Senate Bill 0314c1
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Florida Senate - 1998 CS for SB 314
By the Committee on Health Care and Senator Brown-Waite
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1 A bill to be entitled
2 An act relating to the regulation of health
3 care facilities; amending s. 20.42, F.S.;
4 deleting the responsibility of the Division of
5 Health Policy and Cost Control within the
6 Agency for Health Care Administration for
7 reviewing hospital budgets; abolishing the
8 Health Care Board; amending s. 154.304, F.S.,
9 relating to health care for indigent persons;
10 revising definitions; amending s. 394.4788,
11 F.S., relating to mental health services;
12 updating provisions relating to duties of the
13 agency formerly performed by the Health Care
14 Cost Containment Board; amending s. 240.4076,
15 F.S.; conforming a cross-reference to changes
16 made by the act; amending s. 395.0163, F.S.;
17 providing exemptions from construction
18 inspections and investigations by the Agency
19 for Health Care Administration for certain
20 outpatient facilities; providing exceptions;
21 amending s. 395.1055, F.S.; requiring the
22 Agency for Health Care Administration to adopt
23 rules to assure that, following a disaster,
24 licensed facilities are capable of serving as
25 shelters only for patients, staff, and the
26 families of staff and patients; providing for
27 applicability; providing for a report by the
28 agency to the Governor and Legislature;
29 amending s. 395.401, F.S.; providing for
30 certain reports formerly made to the Health
31 Care Board to be made to the agency; amending
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1 s. 395.701, F.S., relating to the Public
2 Medical Assistance Trust Fund; revising
3 definitions; amending ss. 408.05, 408.061,
4 408.062, 408.063, F.S., relating to the State
5 Center for Health Statistics and the collection
6 and dissemination of health care information;
7 updating provisions to reflect the assumption
8 by the Agency for Health Care Administration of
9 duties formerly performed by the Health Care
10 Board and the former Department of Health and
11 Rehabilitative Services; authorizing the agency
12 to conduct data-based studies and make
13 recommendations; deleting obsolete provisions;
14 amending s. 408.07, F.S.; deleting definitions
15 made obsolete by the repeal of requirements
16 with respect to hospital budget reviews;
17 amending s. 408.08, F.S.; deleting provisions
18 requiring the Health Care Board to review the
19 budgets of certain hospitals; deleting
20 requirements that a hospital file budget
21 letters; deleting certain administrative
22 penalties; amending s. 408.40, F.S.; removing a
23 reference to the duties of the Public Counsel
24 with respect to hospital budget review
25 proceedings; amending ss. 409.2673, 409.9113,
26 F.S., relating to health care programs for
27 low-income persons and the disproportionate
28 share program for teaching hospitals; updating
29 provisions to reflect the abolishment of the
30 Health Care Cost Containment Board and the
31 assumption of its duties by the agency;
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1 repealing ss. 395.403(9), 395.806(3), 407.61,
2 408.003, 408.072, 408.085, F.S., relating to
3 reimbursement of state-sponsored trauma
4 centers, studies by the Health Care Board,
5 appointment of members to the Health Care
6 Board, review of hospital budgets, and budget
7 reviews of comprehensive inpatient
8 rehabilitation hospitals; providing for
9 retroactive application of provisions of the
10 act relating to repeal of review of hospital
11 budgets; amending ss. 381.026, 381.0261, F.S.;
12 requiring distribution of the Florida Patient's
13 Bill of Rights and Responsibilities; providing
14 penalties; repealing s. 395.002(2) and (15),
15 F.S.; deleting definitions of "adverse or
16 untoward incident" and "injury"; amending s.
17 395.0193, F.S.; revising provisions relating to
18 facility peer review disciplinary actions
19 against practitioners; requiring a report to
20 the Agency for Health Care Administration;
21 providing penalties; amending s. 395.0197,
22 F.S.; revising provisions relating to internal
23 risk management; defining the term "adverse
24 incident"; requiring certain reports to the
25 agency; including minors in provisions relating
26 to notification of sexual misconduct or abuse;
27 requiring facility corrective action plans;
28 providing penalties; renumbering s. 626.941,
29 F.S., relating to the purpose of the health
30 care risk manager licensure program;
31 renumbering and amending s. 626.942, F.S.,
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1 relating to the Health Care Risk Manager
2 Advisory Council; renumbering and amending s.
3 626.943, F.S.; providing powers and duties of
4 the agency; renumbering and amending s.
5 626.944, F.S., relating to qualifications for
6 health care risk managers; providing for fees;
7 providing for issuance, cancellation, and
8 renewal of licenses; renumbering and amending
9 s. 626.945, F.S., relating to grounds for
10 denial, suspension, or revocation of licenses;
11 amending s. 766.101, F.S., relating to medical
12 review committees; adding "physician-hospital
13 organization," "provider-sponsored
14 organization," and "integrated delivery system"
15 to the definition of "medical review committee"
16 or "committee"; amending ss. 394.4787, 395.602,
17 400.051, 409.905, 440.13, 458.331, 459.015,
18 468.505, 641.55, 766.1115, F.S.; conforming
19 references and correcting cross-references;
20 transferring the internal risk manager
21 licensure program from the Department of
22 Insurance to the Agency for Health Care
23 Administration; providing an appropriation;
24 providing effective dates.
25
26 Be It Enacted by the Legislature of the State of Florida:
27
28 Section 1. Paragraphs (b), (d), and (e) of subsection
29 (2) and subsections (6) and (7) of section 20.42, Florida
30 Statutes, are amended to read:
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1 20.42 Agency for Health Care Administration.--There is
2 created the Agency for Health Care Administration within the
3 Department of Business and Professional Regulation. The agency
4 shall be a separate budget entity, and the director of the
5 agency shall be the agency head for all purposes. The agency
6 shall not be subject to control, supervision, or direction by
7 the Department of Business and Professional Regulation in any
8 manner, including, but not limited to, personnel, purchasing,
9 transactions involving real or personal property, and
10 budgetary matters.
11 (2) ORGANIZATION OF THE AGENCY.--The agency shall be
12 organized as follows:
13 (b) The Division of Health Policy and Cost Control,
14 which shall be responsible for health policy, the State Center
15 for Health Statistics, the development of The Florida Health
16 Plan, certificate of need, hospital budget review, state and
17 local health planning under s. 408.033, and research and
18 analysis.
19 (d) The Health Care Board, which shall be responsible
20 for hospital budget review, nursing home financial analysis,
21 and special studies as assigned by the secretary or the
22 Legislature.
23 (d)(e) The Division of Administrative Services, which
24 shall be responsible for revenue management, budget,
25 personnel, and general services.
26 (6) HEALTH CARE BOARD.--The Health Care Board shall be
27 composed of 11 members appointed by the Governor, subject to
28 confirmation by the Senate. The members of the board shall
29 biennially elect a chairperson and a vice chairperson from its
30 membership. The board shall be responsible for hospital budget
31 review, nursing home financial review and analysis, and
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1 special studies requested by the Governor, the Legislature, or
2 the director.
3 (6)(7) DEPUTY DIRECTOR OF ADMINISTRATIVE
4 SERVICES.--The director shall appoint a Deputy Director of
5 Administrative Services who shall serve at the pleasure of,
6 and be directly responsible to, the director. The deputy
7 director shall be responsible for the Division of
8 Administrative Services.
9 Section 2. Subsections (1) and (8) of section 154.304,
10 Florida Statutes, are amended to read:
11 154.304 Definitions.--For the purpose of this act:
12 (1) "Agency" means the Agency for Health Care
13 Administration. "Board" means the Health Care Board as
14 established in chapter 408.
15 (8) "Participating hospital" means a hospital which is
16 eligible to receive reimbursement under the provisions of this
17 act because it has been certified by the agency board as
18 having met its charity care obligation and has either:
19 (a) A formal signed agreement with a county or
20 counties to treat such county's indigent patients; or
21 (b) Demonstrated to the agency board that at least 2.5
22 percent of its uncompensated charity care, as reported to the
23 board, is generated by out-of-county residents.
24 Section 3. Subsections (2) and (3) of section
25 394.4788, Florida Statutes, are amended to read:
26 394.4788 Use of certain PMATF funds for the purchase
27 of acute care mental health services.--
28 (2) By October 1, 1989, and annually thereafter, The
29 agency shall annually calculate a per diem reimbursement rate
30 for each specialty psychiatric hospital to be paid to the
31 specialty psychiatric hospitals for the provision of acute
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1 mental health services provided to indigent mentally ill
2 patients who meet the criteria in subsection (1). After the
3 first rate period, providers shall be notified of new
4 reimbursement rates for each new state fiscal year by June 1.
5 The new reimbursement rates shall commence July 1.
6 (3) Reimbursement rates shall be calculated using the
7 most recent audited actual costs received by the agency. Cost
8 data received as of August 15, 1989, and each April 15
9 thereafter shall be used in the calculation of the rates.
10 Historic costs shall be inflated from the midpoint of a
11 hospital's fiscal year to the midpoint of the state fiscal
12 year. The inflation adjustment shall be made utilizing the
13 latest available projections as of March 31 for the Data
14 Resources Incorporated National and Regional Hospital Input
15 Price Indices as calculated by the Medicaid program office.
16 Section 4. Paragraph (a) of subsection (4) of section
17 240.4076, Florida Statutes, is amended to read:
18 240.4076 Nursing scholarship loan program.--
19 (4) Credit for repayment of a scholarship loan shall
20 be on a year-for-year basis as follows:
21 (a) For each year of scholarship loan assistance, the
22 recipient agrees to work for 12 months at a health care
23 facility in a medically underserved area as approved by the
24 Department of Health and Rehabilitative Services. Eligible
25 health care facilities include state-operated medical or
26 health care facilities, county public health units, federally
27 sponsored community health centers, or teaching hospitals as
28 defined in s. 408.07 s. 408.07(49).
29 Section 5. Subsection (1) of section 395.0163, Florida
30 Statutes, is amended to read:
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1 395.0163 Construction inspections; plan submission and
2 approval; fees.--
3 (1)(a) The agency shall make, or cause to be made,
4 such construction inspections and investigations as it deems
5 necessary. The agency may prescribe by rule that any licensee
6 or applicant desiring to make specified types of alterations
7 or additions to its facilities or to construct new facilities
8 shall, before commencing such alteration, addition, or new
9 construction, submit plans and specifications therefor to the
10 agency for preliminary inspection and approval or
11 recommendation with respect to compliance with agency rules
12 and standards. The agency shall approve or disapprove the
13 plans and specifications within 60 days after receipt of the
14 fee for review of plans as required in subsection (2). The
15 agency may be granted one 15-day extension for the review
16 period if the director of the agency approves the extension.
17 If the agency fails to act within the specified time, it shall
18 be deemed to have approved the plans and specifications. When
19 the agency disapproves plans and specifications, it shall set
20 forth in writing the reasons for its disapproval. Conferences
21 and consultations may be provided as necessary.
22 (b) All outpatient facilities that provide surgical
23 treatments requiring general anesthesia or IV conscious
24 sedation, that provide cardiac catheterization services, or
25 that are to be licensed as ambulatory surgical centers shall
26 submit plans and specifications to the agency for review under
27 this section. All other outpatient facilities must be reviewed
28 under this section, except that those that are physically
29 detached from, and have no utility connections with, the
30 hospital and that do not block emergency egress from or create
31 a fire hazard to the hospital are exempt from review under
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1 this section. This paragraph applies to applications for which
2 review is pending on or after July 1, 1998.
3 Section 6. Paragraph (d) of subsection (1) of section
4 395.1055, Florida Statutes, is amended to read:
5 395.1055 Rules and enforcement.--
6 (1) The agency shall adopt, amend, promulgate, and
7 enforce rules to implement the provisions of this part, which
8 shall include reasonable and fair minimum standards for
9 ensuring that:
10 (d) New facilities and a new wing or floor added to an
11 existing facility after July 1, 1999, are structurally capable
12 of serving as shelters only for patients, staff, and families
13 of staff and patients, and equipped to be self-supporting
14 during and immediately following disasters.
15 Section 7. The Agency for Health Care Administration
16 shall work with persons affected by section 6 and report to
17 the Governor and Legislature by April 1, 1998, its
18 recommendations for cost-effective renovation standards to be
19 applied to existing facilities.
20 Section 8. Paragraphs (a) and (b) of subsection (1) of
21 section 395.401, Florida Statutes, are amended to read:
22 395.401 Trauma services system plans; verification of
23 trauma centers and pediatric trauma referral centers;
24 procedures; renewal.--
25 (1) As used in this part, the term:
26 (a) "Agency" means the Agency for Health Care
27 Administration. "Board" means the Health Care Board.
28 (b) "Charity care" or "uncompensated charity care"
29 means that portion of hospital charges reported to the agency
30 board for which there is no compensation for care provided to
31 a patient whose family income for the 12 months preceding the
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1 determination is less than or equal to 150 percent of the
2 federal poverty level, unless the amount of hospital charges
3 due from the patient exceeds 25 percent of the annual family
4 income. However, in no case shall the hospital charges for a
5 patient whose family income exceeds 4 times the federal
6 poverty level for a family of four be considered charity.
7 Section 9. Subsections (1), (2), (3), and (4) of
8 section 395.701, Florida Statutes, are amended to read:
9 395.701 Annual assessments on net operating revenues
10 to fund public medical assistance; administrative fines for
11 failure to pay assessments when due.--
12 (1) For the purposes of this section, the term:
13 (a) "Agency" means the Agency for Health Care
14 Administration.
15 (b)(a) "Gross operating revenue" or "gross revenue"
16 means the sum of daily hospital service charges, ambulatory
17 service charges, ancillary service charges, and other
18 operating revenue.
19 (b) "Health Care Board" or "board" means the Health
20 Care Board created by s. 20.42.
21 (c) "Hospital" means a health care institution as
22 defined in s. 395.002(11) s. 395.002(12), but does not include
23 any hospital operated by the agency or the Department of
24 Corrections.
25 (d) "Net operating revenue" or "net revenue" means
26 gross revenue less deductions from revenue.
27 (e) "Total deductions from gross revenue" or
28 "deductions from revenue" means reductions from gross revenue
29 resulting from inability to collect payment of charges. Such
30 reductions include bad debts; contractual adjustments;
31 uncompensated care; administrative, courtesy, and policy
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1 discounts and adjustments; and other such revenue deductions,
2 but also includes the offset of restricted donations and
3 grants for indigent care.
