Florida Senate - 2016              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 1722
       
       
       
       
       
                               Ì950510hÎ950510                          
       
       594-03723-16                                                    
       Proposed Committee Substitute by the Committee on Fiscal Policy
       (Appropriations Subcommittee on Health and Human Services)
    1                        A bill to be entitled                      
    2         An act relating to termination of pregnancies;
    3         amending s. 390.011, F.S.; defining the term
    4         “gestation” and revising the term “third trimester”;
    5         amending s. 390.0111, F.S.; revising the requirements
    6         for disposal of fetal remains; revising the criminal
    7         punishment for failure to properly dispose of fetal
    8         remains; prohibiting state agencies, local
    9         governmental entities, and Medicaid managed care plans
   10         from expending or paying funds to or initiating or
   11         renewing contracts under certain circumstances with
   12         certain organizations that perform abortions;
   13         providing exceptions; amending s. 390.0112, F.S.;
   14         requiring directors of certain hospitals and
   15         physicians’ offices and licensed abortion clinics to
   16         submit monthly reports to the Agency for Health Care
   17         Administration on a specified form; prohibiting the
   18         report from including personal identifying
   19         information; requiring the agency to submit certain
   20         data to the Centers for Disease Control and Prevention
   21         on a quarterly basis; amending s. 390.012, F.S.;
   22         requiring the agency to develop and enforce rules
   23         relating to license inspections and investigations of
   24         certain clinics; requiring the agency to adopt rules
   25         that require certain clinics to have written
   26         agreements with local hospitals for certain
   27         contingencies; specifying that the rules must require
   28         physicians who perform abortions at a clinic that
   29         performs abortions in the first trimester of pregnancy
   30         to have admitting privileges at a hospital within
   31         reasonable proximity of the clinic; specifying for
   32         clinics that perform or claim to perform abortions
   33         after the first trimester of pregnancy that the rules
   34         must require all physicians performing abortions at
   35         the clinic to have admitting privileges at a hospital
   36         within a reasonable proximity unless the clinic has a
   37         transfer agreement with such a hospital and the
   38         agreement includes certain provisions; revising
   39         requirements for rules that prescribe minimum recovery
   40         room standards; revising requirements for the disposal
   41         of fetal remains; requiring the agency to submit an
   42         annual report to the Legislature; amending s. 390.014,
   43         F.S.; providing a different limitation on the amount
   44         of a fee; amending s. 390.025, F.S.; requiring certain
   45         organizations that provide abortion referral services
   46         or abortion counseling services to register with the
   47         agency, pay a specified fee, and include certain
   48         information in advertisements; requiring biennial
   49         renewal of a registration; providing exemptions from
   50         the registration requirement; requiring the agency to
   51         adopt rules; providing for the assessment of costs in
   52         certain circumstances; amending s. 873.05, F.S.;
   53         prohibiting an offer to purchase, sell, donate, or
   54         transfer fetal remains obtained from an abortion and
   55         the purchase, sale, donation, or transfer of such
   56         remains, excluding costs associated with certain
   57         transportation of remains; providing effective dates.
   58          
   59  Be It Enacted by the Legislature of the State of Florida:
   60  
   61         Section 1. Present subsections (6) through (12) of section
   62  390.011, Florida Statutes, are redesignated as subsections (7)
   63  through (13), respectively, a new subsection (6) is added to
   64  that section, and present subsection (11) of that section is
   65  amended, to read:
   66         390.011 Definitions.—As used in this chapter, the term:
   67         (6) “Gestation” means the development of a human embryo or
   68  fetus between fertilization and birth.
   69         (12)(11) “Third Trimester” means one of the following three
   70  distinct periods of time in the duration of a pregnancy:
   71         (a) “First trimester,” which is the period of time from
   72  fertilization through the end of the 11th week of gestation.
   73         (b) “Second trimester,” which is the period of time from
   74  the beginning of the 12th week of gestation through the end of
   75  the 23rd week of gestation.
   76         (c) “Third trimester,” which is the period of time from the
   77  beginning of the 24th week of gestation through birth the weeks
   78  of pregnancy after the 24th week of pregnancy.
   79         Section 2. Subsection (7) of section 390.0111, Florida
   80  Statutes, is amended, and subsection (15) is added to that
   81  section, to read:
   82         390.0111 Termination of pregnancies.—
   83         (7) FETAL REMAINS.—Fetal remains shall be disposed of in a
   84  sanitary and appropriate manner pursuant to s. 381.0098 and
   85  rules adopted thereunder and in accordance with standard health
   86  practices, as provided by rule of the Department of Health.
