Transparency and Patient Billing

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NO.:RULE TITLE:

59A-5.032Transparency 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.

The following sections of the proposed rule will be changed to read:

 

59A-5.032 Price Transparency and Patient Billing.

(1) Website. Each center shall make available to patients and prospective patients price transparency and patient billing information on its website to include estimates of costs that may be incurred by the patient, financial assistance, and billing practices. The content on the website shall be reviewed at least every 90 days and updated as needed to maintain timely and accurate information. For the purpose of this rule, service bundles means the reasonably expected center services and care provided to a patient for a specific treatment, procedure, or diagnosis as posted on the Agency’s website. In accordance with s. 395.301, F.S, the center’s website must include:

(a) A hyperlink to the Agency’s pricing website upon implementation of the same that provides information on payments made to the facilities for defined bundles of services and procedures. The Agency’s pricing website is located at: http://pricing.floridahealthfinder.gov;

(b) through (c) No change.

(d) A statement informing patients of the center’s financial assistance policy, charity care policy, and collection procedure;;

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

(f) No change.

(2) Estimate. The Each center shall provide an estimate upon request of the timely and accurate responses to the patient, prospective patient, or legal guardian for nonemergency medical services regarding requests for estimates.

(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 may shall be based upon the average payment received for the anticipated service bundle. Every estimate shall include:

1. through 4. No change.

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

6. A statement, including a web address if different from above, that cContact information for health care practitioners and practitioner names, medical practice groups, or organizations that are expected to bill separately based on anticipated services to be provided, is available on the center’s website; and

7. No change.

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

(c) No change.

(3) Itemized statement or bill. The center 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 days after the request, whichever is later.  The itemized statement or bill must include:

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

(b) Contact information for health care practitioners and medical practice groups practitioner names, group or organization that are expected to bill separately based on services provided; and

(c) No change.

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