4 (2) There is hereby imposed upon each hospital an
5 assessment in an amount equal to 1.5 percent of the annual net
6 operating revenue for each hospital, such revenue to be
7 determined by the agency department, based on the actual
8 experience of the hospital as reported to the agency
9 department. Within 6 months after the end of each hospital
10 fiscal year, the agency department shall certify the amount of
11 the assessment for each hospital. The assessment shall be
12 payable to and collected by the agency department in equal
13 quarterly amounts, on or before the first day of each calendar
14 quarter, beginning with the first full calendar quarter that
15 occurs after the agency department certifies the amount of the
16 assessment for each hospital. All moneys collected pursuant to
17 this subsection shall be deposited into the Public Medical
18 Assistance Trust Fund.
19 (3) The agency department shall impose an
20 administrative fine, not to exceed $500 per day, for failure
21 of any hospital to pay its assessment by the first day of the
22 calendar quarter on which it is due. The failure of a
23 hospital to pay its assessment within 30 days after the
24 assessment is due is ground for the agency department to
25 impose an administrative fine not to exceed $5,000 per day.
26 (4) The purchaser, successor, or assignee of a
27 facility subject to the agency's board's jurisdiction shall
28 assume full liability for any assessments, fines, or penalties
29 of the facility or its employees, regardless of when
30 identified. Such assessments, fines, or penalties shall be
31 paid by the employee, owner, or licensee who incurred them,
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1 within 15 days of the sale, transfer, or assignment. However,
2 the purchaser, successor, or assignee of the facility may
3 withhold such assessments, fines, or penalties from purchase
4 moneys or payment due to the seller, transferor, or employee,
5 and shall make such payment on behalf of the seller,
6 transferor, or employee. Any employer, purchaser, successor,
7 or assignee who fails to withhold sufficient funds to pay
8 assessments, fines, or penalties arising under the provisions
9 of chapter 408 shall make such payments within 15 days of the
10 date of the transfer, purchase, or assignment. Failure by the
11 transferee to make payments as provided in this subsection
12 shall subject such transferee to the penalties and assessments
13 provided in chapter 408. Further, in the event of sale,
14 transfer, or assignment of any facility under the agency's
15 board's jurisdiction, future assessments shall be based upon
16 the most recently available prior year report or audited
17 actual experience for the facility. It shall be the
18 responsibility of the new owner or licensee to require the
19 production of the audited financial data for the period of
20 operation of the prior owner. If the transferee fails to
21 obtain current audited financial data from the previous owner
22 or licensee, the new owner shall be assessed based upon the
23 most recent year of operation for which 12 months of audited
24 actual experience are available or upon a reasonable estimate
25 of 12 months of full operation as calculated by the agency
26 board.
27 Section 10. Subsection (1), paragraphs (e) and (f) of
28 subsection (3), subsection (6), and paragraphs (c) and (d) of
29 subsection (7) of section 408.05, Florida Statutes, are
30 amended to read:
31 408.05 State Center for Health Statistics.--
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1 (1) ESTABLISHMENT.--The agency department shall
2 establish a State Center for Health Statistics. The center
3 shall establish a comprehensive health information system to
4 provide for the collection, compilation, coordination,
5 analysis, indexing, dissemination, and utilization of both
6 purposefully collected and extant health-related data and
7 statistics. The center shall be staffed with public health
8 experts, biostatisticians, information system analysts, health
9 policy experts, economists, and other staff necessary to carry
10 out its functions.
11 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order
12 to produce comparable and uniform health information and
13 statistics, the agency shall perform the following functions:
14 (e) The agency department shall establish by rule the
15 types of data collected, compiled, processed, used, or shared.
16 Decisions regarding center data sets should be made based on
17 consultation with the Comprehensive Health Information System
18 Advisory Council and other public and private users regarding
19 the types of data which should be collected and their uses.
20 (f) The center shall establish standardized means for
21 collecting health information and statistics under laws and
22 rules administered by the agency department.
23 (6) PROVIDER DATA REPORTING.--This section does not
24 confer on the agency department the power to demand or require
25 that a health care provider or professional furnish
26 information, records of interviews, written reports,
27 statements, notes, memoranda, or data other than as expressly
28 required by law.
29 (7) BUDGET; FEES; TRUST FUND.--
30 (c) The center may charge such reasonable fees for
31 services as the agency department prescribes by rule. The
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1 established fees may shall not exceed the reasonable cost for
2 such services. Fees collected may not be used to offset
3 annual appropriations from the General Revenue Fund.
4 (d) The agency department shall establish a
5 Comprehensive Health Information System Trust Fund as the
6 repository of all funds appropriated to, and fees and grants
7 collected for, services of the State Center for Health
8 Statistics. Any funds, other than funds appropriated to the
9 center from the General Revenue Fund, which are raised or
10 collected by the agency department for the operation of the
11 center and which are not needed to meet the expenses of the
12 center for its current fiscal year shall be available to the
13 agency board in succeeding years.
14 Section 11. Subsections (10) and (11) of section
15 408.061, Florida Statutes, are amended to read:
16 408.061 Data collection; uniform systems of financial
17 reporting; information relating to physician charges;
18 confidentiality of patient records; immunity.--
19 (10) No health care facility, health care provider,
20 health insurer, or other reporting entity or its employees or
21 agents shall be held liable for civil damages or subject to
22 criminal penalties either for the reporting of patient data to
23 the agency board or for the release of such data by the agency
24 board as authorized by this chapter.
25 (11) The agency shall be the primary source for
26 collection and dissemination of health care data. No other
27 agency of state government may gather data from a health care
28 provider licensed or regulated under this chapter without
29 first determining if the data is currently being collected by
30 the agency and affirmatively demonstrating that it would be
31 more cost-effective for an agency of state government other
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1 than the agency to gather the health care data. The director
2 secretary shall ensure that health care data collected by the
3 divisions within the agency is coordinated. It is the express
4 intent of the Legislature that all health care data be
5 collected by a single source within the agency and that other
6 divisions within the agency, and all other agencies of state
7 government, obtain data for analysis, regulation, and public
8 dissemination purposes from that single source. Confidential
9 information may be released to other governmental entities or
10 to parties contracting with the agency to perform agency
11 duties or functions as needed in connection with the
12 performance of the duties of the receiving entity. The
13 receiving entity or party shall retain the confidentiality of
14 such information as provided for herein.
15 Section 12. Subsections (2) and (5) of section
16 408.062, Florida Statutes, are amended to read:
17 408.062 Research, analyses, studies, and reports.--
18 (2) The agency board shall evaluate data from nursing
19 home financial reports and shall document and monitor:
20 (a) Total revenues, annual change in revenues, and
21 revenues by source and classification, including contributions
22 for a resident's care from the resident's resources and from
23 the family and contributions not directed toward any specific
24 resident's care.
25 (b) Average resident charges by geographic region,
26 payor, and type of facility ownership.
27 (c) Profit margins by geographic region and type of
28 facility ownership.
29 (d) Amount of charity care provided by geographic
30 region and type of facility ownership.
31 (e) Resident days by payor category.
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1 (f) Experience related to Medicaid conversion as
2 reported under s. 408.061.
3 (g) Other information pertaining to nursing home
4 revenues and expenditures.
5
6 The findings of the agency board shall be included in an
7 annual report to the Governor and Legislature by January 1
8 each year.
9 (5)(a) The agency may conduct data-based studies and
10 evaluations and make recommendations to the Legislature and
11 the Governor concerning exemptions, the effectiveness of
12 limitations of referrals, restrictions on investment interests
13 and compensation arrangements, and the effectiveness of public
14 disclosure. Such analysis may include, but need not be
15 limited to, utilization of services, cost of care, quality of
16 care, and access to care. The agency may require the
17 submission of data necessary to carry out this duty, which may
18 include, but need not be limited to, data concerning
19 ownership, Medicare and Medicaid, charity care, types of
20 services offered to patients, revenues and expenses,
21 patient-encounter data, and other data reasonably necessary to
22 study utilization patterns and the impact of health care
23 provider ownership interests in health-care-related entities
24 on the cost, quality, and accessibility of health care.
25 (b) The agency may collect such data from any health
26 facility as a special study. The board is directed to research
27 hospital financial and nonfinancial data in order to determine
28 the need for establishing a category of inpatient hospital
29 patients defined as medically indigent. For purposes of this
30 section, a medically indigent patient is an individual who is
31 admitted as an inpatient to a hospital, who is not classified
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1 as a Medicare beneficiary, a Medicaid recipient, or a charity
2 care patient, but who has insufficient financial resources to
3 pay for needed medical care. In its determination of the need
4 for establishing a category of medically indigent patients,
5 the board shall consider the creation of income and asset
6 levels that would establish a person as medically indigent.
7 The board shall submit a report and recommendations to the
8 Governor and the Legislature on the establishment of a
9 category of medically indigent inpatient hospital patients on
10 or before January 1, 1994. If the board recommends the
11 establishment of a category of medically indigent patients, it
12 shall provide a specific recommendation for the eligibility
13 determination process to be used in classifying a patient as
14 medically indigent.
15 Section 13. Subsection (1) of section 408.063, Florida
16 Statutes, is amended to read:
17 408.063 Dissemination of health care information.--
18 (1) The agency, relying on data collected pursuant to
19 this chapter, shall establish a reliable, timely, and
20 consistent information system that which distributes
21 information and serves as the basis for the agency's board's
22 public education programs. The agency shall seek advice from
23 consumers, health care purchasers, health care providers,
24 health care facilities, health insurers, and local health
25 councils in the development and implementation of its
26 information system. Whenever appropriate, the agency shall use
27 the local health councils for the dissemination of information
28 and education of the public.
29 Section 14. Section 408.07, Florida Statutes, is
30 amended to read:
31
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1 408.07 Definitions.--As used in this chapter, with the
2 exception of ss. 408.031-408.045, the term:
3 (1) "Accepted" means that the agency board has found
4 that a report or data submitted by a health care facility or a
5 health care provider contains all schedules and data required
6 by the agency board and has been prepared in the format
7 specified by the agency board, and otherwise conforms to
8 applicable rule or Florida Hospital Uniform Reporting System
9 manual requirements regarding reports in effect at the time
10 such report was submitted, and the data are mathematically
11 reasonable and accurate.
12 (2) "Adjusted admission" means the sum of acute and
13 intensive care admissions divided by the ratio of inpatient
14 revenues generated from acute, intensive, ambulatory, and
15 ancillary patient services to gross revenues. If a hospital
16 reports only subacute admissions, then "adjusted admission"
17 means the sum of subacute admissions divided by the ratio of
18 total inpatient revenues to gross revenues.
19 (3) "Agency" means the Agency for Health Care
20 Administration.
21 (4) "Alcohol or chemical dependency treatment center"
22 means an organization licensed under chapter 397.
23 (5) "Ambulatory care center" means an organization
24 which employs or contracts with licensed health care
25 professionals to provide diagnosis or treatment services
26 predominantly on a walk-in basis and the organization holds
27 itself out as providing care on a walk-in basis. Such an
28 organization is not an ambulatory care center if it is wholly
29 owned and operated by five or fewer health care providers.
30 (6) "Ambulatory surgical center" means a facility
31 licensed as an ambulatory surgical center under chapter 395.
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1 (7) "Applicable rate of increase" means the maximum
2 allowable rate of increase (MARI) when applied to gross
3 revenue per adjusted admission, unless the board has approved
4 a different rate of increase, in which case the board-approved
5 rate of increase shall apply.
6 (7)(8) "Audited actual data" means information
7 contained within financial statements examined by an
8 independent, Florida-licensed, certified public accountant in
9 accordance with generally accepted auditing standards, but
10 does not include data within a financial statement about which
11 the certified public accountant does not express an opinion or
12 issues a disclaimer.
13 (9) "Banked points" means the percentage points earned
14 by a hospital when the actual rate of increase in gross
15 revenue per adjusted admission (GRAA) is less than the maximum
16 allowable rate of increase (MARI) or the actual rate of
17 increase in the net revenue per adjusted admission (NRAA) is
18 less than the market basket index.
19 (8)(10) "Birth center" means an organization licensed
20 under s. 383.305.
21 (11) "Board" means the Health Care Board established
22 under s. 408.003.
23 (12) "Budget" means the projections by the hospital,
24 for a specified future time period, of expenditures and
25 revenues, with supporting statistical indicators, or a budget
26 letter verified by the board pursuant to s. 408.072(3)(a).
27 (9)(13) "Cardiac catheterization laboratory" means a
28 freestanding facility that which employs or contracts with
29 licensed health care professionals to provide diagnostic or
30 therapeutic services for cardiac conditions such as cardiac
31 catheterization or balloon angioplasty.
19
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1 (10)(14) "Case mix" means a calculated index for each
2 health care facility or health care provider, based on patient
3 data, reflecting the relative costliness of the mix of cases
4 to that facility or provider compared to a state or national
5 mix of cases.
6 (11)(15) "Clinical laboratory" means a facility
7 licensed under s. 483.091, excluding: any hospital laboratory
8 defined under s. 483.041(5); any clinical laboratory operated
9 by the state or a political subdivision of the state; any
10 blood or tissue bank where the majority of revenues are
11 received from the sale of blood or tissue and where blood,
12 plasma, or tissue is procured from volunteer donors and
13 donated, processed, stored, or distributed on a nonprofit
14 basis; and any clinical laboratory which is wholly owned and
15 operated by physicians who are licensed pursuant to chapter
16 458 or chapter 459 and who practice in the same group
17 practice, and at which no clinical laboratory work is
18 performed for patients referred by any health care provider
19 who is not a member of that same group practice.
20 (12)(16) "Comprehensive rehabilitative hospital" or
21 "rehabilitative hospital" means a hospital licensed by the
22 agency for Health Care Administration as a specialty hospital
23 as defined in s. 395.002; provided that the hospital provides
24 a program of comprehensive medical rehabilitative services and
25 is designed, equipped, organized, and operated solely to
26 deliver comprehensive medical rehabilitative services, and
27 further provided that all licensed beds in the hospital are
28 classified as "comprehensive rehabilitative beds" pursuant to
29 s. 395.003(4), and are not classified as "general beds."
30 (13)(17) "Consumer" means any person other than a
31 person who administers health activities, is a member of the
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1 governing body of a health care facility, provides health
2 services, has a fiduciary interest in a health facility or
3 other health agency or its affiliated entities, or has a
4 material financial interest in the rendering of health
5 services.
6 (14)(18) "Continuing care facility" means a facility
7 licensed under chapter 651.
8 (15)(19) "Cross-subsidization" means that the revenues
9 from one type of hospital service are sufficiently higher than
10 the costs of providing such service as to offset some of the
11 costs of providing another type of service in the hospital.
12 Cross-subsidization results from the lack of a direct
13 relationship between charges and the costs of providing a
14 particular hospital service or type of service.
15 (16)(20) "Deductions from gross revenue" or
16 "deductions from revenue" means reductions from gross revenue
17 resulting from inability to collect payment of charges. For
18 hospitals, such reductions include contractual adjustments;
19 uncompensated care; administrative, courtesy, and policy
20 discounts and adjustments; and other such revenue deductions,
21 but also includes the offset of restricted donations and
22 grants for indigent care.
