Bill Text: FL S1440 | 2015 | Regular Session | Introduced


Bill Title: Health Care

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2015-03-18 - Withdrawn from further consideration [S1440 Detail]

Download: Florida-2015-S1440-Introduced.html
       Florida Senate - 2015                                    SB 1440
       
       
        
       By Senator Sobel
       
       
       
       
       
       33-01220-15                                           20151440__
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 381.026,
    3         F.S.; revising patient responsibilities contained in
    4         the Florida Patient’s Bill of Rights and
    5         Responsibilities; specifying that a patient is
    6         responsible for reviewing a document, presented upon
    7         admission for treatment, indicating that the patient
    8         may be charged for out-of-network physician services;
    9         amending s. 395.301, F.S.; requiring a health care
   10         provider or facility to present patients with a
   11         document advising them that they may be charged for
   12         out-of-network physician services; creating ss.
   13         627.64194 and 627.66915, F.S., and amending s. 641.31,
   14         F.S.; requiring individual accident or health
   15         insurance policies, group, blanket, or franchise
   16         accident or health insurance policies, and managed
   17         care plans to evaluate and review coverage for
   18         orthotics and prosthetics and orthoses and prostheses;
   19         providing requirements and limitations; specifying
   20         deductible and copayment recommendations; authorizing
   21         insurers to define certain benefits limitations;
   22         providing for nonapplication to certain policy
   23         coverages; providing an effective date.
   24          
   25  Be It Enacted by the Legislature of the State of Florida:
   26  
   27         Section 1. Subsection (6) of section 381.026, Florida
   28  Statutes, is amended to read:
   29         381.026 Florida Patient’s Bill of Rights and
   30  Responsibilities.—
   31         (6) SUMMARY OF RIGHTS AND RESPONSIBILITIES.—Any health care
   32  provider who treats a patient in an office or any health care
   33  facility licensed under chapter 395 that provides emergency
   34  services and care or outpatient services and care to a patient,
   35  or admits and treats a patient, shall adopt and make available
   36  to the patient, in writing, a statement of the rights and
   37  responsibilities of patients, including the following:
   38                SUMMARY OF THE FLORIDA PATIENT’S BILL              
   39                   OF RIGHTS AND RESPONSIBILITIES                  
   40         Florida law requires that your health care provider or
   41  health care facility recognize your rights while you are
   42  receiving medical care and that you respect the health care
   43  provider’s or health care facility’s right to expect certain
   44  behavior on the part of patients. You may request a copy of the
   45  full text of this law from your health care provider or health
   46  care facility. A summary of your rights and responsibilities
   47  follows:
   48         A patient has the right to be treated with courtesy and
   49  respect, with appreciation of his or her individual dignity, and
   50  with protection of his or her need for privacy.
   51         A patient has the right to a prompt and reasonable response
   52  to questions and requests.
   53         A patient has the right to know who is providing medical
   54  services and who is responsible for his or her care.
   55         A patient has the right to know what patient support
   56  services are available, including whether an interpreter is
   57  available if he or she does not speak English.
   58         A patient has the right to know what rules and regulations
   59  apply to his or her conduct.
   60         A patient has the right to be given by the health care
   61  provider information concerning diagnosis, planned course of
   62  treatment, alternatives, risks, and prognosis.
   63         A patient has the right to refuse any treatment, except as
   64  otherwise provided by law.
   65         A patient has the right to be given, upon request, full
   66  information and necessary counseling on the availability of
   67  known financial resources for his or her care.
   68         A patient who is eligible for Medicare has the right to
   69  know, upon request and in advance of treatment, whether the
   70  health care provider or health care facility accepts the
   71  Medicare assignment rate.
   72         A patient has the right to receive, upon request, prior to
   73  treatment, a reasonable estimate of charges for medical care.
   74         A patient has the right to receive a copy of a reasonably
   75  clear and understandable, itemized bill and, upon request, to
   76  have the charges explained.
   77         A patient has the right to impartial access to medical
   78  treatment or accommodations, regardless of race, national
   79  origin, religion, handicap, or source of payment.
   80         A patient has the right to treatment for any emergency
   81  medical condition that will deteriorate from failure to provide
   82  treatment.
   83         A patient has the right to know if medical treatment is for
   84  purposes of experimental research and to give his or her consent
