House Bill 0349c3
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Florida House of Representatives - 1998 CS/CS/CS/HB 349
By the Committees on Health Care Standards & Regulatory
Reform, Health & Human Services Appropriations, Health Care
Standards & Regulatory Reform and Representatives Sanderson,
Saunders and Murman
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 ss. 154.304,
9 154.306, and 154.312, F.S., relating to health
10 care for indigent persons; revising
11 definitions; conforming references to changes
12 made by the act; amending s. 394.4788, F.S.,
13 relating to mental health services; updating
14 provisions relating to duties of the agency
15 formerly performed by the Health Care Cost
16 Containment Board; amending s. 395.0163, F.S.;
17 providing exemptions from construction
18 inspections and investigations by the Agency
19 for Health Care Administration for certain
20 outpatient facilities; providing exceptions;
21 amending s. 395.1055, F.S.; requiring the
22 Agency for Health Care Administration to adopt
23 rules to assure that, following a disaster,
24 licensed facilities are capable of serving as
25 shelters only for patients, staff, and the
26 families of patients and staff; providing for
27 applicability; providing for a report by the
28 agency to the Governor and Legislature;
29 amending s. 395.401, F.S.; providing for
30 certain reports formerly made to the Health
31 Care Board to be made to the agency; amending
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1 s. 395.701, F.S., relating to the Public
2 Medical Assistance Trust Fund; revising
3 definitions; amending ss. 395.403, 395.605,
4 395.7015, and 395.806, F.S.; conforming
5 references; amending ss. 408.05, 408.061,
6 408.062, and 408.063, F.S., relating to the
7 State Center for Health Statistics and the
8 collection and dissemination of health care
9 information; updating provisions to reflect the
10 assumption by the Agency for Health Care
11 Administration of duties formerly performed by
12 the Health Care Board and the former Department
13 of Health and Rehabilitative Services;
14 authorizing the agency to conduct data-based
15 studies and make recommendations; deleting
16 obsolete provisions; amending s. 408.07, F.S.;
17 deleting definitions made obsolete by the
18 repeal of requirements with respect to hospital
19 budget reviews; amending s. 408.08, F.S.;
20 deleting provisions requiring the Health Care
21 Board to review the budgets of certain
22 hospitals; deleting requirements that a
23 hospital file budget letters; deleting certain
24 administrative penalties; amending s. 408.40,
25 F.S.; removing a reference to the duties of the
26 Public Counsel with respect to hospital budget
27 review proceedings; amending s. 408.50, F.S.;
28 conforming a reference; amending ss. 409.2673
29 and 409.9113, F.S., relating to health care
30 programs for low-income persons and the
31 disproportionate share program for teaching
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1 hospitals; updating provisions to reflect the
2 abolishment of the Health Care Cost Containment
3 Board and the assumption of its duties by the
4 agency; repealing ss. 395.403(9), 407.61,
5 408.003, 408.072, and 408.085, F.S., relating
6 to reimbursement of state-sponsored trauma
7 centers, studies by the Health Care Board,
8 appointment of members to the Health Care
9 Board, review of hospital budgets, and budget
10 reviews of comprehensive inpatient
11 rehabilitation hospitals; providing for
12 retroactive application of provisions of the
13 act relating to repeal of review of hospital
14 budgets; amending ss. 381.026 and 381.0261,
15 F.S.; requiring distribution of the Florida
16 Patient's Bill of Rights and Responsibilities;
17 providing penalties; repealing s. 395.002(2)
18 and (15), F.S.; deleting definitions of
19 "adverse or untoward incident" and "injury";
20 amending s. 395.0193, F.S.; revising provisions
21 relating to facility peer review disciplinary
22 actions against practitioners; requiring a
23 report to the Agency for Health Care
24 Administration; providing penalties; amending
25 s. 395.0197, F.S.; revising provisions relating
26 to internal risk management; defining the term
27 "adverse incident"; requiring certain reports
28 to the agency; including minors in provisions
29 relating to notification of sexual misconduct
30 or abuse; requiring facility corrective action
31 plans; providing penalties; renumbering s.
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1 626.941, F.S., relating to the purpose of the
2 health care risk manager licensure program;
3 renumbering and amending s. 626.942, F.S.,
4 relating to the Health Care Risk Manager
5 Advisory Council; renumbering and amending s.
6 626.943, F.S.; providing powers and duties of
7 the agency; renumbering and amending s.
8 626.944, F.S., relating to qualifications for
9 health care risk managers; providing for fees;
10 providing for issuance, cancellation, and
11 renewal of licenses; renumbering and amending
12 s. 626.945, F.S., relating to grounds for
13 denial, suspension, or revocation of licenses;
14 amending ss. 394.4787, 395.602, 400.051,
15 409.905, 440.13, 458.331, 459.015, 468.505,
16 641.55, and 766.1115, F.S.; conforming
17 references and correcting cross references;
18 transferring the internal risk manager
19 licensure program from the Department of
20 Insurance to the Agency for Health Care
21 Administration; providing an appropriation;
22 providing effective dates.
23
24 Be It Enacted by the Legislature of the State of Florida:
25
26 Section 1. Paragraphs (b), (d), and (e) of subsection
27 (2) and subsections (6) and (7) of section 20.42, Florida
28 Statutes, are amended to read:
29 20.42 Agency for Health Care Administration.--There is
30 created the Agency for Health Care Administration within the
31 Department of Business and Professional Regulation. The agency
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1 shall be a separate budget entity, and the director of the
2 agency shall be the agency head for all purposes. The agency
3 shall not be subject to control, supervision, or direction by
4 the Department of Business and Professional Regulation in any
5 manner, including, but not limited to, personnel, purchasing,
6 transactions involving real or personal property, and
7 budgetary matters.
8 (2) ORGANIZATION OF THE AGENCY.--The agency shall be
9 organized as follows:
10 (b) The Division of Health Policy and Cost Control,
11 which shall be responsible for health policy, the State Center
12 for Health Statistics, the development of The Florida Health
13 Plan, certificate of need, hospital budget review, state and
14 local health planning under s. 408.033, and research and
15 analysis.
16 (d) The Health Care Board, which shall be responsible
17 for hospital budget review, nursing home financial analysis,
18 and special studies as assigned by the secretary or the
19 Legislature.
20 (d)(e) The Division of Administrative Services, which
21 shall be responsible for revenue management, budget,
22 personnel, and general services.
23 (6) HEALTH CARE BOARD.--The Health Care Board shall be
24 composed of 11 members appointed by the Governor, subject to
25 confirmation by the Senate. The members of the board shall
26 biennially elect a chairperson and a vice chairperson from its
27 membership. The board shall be responsible for hospital budget
28 review, nursing home financial review and analysis, and
29 special studies requested by the Governor, the Legislature, or
30 the director.
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1 (6)(7) DEPUTY DIRECTOR OF ADMINISTRATIVE
2 SERVICES.--The director shall appoint a Deputy Director of
3 Administrative Services who shall serve at the pleasure of,
4 and be directly responsible to, the director. The deputy
5 director shall be responsible for the Division of
6 Administrative Services.
7 Section 2. Subsections (1) and (8) of section 154.304,
8 Florida Statutes, are amended to read:
9 154.304 Definitions.--For the purpose of this act:
10 (1) "Agency" means the Agency for Health Care
11 Administration. "Board" means the Health Care Board as
12 established in chapter 408.
13 (8) "Participating hospital" means a hospital which is
14 eligible to receive reimbursement under the provisions of this
15 act because it has been certified by the agency board as
16 having met its charity care obligation and has either:
17 (a) A formal signed agreement with a county or
18 counties to treat such county's indigent patients; or
19 (b) Demonstrated to the agency board that at least 2.5
20 percent of its uncompensated charity care, as reported to the
21 agency board, is generated by out-of-county residents.
