This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1527a.HHS
DATE: 2/16/2022
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 1527 Health Care Expenses
SPONSOR(S): Finance & Facilities Subcommittee, Tomkow
TIED BILLS: IDEN./SIM. BILLS: SB 296
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Finance & Facilities Subcommittee 15 Y, 0 N, As CS Poche Lloyd
2) Health & Human Services Committee Poche Calamas
SUMMARY ANALYSIS
The United States is experiencing significant changes in health care payment and delivery. Consumers bear a
greater share of health care costs, and more participate in high deductible health plans. Clear, accurate
information about the cost and quality of health care is necessary for consumers to select value-based health
care.
CS for HB 1527 requires hospitals and ambulatory surgical centers (ASCs) to post a consumer-friendly list of
standard charges for at least 300 shoppable health care services on a facility website, consistent with federal
rule.
The bill prohibits hospitals and ASCs from taking actions to collect medical debt before determining whether a
patient is eligible for financial assistance, before providing an itemized bill, during an ongoing grievance
process, prior to billing any applicable insurance coverage, and for 30 days after notifying a patient in writing
that a collections action will commence. The bill also requires hospitals and ASCs to establish an internal
grievance process for patients to dispute charges that appear on an itemized statement or bill.
Current law provides a court process for the collection of lawful debts, and makes some limited exemptions for
personal property. The bill increases exemptions from attachment, garnishment, or other legal process to
include a single motor vehicle and personal property of a debtor of a value up to $10,000 when debt is incurred
as a result of medical services provided in a licensed hospital facility, unless the property receives the higher
protection of a homestead exemption.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2022. STORAGE NAME: h1527a.HHS PAGE: 2
DATE: 2/16/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Health Care Price Transparency
The United States is experiencing significant changes in health care payment and delivery. Consumers
bear a greater share of health care costs, and more participate in high deductible health plans. Clear,
factual information about the cost and quality of health care is necessary for consumers to select value-
driven health care options and for consumers and providers to be involved in and accountable for
decisions about health and health care services. To promote consumer involvement, health care pricing
and other data needs to be free, timely, reliable, and reflect individual health care needs and insurance
coverage.
Price transparency can refer to the availability of provider-specific information on the price for a specific
health care service or set of services to consumers and other interested parties.
1
Price can be defined
as an estimate of a consumer’s complete cost on a health care service or services that reflects any
negotiated discounts; is inclusive of all costs to the consumer associated with a service or services,
including hospital, physician, and lab fees; and, identifies a consumer’s out-of-pocket cost.
2
Further,
price transparency can be considered "readily available information on the price of health care services
that, together with other information, helps define the value of those services and enables patients and
other care purchasers to identify, compare, and choose providers that offer the desired level of value."
3
Indeed, the definition of the price or cost of health care has different meanings depending on who is
incurring the cost.
4
As health care costs continue to rise, most health insurance buyers are asking their consumers to take
on a greater share of their costs, increasing both premiums and out-of-pocket expenses. According to
the Kaiser Family Foundation, more than one in five Americans with private insurance is enrolled in a
high deductible health plan. Most covered workers face additional out-of-pocket costs when they use
health care services, such as co-payments or coinsurance for physician visits and hospitalizations.
Eighty-five percent of covered workers have a general annual deductible
5
for single coverage that must
be met before most services are paid for by their health plan.
6
Among covered workers with a general annual deductible, the average deductible amount for single
coverage is $1,644.
7
Deductibles differ by firm size; for workers in plans with a deductible, the average
deductible for single coverage is $2,295 in small firms, compared to $1,418 for workers in large firms.
8
Sixty-four percent of covered workers in small firms are in a plan with a deductible of at least $1,000 for
single coverage compared to 54 percent in large firms; a similar pattern exists for those in plans with a
deductible of at least $2,000 (42 percent for small firms vs. 20 percent for large firms). The chart below
shows the percent of workers enrolled in employer-sponsored insurance with an annual deductible of
$1,000 or more for single coverage by employer size for 2009 through 2020.
