Current through Reg. 50, No. 187; September 24, 2024
(1) Website. Each hospital shall make
available to patients and prospective patients price transparency and patient
billing information on its website regarding the availability of estimates of
costs that may be incurred by the patient, financial assistance, billing
practices, and a hyperlink to the Agency's service bundle pricing website. The
content on the hospital's website shall be reviewed at least every 90 days and
updated as needed to maintain timely and accurate information. For the purpose
of this rule, service bundles means the reasonably expected hospital services
and care provided to a patient for a specific treatment, procedure, or
diagnosis as posted on the Agency's website. In accordance with section
395.301, F.S., the hospital's
website must include:
(a) A hyperlink to the
Agency's pricing website upon implementation of the same that provides
information on payments made to the facilities for defined service bundles and
procedures. The Agency's pricing website is located at:
http://pricing.floridahealthfinder.gov;
(b) A statement informing patients and
prospective patients that the service bundle information is a non-personalized
estimate of costs that may be incurred by the patient for anticipated services
and that actual costs will be based on services actually provided to the
patient;
(c) A statement informing
patients and prospective patients of their right to request a personalized
estimate from the hospital;
(d) A
statement informing patients of the hospital's financial assistance policy,
charity care policy, and collection procedure;
(e) A list of names and web addresses of
health insurers and health maintenance organizations (HMO) contracted with the
hospital as a network provider or participating provider;
(f) A list of names and contact information
of health care practitioners and medical practice groups contracted to provide
services within the hospital, grouped by specialty or service; and,
(g) A statement informing patients to contact
the health care practitioners anticipated to provide services to the patient
while in the hospital regarding a personalized estimate, billing practices, and
participation with the patient's insurance provider or HMO as the practitioners
may not participate with the same health insurers or HMO as the
hospital.
(2) Estimate.
The hospital shall provide an estimate upon request of the patient, prospective
patient, or legal guardian for nonemergency medical services.
(a) An estimate or an update to a previous
estimate shall be provided within 7 business days from receipt of the request.
Unless the patient requests a more personalized estimate, the estimate may be
based upon the average payment received for the anticipated service bundle.
Every estimate shall include:
1. A statement
informing the requestor to contact their health insurer or HMO for anticipated
cost sharing responsibilities,
2. A
statement advising the requestor that the actual cost may exceed the
estimate,
3. The web address of the
hospital's financial assistance policies, charity care policy, and collection
procedures,
4. A description and
purpose of any facility fees, if applicable,
5. A statement that services may be provided
by other health care providers who may bill separately,
6. A statement, including a web address if
different from above, that contact information for health care practitioners
and medical practice groups that are expected to bill separately is available
on the hospital's website; and,
7.
A statement advising the requestor that the patient may pay less for the
procedure or service at another facility or in another health care
setting.
(b) If the
hospital provides a non-personalized estimate, the estimate shall include a
statement that a personalized estimate is available upon request.
(c) A personalized estimate must include the
charges specific to the patient's anticipated services.
(3) Itemized statement or bill. The hospital
shall provide an itemized statement or bill upon request of the patient or the
patient's survivor or legal guardian. The itemized statement or bill shall be
provided within 7 business days after the patient's discharge or release, or 7
business days after the request, whichever is later. The itemized statement or
bill must include:
(a) A description of the
individual charges from each department or service area by date, as prescribed
in subsection 395.301(1)(d),
F.S.;
(b) Contact information for
health care practitioners or medical practice groups that are expected to bill
separately based on services provided; and,
(c) The hospital's contact information for
billing questions and disputes.
Rulemaking Authority 395.301 FS. Law Implemented 395.301
FS.
New 2-19-18.