   85  or refusal to participate in such experimental research.
   86         A patient has the right to express grievances regarding any
   87  violation of his or her rights, as stated in Florida law,
   88  through the grievance procedure of the health care provider or
   89  health care facility which served him or her and to the
   90  appropriate state licensing agency.
   91         A patient is responsible for providing to the health care
   92  provider, to the best of his or her knowledge, accurate and
   93  complete information about present complaints, past illnesses,
   94  hospitalizations, medications, and other matters relating to his
   95  or her health.
   96         A patient is responsible for reporting unexpected changes
   97  in his or her condition to the health care provider.
   98         A patient who is admitted for treatment is responsible for
   99  reviewing the document required to be presented upon admission,
  100  indicating that the patient may be charged for out-of-network
  101  physician services.
  102         A patient is responsible for reporting to the health care
  103  provider whether he or she comprehends a contemplated course of
  104  action and what is expected of him or her.
  105         A patient is responsible for following the treatment plan
  106  recommended by the health care provider.
  107         A patient is responsible for keeping appointments and, when
  108  he or she is unable to do so for any reason, for notifying the
  109  health care provider or health care facility.
  110         A patient is responsible for his or her actions if he or
  111  she refuses treatment or does not follow the health care
  112  provider’s instructions.
  113         A patient is responsible for assuring that the financial
  114  obligations of his or her health care are fulfilled as promptly
  115  as possible.
  116         A patient is responsible for following health care facility
  117  rules and regulations affecting patient care and conduct.
  118         Section 2. Subsection (5) of section 395.301, Florida
  119  Statutes, is amended to read:
  120         395.301 Itemized patient bill; form and content prescribed
  121  by the agency.—
  122         (5) In any billing for services subsequent to the initial
  123  billing for such services, the patient, or the patient’s
  124  survivor or legal guardian, may elect, at his or her option, to
  125  receive a copy of the detailed statement of specific services
  126  received and expenses incurred for each such item of service as
  127  provided in subsection (1). Before services are rendered, a
  128  patient must be presented with a document indicating that the
  129  patient may be charged for out-of-network physician services.
  130  The patient may sign the document, thereby indicating that he or
  131  she has reviewed the information contained therein, or, if the
  132  patient declines to sign, the medical facility employee who
  133  presents the document to the patient may sign the document to
  134  verify that the patient was presented with that information.
  135         Section 3. Section 627.64194, Florida Statutes, is created
  136  to read:
  137         627.64194 Coverage for orthotics and prosthetics and
  138  orthoses and prostheses.—Each accident or health insurance
  139  policy issued, amended, delivered, or renewed in this state on
  140  or after July 1, 2016, which provides medical coverage that
  141  includes physician services in a physician’s office and which
  142  provides major medical or similar comprehensive type coverage
  143  must evaluate and review coverage for orthotics and prosthetics
  144  and orthoses and prostheses as those terms are defined in s.
  145  468.80. Such evaluation and review must compare the coverage
  146  provided under federal law by health insurance for the aged and
  147  disabled pursuant to 42 U.S.C. ss. 1395k, 1395l, and 1395m and
  148  42 C.F.R. ss. 410.100, 414.202, 414.210, and 414.228, and as
  149  applicable to this section.
  150         (1) The insurance policy may require recommendations for
  151  orthotics and prosthetics and orthoses and prostheses in the
  152  same manner that prior authorization is required for any other
  153  covered benefit.
  154         (2) Recommended benefits for orthoses or prostheses are
  155  limited to the most appropriate model that adequately meets the
  156  medical needs of the patient as determined by the insured’s
  157  treating physician. Subject to copayments and deductibles, the
  158  repair and replacement of orthoses or prostheses are also
  159  recommended unless necessitated by misuse or loss.
  160         (3) An insurer may require that benefits recommended
  161  pursuant to this section be covered benefits only if orthotics
  162  or prosthetics are rendered by an orthotist or prosthetist and
  163  the orthoses or prostheses are provided by a vendor.
  164         (4) This section does not apply to insurance coverage
  165  recommended benefits for hospital confinement indemnity,
  166  disability income, accident only, long-term care, Medicare
  167  supplement, limited benefit health, specified disease indemnity,
  168  sickness or bodily injury or death by accident or both, and
  169  other limited benefit policies.
  170         Section 4. Section 627.66915, Florida Statutes, is created
  171  to read:
  172         627.66915 Recommended coverage for orthoses and prostheses