23 (17)(21) "Diagnostic-imaging center" means a
24 freestanding outpatient facility that provides specialized
25 services for the diagnosis of a disease by examination and
26 also provides radiological services. Such a facility is not a
27 diagnostic-imaging center if it is wholly owned and operated
28 by physicians who are licensed pursuant to chapter 458 or
29 chapter 459 and who practice in the same group practice and no
30 diagnostic-imaging work is performed at such facility for
31
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1 patients referred by any health care provider who is not a
2 member of that same group practice.
3 (18)(22) "FHURS" means the Florida Hospital Uniform
4 Reporting System developed by the agency board.
5 (19)(23) "Freestanding" means that a health facility
6 bills and receives revenue which is not directly subject to
7 the hospital assessment for the Public Medical Assistance
8 Trust Fund as described in s. 395.701.
9 (20)(24) "Freestanding radiation therapy center" means
10 a facility where treatment is provided through the use of
11 radiation therapy machines that are registered under s. 404.22
12 and the provisions of the Florida Administrative Code
13 implementing s. 404.22. Such a facility is not a freestanding
14 radiation therapy center if it is wholly owned and operated by
15 physicians licensed pursuant to chapter 458 or chapter 459 who
16 practice within the specialty of diagnostic or therapeutic
17 radiology.
18 (21)(25) "GRAA" means gross revenue per adjusted
19 admission.
20 (22)(26) "Gross revenue" means the sum of daily
21 hospital service charges, ambulatory service charges,
22 ancillary service charges, and other operating revenue. Gross
23 revenues do not include contributions, donations, legacies, or
24 bequests made to a hospital without restriction by the donors.
25 (23)(27) "Health care facility" means an ambulatory
26 surgical center, a hospice, a nursing home, a hospital, a
27 diagnostic-imaging center, a freestanding or hospital-based
28 therapy center, a clinical laboratory, a home health agency, a
29 cardiac catheterization laboratory, a medical equipment
30 supplier, an alcohol or chemical dependency treatment center,
31 a physical rehabilitation center, a lithotripsy center, an
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1 ambulatory care center, a birth center, or a nursing home
2 component licensed under chapter 400 within a continuing care
3 facility licensed under chapter 651.
4 (24)(28) "Health care provider" means a health care
5 professional licensed under chapter 458, chapter 459, chapter
6 460, chapter 461, chapter 463, chapter 464, chapter 465,
7 chapter 466, part I, part III, part IV, part V, or part X of
8 chapter 468, chapter 483, chapter 484, chapter 486, chapter
9 490, or chapter 491.
10 (25)(29) "Health care purchaser" means an employer in
11 the state, other than a health care facility, health insurer,
12 or health care provider, who provides health care coverage for
13 her or his employees.
14 (26)(30) "Health insurer" means any insurance company
15 authorized to transact health insurance in the state, any
16 insurance company authorized to transact health insurance or
17 casualty insurance in the state that is offering a minimum
18 premium plan or stop-loss coverage for any person or entity
19 providing health care benefits, any self-insurance plan as
20 defined in s. 624.031, any health maintenance organization
21 authorized to transact business in the state pursuant to part
22 I of chapter 641, any prepaid health clinic authorized to
23 transact business in the state pursuant to part II of chapter
24 641, any multiple-employer welfare arrangement authorized to
25 transact business in the state pursuant to ss. 624.436-624.45,
26 or any fraternal benefit society providing health benefits to
27 its members as authorized pursuant to chapter 632.
28 (27)(31) "Home health agency" means an organization
29 licensed under part IV of chapter 400.
30 (28)(32) "Hospice" means an organization licensed
31 under part VI of chapter 400.
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1 (29)(33) "Hospital" means a health care institution
2 licensed by the Agency for Health Care Administration as a
3 hospital under chapter 395.
4 (30)(34) "Lithotripsy center" means a freestanding
5 facility that which employs or contracts with licensed health
6 care professionals to provide diagnosis or treatment services
7 using electro-hydraulic shock waves.
8 (31)(35) "Local health council" means the agency
9 defined in s. 408.033.
10 (32)(36) "Market basket index" means the Florida
11 hospital input price index (FHIPI), which is a statewide
12 market basket index used to measure inflation in hospital
13 input prices weighted for the Florida-specific experience
14 which uses multistate regional and state-specific price
15 measures, when available. The index shall be constructed in
16 the same manner as the index employed by the Secretary of the
17 United States Department of Health and Human Services for
18 determining the inflation in hospital input prices for
19 purposes of Medicare reimbursement.
20 (37) "Maximum allowable rate of increase" or "MARI"
21 means the maximum rate at which a hospital is normally
22 expected to increase its average gross revenues per adjusted
23 admission for a given period. The board, using the most
24 recent audited actual data for each hospital, shall calculate
25 the MARI for each hospital as follows: The projected rate of
26 increase in the market basket index shall be divided by a
27 number which is determined by subtracting the sum of one-half
28 of the proportion of Medicare days plus one-half of the
29 proportion of CHAMPUS days plus the proportion of Medicaid
30 days plus 1.5 times the proportion of charity care days from
31
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1 the number one. The formula to be employed by the board to
2 calculate the MARI shall take the following form:
3
4 FHIPI
5 MARI = (....................................)
6 1-[(Me x 0.5) + (Cp x 0.5) + Md + (Cc x 1.5)]
7
8 where:
9 MARI = maximum allowable rate of increase applied to
10 gross revenue.
11 FHIPI = Florida hospital input price index, which shall
12 be the projected rate of change in the market basket index.
13 Me = proportion of Medicare days, including when
14 available and reported to the board Medicare HMO days, to
15 total days.
16 Cp = proportion of Civilian Health and Medical Program
17 of the Uniformed Services (CHAMPUS) days to total days.
18 Md = proportion of Medicaid days, including when
19 available and reported to the board Medicaid HMO days, to
20 total days.
21 Cc = proportion of charity care days to total days with
22 a 50-percent offset for restricted grants for charity care and
23 unrestricted grants from local governments.
24 (33)(38) "Medical equipment supplier" means an
25 organization that which provides medical equipment and
26 supplies used by health care providers and health care
27 facilities in the diagnosis or treatment of disease.
28 (34)(39) "Net revenue" means gross revenue minus
29 deductions from revenue.
30 (35)(40) "New hospital" means a hospital in its
31 initial year of operation as a licensed hospital and does not
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1 include any facility which has been in existence as a licensed
2 hospital, regardless of changes in ownership, for over 1
3 calendar year.
4 (36)(41) "Nursing home" means a facility licensed
5 under s. 400.062 or, for resident level and financial data
6 collection purposes only, any institution licensed under
7 chapter 395 and which has a Medicare or Medicaid certified
8 distinct part used for skilled nursing home care, but does not
9 include a facility licensed under chapter 651.
10 (37)(42) "Operating expenses" means total expenses
11 excluding income taxes.
12 (38)(43) "Other operating revenue" means all revenue
13 generated from hospital operations other than revenue directly
14 associated with patient care.
15 (39)(44) "Physical rehabilitation center" means an
16 organization that which employs or contracts with health care
17 professionals licensed under part I or part III of chapter 468
18 or chapter 486 to provide speech, occupational, or physical
19 therapy services on an outpatient or ambulatory basis.
20 (40)(45) "Prospective payment arrangement" means a
21 financial agreement negotiated between a hospital and an
22 insurer, health maintenance organization, preferred provider
23 organization, or other third-party payor which contains, at a
24 minimum, the elements provided for in s. 408.50.
25 (41)(46) "Rate of return" means the financial
26 indicators used to determine or demonstrate reasonableness of
27 the financial requirements of a hospital. Such indicators
28 shall include, but not be limited to: return on assets,
29 return on equity, total margin, and debt service coverage.
30 (42)(47) "Rural hospital" means an acute care hospital
31 licensed under chapter 395, with 85 licensed beds or fewer,
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1 which has an emergency room and is located in an area defined
2 as rural by the United States Census, and which is:
3 (a) The sole provider within a county with a
4 population density of no greater than 100 persons per square
5 mile;
6 (b) An acute care hospital, in a county with a
7 population density of no greater than 100 persons per square
8 mile, which is at least 30 minutes of travel time, on normally
9 traveled roads under normal traffic conditions, from another
10 acute care hospital within the same county; or
11 (c) A hospital supported by a tax district or
12 subdistrict whose boundaries encompass a population of 100
13 persons or less per square mile.
14 (43)(48) "Special study" means a nonrecurring
15 data-gathering and analysis effort designed to aid the agency
16 for Health Care Administration in meeting its responsibilities
17 pursuant to this chapter.
18 (44)(49) "Teaching hospital" means any hospital
19 formally affiliated with an accredited medical school which
20 that exhibits activity in the area of medical education as
21 reflected by at least seven different resident physician
22 specialties and the presence of 100 or more resident
23 physicians.
24 Section 15. Section 408.08, Florida Statutes, is
25 amended to read:
26 408.08 Inspections and audits; violations; penalties;
27 fines; enforcement.--
28 (1) The agency may inspect and audit books and records
29 of individual or corporate ownership, including books and
30 records of related organizations with which a health care
31 provider or a health care facility had transactions, for
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1 compliance with this chapter. Upon presentation of a written
2 request for inspection to a health care provider or a health
3 care facility by the agency or its staff, the health care
4 provider or the health care facility shall make available to
5 the agency or its staff for inspection, copying, and review
6 all books and records relevant to the determination of whether
7 the health care provider or the health care facility has
8 complied with this chapter.
9 (2) The board shall annually compare the audited
10 actual experience of each hospital to the audited actual
11 experience of that hospital for the previous year.
12 (a) For a hospital submitting a budget letter, if the
13 board determines that the audited actual experience of the
14 hospital exceeded its previous year's audited actual
15 experience by more than the maximum allowable rate of increase
16 as certified in the budget letter plus any banked points
17 utilized in the budget letter, the amount of such excess shall
18 be determined by the board and a penalty shall be levied
19 against such hospital pursuant to subsection (3).
20 (b) For a hospital subject to budget review, if the
21 board determines that the audited actual experience of the
22 hospital exceeded its previous year's audited actual
23 experience by more than the most recent approved budget or the
24 most recent approved budget as amended, the amount of such
25 excess shall be determined by the board, and a penalty shall
26 be levied against such hospital pursuant to subsection (3).
27 (c) For a hospital submitting a budget letter and for
28 a hospital subject to budget review, the board shall annually
29 compare each hospital's audited actual experience for net
30 revenues per adjusted admission to the hospital's audited
31 actual experience for net revenues per adjusted admission for
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1 the previous year. If the rate of increase in net revenues
2 per adjusted admission between the previous year and the
3 current year was less than the market basket index, the
4 hospital may carry forward the difference and earn up to a
5 cumulative maximum of 3 banked net revenue percentage points.
6 Such banked net revenue percentage points shall be available
7 to the hospital to offset, in any future year, penalties for
8 exceeding the approved budget or the maximum allowable rate of
9 increase as set forth in subsection (3). Nothing in this
10 paragraph shall be used by a hospital to justify the approval
11 of a budget or a budget amendment by the board in excess of
12 the maximum allowable rate of increase pursuant to s. 408.072.
13 (3) Penalties shall be assessed as follows:
14 (a) For the first occurrence within a 5-year period,
15 the board shall prospectively reduce the current budget of the
16 hospital by the amount of the excess up to 5 percent; and, if
17 such excess is greater than 5 percent over the maximum
18 allowable rate of increase, any amount in excess of 5 percent
19 shall be levied by the board as a fine against such hospital
20 to be deposited in the Public Medical Assistance Trust Fund.
21 (b) For the second occurrence with the 5-year period
22 following the first occurrence as set forth in paragraph (a),
23 the board shall prospectively reduce the current budget of the
24 hospital by the amount of the excess up to 2 percent; and, if
25 such excess is greater than 2 percent over the maximum
26 allowable rate of increase, any amount in excess of 2 percent
27 shall be levied by the board as a fine against such hospital
28 to be deposited in the Public Medical Assistance Trust Fund.
29 (c) For the third occurrence within the 5-year period
30 following the first occurrence as set forth in paragraph (a),
31 the board shall:
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1 1. Levy a fine against the hospital in the total
2 amount of the excess, to be deposited in the Public Medical
3 Assistance Trust Fund.
4 2. Notify the agency of the violation, whereupon the
5 agency shall not accept any application for a certificate of
6 need pursuant to ss. 408.031-408.045 from or on behalf of such
7 hospital until such time as the hospital has demonstrated to
8 the satisfaction of the board that, following the date the
9 penalty was imposed under subparagraph 1., the hospital has
10 stayed within its projected or amended budget or its
11 applicable maximum allowable rate of increase for a period of
12 at least 1 year. However, this provision does not apply with
13 respect to a certificate-of-need application filed to satisfy
14 a life or safety code violation.
15 3. Upon a determination that the hospital knowingly
16 and willfully generated such excess, notify the agency,
17 whereupon the agency shall initiate disciplinary proceedings
18 to deny, modify, suspend, or revoke the license of such
19 hospital or impose an administrative fine on such hospital not
20 to exceed $20,000.
21
22 The determination of the amount of any such excess shall be
23 based upon net revenues per adjusted admission, excluding
24 funds distributed to the hospital from the Public Medical
25 Assistance Trust Fund. However, in making such determination,
26 the board shall appropriately reduce the amount of the excess
27 by the total amount of the assessment paid by such hospital
28 pursuant to s. 395.701 minus the amount of revenues received
29 by the hospital through the Public Medical Assistance Trust
30 Fund. It is the responsibility of the hospital to demonstrate
31 to the satisfaction of the board its entitlement to such
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1 reduction. It is the intent of the Legislature that the
2 Health Care Board, in levying any penalty imposed against a
3 hospital for exceeding its maximum allowable rate of increase
4 or its approved budget pursuant to this subsection, consider
5 the effect of changes in the case mix of the hospital and in
6 the hospital's intensity and severity of illness as measured
7 by changes in the hospital's actual proportion of outlier
8 cases to total cases and dollar increases in outlier cases'
9 average charge per case. It is the responsibility of the
10 hospital to demonstrate to the satisfaction of the board any
11 change in its case mix and in its intensity and severity of
12 illness. For psychiatric hospitals and other hospitals not
13 reimbursed under a prospective payment system by the Federal
14 Government, until a proxy for case mix is available, the board
15 shall also reduce the amount of excess by the change in a
16 hospital's audited actual average length of stay without any
17 thresholds or limitations.
