Florida was active in healthcare legislation during its 2018 session, though most bills failed to pass. The legislature did, however, pass HB 351, which requires pharmacists to inform customers of certain generically equivalent drug products and whether cost-sharing obligations to such customers exceed retail price of prescription.
In 2017, Florida introduced, but failed to pass legislation (HB 7) to eliminate its Certificate of Need program. The Florida legislature was also active in pushing for healthcare transparency legislation. However, only one measure relating to prescription cost transparency passed. In past legislative sessions, Florida passed legislation promoting healthcare transparency and protecting patients from surprise out-of-network bills. Another key Florida effort in healthcare transparency is the FloridaHealthFinder.gov website, which allows consumers to view performance and outcome data, including average costs, for healthcare facilities in the state. Florida is also active in promoting the use of electronic Health Information Exchanges to streamline provider access to patient information and consequently lower costs and improve quality of care.
Florida’s most recent regular legislative session ran from 1/9/2018 – 3/9/2018.
Recent Legislative Developments
|2018||SB 98||HEALTH INSURER AUTHORIZATION: Prohibiting prior authorization forms from requiring certain information; requiring health insurers and pharmacy benefits managers on behalf of health insurers to provide certain information relating to prior authorization by specified means; requiring health insurers to publish on their websites and provide to insureds in writing a procedure for insureds and health care providers to request protocol exceptions, etc.||Inactive – Died in Messages on 3/10/18.|
|HB 289 / SB 492||PROVISION OF PHARMACEUTICAL SERVICES: Prohibits certain insurers & HMOs from requiring insured and subscribers to obtain prescription drug for treatment of chronic illness, except for excluded drugs, exclusively from mail order pharmacy & from imposing copayments or certain conditions on insured who elects to obtain certain drugs from retail pharmacy if certain requirements are met; requires disclosure that an insured may obtain certain prescription drugs, except excluded drugs, from retail pharmacy.||Inactive – Died on 3/10/18.|
|HB 351||PRESCRIPTION DRUG PRICING TRANSPARENCY: Requires pharmacists to inform customers of certain generically equivalent drug products & whether cost-sharing obligations to such customers exceed retail price of prescription; requires registration with OIR; provides registration requirements; requires registrant to report certain changes by specified date; requires office to issue registration certificate upon receipt of completed registration form; provides for expiration; requires rulemaking; requires certain terms in health insurer or health maintenance organization contracts with pharmacy benefit managers.||Passed – Signed by Governor on 3/23/18. Amended Stat. 465.0244, repealed Stat. 465.1862, and added Stat. 624.490, 627.64741, 627.6572, and 641.314.|
|SB 1494||PRESCRIPTION DRUG PRICING TRANSPARENCY: Requiring a pharmacist to inform a customer of a lower cost alternative to a prescription and of whether the customer’s cost-sharing obligation exceeds the retail price of the prescription; requiring a pharmacy benefit manager to register with the Office of Insurance Regulation, etc.||Inactive – Dead, but incorporated into HB 351 on 3/8/18.|
|2017||HB 589/SB 888||PRESCRIPTION DRUG PRICE TRANSPARENCY: Requires the Agency for Healthcare Administration to collect data on retail prices charged by pharmacies for the most frequently prescribed medicines; requires the agency to update its website monthly.||Passed – Signed by Governor on 6/9/17.|
|SB 1550||HEALTH INFORMATION TRANSPARENCY: Requiring the Agency for Health Care Administration to contract with a vendor to evaluate health information technology activities to identify best practices and methods to increase interoperability; revising the definition of the term “third party” for purposes of liability for payment of certain medical services covered by Medicaid; revising provisions relating to responsibility for Medicaid payments in settlement proceedings, etc.||Inactive – Died in Committee on 5/5/17.|
|2016||HB 1175||TRANSPARENCY IN HEALTH CARE: Requiring a facility licensed under ch. 395, F.S., to provide timely and accurate financial information and quality of service measures to certain individuals; requiring a health care practitioner to provide a patient upon his or her request a written or electronic good faith estimate of anticipated charges within a certain timeframe; requiring a health insurer to make available on its website certain methods that a policyholder can use to make estimates of certain costs and charges; revising a requirement that a health maintenance organization make certain information available to its subscribers, etc.||Passed — Signed by the Governor on 4/14/16.|
|2018||HB 199||STEP THERAPY PROTOCOLS: Defines “step therapy”; prohibits health insurers & health maintenance organizations from requiring insureds or subscribers to repeat step therapy protocols; provides that certain health insurers & health maintenance organizations may impose specified requirement for continued coverage; provides that such entities are not required to take specified actions.||Inactive – Died in Health and Human Services Committee on 3/10/18.|
|HB 229||CONSUMER PROTECTION FROM NONMEDICAL CHANGES TO PRESCRIPTION DRUG FORMULARIES: Limits changes to health insurance policies’ prescription drug formulary during a policy year and requires small employer carriers to limit changes to prescription drug formularies.||Inactive – Died in Health Innovation Subcommittee on 3/10/18.|