22 Section 3. Subsection (4) of section 154.306, Florida
23 Statutes, is amended to read:
24 154.306 Financial responsibility for certified
25 residents who are qualified indigent patients treated at an
26 out-of-county participating hospital or regional referral
27 hospital.--Ultimate financial responsibility for treatment
28 received at a participating hospital or a regional referral
29 hospital by a qualified indigent patient who is a certified
30 resident of a county in the State of Florida, but is not a
31 resident of the county in which the participating hospital or
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1 regional referral hospital is located, shall be the obligation
2 of the county of which the qualified indigent patient is a
3 resident. Each county is directed to reimburse participating
4 hospitals or regional referral hospitals as provided for in
5 this act, and shall provide or arrange for indigent
6 eligibility determination procedures and resident
7 certification determination procedures as provided for in
8 rules developed to implement this act. The department, or any
9 county determining eligibility of a qualified indigent, shall
10 provide to the county of residence, upon request, a copy of
11 any documents, forms, or other information, as determined by
12 rule, which may be used in making an eligibility
13 determination.
14 (4) No county shall be liable for payment for
15 treatment of a qualified indigent who is a certified resident
16 and has received services at an out-of-county participating
17 hospital or regional referral hospital, until such time as
18 that hospital has documented to the agency board and the
19 agency board has determined that it has met its charity care
20 obligation based on the most recent audited actual experience.
21 Section 4. Section 154.312, Florida Statutes, is
22 amended to read:
23 154.312 Procedure for settlement of disputes.--All
24 disputes among counties, the agency board, the department, a
25 participating hospital, or a regional referral hospital shall
26 be resolved by order as provided in chapter 120. Hearings held
27 under this provision shall be conducted in the same manner as
28 provided in ss. 120.569 and 120.57, except that the presiding
29 officer's order shall be final agency action. Cases filed
30 under chapter 120 may combine all disputes between parties.
31 Notwithstanding any other provisions of this part, when a
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1 county alleges that a residency determination or eligibility
2 determination made by the department is incorrect, the burden
3 of proof shall be on the county to demonstrate that such
4 determination is, in light of the total record, not supported
5 by the evidence.
6 Section 5. Subsections (2) and (3) of section
7 394.4788, Florida Statutes, are amended to read:
8 394.4788 Use of certain PMATF funds for the purchase
9 of acute care mental health services.--
10 (2) By October 1, 1989, and annually thereafter, The
11 agency shall annually calculate a per diem reimbursement rate
12 for each specialty psychiatric hospital to be paid to the
13 specialty psychiatric hospitals for the provision of acute
14 mental health services provided to indigent mentally ill
15 patients who meet the criteria in subsection (1). After the
16 first rate period, providers shall be notified of new
17 reimbursement rates for each new state fiscal year by June 1.
18 The new reimbursement rates shall commence July 1.
19 (3) Reimbursement rates shall be calculated using the
20 most recent audited actual costs received by the agency. Cost
21 data received as of August 15, 1989, and each April 15
22 thereafter shall be used in the calculation of the rates.
23 Historic costs shall be inflated from the midpoint of a
24 hospital's fiscal year to the midpoint of the state fiscal
25 year. The inflation adjustment shall be made utilizing the
26 latest available projections as of March 31 for the Data
27 Resources Incorporated National and Regional Hospital Input
28 Price Indices as calculated by the Medicaid program office.
29 Section 6. Subsection (1) of section 395.0163, Florida
30 Statutes, is amended to read:
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1 395.0163 Construction inspections; plan submission and
2 approval; fees.--
3 (1)(a) The agency shall make, or cause to be made,
4 such construction inspections and investigations as it deems
5 necessary. The agency may prescribe by rule that any licensee
6 or applicant desiring to make specified types of alterations
7 or additions to its facilities or to construct new facilities
8 shall, before commencing such alteration, addition, or new
9 construction, submit plans and specifications therefor to the
10 agency for preliminary inspection and approval or
11 recommendation with respect to compliance with agency rules
12 and standards. The agency shall approve or disapprove the
13 plans and specifications within 60 days after receipt of the
14 fee for review of plans as required in subsection (2). The
15 agency may be granted one 15-day extension for the review
16 period if the director of the agency approves the extension.
17 If the agency fails to act within the specified time, it shall
18 be deemed to have approved the plans and specifications. When
19 the agency disapproves plans and specifications, it shall set
20 forth in writing the reasons for its disapproval. Conferences
21 and consultations may be provided as necessary.
22 (b) All outpatient facilities that provide surgical
23 treatments requiring general anesthesia or intravenous
24 conscious sedation, that provide cardiac catheterization
25 services, or that are to be licensed as ambulatory surgical
26 centers shall submit plans and specifications to the agency
27 for review under this section. All other outpatient facilities
28 must be reviewed under this section, except that those that
29 are physically detached from, and have no utility connections
30 with, the hospital and that do not block emergency egress from
31 or create a fire hazard to the hospital are exempt from review
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1 under this section. This section applies to applications for
2 which review is pending on or after July 1, 1998.
3 Section 7. Paragraph (d) of subsection (1) of section
4 395.1055, Florida Statutes, is amended to read:
5 395.1055 Rules and enforcement.--
6 (1) The agency shall adopt, amend, promulgate, and
7 enforce rules to implement the provisions of this part, which
8 shall include reasonable and fair minimum standards for
9 ensuring that:
10 (d) New facilities and a new wing or floor added to an
11 existing facility after July 1, 1999, are structurally capable
12 of serving as shelters only for patients, staff, and families
13 of patients and staff, and equipped to be self-supporting
14 during and immediately following disasters.
15 Section 8. The Agency for Health Care Administration
16 shall work with persons affected by s. 395.1055(1)(d), Florida
17 Statutes, as amended by this act, and report to the Governor
18 and Legislature by March 1, 1999, its recommendations for
19 cost-effective renovation standards to be applied to existing
20 facilities.
21 Section 9. Paragraphs (a) and (b) of subsection (1) of
22 section 395.401, Florida Statutes, are amended to read:
23 395.401 Trauma services system plans; verification of
24 trauma centers and pediatric trauma referral centers;
25 procedures; renewal.--
26 (1) As used in this part, the term:
27 (a) "Agency" means the Agency for Health Care
28 Administration. "Board" means the Health Care Board.
29 (b) "Charity care" or "uncompensated charity care"
30 means that portion of hospital charges reported to the agency
31 board for which there is no compensation for care provided to
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1 a patient whose family income for the 12 months preceding the
2 determination is less than or equal to 150 percent of the
3 federal poverty level, unless the amount of hospital charges
4 due from the patient exceeds 25 percent of the annual family
5 income. However, in no case shall the hospital charges for a
6 patient whose family income exceeds 4 times the federal
7 poverty level for a family of four be considered charity.
8 Section 10. Paragraph (b) of subsection (6) of section
9 395.403, Florida Statutes, is amended to read:
10 395.403 Reimbursement of state-sponsored trauma
11 centers.--
12 (6)
13 (b) The database to be used for this calculation shall
14 be the detailed patient discharge data of the most recently
15 completed calendar year for which the agency board possesses
16 data. Out-of-state days that are included in the database
17 shall be allocated to the service area where the treating
18 hospital is located.
19 Section 11. Subsection (6) of section 395.605, Florida
20 Statutes, is amended to read:
21 395.605 Emergency care hospitals.--
22 (6) The agency board shall treat emergency care
23 hospitals in the same manner as hospitals defined in s.
24 408.07.
25 Section 12. Subsections (1), (2), (3), and (4) of
26 section 395.701, Florida Statutes, are 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:
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1 (a) "Agency" means the Agency for Health Care
2 Administration.
3 (b)(a) "Gross operating revenue" or "gross revenue"
4 means the sum of daily hospital service charges, ambulatory
5 service charges, ancillary service charges, and other
6 operating revenue.
7 (b) "Health Care Board" or "board" means the Health
8 Care Board created by s. 20.42.
9 (c) "Hospital" means a health care institution as
10 defined in s. 395.002(11) s. 395.002(12), but does not include
11 any hospital operated by the agency or the Department of
12 Corrections.
13 (d) "Net operating revenue" or "net revenue" means
14 gross revenue less deductions from revenue.