9
1
Government Accounting Office, Meaningful Price Information is Difficult for Consumers to Obtain Prior to Receiving Care, September
2011, pg. 2, available at http://www.gao.gov/products/GAO-11-791.
2
Id.
3
Healthcare Financial Management Association, Price Transparency in Health Care: Report from the HFMA Price Transparency Task
Force, pg. 2, 2014, available at https://www.hfma.org/content/dam/hfma/document/policies_and_practices/PDF/22279.pdf.
4
Id.
5
The term “general annual deductible” means a deductible which applies to both medical and pharmaceutical benefits and which must
be met by the insured individual before most services are covered by the health plan.
6
The Henry J. Kaiser Family Foundation, 2021 Employer Health Benefits Survey, November 10, 2021, available at
https://www.kff.org/health-costs/report/2021-employer-health-benefits-survey/.
7
Id.
8
Id.
9
Id. at figure 7.13. STORAGE NAME: h1527a.HHS PAGE: 3
DATE: 2/16/2022
Looking at the increase in deductible amounts over time does not capture the full impact for workers
because the share of covered workers in plans with a general annual deductible also has increased
significantly, from 59% in 2008 to 74% in 2011 to 85% in 2021. If we look at the change in deductible
amounts for all covered workers (assigning a zero value to workers in plans with no deductible), we can
look at the impact of both trends together. Using this approach, the average deductible for all covered
workers in 2021 is $1,669, up 89% from $883 in 2013 and 279% from $433 in 2008.
From 2015 to 2021, the average premium for covered workers with family coverage increased 22%,
while inflation totals just 11% over the same period; over the last ten years, the average premium rose
47%, while inflation grew at 19% over the same time frame.
10
The dramatic increases in the costs of
health care in recent years have focused significant attention on the need for greater communication
and transparency to inform individual health care choices.
National Price Transparency Studies
To explore how expanding price transparency efforts could produce significant cost savings for the
healthcare system, the Gary and Mary West Health Policy Center funded an analysis, “Healthcare
Price Transparency: Policy Approaches and Estimated Impacts on Spending.” This report, conducted in
collaboration with researchers from the Center for Studying Health System Change and RAND, found
that implementation of three policy changes could save $100 billion over ten years.
Provide personalized out-of-pocket expense information to patients and families before
receiving care.
Provide prices to physicians through electronic health record systems when ordering treatments
and tests.
10
Id. STORAGE NAME: h1527a.HHS PAGE: 4
DATE: 2/16/2022
Expand state-based all-payer health claims databases, which could save up to $55 billion by
collecting and providing data and analytics tools that supply quality, efficiency and cost
information to policy makers, employers, providers, and patients.
11
The report specifically found that requiring all private health insurance plans to provide personalized
out-of-pocket price data to enrollees would reduce total health spending by an estimated $18 billion
over the 10-year period from 2014 to 2023.
12
As Americans take on more of their health care costs, research suggests that they are looking for more
and better price information.
13
One study in 2014, which included a survey of more than 2,000 adults from across the country, found
that 56 percent of Americans actively searched for price information before obtaining health care,
including 21 percent who compared the price of health care services across multiple providers.
14
The
chart below illustrates the finding that, as a consumer's health plan deductible increases, the consumer
is more likely to seek out price information.
15
11
White, C., Ginsburg, P., et al., Gary and Mary West Health Policy Center, Healthcare Price Transparency: Policy Approaches and
Estimated Impacts on Spending, May 2014, available at http://www.westhealth.org/wp-content/uploads/2015/05/Price-Transparency-
Policy-Analysis-FINAL-5-2-14.pdf.
12
Id., pg. 1.
13
Public Agenda and Robert Wood Johnson Foundation, How Much Will It Cost? How Americans Use Prices in Health Care, March
2015, page 34, available at https://www.publicagenda.org/reports/how-much-will-it-cost-how-americans-use-prices-in-health-care/.
14
Id., pg. 3.
15
Id., pg. 13. STORAGE NAME: h1527a.HHS PAGE: 5
DATE: 2/16/2022
The individuals who compared prices stated that such research affected their health care choices and
saved them money.
