Florida Senate - 2024 SB 1640 By Senator Collins 14-01322B-24 20241640__ 1 A bill to be entitled 2 An act relating to payments for health care services; 3 amending s. 95.11, F.S.; establishing a 3-year statute 4 of limitations for an action to collect medical debt 5 for services rendered by certain health care 6 facilities; creating s. 222.26, F.S.; providing 7 additional personal property exemptions from legal 8 process for medical debts resulting from services 9 provided in certain licensed facilities; amending s. 10 395.301, F.S.; requiring certain licensed facilities 11 to post on their respective websites a consumer 12 friendly list of standard charges for a minimum number 13 of shoppable health care services; requiring the 14 facilities to provide such information in an 15 alternative format as requested by the patient; 16 defining terms; requiring licensed facilities to 17 provide a good faith estimate of reasonably 18 anticipated charges to the patients health insurer 19 and the patient, prospective patient, or patients 20 legal guardian within specified timeframes; requiring 21 such facilities to provide the estimate in the manner 22 selected by the patient, prospective patient, or 23 patients legal guardian; revising notification 24 requirements for such estimates to include 25 notification of a patients legal guardian, if any; 26 deleting the requirement that licensed facilities 27 educate the public on the availability of such 28 estimates upon request; revising a penalty; deleting 29 construction; requiring licensed facilities to 30 establish an internal grievance process for patients 31 to submit grievances, including to dispute charges; 32 requiring licensed facilities to make available on 33 their respective websites information necessary for 34 initiating a grievance; requiring licensed facilities 35 to respond to a patient grievance within a specified 36 timeframe; requiring licensed facilities to disclose 37 certain information to patients, prospective patients, 38 and patients legal guardians, as applicable; 39 providing a civil penalty; creating s. 395.3011, F.S.; 40 defining the term extraordinary collection action; 41 prohibiting licensed facilities from engaging in 42 extraordinary collection actions against individuals 43 to obtain payment for services under specified 44 circumstances; amending s. 624.27, F.S.; revising the 45 definition of the term health care provider for 46 purposes of direct health care agreements; creating s. 47 627.446, F.S.; defining the term health insurer; 48 requiring health insurers to provide an insured with 49 an advanced explanation of benefits after receiving a 50 patient estimate from a facility for scheduled 51 services; providing requirements for the advanced 52 explanation of benefits; creating s. 627.447, F.S.; 53 prohibiting health insurers from prohibiting providers 54 from disclosing certain information to an insured; 55 defining the term discounted cash price; amending s. 56 627.6387, F.S.; revising the definition of the terms 57 health insurer and shared savings incentive to 58 conform to changes made by the act; requiring, rather 59 than authorizing, health insurers to offer a shared 60 savings incentive program under certain circumstances; 61 requiring that a certain notification required of 62 health insurers include specified information; 63 providing that a shared savings incentive offered by a 64 health insurer constitutes a medical expense for 65 purposes of rate development and rate filing; amending 66 ss. 627.6648 and 641.31076, F.S.; providing that a 67 shared savings incentive offered by a health insurer 68 or health maintenance organization, respectively, 69 constitutes a medical expense for rate development and 70 rate filing purposes; amending ss. 475.01, 475.611, 71 517.191, 768.28, and 787.061, F.S.; conforming cross 72 references; providing an effective date. 73 74 Be It Enacted by the Legislature of the State of Florida: 75 76 Section 1.Present subsections (4) through (12) of section 77 95.11, Florida Statutes, are redesignated as subsections (5) 78 through (13), respectively, a new subsection (4) is added to 79 that section, and paragraph (b) of subsection (2), paragraph (n) 80 of subsection (3), paragraphs (f) and (g) of present subsection 81 (5), and present subsection (10) of that section are amended, to 82 read: 83 95.11Limitations other than for the recovery of real 84 property.Actions other than for recovery of real property shall 85 be commenced as follows: 86 (2)WITHIN FIVE YEARS. 87 (b)A legal or equitable action on a contract, obligation, 88 or liability founded on a written instrument, except for an 89 action to enforce a claim against a payment bond, which shall be 90 governed by the applicable provisions of paragraph (6)(e) 91 (5)(e), s. 255.05(10), s. 337.18(1), or s. 713.23(1)(e), and 92 except for an action for a deficiency judgment governed by 93 paragraph (6)(h) (5)(h). 94 (3)WITHIN FOUR YEARS. 