15 (e) "Total deductions from gross revenue" or
16 "deductions from revenue" means reductions from gross revenue
17 resulting from inability to collect payment of charges. Such
18 reductions include bad debts; contractual adjustments;
19 uncompensated care; administrative, courtesy, and policy
20 discounts and adjustments; and other such revenue deductions,
21 but also includes the offset of restricted donations and
22 grants for indigent care.
23 (2) There is hereby imposed upon each hospital an
24 assessment in an amount equal to 1.5 percent of the annual net
25 operating revenue for each hospital, such revenue to be
26 determined by the agency department, based on the actual
27 experience of the hospital as reported to the agency
28 department. Within 6 months after the end of each hospital
29 fiscal year, the agency department shall certify the amount of
30 the assessment for each hospital. The assessment shall be
31 payable to and collected by the agency department in equal
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1 quarterly amounts, on or before the first day of each calendar
2 quarter, beginning with the first full calendar quarter that
3 occurs after the agency department certifies the amount of the
4 assessment for each hospital. All moneys collected pursuant to
5 this subsection shall be deposited into the Public Medical
6 Assistance Trust Fund.
7 (3) The agency department shall impose an
8 administrative fine, not to exceed $500 per day, for failure
9 of any hospital to pay its assessment by the first day of the
10 calendar quarter on which it is due. The failure of a
11 hospital to pay its assessment within 30 days after the
12 assessment is due is ground for the agency department to
13 impose an administrative fine not to exceed $5,000 per day.
14 (4) The purchaser, successor, or assignee of a
15 facility subject to the agency's board's jurisdiction shall
16 assume full liability for any assessments, fines, or penalties
17 of the facility or its employees, regardless of when
18 identified. Such assessments, fines, or penalties shall be
19 paid by the employee, owner, or licensee who incurred them,
20 within 15 days of the sale, transfer, or assignment. However,
21 the purchaser, successor, or assignee of the facility may
22 withhold such assessments, fines, or penalties from purchase
23 moneys or payment due to the seller, transferor, or employee,
24 and shall make such payment on behalf of the seller,
25 transferor, or employee. Any employer, purchaser, successor,
26 or assignee who fails to withhold sufficient funds to pay
27 assessments, fines, or penalties arising under the provisions
28 of chapter 408 shall make such payments within 15 days of the
29 date of the transfer, purchase, or assignment. Failure by the
30 transferee to make payments as provided in this subsection
31 shall subject such transferee to the penalties and assessments
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1 provided in chapter 408. Further, in the event of sale,
2 transfer, or assignment of any facility under the agency's
3 board's jurisdiction, future assessments shall be based upon
4 the most recently available prior year report or audited
5 actual experience for the facility. It shall be the
6 responsibility of the new owner or licensee to require the
7 production of the audited financial data for the period of
8 operation of the prior owner. If the transferee fails to
9 obtain current audited financial data from the previous owner
10 or licensee, the new owner shall be assessed based upon the
11 most recent year of operation for which 12 months of audited
12 actual experience are available or upon a reasonable estimate
13 of 12 months of full operation as calculated by the agency
14 board.
15 Section 13. Paragraph (a) of subsection (3) of section
16 395.7015, Florida Statutes, is amended to read:
17 395.7015 Annual assessment on health care entities.--
18 (3)(a) Beginning July 1, 1993, the assessment shall be
19 on the actual experience of the entity as reported to the
20 agency within 120 days after the end of its fiscal year in the
21 preceding calendar year based upon reports developed by the
22 agency board in a rule after consultation with appropriate
23 professional and governmental advisory bodies.
24 Section 14. Subsection (3) of section 395.806, Florida
25 Statutes, is amended to read:
26 395.806 Designation of family practice teaching
27 hospitals.--
28 (3) The agency shall create a separate review category
29 for family practice teaching hospitals for the purpose of
30 review by the Health Care Board.
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1 Section 15. Subsection (1), paragraphs (e) and (f) of
2 subsection (3), subsection (6), and paragraphs (c) and (d) of
3 subsection (7) of section 408.05, Florida Statutes, are
4 amended to read:
5 408.05 State Center for Health Statistics.--
6 (1) ESTABLISHMENT.--The agency department shall
7 establish a State Center for Health Statistics. The center
8 shall establish a comprehensive health information system to
9 provide for the collection, compilation, coordination,
10 analysis, indexing, dissemination, and utilization of both
11 purposefully collected and extant health-related data and
12 statistics. The center shall be staffed with public health
13 experts, biostatisticians, information system analysts, health
14 policy experts, economists, and other staff necessary to carry
15 out its functions.
16 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order
17 to produce comparable and uniform health information and
18 statistics, the agency shall perform the following functions:
19 (e) The agency department shall establish by rule the
20 types of data collected, compiled, processed, used, or shared.
21 Decisions regarding center data sets should be made based on
22 consultation with the Comprehensive Health Information System
23 Advisory Council and other public and private users regarding
24 the types of data which should be collected and their uses.
25 (f) The center shall establish standardized means for
26 collecting health information and statistics under laws and
27 rules administered by the agency department.
28 (6) PROVIDER DATA REPORTING.--This section does not
29 confer on the agency department the power to demand or require
30 that a health care provider or professional furnish
31 information, records of interviews, written reports,
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1 statements, notes, memoranda, or data other than as expressly
2 required by law.
3 (7) BUDGET; FEES; TRUST FUND.--
4 (c) The center may charge such reasonable fees for
5 services as the agency department prescribes by rule. The
6 established fees may shall not exceed the reasonable cost for
7 such services. Fees collected may not be used to offset
8 annual appropriations from the General Revenue Fund.
9 (d) The agency department shall establish a
10 Comprehensive Health Information System Trust Fund as the
11 repository of all funds appropriated to, and fees and grants
12 collected for, services of the State Center for Health
13 Statistics. Any funds, other than funds appropriated to the
14 center from the General Revenue Fund, which are raised or
15 collected by the agency department for the operation of the
16 center and which are not needed to meet the expenses of the
17 center for its current fiscal year shall be available to the
18 agency board in succeeding years.
19 Section 16. Subsections (10) and (11) of section
20 408.061, Florida Statutes, are amended to read:
21 408.061 Data collection; uniform systems of financial
22 reporting; information relating to physician charges;
23 confidentiality of patient records; immunity.--
24 (10) No health care facility, health care provider,
25 health insurer, or other reporting entity or its employees or
26 agents shall be held liable for civil damages or subject to
27 criminal penalties either for the reporting of patient data to
28 the agency board or for the release of such data by the agency
29 board as authorized by this chapter.
30 (11) The agency shall be the primary source for
31 collection and dissemination of health care data. No other
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1 agency of state government may gather data from a health care
2 provider licensed or regulated under this chapter without
3 first determining if the data is currently being collected by
4 the agency and affirmatively demonstrating that it would be
5 more cost-effective for an agency of state government other
6 than the agency to gather the health care data. The director
7 secretary shall ensure that health care data collected by the
8 divisions within the agency is coordinated. It is the express
9 intent of the Legislature that all health care data be
10 collected by a single source within the agency and that other
11 divisions within the agency, and all other agencies of state
12 government, obtain data for analysis, regulation, and public
13 dissemination purposes from that single source. Confidential
14 information may be released to other governmental entities or
15 to parties contracting with the agency to perform agency
16 duties or functions as needed in connection with the
17 performance of the duties of the receiving entity. The
18 receiving entity or party shall retain the confidentiality of
19 such information as provided for herein.
20 Section 17. Subsections (2) and (5) of section
21 408.062, Florida Statutes, are amended to read:
22 408.062 Research, analyses, studies, and reports.--
23 (2) The agency board shall evaluate data from nursing
24 home financial reports and shall document and monitor:
25 (a) Total revenues, annual change in revenues, and
26 revenues by source and classification, including contributions
27 for a resident's care from the resident's resources and from
28 the family and contributions not directed toward any specific
29 resident's care.
30 (b) Average resident charges by geographic region,
31 payor, and type of facility ownership.
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1 (c) Profit margins by geographic region and type of
2 facility ownership.
