Florida Senate - 2013                                     SB 966
       
       
       
       By Senator Bean
       
       
       
       
       4-00271A-13                                            2013966__
    1                        A bill to be entitled                      
    2         An act relating to health care; amending ss. 154.11,
    3         394.741, 395.3038, 397.403, 400.925, 400.9935,
    4         402.7306, 408.05, 409.966, 409.967, 430.80, 440.13,
    5         627.645, 627.668, 627.669, 627.736, 641.495, and
    6         766.1015, F.S.; conforming provisions to a
    7         redefinition of the term “accrediting organizations”
    8         in s. 395.002, F.S., relating to hospital licensing
    9         and regulation; creating s. 385.2035, F.S.;
   10         designating the Florida Hospital Sanford-Burnham
   11         Translational Research Institute for Metabolism and
   12         Diabetes as a resource for diabetes research in this
   13         state; providing an effective date.
   14  
   15  Be It Enacted by the Legislature of the State of Florida:
   16  
   17         Section 1. Paragraph (n) of subsection (1) of section
   18  154.11, Florida Statutes, is amended to read:
   19         154.11 Powers of board of trustees.—
   20         (1) The board of trustees of each public health trust shall
   21  be deemed to exercise a public and essential governmental
   22  function of both the state and the county and in furtherance
   23  thereof it shall, subject to limitation by the governing body of
   24  the county in which such board is located, have all of the
   25  powers necessary or convenient to carry out the operation and
   26  governance of designated health care facilities, including, but
   27  without limiting the generality of, the foregoing:
   28         (n) To appoint originally the staff of physicians to
   29  practice in a any designated facility owned or operated by the
   30  board and to approve the bylaws and rules to be adopted by the
   31  medical staff of a any designated facility owned and operated by
   32  the board, such governing regulations to be in accordance with
   33  the standards of the Joint Commission or a national accrediting
   34  organization that is approved by the Centers for Medicare and
   35  Medicaid Services and whose standards incorporate comparable
   36  licensure regulations required by the state on the Accreditation
   37  of Hospitals which provide, among other things, for the method
   38  of appointing additional staff members and for the removal of
   39  staff members.
   40         Section 2. Subsection (2) of section 394.741, Florida
   41  Statutes, is amended to read:
   42         394.741 Accreditation requirements for providers of
   43  behavioral health care services.—
   44         (2) Notwithstanding any provision of law to the contrary,
   45  accreditation shall be accepted by the agency and department in
   46  lieu of the agency’s and department’s facility licensure onsite
   47  review requirements and shall be accepted as a substitute for
   48  the department’s administrative and program monitoring
   49  requirements, except as required by subsections (3) and (4),
   50  for:
   51         (a) An Any organization from which the department purchases
   52  behavioral health care services which that is accredited by the
   53  Joint Commission, a national accrediting organization that is
   54  approved by the Centers for Medicare and Medicaid Services and
   55  whose standards incorporate comparable licensure regulations
   56  required by the state, on Accreditation of Healthcare
   57  Organizations or the Council on Accreditation for Children and
   58  Family Services, or which obtains accreditation from CARF
   59  International for the has those services that are being
   60  purchased by the department accredited by CARF—the
   61  Rehabilitation Accreditation Commission.
   62         (b) A Any mental health facility licensed by the agency or
   63  a any substance abuse component licensed by the department which
   64  that is accredited by the Joint Commission, a national
   65  accrediting organization that is approved by the Centers for
   66  Medicare and Medicaid Services and whose standards incorporate
   67  comparable licensure regulations required by the state, CARF
   68  International on Accreditation of Healthcare Organizations,
   69  CARF—the Rehabilitation Accreditation Commission, or the Council
   70  on Accreditation of Children and Family Services.
   71         (c) A Any network of providers from which the department or
   72  the agency purchases behavioral health care services accredited
   73  by the Joint Commission, a national accrediting organization
   74  that is approved by the Centers for Medicare and Medicaid
   75  Services and whose standards incorporate comparable licensure
   76  regulations required by the state, CARF International on
   77  Accreditation of Healthcare Organizations, CARF—the
   78  Rehabilitation Accreditation Commission, the Council on
   79  Accreditation of Children and Family Services, or the National
   80  Committee for Quality Assurance. A provider organization that ,
   81  which is part of an accredited network, is afforded the same
   82  rights under this part.
   83         Section 3. Section 395.3038, Florida Statutes, is amended
   84  to read:
   85         395.3038 State-listed primary stroke centers and
   86  comprehensive stroke centers; notification of hospitals.—
   87         (1) The agency shall make available on its website and to
   88  the department a list of the name and address of each hospital
   89  that meets the criteria for a primary stroke center and the name
   90  and address of each hospital that meets the criteria for a
   91  comprehensive stroke center. The list of primary and
   92  comprehensive stroke centers must shall include only those
   93  hospitals that attest in an affidavit submitted to the agency
   94  that the hospital meets the named criteria, or those hospitals
   95  that attest in an affidavit submitted to the agency that the
   96  hospital is certified as a primary or a comprehensive stroke
   97  center by the Joint Commission or a national accrediting
   98  organization that is approved by the Centers for Medicare and
   99  Medicaid Services and whose standards incorporate comparable
  100  licensure regulations required by the state on Accreditation of
  101  Healthcare Organizations.
  102         (2)(a) If a hospital no longer chooses to meet the criteria
  103  for a primary or comprehensive stroke center, the hospital shall
  104  notify the agency and the agency shall immediately remove the
  105  hospital from the list.