16
In addition, the study found that most Americans do not equate price with quality
of care. Seventy-one percent do not believe higher price reflects a higher level care quality and 63
percent do not believe that lower price is indicative of lower level care quality.
17
Consumers enrolled in
high-deductible and consumer-directed health plans are more price-sensitive than consumers with
plans that have much lower cost-sharing obligations. Accordingly, these consumers find an estimate of
their individual out-of-pocket costs more useful than any other kind of health care price transparency
tool.
18
Another study found that when they have access to well-designed reports on price and quality,
80 percent of health care consumers will select the highest value health care provider.
19
Florida Price Transparency: Florida Patient's Bill of Rights and Responsibilities
In 1991, the Legislature enacted the Florida Patient’s Bill of Rights and Responsibilities (Patient’s Bill of
Rights).
20
The statute established the right of patients to expect medical providers to observe standards
of care in providing medical treatment and communicating with their patients.
21
The standards of care
include, but are not limited to, the following aspects of medical treatment and patient communication:
Individual dignity;
Provision of information;
Financial information and the disclosure of financial information;
Access to health care;
Experimental research; and
Patient’s knowledge of rights and responsibilities.
16
Id., pg. 4.
17
Supra, FN 14.
18
American Institute for Research, Consumer Beliefs and Use of Information About Health Care Cost, Resource Use, and Value,
Robert Wood Johnson Foundation, October 2012, pg. 4, available at
https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf402126.
19
Hibbard, JH, et al., An Experiment Shows That a Well-Designed Report on Costs and Quality Can Help Consumers Choose High-
Value Health Care, Health Affairs 2012; 31(3): 560-568.
20
S. 1, Ch. 91-127, Laws of Fla. (1991); s. 381.026, F.S.; The Florida Patient’s Bill of Rights and Responsibilities is intended to promote
better communication and eliminate misunderstandings between the patient and health care provider or health care facility. The rights
of patients include standards related to individual dignity; information about the provider, facility, diagnosis, treatments, risks, etc.;
financial information and disclosure; access to health care; experimental research; and patient’s knowledge of rights and
responsibilities. Patient responsibilities include giving the provider accurate and complete information regarding the patient’s health,
comprehending the course of treatment and following the treatment plan, keeping appointments, fulfilling financial obligations, and
following the facility’s rules and regulations affecting patient care and conduct.
21
S. 381.026(3), F.S. STORAGE NAME: h1527a.HHS PAGE: 6
DATE: 2/16/2022
A patient has the right to request certain financial information from health care providers and facilities.
22
Specifically, upon request, a health care provider or health care facility must provide a person with a
reasonable estimate of the cost of medical treatment prior to the provision of treatment.
23
Estimates
must be written in language “comprehensible to an ordinary layperson.”
24
The reasonable estimate
does not preclude the health care provider or health care facility from exceeding the estimate or making
additional charges as the patient’s needs or medical condition warrant.
25
A patient has the right to
receive a copy of an itemized bill upon request and to receive an explanation of charges upon
request.
26
Currently, under the Patient’s Bill of Rights financial information and disclosure provisions:
A request is necessary before a health care provider or health care facility must disclose to a
Medicare-eligible patient whether the provider or facility accepts Medicare payment as full
payment for medical services and treatment rendered in the provider’s office or health care
facility.
A request is necessary before a health care provider or health care facility is required to furnish
a person an estimate of charges for medical services before providing the services. The Florida
Patient’s Bill of Rights and Responsibilities does not require that the components making up the
estimate be itemized or that the estimate be presented in a manner that is easily understood by
an ordinary layperson.
A licensed facility must place a notice in its reception area that financial information related to
that facility is available on the website of the Agency for Health Care Administration (AHCA).
The facility may indicate that the pricing information is based on a compilation of charges for the
average patient and that an individual patient’s charges may vary.
A patient has the right to receive an itemized bill upon request.
Health care providers and health care facilities are required to make available to patients a summary of
their rights. The applicable regulatory board or Agency may impose an administrative fine when a
provider or facility fails to make available to patients a summary of their rights.
