The Agency proposes to open a new section of rule as directed by the recent statutory changes.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NO.:RULE TITLE:

59A-3.256Transparency and Patient Billing

PURPOSE AND EFFECT: The Agency proposes to open a new section of rule as directed by the recent statutory changes.

SUMMARY: The Agency will clarify requirements of price transparency and patient billing as outlined in s. 395.301, Florida Statutes.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

For rules listed where no SERC was prepared, the Agency prepared a checklist for each rule to determine the necessity for a SERC.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 395.301, F.S.

LAW IMPLEMENTED: 395.301, F.S.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: April 18, 2017, 1:00 p.m. – 2:30 p.m.

PLACE: Agency for Health Care Administration, Conference Room D, 2727 Mahan Drive, Building #3, Tallahassee, FL 32308. Interested parties that would like to join the hearing by phone can do so by using a call-in number and passcode: Call-in Number: 1(888)670-3525, Participant Passcode: 8032219783#

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 3 days before the workshop/meeting by contacting: Jessica Munn, Hospital & Outpatient Services Unit, 2727 Mahan Drive, Tallahassee, Florida, [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Jessica Munn, Hospital & Outpatient Services Unit, Bureau of Health Facility Regulation, [phone], email: [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59A-3.256 Transparency and Patient Billing.

(1) Each hospital shall make available to patients and prospective patients cost transparency information on its website.  The cost transparency information shall include billing policies and procedures and a mechanism to obtain estimated costs for services.  Data affecting billing policies and procedures or estimated costs for services shall be reviewed and updated at least every 90 days.  For the purpose of this section, service bundles means the reasonably expected hospital services and care provided to a patient for a specific treatment, procedure, or diagnosis, and as posted on the Agency’s website.  The hospital’s website must include:

(a) Searchable information on payments received from all payor sources except Medicare and Medicaid for service bundles, including an estimated payment range for such bundles;

(b) A statement informing patients and prospective patients that the information on average payments and payment ranges may be used as an estimate of costs for services and that actual costs will be based on service provided;

(c) A statement informing patients and prospective patients of their right to request a personalized estimate, including the process for requesting the personalized estimate;

(d) A link to the website developed by the Agency for health information transparency, in accordance with s. 408.05(3)(c), Florida Statutes, once available;

(e) A list of health insurers and health maintenance organizations (HMO) contracted with the hospital, including links to their websites, if available;

(f) A list of names and contact information of health care providers and practitioners contracted to provide services within the hospital, grouped by specialty or service;

(g) A statement informing patients that health care providers and practitioners contracted to provide services within the hospital may not participate with the same health insurers or health maintenance organizations as the hospital;

(h) The hospital’s billing, collections, and financial assistance policies, including details of how to request financial assistance offered by the hospital; and

(i) The hospital’s contact information for handling estimates, billing questions, and disputes.

(2) Each hospital shall provide timely and accurate responses to the patient, prospective patient, or responsible party regarding requests for estimates and itemized bills or statements.

(a) An estimate or an update to a previous estimate shall be provided within 7 days from receipt of the request.  Unless the patient requests a more personalized estimate, the estimate shall be based upon the average payment received for the service bundle. Every estimate shall include:

1. A statement informing the requestor to contact their health insurer or HMO for anticipated cost sharing responsibilities;

2. A statement advising the requestor that the actual cost may exceed the estimate;

3. Information on accessing the hospital’s posted billing, collections, and financial assistance policies;

4. A description and purpose of any facility fees, if applicable;

5. A statement that services may be provided by other health care providers who may bill separately;

6. Specific services and health care practitioner names, group or organization and corresponding contact information who are expected to bill separately; and

7. A statement advising the requestor that the patient may pay less for the procedure or service at another facility or in another health care setting.

(b) If the hospital provides a non-personalized estimate, the estimate shall include a statement that a personalized estimate is available upon request and that the estimate is based on average payments made to the hospital.

(c) A personalized estimate must include the charges specific to the patient’s anticipated services.

(d) The hospital shall provide an itemized statement or bill upon request of the patient or the patient’s survivor or legal guardian.  The itemized statement or bill shall be provided within 7 business days after the patient’s discharge or release, or 7 days business after the request, whichever is later.  The itemized statement or bill must include:

1. A description of the individual charges from each department or service area by date, identifying in language comprehensible to the ordinary layperson each test, procedure, service, brand or generic medication name, therapy, equipment, and supplies billed;

2. A description and purpose of any additional fee(s), if applicable;

3. Specific services and health care practitioner names with corresponding contact information who are expected to bill separately; and

4. The hospital’s contact information for billing questions and disputes.

(e) Any subsequent statement or bill must clearly delineate revisions to the initial statement or bill.

(f) The statement or bill must not include any generalized category of expenses such as “other” or “miscellaneous”.

(3) The hospital shall develop and implement a policy for educating the public regarding transparency and patient billing, which shall identify tools, resources and methods used to educate the public.

(4) Hospitals operating exclusively as state facilities are exempt from these requirements.

Rulemaking Authority 395.301 FS. Law Implemented 395.301 FS. History–New _____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jessica Munn

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Justin M. Senior

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: March 22, 2017

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 29, 2016