  106         (b)1. This subsection does not apply if the hospital is
  107  unable to provide stroke treatment services for a period of time
  108  not to exceed 2 months. The hospital shall immediately notify
  109  all local emergency medical services providers when the
  110  temporary unavailability of stroke treatment services begins and
  111  when the services resume.
  112         2. If stroke treatment services are unavailable for more
  113  than 2 months, the agency shall remove the hospital from the
  114  list of primary or comprehensive stroke centers until the
  115  hospital notifies the agency that stroke treatment services have
  116  been resumed.
  117         (3) The agency shall notify all hospitals in this state by
  118  February 15, 2005, that the agency is compiling a list of
  119  primary stroke centers and comprehensive stroke centers in this
  120  state. The notice must shall include an explanation of the
  121  criteria necessary for designation as a primary stroke center
  122  and the criteria necessary for designation as a comprehensive
  123  stroke center. The notice must shall also advise hospitals of
  124  the process by which a hospital might be added to the list of
  125  primary or comprehensive stroke centers.
  126         (4) The agency shall adopt by rule criteria for a primary
  127  stroke center which are substantially similar to the
  128  certification standards for primary stroke centers of the Joint
  129  Commission or a national accrediting organization that is
  130  approved by the Centers for Medicare and Medicaid Services and
  131  whose standards incorporate comparable licensure regulations
  132  required by the state on Accreditation of Healthcare
  133  Organizations.
  134         (5) The agency shall adopt by rule criteria for a
  135  comprehensive stroke center. However, if the Joint Commission or
  136  a national accrediting organization that is approved by the
  137  Centers for Medicare and Medicaid Services and whose standards
  138  incorporate comparable licensure regulations required by the
  139  state on Accreditation of Healthcare Organizations establishes
  140  criteria for a comprehensive stroke center, the agency shall
  141  establish criteria for a comprehensive stroke center which are
  142  substantially similar to those criteria established by the Joint
  143  Commission or such national accrediting organization on
  144  Accreditation of Healthcare Organizations.
  145         (6) This act is not a medical practice guideline and may
  146  not be used to restrict the authority of a hospital to provide
  147  services for which it is licensed has received a license under
  148  chapter 395. The Legislature intends that all patients be
  149  treated individually based on each patient’s needs and
  150  circumstances.
  151         Section 4. Subsection (3) of section 397.403, Florida
  152  Statutes, is amended to read:
  153         397.403 License application.—
  154         (3) The department shall accept proof of accreditation by
  155  CARF International, the Commission on Accreditation of
  156  Rehabilitation Facilities(CARF) or the Joint Commission, a
  157  national accrediting organization that is approved by the
  158  Centers for Medicare and Medicaid Services and whose standards
  159  incorporate comparable licensure regulations required by the
  160  state, or through another any other nationally recognized
  161  certification process that is acceptable to the department and
  162  meets the minimum licensure requirements under this chapter, in
  163  lieu of requiring the applicant to submit the information
  164  required by paragraphs (1)(a)-(c).
  165         Section 5. Subsection (1) of section 400.925, Florida
  166  Statutes, is amended to read:
  167         400.925 Definitions.—As used in this part, the term:
  168         (1) “Accrediting organizations” means the Joint Commission,
  169  a national accrediting organization that is approved by the
  170  Centers for Medicare and Medicaid Services and whose standards
  171  incorporate comparable licensure regulations required by the
  172  state, on Accreditation of Healthcare Organizations or other
  173  national accrediting accreditation agencies whose standards for
  174  accreditation are comparable to those required by this part for
  175  licensure.
  176         Section 6. Paragraph (g) of subsection (1) and subsection
  177  (7) of section 400.9935, Florida Statutes, are amended to read:
  178         400.9935 Clinic responsibilities.—
  179         (1) Each clinic shall appoint a medical director or clinic
  180  director who shall agree in writing to accept legal
  181  responsibility for the following activities on behalf of the
  182  clinic. The medical director or the clinic director shall:
  183         (g) Conduct systematic reviews of clinic billings to ensure
  184  that the billings are not fraudulent or unlawful. Upon discovery
  185  of an unlawful charge, the medical director or clinic director
  186  shall take immediate corrective action. If the clinic performs
  187  only the technical component of magnetic resonance imaging,
  188  static radiographs, computed tomography, or positron emission
  189  tomography, and provides the professional interpretation of such
  190  services, in a fixed facility that is accredited by the Joint
  191  Commission on Accreditation of Healthcare Organizations or, the
  192  Accreditation Association for Ambulatory Health Care, Inc., a
  193  national accrediting organization that is approved by the
  194  Centers for Medicare and Medicaid Services and whose standards
  195  incorporate comparable licensure regulations required by the
  196  state, and the American College of Radiology; and if, in the
  197  preceding quarter, the percentage of scans performed by that
  198  clinic which was billed to all personal injury protection
  199  insurance carriers was less than 15 percent, the chief financial
  200  officer of the clinic may, in a written acknowledgment provided
  201  to the agency, assume the responsibility for the conduct of the
  202  systematic reviews of clinic billings to ensure that the
  203  billings are not fraudulent or unlawful.
