Senate Bill 1976 (2021) — Freestanding emergency departments
SB 1976
Florida Bills
Florida Senate - 2021 SB 1976 By Senator Brodeur 9-01437-21 20211976__ Page 1 of 13 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1
An act relating to freestanding emergency departments; 2 amending s. 395.002, F.S.; defining and revising 3 terms; amending s. 395.003, F.S.; deleting an obsolete 4 provision relating to a prohibition on new emergency 5 departments located off the premises of licensed 6 hospitals; amending s. 395.1041, F.S.; prohibiting a 7 freestanding emergency department from holding itself 8 out to the public as an urgent care center; requiring 9 a freestanding emergency department to clearly 10 identify itself as a hospital emergency department 11 using certain signage; requiring a freestanding 12 emergency department to post signs in certain 13 locations which contain specified statements; 14 providing requirements for such signs; providing 15 requirements for the advertisement of freestanding 16 emergency departments; requiring the Agency for Health 17 Care Administration to post information on its website 18 describing the differences between a freestanding 19 emergency department and an urgent care center; 20 requiring the agency to update such information on its 21 website at least annually; requiring hospitals to post 22 a link to such information on their websites; amending 23 s. 627.6405, F.S.; deleting legislative findings and 24 intent; requiring health insurers to post certain 25 information regarding appropriate use of emergency 26 care services on their websites and update such 27 information at least annually; revising the definition 28 of the term “emergency care”; amending ss. 385.211, 29
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 2 of 13 CODING: Words stricken are deletions; words underlined are additions. 390.011, 394.4787, 395.701, 400.9935, 409.905, 30 409.975, 468.505, 627.64194, and 765.101, F.S.; 31 conforming cross-references; providing an effective 32 date. 33 34 Be It Enacted by the Legislature of the State of Florida: 35 36
Section 1. Present subsections (10) through (32) of
section 37 395.002, Florida Statutes, are redesignated as subsections (11) 38 through (33), respectively, a new subsection (10) is added to 39 that section, and present subsections (10), (27), and (29) are 40 amended, to read: 41 395.002
Definitions.—As used in this chapter: 42 (10) “Freestanding emergency department” means a facility 43 that: 44 (
a) Provides emergency services and care; 45 (
b) Is owned and operated by a licensed hospital and 46 operates under the license of the hospital; and 47 (
c) Is located on separate premises from the hospital. 48 (11)(10) “General hospital” means any facility which meets 49 the provisions of subsection (13) (12) and which regularly makes 50 its facilities and services available to the general population. 51 (28)(27) “Specialty hospital” means any facility which 52 meets the provisions of subsection (13) (12), and which 53 regularly makes available either: 54 (
a) The range of medical services offered by general 55 hospitals, but restricted to a defined age or gender group of 56 the population; 57 (
b) A restricted range of services appropriate to the 58
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 3 of 13 CODING: Words stricken are deletions; words underlined are additions. diagnosis, care, and treatment of patients with specific 59 categories of medical or psychiatric illnesses or disorders; or 60 (
c) Intensive residential treatment programs for children 61 and adolescents as defined in subsection (16) (15). 62 (30)(29) “Urgent care center” means a facility or clinic 63 that provides immediate but not emergent ambulatory medical care 64 to patients. The term includes an offsite emergency department 65 of a hospital that is presented to the general public in any 66 manner as a department where immediate and not only emergent 67 medical care is provided. The term also includes: 68 (
a) An offsite facility of a facility licensed under this 69 chapter, or a joint venture between a facility licensed under 70 this
chapter and a provider licensed under
chapter 458 or 71
chapter 459, that does not require a patient to make an 72 appointment and is presented to the general public in any manner 73 as a facility where immediate but not emergent medical care is 74 provided. 75 (
b) A clinic organization that is licensed under
part X of 76
chapter 400, maintains three or more locations using the same or 77 a similar name, does not require a patient to make an 78 appointment, and holds itself out to the general public in any 79 manner as a facility or clinic where immediate but not emergent 80 medical care is provided. 81
Section 2. Paragraph (
c) of subsection (1) of
section 82 395.003, Florida Statutes, is amended to read: 83 395.003 Licensure; denial, suspension, and revocation.— 84 (1) 85 (
c) Until July 1, 2006, additional emergency departments 86 located off the premises of licensed hospitals may not be 87
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 4 of 13 CODING: Words stricken are deletions; words underlined are additions. authorized by the agency. 88
Section 3. Paragraph (
m) is added to subsection (3) of 89
section 395.1041, Florida Statutes, to read: 90 395.1041 Access to emergency services and care.— 91
(3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF 92 FACILITY OR HEALTH CARE PERSONNEL.— 93 (m)1. A freestanding emergency department may not hold 94 itself out to the public as an urgent care center and must 95 clearly identify itself as a hospital emergency department 96 using, at a minimum, prominent lighted external signage that 97 includes the word “EMERGENCY” in conjunction with the name of 98 the hospital. 99 2.
