Affordable Health Insurance

(HB 1629) ­ This was a major legislative initiative built on the work of the Governor’s Task Force on Affordable Health Insurance, which made recommendations to the Legislature in February. A number of the Task Force ideas were adopted, including data reporting requirements from facilities and insurers, the creation or expansion of a number of alternative and high-risk insurance pool programs, encouragement for facilities and requirements for insurers to adopt emergency department diversion (i.e., utilization) programs and the creation of the Florida Patient Safety Corporation. FCEP worked with legislators and committee staff to ensure that patients continue to have access to high quality emergency and trauma care. Specific provisions include:

Creation of a high-risk pool for uninsurable medical risks.

Expansion of the “Health Flex” program.

Creation of the Small Employers Access Program, designed for
employers with fewer than 25 employees.

Authorization of rebates for employers and employees who maintain healthy lifestyles.

Authorization for hospitals who choose to do so to develop “emergency department diversion programs” (i.e., utilization) allowing patients to determine if hospital emergency department services are appropriate or if an alternative health care setting may be more appropriate. The legislation implies that “diversion” means methods used to provide alternatives to emergency department care when the medical condition warrants non-emergency care (i.e., appropriate utilization of the emergency department). It is not referring to EMS transport diversion due to overcrowding or an emergency department’s ability to provide care.

Requirement that insurers and health maintenance organizations provide information to consumers on appropriate emergency department utilization and to develop emergency department “diversion” programs (i.e., utilization).

Permission for local community health centers to treat non-emergency patients in conjunction with a hospital emergency department diversion program (i.e., utilization program).

Requirement for hospitals to report specific data on the number of patients treated in the emergency department by patient acuity level.

Requirement that AHCA collect emergency department data by patient acuity level and report implications of non-emergency use of the emergency department to the Governor and Legislature. “Acuity level” is not defined in the legislation, nor is it determined how AHCA is to obtain this information. FCEP will continue to work with AHCA and other stakeholders to ensure that data collection and definitions reflect appropriate measures.

Permission for insurers to charge higher co-payments for non-emergency use of the emergency department and for non-emergency use of out of network hospital emergency departments. FCEP was able to work with key legislators and committee staff to ensure that access to emergency care was not compromised and that patients would continue to receive emergency care at the most appropriate facility. Due to FCEP’s efforts, the bill clearly states that “Higher co-payments may not be charged for the utilization of emergency departments for emergency care.”

Creation of the Florida Patient Safety Corporation to collect data relative to patient safety and issue reports to the public, develop and recommend core competencies on patient safety, establish a pilot project to report on “near misses” and provide for an active library of evidence based medicine and patient safety practices.