95 (n)An action for assault, battery, false arrest, malicious 96 prosecution, malicious interference, false imprisonment, or any 97 other intentional tort, except as provided in subsections (4), 98 (5), (6), and (8) (7). 99 (4)WITHIN THREE YEARS.An action to collect medical debt 100 for services rendered by a facility licensed under chapter 395, 101 provided that the period of limitations runs from the date on 102 which the facility completes written notification of the medical 103 debt, either through the mail or via electronic means with 104 evidence of receipt, in the delivery manner selected by the 105 affected patient or the patients legal representative or the 106 date on which the facility refers the medical debt to a third 107 party for collection, whichever date is later. 108 (6)(5)WITHIN ONE YEAR. 109 (f)Except for actions described in subsection (9) (8), a 110 petition for extraordinary writ, other than a petition 111 challenging a criminal conviction, filed by or on behalf of a 112 prisoner as defined in s. 57.085. 113 (g)Except for actions described in subsection (9) (8), an 114 action brought by or on behalf of a prisoner, as defined in s. 115 57.085, relating to the conditions of the prisoners 116 confinement. 117 (11)(10)FOR INTENTIONAL TORTS RESULTING IN DEATH FROM ACTS 118 DESCRIBED IN S. 782.04 OR S. 782.07.Notwithstanding paragraph 119 (5)(e) (4)(e), an action for wrongful death seeking damages 120 authorized under s. 768.21 brought against a natural person for 121 an intentional tort resulting in death from acts described in s. 122 782.04 or s. 782.07 may be commenced at any time. This 123 subsection shall not be construed to require an arrest, the 124 filing of formal criminal charges, or a conviction for a 125 violation of s. 782.04 or s. 782.07 as a condition for filing a 126 civil action. 127 Section 2.Section 222.26, Florida Statutes, is created to 128 read: 129 222.26Additional exemptions from legal process concerning 130 medical debt.If a debt is owed for medical services provided by 131 a facility licensed under chapter 395, the following property is 132 exempt from attachment, garnishment, or other legal process in 133 an action on such debt: 134 (1)A debtors interest, not to exceed $10,000 in value, in 135 a single motor vehicle as defined in s. 320.01(1). 136 (2)A debtors interest in personal property, not to exceed 137 $10,000 in value, if the debtor does not claim or receive the 138 benefits of a homestead exemption under s. 4, Art. X of the 139 State Constitution. 140 Section 3.Present paragraphs (b), (c), and (d) of 141 subsection (1) of section 395.301, Florida Statutes, are 142 redesignated as paragraphs (c), (d), and (e), respectively, 143 present subsection (6) is redesignated as subsection (8), a new 144 paragraph (b) is added to subsection (1), a new subsection (6) 145 and subsection (7) are added to that section, and present 146 paragraph (b) of subsection (1) of that section is amended, to 147 read: 148 395.301Price transparency; itemized patient statement or 149 bill; patient admission status notification. 150 (1)A facility licensed under this chapter shall provide 151 timely and accurate financial information and quality of service 152 measures to patients and prospective patients of the facility, 153 or to patients survivors or legal guardians, as appropriate. 154 Such information shall be provided in accordance with this 155 section and rules adopted by the agency pursuant to this chapter 156 and s. 408.05. Licensed facilities operating exclusively as 157 state facilities are exempt from this subsection. 158 (b)Each licensed facility shall post on its website a 159 consumer-friendly list of standard charges for at least 300 160 shoppable health care services. If a facility provides fewer 161 than 300 distinct shoppable health care services, it must make 162 available on its website the standard charges for each service 163 it provides. A facility shall provide the information in an 164 alternative format as requested by the patient. As used in this 165 paragraph, the term: 166 1.Shoppable health care service means a service that can 167 be scheduled by a health care consumer in advance. The term 168 includes, but is not limited to, the services described in s. 169 627.6387(2)(e) and any services defined in regulations or 170 guidance issued by the United States Department of Health and 171 Human Services. 172 2.Standard charge has the same meaning as the definition 173 of that term in regulations or guidance issued by the United 174 States Department of Health and Human Services for purposes of 175 hospital price transparency. 176 (c)1.