Bill Text: FL S1976 | 2021 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Freestanding Emergency Departments
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2021-04-26 - Laid on Table, companion bill(s) passed, see CS/HB 1157 (Ch. 2021-112) [S1976 Detail]
Download: Florida-2021-S1976-Introduced.html
Bill Title: Freestanding Emergency Departments
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2021-04-26 - Laid on Table, companion bill(s) passed, see CS/HB 1157 (Ch. 2021-112) [S1976 Detail]
Download: Florida-2021-S1976-Introduced.html
Florida Senate - 2021 SB 1976 By Senator Brodeur 9-01437-21 20211976__ 1 A bill to be entitled 2 An act relating to freestanding emergency departments; 3 amending s. 395.002, F.S.; defining and revising 4 terms; amending s. 395.003, F.S.; deleting an obsolete 5 provision relating to a prohibition on new emergency 6 departments located off the premises of licensed 7 hospitals; amending s. 395.1041, F.S.; prohibiting a 8 freestanding emergency department from holding itself 9 out to the public as an urgent care center; requiring 10 a freestanding emergency department to clearly 11 identify itself as a hospital emergency department 12 using certain signage; requiring a freestanding 13 emergency department to post signs in certain 14 locations which contain specified statements; 15 providing requirements for such signs; providing 16 requirements for the advertisement of freestanding 17 emergency departments; requiring the Agency for Health 18 Care Administration to post information on its website 19 describing the differences between a freestanding 20 emergency department and an urgent care center; 21 requiring the agency to update such information on its 22 website at least annually; requiring hospitals to post 23 a link to such information on their websites; amending 24 s. 627.6405, F.S.; deleting legislative findings and 25 intent; requiring health insurers to post certain 26 information regarding appropriate use of emergency 27 care services on their websites and update such 28 information at least annually; revising the definition 29 of the term “emergency care”; amending ss. 385.211, 30 390.011, 394.4787, 395.701, 400.9935, 409.905, 31 409.975, 468.505, 627.64194, and 765.101, F.S.; 32 conforming cross-references; providing an effective 33 date. 34 35 Be It Enacted by the Legislature of the State of Florida: 36 37 Section 1. Present subsections (10) through (32) of section 38 395.002, Florida Statutes, are redesignated as subsections (11) 39 through (33), respectively, a new subsection (10) is added to 40 that section, and present subsections (10), (27), and (29) are 41 amended, to read: 42 395.002 Definitions.—As used in this chapter: 43 (10) “Freestanding emergency department” means a facility 44 that: 45 (a) Provides emergency services and care; 46 (b) Is owned and operated by a licensed hospital and 47 operates under the license of the hospital; and 48 (c) Is located on separate premises from the hospital. 49 (11)(10)“General hospital” means any facility which meets 50 the provisions of subsection (13)(12)and which regularly makes 51 its facilities and services available to the general population. 52 (28)(27)“Specialty hospital” means any facility which 53 meets the provisions of subsection (13)(12), and which 54 regularly makes available either: 55 (a) The range of medical services offered by general 56 hospitals,but restricted to a defined age or gender group of 57 the population; 58 (b) A restricted range of services appropriate to the 59 diagnosis, care, and treatment of patients with specific 60 categories of medical or psychiatric illnesses or disorders; or 61 (c) Intensive residential treatment programs for children 62 and adolescents as defined in subsection (16)(15). 63 (30)(29)“Urgent care center” means a facility or clinic 64 that provides immediate but not emergent ambulatory medical care 65 to patients.The term includes an offsite emergency department66of a hospital that is presented to the general public in any67manner as a department where immediate and not only emergent68medical care is provided.The termalsoincludes: 69 (a) An offsite facility of a facility licensed under this 70 chapter, or a joint venture between a facility licensed under 71 this chapter and a provider licensed under chapter 458 or 72 chapter 459, that does not require a patient to make an 73 appointment and is presented to the general public in any manner 74 as a facility where immediate but not emergent medical care is 75 provided. 76 (b) A clinic organization that is licensed under part X of 77 chapter 400, maintains three or more locations using the same or 78 a similar name, does not require a patient to make an 79 appointment, and holds itself out to the general public in any 80 manner as a facility or clinic where immediate but not emergent 81 medical care is provided. 82 Section 2. Paragraph (c) of subsection (1) of section 83 395.003, Florida Statutes, is amended to read: 84 395.003 Licensure; denial, suspension, and revocation.— 85 (1) 86(c)Until July 1, 2006, additional emergency departments87located off the premises of licensed hospitals may not be88authorized by the agency.89 Section 3. Paragraph (m) is added to subsection (3) of 90 section 395.1041, Florida Statutes, to read: 91 395.1041 Access to emergency services and care.