27
The Patient’s Bill of Rights also authorizes, but does not require, primary care providers
28
to publish a
schedule of charges for the medical services offered to patients.
29
The schedule must include certain
price information for at least the 50 services most frequently provided by the primary care provider.
30
The law also requires the posting of the schedule in a conspicuous place in the reception area of the
provider’s office and at least 15 square feet in size.
31
A primary care provider who publishes and
maintains a schedule of charges is exempt from licensure fees for a single renewal of a professional
license and from the continuing education requirements for a single 2-year period.
32
The law also requires urgent care centers to publish a schedule of charges for the medical services
offered to patients.
33
This applies to any entity that holds itself out to the general public, in any manner,
as a facility or clinic where immediate, but not emergent, care is provided, expressly including offsite
facilities of hospitals or hospital-physician joint ventures; and licensed health care clinics that operate in
three or more locations. The schedule requirements for urgent care centers are the same as those
established for primary care providers.
34
The schedule must describe each medical service in language
22
S. 381.026(4)(c), F.S.
23
S. 381.026(4)(c)3., F.S.
24
Id.
25
Id.
26
S. 381.026(4)(c)5., F.S.
27
S. 381.0261, F.S.
28
S. 381.026(2)(d), F.S., defines primary care providers to include allopathic physicians, osteopathic physicians, and nurses who
provide medical services that are commonly provided without referral from another health care provider, including family and general
practice, general pediatrics, and general internal medicine.
29
S. 381.026(4)(c)3., F.S.
30
Id.
31
Id.
32
S. 381.026(4)(c)4., F.S.
33
S. 395.107(1), F.S.
34
S. 395.107(2), F.S. STORAGE NAME: h1527a.HHS PAGE: 7
DATE: 2/16/2022
comprehensible to a layperson. This provision prevents a center from using medical or billing codes,
Latin phrases, or technical medical jargon as the only description of each medical service. An urgent
care center that fails to publish and post the schedule of charges is subject to a fine of not more than
$1,000 per day (until the schedule is published and posted).
35
Florida Price Transparency: Health Care Facilities
Under s. 395.301, F.S., a health care facility
36
must provide, within 7 days of a written request, a good
faith estimate of reasonably anticipated charges for the facility to treat the patient’s condition. Upon
request, the facility must also provide revisions to the estimate. The estimate may represent the
average charges for that diagnosis related group
37
or the average charges for that procedure. The
facility is required to place a notice in the reception area that this information is available. A facility that
fails to provide the estimate as required may be fined $500 for each instance of the facility’s failure to
provide the requested information.
Also pursuant to s. 395.301, F.S., a licensed facility must notify each patient during admission and at
discharge of his or her right to receive an itemized bill upon request. If requested, within 7 days of
discharge or release, the licensed facility must provide an itemized statement, in language
comprehensible to an ordinary layperson, detailing the specific nature of charges or expenses incurred
by the patient. This initial bill must contain a statement of specific services received and expenses
incurred for the items of service, enumerating in detail the constituent components of the services
received within each department of the licensed facility and including unit price data on rates charged
by the licensed facility. The patient or patient’s representative may elect to receive this level of detail in
subsequent billings for services.
Current law also directs these health care facilities to publish information on their websites detailing the
cost of specific health care services and procedures, as well as information on financial assistance that
may be available to prospective patients. The facility must disclose to the consumer that these
averages and ranges of payments are estimates, and that actual charges will be based on the services
actually provided.
38
Under s. 408.05, F.S., AHCA contracts with a vendor to collect and publish this cost
information to consumers on an internet site.
39
Hospitals and other facilities post a link to this site -
https://pricing.floridahealthfinder.gov/ - to comply with the price transparency requirements. The cost
information is searchable, and based on descriptive bundles of commonly performed procedures and
services. The information must, at a minimum, provide the estimated average payment received and
the estimated range of payment from all non-governmental payers for the bundles available at the
facility.
40
The law also establishes the right of a patient to request a personalized estimate on the costs of care
from health care practitioners who provide services in a licensed hospital facility or ambulatory surgical
center.
