House Bill 0349c1
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Florida House of Representatives - 1997 CS/HB 349
By the Committee on Health Care Standards & Regulatory
Reform and Representative Saunders
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. 112.153, F.S.,
9 relating to local governmental group insurance
10 plans; updating provisions to reflect the
11 assumption by the Agency for Health Care
12 Administration of duties formerly performed by
13 the Health Care Cost Containment Board;
14 amending s. 154.209, F.S.; expanding programs
15 eligible for financing by a health facilities
16 authority; amending s. 154.304, F.S., relating
17 to health care for indigent persons; revising
18 definitions; amending ss. 212.055 and 394.4788,
19 F.S., relating to discretionary sales surtaxes
20 and mental health services; updating provisions
21 relating to duties of the agency formerly
22 performed by the Health Care Cost Containment
23 Board; amending s. 240.4076, F.S.; conforming a
24 cross reference to changes made by the act;
25 amending s. 395.0163, F.S.; providing
26 exemptions from construction inspections and
27 investigations by the Agency for Health Care
28 Administration for certain outpatient
29 facilities; providing exceptions; amending s.
30 395.0197, F.S.; exempting ambulatory surgical
31 centers and hospitals from certain staffing
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1 requirements in surgical recovery rooms;
2 amending s. 395.1055, F.S.; requiring the
3 Agency for Health Care Administration to adopt
4 rules to assure that, following a disaster,
5 licensed facilities are capable of serving as
6 shelters only for patients, staff, and the
7 families of staff; providing for applicability;
8 providing for a report by the agency to the
9 Governor and Legislature; amending s. 395.3025,
10 F.S.; revising charges for copies of medical
11 records; amending s. 395.401, F.S.; providing
12 for certain reports formerly made to the Health
13 Care Board to be made to the agency; amending
14 s. 395.701, F.S., relating to the Public
15 Medical Assistance Trust Fund; revising
16 definitions; amending s. 408.033, F.S.;
17 revising membership on the Statewide Health
18 Council to reflect the abolishment of the
19 Health Care Board; amending ss. 408.05,
20 408.061, 408.062, and 408.063, F.S., relating
21 to the State Center for Health Statistics and
22 the collection and dissemination of health care
23 information; updating provisions to reflect the
24 assumption by the Agency for Health Care
25 Administration of duties formerly performed by
26 the Health Care Board and the former Department
27 of Health and Rehabilitative Services;
28 authorizing the agency to conduct data-based
29 studies and make recommendations; deleting
30 obsolete provisions; amending s. 408.07, F.S.;
31 deleting definitions made obsolete by the
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1 repeal of requirements with respect to hospital
2 budget reviews; amending s. 408.08, F.S.;
3 deleting provisions requiring the Health Care
4 Board to review the budgets of certain
5 hospitals; deleting requirements that a
6 hospital file budget letters; deleting certain
7 administrative penalties; amending s. 408.40,
8 F.S.; removing a reference to the duties of the
9 Public Counsel with respect to hospital budget
10 review proceedings; amending ss. 409.2673 and
11 409.9113, F.S., relating to health care
12 programs for low-income persons and the
13 disproportionate share program for teaching
14 hospitals; updating provisions to reflect the
15 abolishment of the Health Care Cost Containment
16 Board and the assumption of its duties by the
17 agency; repealing ss. 395.403(9), 407.61,
18 408.003, 408.072, and 408.085, F.S., relating
19 to reimbursement of state-sponsored trauma
20 centers, studies by the Health Care Board,
21 appointment of members to the Health Care
22 Board, review of hospital budgets, and budget
23 reviews of comprehensive inpatient
24 rehabilitation hospitals; providing for
25 retroactive application of provisions of the
26 act relating to repeal of review of hospital
27 budgets; amending ss. 381.026 and 381.0261,
28 F.S.; requiring distribution of the Florida
29 Patient's Bill of Rights and Responsibilities;
30 providing penalties; repealing s. 395.002(2)
31 and (15), F.S.; deleting definitions of
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1 "adverse or untoward incident" and "injury";
2 amending s. 395.0193, F.S.; revising provisions
3 relating to facility peer review disciplinary
4 actions against practitioners; requiring report
5 to the Agency for Health Care Administration;
6 providing penalties; amending s. 395.0197,
7 F.S.; revising provisions relating to internal
8 risk management; defining "adverse incident";
9 requiring certain reports to the agency;
10 including minors in provisions relating to
11 notification of sexual misconduct or abuse;
12 requiring facility corrective action plans;
13 providing penalties; renumbering s. 626.941,
14 F.S., relating to purpose of the health care
15 risk manager licensure program; renumbering and
16 amending s. 626.942, F.S., relating to the
17 Health Care Risk Manager Advisory Council;
18 renumbering and amending s. 626.943, F.S.;
19 providing powers and duties of the agency;
20 renumbering and amending s. 626.944, F.S.,
21 relating to qualifications for health care risk
22 managers; providing for fees; providing for
23 issuance, cancellation, and renewal of
24 licenses; renumbering and amending s. 626.945,
25 F.S., relating to grounds for denial,
26 suspension, or revocation of licenses; amending
27 ss. 394.4787, 395.602, 395.701, 400.051,
28 408.072, 409.905, 440.13, 458.331, 459.015,
29 468.505, 641.55, and 766.1115, F.S.; conforming
30 references and correcting cross references;
31 transferring the internal risk manager
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1 licensure program from the Department of
2 Insurance to the Agency for Health Care
3 Administration; providing an appropriation;
4 providing effective dates.
5
6 Be It Enacted by the Legislature of the State of Florida:
7
8 Section 1. Paragraphs (b), (d), and (e) of subsection
9 (2) and subsections (6) and (7) of section 20.42, Florida
10 Statutes, 1996 Supplement, are amended to read:
11 20.42 Agency for Health Care Administration.--There is
12 created the Agency for Health Care Administration within the
13 Department of Business and Professional Regulation. The agency
14 shall be a separate budget entity, and the director of the
15 agency shall be the agency head for all purposes. The agency
16 shall not be subject to control, supervision, or direction by
17 the Department of Business and Professional Regulation in any
18 manner, including, but not limited to, personnel, purchasing,
19 transactions involving real or personal property, and
20 budgetary matters.
21 (2) ORGANIZATION OF THE AGENCY.--The agency shall be
22 organized as follows:
23 (b) The Division of Health Policy and Cost Control,
24 which shall be responsible for health policy, the State Center
25 for Health Statistics, the development of The Florida Health
26 Plan, certificate of need, hospital budget review, state and
27 local health planning under s. 408.033, and research and
28 analysis.
29 (d) The Health Care Board, which shall be responsible
30 for hospital budget review, nursing home financial analysis,
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1 and special studies as assigned by the secretary or the
2 Legislature.
3 (d)(e) The Division of Administrative Services, which
4 shall be responsible for revenue management, budget,
5 personnel, and general services.
6 (6) HEALTH CARE BOARD.--The Health Care Board shall be
7 composed of 11 members appointed by the Governor, subject to
8 confirmation by the Senate. The members of the board shall
9 biennially elect a chairperson and a vice chairperson from its
10 membership. The board shall be responsible for hospital budget
11 review, nursing home financial review and analysis, and
12 special studies requested by the Governor, the Legislature, or
13 the director.
14 (6)(7) DEPUTY DIRECTOR OF ADMINISTRATIVE
15 SERVICES.--The director shall appoint a Deputy Director of
16 Administrative Services who shall serve at the pleasure of,
17 and be directly responsible to, the director. The deputy
18 director shall be responsible for the Division of
19 Administrative Services.
20 Section 2. Section 112.153, Florida Statutes, is
21 amended to read:
22 112.153 Local governmental group insurance plans;
23 refunds with respect to overcharges by providers.--A
24 participant in a group insurance plan offered by a county,
25 municipality, school board, local governmental unit, and
26 special taxing unit, who discovers that he or she was
27 overcharged by a hospital, physician, clinical lab, and other
28 health care providers, shall receive a refund of 50 percent of
29 any amount recovered as a result of such overcharge, up to a
30 maximum of $1,000 per admission. All such instances of
31 overcharge shall be reported to the Agency for Health Care
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1 Administration Health Care Cost Containment Board for action
2 it deems appropriate.
3 Section 3. Subsection (18) of section 154.209, Florida
4 Statutes, is amended to read:
5 154.209 Powers of authority.--The purpose of the
6 authority shall be to assist health facilities in the
7 acquisition, construction, financing, and refinancing of
8 projects in any corporated or unincorporated area within the
9 geographical limits of the local agency. For this purpose,
10 the authority is authorized and empowered:
11 (18) To participate in and issue bonds and other forms
12 of indebtedness for the purpose of establishing and
13 maintaining an accounts receivable program on behalf of a
14 health facility or group of health facilities.
15 Notwithstanding any other provisions of this part, the
16 structuring and financing of an accounts receivable program or
17 the acquisition and financing of accounts receivable from
18 other not-for-profit health care corporations pursuant to this
19 subsection shall constitute a project and may be structured
20 for the benefit of health facilities within or outside the
21 geographical limits of the local agency.
22 Section 4. Subsections (1), (4), and (8) of section
23 154.304, Florida Statutes, are amended to read:
24 154.304 Definitions.--For the purpose of this act:
25 (1) "Agency" means the Agency for Health Care
26 Administration "Board" means the Health Care Board as
27 established in chapter 408.
28 (4) "Charity care obligation" means the minimum amount
29 of uncompensated charity care as reported to the agency Health
30 Care Cost Containment Board, based on the hospital's most
31 recent audited actual experience, which must be provided by a
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1 participating hospital or a regional referral hospital before
2 the hospital is eligible to be reimbursed by a county under
3 the provisions of this act. That amount shall be the ratio of
4 uncompensated charity care days compared to total acute care
5 inpatient days, which shall be equal to or greater than 2
6 percent.
7 (8) "Participating hospital" means a hospital which is
8 eligible to receive reimbursement under the provisions of this
9 act because it has been certified by the agency board as
10 having met its charity care obligation and has either:
11 (a) A formal signed agreement with a county or
12 counties to treat such county's indigent patients; or
13 (b) Demonstrated to the agency board that at least 2.5
14 percent of its uncompensated charity care, as reported to the
15 board, is generated by out-of-county residents.
16 Section 5. Paragraph (d) of subsection (4) and
17 paragraph (c) of subsection (6) of section 212.055, Florida
18 Statutes, 1996 Supplement, are amended to read:
19 212.055 Discretionary sales surtaxes; legislative
20 intent; authorization and use of proceeds.--It is the
21 legislative intent that any authorization for imposition of a
22 discretionary sales surtax shall be published in the Florida
23 Statutes as a subsection of this section, irrespective of the
24 duration of the levy. Each enactment shall specify the types
25 of counties authorized to levy; the rate or rates which may be
26 imposed; the maximum length of time the surtax may be imposed,
27 if any; the procedure which must be followed to secure voter
28 approval, if required; the purpose for which the proceeds may
29 be expended; and such other requirements as the Legislature
30 may provide. Taxable transactions and administrative
31 procedures shall be as provided in s. 212.054.
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1 (4) INDIGENT CARE SURTAX.--
2 (d) The ordinance adopted by the governing body
3 providing for the imposition of the surtax shall set forth a
4 plan for providing health care services to qualified
5 residents, as defined in paragraph (e). Such plan and
6 subsequent amendments to it shall fund a broad range of health
7 care services for both indigent persons and the medically
8 poor, including, but not limited to, primary care and
9 preventive care as well as hospital care. It shall emphasize
10 a continuity of care in the most cost-effective setting,
11 taking into consideration both a high quality of care and
12 geographic access. Where consistent with these objectives, it
13 shall include, without limitation, services rendered by
14 physicians, clinics, community hospitals, mental health
15 centers, and alternative delivery sites, as well as at least
16 one regional referral hospital where appropriate. It shall
17 provide that agreements negotiated between the county and
18 providers will include reimbursement methodologies that take
19 into account the cost of services rendered to eligible
20 patients, recognize hospitals that render a disproportionate
21 share of indigent care, provide other incentives to promote
22 the delivery of charity care, and require cost containment
23 including, but not limited to, case management. It must also
24 provide that any hospitals that are owned and operated by
25 government entities on May 21, 1991, must, as a condition of
26 receiving funds under this subsection, afford public access
27 equal to that provided under s. 286.011 as to meetings of the
28 governing board, the subject of which is budgeting resources
29 for the rendition of charity care as that term is defined in
30 the rules of the Agency for Health Care Administration Health
31 Care Cost Containment Board. The plan must shall also include
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1 innovative health care programs that provide cost-effective
2 alternatives to traditional methods of service delivery and
3 funding.
4 (6) SMALL COUNTY INDIGENT CARE SURTAX.--
5 (c) The ordinance adopted by the governing body
6 providing for the imposition of the surtax shall set forth a
7 brief plan for providing health care services to qualified
8 residents, as defined in paragraph (d). Such plan and
9 subsequent amendments to it shall fund a broad range of health
10 care services for both indigent persons and the medically
11 poor, including, but not limited to, primary care and
12 preventive care as well as hospital care. It shall emphasize
13 a continuity of care in the most cost-effective setting,
14 taking into consideration both a high quality of care and
15 geographic access. Where consistent with these objectives, it
16 shall include, without limitation, services rendered by
17 physicians, clinics, community hospitals, mental health
18 centers, and alternative delivery sites, as well as at least
19 one regional referral hospital where appropriate. It shall
20 provide that agreements negotiated between the county and
21 providers will include reimbursement methodologies that take
22 into account the cost of services rendered to eligible
23 patients, recognize hospitals that render a disproportionate
24 share of indigent care, provide other incentives to promote
25 the delivery of charity care, and require cost containment
26 including, but not limited to, case management. It shall also
27 provide that any hospitals that are owned and operated by
28 government entities on May 21, 1991, must, as a condition of
29 receiving funds under this subsection, afford public access
30 equal to that provided under s. 286.011 as to meetings of the
31 governing board, the subject of which is budgeting resources
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1 for the rendition of charity care as that term is defined in
2 the rules of the Agency for Health Care Administration Health
3 Care Cost Containment Board. The plan must shall also include
4 innovative health care programs that provide cost-effective
5 alternatives to traditional methods of service delivery and
6 funding.
7 Section 6. Subsections (2) and (3) of section
8 394.4788, Florida Statutes, 1996 Supplement, are amended to
9 read:
10 394.4788 Use of certain PMATF funds for the purchase
11 of acute care mental health services.--
12 (2) By October 1, 1989, and annually thereafter, The
13 agency shall annually calculate a per diem reimbursement rate
14 for each specialty psychiatric hospital to be paid to the
15 specialty psychiatric hospitals for the provision of acute
16 mental health services provided to indigent mentally ill
17 patients who meet the criteria in subsection (1). After the
18 first rate period, providers shall be notified of new
19 reimbursement rates for each new state fiscal year by June 1.
20 The new reimbursement rates shall commence July 1.
21 (3) Reimbursement rates shall be calculated using the
22 most recent audited actual costs received by the agency. Cost
23 data received as of August 15, 1989, and each April 15
24 thereafter shall be used in the calculation of the rates.
25 Historic costs shall be inflated from the midpoint of a
26 hospital's fiscal year to the midpoint of the state fiscal
27 year. The inflation adjustment shall be made utilizing the
28 latest available projections as of March 31 for the Data
29 Resources Incorporated National and Regional Hospital Input
30 Price Indices as calculated by the Medicaid program office.
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1 Section 7. Paragraph (a) of subsection (4) of section
2 240.4076, Florida Statutes, is amended to read:
3 240.4076 Nursing scholarship loan program.--
4 (4) Credit for repayment of a scholarship loan shall
5 be on a year-for-year basis as follows:
6 (a) For each year of scholarship loan assistance, the
7 recipient agrees to work for 12 months at a health care
8 facility in a medically underserved area as approved by the
9 Department of Health and Rehabilitative Services. Eligible
10 health care facilities include state-operated medical or
11 health care facilities, county public health units, federally
12 sponsored community health centers, or teaching hospitals as
13 defined in s. 408.07 s. 408.07(49).
