Bill Text: FL S1550 | 2017 | Regular Session | Comm Sub
Bill Title: Health Information Transparency
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Failed) 2017-05-05 - Died in Appropriations, companion bill(s) passed, see SB 2514 (Ch. 2017-129) [S1550 Detail]
Download: Florida-2017-S1550-Comm_Sub.html
Florida Senate - 2017 CS for SB 1550
By the Committee on Health Policy; and Senator Artiles
588-03372-17 20171550c1
1 A bill to be entitled
2 An act relating to health information transparency;
3 amending s. 408.05, F.S.; requiring the Agency for
4 Health Care Administration to contract with a vendor
5 to evaluate health information technology activities
6 to identify best practices and methods to increase
7 interoperability; requiring a report to the
8 Legislature by a specified date; amending s. 409.901,
9 F.S.; revising the definition of the term “third
10 party” for purposes of liability for payment of
11 certain medical services covered by Medicaid; amending
12 s. 409.910, F.S.; revising provisions relating to
13 responsibility for Medicaid payments in settlement
14 proceedings; extending the period of time for filing a
15 claim of lien filed for purposes of third-party
16 liability; extending the period of time within which
17 the agency is authorized to pursue certain causes of
18 action; revising procedures for a recipient to contest
19 the amount payable to the agency when federal law
20 limits reimbursement under certain circumstances;
21 requiring certain entities responsible for payment of
22 claims to provide certain records and information and
23 respond to requests for payment of claims within a
24 specified timeframe as a condition of doing business
25 in the state; providing circumstances under which such
26 parties are obligated to pay claims; deleting
27 provisions relating to cooperative agreements between
28 the agency, the Office of Insurance Regulation, and
29 the Department of Revenue; providing an effective
30 date.
31
32 Be It Enacted by the Legislature of the State of Florida:
33
34 Section 1. Present paragraphs (d) through (j) of subsection
35 (3) of section 408.05, Florida Statutes, are redesignated as
36 paragraphs (e) through (k), respectively, and a new paragraph
37 (d) is added to that subsection, to read:
38 408.05 Florida Center for Health Information and
39 Transparency.—
40 (3) HEALTH INFORMATION TRANSPARENCY.—In order to
41 disseminate and facilitate the availability of comparable and
42 uniform health information, the agency shall perform the
43 following functions:
44 (d) Contract with a vendor to evaluate health information
45 technology activities within the state. The vendor shall
46 identify best practices for developing data systems which will
47 leverage existing public and private health care data sources to
48 provide health care providers with real-time access to their
49 patients’ health records. The evaluation shall identify methods
50 to increase interoperability across delivery systems regardless
51 of geographic location and include a review of eligibility for
52 public programs or private insurance to ensure that health care
53 services, including Medicaid services, are clinically
54 appropriate. The evaluation shall address cost-avoidance through
55 the elimination of duplicative services or overutilization of
56 services. The agency shall submit a report of the vendor’s
57 findings and recommendations to the President of the Senate and
58 the Speaker of the House of Representatives by December 31,
59 2017.
60 Section 2. Subsection (27) of section 409.901, Florida
61 Statutes, is amended to read:
62 409.901 Definitions; ss. 409.901-409.920.—As used in ss.
63 409.901-409.920, except as otherwise specifically provided, the
64 term:
65 (27) “Third party” means an individual, entity, or program,
66 excluding Medicaid, that is, may be, could be, should be, or has
67 been liable for all or part of the cost of medical services
68 related to any medical assistance covered by Medicaid. A third
69 party includes a third-party administrator; or a pharmacy
70 benefits manager; health insurer; self-insured plan; group
71 health plan, as defined in s. 607(1) of the Employee Retirement
72 Income Security Act of 1974; service benefit plan; managed care
73 organization; liability insurance, including self-insurance; no
74 fault insurance; workers’ compensation laws or plans; or other
75 parties that are, by statute, contract, or agreement, legally
76 responsible for payment of a claim for a health care item or
77 service.