3 (d) Amount of charity care provided by geographic
4 region and type of facility ownership.
5 (e) Resident days by payor category.
6 (f) Experience related to Medicaid conversion as
7 reported under s. 408.061.
8 (g) Other information pertaining to nursing home
9 revenues and expenditures.
10
11 The findings of the agency board shall be included in an
12 annual report to the Governor and Legislature by January 1
13 each year.
14 (5)(a) The agency may conduct data-based studies and
15 evaluations and make recommendations to the Legislature and
16 the Governor concerning exemptions, the effectiveness of
17 limitations of referrals, restrictions on investment interests
18 and compensation arrangements, and the effectiveness of public
19 disclosure. Such analysis may include, but need not be
20 limited to, utilization of services, cost of care, quality of
21 care, and access to care. The agency may require the
22 submission of data necessary to carry out this duty, which may
23 include, but need not be limited to, data concerning
24 ownership, Medicare and Medicaid, charity care, types of
25 services offered to patients, revenues and expenses,
26 patient-encounter data, and other data reasonably necessary to
27 study utilization patterns and the impact of health care
28 provider ownership interests in health-care-related entities
29 on the cost, quality, and accessibility of health care.
30 (b) The agency may collect such data from any health
31 facility as a special study. The board is directed to research
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1 hospital financial and nonfinancial data in order to determine
2 the need for establishing a category of inpatient hospital
3 patients defined as medically indigent. For purposes of this
4 section, a medically indigent patient is an individual who is
5 admitted as an inpatient to a hospital, who is not classified
6 as a Medicare beneficiary, a Medicaid recipient, or a charity
7 care patient, but who has insufficient financial resources to
8 pay for needed medical care. In its determination of the need
9 for establishing a category of medically indigent patients,
10 the board shall consider the creation of income and asset
11 levels that would establish a person as medically indigent.
12 The board shall submit a report and recommendations to the
13 Governor and the Legislature on the establishment of a
14 category of medically indigent inpatient hospital patients on
15 or before January 1, 1994. If the board recommends the
16 establishment of a category of medically indigent patients, it
17 shall provide a specific recommendation for the eligibility
18 determination process to be used in classifying a patient as
19 medically indigent.
20 Section 18. Subsection (1) of section 408.063, Florida
21 Statutes, is amended to read:
22 408.063 Dissemination of health care information.--
23 (1) The agency, relying on data collected pursuant to
24 this chapter, shall establish a reliable, timely, and
25 consistent information system that which distributes
26 information and serves as the basis for the agency's board's
27 public education programs. The agency shall seek advice from
28 consumers, health care purchasers, health care providers,
29 health care facilities, health insurers, and local health
30 councils in the development and implementation of its
31 information system. Whenever appropriate, the agency shall use
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1 the local health councils for the dissemination of information
2 and education of the public.
3 Section 19. Section 408.07, Florida Statutes, is
4 amended to read:
5 408.07 Definitions.--As used in this chapter, with the
6 exception of ss. 408.031-408.045, the term:
7 (1) "Accepted" means that the agency board has found
8 that a report or data submitted by a health care facility or a
9 health care provider contains all schedules and data required
10 by the agency board and has been prepared in the format
11 specified by the agency board, and otherwise conforms to
12 applicable rule or Florida Hospital Uniform Reporting System
13 manual requirements regarding reports in effect at the time
14 such report was submitted, and the data are mathematically
15 reasonable and accurate.
16 (2) "Adjusted admission" means the sum of acute and
17 intensive care admissions divided by the ratio of inpatient
18 revenues generated from acute, intensive, ambulatory, and
19 ancillary patient services to gross revenues. If a hospital
20 reports only subacute admissions, then "adjusted admission"
21 means the sum of subacute admissions divided by the ratio of
22 total inpatient revenues to gross revenues.
23 (3) "Agency" means the Agency for Health Care
24 Administration.
25 (4) "Alcohol or chemical dependency treatment center"
26 means an organization licensed under chapter 397.
27 (5) "Ambulatory care center" means an organization
28 which employs or contracts with licensed health care
29 professionals to provide diagnosis or treatment services
30 predominantly on a walk-in basis and the organization holds
31 itself out as providing care on a walk-in basis. Such an
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1 organization is not an ambulatory care center if it is wholly
2 owned and operated by five or fewer health care providers.
3 (6) "Ambulatory surgical center" means a facility
4 licensed as an ambulatory surgical center under chapter 395.
5 (7) "Applicable rate of increase" means the maximum
6 allowable rate of increase (MARI) when applied to gross
7 revenue per adjusted admission, unless the board has approved
8 a different rate of increase, in which case the board-approved
9 rate of increase shall apply.
10 (7)(8) "Audited actual data" means information
11 contained within financial statements examined by an
12 independent, Florida-licensed, certified public accountant in
13 accordance with generally accepted auditing standards, but
14 does not include data within a financial statement about which
15 the certified public accountant does not express an opinion or
16 issues a disclaimer.
17 (9) "Banked points" means the percentage points earned
18 by a hospital when the actual rate of increase in gross
19 revenue per adjusted admission (GRAA) is less than the maximum
20 allowable rate of increase (MARI) or the actual rate of
21 increase in the net revenue per adjusted admission (NRAA) is
22 less than the market basket index.
23 (8)(10) "Birth center" means an organization licensed
24 under s. 383.305.
25 (11) "Board" means the Health Care Board established
26 under s. 408.003.
27 (12) "Budget" means the projections by the hospital,
28 for a specified future time period, of expenditures and
29 revenues, with supporting statistical indicators, or a budget
30 letter verified by the board pursuant to s. 408.072(3)(a).
31
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1 (9)(13) "Cardiac catheterization laboratory" means a
2 freestanding facility that which employs or contracts with
3 licensed health care professionals to provide diagnostic or
4 therapeutic services for cardiac conditions such as cardiac
5 catheterization or balloon angioplasty.
6 (10)(14) "Case mix" means a calculated index for each
7 health care facility or health care provider, based on patient
8 data, reflecting the relative costliness of the mix of cases
9 to that facility or provider compared to a state or national
10 mix of cases.
11 (11)(15) "Clinical laboratory" means a facility
12 licensed under s. 483.091, excluding: any hospital laboratory
13 defined under s. 483.041(5); any clinical laboratory operated
14 by the state or a political subdivision of the state; any
15 blood or tissue bank where the majority of revenues are
16 received from the sale of blood or tissue and where blood,
17 plasma, or tissue is procured from volunteer donors and
18 donated, processed, stored, or distributed on a nonprofit
19 basis; and any clinical laboratory which is wholly owned and
20 operated by physicians who are licensed pursuant to chapter
21 458 or chapter 459 and who practice in the same group
22 practice, and at which no clinical laboratory work is
23 performed for patients referred by any health care provider
24 who is not a member of that same group practice.
25 (12)(16) "Comprehensive rehabilitative hospital" or
26 "rehabilitative hospital" means a hospital licensed by the
27 agency for Health Care Administration as a specialty hospital
28 as defined in s. 395.002; provided that the hospital provides
29 a program of comprehensive medical rehabilitative services and
30 is designed, equipped, organized, and operated solely to
31 deliver comprehensive medical rehabilitative services, and
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1 further provided that all licensed beds in the hospital are
2 classified as "comprehensive rehabilitative beds" pursuant to
3 s. 395.003(4), and are not classified as "general beds."
4 (13)(17) "Consumer" means any person other than a
5 person who administers health activities, is a member of the
6 governing body of a health care facility, provides health
7 services, has a fiduciary interest in a health facility or
8 other health agency or its affiliated entities, or has a
9 material financial interest in the rendering of health
10 services.
11 (14)(18) "Continuing care facility" means a facility
12 licensed under chapter 651.
13 (15)(19) "Cross-subsidization" means that the revenues
14 from one type of hospital service are sufficiently higher than
15 the costs of providing such service as to offset some of the
16 costs of providing another type of service in the hospital.
17 Cross-subsidization results from the lack of a direct
18 relationship between charges and the costs of providing a
19 particular hospital service or type of service.