14 Section 8. Subsection (1) of section 395.0163, Florida
15 Statutes, is amended to read:
16 395.0163 Construction inspections; plan submission and
17 approval; fees.--
18 (1) The agency shall make, or cause to be made, such
19 construction inspections and investigations as it deems
20 necessary. The agency may prescribe by rule that any licensee
21 or applicant desiring to make specified types of alterations
22 or additions to its facilities or to construct new facilities
23 shall, before commencing such alteration, addition, or new
24 construction, submit plans and specifications therefor to the
25 agency for preliminary inspection and approval or
26 recommendation with respect to compliance with agency rules
27 and standards. The agency shall approve or disapprove the
28 plans and specifications within 60 days after receipt of the
29 fee for review of plans as required in subsection (2). The
30 agency may be granted one 15-day extension for the review
31 period if the director of the agency approves the extension.
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1 If the agency fails to act within the specified time, it shall
2 be deemed to have approved the plans and specifications. When
3 the agency disapproves plans and specifications, it shall set
4 forth in writing the reasons for its disapproval. Conferences
5 and consultations may be provided as necessary. Outpatient
6 facilities that provide surgical treatments requiring general
7 anesthesia or intravenous conscious sedation or that provide
8 cardiac catheterization services shall submit plans and
9 specifications to the agency for review under this section.
10 All other outpatient facilities that are physically detached
11 from the hospital with no utility connections and that do not
12 block emergency egress from or create a fire hazard to the
13 hospital are exempt from review under this section.
14 Applications pending review on the effective date of this act
15 shall be governed by the exemption provided in this
16 subsection.
17 Section 9. Paragraph (b) of subsection (1) of section
18 395.0197, Florida Statutes, 1996 Supplement, is amended to
19 read:
20 395.0197 Internal risk management program.--
21 (1) Every licensed facility shall, as a part of its
22 administrative functions, establish an internal risk
23 management program that includes all of the following
24 components:
25 (b) The development of appropriate measures to
26 minimize the risk of injuries and adverse incidents to
27 patients, including, but not limited to:
28 1. Risk management and risk prevention education and
29 training of all nonphysician personnel as follows:
30 a. Such education and training of all nonphysician
31 personnel as part of their initial orientation; and
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1 b. At least 1 hour of such education and training
2 annually for all nonphysician personnel of the licensed
3 facility working in clinical areas and providing patient care.
4 2. A prohibition, except when emergency circumstances
5 require otherwise, against a staff member of the licensed
6 facility attending a patient in the recovery room, unless the
7 staff member is authorized to attend the patient in the
8 recovery room and is in the company of at least one other
9 person. However, a licensed facility hospital is exempt from
10 the two-person requirement if it has:
11 a. Live visual observation;
12 b. Electronic observation; or
13 c. Any other reasonable measure taken to ensure
14 patient protection and privacy.
15 Section 10. Paragraph (d) of subsection (1) of section
16 395.1055, Florida Statutes, 1996 Supplement, is amended to
17 read:
18 395.1055 Rules and enforcement.--
19 (1) The agency shall adopt, amend, promulgate, and
20 enforce rules to implement the provisions of this part, which
21 shall include reasonable and fair minimum standards for
22 ensuring that:
23 (d) New facilities and a new wing or floor added to an
24 existing facility after July 1, 1997, are structurally capable
25 of serving as shelters only for patients, staff, and families
26 of staff, and equipped to be self-supporting during and
27 immediately following disasters.
28 Section 11. The Agency for Health Care Administration
29 shall work with persons affected by section 9 and report to
30 the Governor and Legislature by March 1, 1998, its
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1 recommendations for cost-effective renovation standards to be
2 applied to existing facilities.
3 Section 12. Subsection (1) of section 395.3025,
4 Florida Statutes, 1996 Supplement, is amended to read:
5 395.3025 Patient and personnel records; copies;
6 examination.--
7 (1) Any licensed facility shall, upon written request,
8 and only after discharge of the patient, furnish, in a timely
9 manner, without delays for legal review, to any person
10 admitted therein for care and treatment or treated thereat, or
11 to any such person's guardian, curator, or personal
12 representative, or in the absence of one of those persons, to
13 the next of kin of a decedent or the parent of a minor, or to
14 anyone designated by such person in writing, a true and
15 correct copy of all patient records, including X rays, and
16 insurance information concerning such person, which records
17 are in the possession of the licensed facility, provided the
18 person requesting such records pays agrees to pay a charge.
19 The exclusive charge for copies of patient records stored in
20 paper form may include sales tax and actual postage, and,
21 except for nonpaper records which are subject to a charge not
22 to exceed $2 as provided in s. 28.24(9)(c), may not exceed $1
23 per page, and for copies of patient records stored in nonpaper
24 form, such as microfilm, microfiche, and disk, may not exceed
25 $2 per page for each paper copy of not more than 14 inches by
26 8-1/2 inches furnished. These maximum charges are deemed to be
27 reasonable. In addition, a search fee of $1 for each year of
28 records requested, any sales tax due with respect to the
29 charge for copies and for the search, and actual postage may
30 be charged. Charges for X-ray copies are limited to a
31 reasonable amount. as provided in s. 28.24(8)(a). A fee of up
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1 to $1 may be charged for each year of records requested. These
2 charges shall apply to all records furnished, whether directly
3 from the facility or from a copy service providing these
4 services on behalf of the facility. However, a patient whose
5 records are copied or searched for the purpose of continuing
6 to receive medical care is not required to pay a charge for
7 copying or for the search. The licensed facility shall
8 further allow any such person to examine the original records
9 in its possession, or microforms or other suitable
10 reproductions of the records, upon such reasonable terms as
11 shall be imposed to assure that the records will not be
12 damaged, destroyed, or altered.
13 Section 13. Paragraphs (a) and (b) of subsection (1)
14 of section 395.401, Florida Statutes, are amended to read:
15 395.401 Trauma services system plans; verification of
16 trauma centers and pediatric trauma referral centers;
17 procedures; renewal.--
18 (1) As used in this part, the term:
19 (a) "Agency" means the Agency for Health Care
20 Administration "Board" means the Health Care Board.
21 (b) "Charity care" or "uncompensated charity care"
22 means that portion of hospital charges reported to the agency
23 board for which there is no compensation for care provided to
24 a patient whose family income for the 12 months preceding the
25 determination is less than or equal to 150 percent of the
26 federal poverty level, unless the amount of hospital charges
27 due from the patient exceeds 25 percent of the annual family
28 income. However, in no case shall the hospital charges for a
29 patient whose family income exceeds 4 times the federal
30 poverty level for a family of four be considered charity.
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1 Section 14. Subsections (1), (2), (3), and (4) of
2 section 395.701, Florida Statutes, are amended to read:
3 395.701 Annual assessments on net operating revenues
4 to fund public medical assistance; administrative fines for
5 failure to pay assessments when due.--
6 (1) For the purposes of this section, the term:
7 (a) "Agency" means the Agency for Health Care
8 Administration.
9 (b)(a) "Gross operating revenue" or "gross revenue"
10 means the sum of daily hospital service charges, ambulatory
11 service charges, ancillary service charges, and other
12 operating revenue.
13 (b) "Health Care Board" or "board" means the Health
14 Care Board created by s. 20.42.
15 (c) "Hospital" means a health care institution as
16 defined in s. 395.002(12), but does not include any hospital
17 operated by the agency or the Department of Corrections.
18 (d) "Net operating revenue" or "net revenue" means
19 gross revenue less deductions from revenue.
20 (e) "Total deductions from gross revenue" or
21 "deductions from revenue" means reductions from gross revenue
22 resulting from inability to collect payment of charges. Such
23 reductions include bad debts; contractual adjustments;
24 uncompensated care; administrative, courtesy, and policy
25 discounts and adjustments; and other such revenue deductions,
26 but also includes the offset of restricted donations and
27 grants for indigent care.
28 (2) There is hereby imposed upon each hospital an
29 assessment in an amount equal to 1.5 percent of the annual net
30 operating revenue for each hospital, such revenue to be
31 determined by the agency department, based on the actual
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1 experience of the hospital as reported to the agency
2 department. Within 6 months after the end of each hospital
3 fiscal year, the agency department shall certify the amount of
4 the assessment for each hospital. The assessment shall be
5 payable to and collected by the agency department in equal
6 quarterly amounts, on or before the first day of each calendar
7 quarter, beginning with the first full calendar quarter that
8 occurs after the agency department certifies the amount of the
9 assessment for each hospital. All moneys collected pursuant to
10 this subsection shall be deposited into the Public Medical
11 Assistance Trust Fund.
12 (3) The agency department shall impose an
13 administrative fine, not to exceed $500 per day, for failure
14 of any hospital to pay its assessment by the first day of the
15 calendar quarter on which it is due. The failure of a
16 hospital to pay its assessment within 30 days after the
17 assessment is due is ground for the agency department to
18 impose an administrative fine not to exceed $5,000 per day.
19 (4) The purchaser, successor, or assignee of a
20 facility subject to the agency's board's jurisdiction shall
21 assume full liability for any assessments, fines, or penalties
22 of the facility or its employees, regardless of when
23 identified. Such assessments, fines, or penalties shall be
24 paid by the employee, owner, or licensee who incurred them,
25 within 15 days of the sale, transfer, or assignment. However,
26 the purchaser, successor, or assignee of the facility may
27 withhold such assessments, fines, or penalties from purchase
28 moneys or payment due to the seller, transferor, or employee,
29 and shall make such payment on behalf of the seller,
30 transferor, or employee. Any employer, purchaser, successor,
31 or assignee who fails to withhold sufficient funds to pay
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1 assessments, fines, or penalties arising under the provisions
2 of chapter 408 shall make such payments within 15 days of the
3 date of the transfer, purchase, or assignment. Failure by the
4 transferee to make payments as provided in this subsection
5 shall subject such transferee to the penalties and assessments
6 provided in chapter 408. Further, in the event of sale,
7 transfer, or assignment of any facility under the agency's
8 board's jurisdiction, future assessments shall be based upon
9 the most recently available prior year report or audited
10 actual experience for the facility. It shall be the
11 responsibility of the new owner or licensee to require the
12 production of the audited financial data for the period of
13 operation of the prior owner. If the transferee fails to
14 obtain current audited financial data from the previous owner
15 or licensee, the new owner shall be assessed based upon the
16 most recent year of operation for which 12 months of audited
17 actual experience are available or upon a reasonable estimate
18 of 12 months of full operation as calculated by the agency
19 board.
20 Section 15. Subsection (2) of section 408.033, Florida
21 Statutes, is amended to read:
22 408.033 Local and state health planning.--
23 (2) STATEWIDE HEALTH COUNCIL.--The Statewide Health
24 Council is hereby established as a state-level comprehensive
25 health planning and policy advisory board. For administrative
26 purposes, the council shall be located within the agency. The
27 Statewide Health Council shall be composed of: the State
28 Health Officer; the Deputy Director for Health Policy and Cost
29 Control and the Deputy Director for Health Quality Assurance
30 of the agency department; the director of the Health Care
31 Board; the Insurance Commissioner or his designee; the Vice
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1 Chancellor for Health Affairs of the Board of Regents; three
2 chairmen of regional planning councils, selected by the
3 regional planning councils; five chairmen of local health
4 councils, selected by the local health councils; four members
5 appointed by the Governor, one of whom is a consumer over 60
6 years of age, one of whom is a representative of organized
7 labor, one of whom is a physician, and one of whom represents
8 the nursing home industry; five members appointed by the
9 President of the Senate, one of whom is a representative of
10 the insurance industry in this state, one of whom is the chief
11 executive officer of a business with more than 300 employees
12 in this state, one of whom represents the hospital industry,
13 one of whom is a primary care physician, and one of whom is a
14 nurse, and five members appointed by the Speaker of the House
15 of Representatives, one of whom is a consumer who represents a
16 minority group in this state, one of whom represents the home
17 health care industry in this state, one of whom is an allied
18 health care professional, one of whom is the chief executive
19 officer of a business with fewer than 25 employees in this
20 state, and one of whom represents a county social services
21 program that provides health care services to the indigent.
22 Appointed members of the council shall serve for 2-year terms
23 commencing October 1 of each even-numbered year. The council
24 shall elect a president from among the members who are not
25 state employees. The Statewide Health Council shall:
26 (a) Advise the Governor, the Legislature, and the
27 agency department on state health policy issues, state and
28 local health planning activities, and state health regulation
29 programs;
30 (b) Prepare a state health plan that specifies
31 subgoals, quantifiable objectives, strategies, and resource
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1 requirements to implement the goals and policies of the health
2 element of the State Comprehensive Plan. The plan must assess
3 the health status of residents of this state; evaluate the
4 adequacy, accessibility, and affordability of health services
5 and facilities; assess government-financed programs and
6 private health care insurance coverages; and address other
7 topical local and state health care issues. Within 2 years
8 after the health element of the State Comprehensive Plan is
9 amended, and by July 1 of every 3rd year, if it is not
10 amended, the Statewide Health Council shall submit the state
11 health plan to the Executive Office of the Governor, the
12 director of the agency secretary of the department, the
13 President of the Senate, and the Speaker of the House of
14 Representatives;
15 (c) Promote public awareness of state health care
16 issues and, in conjunction with the local health councils,
17 conduct public forums throughout the state to solicit the
18 comments and advice of the public on the adequacy,
19 accessibility, and affordability of health care services in
20 this state and other health care issues;
21 (d) Consult with local health councils, the Department
22 of Insurance, the Department of Health and Rehabilitative
23 Services, and other appropriate public and private entities,
24 including health care industry representatives regarding the
25 development of health policies;
26 (e) Serve as a forum for the discussion of local
27 health planning issues of concern to the local health councils
28 and regional planning councils;
29 (f) Review district health plans for consistency with
30 the State Comprehensive Plan and the state health plan;
31
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1 (g) Review the health components of agency functional
2 plans for consistency with the health element of the State
3 Comprehensive Plan, advise the Executive Office of the
4 Governor regarding inconsistencies, and recommend revisions to
5 agency functional plans to make them consistent with the State
6 Comprehensive Plan;
7 (h) Review any strategic regional plans that address
8 health issues for consistency with the health element of the
9 State Comprehensive Plan, advise the Executive Office of the
10 Governor regarding inconsistencies, and recommend revisions to
11 strategic regional policy plans to make them consistent with
12 the State Comprehensive Plan;
13 (i) Assist the Department of Community Affairs in the
14 review of local government comprehensive plans to ensure
15 consistency with policy developed in the district health
16 plans;
17 (j) With the assistance of the local health councils,
18 conduct public forums and use other means to determine the
19 opinions of health care consumers, providers, payors, and
20 insurers regarding the state's health care goals and policies
21 and develop suggested revisions to the health element of the
22 State Comprehensive Plan. The council shall submit the
23 proposed revisions to the health element of the State
24 Comprehensive Plan to the Governor, the President of the
25 Senate, and the Speaker of the House of Representatives by
26 February 1, 1993, and shall widely circulate the proposed
27 revisions to affected parties. The council shall periodically
28 assess the progress made in achieving the goals and policies
29 contained in the health element of the State Comprehensive
30 Plan and report to the agency department, the Governor, the
31
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1 President of the Senate, and the Speaker of the House of
2 Representatives; and
3 (k) Conduct any other functions or studies and
4 analyses falling under the duties listed above.