(b)1.Upon request, and Before providing any 177 nonemergency medical services, each licensed facility shall 178 provide in writing or by electronic means, in the manner 179 requested by the patient, prospective patient, or patients 180 legal guardian, a good faith estimate of reasonably anticipated 181 charges by the facility for the treatment of the patients or 182 prospective patients specific condition. Such estimate must be 183 provided to the patient, prospective patient, or patients legal 184 guardian upon scheduling a medical service. The facility must 185 provide the estimate to the patient or prospective patient 186 within 7 business days after the receipt of the request and is 187 not required to adjust the estimate for any potential insurance 188 coverage. The facility shall provide the estimate to the 189 patients health insurer, as defined in s. 627.446(1), and the 190 patient or the patients legal guardian at least 3 business days 191 before a service is to be furnished, but no later than 1 192 business day after the service is scheduled or, in the case of a 193 service scheduled at least 10 business days in advance, no later 194 than 3 business days after the service is scheduled. The 195 estimate may be based on the descriptive service bundles 196 developed by the agency under s. 408.05(3)(c) unless the 197 patient, or prospective patient, or patients legal guardian 198 requests a more personalized and specific estimate that accounts 199 for the specific condition and characteristics of the patient or 200 prospective patient. The facility shall inform the patient, or 201 prospective patient, or patients legal guardian that he or she 202 may contact the patients his or her health insurer or health 203 maintenance organization for additional information concerning 204 cost-sharing responsibilities. 205 2.In the estimate, the facility shall provide to the 206 patient, or prospective patient, or patients legal guardian 207 information delivered in the patients preferred format on the 208 facilitys financial assistance policy, including the 209 application process, payment plans, and discounts and the 210 facilitys charity care policy and collection procedures. 211 3.The estimate shall clearly identify any facility fees 212 and, if applicable, include a statement notifying the patient, 213 or prospective patient, or patients legal guardian that a 214 facility fee is included in the estimate, the purpose of the 215 fee, and that the patient may pay less for the procedure or 216 service at another facility or in another health care setting. 217 4.Upon request, The facility shall notify the patient, or 218 prospective patient, or patients legal guardian of any revision 219 to the estimate. 220 5.In the estimate, the facility must notify the patient, 221 or prospective patient, or patients legal guardian that 222 services may be provided in the health care facility by the 223 facility as well as by other health care providers that may 224 separately bill the patient, if applicable. 225 6.The facility shall take action to educate the public 226 that such estimates are available upon request. 227 7.Failure to timely provide the estimate pursuant to this 228 paragraph shall result in a daily fine of $1,000 until the 229 estimate is provided to the patient, or prospective patient, or 230 patients legal guardian and the health insurer. The total fine 231 per patient estimate may not exceed $10,000. 232 233 The provision of an estimate does not preclude the actual 234 charges from exceeding the estimate. 235 (6)Each facility shall establish an internal process for 236 reviewing and responding to grievances from patients. Such 237 process must allow patients to dispute charges that appear on 238 the patients itemized statement or bill. The facility shall 239 prominently post on its website and indicate in bold print on 240 each itemized statement or bill the instructions for initiating 241 a grievance and the direct contact information required to 242 initiate the grievance process. The facility shall provide an 243 initial response to a patient grievance within 7 business days 244 after the patient formally files a grievance disputing all or a 245 portion of an itemized statement or bill. 246 (7)Each licensed facility shall disclose to a patient, 247 prospective patient, or a patients legal guardian whether a 248 cost-sharing obligation for a particular covered health care 249 service or item exceeds the charge that applies to an individual 250 who pays cash or the cash equivalent for the same health care 251 service or item in the absence of health insurance coverage. The 252 facilitys failure to provide a disclosure compliant with this 253 section may result in a fine not to exceed $500 per incident. 254 Section 4.Section 395.3011, Florida Statutes, is created 255 to read: 256 395.3011Billing and collection activities. 257 (1)As used in this section, the term extraordinary 258 collection action means any of the following actions taken by a 259 licensed facility against an individual in relation to obtaining 260 payment of a bill for care covered under the facilitys 261 financial assistance policy: 262 (a)Selling the individuals debt to another party. 