— 92 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF 93 FACILITY OR HEALTH CARE PERSONNEL.— 94 (m)1. A freestanding emergency department may not hold 95 itself out to the public as an urgent care center and must 96 clearly identify itself as a hospital emergency department 97 using, at a minimum, prominent lighted external signage that 98 includes the word “EMERGENCY” in conjunction with the name of 99 the hospital. 100 2. A freestanding emergency department shall conspicuously 101 post signs at locations that are readily accessible to and 102 visible by patients outside the entrance to the facility and in 103 patient waiting areas which state the following: “THIS IS A 104 HOSPITAL EMERGENCY DEPARTMENT.” Unless the freestanding 105 emergency department shares a location and a public entrance 106 with an urgent care center, the signs must also state the 107 following: “THIS IS NOT AN URGENT CARE CENTER. HOSPITAL 108 EMERGENCY DEPARTMENT RATES ARE BILLED FOR OUR SERVICES.” The 109 signs must also specify the facility’s average facility fee, if 110 any, and notify the public that the facility or a physician 111 providing medical care at the facility may be an out-of-network 112 provider. The signs must be at least 2 square feet in size and 113 the text must be in at least 36-point type. 114 3. Except as provided in this paragraph, any advertisement 115 for a freestanding emergency department must include the 116 following statement: “This emergency department is not an urgent 117 care center. It is part of (insert hospital name) and its 118 services and care are billed at hospital emergency department 119 rates.” Any billboard advertising a freestanding emergency 120 department which measures at least 200 square feet must include 121 the following statement in clearly legible contrasting color 122 text at least 15 inches high: “(INSERT NAME OF HOSPITAL) 123 EMERGENCY DEPARTMENT. THIS IS NOT AN URGENT CARE CENTER.” 124 4.a. The agency shall post on its website information that 125 provides a description of the differences between a freestanding 126 emergency department and an urgent care center. Such description 127 must include: 128 (I) At least two examples illustrating the impact on 129 insured and insurer paid amounts of inappropriate utilization of 130 nonemergent services and care in a hospital emergency department 131 setting compared to utilization of nonemergent services and care 132 in an urgent care center; 133 (II) An interactive tool to locate local urgent care 134 centers; and 135 (III) What to do in the event of a true emergency. 136 b. The agency shall update the information required in sub 137 subparagraph a. at least annually. Each hospital shall post a 138 link to such information in a prominent location on its website. 139 Section 4. Section 627.6405, Florida Statutes, is amended 140 to read: 141 627.6405 Decreasing inappropriate utilization of emergency 142 care.— 143 (1)The Legislature finds and declares it to be of vital144importance that emergency services and care be provided by145hospitals and physicians to every person in need of such care,146but with the double-digit increases in health insurance147premiums, health care providers and insurers should encourage148patients and the insured to assume responsibility for their149treatment, including emergency care. The Legislature finds that150inappropriate utilization of emergency department services151increases the overall cost of providing health care and these152costs are ultimately borne by the hospital, the insured153patients, and, many times, by the taxpayers of this state.154Finally, the Legislature declares that the providers and155insurers must share the responsibility of providing alternative156treatment options to urgent care patients outside of the157emergency department. Therefore, it is the intent of the158Legislature to place the obligation for educating consumers and159creating mechanisms for delivery of care that will decrease the160overutilization of emergency service on health insurers and161providers.162(2)A health insurerinsurersshall postprovideon its 163 websitetheir websitesinformation regarding appropriate 164 utilization of emergency care services which shall include, but 165 need not be limited to:,166 (a) A list of alternative urgent care contracted 167 providers;,168 (b) The types of services offered by these providers;,169 (c) A comparison of statewide average in-network and out 170 of-network urgent care center and freestanding emergency 171 department charges for the 30 most common urgent care center 172 services; 173 (d) At least two examples illustrating the impact on 174 insured and insurer paid amounts of inappropriate utilization of 175 nonemergent services and care in a hospital emergency department 176 setting compared to utilization of nonemergent services and care 177 in an urgent care center; 178 (e) An interactive tool to locate local in-network and out 179 of-network urgent care centers; and 180 (f) What to do in the event of a true emergency. 181 182 Health insurers shall update the information required in this 183 subsection on its website at least annually. 