18 (4) The following factors may be used by the board to
19 reduce the amount of excess of the hospital as determined
20 pursuant to this section:
21 (a) Unforeseen and unforeseeable events which affect
22 the net revenue per adjusted admission and which are beyond
23 the control of the hospital, such as prior year Medicare cost
24 report settlements, retroactive changes in Medicare
25 reimbursement methodology, and increases in malpractice
26 insurance premiums, which occurred in the last 3 months of the
27 hospital fiscal year during which the hospital generated the
28 excess; or
29 (b) Imposition of the penalty would have a severe
30 adverse effect which would jeopardize the continued existence
31 of an otherwise economically viable hospital.
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1 (5) The board shall reduce the amount of the excess
2 for hospitals submitting budget letters pursuant to s.
3 408.072(3)(a) by the amount of any documented costs from
4 financial assistance provided to expand or supplement the
5 curriculum of a community college, university, or vocational
6 training school for the purpose of training nurses or other
7 health professionals, not including physicians. Financial
8 assistance would include, but not be limited to, the direct
9 costs for faculty salaries and expenses, books, equipment,
10 recruiting efforts, tuition assistance, and hospital
11 internships. The reduction would be based on actual
12 documented expenses increased by the gross revenues necessary
13 to generate net revenues sufficient to cover the expenses.
14 (6) If the board finds that any hospital chief
15 executive officer or any person who is in charge of hospital
16 administration or operations has knowingly and willfully
17 allowed or authorized actual operating revenues or
18 expenditures that are in excess of projected operating
19 revenues or expenditures in the hospital's approved budget,
20 the board shall order such officer or person to pay an
21 administrative fine not to exceed $5,000.
22 (7) For hospitals filing budget letters, the board
23 shall annually compare the audited actual experience of each
24 hospital for the year under review to the audited actual
25 experience of that hospital for the previous year. For
26 hospitals which submitted detailed budgets or budget
27 amendments, the board shall compare the audited actual
28 experience of each hospital for the year under review to its
29 approved gross revenue per adjusted admission for the year
30 under review, for purposes of levying an administrative fine.
31
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1 (a) For a hospital submitting a budget letter pursuant
2 to s. 408.072(3)(a), if the board determines that the audited
3 actual experience for the year under review exceeded the
4 hospital's previous year's audited actual experience by more
5 than the maximum allowable rate of increase as certified in
6 the budget letter plus any banked points utilized in the
7 budget letter, the amount of the excess shall be determined
8 and an administrative fine shall be levied against such
9 hospital pursuant to subsection (8).
10 (b) For a hospital which submitted a budget pursuant
11 to s. 408.072(1), or a budget amendment pursuant to s.
12 408.072(6), if the board determines that the gross revenue per
13 adjusted admission contained in the hospital's audited actual
14 experience exceeded its board-approved gross revenue per
15 adjusted admission, the amount of the excess shall be
16 determined and an administrative fine shall be levied against
17 such hospital pursuant to subsection (8).
18 (8) If the board determines that an excess exists
19 pursuant to subsection (7), the board shall multiply the
20 excess by the number of actual adjusted admissions contained
21 in the year at issue to determine the amount of the base fine.
22 The base fine shall be multiplied by the applicable occurrence
23 factor to determine the amount of the administrative fine
24 levied against the hospital.
25 (a) For the first occurrence within a 5-year period,
26 the applicable occurrence factor shall be 0.25. For the
27 second occurrence within a 5-year period, the applicable
28 occurrence factor shall be 0.55. For the third occurrence
29 within a 5-year period, the applicable occurrence factor shall
30 be 1.0.
31
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1 (b) In no event shall any administrative fine levied
2 pursuant to this subsection exceed $365,000.
3 (9) In levying any administrative fine against a
4 hospital pursuant to subsection (8), the board shall consider
5 the effect of any changes in the hospital's case mix, and in
6 the hospital's intensity and severity of illness as measured
7 by changes in the hospital's actual proportion of outlier
8 cases to total cases and dollar increases in outlier cases'
9 average charge per case. The board shall adjust the amount of
10 any excess by the changes in the hospital's case mix and in
11 its intensity and severity of illness, based upon certified
12 hospital patient discharge data provided to the board pursuant
13 to s. 408.061. For psychiatric hospitals and other hospitals
14 not reimbursed under a prospective payment system by the
15 Federal Government, until a proxy for case mix is available,
16 the board shall adjust the amount of any excess by the change
17 in a hospital's audited actual average length of stay without
18 any thresholds or limitation.
19 (10) In levying any administrative fine against a
20 hospital pursuant to subsection (8), it is the intent of the
21 Legislature that if a hospital can demonstrate to the
22 satisfaction of the board that it operated within its approved
23 gross revenue per adjusted admission for the first 8 months of
24 its fiscal year and did not increase its prices, except for
25 exceptions determined by the board during the last 5 months of
26 its fiscal year, it shall not be subject to any administrative
27 fine levied pursuant to subsection (8).
28 (11) It is the further intent of the Legislature that
29 if a hospital can demonstrate to the satisfaction of the board
30 that it did not increase its prices on average in excess of
31
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1 the MARI for the prior year, it shall not be subject to any
2 administrative fine levied pursuant to subsection (8).
3 (12) If the board finds that any hospital chief
4 executive officer or any person who is in charge of hospital
5 administration or operations has knowingly and willfully
6 allowed or authorized gross revenue per adjusted admission,
7 net revenue per adjusted admission, or rates of increase that
8 are in excess of gross or net revenue per adjusted admission,
9 or rates of increase in the hospital's approved budget, budget
10 amendment, or budget letter, the agency shall order such
11 officer or person to pay an administrative fine not to exceed
12 $5,000.
13 (2)(13) Any health care facility that refuses to file
14 a report, fails to timely file a report, files a false report,
15 or files an incomplete report and upon notification fails to
16 timely file a complete report required under this section and
17 s. 408.061; that violates any provision of this section, s.
18 408.061, or s. 408.20, or rule adopted thereunder; or that
19 fails to provide documents or records requested by the agency
20 under the provisions of this chapter shall be punished by a
21 fine not exceeding $1,000 per day for each day in violation,
22 to be imposed and collected by the agency.
23 (3)(14) Any health care provider that refuses to file
24 a report, fails to timely file a report, files a false report,
25 or files an incomplete report and upon notification fails to
26 timely file a complete report required under this section and
27 s. 408.061; that violates any provision of this section, s.
28 408.061, or s. 408.20, or rule adopted thereunder; or that
29 fails to provide documents or records requested by the agency
30 under the provisions of this chapter shall be referred to the
31
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1 appropriate licensing board which shall take appropriate
2 action against the health care provider.
3 (4)(15) If In the event that a health insurer does not
4 comply with the requirements of s. 408.061, the agency shall
5 report a health insurer's failure to comply to the Department
6 of Insurance, which shall take into account the failure by the
7 health insurer to comply in conjunction with its approval
8 authority under s. 627.410. The agency shall adopt any rules
9 necessary to carry out its responsibilities required by this
10 subsection.
11 (5)(16) Refusal to file, failure to timely file, or
12 filing false or incomplete reports or other information
13 required to be filed under the provisions of this chapter,
14 failure to pay or failure to timely pay any assessment
15 authorized to be collected by the agency, or violation of any
16 other provision of this chapter or lawfully entered order of
17 the agency or rule adopted under this chapter, shall be
18 punished by a fine not exceeding $1,000 a day for each day in
19 violation, to be fixed, imposed, and collected by the agency.
20 Each day in violation shall be considered a separate offense.
21 (6)(17) Notwithstanding any other provisions of this
22 chapter, when a hospital alleges that a factual determination
23 made by the agency board is incorrect, the burden of proof
24 shall be on the hospital to demonstrate that such
25 determination is, in light of the total record, not supported
26 by a preponderance of the evidence. The burden of proof
27 remains with the hospital in all cases involving
28 administrative agency action.
29 Section 16. Section 408.40, Florida Statutes, is
30 amended to read:
31
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1 408.40 Budget review proceedings; duty of Public
2 Counsel.--
3 (1) Notwithstanding any other provisions of this
4 chapter, it shall be the duty of the Public Counsel shall to
5 represent the general public of the state in any proceeding
6 before the agency or its advisory panels in any administrative
7 hearing conducted pursuant to the provisions of chapter 120 or
8 before any other state and federal agencies and courts in any
9 issue before the agency, any court, or any agency. With
10 respect to any such proceeding, the Public Counsel is subject
11 to the provisions of and may use utilize the powers granted to
12 him or her by ss. 350.061-350.0614.
13 (2) The Public Counsel shall:
14 (a) Recommend to the agency, by petition, the
15 commencement of any proceeding or action or to appear, in the
16 name of the state or its citizens, in any proceeding or action
17 before the agency and urge therein any position that which he
18 or she deems to be in the public interest, whether consistent
19 or inconsistent with positions previously adopted by the
20 agency, and use utilize therein all forms of discovery
21 available to attorneys in civil actions generally, subject to
22 protective orders of the agency, which shall be reviewable by
23 summary procedure in the circuit courts of this state.
24 (b) Have access to and use of all files, records, and
25 data of the agency available to any other attorney
26 representing parties in a proceeding before the agency.
27 (c) In any proceeding in which he or she has
28 participated as a party, seek review of any determination,
29 finding, or order of the agency, or of any administrative law
30 judge, or any hearing officer or hearing examiner designated
31 by the agency, in the name of the state or its citizens.
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1 (d) Prepare and issue reports, recommendations, and
2 proposed orders to the agency, the Governor, and the
3 Legislature on any matter or subject within the jurisdiction
4 of the agency, and to make such recommendations as he or she
5 deems appropriate for legislation relative to agency
6 procedures, rules, jurisdiction, personnel, and functions.
7 (e) Appear before other state agencies, federal
8 agencies, and state and federal courts in connection with
9 matters under the jurisdiction of the agency, in the name of
10 the state or its citizens.
11 Section 17. Paragraph (e) of subsection (10) and
12 subsection (14) of section 409.2673, Florida Statutes, are
13 amended to read:
14 409.2673 Shared county and state health care program
15 for low-income persons; trust fund.--
16 (10) Under the shared county and state program,
17 reimbursement to a hospital for services for an eligible
18 person must:
19 (e) Be conditioned, for tax district hospitals that
20 deliver services as part of this program, on the delivery of
21 charity care, as defined in the rules of the Agency for Health
22 Care Administration Health Care Cost Containment Board, which
23 equals a minimum of 2.5 percent of the tax district hospital's
24 net revenues; however, those tax district hospitals which by
25 virtue of the population within the geographic boundaries of
26 the tax district can not feasibly provide this level of
27 charity care shall assure an "open door" policy to those
28 residents of the geographic boundaries of the tax district who
29 would otherwise be considered charity cases.
30 (14) Any dispute among a county, the Agency for Health
31 Care Administration Health Care Cost Containment Board, the
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1 department, or a participating hospital shall be resolved by
2 order as provided in chapter 120. Hearings held under this
3 subsection shall be conducted in the same manner as provided
4 in ss. 120.569 and 120.57, except that the administrative law
5 judge's or hearing officer's order constitutes final agency
6 action. Cases filed under chapter 120 may combine all relevant
7 disputes between parties.
8 Section 18. Section 409.9113, Florida Statutes, is
9 amended to read:
10 409.9113 Disproportionate share program for teaching
11 hospitals.--In addition to the payments made under ss. 409.911
12 and 409.9112, the Agency for Health Care Administration
13 Department of Health and Rehabilitative Services shall make
14 disproportionate share payments to statutorily defined
15 teaching hospitals for their increased costs associated with
16 medical education programs and for tertiary health care
17 services provided to the indigent. This system of payments
18 shall conform with federal requirements and shall distribute
19 funds in each fiscal year for which an appropriation is made
20 by making quarterly Medicaid payments. Notwithstanding the
21 provisions of s. 409.915, counties are exempt from
22 contributing toward the cost of this special reimbursement for
23 hospitals serving a disproportionate share of low-income
24 patients.
25 (1) On or before September 15 of each year, the Agency
26 for Health Care Administration shall calculate an allocation
27 fraction to be used for distributing funds to state statutory
28 teaching hospitals. Subsequent to the end of each quarter of
29 the state fiscal year, the agency department shall distribute
30 to each statutory teaching hospital, as defined in s. 408.07,
31 an amount determined by multiplying one-fourth of the funds
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1 appropriated for this purpose by the Legislature times such
2 hospital's allocation fraction. The allocation fraction for
3 each such hospital shall be determined by the sum of three
4 primary factors, divided by three. The primary factors are:
5 (a) The number of nationally accredited graduate
6 medical education programs offered by the hospital, including
7 programs accredited by the Accreditation Council for Graduate
8 Medical Education and the combined Internal Medicine and
9 Pediatrics programs acceptable to both the American Board of
10 Internal Medicine and the American Board of Pediatrics at the
11 beginning of the state fiscal year preceding the date on which
12 the allocation fraction is calculated. The numerical value of
13 this factor is the fraction that the hospital represents of
14 the total number of programs, where the total is computed for
15 all state statutory teaching hospitals.
16 (b) The number of full-time equivalent trainees in the
17 hospital, which comprises two components:
18 1. The number of trainees enrolled in nationally
19 accredited graduate medical education programs, as defined in
20 paragraph (a). Full-time equivalents are computed using the
21 fraction of the year during which each trainee is primarily
22 assigned to the given institution, over the state fiscal year
23 preceding the date on which the allocation fraction is
24 calculated. The numerical value of this factor is the fraction
25 that the hospital represents of the total number of full-time
26 equivalent trainees enrolled in accredited graduate programs,
27 where the total is computed for all state statutory teaching
28 hospitals.
29 2. The number of medical students enrolled in
30 accredited colleges of medicine and engaged in clinical
31 activities, including required clinical clerkships and
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1 clinical electives. Full-time equivalents are computed using
2 the fraction of the year during which each trainee is
3 primarily assigned to the given institution, over the course
4 of the state fiscal year preceding the date on which the
5 allocation fraction is calculated. The numerical value of this
6 factor is the fraction that the given hospital represents of
7 the total number of full-time equivalent students enrolled in
8 accredited colleges of medicine, where the total is computed
9 for all state statutory teaching hospitals.
10
11 The primary factor for full-time equivalent trainees is
12 computed as the sum of these two components, divided by two.
13 (c) A service index that which comprises three
14 components:
15 1. The Agency for Health Care Administration Health
16 Care Cost Containment Board Service Index, computed by
17 applying the standard Service Inventory Scores established by
18 the Agency for Health Care Administration Health Care Cost
19 Containment Board to services offered by the given hospital,
20 as reported on the Health Care Cost Containment Board
21 Worksheet A-2 for the last fiscal year reported to the agency
22 board before the date on which the allocation fraction is
23 calculated. The numerical value of this factor is the
24 fraction that the given hospital represents of the total
25 Agency for Health Care Administration Health Care Cost
26 Containment Board Service Index values, where the total is
27 computed for all state statutory teaching hospitals.