41
Hospital Facility Transparency
35
S. 395.107(6), F.S.
36
The term "health care facilities" refers to hospitals and ambulatory surgical centers, which are licensed under part I of Chapter 395,
F.S.
37
Diagnosis related groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a
hospital treats (i.e., its case mix) to the costs incurred by the hospital. DRGs allow facilities to categorize patients based on severity of
illness, prognosis, treatment difficulty, need for intervention and resource intensity. For more information, see
https://www.cms.gov/icd10m/version37-fullcode-
cms/fullcode_cms/Design_and_development_of_the_Diagnosis_Related_Group_(DRGs).pdf.
38
S. 395.301, F.S.
39
S. 408.05(3)(c), F.S.
40
Id.
41
S. 456.0575(2), F.S. STORAGE NAME: h1527a.HHS PAGE: 8
DATE: 2/16/2022
On November 15, 2019, the federal Centers for Medicare & Medicaid Services (CMS) finalized
regulations
42
changing payment policies and rates for services furnished to Medicare beneficiaries in
hospital outpatient departments. In doing so, CMS also established new requirements for hospitals to
publish standard charges for a wide range of health care services offered by such facilities. Specifically,
the regulations require hospitals to make public both a machine-readable file of standard charges and a
consumer-friendly presentation of prices for at least 300 shoppable health care services. The
regulations became effective on January 1, 2021.
43
The regulations define a shoppable service as one that can be scheduled in advance, effectively giving
patients the opportunity to select the venue in which to receive the service. This is a more expansive
designation of shoppable services than currently exists in Florida law. For each shoppable service, a
hospital must disclose several pricing benchmarks to include:
The gross charge;
The payer-specific negotiated charge;
A de-identified minimum negotiated charge;
A de-identified maximum negotiated charge; and,
The discounted cash price.
This information should provide a patient with both a reasonable point estimate of the charge for a
shoppable service, and also a range in which the actual charge can be expected to fall.
The penalty for facility noncompliance under the federal regulations is a maximum fine of $300 per
day.
44
Very early indications suggest that there are varying levels of compliance with the new rules
among hospital facilities.
45
Medical Debt
Medical costs can result in overwhelming debts to patients, and in some cases, bankruptcy. A 2007
study suggested that illness and medical bills contributed to 62.1% of all personal bankruptcies filed in
the U.S. during that year.
46
A more recent analysis, which considered only the impact of hospital
charges, found that 4% of U.S. bankruptcies among non-elderly adults resulted from hospitalizations.
47
Even when medical costs do not result in personal bankruptcy, they often weigh heavily on the financial
health of patients and their families. According to the Kaiser Family Foundation, about a quarter of U.S.
adults ages 18-64 say they or someone in their household had problems paying or an inability to pay
medical bills in the past 12 months.
48
About three in ten survey respondents reported medical debt of
$5,000 or more, with 13 percent of respondents indicating medical debt in excess of $10,000. Even
patients with lower amounts of medical debt reported that the outstanding bills led to financial distress,
in light of other financial commitments and/or limited income.
49
Among those who reported problems paying medical bills, 66 percent said the bills were the result of a
one-time or short-term medical expense such as a hospital stay or an accident, while 33 percent cited
42
Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical
Center Payment System Policy Changes and Payment Rates. Price Transparency Requirements for Hospitals To Make Standard
Charges Public, 84 FR 65524 (November 27, 2019)(codified at 45 CFR Part 180).
43
Id.
44
Supra, FN 42.
45
ADVI, “Implementation of Newly Enacted Hospital Price Transparency,” available at
https://advi.com/analysis/Hospital_Transparency_-_ADVI_Summary.pdf.
46
David U. Himmelstein, et al. “Medical Bankruptcy in the United States, 2007: Results of a National Study.” American Journal of
Medicine 2009; 122: 741-6. Available at https://www.amjmed.com/article/S0002-9343(09)00404-5/abstract.
47
Carlos Dobkin, et al. “Myth and Measurement: The Case of Medical Bankruptcies.” New England Journal of Medicine 2018;
378:1076-1078. Available at https://www.nejm.org/doi/full/10.1056/NEJMp1716604.