   87  Failure to dispose of fetal remains in accordance with this
   88  subsection department rules is a misdemeanor of the first second
   89  degree, punishable as provided in s. 775.082 or s. 775.083.
   90         (15) USE OF PUBLIC FUNDS RESTRICTED.—A state agency, a
   91  local governmental entity, or a managed care plan providing
   92  services under part IV of chapter 409 may not expend funds for
   93  the benefit of, pay funds to, or initiate or renew a contract
   94  with an organization that owns, operates, or is affiliated with
   95  one or more clinics that are licensed under this chapter and
   96  perform abortions unless one or more of the following applies:
   97         (a) All abortions performed by such clinics are:
   98         1. On fetuses that are conceived through rape or incest; or
   99         2. Are medically necessary to preserve the life of the
  100  pregnant woman or to avert a serious risk of substantial and
  101  irreversible physical impairment of a major bodily function of
  102  the pregnant woman, other than a psychological condition.
  103         (b) The funds must be expended to fulfill the terms of a
  104  contract entered into before July 1, 2016.
  105         (c) The funds must be expended as reimbursement for
  106  Medicaid services provided on a fee-for-service basis.
  107         Section 3. Subsection (1) of section 390.0112, Florida
  108  Statutes, is amended, present subsections (2), (3), and (4) of
  109  that section are redesignated as subsections (3), (4), and (5),
  110  respectively, and a new subsection (2) is added to that section,
  111  to read:
  112         390.0112 Termination of pregnancies; reporting.—
  113         (1) The director of any medical facility in which abortions
  114  are performed, including a physician’s office, any pregnancy is
  115  terminated shall submit a monthly report each month to the
  116  agency. The report may be submitted electronically, may not
  117  include personal identifying information, and must include:
  118         (a) Until the agency begins collecting data under paragraph
  119  (e), the number of abortions performed.
  120         (b) The reasons such abortions were performed.
  121         (c) For each abortion, the period of gestation at the time
  122  the abortion was performed.
  123         (d)which contains the number of procedures performed, the
  124  reason for same, the period of gestation at the time such
  125  procedures were performed, and The number of infants born alive
  126  or alive during or immediately after an attempted abortion.
  127         (e) Beginning no later than January 1, 2017, information
  128  consistent with the United States Standard Report of Induced
  129  Termination of Pregnancy adopted by the Centers for Disease
  130  Control and Prevention.
  131         (2) The agency shall keep be responsible for keeping such
  132  reports in a central location for the purpose of compiling and
  133  analyzing place from which statistical data and shall submit
  134  data reported pursuant to paragraph (1)(e) to the Division of
  135  Reproductive Health within the Centers for Disease Control and
  136  Prevention, as requested by the Centers for Disease Control and
  137  Prevention analysis can be made.
  138         Section 4. Paragraph (c) of subsection (1), subsection (2),
  139  paragraphs (c) and (f) of subsection (3), and subsection (7) of
  140  section 390.012, Florida Statutes, are amended, and subsection
  141  (8) is added to that section, to read:
  142         390.012 Powers of agency; rules; disposal of fetal
  143  remains.—
  144         (1) The agency may develop and enforce rules pursuant to
  145  ss. 390.011-390.018 and part II of chapter 408 for the health,
  146  care, and treatment of persons in abortion clinics and for the
  147  safe operation of such clinics.
  148         (c) The rules shall provide for:
  149         1. The performance of pregnancy termination procedures only
  150  by a licensed physician.
  151         2. The making, protection, and preservation of patient
  152  records, which shall be treated as medical records under chapter
  153  458. When performing a license inspection of a clinic, the
  154  agency shall inspect at least 50 percent of patient records
  155  generated since the clinic’s last license inspection.
  156         3. Annual inspections by the agency of all clinics licensed
  157  under this chapter to ensure that such clinics are in compliance
  158  with this chapter and agency rule.
  159         4. The prompt investigation of credible allegations of
  160  abortions being performed at a clinic that is not licensed to
  161  perform such procedures.