  204         (7)(a) Each clinic engaged in magnetic resonance imaging
  205  services must be accredited by the Joint Commission, a national
  206  accrediting organization that is approved by the Centers for
  207  Medicare and Medicaid Services and whose standards incorporate
  208  comparable licensure regulations required by the state, on
  209  Accreditation of Healthcare Organizations, the American College
  210  of Radiology, or the Accreditation Association for Ambulatory
  211  Health Care, Inc., within 1 year after licensure. A clinic that
  212  is accredited by the American College of Radiology or that is
  213  within the original 1-year period after licensure and replaces
  214  its core magnetic resonance imaging equipment shall be given 1
  215  year after the date on which the equipment is replaced to attain
  216  accreditation. However, a clinic may request a single, 6-month
  217  extension if it provides evidence to the agency establishing
  218  that, for good cause shown, such clinic cannot be accredited
  219  within 1 year after licensure, and that such accreditation will
  220  be completed within the 6-month extension. After obtaining
  221  accreditation as required by this subsection, each such clinic
  222  must maintain accreditation as a condition of renewal of its
  223  license. A clinic that files a change of ownership application
  224  must comply with the original accreditation timeframe
  225  requirements of the transferor. The agency shall deny a change
  226  of ownership application if the clinic is not in compliance with
  227  the accreditation requirements. When a clinic adds, replaces, or
  228  modifies magnetic resonance imaging equipment and the
  229  accrediting accreditation agency requires new accreditation, the
  230  clinic must be accredited within 1 year after the date of the
  231  addition, replacement, or modification but may request a single,
  232  6-month extension if the clinic provides evidence of good cause
  233  to the agency.
  234         (b) The agency may deny the application or revoke the
  235  license of an any entity formed for the purpose of avoiding
  236  compliance with the accreditation provisions of this subsection
  237  and whose principals were previously principals of an entity
  238  that was unable to meet the accreditation requirements within
  239  the specified timeframes. The agency may adopt rules as to the
  240  accreditation of magnetic resonance imaging clinics.
  241         Section 7. Subsections (1) and (2) of section 402.7306,
  242  Florida Statutes, are amended to read:
  243         402.7306 Administrative monitoring of child welfare
  244  providers, and administrative, licensure, and programmatic
  245  monitoring of mental health and substance abuse service
  246  providers.—The Department of Children and Family Services, the
  247  Department of Health, the Agency for Persons with Disabilities,
  248  the Agency for Health Care Administration, community-based care
  249  lead agencies, managing entities as defined in s. 394.9082, and
  250  agencies who have contracted with monitoring agents shall
  251  identify and implement changes that improve the efficiency of
  252  administrative monitoring of child welfare services, and the
  253  administrative, licensure, and programmatic monitoring of mental
  254  health and substance abuse service providers. For the purpose of
  255  this section, the term “mental health and substance abuse
  256  service provider” means a provider who provides services to this
  257  state’s priority population as defined in s. 394.674. To assist
  258  with that goal, each such agency shall adopt the following
  259  policies:
  260         (1) Limit administrative monitoring to once every 3 years
  261  if the child welfare provider is accredited by the Joint
  262  Commission, a national accrediting organization that is approved
  263  by the Centers for Medicare and Medicaid Services and whose
  264  standards incorporate comparable licensure regulations required
  265  by the state, CARF International the Commission on Accreditation
  266  of Rehabilitation Facilities, or the Council on Accreditation.
  267  If the accrediting body does not require documentation that the
  268  state agency requires, that documentation shall be requested by
  269  the state agency and may be posted by the service provider on
  270  the data warehouse for the agency’s review. Notwithstanding the
  271  survey or inspection of an accrediting organization specified in
  272  this subsection, an agency specified in and subject to this
  273  section may continue to monitor the service provider as
  274  necessary with respect to:
  275         (a) Ensuring that services for which the agency is paying
  276  are being provided.
  277         (b) Investigating complaints or suspected problems and
  278  monitoring the service provider’s compliance with any resulting
  279  negotiated terms and conditions, including provisions relating
  280  to consent decrees that are unique to a specific service and are
  281  not statements of general applicability.
  282         (c) Ensuring compliance with federal and state laws,
  283  federal regulations, or state rules if such monitoring does not
  284  duplicate the accrediting organization’s review pursuant to
  285  accreditation standards.
  286  
  287  Medicaid certification and precertification reviews are exempt
  288  from this subsection to ensure Medicaid compliance.
