During the 2016 Legislative Session, HB 221 passed and was signed into law on April 14, 2016, as Chapter 2016-222, Laws of Florida. The bill prohibits an out-of-network provider from balance billing members of a preferred provider organization (PPO) or an exclusive provider organization (EPO) for covered emergency services or covered nonemergency services.
The bill amends the claims resolution process to add several mandatory components and voluntary steps to resolve billing issues between providers and insurers. In addition, the bill requires insurers to provide coverage for emergency services without a prior authorization determination and regardless of whether the provider is a participating provider.
Willful noncompliance by an out-of-network provider (as defined in 627.419 and 627.6471, Florida Statutes) with the balance billing provisions for covered emergency services and nonemergency services, is grounds for discipline by the Florida Department of Health if it occurs with such frequency that it constitutes a general business practice. Other specified providers (hospitals, ambulatory surgical centers, specialty hospitals, and urgent care centers) are required to comply with the balance billing provisions as a condition of licensure.
To read the entire bill,
https://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=_h0221er.docx&DocumentType=Bill&BillNumber=0221&Session=2016 or visit www.FLHealthSource.gov/2016-Bills for information on this and other bills passed in 2016.