5 Section 16. Subsection (1), paragraphs (e) and (f) of
6 subsection (3), subsection (6), and paragraphs (c) and (d) of
7 subsection (7) of section 408.05, Florida Statutes, are
8 amended to read:
9 408.05 State Center for Health Statistics.--
10 (1) ESTABLISHMENT.--The agency department shall
11 establish a State Center for Health Statistics. The center
12 shall establish a comprehensive health information system to
13 provide for the collection, compilation, coordination,
14 analysis, indexing, dissemination, and utilization of both
15 purposefully collected and extant health-related data and
16 statistics. The center shall be staffed with public health
17 experts, biostatisticians, information system analysts, health
18 policy experts, economists, and other staff necessary to carry
19 out its functions.
20 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order
21 to produce comparable and uniform health information and
22 statistics, the agency shall perform the following functions:
23 (e) The agency department shall establish by rule the
24 types of data collected, compiled, processed, used, or shared.
25 Decisions regarding center data sets should be made based on
26 consultation with the Comprehensive Health Information System
27 Advisory Council and other public and private users regarding
28 the types of data which should be collected and their uses.
29 (f) The center shall establish standardized means for
30 collecting health information and statistics under laws and
31 rules administered by the agency department.
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1 (6) PROVIDER DATA REPORTING.--This section does not
2 confer on the agency department the power to demand or require
3 that a health care provider or professional furnish
4 information, records of interviews, written reports,
5 statements, notes, memoranda, or data other than as expressly
6 required by law.
7 (7) BUDGET; FEES; TRUST FUND.--
8 (c) The center may charge such reasonable fees for
9 services as the agency department prescribes by rule. The
10 established fees may shall not exceed the reasonable cost for
11 such services. Fees collected may not be used to offset
12 annual appropriations from the General Revenue Fund.
13 (d) The agency department shall establish a
14 Comprehensive Health Information System Trust Fund as the
15 repository of all funds appropriated to, and fees and grants
16 collected for, services of the State Center for Health
17 Statistics. Any funds, other than funds appropriated to the
18 center from the General Revenue Fund, which are raised or
19 collected by the agency department for the operation of the
20 center and which are not needed to meet the expenses of the
21 center for its current fiscal year shall be available to the
22 agency board in succeeding years.
23 Section 17. Subsections (10) and (11) of section
24 408.061, Florida Statutes, 1996 Supplement, are amended to
25 read:
26 408.061 Data collection; uniform systems of financial
27 reporting; information relating to physician charges;
28 confidentiality of patient records; immunity.--
29 (10) No health care facility, health care provider,
30 health insurer, or other reporting entity or its employees or
31 agents shall be held liable for civil damages or subject to
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1 criminal penalties either for the reporting of patient data to
2 the agency board or for the release of such data by the agency
3 board as authorized by this chapter.
4 (11) The agency shall be the primary source for
5 collection and dissemination of health care data. No other
6 agency of state government may gather data from a health care
7 provider licensed or regulated under this chapter without
8 first determining if the data is currently being collected by
9 the agency and affirmatively demonstrating that it would be
10 more cost-effective for an agency of state government other
11 than the agency to gather the health care data. The director
12 secretary shall ensure that health care data collected by the
13 divisions within the agency is coordinated. It is the express
14 intent of the Legislature that all health care data be
15 collected by a single source within the agency and that other
16 divisions within the agency, and all other agencies of state
17 government, obtain data for analysis, regulation, and public
18 dissemination purposes from that single source. Confidential
19 information may be released to other governmental entities or
20 to parties contracting with the agency to perform agency
21 duties or functions as needed in connection with the
22 performance of the duties of the receiving entity. The
23 receiving entity or party shall retain the confidentiality of
24 such information as provided for herein.
25 Section 18. Subsections (2) and (5) of section
26 408.062, Florida Statutes, are amended to read:
27 408.062 Research, analyses, studies, and reports.--
28 (2) The agency board shall evaluate data from nursing
29 home financial reports and shall document and monitor:
30 (a) Total revenues, annual change in revenues, and
31 revenues by source and classification, including contributions
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1 for a resident's care from the resident's resources and from
2 the family and contributions not directed toward any specific
3 resident's care.
4 (b) Average resident charges by geographic region,
5 payor, and type of facility ownership.
6 (c) Profit margins by geographic region and type of
7 facility ownership.
8 (d) Amount of charity care provided by geographic
9 region and type of facility ownership.
10 (e) Resident days by payor category.
11 (f) Experience related to Medicaid conversion as
12 reported under s. 408.061.
13 (g) Other information pertaining to nursing home
14 revenues and expenditures.
15
16 The findings of the agency board shall be included in an
17 annual report to the Governor and Legislature by January 1
18 each year.
19 (5)(a) The agency is empowered to conduct data-based
20 studies and evaluations and to make recommendations to the
21 Legislature and the Governor concerning exemptions, the
22 effectiveness of limitations of referrals, restrictions on
23 investment interests and compensation arrangements, and the
24 effectiveness of public disclosure. Such analysis may
25 include, but need not be limited to, utilization of services,
26 cost of care, quality of care, and access to care. The agency
27 may require the submission of data necessary to carry out this
28 duty, which may include, but need not be limited to, data
29 concerning ownership, Medicare and Medicaid, charity care,
30 types of services offered to patients, revenues and expenses,
31 patient-encounter data, and other data reasonably necessary to
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1 study utilization patterns and the impact of health care
2 provider ownership interests in health-care-related entities
3 on the cost, quality, and accessibility of health care.
4 (b) The agency may collect such data from any health
5 facility as a special study. The board is directed to research
6 hospital financial and nonfinancial data in order to determine
7 the need for establishing a category of inpatient hospital
8 patients defined as medically indigent. For purposes of this
9 section, a medically indigent patient is an individual who is
10 admitted as an inpatient to a hospital, who is not classified
11 as a Medicare beneficiary, a Medicaid recipient, or a charity
12 care patient, but who has insufficient financial resources to
13 pay for needed medical care. In its determination of the need
14 for establishing a category of medically indigent patients,
15 the board shall consider the creation of income and asset
16 levels that would establish a person as medically indigent.
17 The board shall submit a report and recommendations to the
18 Governor and the Legislature on the establishment of a
19 category of medically indigent inpatient hospital patients on
20 or before January 1, 1994. If the board recommends the
21 establishment of a category of medically indigent patients, it
22 shall provide a specific recommendation for the eligibility
23 determination process to be used in classifying a patient as
24 medically indigent.
25 Section 19. Subsection (1) of section 408.063, Florida
26 Statutes, is amended to read:
27 408.063 Dissemination of health care information.--
28 (1) The agency, relying on data collected pursuant to
29 this chapter, shall establish a reliable, timely, and
30 consistent information system which distributes information
31 and serves as the basis for the agency's board's public
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1 education programs. The agency shall seek advice from
2 consumers, health care purchasers, health care providers,
3 health care facilities, health insurers, and local health
4 councils in the development and implementation of its
5 information system. Whenever appropriate, the agency shall use
6 the local health councils for the dissemination of information
7 and education of the public.
8 Section 20. Section 408.07, Florida Statutes, is
9 amended to read:
10 408.07 Definitions.--As used in this chapter, with the
11 exception of ss. 408.031-408.045, the term:
12 (1) "Accepted" means that the agency board has found
13 that a report or data submitted by a health care facility or a
14 health care provider contains all schedules and data required
15 by the agency board and has been prepared in the format
16 specified by the agency board, and otherwise conforms to
17 applicable rule or Florida Hospital Uniform Reporting System
18 manual requirements regarding reports in effect at the time
19 such report was submitted, and the data are mathematically
20 reasonable and accurate.
21 (2) "Adjusted admission" means the sum of acute and
22 intensive care admissions divided by the ratio of inpatient
23 revenues generated from acute, intensive, ambulatory, and
24 ancillary patient services to gross revenues. If a hospital
25 reports only subacute admissions, then "adjusted admission"
26 means the sum of subacute admissions divided by the ratio of
27 total inpatient revenues to gross revenues.
28 (3) "Agency" means the Agency for Health Care
29 Administration.
30 (4) "Alcohol or chemical dependency treatment center"
31 means an organization licensed under chapter 397.
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1 (5) "Ambulatory care center" means an organization
2 which employs or contracts with licensed health care
3 professionals to provide diagnosis or treatment services
4 predominantly on a walk-in basis and the organization holds
5 itself out as providing care on a walk-in basis. Such an
6 organization is not an ambulatory care center if it is wholly
7 owned and operated by five or fewer health care providers.
8 (6) "Ambulatory surgical center" means a facility
9 licensed as an ambulatory surgical center under chapter 395.
10 (7) "Applicable rate of increase" means the maximum
11 allowable rate of increase (MARI) when applied to gross
12 revenue per adjusted admission, unless the board has approved
13 a different rate of increase, in which case the board-approved
14 rate of increase shall apply.
15 (7)(8) "Audited actual data" means information
16 contained within financial statements examined by an
17 independent, Florida-licensed, certified public accountant in
18 accordance with generally accepted auditing standards, but
19 does not include data within a financial statement about which
20 the certified public accountant does not express an opinion or
21 issues a disclaimer.
22 (9) "Banked points" means the percentage points earned
23 by a hospital when the actual rate of increase in gross
24 revenue per adjusted admission (GRAA) is less than the maximum
25 allowable rate of increase (MARI) or the actual rate of
26 increase in the net revenue per adjusted admission (NRAA) is
27 less than the market basket index.
28 (8)(10) "Birth center" means an organization licensed
29 under s. 383.305.
30 (11) "Board" means the Health Care Board established
31 under s. 408.003.
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1 (12) "Budget" means the projections by the hospital,
2 for a specified future time period, of expenditures and
3 revenues, with supporting statistical indicators, or a budget
4 letter verified by the board pursuant to s. 408.072(3)(a).
5 (9)(13) "Cardiac catheterization laboratory" means a
6 freestanding facility that which employs or contracts with
7 licensed health care professionals to provide diagnostic or
8 therapeutic services for cardiac conditions such as cardiac
9 catheterization or balloon angioplasty.
10 (10)(14) "Case mix" means a calculated index for each
11 health care facility or health care provider, based on patient
12 data, reflecting the relative costliness of the mix of cases
13 to that facility or provider compared to a state or national
14 mix of cases.
15 (11)(15) "Clinical laboratory" means a facility
16 licensed under s. 483.091, excluding: any hospital laboratory
17 defined under s. 483.041(5); any clinical laboratory operated
18 by the state or a political subdivision of the state; any
19 blood or tissue bank where the majority of revenues are
20 received from the sale of blood or tissue and where blood,
21 plasma, or tissue is procured from volunteer donors and
22 donated, processed, stored, or distributed on a nonprofit
23 basis; and any clinical laboratory which is wholly owned and
24 operated by physicians who are licensed pursuant to chapter
25 458 or chapter 459 and who practice in the same group
26 practice, and at which no clinical laboratory work is
27 performed for patients referred by any health care provider
28 who is not a member of that same group practice.
29 (12)(16) "Comprehensive rehabilitative hospital" or
30 "rehabilitative hospital" means a hospital licensed by the
31 agency for Health Care Administration as a specialty hospital
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1 as defined in s. 395.002; provided that the hospital provides
2 a program of comprehensive medical rehabilitative services and
3 is designed, equipped, organized, and operated solely to
4 deliver comprehensive medical rehabilitative services, and
5 further provided that all licensed beds in the hospital are
6 classified as "comprehensive rehabilitative beds" pursuant to
7 s. 395.003(4), and are not classified as "general beds."
8 (13)(17) "Consumer" means any person other than a
9 person who administers health activities, is a member of the
10 governing body of a health care facility, provides health
11 services, has a fiduciary interest in a health facility or
12 other health agency or its affiliated entities, or has a
13 material financial interest in the rendering of health
14 services.
15 (14)(18) "Continuing care facility" means a facility
16 licensed under chapter 651.
17 (15)(19) "Cross-subsidization" means that the revenues
18 from one type of hospital service are sufficiently higher than
19 the costs of providing such service as to offset some of the
20 costs of providing another type of service in the hospital.
21 Cross-subsidization results from the lack of a direct
22 relationship between charges and the costs of providing a
23 particular hospital service or type of service.
24 (16)(20) "Deductions from gross revenue" or
25 "deductions from revenue" means reductions from gross revenue
26 resulting from inability to collect payment of charges. For
27 hospitals, such reductions include contractual adjustments;
28 uncompensated care; administrative, courtesy, and policy
29 discounts and adjustments; and other such revenue deductions,
30 but also includes the offset of restricted donations and
31 grants for indigent care.
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1 (17)(21) "Diagnostic-imaging center" means a
2 freestanding outpatient facility that provides specialized
3 services for the diagnosis of a disease by examination and
4 also provides radiological services. Such a facility is not a
5 diagnostic-imaging center if it is wholly owned and operated
6 by physicians who are licensed pursuant to chapter 458 or
7 chapter 459 and who practice in the same group practice and no
8 diagnostic-imaging work is performed at such facility for
9 patients referred by any health care provider who is not a
10 member of that same group practice.
11 (18)(22) "FHURS" means the Florida Hospital Uniform
12 Reporting System developed by the agency board.
13 (19)(23) "Freestanding" means that a health facility
14 bills and receives revenue which is not directly subject to
15 the hospital assessment for the Public Medical Assistance
16 Trust Fund as described in s. 395.701.
17 (20)(24) "Freestanding radiation therapy center" means
18 a facility where treatment is provided through the use of
19 radiation therapy machines that are registered under s. 404.22
20 and the provisions of the Florida Administrative Code
21 implementing s. 404.22. Such a facility is not a freestanding
22 radiation therapy center if it is wholly owned and operated by
23 physicians licensed pursuant to chapter 458 or chapter 459 who
24 practice within the specialty of diagnostic or therapeutic
25 radiology.
26 (21)(25) "GRAA" means gross revenue per adjusted
27 admission.
28 (22)(26) "Gross revenue" means the sum of daily
29 hospital service charges, ambulatory service charges,
30 ancillary service charges, and other operating revenue. Gross
31
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1 revenues do not include contributions, donations, legacies, or
2 bequests made to a hospital without restriction by the donors.
3 (23)(27) "Health care facility" means an ambulatory
4 surgical center, a hospice, a nursing home, a hospital, a
5 diagnostic-imaging center, a freestanding or hospital-based
6 therapy center, a clinical laboratory, a home health agency, a
7 cardiac catheterization laboratory, a medical equipment
8 supplier, an alcohol or chemical dependency treatment center,
9 a physical rehabilitation center, a lithotripsy center, an
10 ambulatory care center, a birth center, or a nursing home
11 component licensed under chapter 400 within a continuing care
12 facility licensed under chapter 651.
13 (24)(28) "Health care provider" means a health care
14 professional licensed under chapter 458, chapter 459, chapter
15 460, chapter 461, chapter 463, chapter 464, chapter 465,
16 chapter 466, part I, part III, part IV, part V, or part X of
17 chapter 468, chapter 483, chapter 484, chapter 486, chapter
18 490, or chapter 491.
19 (25)(29) "Health care purchaser" means an employer in
20 the state, other than a health care facility, health insurer,
21 or health care provider, who provides health care coverage for
22 his employees.
23 (26)(30) "Health insurer" means any insurance company
24 authorized to transact health insurance in the state, any
25 insurance company authorized to transact health insurance or
26 casualty insurance in the state that is offering a minimum
27 premium plan or stop-loss coverage for any person or entity
28 providing health care benefits, any self-insurance plan as
29 defined in s. 624.031, any health maintenance organization
30 authorized to transact business in the state pursuant to part
31 I of chapter 641, any prepaid health clinic authorized to
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1 transact business in the state pursuant to part II of chapter
2 641, any multiple-employer welfare arrangement authorized to
3 transact business in the state pursuant to ss. 624.436-624.45,
4 or any fraternal benefit society providing health benefits to
5 its members as authorized pursuant to chapter 632.
