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

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Bill Title: Health Care Price Transparency

Spectrum: Bipartisan Bill

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

Download: Florida-2011-H0935-Engrossed.html

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CS/CS/HB 935

1	A bill to be entitled
2	An act relating to health care price transparency;
3	amending s. 381.026, F.S.; providing a definition;
4	authorizing a primary care provider to publish and post a
5	schedule of certain charges for medical services offered
6	to patients; providing a minimum size for the posting;
7	requiring a schedule of charges to include certain
8	information regarding medical services offered; providing
9	that the schedule may group the provider's services by
10	price levels and list the services in each price level;
11	providing an exemption from license fee and continuing
12	education requirements for a provider who publishes and
13	maintains a schedule of charges; requiring a primary care
14	provider's estimates of charges for medical services to be
15	consistent with the posted schedule; requiring a provider
16	to post the schedule of charges for a certain time period;
17	providing for repayment of license fees and compliance
18	with continuing education requirements previously waived
19	if the schedule of charges was not posted for a certain
20	time period; amending s. 395.002, F.S.; providing a
21	definition; creating s. 395.107, F.S.; requiring urgent
22	care centers to publish and post a schedule of certain
23	charges for medical services offered to patients;
24	providing a minimum size for the posting; requiring a
25	schedule of charges to include certain information
26	regarding medical services offered; providing that the
27	schedule may group the urgent care center's services by
28	price levels and list the services in each price level;
29	providing a fine for failure to publish and post a
30	schedule of medical services; amending s. 400.9935, F.S.;
31	requiring medical directors or clinic directors of health
32	care clinics and entities with a certificate of exemption
33	under the Health Care Clinic Act to publish and post a
34	schedule of certain charges for medical services offered
35	to patients; providing a minimum size for the posting;
36	requiring a schedule of charges to include certain
37	information regarding medical services offered; providing
38	that the schedule may group the urgent care center's
39	services by price levels and list the services in each
40	price level; providing a fine for clinic failure to
41	publish and post a schedule of medical services; providing
42	an effective date.
43
44	Be It Enacted by the Legislature of the State of Florida:
45
46	Section 1.  Subsection (2) and paragraph (c) of subsection
47	(4) of section 381.026, Florida Statutes, are amended to read:
48	381.026  Florida Patient's Bill of Rights and
49	Responsibilities.-
50	(2)  DEFINITIONS.-As used in this section and s. 381.0261,
51	the term:
52	(a)  "Department" means the Department of Health.
53	(b)  "Health care facility" means a facility licensed under
54	chapter 395.
55	(c)  "Health care provider" means a physician licensed
56	under chapter 458, an osteopathic physician licensed under
57	chapter 459, or a podiatric physician licensed under chapter
58	461.
59	(d)  "Primary care provider" means a health care provider
60	licensed under chapter 458, chapter 459, or chapter 464 who
61	provides medical services to patients which are commonly
62	provided without referral from another health care provider,
63	including family and general practice, general pediatrics, and
64	general internal medicine.
65	(e)(d)  "Responsible provider" means a health care provider
66	who is primarily responsible for patient care in a health care
67	facility or provider's office.
68	(4)  RIGHTS OF PATIENTS.-Each health care facility or
69	provider shall observe the following standards:
70	(c)  Financial information and disclosure.-
71	1.  A patient has the right to be given, upon request, by
72	the responsible provider, his or her designee, or a
73	representative of the health care facility full information and
74	necessary counseling on the availability of known financial
75	resources for the patient's health care.
76	2.  A health care provider or a health care facility shall,
77	upon request, disclose to each patient who is eligible for
78	Medicare, before in advance of treatment, whether the health
79	care provider or the health care facility in which the patient
80	is receiving medical services accepts assignment under Medicare
81	reimbursement as payment in full for medical services and
82	treatment rendered in the health care provider's office or
83	health care facility.
84	3.  A primary care provider may publish a schedule of
85	charges for the medical services that the provider offers to
86	patients. The schedule must include the prices charged to an
87	uninsured person paying for such services by cash, check, credit
88	card, or debit card. The schedule must be posted in a
