Transparency in Health Care, Senate Bill 1496, jumped a major hurdle today when the Senate Appropriations Subcommittee on Health and Human Services passed the Gov. Rick Scott-favored legislation. Sponsored by Sen. Rob Bradley, R-Fleming Island, it is meant to increase the transparency and availability of health care pricing and quality of service information.
Senate President Andy Gardiner, R-Orlando, said he was grateful to see the bill move forward. “Patients in need of medical treatment deserve to know how much they should reasonably expect to pay for particular services. This bill will make that information more readily available and also includes penalties for those entities who would charge unconscionable prices to Floridians in need of medical attention.”
In a prepared statement, Gardiner's office described the legislation's benefits as follows:
Creates Online Transparency Portal
SB 1496 requires the Agency for Health Care Administration (AHCA) to contract with a vendor to provide a consumer-friendly, Internet-based platform that allows a consumer to research the cost of health care services and procedures to facilitate price comparison of typical health care services provided in hospitals and ambulatory surgery centers (ASCs). Quality indicators for services at the facilities will also be made available to the consumer to facilitate health care decision making.
Under the bill, hospitals and ASCs are required to provide access to the searchable service bundles on their website. Consumers will be presented with estimated average payment and estimated payment ranges for each service bundle, by facility, facilities within geographic boundaries, and nationally. A hospital or ASC must notify consumers of other health care providers that may bill separately from the facility, as well as information about the facility’s financial assistance policies and collection procedures.
Enhances Consumer Protections and Establishes Penalties for Price Gouging
The bill requires the consumer advocate in the Department of Financial Services (DFS) to receive and investigate complaints from insured and uninsured patients concerning billing practices. If, after investigating a complaint, the consumer advocate determines the billing practices and charges were unfair, the consumer advocate will report these findings to the AHCA and the Department of Health (DOH) for regulatory and disciplinary action.
The bill provides for penalties for unconscionable prices. The consumer advocate is also authorized to mediate billing complaints and negotiate payment arrangements.
Requires Good Faith Estimates and Itemized Billing Upon Request
Consumers may request personalized good faith estimates of charges for non-emergency medical services from hospitals, ASCs, and health care practitioners relating to medical services provided in the hospital or ASC.
The bill also requires home health agencies and home medical equipment providers to provide consumers with good-faith estimates of medical services and supplies. These good-faith estimates must be provided to the consumer within seven days after the request. Information must also be provided about the health care provider’s financial assistance policies and collection procedures. A patient may also request an itemized bill or statement from the hospital and ASC after discharge. The hospital or ASC must provide an itemized bill or statement within seven days that is specific, written in plain language, and identifies all services provided by the facility, as well as rates charged, amounts due, and the payment status. The itemized bill or statement must inform the patient to contact his or her insurer regarding the patient’s share of costs. The facility must provide records to verify the bill or statement upon request.
Improves Transparency of Health Insurance Options
Hospital and ASC websites must also provide hyperlinks to the websites of insurers and health maintenance organizations (HMOs) for which the facility is in-network or a preferred provider to enable an insured patient to research cost-sharing responsibilities for the service bundle. Insurers and HMOs are required to provide on their websites a method for policy holders to estimate their cost-sharing responsibilities by service bundle, based on the insured’s policy and known usage. These estimates must include both in-network and out-of-network providers. Insurers and HMOs are also required to provide hyperlinks on their website to the AHCA’s performance outcome and financial data.
For more information on SB 1496, visit www.FLSenate.gov.