Two Bills Go Into Law July 1 That Impact Home Health and Access to Healthcare Cost Information

Earlier this month, Florida Gov. Ron Desantis signed bills into law designed to help patients in need of home health care and to improve healthcare cost transparency. Both bills take effect July 1 and are among six pieces of legislation that make up the $1.1 billion “Live Healthy” package.

CS/CS/HB 935 allows advanced practice registered nurses (APRNs) and physician assistants (PAs) to order or write prescriptions for Medicaid home healthcare services. An APRN or PA ordering the services may not be employed, under contract with, or otherwise affiliated with the home health agency (HHA) providing the services.

What the Home Healthcare Bill Requires

For the Agency for Health Care Administration (AHCA) to reimburse when an APRN or a PA orders or writes prescriptions for Medicaid home healthcare services, the bill requires that:

• The examination by the APRN or the PA must happen within the 30 days before the initial request for the services and biannually thereafter, which are the same requirements for physicians.
• The national provider identifier, Medicaid identification number, or medical practitioner license number of the APRN or the PA must be listed on the written prescription, the claim for reimbursement, and the prior authorization request, which is also required of physicians under current law.

APRNs include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. Physician assistants examine, diagnose and treat patients under the supervision of a physician.

Bill Sponsored by Healthcare Professional

The bill was sponsored by Rep. Gallop Franklin II of Tallahassee, a clinical pharmacist. He noted Florida’s expected growth, especially among seniors, requires the state to embrace innovative and fiscally responsible healthcare solutions.

“Home healthcare promotes greater independence, reduces hospital stays and helps maintain patient independence. Enhancing home healthcare services is a compassionate, respectful, and responsible step that promotes extraordinary cost savings for patients and their families, as well as Florida taxpayers,” Franklin said in a news release.

Consumer Protections Relating to Debt Collection Practices

This healthcare bill creates several consumer protections relating to the collection of medical debt. The bill requires hospitals and ambulatory surgical centers (ASCs) to have an internal grievance process for patients to dispute charges.

It also prohibits a hospital or ASC from engaging in extraordinary collections actions such as certain legal or judicial processes including commencing a civil action, garnishing wages, or placing a lien on property:

• Before the facility makes a reasonable effort to determine whether the individual is eligible for assistance under the facility’s financial assistance plan and, if eligible, before the facility decides regarding the patient’s application for financial assistance.
• Before the facility has provided the individual with an itemized statement or bill.
• During an ongoing grievance process or an ongoing appeal of a claim adjudication.
• Before billing any applicable insurer and allowing the insurer to adjudicate a claim.
• For 30 days after notifying the patient, in writing by a traceable delivery method, that a collection action will commence absent additional action by the patient.
• While the individual:
  • Negotiates in good faith the final amount of a bill for services rendered; or
  • Complies with all terms of a payment plant with the facility.

The bill creates a three-year statute of limitations to collect medical debt, which runs from the date on which the healthcare facility refers the medical debt to a third-party for collection. Currently, medical debt is subject to a five-year statute of limitation.

The bill exempts from attachment, garnishment, or other legal process in an action on hospital medical debt:

• A debtor’s interest, not to exceed $10,000 in value, in a single motor vehicle. Currently, the exempt interest is $1,000.
• A debtor’s interest in personal property, not to exceed $10,000 in value, if the debtor does not claim or receive the benefits of a homestead exemption. Currently, the exempt interest is $1,000.

Healthcare Price Transparency Provisions

The bill requires a hospital or ASC to post standard charges for specified healthcare services on its website or implement an internet-based price estimator tool that meets federal standards.

The bill requires hospitals and ASCs to provide estimates of anticipated charges for non-emergency healthcare services and provide such good faith estimates (to the patient’s health insurer and the patient. A health insurer, in turn, must prepare an advanced explanation of benefits for the insured patient, within a specified time frame prior to the service being provided, based on the facility’s estimate.

The federal government has required hospitals to provide clear, accessible pricing information online about the items and services they provide, since 2021. However, 41 percent of Florida hospitals are not in compliance, according to a report published by PatientRightsAdvocate.org, a nonprofit organization fighting for systemwide healthcare price transparency.

An individual may request a good faith estimate from a facility or an advanced explanation of benefits from an insurer, and the facility or the insurer must provide the applicable document within three business days after receipt of a request from an individual.

Some Changes Deferred

The bill defers implementation of these provisions until federal rules are drawn up.

• The changes made in this act relating to shoppable services, do not apply to ASCs until January 1, 2026.
• The changes made relating to the issuance of good faith estimates by facilities are not effective until the federal agencies adopt rules to implement the law.
• The changes made by this act relating to the advanced explanation of benefits issued by insurers upon the submission of a good faith estimate by a facility, are not effective until federal rules are adopted relating to these estimates.

Direct Health Care Agreements

The bill adds the types of healthcare providers who may participate in a direct healthcare agreement that is exempt from the insurance code to include those licensed to practice psychology, clinical counseling, and psychotherapy services.

Other Provisions

The bill also amends laws governing contracts of the Department of Children and Families with community-based care lead agencies to increase transparency and accountability related to the administration of and services provided by these agencies.

Bills Part of Live Healthy Package

The bill was the last holdout among the six pieces of legislation that make up the $1.1 billion “Live Healthy” package, the main priority during this year’s legislative session of Senate President Kathleen Passidomo.

The package expands Florida’s healthcare workforce with new opportunities for education, training and retention. This includes enhancing partnerships between hospitals and Florida colleges and universities that train healthcare workers, as well as more residency slots and creative loan repayment options that drive providers to under-served areas, according to Passidomo.

“We want to make sure our medical school graduates stay in Florida, and also attract more out-of-state residents – not only for their residencies, but to build their lives and medical practices right here in our communities,” she said. “We are also funding provider increases that incentivize our healthcare workers to continue serving in needed fields like mental health, labor

and delivery and helping Floridians with disabilities.”

Take Action for Compliance and Clarity in Florida’s “Live Healthy Package”

Navigating the new provisions of the Live Healthy package in Florida can be challenging, especially with the new consumer protections, price transparency provisions, and the expanded roles of APRN’s and PA’s in ordering and prescribing Medicaid home health services. Ensuring your practice remains compliant with these changes is crucial.

At The Health Law Offices of Anthony C. Vitale, we specialize in healthcare compliance and legal guidance. Our firm represents healthcare professionals in state and federal court who are charged with fraudulent billing, kickbacks, Medicare and Medicaid fraud and false claims, among others.

Whether you’re a doctor, nurse, or clinic involved in home health, our expert team is here to help you understand and implement these new regulations seamlessly.

For more information, contact us at 305-358-4500 or email info@vitalehealthlaw.com