In the Know: The Health Care Price Transparency Act

By Shachi Mankodi

The Healthcare Price Transparency Act, HB 935 (the “Act”) which took effect July 1, 2011, implements new requirements for the publication and posting of charges for medical services offered by certain medical offices, urgent care centers, and health care clinics.

Amendments to the Florida Patient’s Bill of Rights and Responsibilities
The first significant amendment is the inclusion of a definition for “primary care provider” (“PCP”). A PCP is defined as a physician, osteopathic physician or an individual licensed by the Board of Nursing, who provides medical services to patients, which are commonly provided without referral from another health care provider, including family and general practice, general pediatrics, and general internal medicine. The Act allows, but does not require, a PCP to publish and post a “schedule of charges” (“Schedule”) for medical services offered to patients. The Schedule must:

  • Include the prices charged, per service, to an uninsured person paying by cash, check, credit card, or debit card;
  • Include (but is not limited to) the 50 services most frequently provided;
  • Be posted in a conspicuous place in the reception area of the provider’s office; and
  • Be at least 15 square feet in size.

Further, the Schedule may group services by three price levels, listing services in each price level. However, the Act supplies no guidance on how the three price levels should be determined. The Act also provides that any estimate of charges for medical treatment provided to patients must be consistent with the posted Schedule.

Although posting a schedule is not mandatory for PCPs, those who choose to do so will be exempted from license fee requirements for a single renewal period, and continuing education requirements for a single two year period. A PCP who chooses to publish a Schedule must continually post it for the duration of active licensure in Florida as long as the PCP is providing primary care services to patients. If a PCP removes the Schedule at any time, he or she will be required to pay any license fee that was previously waived, and comply with any continuing education requirements from which they were exempted.

Posting Requirements for Urgent Care Centers
The Act defines urgent care centers as “facilit[ies] or clinic[s] that provide immediate but not emergent ambulatory medical care to patients with or without an appointment.” Emergency departments of hospitals are specifically excluded from this definition. The Act does not define “immediate” and so almost any physician’s office could be deemed an urgent care center if it allows walk-ins. It is mandatory for urgent care centers to publish a Schedule which conforms to the requirements outlined above. Urgent care centers that fail to publish and post a compliant Schedule are subject to a penalty – a fine of not more than $1,000 per day, until the Schedule is published and posted.

Health Care Clinic Responsibilities
Medical directors or clinic directors of licensed health care clinics are responsible for ensuring compliance with the Act’s publishing and posting requirement. Failure to comply with the publishing and posting requirement can result in a fine of not more than $1,000 per day, until the schedule is published and posted.

It remains to be seen how strictly state agencies will be enforcing these new posting requirements and whether they will levy fines on urgent care centers and health care clinics that are noncompliant with the requirements. Nonetheless, it is important that providers be aware of the requirements imposed by the Act in order to avoid violations and potential penalties.

Please click here to view the article in “South Florida Hospital News.”

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