|SB 360||INSURANCE POLICIES; LIMITING CHANGES TO PRESCRIPTION DRUG FORMULARIES. Prohibiting specified changes to certain insurance policy prescription drug formularies, except under certain circumstances; requiring small employer carriers to limit specified changes to prescription drug formularies under certain health benefit plans; prohibiting certain health maintenance organizations from making specified changes to health maintenance contract prescription drug formularies, except under certain circumstances, etc.||Inactive – Died in Health Policy Committee on 3/10/18.|
|SB 1872||HEALTHY FLORIDA ACT: Creates the Healthy Florida program, which would establish a comprehensive, universal single-payer healthcare coverage program and a healthcare cost control system for all residents in the state.||Inactive – Died in Banking and Insurance Committee on 3/10/18.|
|2016||HB 221||HEALTH CARE SERVICES: Providing requirements for settlement offers between certain providers and health plans in a specified dispute resolution program, etc.||Passed — Signed by the Governor on 6/9/2017.|
|2018||HB 27||CERTIFICATES OF NEED FOR HOSPITALS: Eliminates certificates of need for hospitals and provides licensure requirements.||Inactive – Died in Health Policy Committee on 3/10/18.|
|HB 37||DIRECT PRIMARY CARE AGREEMENTS: A direct primary care agreement does not constitute insurance and is not subject to the Florida Insurance Code. The act of entering into a direct primary care agreement does not constitute the business of insurance and is not subject to the Florida Insurance Code. Additionally, a primary care provider or an agent of a primary care provider is not required to obtain a certificate of authority or license under the Florida Insurance Code to market, sell, or offer to sell a direct primary care agreement.||Passed – Signed by Governor on 3/27/18.|
|HB 217 / SB 162||PAYMENT OF HEALTH CARE CLAIMS: Neither a health insurer nor an HMO may retroactively deny a claim because of insured ineligibility at any time, if the health insurer or HMO verified the eligibility of an insured/subscriber at the time of treatment and provided an authorization number. This paragraph applies to policies entered into or renewed on or after January 1, 2019.||Inactive – Died on 3/10/18.|
|2017||HB 7||CERTIFICATES OF NEED FOR HOSPITALS: Eliminates certificates of need for hospitals; provides licensure requirements.||Inactive – Died in Committee on 5/5/17.|
|2017||HB 7007||STATE GROUP INSURANCE PROGRAM: Authorizes state group insurance program to include additional benefits & for employees to use certain portion of state’s contribution to purchase additional & supplemental benefits; requires DMS to develop plan for implementation of benefit levels, submit report, & contract with independent benefits consultant & entity that provides comprehensive pricing & certain inclusive services; directs DMS to provide premium alternatives to Governor & Legislature by specified date; provides criteria for calculating premium alternatives; provides appropriation & authorizes positions. All persons participating in the state group insurancE program may be required to contribute towards a total state group health premium that may vary depending upon the plan, coverage level, and coverage tier selected by the enrollee and the level of state contribution authorized by the Legislature.||Inactive – Died in Committee on 5/5/17.|
We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.
Transparency in Healthcare
- Stat. § 381.026, the “Florida Patient’s Bill of Rights and Responsibilities,” provides that a patient has the right to know who is providing medical services to him/her; that he/she may request and be given information about their condition; that he/she is told whether the health care provider accepts Medicare in advance of the treatment; that he/she may request a reasonable estimate of charges for care before the treatment; that he/she receive an itemized bill which is clear and understandable, and should be explained to him/her upon request; and that the patient is responsible for assuring that his/her financial obligations to the provider are fulfilled as promptly as possible, among other things. A patient may request the Bill of Rights and Responsibilities from a facility.
- Stat. § 395.301 requires a licensed facility not operates by the state to provide an itemized bill to the patient, “detailing in language comprehensible to an ordinary layperson the specific nature of charges or expenses incurred by the patient, which in the initial billing shall contain a statement of specific services received and expenses incurred for such 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, as prescribed by the agency.”
- Stat. § 408.05 creates the Florida Center for Health Information and Policy Analysis, to “establish a comprehensive health information system to provide for the collection, compilation, coordination, analysis, indexing, dissemination, and utilization of both purposefully collected and extant health-related data and statistics.” The Center is charged with collecting data on utilization of health care by type of provider, health care costs and financing sources and targets, the extent of coverage in the state, and the quality of care provided by various providers. In creating the Comprehensive Health Information System, the Center is to “[d]evelop, in conjunction with the State Consumer Health Information and Policy Advisory Council, and implement a long-range plan for making available health care quality measures and financial data that will allow consumers to compare health care services.”