A freestanding emergency department shall conspicuously 100 post signs at locations that are readily accessible to and 101 visible by patients outside the entrance to the facility and in 102 patient waiting areas which state the following: “THIS IS A 103 HOSPITAL EMERGENCY DEPARTMENT.” Unless the freestanding 104 emergency department shares a location and a public entrance 105 with an urgent care center, the signs must also state the 106 following: “THIS IS NOT AN URGENT CARE CENTER.
HOSPITAL 107 EMERGENCY DEPARTMENT RATES ARE BILLED FOR OUR SERVICES.” The 108 signs must also specify the facility’s average facility fee, if 109 any, and notify the public that the facility or a physician 110 providing medical care at the facility may be an out-of-network 111 provider. The signs must be at least 2 square feet in size and 112 the text must be in at least 36-point type. 113 3. Except as provided in this paragraph, any advertisement 114 for a freestanding emergency department must include the 115 following statement: “This emergency department is not an urgent 116
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 5 of 13 CODING: Words stricken are deletions; words underlined are additions. care center. It is part of (insert hospital name) and its 117 services and care are billed at hospital emergency department 118 rates.” Any billboard advertising a freestanding emergency 119 department which measures at least 200 square feet must include 120 the following statement in clearly legible contrasting color 121 text at least 15 inches high: “(INSERT NAME OF HOSPITAL) 122 EMERGENCY DEPARTMENT. THIS IS NOT AN URGENT CARE CENTER.” 123 4.a.
The agency shall post on its website information that 124 provides a description of the differences between a freestanding 125 emergency department and an urgent care center. Such description 126 must include: 127 (
I) At least two examples illustrating the impact on 128 insured and insurer paid amounts of inappropriate utilization of 129 nonemergent services and care in a hospital emergency department 130 setting compared to utilization of nonemergent services and care 131 in an urgent care center; 132 (II) An interactive tool to locate local urgent care 133 centers; and 134 (III) What to do in the event of a true emergency. 135 b. The agency shall update the information required in sub-136 subparagraph a. at least annually. Each hospital shall post a 137 link to such information in a prominent location on its website. 138
Section
Section 627.6405, Florida Statutes, is amended 139 to read: 140 627.6405 Decreasing inappropriate utilization of emergency 141 care.— 142
(1) The Legislature finds and declares it to be of vital 143 importance that emergency services and care be provided by 144 hospitals and physicians to every person in need of such care, 145
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 6 of 13 CODING: Words stricken are deletions; words underlined are additions. but with the double-digit increases in health insurance 146 premiums, health care providers and insurers should encourage 147 patients and the insured to assume responsibility for their 148 treatment, including emergency care.
The Legislature finds that 149 inappropriate utilization of emergency department services 150 increases the overall cost of providing health care and these 151 costs are ultimately borne by the hospital, the insured 152 patients, and, many times, by the taxpayers of this state. 153 Finally, the Legislature declares that the providers and 154 insurers must share the responsibility of providing alternative 155 treatment options to urgent care patients outside of the 156 emergency department.
Therefore, it is the intent of the 157 Legislature to place the obligation for educating consumers and 158 creating mechanisms for delivery of care that will decrease the 159 overutilization of emergency service on health insurers and 160 providers. 161
(2) A health insurer insurers shall post provide on its 162 website their websites information regarding appropriate 163 utilization of emergency care services which shall include, but 164 need not be limited to:, 165 (
a) A list of alternative urgent care contracted 166 providers;, 167 (
b) The types of services offered by these providers;, 168 (
c) A comparison of statewide average in-network and out-169 of-network urgent care center and freestanding emergency 170 department charges for the 30 most common urgent care center 171 services; 172 (
d) At least two examples illustrating the impact on 173 insured and insurer paid amounts of inappropriate utilization of 174
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 7 of 13 CODING: Words stricken are deletions; words underlined are additions. nonemergent services and care in a hospital emergency department 175 setting compared to utilization of nonemergent services and care 176 in an urgent care center; 177 (
e) An interactive tool to locate local in-network and out-178 of-network urgent care centers; and 179 (
f) What to do in the event of a true emergency. 180 181 Health insurers shall update the information required in this 182 subsection on its website at least annually. 183 (2)
(3) Health insurers shall develop community emergency 184 department diversion programs. Such programs may include, at the 185 discretion of the insurer, but not be limited to, enlisting 186 providers to be on call to insurers after hours, coordinating 187 care through local community resources, and providing incentives 188 to providers for case management. 189 (3)
(4) As a disincentive for insureds to inappropriately 190 use emergency department services for nonemergency care, health 191 insurers may require higher copayments for urgent care or 192 primary care provided in an emergency department and higher 193 copayments for use of out-of-network emergency departments. 194 Higher copayments may not be charged for the utilization of the 195 emergency department for emergency care.