48
The Henry J. Kaiser Family Foundation, “The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times
Medical Bills Survey.” January 5, 2016. Available at https://www.kff.org/health-costs/report/the-burden-of-medical-debt-results-from-the-
kaiser-family-foundationnew-york-times-medical-bills-survey/.
49
Id. STORAGE NAME: h1527a.HHS PAGE: 9
DATE: 2/16/2022
bills for treatment of chronic conditions that have accumulated over time. Respondents to the Kaiser
survey reported a wide range of illnesses and injuries that led to an accumulation of medical debt. The
largest share (36 percent) named a specific disease, symptom, or condition like heart disease or
gastrointestinal problems, followed by issues related to chronic pain or injuries (16 percent), accidents
and broken bones (15 percent), surgery (10 percent), dental issues (10 percent), and infections like
pneumonia and flu (9 percent).
50
The following illustration provides additional detail on the type of
medical services that led to an accumulation of medical debt.
51
Medical Debt Collection Process
Current law provides a court process for the collection of lawful debts, including medical debts. A
creditor may sue a debtor and, if the creditor prevails, the creditor may receive a final judgment
awarding monetary damages. If the debtor does not voluntarily pay the judgment, the creditor has
several legal means to collect on the debt, including:
Wage garnishment.
Garnishment of money in a bank account.
Directing the sheriff to seize assets, sell them, and give the proceeds to the creditor.
In order to protect debtors from being destitute, current law provides that certain property is exempt
from being taken by a creditor. The Florida Constitution provides that the debtor's homestead and
$1,000 of personal property is exempt.
52
Statutory law provides numerous categories of exempt
property, and federal statutory law also provides certain exemptions that apply in all of the states.
53
In addition to the protection from creditors contained in the Florida Constitution, chapter 222, F.S.,
protects other personal property from certain claims of creditors and legal process: garnishment of
50
Id.
51
Id., Figure 4.
52
Art. X, s. 4(a), Fla. Const.
53
For example, the federal ERISA law provides that most retirement plans are exempt from creditor claims. STORAGE NAME: h1527a.HHS PAGE: 10
DATE: 2/16/2022
wages for a head of family;
54
proceeds from life insurance policies;
55
wages or unemployment
compensation payments due certain deceased employees;
56
disability income benefits;
57
assets in
qualified tuition programs; medical savings accounts; Coverdell education savings accounts; hurricane
savings accounts;
58
$1,000 interest in a motor vehicle; professionally prescribed health aids; certain
refunds or credits from financial institutions; and $4,000 interest in personal property, if the debtor does
not claim or receive the benefits of a homestead exemption under the State Constitution.
59
Bankruptcy is a means by which a person's assets are liquidated in order to pay the person's debts
under court supervision. The United States Constitution gives Congress the right to uniformly govern
bankruptcy law.
60
Bankruptcy courts are operated by the federal government. A debtor (the bankrupt
person) is not required to give up all of his or her assets in bankruptcy. Certain property is deemed
"exempt" from the bankruptcy case, and may be kept by the debtor without being subject to creditor
claims. The Bankruptcy Code provides for exempt property in a bankruptcy case.
61
In general, a debtor
may choose to utilize the exempt property listing in state law or the exempt property of the Bankruptcy
Code. However, federal law allows a state to opt-out of the federal law and thereby insist that debtors
only utilize state law exemptions.
62
Florida, like most states, has made the opt-out election to prohibit
the use of the federal exemptions and require that debtors may only use state law exemptions.
63
Effect of Proposed Changes
Shoppable Services
CS/HB 1527 requires each licensed hospital and ambulatory surgical center to post a consumer-
friendly list of standard charges for at least 300 shoppable health care services on a facility website. A
facility that provides less than 300 distinct services will be required to post standard charges for each
service it does provide.
The bill requires facilities to post pricing information for shoppable services in accordance with the
definition of “standard charges” established in federal rule.
64
This information extends beyond the
traditional concept of charges to include negotiated and actual prices paid for selected services. For
each shoppable service, a hospital must disclose the following pricing benchmarks:
The gross charge;
The payer-specific negotiated charge;
A de-identified minimum negotiated charge;
A de-identified maximum negotiated charge; and,
The discounted cash price.