  289         (2) Limit administrative, licensure, and programmatic
  290  monitoring to once every 3 years if the mental health or
  291  substance abuse service provider is accredited by the Joint
  292  Commission, a national accrediting organization that is approved
  293  by the Centers for Medicare and Medicaid Services and whose
  294  standards incorporate comparable licensure regulations required
  295  by the state, CARF International the Commission on Accreditation
  296  of Rehabilitation Facilities, or the Council on Accreditation.
  297  If the services being monitored are not the services for which
  298  the provider is accredited, the limitations of this subsection
  299  do not apply. If the accrediting body does not require
  300  documentation that the state agency requires, that
  301  documentation, except documentation relating to licensure
  302  applications and fees, must be requested by the state agency and
  303  may be posted by the service provider on the data warehouse for
  304  the agency’s review. Notwithstanding the survey or inspection of
  305  an accrediting organization specified in this subsection, an
  306  agency specified in and subject to this section may continue to
  307  monitor the service provider as necessary with respect to:
  308         (a) Ensuring that services for which the agency is paying
  309  are being provided.
  310         (b) Investigating complaints, identifying problems that
  311  would affect the safety or viability of the service provider,
  312  and monitoring the service provider’s compliance with any
  313  resulting negotiated terms and conditions, including provisions
  314  relating to consent decrees that are unique to a specific
  315  service and are not statements of general applicability.
  316         (c) Ensuring compliance with federal and state laws,
  317  federal regulations, or state rules if such monitoring does not
  318  duplicate the accrediting organization’s review pursuant to
  319  accreditation standards.
  320  
  321  Federal certification and precertification reviews are exempt
  322  from this subsection to ensure Medicaid compliance.
  323         Section 8. Paragraph (k) of subsection (3) of section
  324  408.05, Florida Statutes, is amended to read:
  325         408.05 Florida Center for Health Information and Policy
  326  Analysis.—
  327         (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
  328  produce comparable and uniform health information and statistics
  329  for the development of policy recommendations, the agency shall
  330  perform the following functions:
  331         (k) Develop, in conjunction with the State Consumer Health
  332  Information and Policy Advisory Council, and implement a long
  333  range plan for making available health care quality measures and
  334  financial data that will allow consumers to compare health care
  335  services. The health care quality measures and financial data
  336  the agency must make available includes shall include, but is
  337  not limited to, pharmaceuticals, physicians, health care
  338  facilities, and health plans and managed care entities. The
  339  agency shall update the plan and report on the status of its
  340  implementation annually. The agency shall also make the plan and
  341  status report available to the public on its Internet website.
  342  As part of the plan, the agency shall identify the process and
  343  timeframes for implementation, any barriers to implementation,
  344  and recommendations of changes in the law that may be enacted by
  345  the Legislature to eliminate the barriers. As preliminary
  346  elements of the plan, the agency shall:
  347         1. Make available patient-safety indicators, inpatient
  348  quality indicators, and performance outcome and patient charge
  349  data collected from health care facilities pursuant to s.
  350  408.061(1)(a) and (2). The terms “patient-safety indicators” and
  351  “inpatient quality indicators” have the same meaning as that
  352  ascribed shall be as defined by the Centers for Medicare and
  353  Medicaid Services, the National Quality Forum, the Joint
  354  Commission on Accreditation of Healthcare Organizations, a
  355  national accrediting organization that is approved by the
  356  Centers for Medicare and Medicaid Services and whose standards
  357  incorporate comparable licensure regulations required by the
  358  state, the Agency for Healthcare Research and Quality, the
  359  Centers for Disease Control and Prevention, or a similar
  360  national entity that establishes standards to measure the
  361  performance of health care providers, or by other states. The
  362  agency shall determine which conditions, procedures, health care
  363  quality measures, and patient charge data to disclose based upon
  364  input from the council. When determining which conditions and
  365  procedures are to be disclosed, the council and the agency shall
  366  consider variation in costs, variation in outcomes, and
  367  magnitude of variations and other relevant information. When
  368  determining which health care quality measures to disclose, the
  369  agency:
  370         a. Shall consider such factors as volume of cases; average
  371  patient charges; average length of stay; complication rates;
  372  mortality rates; and infection rates, among others, which shall
  373  be adjusted for case mix and severity, if applicable.
  374         b. May consider such additional measures that are adopted
  375  by the Centers for Medicare and Medicaid Studies, National
  376  Quality Forum, the Joint Commission on Accreditation of
  377  Healthcare Organizations, a national accrediting organization
  378  that is approved by the Centers for Medicare and Medicaid
  379  Services and whose standards incorporate comparable licensure
  380  regulations required by the state, the Agency for Healthcare
  381  Research and Quality, Centers for Disease Control and
  382  Prevention, or a similar national entity that establishes
  383  standards to measure the performance of health care providers,
  384  or by other states.
  385  
  386  When determining which patient charge data to disclose, the
  387  agency shall include such measures as the average of
  388  undiscounted charges on frequently performed procedures and
  389  preventive diagnostic procedures, the range of procedure charges
  390  from highest to lowest, average net revenue per adjusted patient
  391  day, average cost per adjusted patient day, and average cost per
  392  admission, among others.