6 (27)(31) "Home health agency" means an organization
7 licensed under part IV of chapter 400.
8 (28)(32) "Hospice" means an organization licensed
9 under part VI of chapter 400.
10 (29)(33) "Hospital" means a health care institution
11 licensed by the Agency for Health Care Administration as a
12 hospital under chapter 395.
13 (30)(34) "Lithotripsy center" means a freestanding
14 facility that which employs or contracts with licensed health
15 care professionals to provide diagnosis or treatment services
16 using electro-hydraulic shock waves.
17 (31)(35) "Local health council" means the agency
18 defined in s. 408.033.
19 (32)(36) "Market basket index" means the Florida
20 hospital input price index (FHIPI), which is a statewide
21 market basket index used to measure inflation in hospital
22 input prices weighted for the Florida-specific experience
23 which uses multistate regional and state-specific price
24 measures, when available. The index shall be constructed in
25 the same manner as the index employed by the Secretary of the
26 United States Department of Health and Human Services for
27 determining the inflation in hospital input prices for
28 purposes of Medicare reimbursement.
29 (37) "Maximum allowable rate of increase" or "MARI"
30 means the maximum rate at which a hospital is normally
31 expected to increase its average gross revenues per adjusted
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1 admission for a given period. The board, using the most
2 recent audited actual data for each hospital, shall calculate
3 the MARI for each hospital as follows: The projected rate of
4 increase in the market basket index shall be divided by a
5 number which is determined by subtracting the sum of one-half
6 of the proportion of Medicare days plus one-half of the
7 proportion of CHAMPUS days plus the proportion of Medicaid
8 days plus 1.5 times the proportion of charity care days from
9 the number one. The formula to be employed by the board to
10 calculate the MARI shall take the following form:
11
12 FHIPI
13 MARI = (....................................)
14 1-[(Me x 0.5) + (Cp x 0.5) + Md + (Cc x 1.5)]
15
16 where:
17 MARI = maximum allowable rate of increase applied to
18 gross revenue.
19 FHIPI = Florida hospital input price index, which shall
20 be the projected rate of change in the market basket index.
21 Me = proportion of Medicare days, including when
22 available and reported to the board Medicare HMO days, to
23 total days.
24 Cp = proportion of Civilian Health and Medical Program
25 of the Uniformed Services (CHAMPUS) days to total days.
26 Md = proportion of Medicaid days, including when
27 available and reported to the board Medicaid HMO days, to
28 total days.
29 Cc = proportion of charity care days to total days with
30 a 50-percent offset for restricted grants for charity care and
31 unrestricted grants from local governments.
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1 (33)(38) "Medical equipment supplier" means an
2 organization that which provides medical equipment and
3 supplies used by health care providers and health care
4 facilities in the diagnosis or treatment of disease.
5 (34)(39) "Net revenue" means gross revenue minus
6 deductions from revenue.
7 (35)(40) "New hospital" means a hospital in its
8 initial year of operation as a licensed hospital and does not
9 include any facility which has been in existence as a licensed
10 hospital, regardless of changes in ownership, for over 1
11 calendar year.
12 (36)(41) "Nursing home" means a facility licensed
13 under s. 400.062 or, for resident level and financial data
14 collection purposes only, any institution licensed under
15 chapter 395 and which has a Medicare or Medicaid certified
16 distinct part used for skilled nursing home care, but does not
17 include a facility licensed under chapter 651.
18 (37)(42) "Operating expenses" means total expenses
19 excluding income taxes.
20 (38)(43) "Other operating revenue" means all revenue
21 generated from hospital operations other than revenue directly
22 associated with patient care.
23 (39)(44) "Physical rehabilitation center" means an
24 organization that which employs or contracts with health care
25 professionals licensed under part I or part III of chapter 468
26 or chapter 486 to provide speech, occupational, or physical
27 therapy services on an outpatient or ambulatory basis.
28 (40)(45) "Prospective payment arrangement" means a
29 financial agreement negotiated between a hospital and an
30 insurer, health maintenance organization, preferred provider
31
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1 organization, or other third-party payor which contains, at a
2 minimum, the elements provided for in s. 408.50.
3 (41)(46) "Rate of return" means the financial
4 indicators used to determine or demonstrate reasonableness of
5 the financial requirements of a hospital. Such indicators
6 shall include, but not be limited to: return on assets,
7 return on equity, total margin, and debt service coverage.
8 (42)(47) "Rural hospital" means an acute care hospital
9 licensed under chapter 395, with 85 licensed beds or fewer,
10 which has an emergency room and is located in an area defined
11 as rural by the United States Census, and which is:
12 (a) The sole provider within a county with a
13 population density of no greater than 100 persons per square
14 mile;
15 (b) An acute care hospital, in a county with a
16 population density of no greater than 100 persons per square
17 mile, which is at least 30 minutes of travel time, on normally
18 traveled roads under normal traffic conditions, from another
19 acute care hospital within the same county; or
20 (c) A hospital supported by a tax district or
21 subdistrict whose boundaries encompass a population of 100
22 persons or less per square mile.
23 (43)(48) "Special study" means a nonrecurring
24 data-gathering and analysis effort designed to aid the agency
25 for Health Care Administration in meeting its responsibilities
26 pursuant to this chapter.
27 (44)(49) "Teaching hospital" means any hospital
28 formally affiliated with an accredited medical school which
29 that exhibits activity in the area of medical education as
30 reflected by at least seven different resident physician
31
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1 specialties and the presence of 100 or more resident
2 physicians.
3 Section 21. Section 408.08, Florida Statutes, is
4 amended to read:
5 408.08 Inspections and audits; violations; penalties;
6 fines; enforcement.--
7 (1) The agency may inspect and audit books and records
8 of individual or corporate ownership, including books and
9 records of related organizations with which a health care
10 provider or a health care facility had transactions, for
11 compliance with this chapter. Upon presentation of a written
12 request for inspection to a health care provider or a health
13 care facility by the agency or its staff, the health care
14 provider or the health care facility shall make available to
15 the agency or its staff for inspection, copying, and review
16 all books and records relevant to the determination of whether
17 the health care provider or the health care facility has
18 complied with this chapter.
19 (2) The board shall annually compare the audited
20 actual experience of each hospital to the audited actual
21 experience of that hospital for the previous year.
22 (a) For a hospital submitting a budget letter, if the
23 board determines that the audited actual experience of the
24 hospital exceeded its previous year's audited actual
25 experience by more than the maximum allowable rate of increase
26 as certified in the budget letter plus any banked points
27 utilized in the budget letter, the amount of such excess shall
28 be determined by the board and a penalty shall be levied
29 against such hospital pursuant to subsection (3).
30 (b) For a hospital subject to budget review, if the
31 board determines that the audited actual experience of the
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1 hospital exceeded its previous year's audited actual
2 experience by more than the most recent approved budget or the
3 most recent approved budget as amended, the amount of such
4 excess shall be determined by the board, and a penalty shall
5 be levied against such hospital pursuant to subsection (3).
6 (c) For a hospital submitting a budget letter and for
7 a hospital subject to budget review, the board shall annually
8 compare each hospital's audited actual experience for net
9 revenues per adjusted admission to the hospital's audited
10 actual experience for net revenues per adjusted admission for
11 the previous year. If the rate of increase in net revenues
12 per adjusted admission between the previous year and the
13 current year was less than the market basket index, the
14 hospital may carry forward the difference and earn up to a
15 cumulative maximum of 3 banked net revenue percentage points.
16 Such banked net revenue percentage points shall be available
17 to the hospital to offset, in any future year, penalties for
18 exceeding the approved budget or the maximum allowable rate of
19 increase as set forth in subsection (3). Nothing in this
20 paragraph shall be used by a hospital to justify the approval
21 of a budget or a budget amendment by the board in excess of
22 the maximum allowable rate of increase pursuant to s. 408.072.
23 (3) Penalties shall be assessed as follows:
24 (a) For the first occurrence within a 5-year period,
25 the board shall prospectively reduce the current budget of the
26 hospital by the amount of the excess up to 5 percent; and, if
27 such excess is greater than 5 percent over the maximum
28 allowable rate of increase, any amount in excess of 5 percent
29 shall be levied by the board as a fine against such hospital
30 to be deposited in the Public Medical Assistance Trust Fund.
31
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1 (b) For the second occurrence with the 5-year period
2 following the first occurrence as set forth in paragraph (a),
3 the board shall prospectively reduce the current budget of the
4 hospital by the amount of the excess up to 2 percent; and, if
5 such excess is greater than 2 percent over the maximum
6 allowable rate of increase, any amount in excess of 2 percent
7 shall be levied by the board as a fine against such hospital
8 to be deposited in the Public Medical Assistance Trust Fund.
9 (c) For the third occurrence within the 5-year period
10 following the first occurrence as set forth in paragraph (a),
11 the board shall:
12 1. Levy a fine against the hospital in the total
13 amount of the excess, to be deposited in the Public Medical
14 Assistance Trust Fund.
15 2. Notify the agency of the violation, whereupon the
16 agency shall not accept any application for a certificate of
17 need pursuant to ss. 408.031-408.045 from or on behalf of such
18 hospital until such time as the hospital has demonstrated to
19 the satisfaction of the board that, following the date the
20 penalty was imposed under subparagraph 1., the hospital has
21 stayed within its projected or amended budget or its
22 applicable maximum allowable rate of increase for a period of
23 at least 1 year. However, this provision does not apply with
24 respect to a certificate-of-need application filed to satisfy
25 a life or safety code violation.
26 3. Upon a determination that the hospital knowingly
27 and willfully generated such excess, notify the agency,
28 whereupon the agency shall initiate disciplinary proceedings
29 to deny, modify, suspend, or revoke the license of such
30 hospital or impose an administrative fine on such hospital not
31 to exceed $20,000.
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1
2 The determination of the amount of any such excess shall be
3 based upon net revenues per adjusted admission, excluding
4 funds distributed to the hospital from the Public Medical
5 Assistance Trust Fund. However, in making such determination,
6 the board shall appropriately reduce the amount of the excess
7 by the total amount of the assessment paid by such hospital
8 pursuant to s. 395.701 minus the amount of revenues received
9 by the hospital through the Public Medical Assistance Trust
10 Fund. It is the responsibility of the hospital to demonstrate
11 to the satisfaction of the board its entitlement to such
12 reduction. It is the intent of the Legislature that the
13 Health Care Board, in levying any penalty imposed against a
14 hospital for exceeding its maximum allowable rate of increase
15 or its approved budget pursuant to this subsection, consider
16 the effect of changes in the case mix of the hospital and in
17 the hospital's intensity and severity of illness as measured
18 by changes in the hospital's actual proportion of outlier
19 cases to total cases and dollar increases in outlier cases'
20 average charge per case. It is the responsibility of the
21 hospital to demonstrate to the satisfaction of the board any
22 change in its case mix and in its intensity and severity of
23 illness. For psychiatric hospitals and other hospitals not
24 reimbursed under a prospective payment system by the Federal
25 Government, until a proxy for case mix is available, the board
26 shall also reduce the amount of excess by the change in a
27 hospital's audited actual average length of stay without any
28 thresholds or limitations.
29 (4) The following factors may be used by the board to
30 reduce the amount of excess of the hospital as determined
31 pursuant to this section:
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1 (a) Unforeseen and unforeseeable events which affect
2 the net revenue per adjusted admission and which are beyond
3 the control of the hospital, such as prior year Medicare cost
4 report settlements, retroactive changes in Medicare
5 reimbursement methodology, and increases in malpractice
6 insurance premiums, which occurred in the last 3 months of the
7 hospital fiscal year during which the hospital generated the
8 excess; or
9 (b) Imposition of the penalty would have a severe
10 adverse effect which would jeopardize the continued existence
11 of an otherwise economically viable hospital.
12 (5) The board shall reduce the amount of the excess
13 for hospitals submitting budget letters pursuant to s.
14 408.072(3)(a) by the amount of any documented costs from
15 financial assistance provided to expand or supplement the
16 curriculum of a community college, university, or vocational
17 training school for the purpose of training nurses or other
18 health professionals, not including physicians. Financial
19 assistance would include, but not be limited to, the direct
20 costs for faculty salaries and expenses, books, equipment,
21 recruiting efforts, tuition assistance, and hospital
22 internships. The reduction would be based on actual
23 documented expenses increased by the gross revenues necessary
24 to generate net revenues sufficient to cover the expenses.
25 (6) If the board finds that any hospital chief
26 executive officer or any person who is in charge of hospital
27 administration or operations has knowingly and willfully
28 allowed or authorized actual operating revenues or
29 expenditures that are in excess of projected operating
30 revenues or expenditures in the hospital's approved budget,
31
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1 the board shall order such officer or person to pay an
2 administrative fine not to exceed $5,000.
3 (7) For hospitals filing budget letters, the board
4 shall annually compare the audited actual experience of each
5 hospital for the year under review to the audited actual
6 experience of that hospital for the previous year. For
7 hospitals which submitted detailed budgets or budget
8 amendments, the board shall compare the audited actual
9 experience of each hospital for the year under review to its
10 approved gross revenue per adjusted admission for the year
11 under review, for purposes of levying an administrative fine.
12 (a) For a hospital submitting a budget letter pursuant
13 to s. 408.072(3)(a), if the board determines that the audited
14 actual experience for the year under review exceeded the
15 hospital's previous year's audited actual experience by more
16 than the maximum allowable rate of increase as certified in
17 the budget letter plus any banked points utilized in the
18 budget letter, the amount of the excess shall be determined
19 and an administrative fine shall be levied against such
20 hospital pursuant to subsection (8).
21 (b) For a hospital which submitted a budget pursuant
22 to s. 408.072(1), or a budget amendment pursuant to s.
23 408.072(6), if the board determines that the gross revenue per
24 adjusted admission contained in the hospital's audited actual
25 experience exceeded its board-approved gross revenue per
26 adjusted admission, the amount of the excess shall be
27 determined and an administrative fine shall be levied against
28 such hospital pursuant to subsection (8).
29 (8) If the board determines that an excess exists
30 pursuant to subsection (7), the board shall multiply the
31 excess by the number of actual adjusted admissions contained
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1 in the year at issue to determine the amount of the base fine.
2 The base fine shall be multiplied by the applicable occurrence
3 factor to determine the amount of the administrative fine
4 levied against the hospital.
5 (a) For the first occurrence within a 5-year period,
6 the applicable occurrence factor shall be 0.25. For the
7 second occurrence within a 5-year period, the applicable
8 occurrence factor shall be 0.55. For the third occurrence
9 within a 5-year period, the applicable occurrence factor shall
10 be 1.0.
11 (b) In no event shall any administrative fine levied
12 pursuant to this subsection exceed $365,000.
13 (9) In levying any administrative fine against a
14 hospital pursuant to subsection (8), the board shall consider
15 the effect of any changes in the hospital's case mix, and in
16 the hospital's intensity and severity of illness as measured
17 by changes in the hospital's actual proportion of outlier
18 cases to total cases and dollar increases in outlier cases'
19 average charge per case. The board shall adjust the amount of
20 any excess by the changes in the hospital's case mix and in
21 its intensity and severity of illness, based upon certified
22 hospital patient discharge data provided to the board pursuant
23 to s. 408.061. For psychiatric hospitals and other hospitals
24 not reimbursed under a prospective payment system by the
25 Federal Government, until a proxy for case mix is available,
26 the board shall adjust the amount of any excess by the change
27 in a hospital's audited actual average length of stay without
28 any thresholds or limitation.
