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staff to create www.MissionToCare.org, a consumer-friendly website that compiles publicly available data on hospital costs and quality in an easier-to-use format. The site, which launched in January 2016, helped shape policy discussions during the 2016 Legislative Session and its updated annually. The 2016 Legislature passed legislation, House Bill (HB) 1175 and HB 221 which expanded hospital responsibilities for pricing, billing and consumer notifications. Specifically, HB 1175 expanded and added requirements for hospital websites along with requiring the Agency for Health Care Administration (AHCA) to contract with a vendor to create a database using claims payment data submitted from health plans to show prices for bundles of care. HB 221 addressed “surprise bills,” which may occur when patients go to a hospital in their health plan’s network and are treated by an ‘out-of-network’ provider. In this type of scenario, patients are subject to out-of-pocket fees. HB 221 requires hospitals, providers and health plans to post information about health plan network participation on their website. This guidance details the requirements for both bills, HB 1175 and HB 221, and includes the final rules published by AHCA that outlines the requirements that hospitals must meet. The laws apply to all facilities licensed under Chapter 395, which includes hospitals, ambulatory surgery centers, urgent care centers and diagnostic imaging centers. Since the state requirements were finalized, requirements tied to the Internal Revenue Code and the Centers for Medicare & Medicaid Services have been issued. This April 2019 update includes these additional requirements. Guidance should not be interpreted as exhaustive or substitute legal counsel. Updates will be made as additional clarification is provided. Questions may be directed to FHA staff members:FLORIDA LAW All licensed facilities must make available on its website the following information: 1. Financial Information for Patients (NEW) Effective Date: February 19, 2018 Hospitals are required to provide a link to the AHCA price transparency site, Florida Health Pricing website (https://pricing.floridahealthfinder.gov), which shows average payments for over 200 service bundles. The service bundles include all components of care, including physician, ancillary and hospital payments. The average payment data is based on claims data submitted on non-Medicare and non-Medicaid member health care encounters by health plans. This does not preclude hospitals from providing their own pricing information on the website. Hospitals must include a notice on the website that: a. 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; b. Patients have a right to request a personalized estimate from the hospital; c. Patients should contact the health care providers anticipated to provide services to the patient while in the hospital to obtain a personalized estimate of their costs, their billing practices and whether they participate in the patient’s health plan. 2. Quality of Service Data Effective Date: July 1, 2004 The new legislation maintains a current requirement that hospitals must include a link to Florida Health Finder on their website (www.FloridaHealthFinder.gov). AHCA’s Florida Health Finder website, created by legislation in 2004, provides hospital quality metrics, including readmissions data, mortality rates, complication rates, infection rates, patient experience and other patient safety indicators. In addition to providing the required link to FHF, hospitals may also provide additional quality measures on their website or link to www.MissionToCare.org. 3. Hospital Financial Assistance Policies Effective Date: July 1, 2016 Hospitals are required to post financial assistance policies, the application form, payment plans available, charity care policies, discount policies and collection procedures on their websites.4 FHA Guidance on Implementing HB 1175 and HB 221 Published June 2016; Updated February 2018 and April 2019 4. Health Plans in which the Hospital Participates Effective Date: July 1, 2016 Hospitals are required to provide a list of health plans in which they are contracted on their website with hyperlinks to each health plan’s websites. This only applies to those plans in which hospitals have a direct contract. For example, if a hospital contracts with an organization such as Multiplan, which allows other health plans to access their network, the hospital must only list Multiplan. FHA’s Mission to Care website, http://www.missiontocare.org/cost-and-billing-resources/out-of-pocket-cost-calculators/, has hyperlinks for all major health plans licensed in Florida. Hospitals may choose to include clarifying language on their website to explain that hospitals might not be included in all health plan product offerings. 5. Provider Groups Under Contract with the Hospital Effective Date: July 1, 2016 Hospitals are required to post on their websites a list of health care practitioners or medical groups in which the hospital has a contract to provide certain services within the hospital, such as anesthesiologist, emergency physicians, hospitalists, pathologist and radiologists. Information on these providers must include names, addresses and contact information so consumers can contact them directly to determine if they are a participating provider in the individual’s health plan. *Note: this is not a new requirement for those hospitals that must comply with the Internal Revenue Service (IRS) 501(r) rules. 6. Notice About Providers Involved in Patient Care Effective Date: July 1, 2016 Hospitals must include a statement or warning on their website, along with pricing information, that patients might/will receive a separate bill from other providers and those providers may or may not participate in the same health plans as the hospital. The statement should encourage consumers to contact their provider to determine health plans FLORIDA LAW Requirements to Provide Estimates for Non-Emergency Care Effective Date: July 1, 2016 Hospitals are required to provide a cost estimate upon request of the patient, prospective patient or legal guardian for nonemergency medical services. This estimate must be provided within seven (7) days from the receipt of the request. Unless the patient requires a more personalized estimate, the estimate may be based on the average payment received for the service bundle. Every estimate shall include: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. The pricing estimates can be provided by electronic means in addition in writing. The hospital does not have to adjust the estimate based on any potential insurance coverage. The estimate maybe be based on the service bundles, as opposed to DRGs, unless the patient request a more personalized estimate for their specific condition and characteristics. The penalty for noncompliance is $1,000 per day until the estimate is provided to the patient, not exceeding $10,000. Requirements to Provide Itemized Bills (395.301, F.S.) Effective Date: July 1, 2017 The hospital must provide an itemized statement or bill upon request of the patient or the patient’s survivor or legal guardian within seven (7) business days after the patient’s discharge or release, or seven (7) business days after the request, whichever is later. The itemized statement or bill must include: a) A description of