78 Section 3. Subsection (4), paragraph (c) of subsection (6),
79 paragraph (h) of subsection (11), subsection (16), paragraph (b)
80 of subsection (17), and subsection (20) of section 409.910,
81 Florida Statutes, are amended to read:
82 409.910 Responsibility for payments on behalf of Medicaid
83 eligible persons when other parties are liable.—
84 (4) After the agency has provided medical assistance under
85 the Medicaid program, it shall seek recovery of reimbursement
86 from third-party benefits to the limit of legal liability and
87 for the full amount of third-party benefits, but not in excess
88 of the amount of medical assistance paid by Medicaid, as to:
89 (a) Claims for which the agency has a waiver pursuant to
90 federal law; or
91 (b) Situations in which the agency learns of the existence
92 of a liable third party or in which third-party benefits are
93 discovered or become available after medical assistance has been
94 provided by Medicaid.
95 (6) When the agency provides, pays for, or becomes liable
96 for medical care under the Medicaid program, it has the
97 following rights, as to which the agency may assert independent
98 principles of law, which shall nevertheless be construed
99 together to provide the greatest recovery from third-party
100 benefits:
101 (c) The agency is entitled to, and has, an automatic lien
102 for the full amount of medical assistance provided by Medicaid
103 to or on behalf of the recipient for medical care furnished as a
104 result of any covered injury or illness for which a third party
105 is or may be liable, upon the collateral, as defined in s.
106 409.901.
107 1. The lien attaches automatically when a recipient first
108 receives treatment for which the agency may be obligated to
109 provide medical assistance under the Medicaid program. The lien
110 is perfected automatically at the time of attachment.
111 2. The agency is authorized to file a verified claim of
112 lien. The claim of lien shall be signed by an authorized
113 employee of the agency, and shall be verified as to the
114 employee’s knowledge and belief. The claim of lien may be filed
115 and recorded with the clerk of the circuit court in the
116 recipient’s last known county of residence or in any county
117 deemed appropriate by the agency. The claim of lien, to the
118 extent known by the agency, shall contain:
119 a. The name and last known address of the person to whom
120 medical care was furnished.
121 b. The date of injury.
122 c. The period for which medical assistance was provided.
123 d. The amount of medical assistance provided or paid, or
124 for which Medicaid is otherwise liable.
125 e. The names and addresses of all persons claimed by the
126 recipient to be liable for the covered injuries or illness.
127 3. The filing of the claim of lien pursuant to this section
128 shall be notice thereof to all persons.
129 4. If the claim of lien is filed within 3 years 1 year
130 after the later of the date when the last item of medical care
131 relative to a specific covered injury or illness was paid, or
132 the date of discovery by the agency of the liability of any
133 third party, or the date of discovery of a cause of action
134 against a third party brought by a recipient or his or her legal
135 representative, record notice shall relate back to the time of
136 attachment of the lien.
137 5. If the claim of lien is filed after 3 years 1 year after
138 the later of the events specified in subparagraph 4., notice
139 shall be effective as of the date of filing.
140 6. Only one claim of lien need be filed to provide notice
141 as set forth in this paragraph and shall provide sufficient
142 notice as to any additional or after-paid amount of medical
143 assistance provided by Medicaid for any specific covered injury
144 or illness. The agency may, in its discretion, file additional,
145 amended, or substitute claims of lien at any time after the
146 initial filing, until the agency has been repaid the full amount
147 of medical assistance provided by Medicaid or otherwise has
148 released the liable parties and recipient.
149 7. No release or satisfaction of any cause of action, suit,
150 claim, counterclaim, demand, judgment, settlement, or settlement
151 agreement shall be valid or effectual as against a lien created
152 under this paragraph, unless the agency joins in the release or
153 satisfaction or executes a release of the lien. An acceptance of
154 a release or satisfaction of any cause of action, suit, claim,
155 counterclaim, demand, or judgment and any settlement of any of
156 the foregoing in the absence of a release or satisfaction of a
157 lien created under this paragraph shall prima facie constitute
158 an impairment of the lien, and the agency is entitled to recover
159 damages on account of such impairment. In an action on account
160 of impairment of a lien, the agency may recover from the person
161 accepting the release or satisfaction or making the settlement
162 the full amount of medical assistance provided by Medicaid.