29 (10) In levying any administrative fine against a
30 hospital pursuant to subsection (8), it is the intent of the
31 Legislature that if a hospital can demonstrate to the
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1 satisfaction of the board that it operated within its approved
2 gross revenue per adjusted admission for the first 8 months of
3 its fiscal year and did not increase its prices, except for
4 exceptions determined by the board during the last 5 months of
5 its fiscal year, it shall not be subject to any administrative
6 fine levied pursuant to subsection (8).
7 (11) It is the further intent of the Legislature that
8 if a hospital can demonstrate to the satisfaction of the board
9 that it did not increase its prices on average in excess of
10 the MARI for the prior year, it shall not be subject to any
11 administrative fine levied pursuant to subsection (8).
12 (12) If the board finds that any hospital chief
13 executive officer or any person who is in charge of hospital
14 administration or operations has knowingly and willfully
15 allowed or authorized gross revenue per adjusted admission,
16 net revenue per adjusted admission, or rates of increase that
17 are in excess of gross or net revenue per adjusted admission,
18 or rates of increase in the hospital's approved budget, budget
19 amendment, or budget letter, the agency shall order such
20 officer or person to pay an administrative fine not to exceed
21 $5,000.
22 (2)(13) Any health care facility that refuses to file
23 a report, fails to timely file a report, files a false report,
24 or files an incomplete report and upon notification fails to
25 timely file a complete report required under this section and
26 s. 408.061; that violates any provision of this section, s.
27 408.061, or s. 408.20, or rule adopted thereunder; or that
28 fails to provide documents or records requested by the agency
29 under the provisions of this chapter shall be punished by a
30 fine not exceeding $1,000 per day for each day in violation,
31 to be imposed and collected by the agency.
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1 (3)(14) Any health care provider that refuses to file
2 a report, fails to timely file a report, files a false report,
3 or files an incomplete report and upon notification fails to
4 timely file a complete report required under this section and
5 s. 408.061; that violates any provision of this section, s.
6 408.061, or s. 408.20, or rule adopted thereunder; or that
7 fails to provide documents or records requested by the agency
8 under the provisions of this chapter shall be referred to the
9 appropriate licensing board which shall take appropriate
10 action against the health care provider.
11 (4)(15) If In the event that a health insurer does not
12 comply with the requirements of s. 408.061, the agency shall
13 report a health insurer's failure to comply to the Department
14 of Insurance, which shall take into account the failure by the
15 health insurer to comply in conjunction with its approval
16 authority under s. 627.410. The agency shall adopt any rules
17 necessary to carry out its responsibilities required by this
18 subsection.
19 (5)(16) Refusal to file, failure to timely file, or
20 filing false or incomplete reports or other information
21 required to be filed under the provisions of this chapter,
22 failure to pay or failure to timely pay any assessment
23 authorized to be collected by the agency, or violation of any
24 other provision of this chapter or lawfully entered order of
25 the agency or rule adopted under this chapter, shall be
26 punished by a fine not exceeding $1,000 a day for each day in
27 violation, to be fixed, imposed, and collected by the agency.
28 Each day in violation shall be considered a separate offense.
29 (6)(17) Notwithstanding any other provisions of this
30 chapter, when a hospital alleges that a factual determination
31 made by the agency board is incorrect, the burden of proof
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1 shall be on the hospital to demonstrate that such
2 determination is, in light of the total record, not supported
3 by a preponderance of the evidence. The burden of proof
4 remains with the hospital in all cases involving
5 administrative agency action.
6 Section 22. Section 408.40, Florida Statutes, 1996
7 Supplement, is amended to read:
8 408.40 Budget review proceedings; duty of Public
9 Counsel.--
10 (1) Notwithstanding any other provisions of this
11 chapter, it shall be the duty of the Public Counsel shall to
12 represent the general public of the state in any proceeding
13 before the agency or its advisory panels in any administrative
14 hearing conducted pursuant to the provisions of chapter 120 or
15 before any other state and federal agencies and courts in any
16 issue before the agency, any court, or any agency. With
17 respect to any such proceeding, the Public Counsel is subject
18 to the provisions of and may use utilize the powers granted to
19 him by ss. 350.061-350.0614.
20 (2) The Public Counsel shall:
21 (a) Recommend to the agency, by petition, the
22 commencement of any proceeding or action or to appear, in the
23 name of the state or its citizens, in any proceeding or action
24 before the agency and urge therein any position that which he
25 deems to be in the public interest, whether consistent or
26 inconsistent with positions previously adopted by the agency,
27 and use utilize therein all forms of discovery available to
28 attorneys in civil actions generally, subject to protective
29 orders of the agency, which shall be reviewable by summary
30 procedure in the circuit courts of this state.
31
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1 (b) Have access to and use of all files, records, and
2 data of the agency available to any other attorney
3 representing parties in a proceeding before the agency.
4 (c) In any proceeding in which he has participated as
5 a party, seek review of any determination, finding, or order
6 of the agency, or of any administrative law judge, or any
7 hearing officer or hearing examiner designated by the agency,
8 in the name of the state or its citizens.
9 (d) Prepare and issue reports, recommendations, and
10 proposed orders to the agency, the Governor, and the
11 Legislature on any matter or subject within the jurisdiction
12 of the agency, and to make such recommendations as he deems
13 appropriate for legislation relative to agency procedures,
14 rules, jurisdiction, personnel, and functions.
15 (e) Appear before other state agencies, federal
16 agencies, and state and federal courts in connection with
17 matters under the jurisdiction of the agency, in the name of
18 the state or its citizens.
19 Section 23. Paragraph (e) of subsection (10) and
20 subsection (14) of section 409.2673, Florida Statutes, 1996
21 Supplement, are amended to read:
22 409.2673 Shared county and state health care program
23 for low-income persons; trust fund.--
24 (10) Under the shared county and state program,
25 reimbursement to a hospital for services for an eligible
26 person must:
27 (e) Be conditioned, for tax district hospitals that
28 deliver services as part of this program, on the delivery of
29 charity care, as defined in the rules of the Agency for Health
30 Care Administration Health Care Cost Containment Board, which
31 equals a minimum of 2.5 percent of the tax district hospital's
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1 net revenues; however, those tax district hospitals which by
2 virtue of the population within the geographic boundaries of
3 the tax district can not feasibly provide this level of
4 charity care shall assure an "open door" policy to those
5 residents of the geographic boundaries of the tax district who
6 would otherwise be considered charity cases.
7 (14) Any dispute among a county, the Agency for Health
8 Care Administration Health Care Cost Containment Board, the
9 department, or a participating hospital shall be resolved by
10 order as provided in chapter 120. Hearings held under this
11 subsection shall be conducted in the same manner as provided
12 in ss. 120.569 and 120.57, except that the administrative law
13 judge's or hearing officer's order constitutes final agency
14 action. Cases filed under chapter 120 may combine all relevant
15 disputes between parties.
16 Section 24. Section 409.9113, Florida Statutes, is
17 amended to read:
18 409.9113 Disproportionate share program for teaching
19 hospitals.--In addition to the payments made under ss. 409.911
20 and 409.9112, the Agency for Health Care Administration
21 Department of Health and Rehabilitative Services shall make
22 disproportionate share payments to statutorily defined
23 teaching hospitals for their increased costs associated with
24 medical education programs and for tertiary health care
25 services provided to the indigent. This system of payments
26 shall conform with federal requirements and shall distribute
27 funds in each fiscal year for which an appropriation is made
28 by making quarterly Medicaid payments. Notwithstanding the
29 provisions of s. 409.915, counties are exempt from
30 contributing toward the cost of this special reimbursement for
31
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1 hospitals serving a disproportionate share of low-income
2 patients.
3 (1) On or before September 15 of each year, the Agency
4 for Health Care Administration shall calculate an allocation
5 fraction to be used for distributing funds to state statutory
6 teaching hospitals. Subsequent to the end of each quarter of
7 the state fiscal year, the agency department shall distribute
8 to each statutory teaching hospital, as defined in s. 408.07,
9 an amount determined by multiplying one-fourth of the funds
10 appropriated for this purpose by the Legislature times such
11 hospital's allocation fraction. The allocation fraction for
12 each such hospital shall be determined by the sum of three
13 primary factors, divided by three. The primary factors are:
14 (a) The number of nationally accredited graduate
15 medical education programs offered by the hospital, including
16 programs accredited by the Accreditation Council for Graduate
17 Medical Education and the combined Internal Medicine and
18 Pediatrics programs acceptable to both the American Board of
19 Internal Medicine and the American Board of Pediatrics at the
20 beginning of the state fiscal year preceding the date on which
21 the allocation fraction is calculated. The numerical value of
22 this factor is the fraction that the hospital represents of
23 the total number of programs, where the total is computed for
24 all state statutory teaching hospitals.
25 (b) The number of full-time equivalent trainees in the
26 hospital, which comprises two components:
27 1. The number of trainees enrolled in nationally
28 accredited graduate medical education programs, as defined in
29 paragraph (a). Full-time equivalents are computed using the
30 fraction of the year during which each trainee is primarily
31 assigned to the given institution, over the state fiscal year
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1 preceding the date on which the allocation fraction is
2 calculated. The numerical value of this factor is the fraction
3 that the hospital represents of the total number of full-time
4 equivalent trainees enrolled in accredited graduate programs,
5 where the total is computed for all state statutory teaching
6 hospitals.
7 2. The number of medical students enrolled in
8 accredited colleges of medicine and engaged in clinical
9 activities, including required clinical clerkships and
10 clinical electives. Full-time equivalents are computed using
11 the fraction of the year during which each trainee is
12 primarily assigned to the given institution, over the course
13 of the state fiscal year preceding the date on which the
14 allocation fraction is calculated. The numerical value of this
15 factor is the fraction that the given hospital represents of
16 the total number of full-time equivalent students enrolled in
17 accredited colleges of medicine, where the total is computed
18 for all state statutory teaching hospitals.
19
20 The primary factor for full-time equivalent trainees is
21 computed as the sum of these two components, divided by two.
22 (c) A service index that which comprises three
23 components:
24 1. The Agency for Health Care Administration Health
25 Care Cost Containment Board Service Index, computed by
26 applying the standard Service Inventory Scores established by
27 the Agency for Health Care Administration Health Care Cost
28 Containment Board to services offered by the given hospital,
29 as reported on the Health Care Cost Containment Board
30 Worksheet A-2 for the last fiscal year reported to the agency
31 board before the date on which the allocation fraction is
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1 calculated. The numerical value of this factor is the
2 fraction that the given hospital represents of the total
3 Agency for Health Care Administration Health Care Cost
4 Containment Board Service Index values, where the total is
5 computed for all state statutory teaching hospitals.
6 2. A volume-weighted service index, computed by
7 applying the standard Service Inventory Scores established by
8 the Agency for Health Care Administration Health Care Cost
9 Containment Board to the volume of each service, expressed in
10 terms of the standard units of measure reported on the Health
11 Care Cost Containment Board Worksheet A-2 for the last fiscal
12 year reported to the agency board before the date on which the
13 allocation factor is calculated. The numerical value of this
14 factor is the fraction that the given hospital represents of
15 the total volume-weighted service index values, where the
16 total is computed for all state statutory teaching hospitals.
17 3. Total Medicaid payments to each hospital for direct
18 inpatient and outpatient services during the fiscal year
19 preceding the date on which the allocation factor is
20 calculated. This includes payments made to each hospital for
21 such services by Medicaid prepaid health plans, whether the
22 plan was administered by the hospital or not. The numerical
23 value of this factor is the fraction that each hospital
24 represents of the total of such Medicaid payments, where the
25 total is computed for all state statutory teaching hospitals.
26
27 The primary factor for the service index is computed as the
28 sum of these three components, divided by three.
29 (2) By October 1 of each year, the agency shall use
30 the following formula shall be utilized by the department to
31
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1 calculate the maximum additional disproportionate share
2 payment for statutorily defined teaching hospitals:
3
4 TAP = THAF x A
5
6 Where:
7 TAP = total additional payment.
8 THAF = teaching hospital allocation factor.
9 A = amount appropriated for a teaching hospital
10 disproportionate share program.
11
12 (3) The Health Care Cost Containment Board shall
13 report to the department the statutory teaching hospital
14 allocation fraction prior to October 1 of each year.
15 Section 25. Subsection (9) of section 395.403, Florida
16 Statutes, sections 407.61, 408.003, and 408.085, Florida
17 Statutes, and section 408.072, Florida Statutes, as amended by
18 chapter 96-410, Laws of Florida, are hereby repealed.
19 Section 26. The repeal of laws governing the review of
20 hospital budgets and related penalties contained in this act
21 operates retroactively and applies to any hospital budget
22 prepared for a fiscal year that ended during the 1995 calendar
23 year.
24 Section 27. Subsection (6) of section 381.026, Florida
25 Statutes, is amended to read:
26 381.026 Florida Patient's Bill of Rights and
27 Responsibilities.--
28 (6) SUMMARY OF RIGHTS AND RESPONSIBILITIES.--Any
29 health care provider who treats a patient in an office or any
30 health care facility licensed under chapter 395 that provides
31 emergency services and care or outpatient services and care to
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1 a patient, or admits and treats a patient, shall adopt and
2 make available to the patient public, in writing, a statement
3 of the rights and responsibilities of patients, including:
4
5 SUMMARY OF THE FLORIDA PATIENT'S BILL
6 OF RIGHTS AND RESPONSIBILITIES
7
8 Florida law requires that your health care provider or
9 health care facility recognize your rights while you are
10 receiving medical care and that you respect the health care
11 provider's or health care facility's right to expect certain
12 behavior on the part of patients. You may request a copy of
13 the full text of this law from your health care provider or
14 health care facility. A summary of your rights and
15 responsibilities follows:
16 A patient has the right to be treated with courtesy and
17 respect, with appreciation of his or her individual dignity,
18 and with protection of his or her need for privacy.
19 A patient has the right to a prompt and reasonable
20 response to questions and requests.
21 A patient has the right to know who is providing
22 medical services and who is responsible for his or her care.
23 A patient has the right to know what patient support
24 services are available, including whether an interpreter is
25 available if he or she does not speak English.
26 A patient has the right to know what rules and
27 regulations apply to his or her conduct.
28 A patient has the right to be given by the health care
29 provider information concerning diagnosis, planned course of
30 treatment, alternatives, risks, and prognosis.
31
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1 A patient has the right to refuse any treatment, except
2 as otherwise provided by law.
3 A patient has the right to be given, upon request, full
4 information and necessary counseling on the availability of
5 known financial resources for his or her care.
6 A patient who is eligible for Medicare has the right to
7 know, upon request and in advance of treatment, whether the
8 health care provider or health care facility accepts the
9 Medicare assignment rate.
10 A patient has the right to receive, upon request, prior
11 to treatment, a reasonable estimate of charges for medical
12 care.
13 A patient has the right to receive a copy of a
14 reasonably clear and understandable, itemized bill and, upon
15 request, to have the charges explained.
16 A patient has the right to impartial access to medical
17 treatment or accommodations, regardless of race, national
18 origin, religion, physical handicap, or source of payment.
19 A patient has the right to treatment for any emergency
20 medical condition that will deteriorate from failure to
21 provide treatment.
22 A patient has the right to know if medical treatment is
23 for purposes of experimental research and to give his or her
24 consent or refusal to participate in such experimental
25 research.
26 A patient has the right to express grievances regarding
27 any violation of his or her rights, as stated in Florida law,
28 through the grievance procedure of the health care provider or
29 health care facility which served him or her and to the
30 appropriate state licensing agency.
31
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1 A patient is responsible for providing to the health
2 care provider, to the best of his or her knowledge, accurate
3 and complete information about present complaints, past
4 illnesses, hospitalizations, medications, and other matters
5 relating to his or her health.
6 A patient is responsible for reporting unexpected
7 changes in his or her condition to the health care provider.