  162         (2) For clinics that perform abortions in the first
  163  trimester of pregnancy only, these rules must shall be
  164  comparable to rules that apply to all surgical procedures
  165  requiring approximately the same degree of skill and care as the
  166  performance of first trimester abortions and must require:
  167         (a) Clinics to have a written patient transfer agreement
  168  with a hospital within reasonable proximity to the clinic which
  169  includes the transfer of the patient’s medical records held by
  170  the clinic and the treating physician to the licensed hospital;
  171  or
  172         (b) Physicians who perform abortions at the clinic to have
  173  admitting privileges at a hospital within reasonable proximity
  174  to the clinic.
  175         (3) For clinics that perform or claim to perform abortions
  176  after the first trimester of pregnancy, the agency shall adopt
  177  rules pursuant to ss. 120.536(1) and 120.54 to implement the
  178  provisions of this chapter, including the following:
  179         (c) Rules relating to abortion clinic personnel. At a
  180  minimum, these rules shall require that:
  181         1. The abortion clinic designate a medical director who is
  182  licensed to practice medicine in this state, and all physicians
  183  who perform abortions in the clinic have who has admitting
  184  privileges at a licensed hospital in this state within
  185  reasonable proximity of the clinic, unless the clinic or has a
  186  written patient transfer agreement with a licensed hospital
  187  within reasonable proximity of the clinic which includes the
  188  transfer of the patient’s medical records held by both the
  189  clinic and the treating physician.
  190         2. If a physician is not present after an abortion is
  191  performed, a registered nurse, licensed practical nurse,
  192  advanced registered nurse practitioner, or physician assistant
  193  shall be present and remain at the clinic to provide
  194  postoperative monitoring and care until the patient is
  195  discharged.
  196         3. Surgical assistants receive training in counseling,
  197  patient advocacy, and the specific responsibilities associated
  198  with the services the surgical assistants provide.
  199         4. Volunteers receive training in the specific
  200  responsibilities associated with the services the volunteers
  201  provide, including counseling and patient advocacy as provided
  202  in the rules adopted by the director for different types of
  203  volunteers based on their responsibilities.
  204         (f) Rules that prescribe minimum recovery room standards.
  205  At a minimum, these rules must shall require that:
  206         1. Postprocedure recovery rooms be are supervised and
  207  staffed to meet the patients’ needs.
  208         2. Immediate postprocedure care consist consists of
  209  observation in a supervised recovery room for as long as the
  210  patient’s condition warrants.
  211         3. The clinic arranges hospitalization if any complication
  212  beyond the medical capability of the staff occurs or is
  213  suspected.
  214         4. A registered nurse, licensed practical nurse, advanced
  215  registered nurse practitioner, or physician assistant who is
  216  trained in the management of the recovery area and is capable of
  217  providing basic cardiopulmonary resuscitation and related
  218  emergency procedures remain remains on the premises of the
  219  abortion clinic until all patients are discharged.
  220         4.5. A physician shall sign the discharge order and be
  221  readily accessible and available until the last patient is
  222  discharged to facilitate the transfer of emergency cases if
  223  hospitalization of the patient or viable fetus is necessary.
  224         5.6. A physician discuss discusses Rho(D) immune globulin
  225  with each patient for whom it is indicated and ensure ensures
  226  that it is offered to the patient in the immediate postoperative
  227  period or that it will be available to her within 72 hours after
  228  completion of the abortion procedure. If the patient refuses the
  229  Rho(D) immune globulin, she and a witness must sign a refusal
  230  form approved by the agency which must be shall be signed by the
  231  patient and a witness and included in the medical record.
  232         6.7. Written instructions with regard to postabortion
  233  coitus, signs of possible problems, and general aftercare which
  234  are specific to the patient be are given to each patient. The
  235  instructions must include information Each patient shall have
  236  specific written instructions regarding access to medical care
  237  for complications, including a telephone number for use in the
  238  event of a to call for medical emergency emergencies.
  239         7.8.There is A specified minimum length of time be
  240  specified, by type of abortion procedure and duration of
  241  gestation, during which that a patient must remain remains in
  242  the recovery room by type of abortion procedure and duration of
  243  gestation.
  244         8.9. The physician ensure ensures that, with the patient’s
  245  consent, a registered nurse, licensed practical nurse, advanced
  246  registered nurse practitioner, or physician assistant from the
  247  abortion clinic makes a good faith effort to contact the patient
  248  by telephone, with the patient’s consent, within 24 hours after
  249  surgery to assess the patient’s recovery.