28 2. A volume-weighted service index, computed by
29 applying the standard Service Inventory Scores established by
30 the Agency for Health Care Administration Health Care Cost
31 Containment Board to the volume of each service, expressed in
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1 terms of the standard units of measure reported on the Health
2 Care Cost Containment Board Worksheet A-2 for the last fiscal
3 year reported to the agency board before the date on which the
4 allocation factor is calculated. The numerical value of this
5 factor is the fraction that the given hospital represents of
6 the total volume-weighted service index values, where the
7 total is computed for all state statutory teaching hospitals.
8 3. Total Medicaid payments to each hospital for direct
9 inpatient and outpatient services during the fiscal year
10 preceding the date on which the allocation factor is
11 calculated. This includes payments made to each hospital for
12 such services by Medicaid prepaid health plans, whether the
13 plan was administered by the hospital or not. The numerical
14 value of this factor is the fraction that each hospital
15 represents of the total of such Medicaid payments, where the
16 total is computed for all state statutory teaching hospitals.
17
18 The primary factor for the service index is computed as the
19 sum of these three components, divided by three.
20 (2) By October 1 of each year, the agency shall use
21 the following formula shall be utilized by the department to
22 calculate the maximum additional disproportionate share
23 payment for statutorily defined teaching hospitals:
24
25 TAP = THAF x A
26
27 Where:
28 TAP = total additional payment.
29 THAF = teaching hospital allocation factor.
30 A = amount appropriated for a teaching hospital
31 disproportionate share program.
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1
2 (3) The Health Care Cost Containment Board shall
3 report to the department the statutory teaching hospital
4 allocation fraction prior to October 1 of each year.
5 Section 19. Subsection (9) of section 395.403, Florida
6 Statutes, subsection (3) of section 395.806, Florida Statutes,
7 and sections 407.61, 408.003, 408.072, and 408.085, Florida
8 Statutes, are repealed.
9 Section 20. The repeal of laws governing the review of
10 hospital budgets and related penalties contained in this act
11 operates retroactively and applies to any hospital budget
12 prepared for a fiscal year that ended during the 1996 calendar
13 year.
14 Section 21. Subsection (6) of section 381.026, Florida
15 Statutes, is amended to read:
16 381.026 Florida Patient's Bill of Rights and
17 Responsibilities.--
18 (6) SUMMARY OF RIGHTS AND RESPONSIBILITIES.--Any
19 health care provider who treats a patient in an office or any
20 health care facility licensed under chapter 395 that provides
21 emergency services and care or outpatient services and care to
22 a patient, or admits and treats a patient, shall adopt and
23 make available to the patient public, in writing, a statement
24 of the rights and responsibilities of patients, including:
25
26 SUMMARY OF THE FLORIDA PATIENT'S BILL
27 OF RIGHTS AND RESPONSIBILITIES
28
29 Florida law requires that your health care provider or
30 health care facility recognize your rights while you are
31 receiving medical care and that you respect the health care
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1 provider's or health care facility's right to expect certain
2 behavior on the part of patients. You may request a copy of
3 the full text of this law from your health care provider or
4 health care facility. A summary of your rights and
5 responsibilities follows:
6 A patient has the right to be treated with courtesy and
7 respect, with appreciation of his or her individual dignity,
8 and with protection of his or her need for privacy.
9 A patient has the right to a prompt and reasonable
10 response to questions and requests.
11 A patient has the right to know who is providing
12 medical services and who is responsible for his or her care.
13 A patient has the right to know what patient support
14 services are available, including whether an interpreter is
15 available if he or she does not speak English.
16 A patient has the right to know what rules and
17 regulations apply to his or her conduct.
18 A patient has the right to be given by the health care
19 provider information concerning diagnosis, planned course of
20 treatment, alternatives, risks, and prognosis.
21 A patient has the right to refuse any treatment, except
22 as otherwise provided by law.
23 A patient has the right to be given, upon request, full
24 information and necessary counseling on the availability of
25 known financial resources for his or her care.
26 A patient who is eligible for Medicare has the right to
27 know, upon request and in advance of treatment, whether the
28 health care provider or health care facility accepts the
29 Medicare assignment rate.
30
31
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1 A patient has the right to receive, upon request, prior
2 to treatment, a reasonable estimate of charges for medical
3 care.
4 A patient has the right to receive a copy of a
5 reasonably clear and understandable, itemized bill and, upon
6 request, to have the charges explained.
7 A patient has the right to impartial access to medical
8 treatment or accommodations, regardless of race, national
9 origin, religion, physical handicap, or source of payment.
10 A patient has the right to treatment for any emergency
11 medical condition that will deteriorate from failure to
12 provide treatment.
13 A patient has the right to know if medical treatment is
14 for purposes of experimental research and to give his or her
15 consent or refusal to participate in such experimental
16 research.
17 A patient has the right to express grievances regarding
18 any violation of his or her rights, as stated in Florida law,
19 through the grievance procedure of the health care provider or
20 health care facility which served him or her and to the
21 appropriate state licensing agency.
22 A patient is responsible for providing to the health
23 care provider, to the best of his or her knowledge, accurate
24 and complete information about present complaints, past
25 illnesses, hospitalizations, medications, and other matters
26 relating to his or her health.
27 A patient is responsible for reporting unexpected
28 changes in his or her condition to the health care provider.
29 A patient is responsible for reporting to the health
30 care provider whether he or she comprehends a contemplated
31 course of action and what is expected of him or her.
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1 A patient is responsible for following the treatment
2 plan recommended by the health care provider.
3 A patient is responsible for keeping appointments and,
4 when he or she is unable to do so for any reason, for
5 notifying the health care provider or health care facility.
6 A patient is responsible for his or her actions if he
7 or she refuses treatment or does not follow the health care
8 provider's instructions.
9 A patient is responsible for assuring that the
10 financial obligations of his or her health care are fulfilled
11 as promptly as possible.
12 A patient is responsible for following health care
13 facility rules and regulations affecting patient care and
14 conduct.
15 Section 22. Section 381.0261, Florida Statutes, is
16 amended to read:
17 381.0261 Distribution of Summary of patient's bill of
18 rights; distribution; penalty.--
19 (1) The Agency for Health Care Administration
20 Department of Health and Rehabilitative Services shall have
21 printed and made continuously available to health care
22 facilities licensed under chapter 395, physicians licensed
23 under chapter 458, osteopathic physicians licensed under
24 chapter 459, and podiatrists licensed under chapter 461 a
25 summary of the Florida Patient's Bill of Rights and
26 Responsibilities. In adopting and making available to
27 patients public the summary of the Florida Patient's Bill of
28 Rights and Responsibilities, health care providers and health
29 care facilities are not limited to the format in which the
30 Agency for Health Care Administration Department of Health and
31 Rehabilitative Services prints and distributes the summary.
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1 (2) Health care providers and health care facilities,
2 if requested, shall inform patients of the address and
3 telephone number of each state agency responsible for
4 responding to patient complaints about a health care provider
5 or health care facility's alleged noncompliance with state
6 licensing requirements established pursuant to law.
7 (3) Health care facilities shall adopt policies and
8 procedures to ensure that inpatients are provided the
9 opportunity during the course of admission to receive
10 information regarding their rights and how to file complaints
11 with the facility and appropriate state agencies.
12 (4) An administrative fine may be imposed by the
13 agency when any health care provider or health care facility
14 fails to make available to patients a summary of their rights,
15 pursuant to ss. 381.026 and this section. Initial nonwillful
16 violations shall be subject to corrective action and shall not
17 be subject to an administrative fine. The agency may levy a
18 fine against a health care facility of up to $5,000 for
19 nonwillful violations, and up to $25,000 for intentional and
20 willful violations. The agency may levy a fine against a
21 health care provider of up to $100 for nonwillful violations
22 and up to $500 for willful violations. Each intentional and
23 willful violation constitutes a separate violation and is
24 subject to a separate fine.
25 (5) In determining the amount of fine to be levied for
26 a violation, as provided in subsection (4), the following
27 factors shall be considered:
28 (a) The scope and severity of the violation, including
29 the number of patients found to not have received notice of
30 patient rights, and whether the failure to provide notice to
31 patients was willful.
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1 (b) Actions taken by the health care provider or
2 health care facility to correct the violations or to remedy
3 complaints.
4 (c) Any previous violations of this section by the
5 health care provider or health care facility.
6 Section 23. Subsections (2) and (15) of section
7 395.002, Florida Statutes, are repealed:
8 395.002 Definitions.--As used in this chapter:
9 (2) "Adverse or untoward incident," for purposes of
10 reporting to the agency, means an event over which health care
11 personnel could exercise control, which is probably associated
12 in whole or in part with medical intervention rather than the
13 condition for which such intervention occurred, and which
14 causes injury to a patient, and which:
15 (a) Is not consistent with or expected to be a
16 consequence of such medical intervention;
17 (b) Occurs as a result of medical intervention to
18 which the patient has not given his or her informed consent;
19 (c) Occurs as the result of any other action or lack
20 of any other action on the part of the hospital or personnel
21 of the hospital;
22 (d) Results in a surgical procedure being performed on
23 the wrong patient; or
24 (e) Results in a surgical procedure being performed
25 that is unrelated to the patient's diagnosis or medical needs.
26 (15) "Injury," for purposes of reporting to the
27 agency, means any of the following outcomes if caused by an
28 adverse or untoward incident:
29 (a) Death;
30 (b) Brain damage;
31 (c) Spinal damage;
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1 (d) Permanent disfigurement;
2 (e) Fracture or dislocation of bones or joints;
3 (f) Any condition requiring definitive or specialized
4 medical attention which is not consistent with the routine
5 management of the patient's case or patient's preexisting
6 physical condition;
7 (g) Any condition requiring surgical intervention to
8 correct or control;
9 (h) Any condition resulting in transfer of the
10 patient, within or outside the facility, to a unit providing a
11 more acute level of care;
12 (i) Any condition that extends the patient's length of
13 stay; or
14 (j) Any condition that results in a limitation of
15 neurological, physical, or sensory function which continues
16 after discharge from the facility.
17 Section 24. Present subsections (3), (4), (5), and (7)
18 of section 395.0193, Florida Statutes, are amended, present
19 subsections (6), (7), (8), and (9) are renumbered as
20 subsections (7), (8), (9), and (10), respectively, and a new
21 subsection (6) is added to that section, to read:
22 395.0193 Licensed facilities; peer review;
23 disciplinary powers; agency or partnership with physicians.--
24 (3) If reasonable belief exists that conduct by a
25 staff member or physician who delivers health care services at
26 the licensed facility may constitute one or more grounds for
27 discipline as provided in this subsection, a peer review panel
28 shall investigate and determine whether grounds for discipline
29 exist with respect to such staff member or physician. The
30 governing board of any licensed facility, after considering
31 the recommendations of its peer review panel, shall suspend,
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1 deny, revoke, or curtail the privileges, or reprimand,
2 counsel, or require education, of any such staff member or
3 physician after a final determination has been made that one
4 or more of the following grounds exist:
5 (a) Incompetence.
6 (b) Being found to be a habitual user of intoxicants
7 or drugs to the extent that he or she is deemed dangerous to
8 himself, herself, or others.
9 (c) Mental or physical impairment which may adversely
10 affect patient care.
11 (d) Being found liable by a court of competent
12 jurisdiction for medical negligence or malpractice involving
13 negligent conduct.
14 (e) One or more settlements exceeding $10,000 for
15 medical negligence or malpractice involving negligent conduct
16 by the staff member.
17 (f) Medical negligence other than as specified in
18 paragraph (d) or paragraph (e).
19 (g) Failure to comply with the policies, procedures,
20 or directives of the risk management program or any quality
21 assurance committees of any licensed facility.
22
23 However, the grounds specified in paragraphs (a)-(g) are not
24 the only grounds for discipline of a practitioner. procedures
25 for such actions shall comply with the standards outlined by
26 the Joint Commission on Accreditation of Healthcare
27 Organizations, the American Osteopathic Association, the
28 Commission on Accreditation of Rehabilitation Facilities, the
29 Accreditation Association for Ambulatory Health Care, Inc.,
30 and the "Medicare/Medicaid Conditions of Participation," and
31
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1 rules of the agency and the department. The procedures shall
2 be adopted pursuant to hospital bylaws.
3 (4) Pursuant to ss. 458.337 and 459.016, any
4 disciplinary actions taken under subsection (3) shall be
5 reported in writing to the Division of Health Quality
6 Assurance of the agency within 30 working days after its
7 initial occurrence, regardless of the pendency of appeals to
8 the governing board of the hospital. The notification shall
9 identify the disciplined practitioner, the action taken, and
10 the reason for such action. All final disciplinary actions
11 taken under subsection (3), if different than those which were
12 reported to the agency within 30 days after the initial
13 occurrence, shall be reported within 10 working days to the
14 Division of Health Quality Assurance of the agency in writing
15 and shall specify the disciplinary action taken and the
16 specific grounds therefor. The division shall review each
17 report and determine whether it potentially involved conduct
18 by the licensee that is subject to disciplinary action, in
19 which case s. 455.225 shall apply. The reports are not report
20 shall not be subject to inspection under s. 119.07(1) even if
21 the division's investigation results in a finding of probable
22 cause.
23 (5) There shall be no monetary liability on the part
24 of, and no cause of action for damages against, any licensed
25 facility, its governing board or governing board members, peer
26 review panel, medical staff, or disciplinary body, or its
27 agents, investigators, witnesses, or employees; a committee of
28 a hospital;, or any other person, for any action taken without
29 intentional fraud in carrying out the provisions of this
30 section.
31
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1 (6) For a single incident or series of isolated
2 incidents that are nonwillful violations of the reporting
3 requirements of this section, the agency shall first seek to
4 obtain corrective action by the facility. If correction is not
5 demonstrated within the timeframe established by the agency or
6 if there is a pattern of nonwillful violations of this
7 section, the agency may impose an administrative fine, not to
8 exceed $5,000 for any violation of the reporting requirements
9 of this section. The administrative fine for repeated
10 nonwillful violations shall not exceed $10,000 for any
11 violation. The administrative fine for each intentional and
12 willful violation may not exceed $25,000 per violation, per
13 day. The fine for an intentional and willful violation of this
14 section may not exceed $250,000. In determining the amount of
15 fine to be levied, the agency shall be guided by s.
16 395.1065(2)(b).