8 A patient is responsible for reporting to the health
9 care provider whether he or she comprehends a contemplated
10 course of action and what is expected of him or her.
11 A patient is responsible for following the treatment
12 plan recommended by the health care provider.
13 A patient is responsible for keeping appointments and,
14 when he or she is unable to do so for any reason, for
15 notifying the health care provider or health care facility.
16 A patient is responsible for his or her actions if he
17 or she refuses treatment or does not follow the health care
18 provider's instructions.
19 A patient is responsible for assuring that the
20 financial obligations of his or her health care are fulfilled
21 as promptly as possible.
22 A patient is responsible for following health care
23 facility rules and regulations affecting patient care and
24 conduct.
25 Section 28. Section 381.0261, Florida Statutes, is
26 amended to read:
27 381.0261 Distribution of Summary of patient's bill of
28 rights; distribution; penalty.--
29 (1) The Agency for Health Care Administration
30 Department of Health and Rehabilitative Services shall have
31 printed and made continuously available to health care
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1 facilities licensed under chapter 395, physicians licensed
2 under chapter 458, osteopathic physicians licensed under
3 chapter 459, and podiatrists licensed under chapter 461 a
4 summary of the Florida Patient's Bill of Rights and
5 Responsibilities. In adopting and making available to
6 patients public the summary of the Florida Patient's Bill of
7 Rights and Responsibilities, health care providers and health
8 care facilities are not limited to the format in which the
9 Agency for Health Care Administration Department of Health and
10 Rehabilitative Services prints and distributes the summary.
11 (2) Health care providers and health care facilities
12 shall inform patients of the address and telephone number of
13 each state agency responsible for responding to patient
14 complaints about a health care provider or health care
15 facility's alleged noncompliance with state licensing
16 requirements established pursuant to law.
17 (3) Health care facilities shall adopt policies and
18 procedures to ensure that inpatients are provided the
19 opportunity during the course of admission to receive
20 information regarding their rights and how to file complaints
21 with the facility and appropriate state agencies.
22 (4) An administrative fine may be imposed by the
23 agency when any health care provider or health care facility
24 fails to make available to patients a summary of their rights,
25 pursuant to ss. 381.026 and this section. Initial nonwillful
26 violations shall be subject to corrective action and shall not
27 be subject to an administrative fine. The agency may levy a
28 fine of up to $5,000 for repeated nonwillful violations, and
29 up to $25,000 for willful violations. Each willful violation
30 constitutes a separate violation and is subject to a separate
31 fine.
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1 (5) In determining the amount of fine to be levied for
2 a violation, as provided in subsection (4), the following
3 factors shall be considered:
4 (a) The scope and severity of the violation, including
5 the number of patients found to have not received notice of
6 patient rights, and whether the failure to provide notice to
7 patients was willful.
8 (b) Actions taken by the health care provider or
9 health care facility to correct the violations or to remedy
10 complaints.
11 (c) Any previous violations of this section by the
12 health care provider or health care facility.
13 Section 29. Subsections (2) and (15) of section
14 395.002, Florida Statutes, are hereby repealed:
15 395.002 Definitions.--As used in this chapter:
16 (2) "Adverse or untoward incident," for purposes of
17 reporting to the agency, means an event over which health care
18 personnel could exercise control, which is probably associated
19 in whole or in part with medical intervention rather than the
20 condition for which such intervention occurred, and which
21 causes injury to a patient, and which:
22 (a) Is not consistent with or expected to be a
23 consequence of such medical intervention;
24 (b) Occurs as a result of medical intervention to
25 which the patient has not given his or her informed consent;
26 (c) Occurs as the result of any other action or lack
27 of any other action on the part of the hospital or personnel
28 of the hospital;
29 (d) Results in a surgical procedure being performed on
30 the wrong patient; or
31
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1 (e) Results in a surgical procedure being performed
2 that is unrelated to the patient's diagnosis or medical needs.
3 (15) "Injury," for purposes of reporting to the
4 agency, means any of the following outcomes if caused by an
5 adverse or untoward incident:
6 (a) Death;
7 (b) Brain damage;
8 (c) Spinal damage;
9 (d) Permanent disfigurement;
10 (e) Fracture or dislocation of bones or joints;
11 (f) Any condition requiring definitive or specialized
12 medical attention which is not consistent with the routine
13 management of the patient's case or patient's preexisting
14 physical condition;
15 (g) Any condition requiring surgical intervention to
16 correct or control;
17 (h) Any condition resulting in transfer of the
18 patient, within or outside the facility, to a unit providing a
19 more acute level of care;
20 (i) Any condition that extends the patient's length of
21 stay; or
22 (j) Any condition that results in a limitation of
23 neurological, physical, or sensory function which continues
24 after discharge from the facility.
25 Section 30. Present subsections (3), (4), (5), and (7)
26 of section 395.0193, Florida Statutes, 1996 Supplement, are
27 amended, present subsections (6), (7), (8), and (9) are
28 renumbered as subsections (7), (8), (9), and (10),
29 respectively, and a new subsection (6) is added to said
30 section, to read:
31
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1 395.0193 Licensed facilities; peer review;
2 disciplinary powers; agency or partnership with physicians.--
3 (3) If reasonable belief exists that conduct by a
4 staff member or physician who delivers health care services at
5 the licensed facility may constitute one or more grounds for
6 discipline as provided in this subsection, a peer review panel
7 shall investigate and determine whether grounds for discipline
8 exist with respect to such staff member or physician. The
9 governing board of any licensed facility, after considering
10 the recommendations of its peer review panel, shall suspend,
11 deny, revoke, or curtail the privileges, or reprimand,
12 counsel, or require education, of any such staff member or
13 physician after a final determination has been made that one
14 or more of the following grounds exist:
15 (a) Incompetence.
16 (b) Being found to be a habitual user of intoxicants
17 or drugs to the extent that he or she is deemed dangerous to
18 himself, herself, or others.
19 (c) Mental or physical impairment which may adversely
20 affect patient care.
21 (d) Being found liable by a court of competent
22 jurisdiction for medical negligence or malpractice involving
23 negligent conduct.
24 (e) One or more settlements exceeding $10,000 for
25 medical negligence or malpractice involving negligent conduct
26 by the staff member.
27 (f) Medical negligence other than as specified in
28 paragraph (d) or paragraph (e).
29 (g) Failure to comply with the policies, procedures,
30 or directives of the risk management program or any quality
31 assurance committees of any licensed facility.
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1
2 However, the grounds specified in paragraphs (a)-(g) are not
3 the only grounds for discipline of a practitioner. procedures
4 for such actions shall comply with the standards outlined by
5 the Joint Commission on Accreditation of Healthcare
6 Organizations, the American Osteopathic Association, the
7 Commission on Accreditation of Rehabilitation Facilities, the
8 Accreditation Association for Ambulatory Health Care, Inc.,
9 and the "Medicare/Medicaid Conditions of Participation," and
10 rules of the agency and the department. The procedures shall
11 be adopted pursuant to hospital bylaws.
12 (4) Pursuant to ss. 458.337 and 459.016, any
13 disciplinary actions taken under subsection (3) shall be
14 reported in writing to the Division of Health Quality
15 Assurance of the agency within 30 working days after its
16 initial occurrence, regardless of the pendency of appeals. The
17 notification shall identify the disciplined practitioner, the
18 action taken, and the reason for such action. All final
19 disciplinary actions taken under subsection (3), if different
20 than those which were reported to the agency within 30 days
21 after the initial occurrence, shall be reported within 10
22 working days to the Division of Health Quality Assurance of
23 the agency in writing and shall specify the disciplinary
24 action taken and the specific grounds therefor. The division
25 shall review each report and determine whether it potentially
26 involved conduct by the licensee that is subject to
27 disciplinary action, in which case s. 455.225 shall apply. The
28 reports are not report shall not be subject to inspection
29 under s. 119.07(1) even if the division's investigation
30 results in a finding of probable cause.
31
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1 (5) There shall be no monetary liability on the part
2 of, and no cause of action for damages against, any licensed
3 facility, its governing board or governing board members, peer
4 review panel, medical staff, or disciplinary body, or its
5 agents, investigators, witnesses, or employees; a committee of
6 a hospital, a physician-hospital organization, or an
7 integrated delivery system;, or any other person, for any
8 action taken without intentional fraud in carrying out the
9 provisions of this section.
10 (6) For a single incident or series of isolated
11 incidents that are nonwillful violations of the reporting
12 requirements of this section, the agency shall first seek to
13 obtain corrective action by the facility. If correction is not
14 demonstrated within the timeframe established by the agency or
15 if there is a pattern of nonwillful violations of this
16 section, the agency may impose an administrative fine, not to
17 exceed $5,000 for any violation of the reporting requirements
18 of this section. The administrative fine for repeated
19 nonwillful violations shall not exceed $10,000 for any
20 violation. The administrative fine for each willful violation
21 shall not exceed $25,000 per violation, per day. Each day of
22 willful violation constitutes a separate violation and is
23 subject to a separate fine. In determining the amount of fine
24 to be levied, the agency shall be guided by s. 395.1065(2)(b).
25 (8)(7) The investigations, proceedings, and records of
26 the peer review panel, a committee of a hospital, a
27 physician-hospital organization, an integrated delivery
28 system, a disciplinary board, or a governing board, or agent
29 thereof with whom there is a specific written contract for
30 that purpose, as described in this section shall not be
31 subject to discovery or introduction into evidence in any
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1 civil or administrative action against a provider of
2 professional health services arising out of the matters which
3 are the subject of evaluation and review by such group or its
4 agent, and a person who was in attendance at a meeting of such
5 group or its agent may not be permitted or required to testify
6 in any such civil or administrative action as to any evidence
7 or other matters produced or presented during the proceedings
8 of such group or its agent or as to any findings,
9 recommendations, evaluations, opinions, or other actions of
10 such group or its agent or any members thereof. However,
11 information, documents, or records otherwise available from
12 original sources are not to be construed as immune from
13 discovery or use in any such civil or administrative action
14 merely because they were presented during proceedings of such
15 group, and any person who testifies before such group or who
16 is a member of such group may not be prevented from testifying
17 as to matters within his or her knowledge, but such witness
18 may not be asked about his or her testimony before such a
19 group or opinions formed by him or her as a result of such
20 group hearings.
21 Section 31. Section 395.0197, Florida Statutes, 1996
22 Supplement, is amended to read:
23 395.0197 Internal risk management program.--
24 (1) Every licensed facility shall, as a part of its
25 administrative functions, establish an internal risk
26 management program that includes all of the following
27 components:
28 (a) The investigation and analysis of the frequency
29 and causes of general categories and specific types of adverse
30 incidents causing injury to patients.
31
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1 (b) The development of appropriate measures to
2 minimize the risk of injuries and adverse incidents to
3 patients, including, but not limited to:
4 1. Risk management and risk prevention education and
5 training of all nonphysician personnel as follows:
6 a. Such education and training of all nonphysician
7 personnel as part of their initial orientation; and
8 b. At least 1 hour of such education and training
9 annually for all nonphysician personnel of the licensed
10 facility working in clinical areas and providing patient care.
11 2. A prohibition, except when emergency circumstances
12 require otherwise, against a staff member of the licensed
13 facility attending a patient in the recovery room, unless the
14 staff member is authorized to attend the patient in the
15 recovery room and is in the company of at least one other
16 person. However, a hospital is exempt from the two-person
17 requirement if it has:
18 a. Live visual observation;
19 b. Electronic observation; or
20 c. Any other reasonable measure taken to ensure
21 patient protection and privacy.
22 (c) The analysis of patient grievances that relate to
23 patient care and the quality of medical services.
24 (d) The development and implementation of an incident
25 reporting system based upon the affirmative duty of all health
26 care providers and all agents and employees of the licensed
27 health care facility to report adverse incidents to the risk
28 manager, or to his or her designee, within 3 business days
29 after its occurrence.
30 (2) The internal risk management program is the
31 responsibility of the governing board of the health care
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1 facility. Each licensed facility shall hire a risk manager,
2 licensed under part IX of chapter 626, who is responsible for
3 implementation and oversight of such facility's internal risk
4 management program as required by this section. A risk
5 manager must not be made responsible for more than four
6 internal risk management programs in separate licensed
7 facilities, unless the facilities are under one corporate
8 ownership or the risk management programs are in rural
9 hospitals.
10 (3) In addition to the programs mandated by this
11 section, other innovative approaches intended to reduce the
12 frequency and severity of medical malpractice and patient
13 injury claims shall be encouraged and their implementation and
14 operation facilitated. Such additional approaches may include
15 extending internal risk management programs to health care
16 providers' offices and the assuming of provider liability by a
17 licensed health care facility for acts or omissions occurring
18 within the licensed facility.
19 (4) The agency shall, after consulting with the
20 Department of Insurance, adopt rules governing the
21 establishment of internal risk management programs to meet the
22 needs of individual licensed facilities. Each internal risk
23 management program shall include the use of incident reports
24 to be filed with an individual of responsibility who is
25 competent in risk management techniques in the employ of each
26 licensed facility, such as an insurance coordinator, or who is
27 retained by the licensed facility as a consultant. The
28 individual responsible for the risk management program shall
29 have free access to all medical records of the licensed
30 facility. The incident reports are part of the workpapers of
31 the attorney defending the licensed facility in litigation
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1 relating to the licensed facility and are subject to
2 discovery, but are not admissible as evidence in court. A
3 person filing an incident report is not subject to civil suit
4 by virtue of such incident report. As a part of each internal
5 risk management program, the incident reports shall be used to
6 develop categories of incidents which identify problem areas.
7 Once identified, procedures shall be adjusted to correct the
8 problem areas.
9 (5) For purposes of reporting to the agency pursuant
10 to subsections (6), (7), and (8), "adverse incident" means an
11 event over which health care personnel could exercise control
12 and which is associated in whole or in part with medical
13 intervention, rather than the condition for which such
14 intervention occurred, and which:
15 (a) Results in one of the following injuries:
16 1. Death;
17 2. Brain or spinal damage;
18 3. Permanent disfigurement;
19 4. Fracture or dislocation of bones or joints;
20 5. A resulting limitation of neurological, physical,
21 or sensory function which continues after discharge from the
22 facility;
23 6. Any condition that required specialized medical
24 attention or surgical intervention resulting from medical
25 intervention to which the patient has not given his or her
26 informed consent; or
27 7. Any condition that required the transfer of the
28 patient, within or outside the facility, to a unit providing a
29 more acute level of care due to the adverse incident, rather
30 than the patient's condition prior to the adverse incident;
31
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1 (b) Was the performance of: a surgical procedure on
2 the wrong patient, a wrong surgical procedure, a wrong-site
3 surgical procedure, or a surgical procedure otherwise
4 unrelated to the patient's diagnosis or medical condition;
5 (c) Required the surgical repair of damage resulting
6 to a patient from a planned surgical procedure, where the
7 damage was not consistent with or expected to be a consequence
8 of the planned surgical procedure; or
9 (d) Was a procedure to remove unplanned foreign
10 objects remaining from a surgical procedure.
11 (6)(5)(a) Each licensed facility subject to this
12 section shall submit an annual report to the agency
13 summarizing the incident reports that have been filed in the
14 facility for that year. The report shall include:
15 1. The total number of adverse incidents causing
16 injury to patients.
17 2. A listing, by category, of the types of operations,
18 diagnostic or treatment procedures, or other actions causing
19 the injuries, and the number of incidents occurring within
20 each category.
21 3. A listing, by category, of the types of injuries
22 caused and the number of incidents occurring within each
23 category.