20 (16)(20) "Deductions from gross revenue" or
21 "deductions from revenue" means reductions from gross revenue
22 resulting from inability to collect payment of charges. For
23 hospitals, such reductions include 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 (17)(21) "Diagnostic-imaging center" means a
29 freestanding outpatient facility that provides specialized
30 services for the diagnosis of a disease by examination and
31 also provides radiological services. Such a facility is not a
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1 diagnostic-imaging center if it is wholly owned and operated
2 by physicians who are licensed pursuant to chapter 458 or
3 chapter 459 and who practice in the same group practice and no
4 diagnostic-imaging work is performed at such facility for
5 patients referred by any health care provider who is not a
6 member of that same group practice.
7 (18)(22) "FHURS" means the Florida Hospital Uniform
8 Reporting System developed by the agency board.
9 (19)(23) "Freestanding" means that a health facility
10 bills and receives revenue which is not directly subject to
11 the hospital assessment for the Public Medical Assistance
12 Trust Fund as described in s. 395.701.
13 (20)(24) "Freestanding radiation therapy center" means
14 a facility where treatment is provided through the use of
15 radiation therapy machines that are registered under s. 404.22
16 and the provisions of the Florida Administrative Code
17 implementing s. 404.22. Such a facility is not a freestanding
18 radiation therapy center if it is wholly owned and operated by
19 physicians licensed pursuant to chapter 458 or chapter 459 who
20 practice within the specialty of diagnostic or therapeutic
21 radiology.
22 (21)(25) "GRAA" means gross revenue per adjusted
23 admission.
24 (22)(26) "Gross revenue" means the sum of daily
25 hospital service charges, ambulatory service charges,
26 ancillary service charges, and other operating revenue. Gross
27 revenues do not include contributions, donations, legacies, or
28 bequests made to a hospital without restriction by the donors.
29 (23)(27) "Health care facility" means an ambulatory
30 surgical center, a hospice, a nursing home, a hospital, a
31 diagnostic-imaging center, a freestanding or hospital-based
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1 therapy center, a clinical laboratory, a home health agency, a
2 cardiac catheterization laboratory, a medical equipment
3 supplier, an alcohol or chemical dependency treatment center,
4 a physical rehabilitation center, a lithotripsy center, an
5 ambulatory care center, a birth center, or a nursing home
6 component licensed under chapter 400 within a continuing care
7 facility licensed under chapter 651.
8 (24)(28) "Health care provider" means a health care
9 professional licensed under chapter 458, chapter 459, chapter
10 460, chapter 461, chapter 463, chapter 464, chapter 465,
11 chapter 466, part I, part III, part IV, part V, or part X of
12 chapter 468, chapter 483, chapter 484, chapter 486, chapter
13 490, or chapter 491.
14 (25)(29) "Health care purchaser" means an employer in
15 the state, other than a health care facility, health insurer,
16 or health care provider, who provides health care coverage for
17 her or his employees.
18 (26)(30) "Health insurer" means any insurance company
19 authorized to transact health insurance in the state, any
20 insurance company authorized to transact health insurance or
21 casualty insurance in the state that is offering a minimum
22 premium plan or stop-loss coverage for any person or entity
23 providing health care benefits, any self-insurance plan as
24 defined in s. 624.031, any health maintenance organization
25 authorized to transact business in the state pursuant to part
26 I of chapter 641, any prepaid health clinic authorized to
27 transact business in the state pursuant to part II of chapter
28 641, any multiple-employer welfare arrangement authorized to
29 transact business in the state pursuant to ss. 624.436-624.45,
30 or any fraternal benefit society providing health benefits to
31 its members as authorized pursuant to chapter 632.
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1 (27)(31) "Home health agency" means an organization
2 licensed under part IV of chapter 400.
3 (28)(32) "Hospice" means an organization licensed
4 under part VI of chapter 400.
5 (29)(33) "Hospital" means a health care institution
6 licensed by the Agency for Health Care Administration as a
7 hospital under chapter 395.
8 (30)(34) "Lithotripsy center" means a freestanding
9 facility that which employs or contracts with licensed health
10 care professionals to provide diagnosis or treatment services
11 using electro-hydraulic shock waves.
12 (31)(35) "Local health council" means the agency
13 defined in s. 408.033.
14 (32)(36) "Market basket index" means the Florida
15 hospital input price index (FHIPI), which is a statewide
16 market basket index used to measure inflation in hospital
17 input prices weighted for the Florida-specific experience
18 which uses multistate regional and state-specific price
19 measures, when available. The index shall be constructed in
20 the same manner as the index employed by the Secretary of the
21 United States Department of Health and Human Services for
22 determining the inflation in hospital input prices for
23 purposes of Medicare reimbursement.
24 (37) "Maximum allowable rate of increase" or "MARI"
25 means the maximum rate at which a hospital is normally
26 expected to increase its average gross revenues per adjusted
27 admission for a given period. The board, using the most
28 recent audited actual data for each hospital, shall calculate
29 the MARI for each hospital as follows: The projected rate of
30 increase in the market basket index shall be divided by a
31 number which is determined by subtracting the sum of one-half
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1 of the proportion of Medicare days plus one-half of the
2 proportion of CHAMPUS days plus the proportion of Medicaid
3 days plus 1.5 times the proportion of charity care days from
4 the number one. The formula to be employed by the board to
5 calculate the MARI shall take the following form:
6
7 FHIPI
8 MARI = (....................................)
9 1-[(Me x 0.5) + (Cp x 0.5) + Md + (Cc x 1.5)]
10
11 where:
12 MARI = maximum allowable rate of increase applied to
13 gross revenue.
14 FHIPI = Florida hospital input price index, which shall
15 be the projected rate of change in the market basket index.
16 Me = proportion of Medicare days, including when
17 available and reported to the board Medicare HMO days, to
18 total days.
19 Cp = proportion of Civilian Health and Medical Program
20 of the Uniformed Services (CHAMPUS) days to total days.
21 Md = proportion of Medicaid days, including when
22 available and reported to the board Medicaid HMO days, to
23 total days.
24 Cc = proportion of charity care days to total days with
25 a 50-percent offset for restricted grants for charity care and
26 unrestricted grants from local governments.
27 (33)(38) "Medical equipment supplier" means an
28 organization that which provides medical equipment and
29 supplies used by health care providers and health care
30 facilities in the diagnosis or treatment of disease.
31
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1 (34)(39) "Net revenue" means gross revenue minus
2 deductions from revenue.
3 (35)(40) "New hospital" means a hospital in its
4 initial year of operation as a licensed hospital and does not
5 include any facility which has been in existence as a licensed
6 hospital, regardless of changes in ownership, for over 1
7 calendar year.
8 (36)(41) "Nursing home" means a facility licensed
9 under s. 400.062 or, for resident level and financial data
10 collection purposes only, any institution licensed under
11 chapter 395 and which has a Medicare or Medicaid certified
12 distinct part used for skilled nursing home care, but does not
13 include a facility licensed under chapter 651.
14 (37)(42) "Operating expenses" means total expenses
15 excluding income taxes.
16 (38)(43) "Other operating revenue" means all revenue
17 generated from hospital operations other than revenue directly
18 associated with patient care.
19 (39)(44) "Physical rehabilitation center" means an
20 organization that which employs or contracts with health care
21 professionals licensed under part I or part III of chapter 468
22 or chapter 486 to provide speech, occupational, or physical
23 therapy services on an outpatient or ambulatory basis.
24 (40)(45) "Prospective payment arrangement" means a
25 financial agreement negotiated between a hospital and an
26 insurer, health maintenance organization, preferred provider
27 organization, or other third-party payor which contains, at a
28 minimum, the elements provided for in s. 408.50.
29 (41)(46) "Rate of return" means the financial
30 indicators used to determine or demonstrate reasonableness of
31 the financial requirements of a hospital. Such indicators
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1 shall include, but not be limited to: return on assets,
2 return on equity, total margin, and debt service coverage.