17 (8)(7) The investigations, proceedings, and records of
18 the peer review panel, a committee of a hospital, a
19 disciplinary board, or a governing board, or agent thereof
20 with whom there is a specific written contract for that
21 purpose, as described in this section shall not be subject to
22 discovery or introduction into evidence in any civil or
23 administrative action against a provider of professional
24 health services arising out of the matters which are the
25 subject of evaluation and review by such group or its agent,
26 and a person who was in attendance at a meeting of such group
27 or its agent may not be permitted or required to testify in
28 any such civil or administrative action as to any evidence or
29 other matters produced or presented during the proceedings of
30 such group or its agent or as to any findings,
31 recommendations, evaluations, opinions, or other actions of
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1 such group or its agent or any members thereof. However,
2 information, documents, or records otherwise available from
3 original sources are not to be construed as immune from
4 discovery or use in any such civil or administrative action
5 merely because they were presented during proceedings of such
6 group, and any person who testifies before such group or who
7 is a member of such group may not be prevented from testifying
8 as to matters within his or her knowledge, but such witness
9 may not be asked about his or her testimony before such a
10 group or opinions formed by him or her as a result of such
11 group hearings.
12 Section 25. Section 395.0197, Florida Statutes, is
13 amended to read:
14 395.0197 Internal risk management program.--
15 (1) Every licensed facility shall, as a part of its
16 administrative functions, establish an internal risk
17 management program that includes all of the following
18 components:
19 (a) The investigation and analysis of the frequency
20 and causes of general categories and specific types of adverse
21 incidents causing injury to patients.
22 (b) The development of appropriate measures to
23 minimize the risk of injuries and adverse incidents to
24 patients, including, but not limited to:
25 1. Risk management and risk prevention education and
26 training of all nonphysician personnel as follows:
27 a. Such education and training of all nonphysician
28 personnel as part of their initial orientation; and
29 b. At least 1 hour of such education and training
30 annually for all nonphysician personnel of the licensed
31 facility working in clinical areas and providing patient care.
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1 2. A prohibition, except when emergency circumstances
2 require otherwise, against a staff member of the licensed
3 facility attending a patient in the recovery room, unless the
4 staff member is authorized to attend the patient in the
5 recovery room and is in the company of at least one other
6 person. However, a licensed facility hospital is exempt from
7 the two-person requirement if it has:
8 a. Live visual observation;
9 b. Electronic observation; or
10 c. Any other reasonable measure taken to ensure
11 patient protection and privacy.
12 (c) The analysis of patient grievances that relate to
13 patient care and the quality of medical services.
14 (d) The development and implementation of an incident
15 reporting system based upon the affirmative duty of all health
16 care providers and all agents and employees of the licensed
17 health care facility to report adverse incidents to the risk
18 manager, or to his or her designee, within 3 business days
19 after its occurrence.
20 (2) The internal risk management program is the
21 responsibility of the governing board of the health care
22 facility. Each licensed facility shall hire a risk manager,
23 licensed under part IX of chapter 626, who is responsible for
24 implementation and oversight of such facility's internal risk
25 management program as required by this section. A risk
26 manager must not be made responsible for more than four
27 internal risk management programs in separate licensed
28 facilities, unless the facilities are under one corporate
29 ownership or the risk management programs are in rural
30 hospitals.
31
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1 (3) In addition to the programs mandated by this
2 section, other innovative approaches intended to reduce the
3 frequency and severity of medical malpractice and patient
4 injury claims shall be encouraged and their implementation and
5 operation facilitated. Such additional approaches may include
6 extending internal risk management programs to health care
7 providers' offices and the assuming of provider liability by a
8 licensed health care facility for acts or omissions occurring
9 within the licensed facility.
10 (4) The agency shall, after consulting with the
11 Department of Insurance, adopt rules governing the
12 establishment of internal risk management programs to meet the
13 needs of individual licensed facilities. Each internal risk
14 management program shall include the use of incident reports
15 to be filed with an individual of responsibility who is
16 competent in risk management techniques in the employ of each
17 licensed facility, such as an insurance coordinator, or who is
18 retained by the licensed facility as a consultant. The
19 individual responsible for the risk management program shall
20 have free access to all medical records of the licensed
21 facility. The incident reports are part of the workpapers of
22 the attorney defending the licensed facility in litigation
23 relating to the licensed facility and are subject to
24 discovery, but are not admissible as evidence in court. A
25 person filing an incident report is not subject to civil suit
26 by virtue of such incident report. As a part of each internal
27 risk management program, the incident reports shall be used to
28 develop categories of incidents which identify problem areas.
29 Once identified, procedures shall be adjusted to correct the
30 problem areas.
31
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1 (5) For purposes of reporting to the agency pursuant
2 to this section, the term "adverse incident" means an event
3 over which health care personnel could exercise control and
4 which is associated in whole or in part with medical
5 intervention, rather than the condition for which such
6 intervention occurred, and which:
7 (a) Results in one of the following injuries:
8 1. Death;
9 2. Brain or spinal damage;
10 3. Permanent disfigurement;
11 4. Fracture or dislocation of bones or joints;
12 5. A resulting limitation of neurological, physical,
13 or sensory function which continues after discharge from the
14 facility;
15 6. Any condition that required specialized medical
16 attention or surgical intervention resulting from nonemergency
17 medical intervention, other than an emergency medical
18 condition, to which the patient has not given his or her
19 informed consent; or
20 7. Any condition that required the transfer of the
21 patient, within or outside the facility, to a unit providing a
22 more acute level of care due to the adverse incident, rather
23 than the patient's condition prior to the adverse incident;
24 (b) Was the performance of a surgical procedure on the
25 wrong patient, a wrong surgical procedure, a wrong-site
26 surgical procedure, or a surgical procedure otherwise
27 unrelated to the patient's diagnosis or medical condition;
28 (c) Required the surgical repair of damage resulting
29 to a patient from a planned surgical procedure, where the
30 damage was not a recognized specific risk, as disclosed to the
31
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1 patient and documented through the informed-consent process;
2 or
3 (d) Was a procedure to remove unplanned foreign
4 objects remaining from a surgical procedure.
5 (6)(5)(a) Each licensed facility subject to this
6 section shall submit an annual report to the agency
7 summarizing the incident reports that have been filed in the
8 facility for that year. The report shall include:
9 1. The total number of adverse incidents causing
10 injury to patients.
11 2. A listing, by category, of the types of operations,
12 diagnostic or treatment procedures, or other actions causing
13 the injuries, and the number of incidents occurring within
14 each category.
15 3. A listing, by category, of the types of injuries
16 caused and the number of incidents occurring within each
17 category.
18 4. A code number using the health care professional's
19 licensure number and a separate code number identifying all
20 other individuals directly involved in adverse incidents
21 causing injury to patients, the relationship of the individual
22 to the licensed facility, and the number of incidents in which
23 each individual has been directly involved. Each licensed
24 facility shall maintain names of the health care professionals
25 and individuals identified by code numbers for purposes of
26 this section.
27 5. A description of all malpractice claims filed
28 against the licensed facility, including the total number of
29 pending and closed claims and the nature of the incident which
30 led to, the persons involved in, and the status and
31
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1 disposition of each claim. Each report shall update status and
2 disposition for all prior reports.
3 6. A report of all disciplinary actions pertaining to
4 patient care taken against any medical staff member, including
5 the nature and cause of the action.
6 (b) The information reported to the agency pursuant to
7 paragraph (a) which relates to persons licensed under chapter
8 458, chapter 459, chapter 461, or chapter 466 shall be
9 reviewed by the agency. The agency shall determine whether
10 any of the incidents potentially involved conduct by a health
11 care professional who is subject to disciplinary action, in
12 which case the provisions of s. 455.225 shall apply.
13 (c) The report submitted to the agency shall also
14 contain the name and license number of the risk manager of the
15 licensed facility, a copy of its policy and procedures which
16 govern the measures taken by the facility and its risk manager
17 to reduce the risk of injuries and adverse or untoward
18 incidents, and the results of such measures. The annual
19 report is confidential and is not available to the public
20 pursuant to s. 119.07(1) or any other law providing access to
21 public records. The annual report is not discoverable or
22 admissible in any civil or administrative action, except in
23 disciplinary proceedings by the agency or the appropriate
24 regulatory board. The annual report is not available to the
25 public as part of the record of investigation for and
26 prosecution in disciplinary proceedings made available to the
27 public by the agency or the appropriate regulatory board.
28 However, the agency or the appropriate regulatory board shall
29 make available, upon written request by a health care
30 professional against whom probable cause has been found, any
31
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1 such records which form the basis of the determination of
2 probable cause.
3 (7) The licensed facility shall notify the agency no
4 later than 1 business day after the risk manager or his or her
5 designee has received a report pursuant to paragraph (1)(d)
6 and is able to determine within 1 business day that any of the
7 following adverse incidents has occurred, whether occurring in
8 the licensed facility or arising from health care prior to
9 admission in the licensed facility. Notification is not
10 required if the risk manager is unable to determine within 1
11 business day that any of the following incidents occurred:
12 (a) The death of a patient;
13 (b) Brain or spinal damage to a patient;
14 (c) The performance of a surgical procedure on the
15 wrong patient;
16 (d) The performance of a wrong-site surgical
17 procedure; or
18 (e) The performance of a wrong surgical procedure.
19
20 The notification must be made in writing and be provided by
21 facsimile device or overnight mail delivery. The notification
22 must include information regarding the identity of the
23 affected patient, the type of adverse incident, the initiation
24 of an investigation by the facility, and whether the events
25 causing or resulting in the adverse incident represent a
26 potential risk to other patients.
27 (8)(6) Any of the following adverse incidents, whether
28 occurring in the licensed facility or arising from health care
29 prior to admission in the licensed facility, shall be reported
30 by the facility to the agency within 15 calendar days after
31 its occurrence: If an adverse or untoward incident, whether
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1 occurring in the licensed facility or arising from health care
2 prior to admission in the licensed facility, results in:
3 (a) The death of a patient;
4 (b) Brain or spinal damage to a patient;
5 (c) The performance of a surgical procedure on the
6 wrong patient; or
7 (d) The performance of a wrong-site surgical
8 procedure;
9 (e) The performance of a wrong surgical procedure;
10 (f) The performance of a surgical procedure that is
11 medically unnecessary or otherwise unrelated to the patient's
12 diagnosis or medical condition;
13 (g) The surgical repair of damage resulting to a
14 patient from a planned surgical procedure, where the damage is
15 not a recognized specific risk, as disclosed to the patient
16 and documented through the informed-consent process; or
17 (h) The performance of procedures to remove unplanned
18 foreign objects remaining from a surgical procedure.
19 (d) A surgical procedure unrelated to the patient's
20 diagnosis or medical needs being performed on any patient,
21 including the surgical repair of injuries or damage resulting
22 from the planned surgical procedure, wrong site or wrong
23 procedure surgeries, and procedures to remove foreign objects
24 remaining from surgical procedures,
25
26 the licensed facility shall report this incident to the agency
27 within 15 calendar days after its occurrence. The agency may
28 grant extensions to this reporting requirement for more than
29 15 days upon justification submitted in writing by the
30 facility administrator to the agency. The agency may require
31 an additional, final report. These reports shall not be
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1 available to the public pursuant to s. 119.07(1) or any other
2 law providing access to public records, nor be discoverable or
3 admissible in any civil or administrative action, except in
4 disciplinary proceedings by the agency or the appropriate
5 regulatory board, nor shall they be available to the public as
6 part of the record of investigation for and prosecution in
7 disciplinary proceedings made available to the public by the
8 agency or the appropriate regulatory board. However, the
9 agency or the appropriate regulatory board shall make
10 available, upon written request by a health care professional
11 against whom probable cause has been found, any such records
12 which form the basis of the determination of probable cause.
13 The agency may investigate, as it deems appropriate, any such
14 incident and prescribe measures that must or may be taken in
15 response to the incident. The agency shall review each
16 incident and determine whether it potentially involved conduct
17 by the health care professional who is subject to disciplinary
18 action, in which case the provisions of s. 455.225 shall
19 apply.
20 (9)(7) The internal risk manager of each licensed
21 facility shall:
22 (a)(b) Investigate every allegation of sexual
23 misconduct which is made against a member of the facility's
24 personnel who has direct patient contact, when the allegation
25 is that the sexual misconduct occurred at the facility or on
26 the grounds of the facility; and
27 (b)(c) Report every allegation of sexual misconduct to
28 the administrator of the licensed facility.
29 (c)(a) Notify the family or guardian of the victim, if
30 a minor, that an allegation of sexual misconduct has been made
31 and that an investigation is being conducted;
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1 (10)(8) Any witness who witnessed or who possesses
2 actual knowledge of the act that is the basis of an allegation
3 of sexual abuse shall:
4 (a) Notify the local police; and
5 (b) Notify the hospital risk manager and the
6 administrator.
7
8 For purposes of this subsection, "sexual abuse" means acts of
9 a sexual nature committed for the sexual gratification of
10 anyone upon, or in the presence of, a vulnerable adult,
11 without the vulnerable adult's informed consent, or a minor.
12 "Sexual abuse" includes, but is not limited to, the acts
13 defined in s. 794.011(1)(h), fondling, exposure of a
14 vulnerable adult's or minor's sexual organs, or the use of the
15 vulnerable adult or minor to solicit for or engage in
16 prostitution or sexual performance. "Sexual abuse" does not
17 include any act intended for a valid medical purpose or any
18 act which may reasonably be construed to be a normal
19 caregiving action.
20 (11)(9) A person who, with malice or with intent to
21 discredit or harm a licensed facility or any person, makes a
22 false allegation of sexual misconduct against a member of a
23 licensed facility's personnel is guilty of a misdemeanor of
24 the second degree, punishable as provided in s. 775.082 or s.
25 775.083.
26 (12)(10) In addition to any penalty imposed pursuant
27 to this section, the agency shall require a written plan of
28 correction from the facility. For a single incident or series
29 of isolated incidents that are nonwillful violations of the
30 reporting requirements of this section, the agency shall first
31 seek to obtain corrective action by the facility. If the
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1 correction is not demonstrated within the timeframe
2 established by the agency or if there is a pattern of
3 nonwillful violations of this section, the agency may impose
4 an administrative fine, not to exceed $5,000 for any violation
5 of the reporting requirements of this section. The
6 administrative fine for repeated nonwillful violations shall
7 not exceed $10,000 for any violation. The administrative fine
8 for each intentional and willful violation may not exceed
9 $25,000 per violation, per day. The fine for an intentional
10 and willful violation of this section may not exceed $250,000.
11 In determining the amount of fine to be levied, the agency
12 shall be guided by s. 395.1065(2)(b) may impose an
13 administrative fine, not to exceed $5,000, for any violation
14 of the reporting requirements of this section.
15 (13)(11) The agency shall have access to all licensed
16 facility records necessary to carry out the provisions of this
17 section. The records obtained by the agency under subsection
18 (6), subsection (8), or subsection (9) are not available to
19 the public under s. 119.07(1), nor shall they be discoverable
20 or admissible in any civil or administrative action, except in
21 disciplinary proceedings by the agency or the appropriate
22 regulatory board, nor shall records obtained pursuant to s.