  393         2. Make available performance measures, benefit design, and
  394  premium cost data from health plans licensed pursuant to chapter
  395  627 or chapter 641. The agency shall determine which health care
  396  quality measures and member and subscriber cost data to
  397  disclose, based upon input from the council. When determining
  398  which data to disclose, the agency shall consider information
  399  that may be required by either individual or group purchasers to
  400  assess the value of the product, which may include membership
  401  satisfaction, quality of care, current enrollment or membership,
  402  coverage areas, accreditation status, premium costs, plan costs,
  403  premium increases, range of benefits, copayments and
  404  deductibles, accuracy and speed of claims payment, credentials
  405  of physicians, number of providers, names of network providers,
  406  and hospitals in the network. Health plans shall make available
  407  to the agency any such data or information that is not currently
  408  reported to the agency or the office.
  409         3. Determine the method and format for public disclosure of
  410  data reported pursuant to this paragraph. The agency shall make
  411  its determination based upon input from the State Consumer
  412  Health Information and Policy Advisory Council. At a minimum,
  413  the data shall be made available on the agency’s Internet
  414  website in a manner that allows consumers to conduct an
  415  interactive search that allows them to view and compare the
  416  information for specific providers. The website must include
  417  such additional information as is determined necessary to ensure
  418  that the website enhances informed decisionmaking among
  419  consumers and health care purchasers, which shall include, at a
  420  minimum, appropriate guidance on how to use the data and an
  421  explanation of why the data may vary from provider to provider.
  422         4. Publish on its website undiscounted charges for no fewer
  423  than 150 of the most commonly performed adult and pediatric
  424  procedures, including outpatient, inpatient, diagnostic, and
  425  preventative procedures.
  426         Section 9. Paragraph (a) of subsection (3) of section
  427  409.966, Florida Statutes, is amended to read:
  428         409.966 Eligible plans; selection.—
  429         (3) QUALITY SELECTION CRITERIA.—
  430         (a) The invitation to negotiate must specify the criteria
  431  and the relative weight of the criteria that will be used for
  432  determining the acceptability of the reply and guiding the
  433  selection of the organizations with which the agency negotiates.
  434  In addition to criteria established by the agency, the agency
  435  shall consider the following factors in the selection of
  436  eligible plans:
  437         1. Accreditation by the National Committee for Quality
  438  Assurance, the Joint Commission, a national accrediting
  439  organization that is approved by the Centers for Medicare and
  440  Medicaid Services and whose standards incorporate comparable
  441  licensure regulations required by the state, or another
  442  nationally recognized accrediting body.
  443         2. Experience serving similar populations, including the
  444  organization’s record in achieving specific quality standards
  445  with similar populations.
  446         3. Availability and accessibility of primary care and
  447  specialty physicians in the provider network.
  448         4. Establishment of community partnerships with providers
  449  that create opportunities for reinvestment in community-based
  450  services.
  451         5. Organization commitment to quality improvement and
  452  documentation of achievements in specific quality improvement
  453  projects, including active involvement by organization
  454  leadership.
  455         6. Provision of additional benefits, particularly dental
  456  care and disease management, and other initiatives that improve
  457  health outcomes.
  458         7. Evidence that an eligible plan has written agreements or
  459  signed contracts or has made substantial progress in
  460  establishing relationships with providers before the plan
  461  submitting a response.
  462         8. Comments submitted in writing by an any enrolled
  463  Medicaid provider relating to a specifically identified plan
  464  participating in the procurement in the same region as the
  465  submitting provider.
  466         9. Documentation of policies and procedures for preventing
  467  fraud and abuse.
  468         10. The business relationship an eligible plan has with
  469  another any other eligible plan that responds to the invitation
  470  to negotiate.
  471         Section 10. Paragraph (e) of subsection (2) of section
  472  409.967, Florida Statutes, is amended to read:
  473         409.967 Managed care plan accountability.—
  474         (2) The agency shall establish such contract requirements
  475  as are necessary for the operation of the statewide managed care
  476  program. In addition to any other provisions the agency may deem
  477  necessary, the contract must require:
  478         (e) Continuous improvement.—The agency shall establish
  479  specific performance standards and expected milestones or
  480  timelines for improving performance over the term of the
  481  contract.
  482         1. Each managed care plan shall establish an internal
  483  health care quality improvement system, including enrollee
  484  satisfaction and disenrollment surveys. The quality improvement
  485  system must include incentives and disincentives for network
  486  providers.
  487         2. Each plan must collect and report the Health Plan
  488  Employer Data and Information Set (HEDIS) measures, as specified
  489  by the agency. These measures must be published on the plan’s
  490  website in a manner that allows recipients to reliably compare
  491  the performance of plans. The agency shall use the HEDIS
  492  measures as a tool to monitor plan performance.