263 (b)Reporting adverse information about the individual to 264 consumer credit reporting agencies or credit bureaus. 265 (c)Deferring, denying, or requiring a payment before 266 providing medically necessary care because of the individuals 267 nonpayment of one or more bills for previously provided care 268 covered under the facilitys financial assistance policy. 269 (d)Actions that require a legal or judicial process, 270 including, but not limited to: 271 1.Placing a lien on the individuals property; 272 2.Foreclosing on the individuals real property; 273 3.Attaching or seizing the individuals bank account or 274 any other personal property; 275 4.Commencing a civil action against the individual; 276 5.Causing the individuals arrest; or 277 6.Garnishing the individuals wages. 278 (2)A facility may not engage in an extraordinary 279 collection action against an individual to obtain payment for 280 services: 281 (a)Before the facility has made reasonable efforts to 282 determine whether the individual is eligible for assistance 283 under its financial assistance policy for the care provided and, 284 if eligible, before a decision is made by the facility on the 285 patients application for such financial assistance. 286 (b)Before the facility has provided the individual with an 287 itemized statement or bill. 288 (c)During an ongoing grievance process as described in s. 289 395.301(6) or an ongoing appeal of a claim adjudication. 290 (d)Before billing any applicable insurer and allowing the 291 insurer to adjudicate a claim. 292 (e)For 30 calendar days after notifying the patient in 293 writing, by certified mail or by other traceable delivery 294 method, that a collection action will commence absent additional 295 action by the patient. 296 (f)While the individual: 297 1.Negotiates in good faith the final amount of a bill for 298 services rendered; or 299 2.Complies with all terms of a payment plan with the 300 facility. 301 Section 5.Paragraph (b) of subsection (1) of section 302 624.27, Florida Statutes, is amended to read: 303 624.27Direct health care agreements; exemption from code. 304 (1)As used in this section, the term: 305 (b)Health care provider means a health care provider 306 licensed under chapter 458, chapter 459, chapter 460, chapter 307 461, chapter 464, or chapter 466, chapter 490, or chapter 491, 308 or a health care group practice, who provides health care 309 services to patients. 310 Section 6.Section 627.446, Florida Statutes, is created to 311 read: 312 627.446Advanced explanation of benefits. 313 (1)As used in this section, the term health insurer 314 means an authorized insurer issuing individual or group coverage 315 under this chapter or a health maintenance organization issuing 316 coverage through an individual or a group contract under chapter 317 641. 318 (2)Each health insurer shall prepare an advanced 319 explanation of benefits upon receiving a patient estimate from a 320 facility pursuant to s. 395.301(1). The health insurer must 321 provide the advanced explanation of benefits to the insured no 322 later than 1 business day after receiving the patient estimate 323 from the facility or, in the case of a service scheduled at 324 least 10 business days in advance, no later than 3 business days 325 after receiving such estimate. 326 (3)At a minimum, the advanced explanation of benefits must 327 include detailed coverage and cost-sharing information pursuant 328 to 42 U.S.C. s. 300gg-111 (2020) and the regulations and 329 guidance adopted thereunder. 330 Section 7.Section 627.447, Florida Statutes, is created to 331 read: 332 627.447Disclosure of discounted cash prices.A health 333 insurer may not prohibit a provider from disclosing to an 334 insured the option to pay the providers discounted cash price 335 for health care services. For purposes of this section, the term 336 discounted cash price has the following meanings: 337 (1)With respect to a hospital facility, the term has the 338 same meaning as provided in 45 C.F.R. s. 180.20. The term does 339 not include the amount charged to an individual pursuant to a 340 facilitys financial assistance policy. 341 (2)With respect to a provider that is not a hospital, the 342 term means the charge that is applied to an individual who paid 343 for a health care service without filing an insurance claim. 344 Section 8.Paragraphs (b) and (c) of subsection (2), 345 subsection (3), and paragraph (a) of subsection (4) of section 346 627.6387, Florida Statutes, are amended to read: 347 627.6387Shared savings incentive program. 348 (2)As used in this section, the term: 349 (b)Health insurer means an authorized insurer offering 350 health insurance as defined in s. 627.446 s. 624.603. 351 (c)Shared savings incentive means a voluntary and 352 optional financial incentive that a health insurer provides may 353 provide to an insured for choosing certain shoppable health care 354 services under a shared savings incentive program, which and may 355 include, but is not limited to, the incentives described in s. 356 626.9541(4)(a). 