Overview
Florida is an active state in promoting healthcare price transparency. A key effort is the state’s all-payer claims database, which was mandated by the legislature and implemented in 2016. It also has a consumer-facing website, FloridaHealthFinder, which allows consumers to view performance and outcome data, including average costs, for healthcare facilities in the state. The website also provides consumers with the ability to compare health care costs at the national, state and local levels. 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.
In 2019, the legislature enacted legislation that authorizes individual and group health insurers and health maintenance organizations to offer shared savings incentive programs. The laws require health insurers that offer the program to publish on an easily accessible webpage a list of shoppable health care services and health care providers and the shared savings incentive amount applicable for each service. Additionally, Florida law protects patients from surprise out-of-network bills by prohibiting balance billing for emergency services and requiring a no liability notice and hold harmless provision for non-emergency situations.
In healthcare market competition, Florida law limits enforceability of non-compete agreements for physicians but provides no statutory authority for oversight or review of mergers, acquisitions, and other transactions involving healthcare entities. In 2019, the legislature repealed certificate of need (CON) requirements, the state’s longstanding approval system for expanding healthcare facilities. The CON program will not be eliminated for nursing homes, hospices and intermediate care facilities for the developmentally disabled.
On the pharmaceutical front, the legislature continues to advance its efforts to rein in prescription drug costs. In recent sessions, the state enacted laws to allow drug importation from Canada and to promote price transparency by requiring pharmacists to inform customers of generic equivalents and whether cost-sharing obligations exceed the retail price of prescription.
See below for an overview of existing Florida state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 3/7/2023 - 5/5/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1111 (see companion bill SB 312) – Florida
Introduced: 2023 Status: Inactive / Dead
Insurance: Revising a minimum coursework qualification for licensure as a life agent; providing that certain restrictions against unfair discrimination or unlawful rebates do not include value-added products or services offered or provided by life or …
HB 1113 – Florida
Introduced: 2019 Status: Enacted
Requiring health maintenance organization to be cost-effective and to offer high value; authorizing the Department of Management Services to limit the number of HMOs that it contracts with in each region; authorizing the Department of …
HB 1155 – Florida
Introduced: 2021 Status: Inactive / Dead
Pharmacies and Pharmacy Benefit Managers; Authorizes audited pharmacies to appeal certain findings in audit reports; provides that health insurers & health maintenance organizations that transfer certain payment obligation to pharmacy benefit managers remain responsible for …
HB 1157 – Florida
Introduced: 2021 Status: Enacted
Freestanding Emergency Departments; Prohibits hospital-based off-campus emergency department from holding itself out to public as urgent care center; requires such departments to post signs containing specified statements; provides requirements for advertisement of such departments; requires …
HB 1175 – Florida
Introduced: 2016 Status: Enacted
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 …
Fla. Stat. § 381.83. Trade secrets; confidentiality: Public Health: General Provisions – Florida
Introduced: Status: Enacted
States that information collected by the Department of Public Health must be available to the public unless it contains trade secrets.
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Fla. Stat. § 381.931. Annual report on Medicaid expenditures: Public Health: General Provisions – Florida
Introduced: Status: Enacted
If Medicaid expenditures are projected to exceed the amount appropriated by the Legislature, the Department of Health shall limit the number of screenings to ensure Medicaid expenditures do not exceed the amount appropriated.
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Fla. Stat. § 395.1041. Access to emergency services and care: Hospitals and Other Licensed Facilities – Florida
Introduced: Status: Enacted
he agency shall establish and maintain an inventory of hospitals with emergency services. The inventory shall list all services within the service capability of the hospital, and such services shall appear on the face of …
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Fla. Stat. § 395.107. Facilities; publishing and posting schedule of charges; penalties: Hospitals and Other Licensed Facilities – Florida
Introduced: Status: Enacted
Provides a facility must publish and post a schedule of charges for the medical services offered to patients. The schedule of charges must describe the medical services in language comprehensible to a layperson. The schedule …
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Fla. Stat. § 395.301. Price transparency; itemized patient statement or bill; patient admission status notification:Hospitals and Other Licensed Facilities – Florida
Introduced: Status: Enacted
A facility licensed under this chapter shall provide timely and accurate financial information and quality of service measures to patients and prospective patients of the facility, or to patients’ survivors or legal guardians, as appropriate. …
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Location 24 LLC v. Doctors Same Day Surgery Center & HCA Holdings – Florida
District Court: Middle District of Florida Tampa Division Status: Decided
The lawsuit claims that HCA engaged in a pattern of conduct that formed partnerships with large surgical practices in the Sarasota area, only such “partnerships” …
Omni Healthcare Inc. et al. v. Health First, Inc. et al. – Florida
District Court: Middle District of Florida Status: Decided
A set of physicians, physicians’ groups and physicians’ assistants in Orlando sued Health First, a fully integrated healthcare corporation, for a monopolization scheme through which …
Herrera et al. v. JFK Medical Center et al. – Florida
District Court: M.D. Florida Status: Decided
In August 2014, plaintiffs filed a putative class action against multiple HCA-operated hospitals in Tampa, alleging they were charged unreasonable amounts for emergency radiological services. …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
RxStrategies v. CVS Pharmacy – Florida
District Court: M.D. Florida Status: Pending
340B administrator RxStrategies sued CVS pharmacy alleging that since CVS aquired Wellpartner, the company has engaged in unlawful tying, using its status as a “must …
Additional Resources
STATE BUDGET
Florida operates on an annual budget cycle. The state’s fiscal year begins on July 1 with budget hearings beginning October and ending on June 30th of the following year. The legislature adopts a budget in April/May, which is required to pass by a simple majority, and becomes effective for the fiscal year beginning in July.
REGULATION & ENFORCEMENT
- The portal for accessing administrative enforcement orders from the Agency for Health Care Administration is 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.
KEY RESOURCES