163 Nothing in this section shall be construed as creating a lien or
164 other obligation on the part of an insurer which in good faith
165 has paid a claim pursuant to its contract without knowledge or
166 actual notice that the agency has provided medical assistance
167 for the recipient related to a particular covered injury or
168 illness. However, notice or knowledge that an insured is, or has
169 been a Medicaid recipient within 1 year from the date of service
170 for which a claim is being paid creates a duty to inquire on the
171 part of the insurer as to any injury or illness for which the
172 insurer intends or is otherwise required to pay benefits.
173 8. The lack of a properly filed claim of lien shall not
174 affect the agency’s assignment or subrogation rights provided in
175 this subsection, nor shall it affect the existence of the lien,
176 but only the effective date of notice as provided in
177 subparagraph 5.
178 9. The lien created by this paragraph is a first lien and
179 superior to the liens and charges of any provider, and shall
180 exist for a period of 7 years, if recorded, after the date of
181 recording; and shall exist for a period of 7 years after the
182 date of attachment, if not recorded. If recorded, the lien may
183 be extended for one additional period of 7 years by rerecording
184 the claim of lien within the 90-day period preceding the
185 expiration of the lien.
186 10. The clerk of the circuit court for each county in the
187 state shall endorse on a claim of lien filed under this
188 paragraph the date and hour of filing and shall record the claim
189 of lien in the official records of the county as for other
190 records received for filing. The clerk shall receive as his or
191 her fee for filing and recording any claim of lien or release of
192 lien under this paragraph the total sum of $2. Any fee required
193 to be paid by the agency shall not be required to be paid in
194 advance of filing and recording, but may be billed to the agency
195 after filing and recording of the claim of lien or release of
196 lien.
197 11. After satisfaction of any lien recorded under this
198 paragraph, the agency shall, within 60 days after satisfaction,
199 either file with the appropriate clerk of the circuit court or
200 mail to any appropriate party, or counsel representing such
201 party, if represented, a satisfaction of lien in a form
202 acceptable for filing in Florida.
203 (11) The agency may, as a matter of right, in order to
204 enforce its rights under this section, institute, intervene in,
205 or join any legal or administrative proceeding in its own name
206 in one or more of the following capacities: individually, as
207 subrogee of the recipient, as assignee of the recipient, or as
208 lienholder of the collateral.
209 (h) Except as otherwise provided in this section, actions
210 to enforce the rights of the agency under this section shall be
211 commenced within 6 5 years after the date a cause of action
212 accrues, with the period running from the later of the date of
213 discovery by the agency of a case filed by a recipient or his or
214 her legal representative, or of discovery of any judgment,
215 award, or settlement contemplated in this section, or of
216 discovery of facts giving rise to a cause of action under this
217 section. Nothing in this paragraph affects or prevents a
218 proceeding to enforce a lien during the existence of the lien as
219 set forth in subparagraph (6)(c)9.
220 (16) Any transfer or encumbrance of any right, title, or
221 interest to which the agency has a right pursuant to this
222 section, with the intent, likelihood, or practical effect of
223 defeating, hindering, or reducing reimbursement to recovery by
224 the agency for reimbursement of medical assistance provided by
225 Medicaid, shall be deemed to be a fraudulent conveyance, and
226 such transfer or encumbrance shall be void and of no effect
227 against the claim of the agency, unless the transfer was for
228 adequate consideration and the proceeds of the transfer are
229 reimbursed in full to the agency, but not in excess of the
230 amount of medical assistance provided by Medicaid.