89	conspicuous place in the reception area of the provider's office
90	and must include, but is not limited to, the 50 services most
91	frequently provided by the primary care provider. The schedule
92	may group services by three price levels, listing services in
93	each price level. The posting must be at least 15 square feet in
94	size. A primary care provider who publishes and maintains a
95	schedule of charges for medical services is exempt from the
96	license fee requirements for a single period of renewal of a
97	professional license under chapter 456 for that licensure term
98	and is exempt from the continuing education requirements of
99	chapter 456 and the rules implementing those requirements for a
100	single 2-year period.
101	4.  If a primary care provider publishes a schedule of
102	charges pursuant to subparagraph 3., he or she must continually
103	post it at all times for the duration of active licensure in
104	this state when primary care services are provided to patients.
105	If a primary care provider fails to post the schedule of charges
106	in accordance with this subparagraph, the provider shall be
107	required to pay any license fee and comply with any continuing
108	education requirements for which an exemption was received.
109	5.3.  A health care provider or a health care facility
110	shall, upon request, furnish a person, before the prior to
111	provision of medical services, a reasonable estimate of charges
112	for such services. The health care provider or the health care
113	facility shall provide an uninsured person, before prior to the
114	provision of a planned nonemergency medical service, a
115	reasonable estimate of charges for such service and information
116	regarding the provider's or facility's discount or charity
117	policies for which the uninsured person may be eligible. Such
118	estimates by a primary care provider must be consistent with the
119	schedule posted under subparagraph 3. Estimates shall, to the
120	extent possible, be written in a language comprehensible to an
121	ordinary layperson. Such reasonable estimate does shall not
122	preclude the health care provider or health care facility from
123	exceeding the estimate or making additional charges based on
124	changes in the patient's condition or treatment needs.
125	6.4.  Each licensed facility not operated by the state
126	shall make available to the public on its Internet website or by
127	other electronic means a description of and a link to the
128	performance outcome and financial data that is published by the
129	agency pursuant to s. 408.05(3)(k). The facility shall place a
130	notice in the reception area that such information is available
131	electronically and the website address. The licensed facility
132	may indicate that the pricing information is based on a
133	compilation of charges for the average patient and that each
134	patient's bill may vary from the average depending upon the
135	severity of illness and individual resources consumed. The
136	licensed facility may also indicate that the price of service is
137	negotiable for eligible patients based upon the patient's
138	ability to pay.
139	7.5.  A patient has the right to receive a copy of an
140	itemized bill upon request. A patient has a right to be given an
141	explanation of charges upon request.
142	Section 2.  Subsections (30) through (32) of section
143	395.002, Florida Statutes, are renumbered as subsections (31)
144	through (33), respectively, and a new subsection (30) is added
145	to that section to read:
146	395.002  Definitions.-As used in this chapter:
147	(30)  "Urgent care center" means a facility or clinic that
148	provides immediate but not emergent ambulatory medical care to
149	patients with or without an appointment. It does not include the
150	emergency department of a hospital.
151	Section 3.  Section 395.107, Florida Statutes, is created
152	to read:
153	395.107  Urgent care centers; publishing and posting
154	schedule of charges.-An urgent care center must publish a
155	schedule of charges for the medical services offered to
156	patients. The schedule must include the prices charged to an
157	uninsured person paying for such services by cash, check, credit
158	card, or debit card. The schedule must be posted in a
159	conspicuous place in the reception area of the urgent care
160	center and must include, but is not limited to, the 50 services
161	most frequently provided by the urgent care center. The schedule
162	may group services by three price levels, listing services in
163	each price level. The posting must be at least 15 square feet in
164	size. The failure of an urgent care center to publish and post a
165	schedule of charges as required by this section shall result in
166	a fine of not more than $1,000, per day, until the schedule is
167	published and posted.
168	Section 4.  Subsections (1) and (6) of section 400.9935,
169	Florida Statutes, are amended to read:
170	400.9935  Clinic responsibilities.-
171	(1)  Each clinic shall appoint a medical director or clinic
172	director who shall agree in writing to accept legal
173	responsibility for the following activities on behalf of the