23 455.223 be available to the public as part of the record of
24 investigation for and prosecution in disciplinary proceedings
25 made available to the public by the agency or the appropriate
26 regulatory board. However, the agency or the appropriate
27 regulatory board shall make available, upon written request by
28 a health care professional against whom probable cause has
29 been found, any such records which form the basis of the
30 determination of probable cause, except that, with respect to
31 medical review committee records, s. 766.101 controls.
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1 (14)(12) The meetings of the committees and governing
2 board of a licensed facility held solely for the purpose of
3 achieving the objectives of risk management as provided by
4 this section shall not be open to the public under the
5 provisions of chapter 286. The records of such meetings are
6 confidential and exempt from s. 119.07(1), except as provided
7 in subsection (13)(11).
8 (15)(13) The agency shall review, as part of its
9 licensure inspection process, the internal risk management
10 program at each licensed facility regulated by this section to
11 determine whether the program meets standards established in
12 statutes and rules, whether the program is being conducted in
13 a manner designed to reduce adverse incidents, and whether the
14 program is appropriately reporting incidents under subsections
15 (5), and (6), (7), and (8).
16 (16)(14) There shall be no monetary liability on the
17 part of, and no cause of action for damages shall arise
18 against, any risk manager, licensed under part IX of chapter
19 626, for the implementation and oversight of the internal risk
20 management program in a facility licensed under this chapter
21 or chapter 390 as required by this section, for any act or
22 proceeding undertaken or performed within the scope of the
23 functions of such internal risk management program if the risk
24 manager acts without intentional fraud.
25 (17)(15) If the agency, through its receipt of the
26 annual reports prescribed in subsection (6)(5) or through any
27 investigation, has a reasonable belief that conduct by a staff
28 member or employee of a licensed facility is grounds for
29 disciplinary action by the appropriate regulatory board, the
30 agency shall report this fact to such regulatory board.
31
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1 (18)(16) The agency shall annually publish a report
2 summarizing the information contained in the annual incident
3 reports submitted by licensed facilities pursuant to
4 subsection (6) and disciplinary actions reported to the agency
5 pursuant to s. 395.0193 any serious incident reports submitted
6 by licensed facilities. The report must, at a minimum,
7 summarize:
8 (a) Adverse and serious incidents, by service district
9 of the department as defined in s. 20.19, by category of
10 reported incident, and by type of professional involved.
11 (b) Types of malpractice claims filed, by service
12 district of the department as defined in s. 20.19, and by type
13 of professional involved.
14 (c) Disciplinary actions taken against professionals,
15 by service district of the department as defined in s. 20.19,
16 and by type of professional involved.
17 Section 26. Effective January 1, 1999, section
18 626.941, Florida Statutes, is renumbered as section 395.10971,
19 Florida Statutes.
20 Section 27. Effective January 1, 1999, section
21 626.942, Florida Statutes, is renumbered as section 395.10972,
22 Florida Statutes, and amended to read:
23 395.10972 626.942 Health Care Risk Manager Advisory
24 Council.--The Director of Health Care Administration Insurance
25 Commissioner may appoint a five-member advisory council to
26 advise the agency department on matters pertaining to health
27 care risk managers. The members of the council shall serve at
28 the pleasure of the director Insurance Commissioner. The
29 council shall designate a chair. The council shall meet at
30 the call of the director Insurance Commissioner or at those
31 times as may be required by rule of the agency department.
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1 The members of the advisory council shall receive no
2 compensation for their services, but shall be reimbursed for
3 travel expenses as provided in s. 112.061. The council shall
4 consist of individuals representing the following areas:
5 (1) Two shall be active health care risk managers.
6 (2) One shall be an active hospital administrator.
7 (3) One shall be an employee of an insurer or
8 self-insurer of medical malpractice coverage.
9 (4) One shall be a representative of the
10 health-care-consuming public.
11 Section 28. Effective January 1, 1999, section
12 626.943, Florida Statutes, is renumbered as section 395.10973,
13 Florida Statutes, and amended to read:
14 395.10973 626.943 Powers and duties of the agency
15 department.--It is the function of the agency department to:
16 (1) Adopt Promulgate rules necessary to carry out the
17 duties conferred upon it under this part to protect the public
18 health, safety, and welfare.
19 (2) Develop, impose, and enforce specific standards
20 within the scope of the general qualifications established by
21 this part which must be met by individuals in order to receive
22 licenses as health care risk managers. These standards shall
23 be designed to ensure that health care risk managers are
24 individuals of good character and otherwise suitable and, by
25 training or experience in the field of health care risk
26 management, qualified in accordance with the provisions of
27 this part to serve as health care risk managers, within
28 statutory requirements.
29 (3) Develop a method for determining whether an
30 individual meets the standards set forth in s. 395.10974 s.
31 626.944.
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1 (4) Issue licenses, beginning on June 1, 1986, to
2 qualified individuals meeting the standards set forth in s.
3 395.10974 s. 626.944.
4 (5) Receive, investigate, and take appropriate action
5 with respect to any charge or complaint filed with the agency
6 department to the effect that a certified health care risk
7 manager has failed to comply with the requirements or
8 standards adopted by rule by the agency department or to
9 comply with the provisions of this part.
10 (6) Establish procedures for providing the Department
11 of Health and Rehabilitative Services with periodic reports on
12 persons certified or disciplined by the agency department
13 under this part.
14 (7) Develop a model risk management program for health
15 care facilities which will satisfy the requirements of s.
16 395.0197.
17 Section 29. Effective January 1, 1999, section
18 626.944, Florida Statutes, is renumbered as section 395.10974,
19 Florida Statutes, and amended to read:
20 395.10974 626.944 Qualifications for health care risk
21 managers.--
22 (1) Any person desiring to be licensed as a health
23 care risk manager shall submit an application on a form
24 provided by the agency department. In order to qualify, the
25 applicant shall submit evidence satisfactory to the agency
26 department which demonstrates the applicant's competence, by
27 education or experience, in the following areas:
28 (a) Applicable standards of health care risk
29 management.
30 (b) Applicable federal, state, and local health and
31 safety laws and rules.
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1 (c) General risk management administration.
2 (d) Patient care.
3 (e) Medical care.
4 (f) Personal and social care.
5 (g) Accident prevention.
6 (h) Departmental organization and management.
7 (i) Community interrelationships.
8 (j) Medical terminology.
9
10 The agency department may require such additional information,
11 from the applicant or any other person, as may be reasonably
12 required to verify the information contained in the
13 application.
14 (2) The agency department shall not grant or issue a
15 license as a health care risk manager to any individual unless
16 from the application it affirmatively appears that the
17 applicant:
18 (a) Is 18 years of age or over;
19 (b) Is a high school graduate or equivalent; and
20 (c)1. Has fulfilled the requirements of a 1-year
21 program or its equivalent in health care risk management
22 training which may be developed or approved by the agency
23 department;
24 2. Has completed 2 years of college-level studies
25 which would prepare the applicant for health care risk
26 management, to be further defined by rule; or
27 3. Has obtained 1 year of practical experience in
28 health care risk management.
29 (3) The agency department shall issue a license,
30 beginning on June 1, 1986, to practice health care risk
31 management to any applicant who qualifies under this section
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1 and submits an application fee of not more than $75, a
2 fingerprinting fee of not more than $75, and a license fee of
3 not more than $100. The agency shall by rule establish fees
4 and procedures for the issuance and cancellation of licenses.
5 the license fee as set forth in s. 624.501. Licenses shall be
6 issued and canceled in the same manner as provided in part I
7 of this chapter.
8 (4) The agency department shall renew a health care
9 risk manager license upon receipt of a biennial renewal
10 application and fees. The agency shall by rule establish a
11 procedure for the biennial renewal of licenses in accordance
12 with procedures prescribed in s. 626.381 for agents in
13 general.
14 Section 30. Effective January 1, 1999, section
15 626.945, Florida Statutes, is renumbered as section 395.10975,
16 Florida Statutes, and amended to read:
17 395.10975 626.945 Grounds for denial, suspension, or
18 revocation of a health care risk manager's license;
19 administrative fine.--
20 (1) The agency department may, in its discretion,
21 deny, suspend, revoke, or refuse to renew or continue the
22 license of any health care risk manager or applicant, if it
23 finds that as to such applicant or licensee any one or more of
24 the following grounds exist:
25 (a) Any cause for which issuance of the license could
26 have been refused had it then existed and been known to the
27 agency department.
28 (b) Giving false or forged evidence to the agency
29 department for the purpose of obtaining a license.
30 (c) Having been found guilty of, or having pleaded
31 guilty or nolo contendere to, a crime in this state or any
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1 other state relating to the practice of risk management or the
2 ability to practice risk management, whether or not a judgment
3 or conviction has been entered.
4 (d) Having been found guilty of, or having pleaded
5 guilty or nolo contendere to, a felony, or a crime involving
6 moral turpitude punishable by imprisonment of 1 year or more
7 under the law of the United States, under the law of any
8 state, or under the law of any other country, without regard
9 to whether a judgment of conviction has been entered by the
10 court having jurisdiction of such cases.
11 (e) Making or filing a report or record which the
12 licensee knows to be false; or intentionally failing to file a
13 report or record required by state or federal law; or
14 willfully impeding or obstructing, or inducing another person
15 to impede or obstruct, the filing of a report or record
16 required by state or federal law. Such reports or records
17 shall include only those which are signed in the capacity of a
18 licensed health care risk manager.
19 (f) Fraud or deceit, negligence, incompetence, or
20 misconduct in the practice of health care risk management.
21 (g) Violation of any provision of this part or any
22 other law applicable to the business of health care risk
23 management.
24 (h) Violation of any lawful order or rule of the
25 agency department or failure to comply with a lawful subpoena
26 issued by the department.
27 (i) Practicing with a revoked or suspended health care
28 risk manager license.
29 (j) Repeatedly acting in a manner inconsistent with
30 the health and safety of the patients of the licensed facility
31 in which the licensee is the health care risk manager.
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1 (k) Being unable to practice health care risk
2 management with reasonable skill and safety to patients by
3 reason of illness; drunkenness; or use of drugs, narcotics,
4 chemicals, or any other material or substance or as a result
5 of any mental or physical condition. Any person affected
6 under this paragraph shall have the opportunity, at reasonable
7 intervals, to demonstrate that he or she can resume the
8 competent practices of health care risk manager with
9 reasonable skill and safety to patients.
10 (l) Willfully permitting unauthorized disclosure of
11 information relating to a patient or a patient's records.
12 (m) Discriminating in respect to patients, employees,
13 or staff on account of race, religion, color, sex, or national
14 origin.
15 (2) If the agency department finds that one or more of
16 the grounds set forth in subsection (1) exist, it may, in lieu
17 of or in addition to suspension or revocation, enter an order
18 imposing one or more of the following penalties:
19 (a) Imposition of an administrative fine not to exceed
20 $2,500 for each count or separate offense.
21 (b) Issuance of a reprimand.
22 (c) Placement of the licensee on probation for a
23 period of time and subject to such conditions as the agency
24 department may specify, including requiring the licensee to
25 attend continuing education courses or to work under the
26 supervision of another licensee.
27 (3) The agency department may reissue the license of a
28 disciplined licensee in accordance with the provisions of this
29 part.
30 Section 31. Subsection (1) of section 766.101, Florida
31 Statutes, is amended to read:
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1 766.101 Medical review committee, immunity from
2 liability.--
3 (1) As used in this section:
4 (a) The term "medical review committee" or "committee"
5 means:
6 1.a. A committee of a hospital or ambulatory surgical
7 center licensed under chapter 395 or a health maintenance
8 organization certificated under part I of chapter 641,
9 b. A committee of a physician-hospital organization, a
10 provider-sponsored organization, or an integrated delivery
11 system,
12 c.b. A committee of a state or local professional
13 society of health care providers,
14 d.c. A committee of a medical staff of a licensed
15 hospital or nursing home, provided the medical staff operates
16 pursuant to written bylaws that have been approved by the
17 governing board of the hospital or nursing home,
18 e.d. A committee of the Department of Corrections or
19 the Correctional Medical Authority as created under s.
20 945.602, or employees, agents, or consultants of either the
21 department or the authority or both,
22 f.e. A committee of a professional service corporation
23 formed under chapter 621 or a corporation organized under
24 chapter 607 or chapter 617, which is formed and operated for
25 the practice of medicine as defined in s. 458.305(3), and
26 which has at least 25 health care providers who routinely
27 provide health care services directly to patients,
28 g.f. A committee of a mental health treatment facility
29 licensed under chapter 394 or a community mental health center
30 as defined in s. 394.907, provided the quality assurance
31
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1 program operates pursuant to the guidelines which have been
2 approved by the governing board of the agency,
3 h.g. A committee of a substance abuse treatment and
4 education prevention program licensed under chapter 397
5 provided the quality assurance program operates pursuant to
6 the guidelines which have been approved by the governing board
7 of the agency,
8 i.h. A peer review or utilization review committee
9 organized under chapter 440, or
10 j.i. A committee of a county health department,
11 healthy start coalition, or certified rural health network,
12 when reviewing quality of care, or employees of these entities
13 when reviewing mortality records,
14
15 which committee is formed to evaluate and improve the quality
16 of health care rendered by providers of health service or to
17 determine that health services rendered were professionally
18 indicated or were performed in compliance with the applicable
19 standard of care or that the cost of health care rendered was
20 considered reasonable by the providers of professional health
21 services in the area; or
22 2. A committee of an insurer, self-insurer, or joint
23 underwriting association of medical malpractice insurance, or
24 other persons conducting review under s. 766.106.
25 (b) The term "health care providers" means physicians
26 licensed under chapter 458, osteopathic physicians licensed
27 under chapter 459, podiatrists licensed under chapter 461,
28 optometrists licensed under chapter 463, dentists licensed
29 under chapter 466, chiropractors licensed under chapter 460,
30 pharmacists licensed under chapter 465, or hospitals or
31 ambulatory surgical centers licensed under chapter 395.
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1 Section 32. Subsection (7) of section 394.4787,
2 Florida Statutes, is amended to read:
3 394.4787 Definitions.--As used in this section and ss.
4 394.4786, 394.4788, and 394.4789:
5 (7) "Specialty psychiatric hospital" means a hospital
6 licensed by the agency pursuant to s. 395.002(25) s.
7 395.002(27) as a specialty psychiatric hospital.
8 Section 33. Paragraph (c) of subsection (2) of section
9 395.602, Florida Statutes, is amended to read:
10 395.602 Rural hospitals.--
11 (2) DEFINITIONS.--As used in this part:
12 (c) "Inactive rural hospital bed" means a licensed
13 acute care hospital bed, as defined in s. 395.002(12) s.
14 395.002(13), that is inactive in that it cannot be occupied by
15 acute care inpatients.