357 (3)A health insurer must may offer a shared savings 358 incentive program to provide incentives to an insured when the 359 insured obtains a shoppable health care service from the health 360 insurers shared savings list. An insured may not be required to 361 participate in a shared savings incentive program. A health 362 insurer that offers a shared savings incentive program must: 363 (a)Establish the program as a component part of the policy 364 or certificate of insurance provided by the health insurer and 365 notify the insureds and the office at least 30 days before 366 program termination. 367 (b)File a description of the program on a form prescribed 368 by commission rule. The office must review the filing and 369 determine whether the shared savings incentive program complies 370 with this section. 371 (c)Notify an insured annually and at the time of renewal, 372 and an applicant for insurance at the time of enrollment, of the 373 availability of the shared savings incentive program and the 374 procedure to participate in the program and that participation 375 by the insured is voluntary and optional. 376 (d)Publish on a web page easily accessible to insureds and 377 to applicants for insurance a list of shoppable health care 378 services and health care providers and the shared savings 379 incentive amount applicable for each service. A shared savings 380 incentive may not be less than 25 percent of the savings 381 generated by the insureds participation in any shared savings 382 incentive offered by the health insurer. The baseline for the 383 savings calculation is the average in-network amount paid for 384 that service in the most recent 12-month period or some other 385 methodology established by the health insurer and approved by 386 the office. 387 (e)At least quarterly, credit or deposit the shared 388 savings incentive amount to the insureds account as a return or 389 reduction in premium, or credit the shared savings incentive 390 amount to the insureds flexible spending account, health 391 savings account, or health reimbursement account, or reward the 392 insured directly with cash or a cash equivalent. 393 (f)Submit an annual report to the office within 90 394 business days after the close of each plan year. At a minimum, 395 the report must include the following information: 396 1.The number of insureds who participated in the program 397 during the plan year and the number of instances of 398 participation. 399 2.The total cost of services provided as a part of the 400 program. 401 3.The total value of the shared savings incentive payments 402 made to insureds participating in the program and the values 403 distributed as premium reductions, credits to flexible spending 404 accounts, credits to health savings accounts, or credits to 405 health reimbursement accounts. 406 4.An inventory of the shoppable health care services 407 offered by the health insurer. 408 (4)(a)A shared savings incentive offered by a health 409 insurer in accordance with this section: 410 1.Is not an administrative expense for rate development or 411 rate filing purposes and shall be counted as a medical expense 412 for such purposes. 413 2.Does not constitute an unfair method of competition or 414 an unfair or deceptive act or practice under s. 626.9541 and is 415 presumed to be appropriate unless credible data clearly 416 demonstrates otherwise. 417 Section 9.Paragraph (a) of subsection (4) of section 418 627.6648, Florida Statutes, is amended to read: 419 627.6648Shared savings incentive program. 420 (4)(a)A shared savings incentive offered by a health 421 insurer in accordance with this section: 422 1.Is not an administrative expense for rate development or 423 rate filing purposes and shall be counted as a medical expense 424 for such purposes. 425 2.Does not constitute an unfair method of competition or 426 an unfair or deceptive act or practice under s. 626.9541 and is 427 presumed to be appropriate unless credible data clearly 428 demonstrates otherwise. 429 Section 10.Paragraph (a) of subsection (4) of section 430 641.31076, Florida Statutes, is amended to read: 431 641.31076Shared savings incentive program. 432 (4)A shared savings incentive offered by a health 433 maintenance organization in accordance with this section: 434 (a)Is not an administrative expense for rate development 435 or rate filing purposes and shall be counted as a medical 436 expense for such purposes. 437 Section 11.Paragraphs (a) and (j) of subsection (1) of 438 section 475.01, Florida Statutes, are amended to read: 439 475.01Definitions. 