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:
782 385.2035 Resource 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