Transparency and Patient Billing

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NO.:RULE TITLE:

59A-3.256Transparency and Patient Billing

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 43 No. 58, March 24, 2017 issue of the Florida Administrative Register.

59A-3.256 Price Transparency and Patient Billing.

(1) Website. Each hospital shall make available to patients and prospective patients price cost transparency and patient billing information on its website.  The cost transparency information shall to include estimates of costs that may be incurred by the patient, financial assistance, and billing practices. policies and procedures and a mechanism to obtain estimated costs for services. The content on the website Data affecting billing policies and procedures or estimated costs for services shall be reviewed and updated at least every 90 days and updated as needed to maintain timely and accurate information. For the purpose of this rule 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. In accordance with s. 395.301, F.S, the The hospital’s website must include:

(a) A hyperlink to the Agency’s pricing website upon implementation of the same. The Agency’s pricing website is located at: http://pricing.floridahealthfinder.gov 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 service bundle information is on average payments and payment ranges may be used as an a non-personalized estimate of costs that may be incurred by the patient for services and that actual costs will be based on services service actually provided to the patient;

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

(d) A statement informing patients of the hospital’s financial assistance policy, charity care policy, and collection procedure 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 names and web addresses of health insurers and health maintenance organizations (HMO) contracted with the hospital as a network provider or participating provider, including links to their websites, if available;

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

(g) A statement informing patients to contact the health care practitioners anticipated to provide services to the patient while in the hospital regarding a personalized estimate, billing practices, and participation with the patient’s insurance provider or HMO as the practitioners that health care providers and practitioners contracted to provide services within the hospital may not participate with the same health insurers or HMO 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) Estimate. Each hospital shall provide timely and accurate responses to the patient, prospective patient, or legal guardian 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 business 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 anticipated service bundle. Every estimate shall include:

1. through 2. No change

3. The web address of Information on accessing the hospital’s posted billing, collections, and financial assistance policies, charity care policy, and collection procedures;

4. No change

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

6. Contact information for Specific services and health care practitioner names, groups, or organizations that and corresponding contact information who are expected to bill separately; and based on anticipated services to be provided,

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 the estimate is based on average payments made to the hospital and a personalized estimate is available upon request and that the estimate is based on average payments made to the hospital.

(c) No change

(3)(d) Itemized statement or bill. 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:

(a)1. A description of the individual charges from each department or service area by date, as prescribed in subsection 395.301(1)(d) 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;

(b)3. Contact information for Specific services and health care practitioner names, group or organization that and corresponding contact information who are expected to bill separately; and based on services provided; and

(c)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) Centers operating exclusively as state facilities are exempt from these requirements.

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