  493         3. Each managed care plan must be accredited by the
  494  National Committee for Quality Assurance, the Joint Commission,
  495  a national accrediting organization that is approved by the
  496  Centers for Medicare and Medicaid Services and whose standards
  497  incorporate comparable licensure regulations required by the
  498  state, or another nationally recognized accrediting body, or
  499  have initiated the accreditation process, within 1 year after
  500  the contract is executed. The agency shall suspend automatic
  501  assignment under s. 409.977 and 409.984 for a any plan not
  502  accredited within 18 months after executing the contract, the
  503  agency shall suspend automatic assignment under s. 409.977 and
  504  409.984.
  505         4. By the end of the fourth year of the first contract
  506  term, the agency shall issue a request for information to
  507  determine whether cost savings could be achieved by contracting
  508  for plan oversight and monitoring, including analysis of
  509  encounter data, assessment of performance measures, and
  510  compliance with other contractual requirements.
  511         Section 11. Paragraph (b) of subsection (3) of section
  512  430.80, Florida Statutes, is amended to read:
  513         430.80 Implementation of a teaching nursing home pilot
  514  project.—
  515         (3) To be designated as a teaching nursing home, a nursing
  516  home licensee must, at a minimum:
  517         (b) Participate in a nationally recognized accrediting
  518  accreditation program and hold a valid accreditation, such as
  519  the accreditation awarded by the Joint Commission on
  520  Accreditation of Healthcare Organizations, a national
  521  accrediting organization that is approved by the Centers for
  522  Medicare and Medicaid Services and whose standards incorporate
  523  comparable licensure regulations required by the state, or, at
  524  the time of initial designation, possess a Gold Seal Award as
  525  conferred by the state on its licensed nursing home;
  526         Section 12. Paragraph (a) of subsection (2) of section
  527  440.13, Florida Statutes, is amended to read:
  528         440.13 Medical services and supplies; penalty for
  529  violations; limitations.—
  530         (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
  531         (a) Subject to the limitations specified elsewhere in this
  532  chapter, the employer shall furnish to the employee such
  533  medically necessary remedial treatment, care, and attendance for
  534  such period as the nature of the injury or the process of
  535  recovery may require, which is in accordance with established
  536  practice parameters and protocols of treatment as provided for
  537  in this chapter, including medicines, medical supplies, durable
  538  medical equipment, orthoses, prostheses, and other medically
  539  necessary apparatus. Remedial treatment, care, and attendance,
  540  including work-hardening programs or pain-management programs
  541  accredited by CARF International, the Commission on
  542  Accreditation of Rehabilitation Facilities the or Joint
  543  Commission, a national accrediting organization that is approved
  544  by the Centers for Medicare and Medicaid Services and whose
  545  standards incorporate comparable licensure regulations required
  546  by the state, on the Accreditation of Health Organizations or
  547  pain-management programs affiliated with medical schools, shall
  548  be considered as covered treatment only when such care is given
  549  based on a referral by a physician as defined in this chapter.
  550  Medically necessary treatment, care, and attendance does not
  551  include chiropractic services in excess of 24 treatments or
  552  rendered 12 weeks beyond the date of the initial chiropractic
  553  treatment, whichever comes first, unless the carrier authorizes
  554  additional treatment or the employee is catastrophically
  555  injured.
  556  
  557  Failure of the carrier to timely comply with this subsection
  558  shall be a violation of this chapter and the carrier shall be
  559  subject to penalties as provided for in s. 440.525.
  560         Section 13. Subsection (1) of section 627.645, Florida
  561  Statutes, is amended to read:
  562         627.645 Denial of health insurance claims restricted.—
  563         (1) A No claim for payment under a health insurance policy
  564  or self-insured program of health benefits for treatment, care,
  565  or services in a licensed hospital that which is accredited by
  566  the Joint Commission, a national accrediting organization that
  567  is approved by the Centers for Medicare and Medicaid Services
  568  and whose standards incorporate comparable licensure regulations
  569  required by the state, on the Accreditation of Hospitals, the
  570  American Osteopathic Association, or CARF International the
  571  Commission on the Accreditation of Rehabilitative Facilities may
  572  not shall be denied because such hospital lacks major surgical
  573  facilities and is primarily of a rehabilitative nature, if such
  574  rehabilitation is specifically for treatment of physical
  575  disability.
  576         Section 14. Paragraph (c) of subsection (2) of section
  577  627.668, Florida Statutes, is amended to read:
  578         627.668 Optional coverage for mental and nervous disorders
  579  required; exception.—
  580         (2) Under group policies or contracts, inpatient hospital
  581  benefits, partial hospitalization benefits, and outpatient
  582  benefits consisting of durational limits, dollar amounts,
  583  deductibles, and coinsurance factors shall not be less favorable
  584  than for physical illness generally, except that:
  585         (c) Partial hospitalization benefits shall be provided
  586  under the direction of a licensed physician. For purposes of
  587  this part, the term “partial hospitalization services” is
  588  defined as those services offered by a program accredited by the
  589  Joint Commission or a national accrediting organization that is
  590  approved by the Centers for Medicare and Medicaid Services and
  591  whose standards incorporate comparable licensure regulations
  592  required by the state, on Accreditation of Hospitals (JCAH) or
  593  in compliance with equivalent standards. Alcohol rehabilitation
  594  programs accredited by the Joint Commission on Accreditation of
  595  Hospitals or approved by the state and licensed drug abuse
  596  rehabilitation programs shall also be qualified providers under
  597  this section. In a given any benefit year, if partial
  598  hospitalization services or a combination of inpatient and
  599  partial hospitalization are used utilized, the total benefits
  600  paid for all such services may shall not exceed the cost of 30
  601  days after of inpatient hospitalization for psychiatric
  602  services, including physician fees, which prevail in the
  603  community in which the partial hospitalization services are
  604  rendered. If partial hospitalization services benefits are
  605  provided beyond the limits set forth in this paragraph, the
  606  durational limits, dollar amounts, and coinsurance factors
  607  thereof need not be the same as those applicable to physical
  608  illness generally.