231 (17)
232 (b) If federal law limits the agency to reimbursement from
233 the recovered medical expense damages, a recipient, or his or
234 her legal representative, may contest the amount designated as
235 recovered medical expense damages payable to the agency pursuant
236 to the formula specified in paragraph (11)(f) by filing a
237 petition under chapter 120 within 21 days after the date of
238 payment of funds to the agency or after the date of placing the
239 full amount of the third-party benefits in the trust account for
240 the benefit of the agency pursuant to paragraph (a). The
241 petition shall be filed with the Division of Administrative
242 Hearings. For purposes of chapter 120, the payment of funds to
243 the agency or the placement of the full amount of the third
244 party benefits in the trust account for the benefit of the
245 agency constitutes final agency action and notice thereof. Final
246 order authority for the proceedings specified in this subsection
247 rests with the Division of Administrative Hearings. This
248 procedure is the exclusive method for challenging the amount of
249 third-party benefits payable to the agency. In order to
250 successfully challenge the amount designated as recovered
251 medical expenses payable to the agency, the recipient must
252 prove, by clear and convincing evidence, that the a lesser
253 portion of the total recovery that should be allocated as
254 reimbursement for past and future medical expenses is less than
255 the amount calculated by the agency pursuant to the formula set
256 forth in paragraph (11)(f). Alternatively, the recipient must
257 prove by clear and convincing evidence or that Medicaid provided
258 a lesser amount of medical assistance than that asserted by the
259 agency.
260 (20)(a) Entities providing health insurance as defined in
261 s. 624.603, health maintenance organizations and prepaid health
262 clinics as defined in chapter 641, and, on behalf of their
263 clients, third-party administrators, and pharmacy benefits
264 managers, and any other third parties, as defined in s.
265 409.901(27), which are legally responsible for payment of a
266 claim for a health care item or service as a condition of doing
267 business in the state or providing coverage to residents of this
268 state, shall provide such records and information as are
269 necessary to accomplish the purpose of this section, unless such
270 requirement results in an unreasonable burden.
271 (b) An entity must respond to a request for payment with
272 payment on the claim, a written request for additional
273 information with which to process the claim, or a written reason
274 for denial of the claim within 90 working days after receipt of
275 written proof of loss or claim for payment for a health care
276 item or service provided to a Medicaid recipient who is covered
277 by the entity. Failure to pay or deny a claim within 140 days
278 after receipt of the claim creates an uncontestable obligation
279 to pay the claim.
280 (a) The director of the agency and the Director of the
281 Office of Insurance Regulation of the Financial Services
282 Commission shall enter into a cooperative agreement for
283 requesting and obtaining information necessary to effect the
284 purpose and objective of this section.
285 1. The agency shall request only that information necessary
286 to determine whether health insurance as defined pursuant to s.
287 624.603, or those health services provided pursuant to chapter
288 641, could be, should be, or have been claimed and paid with
289 respect to items of medical care and services furnished to any
290 person eligible for services under this section.
291 2. All information obtained pursuant to subparagraph 1. is
292 confidential and exempt from s. 119.07(1). The agency shall
293 provide the information obtained pursuant to subparagraph 1. to
294 the Department of Revenue for purposes of administering the
295 state Title IV-D program. The agency and the Department of
296 Revenue shall enter into a cooperative agreement for purposes of
297 implementing this requirement.
298 3. The cooperative agreement or rules adopted under this
299 subsection may include financial arrangements to reimburse the
300 reporting entities for reasonable costs or a portion thereof
301 incurred in furnishing the requested information. Neither the
302 cooperative agreement nor the rules shall require the automation
303 of manual processes to provide the requested information.
304 (b) The agency and the Financial Services Commission
305 jointly shall adopt rules for the development and administration
306 of the cooperative agreement. The rules shall include the
307 following:
308 1. A method for identifying those entities subject to
309 furnishing information under the cooperative agreement.
310 2. A method for furnishing requested information.
311 3. Procedures for requesting exemption from the cooperative
312 agreement based on an unreasonable burden to the reporting
313 entity.
314 Section 4. This act shall take effect July 1, 2017.
315