184 (2)(3)Health insurers shall develop community emergency 185 department diversion programs. Such programs may include, at the 186 discretion of the insurer, but not be limited to, enlisting 187 providers to be on call to insurers after hours, coordinating 188 care through local community resources, and providing incentives 189 to providers for case management. 190 (3)(4)As a disincentive for insureds to inappropriately 191 use emergency department services for nonemergency care, health 192 insurers may require higher copayments for urgent care or 193 primary care provided in an emergency department and higher 194 copayments for use of out-of-network emergency departments. 195 Higher copayments may not be charged for the utilization of the 196 emergency department for emergency care. For the purposes of 197 this section, the term “emergency care” has the same meaning as 198 the term “emergency services and care” as definedprovidedin s. 199 395.002(9)s. 395.002and includesshall includeservices 200 provided to rule out an emergency medical condition. 201 Section 5. Subsection (2) of section 385.211, Florida 202 Statutes, is amended to read: 203 385.211 Refractory and intractable epilepsy treatment and 204 research at recognized medical centers.— 205 (2) Notwithstanding chapter 893, medical centers recognized 206 pursuant to s. 381.925, or an academic medical research 207 institution legally affiliated with a licensed children’s 208 specialty hospital as defined in s. 395.002(28)s. 395.002(27)209 that contracts with the Department of Health, may conduct 210 research on cannabidiol and low-THC cannabis. This research may 211 include, but is not limited to, the agricultural development, 212 production, clinical research, and use of liquid medical 213 derivatives of cannabidiol and low-THC cannabis for the 214 treatment for refractory or intractable epilepsy. The authority 215 for recognized medical centers to conduct this research is 216 derived from 21 C.F.R. parts 312 and 316. Current state or 217 privately obtained research funds may be used to support the 218 activities described in this section. 219 Section 6. Subsection (7) of section 390.011, Florida 220 Statutes, is amended to read: 221 390.011 Definitions.—As used in this chapter, the term: 222 (7) “Hospital” means a facility as defined in s. 223 395.002(13)s. 395.002(12)and licensed under chapter 395 and 224 part II of chapter 408. 225 Section 7. Subsection (7) of section 394.4787, Florida 226 Statutes, is amended to read: 227 394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and 228 394.4789.—As used in this section and ss. 394.4786, 394.4788, 229 and 394.4789: 230 (7) “Specialty psychiatric hospital” means a hospital 231 licensed by the agency pursuant to s. 395.002(28)s. 395.002(27)232 and part II of chapter 408 as a specialty psychiatric hospital. 233 Section 8. Paragraph (c) of subsection (1) of section 234 395.701, Florida Statutes, is amended to read: 235 395.701 Annual assessments on net operating revenues for 236 inpatient and outpatient services to fund public medical 237 assistance; administrative fines for failure to pay assessments 238 when due; exemption.— 239 (1) For the purposes of this section, the term: 240 (c) “Hospital” means a health care institution as defined 241 in s. 395.002(13)s. 395.002(12), but does not include any 242 hospital operated by a state agency. 243 Section 9. Paragraph (i) of subsection (1) of section 244 400.9935, Florida Statutes, is amended to read: 245 400.9935 Clinic responsibilities.— 246 (1) Each clinic shall appoint a medical director or clinic 247 director who shall agree in writing to accept legal 248 responsibility for the following activities on behalf of the 249 clinic. The medical director or the clinic director shall: 250 (i) Ensure that the clinic publishes a schedule of charges 251 for the medical services offered to patients. The schedule must 252 include the prices charged to an uninsured person paying for 253 such services by cash, check, credit card, or debit card. The 254 schedule may group services by price levels, listing services in 255 each price level. The schedule must be posted in a conspicuous 256 place in the reception area of any clinic that is considered an 257 urgent care center as defined in s. 395.002(30)(b)s.258395.002(29)(b)and must include, but is not limited to, the 50 259 services most frequently provided by the clinic. The posting may 260 be a sign that must be at least 15 square feet in size or 261 through an electronic messaging board that is at least 3 square 262 feet in size. The failure of a clinic, including a clinic that 263 is considered an urgent care center, to publish and post a 264 schedule of charges as required by this section shall result in 265 a fine of not more than $1,000, per day, until the schedule is 266 published and posted. 267 Section 10. Subsection (8) of section 409.905, Florida 268 Statutes, is amended to read: 269 409.905 Mandatory Medicaid services.