  609         Section 15. Subsection (3) of section 627.669, Florida
  610  Statutes, is amended to read:
  611         627.669 Optional coverage required for substance abuse
  612  impaired persons; exception.—
  613         (3) The benefits provided under this section are shall be
  614  applicable only if treatment is provided by, or under the
  615  supervision of, or is prescribed by, a licensed physician or
  616  licensed psychologist and if services are provided in a program
  617  accredited by the Joint Commission or a national accrediting
  618  organization that is approved by the Centers for Medicare and
  619  Medicaid Services and whose standards incorporate comparable
  620  licensure regulations required by the state, on Accreditation of
  621  Hospitals or approved by the state.
  622         Section 16. Paragraph (a) of subsection (1) of section
  623  627.736, Florida Statutes, is amended to read:
  624         627.736 Required personal injury protection benefits;
  625  exclusions; priority; claims.—
  626         (1) REQUIRED BENEFITS.—An insurance policy complying with
  627  the security requirements of s. 627.733 must provide personal
  628  injury protection to the named insured, relatives residing in
  629  the same household, persons operating the insured motor vehicle,
  630  passengers in the motor vehicle, and other persons struck by the
  631  motor vehicle and suffering bodily injury while not an occupant
  632  of a self-propelled vehicle, subject to subsection (2) and
  633  paragraph (4)(e), to a limit of $10,000 in medical and
  634  disability benefits and $5,000 in death benefits resulting from
  635  bodily injury, sickness, disease, or death arising out of the
  636  ownership, maintenance, or use of a motor vehicle as follows:
  637         (a) Medical benefits.—Eighty percent of all reasonable
  638  expenses for medically necessary medical, surgical, X-ray,
  639  dental, and rehabilitative services, including prosthetic
  640  devices and medically necessary ambulance, hospital, and nursing
  641  services if the individual receives initial services and care
  642  pursuant to subparagraph 1. within 14 days after the motor
  643  vehicle accident. The medical benefits provide reimbursement
  644  only for:
  645         1. Initial services and care that are lawfully provided,
  646  supervised, ordered, or prescribed by a physician licensed under
  647  chapter 458 or chapter 459, a dentist licensed under chapter
  648  466, or a chiropractic physician licensed under chapter 460 or
  649  that are provided in a hospital or in a facility that owns, or
  650  is wholly owned by, a hospital. Initial services and care may
  651  also be provided by a person or entity licensed under part III
  652  of chapter 401 which provides emergency transportation and
  653  treatment.
  654         2. Upon referral by a provider described in subparagraph
  655  1., followup services and care consistent with the underlying
  656  medical diagnosis rendered pursuant to subparagraph 1. which may
  657  be provided, supervised, ordered, or prescribed only by a
  658  physician licensed under chapter 458 or chapter 459, a
  659  chiropractic physician licensed under chapter 460, a dentist
  660  licensed under chapter 466, or, to the extent permitted by
  661  applicable law and under the supervision of such physician,
  662  osteopathic physician, chiropractic physician, or dentist, by a
  663  physician assistant licensed under chapter 458 or chapter 459 or
  664  an advanced registered nurse practitioner licensed under chapter
  665  464. Followup services and care may also be provided by any of
  666  the following persons or entities:
  667         a. A hospital or ambulatory surgical center licensed under
  668  chapter 395.
  669         b. An entity wholly owned by one or more physicians
  670  licensed under chapter 458 or chapter 459, chiropractic
  671  physicians licensed under chapter 460, or dentists licensed
  672  under chapter 466 or by such practitioners and the spouse,
  673  parent, child, or sibling of such practitioners.
  674         c. An entity that owns or is wholly owned, directly or
  675  indirectly, by a hospital or hospitals.
  676         d. A physical therapist licensed under chapter 486, based
  677  upon a referral by a provider described in this subparagraph.
  678         e. A health care clinic licensed under part X of chapter
  679  400 which is accredited by the Joint Commission on Accreditation
  680  of Healthcare Organizations, a national accrediting organization
  681  that is approved by the Centers for Medicare and Medicaid
  682  Services and whose standards incorporate comparable licensure
  683  regulations required by the state, the American Osteopathic
  684  Association, CARF International the Commission on Accreditation
  685  of Rehabilitation Facilities, or the Accreditation Association
  686  for Ambulatory Health Care, Inc., or
  687         (I) Has a medical director licensed under chapter 458,
  688  chapter 459, or chapter 460;
  689         (II) Has been continuously licensed for more than 3 years
  690  or is a publicly traded corporation that issues securities
  691  traded on an exchange registered with the United States
  692  Securities and Exchange Commission as a national securities
  693  exchange; and
  694         (III) Provides at least four of the following medical
  695  specialties:
  696         (A) General medicine.