This bill is intended to mirror the shoppable services requirement included in the hospital facility
transparency regulations finalized by the CMS in 2019. The bill requires facilities to disclose the
relevant cost information as a condition of state licensure, which should result in uniform compliance
among facilities.
Medical Debt Collection
54
S. 222.11, F.S.
55
S. 222.13, F.S.
56
S. 222.15, F.S.
57
S. 222.18, F.S.
58
S. 222.22, F.S.
59
S. 222.25, F.S.
60
Art. 1, s. 8, cl. 4, U.S. Const.
61
11 U.S.C. s. 522.
62
11 U.S.C. s. 522(b).
63
S. 222.20, F.S.
64
Supra, FN 47. STORAGE NAME: h1527a.HHS PAGE: 11
DATE: 2/16/2022
The bill prohibits hospitals and ASCs from engaging in any “extraordinary collection actions” against a
patient prior to determining whether that patient is eligible for financial assistance, before providing an
itemized bill, during an ongoing grievance process, prior to billing any applicable insurance coverage,
and for 30 days after notifying a patient in writing that a collections action will commence. For purposes
of the provision, “extraordinary collection action” means any action that requires a legal or judicial
process, including:
Placing a lien on an individual’s property;
Foreclosing on an individual’s real property;
Attaching or seizing an individual’s bank account or any other personal property;
Commencing a civil action against an individual;
Causing an individual’s arrest; or,
Garnishing an individual’s wages.
The bill also establishes a new set of debt collection exemptions in chapter 222, F.S. that apply
explicitly to debt incurred as a result of medical services provided in hospitals, ambulatory surgical
centers, or urgent care centers. Under current law, this type of medical debt is subject to the uniform
exemptions that apply to all types of debt and are described above. The bill increases the ceiling on the
debt collection exemptions, when the debt results from services provided in a hospital facility or
ambulatory surgical center, as follows:
To $10,000 interest in a single motor vehicle (versus the current law exemption of $1,000);
To $10,000 interest in personal property, provided that a debtor does not claim the homestead
exemption under s. 4, Art. X of the state constitution (versus the current law exemption of
$4,000).
The bill also requires each hospital and ASC to establish an internal grievance process allowing a
patient to dispute any charges that appear on an itemized statement or bill. When a patient initiates a
grievance, the facility must then provide an initial response to that patient within 7 business days.
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Creates s. 222.26, F.S., relating to additional exemptions from legal process concerning
medical debt.
Section 2: Amends s. 395.301, F.S., relating to price transparency; itemized patient statement or bill;
patient admission status notification.
Section 3: Creates s. 395.3011, F.S., relating to billing and collection activities.
Section 4: Provides an effective date of July 1, 2022.
STORAGE NAME: h1527a.HHS PAGE: 12
DATE: 2/16/2022
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
The increased dollar limit on personal property exemptions under chapter 222, F.S., may reduce
revenues for medical service providers or their collection agents.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not Applicable. This bill does not appear to require counties or municipalities to spend funds or act
requiring the expenditures of funds; reduce the authority that counties or municipalities have to raise
revenues in the aggregate; or reduce the percentage of state tax shared with counties or
municipalities.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
STORAGE NAME: h1527a.HHS PAGE: 13
DATE: 2/16/2022
Current law provides AHCA with sufficient rule-making authority to execute the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On February 3, 2022, the Finance & Facilities Subcommittee adopted one amendment to the PCS and
reported the bill favorably as a committee substitute. The amendment required hospitals and ASCs to
establish an internal process for reviewing and responding to grievances from patients, allowing patients to
dispute charges that appear on the patient's itemized statement or bill, and to respond to a grievance within
7 days after it is formally filed by a patient. The amendment also required each facility to prominently post
on its website and on each itemized statement or bill the grievance process instructions and necessary
direct contact information required to initiate the grievance process.
This analysis is drafted to the committee substitute as passed by the Finance & Facilities Subcommittee.