—The agency may make 270 payments for the following services, which are required of the 271 state by Title XIX of the Social Security Act, furnished by 272 Medicaid providers to recipients who are determined to be 273 eligible on the dates on which the services were provided. Any 274 service under this section shall be provided only when medically 275 necessary and in accordance with state and federal law. 276 Mandatory services rendered by providers in mobile units to 277 Medicaid recipients may be restricted by the agency. Nothing in 278 this section shall be construed to prevent or limit the agency 279 from adjusting fees, reimbursement rates, lengths of stay, 280 number of visits, number of services, or any other adjustments 281 necessary to comply with the availability of moneys and any 282 limitations or directions provided for in the General 283 Appropriations Act or chapter 216. 284 (8) NURSING FACILITY SERVICES.—The agency shall pay for 24 285 hour-a-day nursing and rehabilitative services for a recipient 286 in a nursing facility licensed under part II of chapter 400 or 287 in a rural hospital, as defined in s. 395.602, or in a Medicare 288 certified skilled nursing facility operated by a hospital, as 289 defined by s. 395.002(11)s. 395.002(10), that is licensed under 290 part I of chapter 395, and in accordance withprovisions set291forth ins. 409.908(2)(a), which services are ordered by and 292 provided under the direction of a licensed physician. However, 293 if a nursing facility has been destroyed or otherwise made 294 uninhabitable by natural disaster or other emergency and another 295 nursing facility is not available, the agency must pay for 296 similar services temporarily in a hospital licensed under part I 297 of chapter 395 provided federal funding is approved and 298 available. The agency shall pay only for bed-hold days if the 299 facility has an occupancy rate of 95 percent or greater. The 300 agency is authorized to seek any federal waivers to implement 301 this policy. 302 Section 11. Paragraph (b) of subsection (1) of section 303 409.975, Florida Statutes, is amended to read: 304 409.975 Managed care plan accountability.—In addition to 305 the requirements of s. 409.967, plans and providers 306 participating in the managed medical assistance program shall 307 comply with the requirements of this section. 308 (1) PROVIDER NETWORKS.—Managed care plans must develop and 309 maintain provider networks that meet the medical needs of their 310 enrollees in accordance with standards established pursuant to 311 s. 409.967(2)(c). Except as provided in this section, managed 312 care plans may limit the providers in their networks based on 313 credentials, quality indicators, and price. 314 (b) Certain providers are statewide resources and essential 315 providers for all managed care plans in all regions. All managed 316 care plans must include these essential providers in their 317 networks. Statewide essential providers include: 318 1. Faculty plans of Florida medical schools. 319 2. Regional perinatal intensive care centers as defined in 320 s. 383.16(2). 321 3. Hospitals licensed as specialty children’s hospitals as 322 defined in s. 395.002(28)s. 395.002(27). 323 4. Accredited and integrated systems serving medically 324 complex children which comprise separately licensed, but 325 commonly owned, health care providers delivering at least the 326 following services: medical group home, in-home and outpatient 327 nursing care and therapies, pharmacy services, durable medical 328 equipment, and Prescribed Pediatric Extended Care. 329 330 Managed care plans that have not contracted with all statewide 331 essential providers in all regions as of the first date of 332 recipient enrollment must continue to negotiate in good faith. 333 Payments to physicians on the faculty of nonparticipating 334 Florida medical schools shall be made at the applicable Medicaid 335 rate. Payments for services rendered by regional perinatal 336 intensive care centers shall be made at the applicable Medicaid 337 rate as of the first day of the contract between the agency and 338 the plan. Except for payments for emergency services, payments 339 to nonparticipating specialty children’s hospitals shall equal 340 the highest rate established by contract between that provider 341 and any other Medicaid managed care plan. 342 Section 12. Paragraph (l) of subsection (1) of section 343 468.505, Florida Statutes, is amended to read: 344 468.505 Exemptions; exceptions.— 345 (1) Nothing in this part may be construed as prohibiting or 346 restricting the practice, services, or activities of: 347 (l) A person employed by a nursing facility exempt from 348 licensing under s. 395.002(13)s. 395.002(12), or a person 349 exempt from licensing under s. 464.022. 350 Section 13. Paragraph (b) of subsection (1) of section 351 627.64194, Florida Statutes, is amended to read: 352 627.64194 Coverage requirements for services provided by 353 nonparticipating providers; payment collection limitations.— 354 (1) As used in this section, the term: 355 (b) “Facility” means a licensed facility as defined in s. 356 395.002(17)s. 395.002(16)and an urgent care center as defined 357 in s. 395.002. 358 Section 14. Subsection (2) of section 765.101, Florida 359 Statutes, is amended to read: 360 765.101 Definitions.—As used in this chapter: 361 (2) “Attending physician” means the physician who has 362 primary responsibility for the treatment and care of the patient 363 while the patient receives such treatment or care in a hospital 364 as defined in s. 395.002(13)s. 395.002(12). 365 Section 15. This act shall take effect July 1, 2021.