured patients for whom the practitioner is not a
  120  network provider or preferred provider, which discloses the
  121  practitioner’s financial assistance policy, including the
  122  application process, payment plans, discounts, or other
  123  available assistance, and the practitioner’s charity care policy
  124  and collection procedures. Such estimate does not preclude the
  125  actual charges from exceeding the estimate. Written patient
  126  consent is required for a health care practitioner under
  127  contract with a facility licensed under chapter 395 to bill the
  128  patient for services on the itemized estimate under s. 395.301
  129  which are not covered by the patient’s health insurance. The
  130  billing of noncovered services without the patient’s consent
  131  that is required in this subsection, or failure to provide the
  132  estimate in accordance with this subsection, without good cause,
  133  shall result in disciplinary action against the health care
  134  practitioner and a fine of $500 per bill, or a daily fine of
  135  $500 until the estimate is provided to the patient. The total
  136  fine may not exceed $5,000.
  137         Section 3. Subsection (1) of section 627.6385, Florida
  138  Statutes, is amended, and subsection (4) is added to that
  139  section, to read:
  140         627.6385 Disclosures to policyholders; calculations of cost
  141  sharing.—
  142         (1) Each health insurer shall make available on its website
  143  or by request:
  144         (a) A method for policyholders to estimate their
  145  copayments, deductibles, and other cost-sharing responsibilities
  146  for health care services and procedures. Such method of making
  147  an estimate shall be based on service bundles established
  148  pursuant to s. 408.05(3)(c). Estimates do not preclude the
  149  actual copayment, coinsurance percentage, or deductible,
  150  whichever is applicable, from exceeding the estimate.
  151         1. Estimates shall be calculated according to the policy
  152  and known plan usage during the coverage period.
  153         2. Estimates shall be made available based on providers
  154  that are in-network and out-of-network.
  155         3. A policyholder must be able to create estimates by any
  156  combination of the service bundles established pursuant to s.
  157  408.05(3)(c), a specified provider, or a comparison of
  158  providers.
  159         (b) A method for policyholders to estimate their
  160  copayments, deductibles, and other cost-sharing responsibilities
  161  based on a personalized estimate of charges received from a
  162  facility pursuant to s. 395.301 or a practitioner pursuant to s.
  163  456.0575.
  164         (c) A hyperlink to the health information, including, but
  165  not limited to, service bundles and quality of care information,
  166  which is disseminated by the Agency for Health Care
  167  Administration pursuant to s. 408.05(3).
  168         (4) Upon receipt of an itemized estimate from a facility
  169  pursuant to s. 395.301, the health insurer must provide a
  170  response indicating the coverage status of each item to the
  171  policyholder and the facility within 3 business days. Failure to
  172  respond to the policyholder and the facility within such time
  173  constitutes a waiver of the health insurer’s right to contest or
  174  counter the facility’s itemized estimate. This subsection does
  175  not apply to Medicaid health plans.
  176         Section 4. Present subsections (4) through (6) of section
  177  627.64194, Florida Statutes, are redesignated as subsections (5)
  178  through (7), respectively, a new subsection (4) is added to that
  179  section, and present subsections (5) and (6) are amended, to
  180  read:
  181         627.64194 Coverage requirements for services provided by
  182  nonparticipating providers; payment collection limitations.—
  183         (4)If an insurer denies, reduces, or terminates coverage
  184  for an admission, availability of care, a continued stay, or a
  185  health care service after determining that such requested
  186  service, based upon the information provided, does not meet the
  187  insurer’s requirements for medical necessity, appropriateness,
  188  health care setting, level of care, or effectiveness, the
  189  insurer is solely liable for any potential payment of fees and
  190  the insured is not liable for payment of fees other than
  191  applicable copayments, coinsurance, and deductibles to a
  192  participating or nonparticipating provider if:
  193         (a) The insurer’s determination conflicts with a
  194  participating or nonparticipating provider’s determination that
  195  the requirements for medical necessity, appropriateness, health
  196  care setting, level of care, or effectiveness are met; and
  197         (b) The insured did not receive both the itemized estimate
  198  from a facility under s. 395.301 and the indication of the
  199  coverage status of the item under s. 627.6385(4) or s.
  200  641.54(6).
  201  
  202  The provisions of s. 627.638 apply to this subsection. This
  203  subsection does not apply to Medicaid health plans.
  204         (6)(5) A nonparticipating provider of emergency services as
  205  provided in subsection (2) or a nonparticipating provider of
  206  nonemergency services as provided in subsection (3) may not be
  207  reimbursed an amount greater than the amount provided in
  208  subsection (5) (4) and may not collect or attempt to collect
  209  from the insured, directly or indirectly, any excess amount,
  210  other than copayments, coinsurance, and deductibles. This
  211  section does not prohibit a nonparticipating provider from
  212  collecting or attempting to collect from the insured an amount
  213  due for the provision of noncovered services.
  214         (7)(6) Any dispute with regard to the reimbursement to the
  215  nonparticipating provider of emergency or nonemergency services
  216  as provided in subsection (5) (4) shall be resolved in a court
  217  of competent jurisdiction or through the voluntary dispute
  218  resolution process in s. 408.7057.
  219         Section 5. Subsection (6) of section 641.54, Florida
  220  Statutes, is amended to read:
  221         641.54 Information disclosure.—
  222         (6) Each health maintenance organization shall make
  223  available to its subscribers on its website or by request the
  224  estimated copayment, coinsurance percentage, or deductible,
  225  whichever is applicable, for any covered services as described
  226  by the searchable bundles established on a consumer-friendly,
  227  Internet-based platform pursuant to s. 408.05(3)(c) or as
  228  described by a personalized estimate received from a facility
  229  pursuant to s. 395.301 or a practitioner pursuant to s.
  230  456.0575, the status of the subscriber’s maximum annual out-of
  231  pocket payments for a covered individual or family, and the
  232  status of the subscriber’s maximum lifetime benefit. Such
  233  estimate does not preclude the actual copayment, coinsurance
  234  percentage, or deductible, whichever is applicable, from
  235  exceeding the estimate. Upon receipt of an itemized estimate
  236  from a facility pursuant to s. 395.301, the health maintenance
  237  organization must provide a response indicating the coverage
  238  status of each item to the subscriber and the facility within 3
  239  business days. This subsection does not apply to Medicaid health
  240  plans.
  241         Section 6. This act shall take effect July 1, 2017.

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