For the purposes of 196 this section, the term “emergency care” has the same meaning as 197 the term “emergency services and care” as defined provided in s. 198 395.002(9) s. 395.002 and includes shall include services 199 provided to rule out an emergency medical condition. 200
Section 5. Subsection (2) of
section 385.211, Florida 201 Statutes, is amended to read: 202 385.211 Refractory and intractable epilepsy treatment and 203
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 8 of 13 CODING: Words stricken are deletions; words underlined are additions. research at recognized medical centers.— 204
(2) Notwithstanding
chapter 893, medical centers recognized 205 pursuant to s. 381.925, or an academic medical research 206 institution legally affiliated with a licensed children’s 207 specialty hospital as defined in s. 395.002(28) s. 395.002(27) 208 that contracts with the Department of Health, may conduct 209 research on cannabidiol and low-THC cannabis. This research may 210 include, but is not limited to, the agricultural development, 211 production, clinical research, and use of liquid medical 212 derivatives of cannabidiol and low-THC cannabis for the 213 treatment for refractory or intractable epilepsy.
The authority 214 for recognized medical centers to conduct this research is 215 derived from 21 C.F.R. parts 312 and 316. Current state or 216 privately obtained research funds may be used to support the 217 activities described in this section. 218
Section 6. Subsection (7) of
section 390.011, Florida 219 Statutes, is amended to read: 220 390.011
Definitions.—As used in this chapter, the term: 221 (7) “Hospital” means a facility as defined in s. 222 395.002(13) s. 395.002(12) and licensed under
chapter 395 and 223
part II of
chapter 408. 224
Section 7. Subsection (7) of
section 394.4787, Florida 225 Statutes, is amended to read: 226 394.4787
Definitions; ss. 394.4786, 394.4787, 394.4788, and 227 394.4789.—As used in this
section and ss. 394.4786, 394.4788, 228 and 394.4789: 229 (7) “Specialty psychiatric hospital” means a hospital 230 licensed by the agency pursuant to s. 395.002(28) s. 395.002(27) 231 and
part II of
chapter 408 as a specialty psychiatric hospital. 232
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 9 of 13 CODING: Words stricken are deletions; words underlined are additions.
Section 8. Paragraph (
c) of subsection (1) of
section 233 395.701, Florida Statutes, is amended to read: 234 395.701 Annual assessments on net operating revenues for 235 inpatient and outpatient services to fund public medical 236 assistance; administrative fines for failure to pay assessments 237 when due; exemption.— 238
(1) For the purposes of this section, the term: 239 (c) “Hospital” means a health care institution as defined 240 in s. 395.002(13) s. 395.002(12), but does not include any 241 hospital operated by a state agency. 242
Section 9. Paragraph (
i) of subsection (1) of
section 243 400.9935, Florida Statutes, is amended to read: 244 400.9935 Clinic responsibilities.— 245
(1) Each clinic shall appoint a medical director or clinic 246 director who shall agree in writing to accept legal 247 responsibility for the following activities on behalf of the 248 clinic. The medical director or the clinic director shall: 249 (
i) Ensure that the clinic publishes a
schedule of charges 250 for the medical services offered to patients. The
schedule must 251 include the prices charged to an uninsured person paying for 252 such services by cash, check, credit card, or debit card. The 253
schedule may group services by price levels, listing services in 254 each price level. The
schedule must be posted in a conspicuous 255 place in the reception area of any clinic that is considered an 256 urgent care center as defined in s. 395.002(30)(
b) s. 257 395.002(29)(
b) and must include, but is not limited to, the 50 258 services most frequently provided by the clinic. The posting may 259 be a sign that must be at least 15 square feet in size or 260 through an electronic messaging board that is at least 3 square 261
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 10 of 13 CODING: Words stricken are deletions; words underlined are additions. feet in size. The failure of a clinic, including a clinic that 262 is considered an urgent care center, to publish and post a 263
schedule of charges as required by this
section shall result in 264 a fine of not more than $1,000, per day, until the
schedule is 265 published and posted. 266
Section 10. Subsection (8) of
section 409.905, Florida 267 Statutes, is amended to read: 268 409.905 Mandatory Medicaid services.—The agency may make 269 payments for the following services, which are required of the 270 state by Title XIX of the Social Security Act, furnished by 271 Medicaid providers to recipients who are determined to be 272 eligible on the dates on which the services were provided. Any 273 service under this
section shall be provided only when medically 274 necessary and in accordance with state and federal law. 275 Mandatory services rendered by providers in mobile units to 276 Medicaid recipients may be restricted by the agency. Nothing in 277 this