  697         (B) Radiography.
  698         (C) Orthopedic medicine.
  699         (D) Physical medicine.
  700         (E) Physical therapy.
  701         (F) Physical rehabilitation.
  702         (G) Prescribing or dispensing outpatient prescription
  703  medication.
  704         (H) Laboratory services.
  705         3. Reimbursement for services and care provided in
  706  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
  707  licensed under chapter 458 or chapter 459, a dentist licensed
  708  under chapter 466, a physician assistant licensed under chapter
  709  458 or chapter 459, or an advanced registered nurse practitioner
  710  licensed under chapter 464 has determined that the injured
  711  person had an emergency medical condition.
  712         4. Reimbursement for services and care provided in
  713  subparagraph 1. or subparagraph 2. is limited to $2,500 if a any
  714  provider listed in subparagraph 1. or subparagraph 2. determines
  715  that the injured person did not have an emergency medical
  716  condition.
  717         5. Medical benefits do not include massage as defined in s.
  718  480.033 or acupuncture as defined in s. 457.102, regardless of
  719  the person, entity, or licensee providing massage or
  720  acupuncture, and a licensed massage therapist or licensed
  721  acupuncturist may not be reimbursed for medical benefits under
  722  this section.
  723         6. The Financial Services Commission shall adopt by rule
  724  the form that must be used by an insurer and a health care
  725  provider specified in sub-subparagraph 2.b., sub-subparagraph
  726  2.c., or sub-subparagraph 2.e. to document that the health care
  727  provider meets the criteria of this paragraph. Such , which rule
  728  must include a requirement for a sworn statement or affidavit.
  729  
  730  Only insurers writing motor vehicle liability insurance in this
  731  state may provide the required benefits of this section, and
  732  such insurer may not require the purchase of any other motor
  733  vehicle coverage other than the purchase of property damage
  734  liability coverage as required by s. 627.7275 as a condition for
  735  providing such benefits. Insurers may not require that property
  736  damage liability insurance in an amount greater than $10,000 be
  737  purchased in conjunction with personal injury protection. Such
  738  insurers shall make benefits and required property damage
  739  liability insurance coverage available through normal marketing
  740  channels. An insurer writing motor vehicle liability insurance
  741  in this state who fails to comply with such availability
  742  requirement as a general business practice violates part IX of
  743  chapter 626, and such violation constitutes an unfair method of
  744  competition or an unfair or deceptive act or practice involving
  745  the business of insurance. An insurer committing such violation
  746  is subject to the penalties provided under that part, as well as
  747  those provided elsewhere in the insurance code.
  748         Section 17. Subsection (12) of section 641.495, Florida
  749  Statutes, is amended to read:
  750         641.495 Requirements for issuance and maintenance of
  751  certificate.—
  752         (12) The provisions of part I of chapter 395 do not apply
  753  to a health maintenance organization that, on or before January
  754  1, 1991, provides not more than 10 outpatient holding beds for
  755  short-term and hospice-type patients in an ambulatory care
  756  facility for its members, provided that such health maintenance
  757  organization maintains current accreditation by the Joint
  758  Commission on Accreditation of Health Care Organizations, a
  759  national accrediting organization that is approved by the
  760  Centers for Medicare and Medicaid Services and whose standards
  761  incorporate comparable licensure regulations required by the
  762  state, the Accreditation Association for Ambulatory Health Care,
  763  Inc., or the National Committee for Quality Assurance.
  764         Section 18. Subsection (2) of section 766.1015, Florida
  765  Statutes, is amended to read:
  766         766.1015 Civil immunity for members of or consultants to
  767  certain boards, committees, or other entities.—
  768         (2) Such committee, board, group, commission, or other
  769  entity must be established in accordance with state law, or in
  770  accordance with requirements of the Joint Commission or a
  771  national accrediting organization that is approved by the
  772  Centers for Medicare and Medicaid Services and whose standards
  773  incorporate comparable licensure regulations required by the
  774  state on Accreditation of Healthcare Organizations, established
  775  and duly constituted by one or more public or licensed private
  776  hospitals or behavioral health agencies, or established by a
  777  governmental agency. To be protected by this section, the act,
  778  decision, omission, or utterance may not be made or done in bad
  779  faith or with malicious intent.
  780         Section 19. Section 385.2035, Florida Statutes, is created
  781  to read:
  782         385.2035Resource for research in the prevention and
  783  treatment of diabetes.—The Florida Hospital Sanford-Burnham
  784  Translational Research Institute for Metabolism and Diabetes is
  785  designated as a resource in this state for research in the
  786  prevention and treatment of diabetes.
  787         Section 20. This act shall take effect July 1, 2013.
  788