3 (42)(47) "Rural hospital" means an acute care hospital
4 licensed under chapter 395, with 85 licensed beds or fewer,
5 which has an emergency room and is located in an area defined
6 as rural by the United States Census, and which is:
7 (a) The sole provider within a county with a
8 population density of no greater than 100 persons per square
9 mile;
10 (b) An acute care hospital, in a county with a
11 population density of no greater than 100 persons per square
12 mile, which is at least 30 minutes of travel time, on normally
13 traveled roads under normal traffic conditions, from another
14 acute care hospital within the same county; or
15 (c) A hospital supported by a tax district or
16 subdistrict whose boundaries encompass a population of 100
17 persons or less per square mile.
18 (43)(48) "Special study" means a nonrecurring
19 data-gathering and analysis effort designed to aid the agency
20 for Health Care Administration in meeting its responsibilities
21 pursuant to this chapter.
22 (44)(49) "Teaching hospital" means any hospital
23 formally affiliated with an accredited medical school which
24 that exhibits activity in the area of medical education as
25 reflected by at least seven different resident physician
26 specialties and the presence of 100 or more resident
27 physicians.
28 Section 20. Section 408.08, Florida Statutes, is
29 amended to read:
30 408.08 Inspections and audits; violations; penalties;
31 fines; enforcement.--
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1 (1) The agency may inspect and audit books and records
2 of individual or corporate ownership, including books and
3 records of related organizations with which a health care
4 provider or a health care facility had transactions, for
5 compliance with this chapter. Upon presentation of a written
6 request for inspection to a health care provider or a health
7 care facility by the agency or its staff, the health care
8 provider or the health care facility shall make available to
9 the agency or its staff for inspection, copying, and review
10 all books and records relevant to the determination of whether
11 the health care provider or the health care facility has
12 complied with this chapter.
13 (2) The board shall annually compare the audited
14 actual experience of each hospital to the audited actual
15 experience of that hospital for the previous year.
16 (a) For a hospital submitting a budget letter, if the
17 board determines that the audited actual experience of the
18 hospital exceeded its previous year's audited actual
19 experience by more than the maximum allowable rate of increase
20 as certified in the budget letter plus any banked points
21 utilized in the budget letter, the amount of such excess shall
22 be determined by the board and a penalty shall be levied
23 against such hospital pursuant to subsection (3).
24 (b) For a hospital subject to budget review, if the
25 board determines that the audited actual experience of the
26 hospital exceeded its previous year's audited actual
27 experience by more than the most recent approved budget or the
28 most recent approved budget as amended, the amount of such
29 excess shall be determined by the board, and a penalty shall
30 be levied against such hospital pursuant to subsection (3).
31
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1 (c) For a hospital submitting a budget letter and for
2 a hospital subject to budget review, the board shall annually
3 compare each hospital's audited actual experience for net
4 revenues per adjusted admission to the hospital's audited
5 actual experience for net revenues per adjusted admission for
6 the previous year. If the rate of increase in net revenues
7 per adjusted admission between the previous year and the
8 current year was less than the market basket index, the
9 hospital may carry forward the difference and earn up to a
10 cumulative maximum of 3 banked net revenue percentage points.
11 Such banked net revenue percentage points shall be available
12 to the hospital to offset, in any future year, penalties for
13 exceeding the approved budget or the maximum allowable rate of
14 increase as set forth in subsection (3). Nothing in this
15 paragraph shall be used by a hospital to justify the approval
16 of a budget or a budget amendment by the board in excess of
17 the maximum allowable rate of increase pursuant to s. 408.072.
18 (3) Penalties shall be assessed as follows:
19 (a) For the first occurrence within a 5-year period,
20 the board shall prospectively reduce the current budget of the
21 hospital by the amount of the excess up to 5 percent; and, if
22 such excess is greater than 5 percent over the maximum
23 allowable rate of increase, any amount in excess of 5 percent
24 shall be levied by the board as a fine against such hospital
25 to be deposited in the Public Medical Assistance Trust Fund.
26 (b) For the second occurrence with the 5-year period
27 following the first occurrence as set forth in paragraph (a),
28 the board shall prospectively reduce the current budget of the
29 hospital by the amount of the excess up to 2 percent; and, if
30 such excess is greater than 2 percent over the maximum
31 allowable rate of increase, any amount in excess of 2 percent
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1 shall be levied by the board as a fine against such hospital
2 to be deposited in the Public Medical Assistance Trust Fund.
3 (c) For the third occurrence within the 5-year period
4 following the first occurrence as set forth in paragraph (a),
5 the board shall:
6 1. Levy a fine against the hospital in the total
7 amount of the excess, to be deposited in the Public Medical
8 Assistance Trust Fund.
9 2. Notify the agency of the violation, whereupon the
10 agency shall not accept any application for a certificate of
11 need pursuant to ss. 408.031-408.045 from or on behalf of such
12 hospital until such time as the hospital has demonstrated to
13 the satisfaction of the board that, following the date the
14 penalty was imposed under subparagraph 1., the hospital has
15 stayed within its projected or amended budget or its
16 applicable maximum allowable rate of increase for a period of
17 at least 1 year. However, this provision does not apply with
18 respect to a certificate-of-need application filed to satisfy
19 a life or safety code violation.
20 3. Upon a determination that the hospital knowingly
21 and willfully generated such excess, notify the agency,
22 whereupon the agency shall initiate disciplinary proceedings
23 to deny, modify, suspend, or revoke the license of such
24 hospital or impose an administrative fine on such hospital not
25 to exceed $20,000.
26
27 The determination of the amount of any such excess shall be
28 based upon net revenues per adjusted admission, excluding
29 funds distributed to the hospital from the Public Medical
30 Assistance Trust Fund. However, in making such determination,
31 the board shall appropriately reduce the amount of the excess
32
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1 by the total amount of the assessment paid by such hospital
2 pursuant to s. 395.701 minus the amount of revenues received
3 by the hospital through the Public Medical Assistance Trust
4 Fund. It is the responsibility of the hospital to demonstrate
5 to the satisfaction of the board its entitlement to such
6 reduction. It is the intent of the Legislature that the
7 Health Care Board, in levying any penalty imposed against a
8 hospital for exceeding its maximum allowable rate of increase
9 or its approved budget pursuant to this subsection, consider
10 the effect of changes in the case mix of the hospital and in
11 the hospital's intensity and severity of illness as measured
12 by changes in the hospital's actual proportion of outlier
13 cases to total cases and dollar increases in outlier cases'
14 average charge per case. It is the responsibility of the
15 hospital to demonstrate to the satisfaction of the board any
16 change in its case mix and in its intensity and severity of
17 illness. For psychiatric hospitals and other hospitals not
18 reimbursed under a prospective payment system by the Federal
19 Government, until a proxy for case mix is available, the board
20 shall also reduce the amount of excess by the change in a
21 hospital's audited actual average length of stay without any
22 thresholds or limitations.
23 (4) The following factors may be used by the board to
24 reduce the amount of excess of the hospital as determined
25 pursuant to this section:
26 (a) Unforeseen and unforeseeable events which affect
27 the net revenue per adjusted admission and which are beyond
28 the control of the hospital, such as prior year Medicare cost
29 report settlements, retroactive changes in Medicare
30 reimbursement methodology, and increases in malpractice
31 insurance premiums, which occurred in the last 3 months of the
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1 hospital fiscal year during which the hospital generated the
2 excess; or
3 (b) Imposition of the penalty would have a severe
4 adverse effect which would jeopardize the continued existence
5 of an otherwise economically viable hospital.
6 (5) The board shall reduce the amount of the excess
7 for hospitals submitting budget letters pursuant to s.
8 408.072(3)(a) by the amount of any documented costs from
9 financial assistance provided to expand or supplement the
10 curriculum of a community college, university, or vocational
11 training school for the purpose of training nurses or other
12 health professionals, not including physicians. Financial
13 assistance would include, but not be limited to, the direct
14 costs for faculty salaries and expenses, books, equipment,
15 recruiting efforts, tuition assistance, and hospital
16 internships. The reduction would be based on actual
17 documented expenses increased by the gross revenues necessary
18 to generate net revenues sufficient to cover the expenses.