section shall be construed to prevent or limit the agency 278 from adjusting fees, reimbursement rates, lengths of stay, 279 number of visits, number of services, or any other adjustments 280 necessary to comply with the availability of moneys and any 281 limitations or directions provided for in the General 282 Appropriations Act or
chapter 216. 283
(8) NURSING FACILITY SERVICES.—The agency shall pay for 24-284 hour-a-day nursing and rehabilitative services for a recipient 285 in a nursing facility licensed under
part II of
chapter 400 or 286 in a rural hospital, as defined in s. 395.602, or in a Medicare 287 certified skilled nursing facility operated by a hospital, as 288 defined by s. 395.002(11) s. 395.002(10), that is licensed under 289
part I of
chapter 395, and in accordance with provisions set 290
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 11 of 13 CODING: Words stricken are deletions; words underlined are additions. forth in s. 409.908(2)(a), which services are ordered by and 291 provided under the direction of a licensed physician. However, 292 if a nursing facility has been destroyed or otherwise made 293 uninhabitable by natural disaster or other emergency and another 294 nursing facility is not available, the agency must pay for 295 similar services temporarily in a hospital licensed under
part I 296 of
chapter 395 provided federal funding is approved and 297 available. The agency shall pay only for bed-hold days if the 298 facility has an occupancy rate of 95 percent or greater. The 299 agency is authorized to seek any federal waivers to implement 300 this policy. 301
Section 11. Paragraph (
b) of subsection (1) of
section 302 409.975, Florida Statutes, is amended to read: 303 409.975 Managed care plan accountability.—In addition to 304 the requirements of s. 409.967, plans and providers 305 participating in the managed medical assistance program shall 306 comply with the requirements of this section. 307
(1) PROVIDER NETWORKS.—Managed care plans must develop and 308 maintain provider networks that meet the medical needs of their 309 enrollees in accordance with standards established pursuant to 310 s. 409.967(2)(c). Except as provided in this section, managed 311 care plans may limit the providers in their networks based on 312 credentials, quality indicators, and price. 313 (
b) Certain providers are statewide resources and essential 314 providers for all managed care plans in all regions. All managed 315 care plans must include these essential providers in their 316 networks. Statewide essential providers include: 317 1. Faculty plans of Florida medical schools. 318 2. Regional perinatal intensive care centers as defined in 319
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 12 of 13 CODING: Words stricken are deletions; words underlined are additions. s. 383.16(2). 320 3. Hospitals licensed as specialty children’s hospitals as 321 defined in s. 395.002(28) s. 395.002(27). 322 4.
Accredited and integrated systems serving medically 323 complex children which comprise separately licensed, but 324 commonly owned, health care providers delivering at least the 325 following services: medical group home, in-home and outpatient 326 nursing care and therapies, pharmacy services, durable medical 327 equipment, and Prescribed Pediatric Extended Care. 328 329 Managed care plans that have not contracted with all statewide 330 essential providers in all regions as of the first date of 331 recipient enrollment must continue to negotiate in good faith. 332 Payments to physicians on the faculty of nonparticipating 333 Florida medical schools shall be made at the applicable Medicaid 334 rate.
Payments for services rendered by regional perinatal 335 intensive care centers shall be made at the applicable Medicaid 336 rate as of the first day of the contract between the agency and 337 the plan. Except for payments for emergency services, payments 338 to nonparticipating specialty children’s hospitals shall equal 339 the highest rate established by contract between that provider 340 and any other Medicaid managed care plan. 341
Section 12. Paragraph (
l) of subsection (1) of
section 342 468.505, Florida Statutes, is amended to read: 343 468.505 Exemptions; exceptions.— 344
(1) Nothing in this part may be construed as prohibiting or 345 restricting the practice, services, or activities of: 346 (
l) A person employed by a nursing facility exempt from 347 licensing under s. 395.002(13) s. 395.002(12), or a person 348
Florida Senate - 2021 SB 1976 9-01437-21 20211976__ Page 13 of 13 CODING: Words stricken are deletions; words underlined are additions. exempt from licensing under s. 464.022. 349
Section 13. Paragraph (
b) of subsection (1) of
section 350 627.64194, Florida Statutes, is amended to read: 351 627.64194 Coverage requirements for services provided by 352 nonparticipating providers; payment collection limitations.— 353
(1) As used in this section, the term: 354 (b) “Facility” means a licensed facility as defined in s. 355 395.002(17) s. 395.002(16) and an urgent care center as defined 356 in s. 395.002. 357
Section 14. Subsection (2) of
section 765.101, Florida 358 Statutes, is amended to read: 359 765.101
Definitions.—As used in this chapter: 360 (2) “Attending physician” means the physician who has 361 primary responsibility for the treatment and care of the patient 362 while the patient receives such treatment or care in a hospital 363 as defined in s. 395.002(13) s. 395.002(12). 364