  250         9.10. Equipment and services be are readily accessible to
  251  provide appropriate emergency resuscitative and life support
  252  procedures pending the transfer of the patient or viable fetus
  253  to the hospital.
  254         (7) If an any owner, operator, or employee of an abortion
  255  clinic fails to dispose of fetal remains and tissue in a
  256  sanitary manner pursuant to s. 381.0098, rules adopted
  257  thereunder, and rules adopted by the agency pursuant to this
  258  section consistent with the disposal of other human tissue in a
  259  competent professional manner, the license of such clinic may be
  260  suspended or revoked, and such person commits is guilty of a
  261  misdemeanor of the first degree, punishable as provided in s.
  262  775.082 or s. 775.083.
  263         (8) Beginning February 1, 2017, and annually thereafter,
  264  the agency shall submit a report to the President of the Senate
  265  and the Speaker of the House of Representatives which summarizes
  266  all regulatory actions taken during the prior year by the agency
  267  under this chapter.
  268         Section 5. Subsection (3) of section 390.014, Florida
  269  Statutes, is amended to read:
  270         390.014 Licenses; fees.—
  271         (3) In accordance with s. 408.805, an applicant or licensee
  272  shall pay a fee for each license application submitted under
  273  this chapter and part II of chapter 408. The amount of the fee
  274  shall be established by rule and may not be more than required
  275  to pay for the costs incurred by the agency in administering
  276  this chapter less than $70 or more than $500.
  277         Section 6. Effective January 1, 2017, present subsection
  278  (3) of section 390.025, Florida Statutes, is amended, and new
  279  subsections (3), (4), and (5) are added to that section, to
  280  read:
  281         390.025 Abortion referral or counseling agencies;
  282  penalties.—
  283         (3) An abortion referral or counseling agency, as defined
  284  in subsection (1), shall register with the Agency for Health
  285  Care Administration. To register or renew a registration an
  286  applicant must pay an initial or renewal registration fee
  287  established by rule, which must not exceed the costs incurred by
  288  the agency in administering this section. Registrants must
  289  include in any advertising materials the registration number
  290  issued by the agency and must renew their registration
  291  biennially.
  292         (4) The following are exempt from the requirement to
  293  register pursuant to subsection (3):
  294         (a) Facilities licensed pursuant to chapter 390, chapter
  295  395, chapter 400, or chapter 408;
  296         (b) Facilities that are exempt from licensure as a clinic
  297  under s. 400.9905(4) and that refer five or fewer patients for
  298  abortions per month; and
  299         (c) Health care practitioners, as defined in s. 456.001,
  300  who, in the course of their practice outside of a facility
  301  licensed pursuant to chapter 390, chapter 395, chapter 400, or
  302  chapter 408, refer five or fewer patients for abortions each
  303  month.
  304         (5) The agency shall adopt rules to administer this section
  305  and part II of chapter 408.
  306         (6)(3) Any person who violates the provisions of subsection
  307  (2) this section is guilty of a misdemeanor of the first degree,
  308  punishable as provided in s. 775.082 or s. 775.083. In addition
  309  to any other penalties imposed pursuant to this chapter, the
  310  Agency for Health Care Administration may assess costs related
  311  to an investigation of violations of this section which results
  312  in a successful prosecution. Such costs may not include attorney
  313  fees.
  314         Section 7. Section 873.05, Florida Statutes, is amended to
  315  read:
  316         873.05 Advertising, purchase, or sale, or transfer of human
  317  embryos or fetal remains prohibited.—
  318         (1) A No person may not shall knowingly advertise or offer
  319  to purchase or sell, or purchase, sell, or otherwise transfer, a
  320  any human embryo for valuable consideration.
  321         (2) As used in this subsection section, the term “valuable
  322  consideration” does not include the reasonable costs associated
  323  with the removal, storage, and transportation of a human embryo.
  324         (2) A person may not advertise or offer to purchase, sell,
  325  donate, or transfer, or purchase, sell, donate, or transfer,
  326  fetal remains obtained from an abortion, as defined in s.
  327  390.011. This subsection does not prohibit the transportation or
  328  transfer of fetal remains for disposal pursuant to s. 381.0098
  329  or rules adopted thereunder.
  330         (3) A person who violates the provisions of this section is
  331  guilty of a felony of the second degree, punishable as provided
  332  in s. 775.082, s. 775.083, or s. 775.084.
  333         Section 8. Except as otherwise expressly provided in this
  334  act, this act shall take effect July 1, 2016.