24 4. A code number using the health care professional's
25 licensure number and a separate code number identifying all
26 other individuals directly involved in adverse incidents
27 causing injury to patients, the relationship of the individual
28 to the licensed facility, and the number of incidents in which
29 each individual has been directly involved. Each licensed
30 facility shall maintain names of the health care professionals
31
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1 and individuals identified by code numbers for purposes of
2 this section.
3 5. A description of all malpractice claims filed
4 against the licensed facility, including the total number of
5 pending and closed claims and the nature of the incident which
6 led to, the persons involved in, and the status and
7 disposition of each claim. Each report shall update status and
8 disposition for all prior reports.
9 6. A report of all disciplinary actions pertaining to
10 patient care taken against any medical staff member, including
11 the nature and cause of the action.
12 (b) The information reported to the agency pursuant to
13 paragraph (a) which relates to persons licensed under chapter
14 458, chapter 459, chapter 461, or chapter 466 shall be
15 reviewed by the agency. The agency shall determine whether
16 any of the incidents potentially involved conduct by a health
17 care professional who is subject to disciplinary action, in
18 which case the provisions of s. 455.225 shall apply.
19 (c) The report submitted to the agency shall also
20 contain the name and license number of the risk manager of the
21 licensed facility, a copy of its policy and procedures which
22 govern the measures taken by the facility and its risk manager
23 to reduce the risk of injuries and adverse or untoward
24 incidents, and the results of such measures. The annual
25 report is confidential and is not available to the public
26 pursuant to s. 119.07(1) or any other law providing access to
27 public records. The annual report is not discoverable or
28 admissible in any civil or administrative action, except in
29 disciplinary proceedings by the agency or the appropriate
30 regulatory board. The annual report is not available to the
31 public as part of the record of investigation for and
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1 prosecution in disciplinary proceedings made available to the
2 public by the agency or the appropriate regulatory board.
3 However, the agency or the appropriate regulatory board shall
4 make available, upon written request by a health care
5 professional against whom probable cause has been found, any
6 such records which form the basis of the determination of
7 probable cause.
8 (7) The licensed facility shall notify the agency no
9 later than 1 business day after the risk manager or his or her
10 designee has received a report pursuant to paragraph (1)(d)
11 and is able to determine within 1 business day that any of the
12 following adverse incidents has occurred, whether occurring in
13 the licensed facility or arising from health care prior to
14 admission in the licensed facility:
15 (a) The death of a patient;
16 (b) Brain or spinal damage to a patient;
17 (c) The performance of a surgical procedure on the
18 wrong patient;
19 (d) The performance of a wrong-site surgical
20 procedure; or
21 (e) The performance of a wrong surgical procedure.
22
23 The notification must be made in writing and be provided by
24 facsimile device or overnight mail delivery. The notification
25 must include information regarding the identity of the
26 affected patient, the type of adverse incident, the initiation
27 of an investigation by the facility, and whether the events
28 causing or resulting in the adverse incident represent a
29 potential risk to other patients. The information contained
30 in the notification shall be confidential and shall not be
31 available to the public pursuant to s. 119.07(1) or any other
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1 law providing access to public records, nor be discoverable or
2 admissible in any civil or administrative action, except in
3 disciplinary proceedings by the agency or the appropriate
4 regulatory board, nor shall it be available to the public as
5 part of the record of investigation for and prosecution in
6 disciplinary proceedings made available by the agency or the
7 appropriate regulatory board.
8 (8)(6) Any of the following adverse incidents, whether
9 occurring in the licensed facility or arising from health care
10 prior to admission in the licensed facility, shall be reported
11 by the facility to the agency within 15 calendar days after
12 its occurrence: If an adverse or untoward incident, whether
13 occurring in the licensed facility or arising from health care
14 prior to admission in the licensed facility, results in:
15 (a) The death of a patient;
16 (b) Brain or spinal damage to a patient;
17 (c) The performance of a surgical procedure on the
18 wrong patient; or
19 (d) The performance of a wrong-site surgical
20 procedure;
21 (e) The performance of a wrong surgical procedure; or
22 (f) The performance of procedures to remove unplanned
23 foreign objects remaining from a surgical procedure.
24 (d) A surgical procedure unrelated to the patient's
25 diagnosis or medical needs being performed on any patient,
26 including the surgical repair of injuries or damage resulting
27 from the planned surgical procedure, wrong site or wrong
28 procedure surgeries, and procedures to remove foreign objects
29 remaining from surgical procedures,
30
31
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1 the licensed facility shall report this incident to the agency
2 within 15 calendar days after its occurrence. The agency may
3 grant extensions to this reporting requirement for more than
4 15 days upon justification submitted in writing by the
5 facility administrator to the agency. The agency may require
6 an additional, final report. These reports shall not be
7 available to the public pursuant to s. 119.07(1) or any other
8 law providing access to public records, nor be discoverable or
9 admissible in any civil or administrative action, except in
10 disciplinary proceedings by the agency or the appropriate
11 regulatory board, nor shall they be available to the public as
12 part of the record of investigation for and prosecution in
13 disciplinary proceedings made available to the public by the
14 agency or the appropriate regulatory board. However, the
15 agency or the appropriate regulatory board shall make
16 available, upon written request by a health care professional
17 against whom probable cause has been found, any such records
18 which form the basis of the determination of probable cause.
19 The agency may investigate, as it deems appropriate, any such
20 incident and prescribe measures that must or may be taken in
21 response to the incident. The agency shall review each
22 incident and determine whether it potentially involved conduct
23 by the health care professional who is subject to disciplinary
24 action, in which case the provisions of s. 455.225 shall
25 apply.
26 (9)(7) The internal risk manager of each licensed
27 facility shall:
28 (a)(b) Investigate every allegation of sexual
29 misconduct which is made against a member of the facility's
30 personnel who has direct patient contact, when the allegation
31
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1 is that the sexual misconduct occurred at the facility or on
2 the grounds of the facility; and
3 (b)(c) Report every allegation of sexual misconduct to
4 the administrator of the licensed facility.
5 (c)(a) Notify the family or guardian of the victim, if
6 a minor, that an allegation of sexual misconduct has been made
7 and that an investigation is being conducted;
8 (10)(8) Any witness who witnessed or who possesses
9 actual knowledge of the act that is the basis of an allegation
10 of sexual abuse shall:
11 (a) Notify the local police; and
12 (b) Notify the hospital risk manager and the
13 administrator.
14
15 For purposes of this subsection, "sexual abuse" means acts of
16 a sexual nature committed for the sexual gratification of
17 anyone upon, or in the presence of, a vulnerable adult,
18 without the vulnerable adult's informed consent, or a minor.
19 "Sexual abuse" includes, but is not limited to, the acts
20 defined in s. 794.011(1)(h), fondling, exposure of a
21 vulnerable adult's or minor's sexual organs, or the use of the
22 vulnerable adult or minor to solicit for or engage in
23 prostitution or sexual performance. "Sexual abuse" does not
24 include any act intended for a valid medical purpose or any
25 act which may reasonably be construed to be a normal
26 caregiving action.
27 (11)(9) A person who, with malice or with intent to
28 discredit or harm a licensed facility or any person, makes a
29 false allegation of sexual misconduct against a member of a
30 licensed facility's personnel is guilty of a misdemeanor of
31
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1 the second degree, punishable as provided in s. 775.082 or s.
2 775.083.
3 (12)(10) In addition to any penalty imposed pursuant
4 to this section, the agency shall require a written plan of
5 correction from the facility. For a single incident or series
6 of isolated incidents that are nonwillful violations of the
7 reporting requirements of this section, the agency shall first
8 seek to obtain corrective action by the facility. If the
9 correction is not demonstrated within the timeframe
10 established by the agency or if there is a pattern of
11 nonwillful violations of this section, the agency may impose
12 an administrative fine, not to exceed $5,000 for any violation
13 of the reporting requirements of this section. The
14 administrative fine for repeated nonwillful violations shall
15 not exceed $10,000 for any violation. The administrative fine
16 for each willful violation shall not exceed $25,000 per
17 violation, per day. Each day of willful violation constitutes
18 a separate violation and is subject to a separate fine. In
19 determining the amount of fine to be levied, the agency shall
20 be guided by s. 395.1065(2)(b) may impose an administrative
21 fine, not to exceed $5,000, for any violation of the reporting
22 requirements of this section.
23 (13)(11) The agency shall have access to all licensed
24 facility records necessary to carry out the provisions of this
25 section. The records obtained are not available to the public
26 under s. 119.07(1), nor shall they be discoverable or
27 admissible in any civil or administrative action, except in
28 disciplinary proceedings by the agency or the appropriate
29 regulatory board, nor shall records obtained pursuant to s.
30 455.223 be available to the public as part of the record of
31 investigation for and prosecution in disciplinary proceedings
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1 made available to the public by the agency or the appropriate
2 regulatory board. However, the agency or the appropriate
3 regulatory board shall make available, upon written request by
4 a health care professional against whom probable cause has
5 been found, any such records which form the basis of the
6 determination of probable cause, except that, with respect to
7 medical review committee records, s. 766.101 controls.
8 (14)(12) The meetings of the committees and governing
9 board of a licensed facility held solely for the purpose of
10 achieving the objectives of risk management as provided by
11 this section shall not be open to the public under the
12 provisions of chapter 286. The records of such meetings are
13 confidential and exempt from s. 119.07(1), except as provided
14 in subsection (13)(11).
15 (15)(13) The agency shall review, as part of its
16 licensure inspection process, the internal risk management
17 program at each licensed facility regulated by this section to
18 determine whether the program meets standards established in
19 statutes and rules, whether the program is being conducted in
20 a manner designed to reduce adverse incidents, and whether the
21 program is appropriately reporting incidents under subsections
22 (5), and (6), (7), and (8).
23 (16)(14) There shall be no monetary liability on the
24 part of, and no cause of action for damages shall arise
25 against, any risk manager, licensed under part IX of chapter
26 626, for the implementation and oversight of the internal risk
27 management program in a facility licensed under this chapter
28 or chapter 390 as required by this section, for any act or
29 proceeding undertaken or performed within the scope of the
30 functions of such internal risk management program if the risk
31 manager acts without intentional fraud.
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1 (17)(15) If the agency, through its receipt of the
2 annual reports prescribed in subsection (6)(5) or through any
3 investigation, has a reasonable belief that conduct by a staff
4 member or employee of a licensed facility is grounds for
5 disciplinary action by the appropriate regulatory board, the
6 agency shall report this fact to such regulatory board.
7 (18)(16) The agency shall annually publish a report
8 summarizing the information contained in the annual incident
9 reports submitted by licensed facilities pursuant to
10 subsection (6), and any serious incident reports submitted by
11 licensed facilities pursuant to subsection (7), and
12 disciplinary actions reported to the agency pursuant to s.
13 395.0193. The report must, at a minimum, summarize:
14 (a) Adverse and serious incidents, by service district
15 of the department as defined in s. 20.19, by category of
16 reported incident, and by type of professional involved.
17 (b) Types of malpractice claims filed, by service
18 district of the department as defined in s. 20.19, and by type
19 of professional involved.
20 (c) Disciplinary actions taken against professionals,
21 by service district of the department as defined in s. 20.19,
22 and by type of professional involved.
23 Section 32. Effective January 1, 1998, section
24 626.941, Florida Statutes, is renumbered as section 395.10971,
25 Florida Statutes.
26 Section 33. Effective January 1, 1998, section
27 626.942, Florida Statutes, is renumbered as section 395.10972,
28 Florida Statutes, and amended to read:
29 395.10972 626.942 Health Care Risk Manager Advisory
30 Council.--The Director of Health Care Administration Insurance
31 Commissioner may appoint a five-member advisory council to
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1 advise the agency department on matters pertaining to health
2 care risk managers. The members of the council shall serve at
3 the pleasure of the director Insurance Commissioner. The
4 council shall designate a chairman. The council shall meet at
5 the call of the director Insurance Commissioner or at those
6 times as may be required by rule of the agency department.
7 The members of the advisory council shall receive no
8 compensation for their services, but shall be reimbursed for
9 travel expenses as provided in s. 112.061. The council shall
10 consist of individuals representing the following areas:
11 (1) Two shall be active health care risk managers.
12 (2) One shall be an active hospital administrator.
13 (3) One shall be an employee of an insurer or
14 self-insurer of medical malpractice coverage.
15 (4) One shall be a representative of the
16 health-care-consuming public.
17 Section 34. Effective January 1, 1998, section
18 626.943, Florida Statutes, is renumbered as section 395.10973,
19 Florida Statutes, and amended to read:
20 395.10973 626.943 Powers and duties of the agency
21 department.--It is the function of the agency department to:
22 (1) Promulgate rules necessary to carry out the duties
23 conferred upon it under this part to protect the public
24 health, safety, and welfare.
25 (2) Develop, impose, and enforce specific standards
26 within the scope of the general qualifications established by
27 this part which must be met by individuals in order to receive
28 licenses as health care risk managers. These standards shall
29 be designed to ensure that health care risk managers are
30 individuals of good character and otherwise suitable and, by
31 training or experience in the field of health care risk
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1 management, qualified in accordance with the provisions of
2 this part to serve as health care risk managers, within
3 statutory requirements.
4 (3) Develop a method for determining whether an
5 individual meets the standards set forth in s. 395.10974
6 626.944.
7 (4) Issue licenses, beginning on June 1, 1986, to
8 qualified individuals meeting the standards set forth in s.
9 395.10974 626.944.
10 (5) Receive, investigate, and take appropriate action
11 with respect to any charge or complaint filed with the agency
12 department to the effect that a certified health care risk
13 manager has failed to comply with the requirements or
14 standards adopted by rule by the agency department or to
15 comply with the provisions of this part.
16 (6) Establish procedures for providing the Department
17 of Health and Rehabilitative Services with periodic reports on
18 persons certified or disciplined by the agency department
19 under this part.
20 (7) Develop a model risk management program for health
21 care facilities which will satisfy the requirements of s.
22 395.0197.
23 Section 35. Effective January 1, 1998, section
24 626.944, Florida Statutes, is renumbered as section 395.10974,
25 Florida Statutes, and amended to read:
26 395.10974 626.944 Qualifications for health care risk
27 managers.--
28 (1) Any person desiring to be licensed as a health
29 care risk manager shall submit an application on a form
30 provided by the agency department. In order to qualify, the
31 applicant shall submit evidence satisfactory to the agency
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1 department which demonstrates the applicant's competence, by
2 education or experience, in the following areas:
3 (a) Applicable standards of health care risk
4 management.
5 (b) Applicable federal, state, and local health and
6 safety laws and rules.
7 (c) General risk management administration.
8 (d) Patient care.
9 (e) Medical care.
10 (f) Personal and social care.
11 (g) Accident prevention.
12 (h) Departmental organization and management.
13 (i) Community interrelationships.
14 (j) Medical terminology.
15
16 The agency department may require such additional information,
17 from the applicant or any other person, as may be reasonably
18 required to verify the information contained in the
19 application.
20 (2) The agency department shall not grant or issue a
21 license as a health care risk manager to any individual unless
22 from the application it affirmatively appears that the
23 applicant:
24 (a) Is 18 years of age or over;
25 (b) Is a high school graduate or equivalent; and
26 (c)1. Has fulfilled the requirements of a 1-year
27 program or its equivalent in health care risk management
28 training which may be developed or approved by the agency
29 department;
30
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1 2. Has completed 2 years of college-level studies
2 which would prepare the applicant for health care risk
3 management, to be further defined by rule; or
4 3. Has obtained 1 year of practical experience in
5 health care risk management.
6 (3) The agency department shall issue a license,
7 beginning on June 1, 1986, to practice health care risk
8 management to any applicant who qualifies under this section
9 and submits an application fee of not more than $75, a
10 fingerprinting fee of not more than $75, and a license fee of
11 not more than $100. The agency shall by rule establish fees
12 and procedures for the issuance and cancellation of licenses.
