1. House Bill 935 Alan S. Gassman, Esq. agassman@gassmanpa.com Pariksith Singh, M.D. psingh@accesshealthcarellc.com Lester J. Perling, Esq. lperling@broadandcassel.com Recordings of this webinar and additional materials can be found at: http://www.gassmanresourcecenter.com/previously.recorded.webinars.html Copyright © 2011

2. 2 Summary Gassman, Perling, and Singh

3. 3 Summary House Bill 935 was codified as Ch. 2011-122, Laws of Florida. Approved by the Governor on June 2, 2011. Effective: July 1, 2011. Gassman, Perling, and Singh

4. 4 Summary The major changes in this bill are: The bill provides physicians an incentive to post prices in their respective practices. The bill requires clinics and urgent care centers to post their 50 most frequently used charges. The bill requires a health care clinic licensed under Florida Health Care Clinic Act (FHCCA) to ensure compliance with the publishing and posting requirements. Gassman, Perling, and Singh

5. 5 Making Lemonade Out of Lemons: The Bills Unanswered Questions What exactly is the difference between an Urgent Care Center and any clinic that accepts walk-ins? Can a Primary Care Provider simultaneously be an Urgent Care Center? Are there any exceptions for Primary Care Providers? The definition of Urgent Care Facility and other meanings and definitions within the bill are extremely vague. Gassman, Perling, and Singh

6. 6 Prior to HB 935 The Patients Bill of Rights and Responsibilities was established in 1991 and codified in § 381.026, Florida Statutes. The statute established: The right for patients to expect medical providers to observe standards of care in providing medical treatment and communicating with their patients. Gassman, Perling, and Singh

7. 7 Prior to HB 935 Upon request, the patients had a right to be provided with a reasonable estimate of the cost of medical treatment prior to treatment. However, the reasonable estimate did not preclude the health care provider or health care facility from exceeding the estimate or making additional charges. There is no statutory requirement that a physician post a schedule of his or her fees for medical services. Gassman, Perling, and Singh

8. 8 HB 935 Changes Primary Care Providers HB 935 defines a Primary Care Provider (PCP) as a health care provider who provides medical services to patients which are commonly provided without a referral from another health care provider. (Example: pediatricians, family practice physicians, and internists) A PCP may publish and post the schedule of medical services that he or she provides and the cost for each service. Note: Physicians are not required to post, but are permitted to do so. Gassman, Perling, and Singh

9. 9 Primary Care Providers If the PCP chooses to post the pricing schedule: The schedule must list, at least, the 50 most frequently performed services provided by the PCP; The bill requires the posted charges to consist of those fees that would be charged to an uninsured patient paying for medical services by cash, check, credit card, or debit card; The schedule must be posted in a conspicuous location near the reception area of the providers office in an area of at least 15 square feet; and, The bill requires that an estimate of charges for medical treatment provided to a patient be consistent with the posted schedule of charges, if the PCP posts a schedule of charges pursuant to the bill. Gassman, Perling, and Singh

10. 10 Primary Care Providers The bill provides PCP an incentive to post prices by giving the following: Exemption from one period of license renewal fees. Exemption from the continuing medical education requirements for a single 2-year period. Gassman, Perling, and Singh

11. 11 Primary Care Providers If a PCP chooses to publish and post a schedule of charges, the schedule must remain posted as long as the PCP maintains an active license in Florida and provides medical services to patients. If the schedule does not remain posted, the PCP must pay the exemptions license fee amount and make up any continuing medical education credits that were waived. Gassman, Perling, and Singh

12. 12 Urgent Care Centers The bill amends § 395.107, Florida Statutes, and defines term urgent care center to include a facility or clinic that provides immediate, but not emergent, ambulatory medical services to patients with or without an appointment. In other words, clinics that offer immediate appointments may be considered an urgent care center under this definition. The definition does not include the emergency department of a hospital. Making an appointment on short notice for an existing problem related to a current course of treatment would most likely not fall under urgent care center. Gassman, Perling, and Singh

13. 13 Urgent Care Centers Specific requirements for urgent care centers are: They must publish a schedule of charges for the medical services offered to patients; They must include the prices charged to an uninsured person paying for such services by cash, check, credit card, or debit card; The schedule must be posted in a conspicuous place in the reception area of the urgent care center; It must include the 50 services most frequently provided by the urgent care center; It may group services by three price levels, listing services in each price level; and The posting must be at least 15 square feet in size. Gassman, Perling, and Singh

14. 14 Urgent Care Centers The bill imposes a fine of not more than $1,000, per day, upon an urgent care center for each day that the schedule of charges is not published and posted as required by the bill. Gassman, Perling, and Singh

15. 15 Health Care Clinics HB 935 amends § 400.9935, Florida Statutes, to require a medical director or clinic director of a health care clinic licensed under FHCCA, to ensure compliance with the publishing and posting requirements. If an applicant for health care clinic licensure meets the definition of urgent care center" it must post and publish many of its charges so patients can see them. Gassman, Perling, and Singh

16. 16 Health Care Clinics Specific requirements for posting are: Post in a conspicuous place in the reception area of the facility. Must include prices charged to uninsured patients paying at the time of service. The sign must be at least 15 square feet in size and provide prices for at least the top 50 most frequently provided services. The clinic is not limited to listing just 50 services. The pricing can have up to 3 price levels. Gassman, Perling, and Singh

17. 17 Recommendations/ Potential Issues If a physician-owned clinic applies for a certificate of exemption from AHCA in the future, it may have to comply with the new posting requirements, even if it does not meet the laws definition of urgent care center. Florida law does not require clinics that are exempt from clinic licensure obtain a certificate of exemption, but many health care plans, Medicare and Medicaid, may require one for credentialing. Gassman, Perling, and Singh

18. 18 Recommendations/ Potential Issues While the new law may make health care pricing more transparent across the board, it also might dissuade patients from initially seeking medical care. Gassman, Perling, and Singh

19. 19 Recommendations/ Potential Issues Along with the recent bill to limit the prescribing and dispensing of controlled substances in an uncontrolled manner, physicians are now forced to be more compliant and forthright with patients and the government. It is recommend that all primary care clinics that offer any kind of walk-in or immediate appointment service follow the requirements of the law and establish a list of the 50 most common procedures offered at that location along with the cost involved for any self-pay patient. Gassman, Perling, and Singh

20. 20 Recommendations/ Potential Issues Such bills always create work for a practice at the outset, but by raising the bar, practices become more compliant and consumer friendly. Some procedures may not be easy to price. In that case, one may wish to list the price range of the procedure and note the limitation of such price range. Gassman, Perling, and Singh

21. 21 Further Resources The text of the Bill is available at: http://www.flsenate.gov/Session/Bill/2011/0935/BillText/er/PDF An Article, a sample Schedule of Charges as shown on Slide 22, and the chart found on Slide 2 is available from Gassman Law Associates, P.A. Gassman, Perling, and Singh

22. 22 Questions? Lester Perling, Esq. lperling@broadandcassel.com (954) 745-5261 Dr. Pariksith Singh psingh@accesshealthcarellc.net (352) 688-2883 Alan S. Gassman, Esq. agassman@gassmanpa.com (727) 442-1200 Gassman, Perling, and Singh

23. 23 Sample Schedule of Charges Gassman, Perling, and Singh