19 (6) If the board finds that any hospital chief
20 executive officer or any person who is in charge of hospital
21 administration or operations has knowingly and willfully
22 allowed or authorized actual operating revenues or
23 expenditures that are in excess of projected operating
24 revenues or expenditures in the hospital's approved budget,
25 the board shall order such officer or person to pay an
26 administrative fine not to exceed $5,000.
27 (7) For hospitals filing budget letters, the board
28 shall annually compare the audited actual experience of each
29 hospital for the year under review to the audited actual
30 experience of that hospital for the previous year. For
31 hospitals which submitted detailed budgets or budget
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1 amendments, the board shall compare the audited actual
2 experience of each hospital for the year under review to its
3 approved gross revenue per adjusted admission for the year
4 under review, for purposes of levying an administrative fine.
5 (a) For a hospital submitting a budget letter pursuant
6 to s. 408.072(3)(a), if the board determines that the audited
7 actual experience for the year under review exceeded the
8 hospital's previous year's audited actual experience by more
9 than the maximum allowable rate of increase as certified in
10 the budget letter plus any banked points utilized in the
11 budget letter, the amount of the excess shall be determined
12 and an administrative fine shall be levied against such
13 hospital pursuant to subsection (8).
14 (b) For a hospital which submitted a budget pursuant
15 to s. 408.072(1), or a budget amendment pursuant to s.
16 408.072(6), if the board determines that the gross revenue per
17 adjusted admission contained in the hospital's audited actual
18 experience exceeded its board-approved gross revenue per
19 adjusted admission, the amount of the excess shall be
20 determined and an administrative fine shall be levied against
21 such hospital pursuant to subsection (8).
22 (8) If the board determines that an excess exists
23 pursuant to subsection (7), the board shall multiply the
24 excess by the number of actual adjusted admissions contained
25 in the year at issue to determine the amount of the base fine.
26 The base fine shall be multiplied by the applicable occurrence
27 factor to determine the amount of the administrative fine
28 levied against the hospital.
29 (a) For the first occurrence within a 5-year period,
30 the applicable occurrence factor shall be 0.25. For the
31 second occurrence within a 5-year period, the applicable
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1 occurrence factor shall be 0.55. For the third occurrence
2 within a 5-year period, the applicable occurrence factor shall
3 be 1.0.
4 (b) In no event shall any administrative fine levied
5 pursuant to this subsection exceed $365,000.
6 (9) In levying any administrative fine against a
7 hospital pursuant to subsection (8), the board shall consider
8 the effect of any changes in the hospital's case mix, and in
9 the hospital's intensity and severity of illness as measured
10 by changes in the hospital's actual proportion of outlier
11 cases to total cases and dollar increases in outlier cases'
12 average charge per case. The board shall adjust the amount of
13 any excess by the changes in the hospital's case mix and in
14 its intensity and severity of illness, based upon certified
15 hospital patient discharge data provided to the board pursuant
16 to s. 408.061. For psychiatric hospitals and other hospitals
17 not reimbursed under a prospective payment system by the
18 Federal Government, until a proxy for case mix is available,
19 the board shall adjust the amount of any excess by the change
20 in a hospital's audited actual average length of stay without
21 any thresholds or limitation.
22 (10) In levying any administrative fine against a
23 hospital pursuant to subsection (8), it is the intent of the
24 Legislature that if a hospital can demonstrate to the
25 satisfaction of the board that it operated within its approved
26 gross revenue per adjusted admission for the first 8 months of
27 its fiscal year and did not increase its prices, except for
28 exceptions determined by the board during the last 5 months of
29 its fiscal year, it shall not be subject to any administrative
30 fine levied pursuant to subsection (8).
31
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1 (11) It is the further intent of the Legislature that
2 if a hospital can demonstrate to the satisfaction of the board
3 that it did not increase its prices on average in excess of
4 the MARI for the prior year, it shall not be subject to any
5 administrative fine levied pursuant to subsection (8).
6 (12) If the board finds that any hospital chief
7 executive officer or any person who is in charge of hospital
8 administration or operations has knowingly and willfully
9 allowed or authorized gross revenue per adjusted admission,
10 net revenue per adjusted admission, or rates of increase that
11 are in excess of gross or net revenue per adjusted admission,
12 or rates of increase in the hospital's approved budget, budget
13 amendment, or budget letter, the agency shall order such
14 officer or person to pay an administrative fine not to exceed
15 $5,000.
16 (2)(13) Any health care facility that refuses to file
17 a report, fails to timely file a report, files a false report,
18 or files an incomplete report and upon notification fails to
19 timely file a complete report required under this section and
20 s. 408.061; that violates any provision of this section, s.
21 408.061, or s. 408.20, or rule adopted thereunder; or that
22 fails to provide documents or records requested by the agency
23 under the provisions of this chapter shall be punished by a
24 fine not exceeding $1,000 per day for each day in violation,
25 to be imposed and collected by the agency.
26 (3)(14) Any health care provider that refuses to file
27 a report, fails to timely file a report, files a false report,
28 or files an incomplete report and upon notification fails to
29 timely file a complete report required under this section and
30 s. 408.061; that violates any provision of this section, s.
31 408.061, or s. 408.20, or rule adopted thereunder; or that
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1 fails to provide documents or records requested by the agency
2 under the provisions of this chapter shall be referred to the
3 appropriate licensing board which shall take appropriate
4 action against the health care provider.
5 (4)(15) If In the event that a health insurer does not
6 comply with the requirements of s. 408.061, the agency shall
7 report a health insurer's failure to comply to the Department
8 of Insurance, which shall take into account the failure by the
9 health insurer to comply in conjunction with its approval
10 authority under s. 627.410. The agency shall adopt any rules
11 necessary to carry out its responsibilities required by this
12 subsection.
13 (5)(16) Refusal to file, failure to timely file, or
14 filing false or incomplete reports or other information
15 required to be filed under the provisions of this chapter,
16 failure to pay or failure to timely pay any assessment
17 authorized to be collected by the agency, or violation of any
18 other provision of this chapter or lawfully entered order of
19 the agency or rule adopted under this chapter, shall be
20 punished by a fine not exceeding $1,000 a day for each day in
21 violation, to be fixed, imposed, and collected by the agency.
22 Each day in violation shall be considered a separate offense.
23 (6)(17) Notwithstanding any other provisions of this
24 chapter, when a hospital alleges that a factual determination
25 made by the agency board is incorrect, the burden of proof
26 shall be on the hospital to demonstrate that such
27 determination is, in light of the total record, not supported
28 by a preponderance of the evidence. The burden of proof
29 remains with the hospital in all cases involving
30 administrative agency action.
31
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1 Section 21. Section 408.40, Florida Statutes, is
2 amended to read:
3 408.40 Budget review proceedings; duty of Public
4 Counsel.--
5 (1) Notwithstanding any other provisions of this
6 chapter, it shall be the duty of the Public Counsel shall to
7 represent the general public of the state in any proceeding
8 before the agency or its advisory panels in any administrative
9 hearing conducted pursuant to the provisions of chapter 120 or
10 before any other state and federal agencies and courts in any
11 issue before the agency, any court, or any agency. With
12 respect to any such proceeding, the Public Counsel is subject
13 to the provisions of and may use utilize the powers granted to
14 him or her by ss. 350.061-350.0614.
15 (2) The Public Counsel shall:
16 (a) Recommend to the agency, by petition, the
17 commencement of any proceeding or action or to appear, in the
18 name of the state or its citizens, in any proceeding or action
19 before the agency and urge therein any position that which he
20 or she deems to be in the public interest, whether consistent
21 or inconsistent with positions previously adopted by the
22 agency, and use utilize therein all forms of discovery
23 available to attorneys in civil actions generally, subject to
24 protective orders of the agency, which shall be reviewable by
25 summary procedure in the circuit courts of this state.
26 (b) Have access to and use of all files, records, and
27 data of the agency available to any other attorney
28 representing parties in a proceeding before the agency.