174	clinic. The medical director or the clinic director shall:
175	(a)  Have signs identifying the medical director or clinic
176	director posted in a conspicuous location within the clinic
177	readily visible to all patients.
178	(b)  Ensure that all practitioners providing health care
179	services or supplies to patients maintain a current active and
180	unencumbered Florida license.
181	(c)  Review any patient referral contracts or agreements
182	executed by the clinic.
183	(d)  Ensure that all health care practitioners at the
184	clinic have active appropriate certification or licensure for
185	the level of care being provided.
186	(e)  Serve as the clinic records owner as defined in s.
187	456.057.
188	(f)  Ensure compliance with the recordkeeping, office
189	surgery, and adverse incident reporting requirements of chapter
190	456, the respective practice acts, and rules adopted under this
191	part and part II of chapter 408.
192	(g)  Conduct systematic reviews of clinic billings to
193	ensure that the billings are not fraudulent or unlawful. Upon
194	discovery of an unlawful charge, the medical director or clinic
195	director shall take immediate corrective action. If the clinic
196	performs only the technical component of magnetic resonance
197	imaging, static radiographs, computed tomography, or positron
198	emission tomography, and provides the professional
199	interpretation of such services, in a fixed facility that is
200	accredited by the Joint Commission on Accreditation of
201	Healthcare Organizations or the Accreditation Association for
202	Ambulatory Health Care, and the American College of Radiology;
203	and if, in the preceding quarter, the percentage of scans
204	performed by that clinic which was billed to all personal injury
205	protection insurance carriers was less than 15 percent, the
206	chief financial officer of the clinic may, in a written
207	acknowledgment provided to the agency, assume the responsibility
208	for the conduct of the systematic reviews of clinic billings to
209	ensure that the billings are not fraudulent or unlawful.
210	(h)  Not refer a patient to the clinic if the clinic
211	performs magnetic resonance imaging, static radiographs,
212	computed tomography, or positron emission tomography. The term
213	"refer a patient" means the referral of one or more patients of
214	the medical or clinical director or a member of the medical or
215	clinical director's group practice to the clinic for magnetic
216	resonance imaging, static radiographs, computed tomography, or
217	positron emission tomography. A medical director who is found to
218	violate this paragraph commits a felony of the third degree,
219	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
220	(i)  Ensure that the clinic publishes a schedule of charges
221	for the medical services offered to patients. The schedule must
222	include the prices charged to an uninsured person paying for
223	such services by cash, check, credit card, or debit card. The
224	schedule must be posted in a conspicuous place in the reception
225	area of the urgent care center and must include, but is not
226	limited to, the 50 services most frequently provided by the
227	clinic. The schedule may group services by three price levels,
228	listing services in each price level. The posting must be at
229	least 15 square feet in size. The failure of a clinic to publish
230	and post a schedule of charges as required by this section shall
231	result in a fine of not more than $1,000, per day, until the
232	schedule is published and posted.
233	(6)  Any person or entity providing health care services
234	which is not a clinic, as defined under s. 400.9905, may
235	voluntarily apply for a certificate of exemption from licensure
236	under its exempt status with the agency on a form that sets
237	forth its name or names and addresses, a statement of the
238	reasons why it cannot be defined as a clinic, and other
239	information deemed necessary by the agency. An exemption is not
240	transferable. The agency may charge an applicant for a
241	certificate of exemption in an amount equal to $100 or the
242	actual cost of processing the certificate, whichever is less. An
243	entity seeking a certificate of exemption must publish and
244	maintain a schedule of charges for the medical services offered
245	to patients. The schedule must include the prices charged to an
246	uninsured person paying for such services by cash, check, credit
247	card, or debit card. The schedule must be posted in a
248	conspicuous place in the reception area of the entity and must
249	include, but is not limited to, the 50 services most frequently
250	provided by the entity. The schedule may group services by three
251	price levels, listing services in each price level. The posting
252	must be at least 15 square feet in size. As a condition
253	precedent to receiving a certificate of exemption, an applicant
254	must provide to the agency documentation of compliance with
255	these requirements.
256	Section 5.  This act shall take effect July 1, 2011.

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