- Stat. § 408.09 mandates that the Florida Agency for Health Care Administration assist on cost containment strategies, including technical assistance for purchasers and employers, conduct outreach to small businesses for small business health insurance plans, and to assist existing health coalitions and counsels as needed.
- Stat. 408.061 gives the Florida Agency for Health Care Administration the authority to require facilities, providers, and health insurers to submit certain data including charges, claims, premiums, administration data, and financial information. The identity of a provider who submits confidential business information will remain confidential if it relates to “specific provider contract reimbursement information; information relating to security measures, systems, or procedures; and information concerning bids or other contractual data, the disclosure of which would impair efforts to contract for goods or services on favorable terms or would injure the affected entity’s ability to compete in the marketplace”
- Stat. 408-062 through 408-063 requires the agency to conduct research, analyses and studies relating to health care costs and access to and quality of health care services. The agency must publish and disseminate such health care information, which “may identify average charges for specified services, lengths of stay associated with established diagnostic groups, readmission rates, mortality rates, recommended guidelines for selection and use of health care providers, health care facilities, and health care services, and such other information as the agency deems appropriate.” Published studies can be found here.
- Stat. 408.70 articulates the legislature’s findings on health care in the state, concluding that lack of transparency and outcome and cost information has allowed providers to compete on number of services rather than on quality and price, which has led to unreasonable cost inflation.
- Stat. §§ 465.0244, 624.490, 627.64741, 627.6572, and 641.314 (links to online versions pending) requires pharmacists to inform customers of certain generically equivalent drug products and whether cost-sharing obligations to such customers exceed retail price of prescription; requires registration with OIR; provides registration requirements; requires registrant to report certain changes by specified date; requires office to issue registration certificate upon receipt of completed registration form; provides for expiration; requires rulemaking; requires certain terms in health insurer or health maintenance organization contracts with pharmacy benefit managers.
- Stat. 627.6499 requires health insurers to make performance outcome and financial data that is published by the Agency for Health Care Administration available on their respective websites, and to disclose the available of such information in every policy delivered or issued in the state.
- Stat. §§ 408.031 through 408.0455, “Health Facility and Services Development Act,” makes it illegal to undertake a project subject to the act without obtaining a valid certificate of need through a regulatory process with the state agency. A Certificate of Need ensures there is a genuine public need for the expanded capacity, but also can be anticompetitive by creating barriers to entry for new market-entrants.
- Stat 408.18, the “Florida Health Care Community Antitrust Guidance Act,” allows members of the health care community to seek an anti-trust review on a proposed business activity from the Attorney General’s office in order to potentially obtain a no-action letter. The Act notes, “[t]his section is created to provide instruction to the health care community in a time of tremendous change, and to resolve, as completely as possible, the problem of antitrust uncertainty that may deter mergers, joint ventures, or other business activities that can improve the delivery of health care, without creating costly, time-consuming regulations that can lead to more litigation and delay.”
- Stat. § 053 prohibits certain referral arrangements and schemes that may constitute a conflict of interest.
- Stat. §§ 626.951 through 626.99, the “Unfair Insurance Trade Practices Act,” prohibits unfair methods of competitive and unfair or deceptive acts and practices in the provision of insurance.
- § 624.27 (website link pending) amends the Florida Insurance Code to make clear that direct primary care agreements do not violate insurance regulations. Under state law, primary care providers are defined as physicians, osteopathic physicians, chiropractors, nurses, or primary care group practices.
- Stat. § 627.410 for the purposes of rate review, requires that each health insurer insuring groups of 50 or less persons (except Medicare supplement insurance, long-term care insurance, and other delineated policies) shall make an annual filing demonstrating the reasonableness of benefits in relation to premium rates.
FY 2018 BUDGET
Florida’s fiscal year begins on July 1 and ends on June 30th of the following year. The Florida legislature passed its FY 2018 Budget during the regular legislative session. To view Florida’s Department of Health most FY 2018 Budget proposal, click here.
- On August 18, 2014, two Florida women, represented by the law firm of Cohen Milstein Sellers & Toll filed a class action law suit against JFK Medical Center and its owner, HCA Holdings, which owns 80 hospitals across the state, for grossly and unreasonably overcharging for medical services. Under a previous policy that HCA abandoned this year, uninsured patients were also charged a special trauma fee that could add $30,000 or more to their bills irrespective of the service rendered.
- The portal for accessing administrative enforcement orders from the Agency for Health Care Administration is available here.