13 the license fee as set forth in s. 624.501. Licenses shall be
14 issued and canceled in the same manner as provided in part I
15 of this chapter.
16 (4) The agency department shall renew a health care
17 risk manager license upon receipt of a biennial renewal
18 application and fees. The agency shall by rule establish a
19 procedure for the biennial renewal of licenses in accordance
20 with procedures prescribed in s. 626.381 for agents in
21 general.
22 Section 36. Effective January 1, 1998, section
23 626.945, Florida Statutes, is renumbered as section 395.10975,
24 Florida Statutes, and amended to read:
25 395.10975 626.945 Grounds for denial, suspension, or
26 revocation of a health care risk manager's license;
27 administrative fine.--
28 (1) The agency department may, in its discretion,
29 deny, suspend, revoke, or refuse to renew or continue the
30 license of any health care risk manager or applicant, if it
31
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1 finds that as to such applicant or licensee any one or more of
2 the following grounds exist:
3 (a) Any cause for which issuance of the license could
4 have been refused had it then existed and been known to the
5 agency department.
6 (b) Giving false or forged evidence to the agency
7 department for the purpose of obtaining a license.
8 (c) Having been found guilty of, or having pleaded
9 guilty or nolo contendere to, a crime in this state or any
10 other state relating to the practice of risk management or the
11 ability to practice risk management, whether or not a judgment
12 or conviction has been entered.
13 (d) Having been found guilty of, or having pleaded
14 guilty or nolo contendere to, a felony, or a crime involving
15 moral turpitude punishable by imprisonment of 1 year or more
16 under the law of the United States, under the law of any
17 state, or under the law of any other country, without regard
18 to whether a judgment of conviction has been entered by the
19 court having jurisdiction of such cases.
20 (e) Making or filing a report or record which the
21 licensee knows to be false; or intentionally failing to file a
22 report or record required by state or federal law; or
23 willfully impeding or obstructing, or inducing another person
24 to impede or obstruct, the filing of a report or record
25 required by state or federal law. Such reports or records
26 shall include only those which are signed in the capacity of a
27 licensed health care risk manager.
28 (f) Fraud or deceit, negligence, incompetence, or
29 misconduct in the practice of health care risk management.
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1 (g) Violation of any provision of this part or any
2 other law applicable to the business of health care risk
3 management.
4 (h) Violation of any lawful order or rule of the
5 agency department or failure to comply with a lawful subpoena
6 issued by the department.
7 (i) Practicing with a revoked or suspended health care
8 risk manager license.
9 (j) Repeatedly acting in a manner inconsistent with
10 the health and safety of the patients of the licensed facility
11 in which the licensee is the health care risk manager.
12 (k) Being unable to practice health care risk
13 management with reasonable skill and safety to patients by
14 reason of illness; drunkenness; or use of drugs, narcotics,
15 chemicals, or any other material or substance or as a result
16 of any mental or physical condition. Any person affected
17 under this paragraph shall have the opportunity, at reasonable
18 intervals, to demonstrate that he can resume the competent
19 practices of health care risk manager with reasonable skill
20 and safety to patients.
21 (l) Willfully permitting unauthorized disclosure of
22 information relating to a patient or his records.
23 (m) Discriminating in respect to patients, employees,
24 or staff on account of race, religion, color, sex, or national
25 origin.
26 (2) If the agency department finds that one or more of
27 the grounds set forth in subsection (1) exist, it may, in lieu
28 of or in addition to suspension or revocation, enter an order
29 imposing one or more of the following penalties:
30 (a) Imposition of an administrative fine not to exceed
31 $2,500 for each count or separate offense.
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1 (b) Issuance of a reprimand.
2 (c) Placement of the licensee on probation for a
3 period of time and subject to such conditions as the agency
4 department may specify, including requiring the licensee to
5 attend continuing education courses or to work under the
6 supervision of another licensee.
7 (3) The agency department may reissue the license of a
8 disciplined licensee in accordance with the provisions of this
9 part.
10 Section 37. Subsection (7) of section 394.4787,
11 Florida Statutes, 1996 Supplement, is amended to read:
12 394.4787 Definitions.--As used in this section and ss.
13 394.4786, 394.4788, and 394.4789:
14 (7) "Specialty psychiatric hospital" means a hospital
15 licensed by the agency pursuant to s. 395.002(25)(27) as a
16 specialty psychiatric hospital.
17 Section 38. Paragraph (c) of subsection (2) of section
18 395.602, Florida Statutes, is amended to read:
19 395.602 Rural hospitals.--
20 (2) DEFINITIONS.--As used in this part:
21 (c) "Inactive rural hospital bed" means a licensed
22 acute care hospital bed, as defined in s. 395.002(12)(13),
23 that is inactive in that it cannot be occupied by acute care
24 inpatients.
25 Section 39. Paragraph (c) of subsection (1) of section
26 395.701, Florida Statutes, is amended to read:
27 395.701 Annual assessments on net operating revenues
28 to fund public medical assistance; administrative fines for
29 failure to pay assessments when due.--
30 (1) For the purposes of this section, the term:
31
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1 (c) "Hospital" means a health care institution as
2 defined in s. 395.002(11)(12), but does not include any
3 hospital operated by the agency or the Department of
4 Corrections.
5 Section 40. Paragraph (b) of subsection (1) of section
6 400.051, Florida Statutes, is amended to read:
7 400.051 Homes or institutions exempt from the
8 provisions of this part.--
9 (1) The following shall be exempt from the provisions
10 of this part:
11 (b) Any hospital, as defined in s. 395.002(9)(10),
12 that is licensed under chapter 395.
13 Section 41. Paragraph (a) of subsection (11) of
14 section 408.072, Florida Statutes, 1996 Supplement, is amended
15 to read:
16 408.072 Review of hospital budgets.--
17 (11) Notwithstanding any other provisions of this
18 chapter:
19 (a) Any hospital operated by the agency Department of
20 Health and Rehabilitative Services or the Department of
21 Corrections; any rural hospital as defined in s. 408.07; and
22 any intensive residential treatment program for children and
23 adolescents as defined in s. 395.002(14)(16) which received a
24 certificate of need on or before January 1, 1991, and is
25 licensed under chapter 395 for less than 33 beds, which is not
26 part of a multifacility organization and which is part of a
27 community mental health system, shall be exempt from filing a
28 budget, and shall be exempt from budget review and approval
29 for exceeding the maximum allowable rate of increase and from
30 any penalties arising therefrom. However, each such hospital
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1 shall be required to submit to the board its audited actual
2 experience, as required by s. 408.061(4)(a).
3 Section 42. Subsection (8) of section 409.905, Florida
4 Statutes, 1996 Supplement, is amended to read:
5 409.905 Mandatory Medicaid services.--The agency may
6 make payments for the following services, which are required
7 of the state by Title XIX of the Social Security Act,
8 furnished by Medicaid providers to recipients who are
9 determined to be eligible on the dates on which the services
10 were provided. Any service under this section shall be
11 provided only when medically necessary and in accordance with
12 state and federal law. Nothing in this section shall be
13 construed to prevent or limit the agency from adjusting fees,
14 reimbursement rates, lengths of stay, number of visits, number
15 of services, or any other adjustments necessary to comply with
16 the availability of moneys and any limitations or directions
17 provided for in the General Appropriations Act or chapter 216.
18 (8) NURSING FACILITY SERVICES.--The agency shall pay
19 for 24-hour-a-day nursing and rehabilitative services for a
20 recipient in a nursing facility licensed under part II of
21 chapter 400 or in a rural hospital, as defined in s. 395.602,
22 or in a Medicare certified skilled nursing facility operated
23 by a hospital, as defined by s. 395.002(9)(10), that is
24 licensed under part I of chapter 395, and in accordance with
25 provisions set forth in s. 409.908(2)(a), which services are
26 ordered by and provided under the direction of a licensed
27 physician. However, if a nursing facility has been destroyed
28 or otherwise made uninhabitable by natural disaster or other
29 emergency and another nursing facility is not available, the
30 agency must pay for similar services temporarily in a hospital
31
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1 licensed under part I of chapter 395 provided federal funding
2 is approved and available.
3 Section 43. Paragraph (g) of subsection (1) of section
4 440.13, Florida Statutes, 1996 Supplement, is amended to read:
5 440.13 Medical services and supplies; penalty for
6 violations; limitations.--
7 (1) DEFINITIONS.--As used in this section, the term:
8 (g) "Emergency services and care" means emergency
9 services and care as defined in s. 395.002(9).
10 Section 44. Subsection (9) of section 458.331, Florida
11 Statutes, 1996 Supplement, is amended to read:
12 458.331 Grounds for disciplinary action; action by the
13 board and department.--
14 (9) When an investigation of a physician is
15 undertaken, the department shall promptly furnish to the
16 physician or his attorney a copy of the complaint or document
17 which resulted in the initiation of the investigation. For
18 purposes of this subsection, such documents include, but are
19 not limited to: the pertinent portions of an annual report
20 submitted to the department pursuant to s. 395.0197(6)(5)(b);
21 a report of an adverse or untoward incident which is provided
22 to the department pursuant to the provisions of s.
23 395.0197(8)(6); a report of peer review disciplinary action
24 submitted to the department pursuant to the provisions of s.
25 395.0193(4) or s. 458.337, providing that the investigations,
26 proceedings, and records relating to such peer review
27 disciplinary action shall continue to retain their privileged
28 status even as to the licensee who is the subject of the
29 investigation, as provided by ss. 395.0193(8)(7) and
30 458.337(3); a report of a closed claim submitted pursuant to
31 s. 627.912; a presuit notice submitted pursuant to s.
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1 766.106(2); and a petition brought under the Florida
2 Birth-Related Neurological Injury Compensation Plan, pursuant
3 to s. 766.305(2). The physician may submit a written response
4 to the information contained in the complaint or document
5 which resulted in the initiation of the investigation within
6 45 days after service to the physician of the complaint or
7 document. The physician's written response shall be considered
8 by the probable cause panel.
9 Section 45. Subsection (9) of section 459.015, Florida
10 Statutes, 1996 Supplement, is amended to read:
11 459.015 Grounds for disciplinary action by the
12 board.--
13 (9) When an investigation of an osteopathic physician
14 is undertaken, the department shall promptly furnish to the
15 osteopathic physician or his attorney a copy of the complaint
16 or document which resulted in the initiation of the
17 investigation. For purposes of this subsection, such documents
18 include, but are not limited to: the pertinent portions of an
19 annual report submitted to the department pursuant to s.
20 395.0197(6)(5)(b); a report of an adverse or untoward incident
21 which is provided to the department pursuant to the provisions
22 of s. 395.0197(8)(6); a report of peer review disciplinary
23 action submitted to the department pursuant to the provisions
24 of s. 395.0193(4) or s. 459.016, provided that the
25 investigations, proceedings, and records relating to such peer
26 review disciplinary action shall continue to retain their
27 privileged status even as to the licensee who is the subject
28 of the investigation, as provided by ss. 395.0193(8)(7) and
29 459.016(3); a report of a closed claim submitted pursuant to
30 s. 627.912; a presuit notice submitted pursuant to s.
31 766.106(2); and a petition brought under the Florida
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1 Birth-Related Neurological Injury Compensation Plan, pursuant
2 to s. 766.305(2). The osteopathic physician may submit a
3 written response to the information contained in the complaint
4 or document which resulted in the initiation of the
5 investigation within 45 days after service to the osteopathic
6 physician of the complaint or document. The osteopathic
7 physician's written response shall be considered by the
8 probable cause panel.
9 Section 46. Paragraph (l) of subsection (1) of section
10 468.505, Florida Statutes, 1996 Supplement, is amended to
11 read:
12 468.505 Exemptions; exceptions.--
13 (1) Nothing in this part may be construed as
14 prohibiting or restricting the practice, services, or
15 activities of:
16 (l) A person employed by a nursing facility exempt
17 from licensing under s. 395.002(11)(12), or a person exempt
18 from licensing under s. 464.022; or
19 Section 47. Effective January 1, 1998, subsection (2)
20 of section 641.55, Florida Statutes, 1996 Supplement, is
21 amended to read:
22 641.55 Internal risk management program.--
23 (2) The risk management program shall be the
24 responsibility of the governing authority or board of the
25 organization. Every organization which has an annual premium
26 volume of $10 million or more and which directly provides
27 health care in a building owned or leased by the organization
28 shall hire a risk manager, certified under ss.
29 395.10971-395.10975 626.941-626.945, who shall be responsible
30 for implementation of the organization's risk management
31 program required by this section. A part-time risk manager
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1 shall not be responsible for risk management programs in more
2 than four organizations or facilities. Every organization
3 which does not directly provide health care in a building
4 owned or leased by the organization and every organization
5 with an annual premium volume of less than $10 million shall
6 designate an officer or employee of the organization to serve
7 as the risk manager.
8
9 The gross data compiled under this section or s. 395.0197
10 shall be furnished by the agency upon request to organizations
11 to be utilized for risk management purposes. The agency shall
12 adopt rules necessary to carry out the provisions of this
13 section.
14 Section 48. Paragraph (c) of subsection (4) of section
15 766.1115, Florida Statutes, 1996 Supplement, is amended to
16 read:
17 766.1115 Health care providers; creation of agency
18 relationship with governmental contractors.--
19 (4) CONTRACT REQUIREMENTS.--A health care provider
20 that executes a contract with a governmental contractor to
21 deliver health care services on or after April 17, 1992, as an
22 agent of the governmental contractor is an agent for purposes
23 of s. 768.28(9), while acting within the scope of duties
24 pursuant to the contract, if the contract complies with the
25 requirements of this section. A health care provider under
26 contract with the state may not be named as a defendant in any
27 action arising out of the medical care or treatment provided
28 on or after April 17, 1992, pursuant to contracts entered into
29 under this section. The contract must provide that:
30 (c) Adverse incidents and information on treatment
31 outcomes must be reported by any health care provider to the
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1 governmental contractor if such incidents and information
2 pertain to a patient treated pursuant to the contract. The
3 health care provider shall annually submit an adverse incident
4 report that includes all information required by s.
5 395.0197(6)(5)(a), unless the adverse incident involves a
6 result described by s. 395.0197(8)(6), in which case it shall
7 be reported within 15 days of the occurrence of such incident.
8 If an incident involves a professional licensed by the
9 Department of Health Business and Professional Regulation or a
10 facility licensed by the Agency for Health Care Administration
11 Department of Health and Rehabilitative Services, the
12 governmental contractor shall submit such incident reports to
13 the appropriate department or agency, which shall review each
14 incident and determine whether it involves conduct by the
15 licensee that is subject to disciplinary action. All patient
16 medical records and any identifying information contained in
17 adverse incident reports and treatment outcomes which are
18 obtained by governmental entities pursuant to this paragraph
19 are confidential and exempt from the provisions of s.
20 119.07(1) and s. 24(a), Art. I of the State Constitution.
21
22 A governmental contractor that is also a health care provider
23 is not required to enter into a contract under this section
24 with respect to the health care services delivered by its
25 employees.
26 Section 49. Effective January 1, 1998, all powers,
27 duties and functions, rules, records, personnel, property, and
28 unexpended balances of appropriations, allocations, or other
29 funds of the Department of Insurance related to the health
30 care risk manager licensure program, as established in part IX
31 of chapter 626, Florida Statutes, are transferred by a type
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1 two transfer, as defined in s. 20.06(2), Florida Statutes,
2 from the Department of Insurance to the Agency for Health Care
3 Administration.
4 Section 50. There is hereby appropriated from the
5 Health Care Trust Fund to the Agency for Health Care
6 Administration two full-time positions to administer the
7 health care risk manager licensure program.
8 Section 51. Except as otherwise provided herein, this
9 act shall take effect July 1, 1997.
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