  173  and orthotics and prosthetics.—Each group, blanket, or franchise
  174  accident or health insurance policy issued, amended, delivered,
  175  or renewed in this state on or after July 1, 2016, which
  176  recommends coverage for physician services in a physician’s
  177  office and which provides major medical or similar comprehensive
  178  type coverage must recommend coverage for orthotics and
  179  prosthetics and orthoses and prostheses as those terms are
  180  defined in s. 468.80. Such recommendation must equal the
  181  coverage provided under federal law by health insurance for the
  182  aged and disabled pursuant to 42 U.S.C. ss. 1395k, 1395l, and
  183  1395m and 42 C.F.R. ss. 410.100, 414.202, 414.210, and 414.228,
  184  and as applicable to this section.
  185         (1) The recommended coverage is subject to the deductible
  186  and coinsurance provisions applicable to outpatient visits and
  187  to all other terms and conditions applicable to other benefits.
  188         (2) For an appropriate additional premium, an insurer
  189  subject to this section shall make available to the
  190  policyholder, as part of the application, the recommended
  191  coverage in this section without such coverage being subject to
  192  the deductible or coinsurance provisions of the policy.
  193         (3) The insurance policy may recommend prior authorization
  194  for orthotics and prosthetics and orthoses and prostheses in the
  195  same manner that prior authorization is recommended for any
  196  other covered benefit.
  197         (4) Recommended benefits for orthoses or prostheses are
  198  limited to the most appropriate model that adequately meets the
  199  medical needs of the patient as determined by the insured’s
  200  treating physician. Subject to copayments and deductibles, the
  201  repair and replacement of orthoses or prostheses are also
  202  recommended, unless necessitated by misuse or loss.
  203         (5) An insurer may recommend that benefits evaluated and
  204  reviewed pursuant to this section be recommended benefits only
  205  if orthotics or prosthetics are rendered by an orthotist or
  206  prosthetist and the orthoses or prostheses are provided by a
  207  vendor.
  208         (6) This section does not apply to insurance
  209  recommendations providing benefits for hospital confinement
  210  indemnity, disability income, accident only, long-term care,
  211  Medicare supplement, limited benefit health, specified disease
  212  indemnity, sickness or bodily injury or death by accident or
  213  both, and other limited benefit policies.
  214         Section 5. Subsection (44) is added to section 641.31,
  215  Florida Statutes, to read:
  216         641.31 Health maintenance contracts.—
  217         (44) Each health maintenance contract issued, amended,
  218  delivered, or renewed in this state on or after July 1, 2016,
  219  which recommends medical coverage that includes physician
  220  services in a physician’s office and that recommends major
  221  medical or similar comprehensive type coverage must evaluate and
  222  review coverage for orthotics and prosthetics and orthoses and
  223  prostheses as those terms are defined in s. 468.80. Such
  224  recommended coverage must equal the coverage provided under
  225  federal law by health insurance for the aged and disabled
  226  pursuant to 42 U.S.C. ss. 1395k, 1395l, and 1395m and 42 C.F.R.
  227  ss. 410.100, 414.202, 414.210, and 414.228, and as applicable to
  228  this section.
  229         (a) The recommendation is subject to the deductible and
  230  coinsurance provisions applicable to outpatient visits and to
  231  all other terms and conditions applicable to other benefits.
  232         (b) For an appropriate additional premium, a health
  233  maintenance organization subject to this subsection shall
  234  recommend to the subscriber, as part of the application, the
  235  coverage required in this subsection without such coverage being
  236  subject to the deductible or coinsurance provisions of the
  237  contract.
  238         (c) A health maintenance contract may require prior
  239  authorization for orthotics and prosthetics and orthoses and
  240  prostheses in the same manner that prior authorization is
  241  required for any other recommended benefit.
  242         (d) Recommended benefits for orthoses or prostheses are
  243  limited to the most appropriate model that adequately meets the
  244  medical needs of the patient as determined by the insured’s
  245  treating physician. Subject to copayments and deductibles, the
  246  repair and replacement of orthoses or prostheses are also
  247  recommended, unless necessitated by misuse or loss.
  248         (e) A health maintenance contract may require that benefits
  249  recommended pursuant to this subsection be recommended benefits
  250  only if orthotics or prosthetics are rendered by an orthotist or
  251  prosthetist and the orthoses or prostheses are provided by a
  252  vendor.
  253         (f) This subsection does not apply to insurance coverage
  254  providing benefits for hospital confinement indemnity,
  255  disability income, accident only, long-term care, Medicare
  256  supplement, limited benefit health, specified disease indemnity,
  257  sickness or bodily injury or death by accident or both, and
  258  other limited benefit policies.
  259         Section 6. This act shall take effect July 1, 2016.

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