16 Section 34. Paragraph (b) of subsection (1) of section
17 400.051, Florida Statutes, is amended to read:
18 400.051 Homes or institutions exempt from the
19 provisions of this part.--
20 (1) The following shall be exempt from the provisions
21 of this part:
22 (b) Any hospital, as defined in s. 395.002(9) s.
23 395.002(10), that is licensed under chapter 395.
24 Section 35. Subsection (8) of section 409.905, Florida
25 Statutes, is amended to read:
26 409.905 Mandatory Medicaid services.--The agency may
27 make payments for the following services, which are required
28 of the state by Title XIX of the Social Security Act,
29 furnished by Medicaid providers to recipients who are
30 determined to be eligible on the dates on which the services
31 were provided. Any service under this section shall be
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1 provided only when medically necessary and in accordance with
2 state and federal law. Nothing in this section shall be
3 construed to prevent or limit the agency from adjusting fees,
4 reimbursement rates, lengths of stay, number of visits, number
5 of services, or any other adjustments necessary to comply with
6 the availability of moneys and any limitations or directions
7 provided for in the General Appropriations Act or chapter 216.
8 (8) NURSING FACILITY SERVICES.--The agency shall pay
9 for 24-hour-a-day nursing and rehabilitative services for a
10 recipient in a nursing facility licensed under part II of
11 chapter 400 or in a rural hospital, as defined in s. 395.602,
12 or in a Medicare certified skilled nursing facility operated
13 by a hospital, as defined by s. 395.002(9) s. 395.002(10),
14 that is licensed under part I of chapter 395, and in
15 accordance with provisions set forth in s. 409.908(2)(a),
16 which services are ordered by and provided under the direction
17 of a licensed physician. However, if a nursing facility has
18 been destroyed or otherwise made uninhabitable by natural
19 disaster or other emergency and another nursing facility is
20 not available, the agency must pay for similar services
21 temporarily in a hospital licensed under part I of chapter 395
22 provided federal funding is approved and available.
23 Section 36. Paragraph (g) of subsection (1) of section
24 440.13, Florida Statutes, is amended to read:
25 440.13 Medical services and supplies; penalty for
26 violations; limitations.--
27 (1) DEFINITIONS.--As used in this section, the term:
28 (g) "Emergency services and care" means emergency
29 services and care as defined in s. 395.002(9).
30 Section 37. Subsection (9) of section 458.331, Florida
31 Statutes, is amended to read:
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1 458.331 Grounds for disciplinary action; action by the
2 board and department.--
3 (9) When an investigation of a physician is
4 undertaken, the department shall promptly furnish to the
5 physician or the physician's attorney a copy of the complaint
6 or document which resulted in the initiation of the
7 investigation. For purposes of this subsection, such
8 documents include, but are not limited to: the pertinent
9 portions of an annual report submitted to the department
10 pursuant to s. 395.0197(6) s. 395.0197(5)(b); a report of an
11 adverse or untoward incident which is provided to the
12 department pursuant to s. 395.0197(8) the provisions of s.
13 395.0197(6); a report of peer review disciplinary action
14 submitted to the department pursuant to the provisions of s.
15 395.0193(4) or s. 458.337, providing that the investigations,
16 proceedings, and records relating to such peer review
17 disciplinary action shall continue to retain their privileged
18 status even as to the licensee who is the subject of the
19 investigation, as provided by ss. 395.0193(8) 395.0193(7) and
20 458.337(3); a report of a closed claim submitted pursuant to
21 s. 627.912; a presuit notice submitted pursuant to s.
22 766.106(2); and a petition brought under the Florida
23 Birth-Related Neurological Injury Compensation Plan, pursuant
24 to s. 766.305(2). The physician may submit a written response
25 to the information contained in the complaint or document
26 which resulted in the initiation of the investigation within
27 45 days after service to the physician of the complaint or
28 document. The physician's written response shall be considered
29 by the probable cause panel.
30 Section 38. Subsection (9) of section 459.015, Florida
31 Statutes, is amended to read:
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1 459.015 Grounds for disciplinary action by the
2 board.--
3 (9) When an investigation of an osteopathic physician
4 is undertaken, the department shall promptly furnish to the
5 osteopathic physician or his or her attorney a copy of the
6 complaint or document which resulted in the initiation of the
7 investigation. For purposes of this subsection, such documents
8 include, but are not limited to: the pertinent portions of an
9 annual report submitted to the department pursuant to s.
10 395.0197(6) s. 395.0197(5)(b); a report of an adverse or
11 untoward incident which is provided to the department pursuant
12 to s. 395.0197(8) the provisions of s. 395.0197(6); a report
13 of peer review disciplinary action submitted to the department
14 pursuant to the provisions of s. 395.0193(4) or s. 459.016,
15 provided that the investigations, proceedings, and records
16 relating to such peer review disciplinary action shall
17 continue to retain their privileged status even as to the
18 licensee who is the subject of the investigation, as provided
19 by ss. 395.0193(8) 395.0193(7) and 459.016(3); a report of a
20 closed claim submitted pursuant to s. 627.912; a presuit
21 notice submitted pursuant to s. 766.106(2); and a petition
22 brought under the Florida Birth-Related Neurological Injury
23 Compensation Plan, pursuant to s. 766.305(2). The osteopathic
24 physician may submit a written response to the information
25 contained in the complaint or document which resulted in the
26 initiation of the investigation within 45 days after service
27 to the osteopathic physician of the complaint or document. The
28 osteopathic physician's written response shall be considered
29 by the probable cause panel.
30 Section 39. Subsection (1) of section 468.505, Florida
31 Statutes, is amended to read:
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1 468.505 Exemptions; exceptions.--
2 (1) Nothing in this part may be construed as
3 prohibiting or restricting the practice, services, or
4 activities of:
5 (a) A person licensed in this state under chapter 457,
6 chapter 458, chapter 459, chapter 460, chapter 461, chapter
7 462, chapter 463, chapter 464, chapter 465, chapter 466,
8 chapter 480, chapter 490, or chapter 491, when engaging in the
9 profession or occupation for which he or she is licensed, or
10 of any person employed by and under the supervision of the
11 licensee when rendering services within the scope of the
12 profession or occupation of the licensee.;
13 (b) A person employed as a dietitian by the government
14 of the United States, if the person engages in dietetics
15 solely under direction or control of the organization by which
16 the person is employed.;
17 (c) A person employed as a cooperative extension home
18 economist.;
19 (d) A person pursuing a course of study leading to a
20 degree in dietetics and nutrition from a program or school
21 accredited pursuant to s. 468.509(2), if the activities and
22 services constitute a part of a supervised course of study and
23 if the person is designated by a title that clearly indicates
24 the person's status as a student or trainee.;
25 (e) A person fulfilling the supervised experience
26 component of s. 468.509, if the activities and services
27 constitute a part of the experience necessary to meet the
28 requirements of s. 468.509.;
29 (f) Any dietitian or nutritionist from another state
30 practicing dietetics or nutrition incidental to a course of
31 study when taking or giving a postgraduate course or other
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1 course of study in this state, provided such dietitian or
2 nutritionist is licensed in another jurisdiction or is a
3 registered dietitian or holds an appointment on the faculty of
4 a school accredited pursuant to s. 468.509(2).;
5 (g) A person who markets or distributes food, food
6 materials, or dietary supplements, or any person who engages
7 in the explanation of the use and benefits of those products
8 or the preparation of those products, if that person does not
9 engage for a fee in dietetics and nutrition practice or
10 nutrition counseling.;
11 (h) A person who markets or distributes food, food
12 materials, or dietary supplements, or any person who engages
13 in the explanation of the use of those products or the
14 preparation of those products, as an employee of an
15 establishment permitted pursuant to chapter 465.;
16 (i) An educator who is in the employ of a nonprofit
17 organization approved by the council; a federal, state,
18 county, or municipal agency, or other political subdivision;
19 an elementary or secondary school; or an accredited
20 institution of higher education the definition of which, as
21 provided in s. 468.509(2), applies to other sections of this
22 part, insofar as the activities and services of the educator
23 are part of such employment.;
24 (j) Any person who provides weight control services or
25 related weight control products, provided the program has been
26 reviewed by, consultation is available from, and no program
27 change can be initiated without prior approval by a licensed
28 dietitian/nutritionist, a dietitian or nutritionist licensed
29 in another state that has licensure requirements considered by
30 the council to be at least as stringent as the requirements
31 for licensure under this part, or a registered dietitian.;
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1 (k) A person employed by a hospital licensed under
2 chapter 395, or by a nursing home or assisted living facility
3 licensed under part II or part III of chapter 400, or by a
4 continuing care facility certified under chapter 651, if the
5 person is employed in compliance with the laws and rules
6 adopted thereunder regarding the operation of its dietetic
7 department.;
8 (l) A person employed by a nursing facility exempt
9 from licensing under s. 395.002(11) s. 395.002(12), or a
10 person exempt from licensing under s. 464.022.; or
11 (m) A person employed as a dietetic technician.
12 Section 40. Effective January 1, 1999, subsection (2)
13 of section 641.55, Florida Statutes, is amended to read:
14 641.55 Internal risk management program.--
15 (2) The risk management program shall be the
16 responsibility of the governing authority or board of the
17 organization. Every organization which has an annual premium
18 volume of $10 million or more and which directly provides
19 health care in a building owned or leased by the organization
20 shall hire a risk manager, certified under ss.
21 395.10971-395.10975 ss. 626.941-626.945, who shall be
22 responsible for implementation of the organization's risk
23 management program required by this section. A part-time risk
24 manager shall not be responsible for risk management programs
25 in more than four organizations or facilities. Every
26 organization which does not directly provide health care in a
27 building owned or leased by the organization and every
28 organization with an annual premium volume of less than $10
29 million shall designate an officer or employee of the
30 organization to serve as the risk manager.
31
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1 The gross data compiled under this section or s. 395.0197
2 shall be furnished by the agency upon request to organizations
3 to be utilized for risk management purposes. The agency shall
4 adopt rules necessary to carry out the provisions of this
5 section.
6 Section 41. Paragraph (c) of subsection (4) of section
7 766.1115, Florida Statutes, is amended to read:
8 766.1115 Health care providers; creation of agency
9 relationship with governmental contractors.--
10 (4) CONTRACT REQUIREMENTS.--A health care provider
11 that executes a contract with a governmental contractor to
12 deliver health care services on or after April 17, 1992, as an
13 agent of the governmental contractor is an agent for purposes
14 of s. 768.28(9), while acting within the scope of duties
15 pursuant to the contract, if the contract complies with the
16 requirements of this section. A health care provider under
17 contract with the state may not be named as a defendant in any
18 action arising out of the medical care or treatment provided
19 on or after April 17, 1992, pursuant to contracts entered into
20 under this section. The contract must provide that:
21 (c) Adverse incidents and information on treatment
22 outcomes must be reported by any health care provider to the
23 governmental contractor if such incidents and information
24 pertain to a patient treated pursuant to the contract. The
25 health care provider shall annually submit an adverse incident
26 report that includes all information required by s.
27 395.0197(6)(a) s. 395.0197(5)(a), unless the adverse incident
28 involves a result described by s. 395.0197(8) s. 395.0197(6),
29 in which case it shall be reported within 15 days after of the
30 occurrence of such incident. If an incident involves a
31 professional licensed by the Department of Health Business and
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1 Professional Regulation or a facility licensed by the Agency
2 for Health Care Administration Department of Health and
3 Rehabilitative Services, the governmental contractor shall
4 submit such incident reports to the appropriate department or
5 agency, which shall review each incident and determine whether
6 it involves conduct by the licensee that is subject to
7 disciplinary action. All patient medical records and any
8 identifying information contained in adverse incident reports
9 and treatment outcomes which are obtained by governmental
10 entities pursuant to this paragraph are confidential and
11 exempt from the provisions of s. 119.07(1) and s. 24(a), Art.
12 I of the State Constitution.
13
14 A governmental contractor that is also a health care provider
15 is not required to enter into a contract under this section
16 with respect to the health care services delivered by its
17 employees.
18 Section 42. Effective January 1, 1999, all powers,
19 duties and functions, rules, records, personnel, property, and
20 unexpended balances of appropriations, allocations, or other
21 funds of the Department of Insurance related to the health
22 care risk manager licensure program, as established in part IX
23 of chapter 626, Florida Statutes, are transferred by a type
24 two transfer, as defined in section 20.06(2), Florida
25 Statutes, from the Department of Insurance to the Agency for
26 Health Care Administration.
27 Section 43. The sum of $100,281 is appropriated from
28 the Health Care Trust Fund to the Agency for Health Care
29 Administration, and one full-time position is authorized, to
30 administer the provisions of this act.
31
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1 Section 44. Except as otherwise expressly provided in
2 this act, this act shall take effect July 1, 1998.
3
4 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
5 SB 314
6
7 Changes the applicability of the repeal of hospital budget
review from hospital budgets ending in 1995 to hospital
8 budgets ending in 1996.
9 Clarifies that all outpatient facilities that provide surgical
treatments requiring general anesthesia or IV conscious
10 sedation, that provide cardiac catheterization services, or
that are to be licensed as ambulatory surgical centers must
11 submit plans and specifications to AHCA for review. All other
outpatient facilities must be reviewed, except that plans and
12 specifications relating to the construction or alteration of
outpatient facilities that are physically detached from the
13 hospital on whose campus it is located, have no utility
connections with the hospital, and do not block emergency
14 egress from or create a fire hazard to the hospital are made
exempt from review.
15
The effective date of authority for the Agency for Health Care
16 Administration to enforce emergency preparedness requirements
applicable to new facilities and new wings and floors added to
17 existing facilities is changed from July 1, 1998 to July 1,
1999. Restrictions on use of hospitals as emergency shelters
18 are expanded to include families of patients. Also, the date
by which the Agency for Health Care Administration must report
19 to the Governor and Legislature its recommendations for
cost-effective renovation standards for existing health care
20 facilities is changed from March 1, 1999, to April 1, 1998.
21 The Florida Patients Bill of Rights and Responsibilities is
further amended to require health care providers and health
22 care facilities to inform patients of the telephone number and
address of each state agency responsible for responding to
23 patient complaints only if requested. Penalties against health
care providers for failure to provide patients with a summary
24 of the rights are reduced to up to $100 for nonwillful
violations and up to $500 for willful violations. The $5,000
25 and $25,000 limits remain applicable to health care
facilities.
26
Amends s. 766.101, F.S., relating to medical review committees
27 to provide for protection from liability for medical review
committees and committees of physician-hospital organizations,
28 provider-sponsored organizations, and integrated delivery
systems.
29
Appropriates $100,281 from the Health Care Trust Fund to the
30 Agency for Health Care Administration and authorizes one
full-time equivalent position for the agency.
31
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