440 (1)As used in this part: 441 (a)Broker means a person who, for another, and for a 442 compensation or valuable consideration directly or indirectly 443 paid or promised, expressly or impliedly, or with an intent to 444 collect or receive a compensation or valuable consideration 445 therefor, appraises, auctions, sells, exchanges, buys, rents, or 446 offers, attempts or agrees to appraise, auction, or negotiate 447 the sale, exchange, purchase, or rental of business enterprises 448 or business opportunities or any real property or any interest 449 in or concerning the same, including mineral rights or leases, 450 or who advertises or holds out to the public by any oral or 451 printed solicitation or representation that she or he is engaged 452 in the business of appraising, auctioning, buying, selling, 453 exchanging, leasing, or renting business enterprises or business 454 opportunities or real property of others or interests therein, 455 including mineral rights, or who takes any part in the procuring 456 of sellers, purchasers, lessors, or lessees of business 457 enterprises or business opportunities or the real property of 458 another, or leases, or interest therein, including mineral 459 rights, or who directs or assists in the procuring of prospects 460 or in the negotiation or closing of any transaction which does, 461 or is calculated to, result in a sale, exchange, or leasing 462 thereof, and who receives, expects, or is promised any 463 compensation or valuable consideration, directly or indirectly 464 therefor; and all persons who advertise rental property 465 information or lists. A broker renders a professional service 466 and is a professional within the meaning of s. 95.11(5)(b) s. 467 95.11(4)(b). Where the term appraise or appraising appears 468 in the definition of the term broker, it specifically excludes 469 those appraisal services which must be performed only by a 470 state-licensed or state-certified appraiser, and those appraisal 471 services which may be performed by a registered trainee 472 appraiser as defined in part II. The term broker also includes 473 any person who is a general partner, officer, or director of a 474 partnership or corporation which acts as a broker. The term 475 broker also includes any person or entity who undertakes to 476 list or sell one or more timeshare periods per year in one or 477 more timeshare plans on behalf of any number of persons, except 478 as provided in ss. 475.011 and 721.20. 479 (j)Sales associate means a person who performs any act 480 specified in the definition of broker, but who performs such 481 act under the direction, control, or management of another 482 person. A sales associate renders a professional service and is 483 a professional within the meaning of s. 95.11(5)(b) s. 484 95.11(4)(b). 485 Section 12.Paragraph (h) of subsection (1) of section 486 475.611, Florida Statutes, is amended to read: 487 475.611Definitions. 488 (1)As used in this part, the term: 489 (h)Appraiser means any person who is a registered 490 trainee real estate appraiser, a licensed real estate appraiser, 491 or a certified real estate appraiser. An appraiser renders a 492 professional service and is a professional within the meaning of 493 s. 95.11(5)(b) s. 95.11(4)(b). 494 Section 13.Subsection (7) of section 517.191, Florida 495 Statutes, is amended to read: 496 517.191Injunction to restrain violations; civil penalties; 497 enforcement by Attorney General. 498 (7)Notwithstanding s. 95.11(5)(f) s. 95.11(4)(f), an 499 enforcement action brought under this section based on a 500 violation of any provision of this chapter or any rule or order 501 issued under this chapter shall be brought within 6 years after 502 the facts giving rise to the cause of action were discovered or 503 should have been discovered with the exercise of due diligence, 504 but not more than 8 years after the date such violation 505 occurred. 506 Section 14.Subsection (14) of section 768.28, Florida 507 Statutes, is amended to read: 508 768.28Waiver of sovereign immunity in tort actions; 509 recovery limits; civil liability for damages caused during a 510 riot; limitation on attorney fees; statute of limitations; 511 exclusions; indemnification; risk management programs. 512 (14)Every claim against the state or one of its agencies 513 or subdivisions for damages for a negligent or wrongful act or 514 omission pursuant to this section shall be forever barred unless 515 the civil action is commenced by filing a complaint in the court 516 of appropriate jurisdiction within 4 years after such claim 517 accrues; except that an action for contribution must be 518 commenced within the limitations provided in s. 768.31(4), and 519 an action for damages arising from medical malpractice or 520 wrongful death must be commenced within the limitations for such 521 actions in s. 95.11(5) s. 95.11(4). 522 Section 15.Subsection (4) of section 787.061, Florida 523 Statutes, is amended to read: 524 787.061Civil actions by victims of human trafficking. 525 (4)STATUTE OF LIMITATIONS.The statute of limitations as 526 specified in s. 95.11(8) or (10) s. 95.11(7) or (9), as 527 applicable, governs an action brought under this section. 528 Section 16.This act shall take effect October 1, 2024.