29 (c) In any proceeding in which he or she has
30 participated as a party, seek review of any determination,
31 finding, or order of the agency, or of any administrative law
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1 judge, or any hearing officer or hearing examiner designated
2 by the agency, in the name of the state or its citizens.
3 (d) Prepare and issue reports, recommendations, and
4 proposed orders to the agency, the Governor, and the
5 Legislature on any matter or subject within the jurisdiction
6 of the agency, and to make such recommendations as he or she
7 deems appropriate for legislation relative to agency
8 procedures, rules, jurisdiction, personnel, and functions.
9 (e) Appear before other state agencies, federal
10 agencies, and state and federal courts in connection with
11 matters under the jurisdiction of the agency, in the name of
12 the state or its citizens.
13 Section 22. Subsection (1) of section 408.50, Florida
14 Statutes, is amended to read:
15 408.50 Prospective payment arrangements.--
16 (1) Hospitals as defined in s. 395.002, and health
17 insurers regulated pursuant to parts VI and VII of chapter
18 627, shall establish prospective payment arrangements that
19 provide hospitals with financial incentives to contain costs.
20 Each hospital shall enter into a rate agreement with each
21 health insurer which represents 10 percent or more of the
22 private-pay patients of the hospital to establish a
23 prospective payment arrangement. Hospitals and health insurers
24 regulated pursuant to this section shall report annually the
25 results of each specific prospective payment arrangement
26 adopted by each hospital and health insurer to the agency
27 board. The agency shall report a health insurer's failure to
28 comply to the Department of Insurance, which shall take into
29 account the failure by the health insurer to comply in
30 conjunction with its approval authority under s. 627.410. The
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1 agency shall adopt any rules necessary to carry out its
2 responsibilities required by this section.
3 Section 23. Paragraph (e) of subsection (10) and
4 subsection (14) of section 409.2673, Florida Statutes, are
5 amended to read:
6 409.2673 Shared county and state health care program
7 for low-income persons; trust fund.--
8 (10) Under the shared county and state program,
9 reimbursement to a hospital for services for an eligible
10 person must:
11 (e) Be conditioned, for tax district hospitals that
12 deliver services as part of this program, on the delivery of
13 charity care, as defined in the rules of the Agency for Health
14 Care Administration Health Care Cost Containment Board, which
15 equals a minimum of 2.5 percent of the tax district hospital's
16 net revenues; however, those tax district hospitals which by
17 virtue of the population within the geographic boundaries of
18 the tax district can not feasibly provide this level of
19 charity care shall assure an "open door" policy to those
20 residents of the geographic boundaries of the tax district who
21 would otherwise be considered charity cases.
22 (14) Any dispute among a county, the Agency for Health
23 Care Administration Health Care Cost Containment Board, the
24 department, or a participating hospital shall be resolved by
25 order as provided in chapter 120. Hearings held under this
26 subsection shall be conducted in the same manner as provided
27 in ss. 120.569 and 120.57, except that the administrative law
28 judge's or hearing officer's order constitutes final agency
29 action. Cases filed under chapter 120 may combine all relevant
30 disputes between parties.
31
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1 Section 24. Section 409.9113, Florida Statutes, is
2 amended to read:
3 409.9113 Disproportionate share program for teaching
4 hospitals.--In addition to the payments made under ss. 409.911
5 and 409.9112, the Agency for Health Care Administration
6 Department of Health and Rehabilitative Services shall make
7 disproportionate share payments to statutorily defined
8 teaching hospitals for their increased costs associated with
9 medical education programs and for tertiary health care
10 services provided to the indigent. This system of payments
11 shall conform with federal requirements and shall distribute
12 funds in each fiscal year for which an appropriation is made
13 by making quarterly Medicaid payments. Notwithstanding the
14 provisions of s. 409.915, counties are exempt from
15 contributing toward the cost of this special reimbursement for
16 hospitals serving a disproportionate share of low-income
17 patients.
18 (1) On or before September 15 of each year, the agency
19 for Health Care Administration shall calculate an allocation
20 fraction to be used for distributing funds to state statutory
21 teaching hospitals. Subsequent to the end of each quarter of
22 the state fiscal year, the agency department shall distribute
23 to each statutory teaching hospital, as defined in s. 408.07,
24 an amount determined by multiplying one-fourth of the funds
25 appropriated for this purpose by the Legislature times such
26 hospital's allocation fraction. The allocation fraction for
27 each such hospital shall be determined by the sum of three
28 primary factors, divided by three. The primary factors are:
29 (a) The number of nationally accredited graduate
30 medical education programs offered by the hospital, including
31 programs accredited by the Accreditation Council for Graduate
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1 Medical Education and the combined Internal Medicine and
2 Pediatrics programs acceptable to both the American Board of
3 Internal Medicine and the American Board of Pediatrics at the
4 beginning of the state fiscal year preceding the date on which
5 the allocation fraction is calculated. The numerical value of
6 this factor is the fraction that the hospital represents of
7 the total number of programs, where the total is computed for
8 all state statutory teaching hospitals.
9 (b) The number of full-time equivalent trainees in the
10 hospital, which comprises two components:
11 1. The number of trainees enrolled in nationally
12 accredited graduate medical education programs, as defined in
13 paragraph (a). Full-time equivalents are computed using the
14 fraction of the year during which each trainee is primarily
15 assigned to the given institution, over the state fiscal year
16 preceding the date on which the allocation fraction is
17 calculated. The numerical value of this factor is the fraction
18 that the hospital represents of the total number of full-time
19 equivalent trainees enrolled in accredited graduate programs,
20 where the total is computed for all state statutory teaching
21 hospitals.
22 2. The number of medical students enrolled in
23 accredited colleges of medicine and engaged in clinical
24 activities, including required clinical clerkships and
25 clinical electives. Full-time equivalents are computed using
26 the fraction of the year during which each trainee is
27 primarily assigned to the given institution, over the course
28 of the state fiscal year preceding the date on which the
29 allocation fraction is calculated. The numerical value of this
30 factor is the fraction that the given hospital represents of
31 the total number of full-time equivalent students enrolled in
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1 accredited colleges of medicine, where the total is computed
2 for all state statutory teaching hospitals.
3
4 The primary factor for full-time equivalent trainees is
5 computed as the sum of these two components, divided by two.
6 (c) A service index that which comprises three
7 components:
8 1. The Agency for Health Care Administration Health
9 Care Cost Containment Board Service Index, computed by
10 applying the standard Service Inventory Scores established by
11 the agency Health Care Cost Containment Board to services
12 offered by the given hospital, as reported on the Health Care
13 Cost Containment Board Worksheet A-2 for the last fiscal year
14 reported to the agency board before the date on which the
15 allocation fraction is calculated. The numerical value of
16 this factor is the fraction that the given hospital represents
17 of the total Agency for Health Care Administration Health Care
18 Cost Containment Board Service Index values, where the total
19 is computed for all state statutory teaching hospitals.
20 2. A volume-weighted service index, computed by
21 applying the standard Service Inventory Scores established by
22 the agency Health Care Cost Containment Board to the volume of
23 each service, expressed in terms of the standard units of
24 measure reported on the Health Care Cost Containment Board
25 Worksheet A-2 for the last fiscal year reported to the agency
26 board before the date on which the allocation factor is
27 calculated. The numerical value of this factor is the
28 fraction that the given hospital represents of the total
29 volume-weighted service index values, where the total is
30 computed for all state statutory teaching hospitals.
31
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1 3. Total Medicaid payments to each hospital for direct
2 inpatient and outpatient services during the fiscal year
3 preceding the date on which the allocation factor is
4 calculated. This includes payments made to each hospital for
5 such services by Medicaid prepaid health plans, whether the
6 plan was administered by the hospital or not. The numerical
7 value of this factor is the fraction that each hospital
8 represents of the total of such Medicaid payments, where the
9 total is computed for all state statutory teaching hospitals.
10
11 The primary factor for the service index is computed as the
12 sum of these three components, divided by three.
13 (2) By October 1 of each year, the agency shall use
14 the following formula shall be utilized by the department to
15 calculate the maximum additional disproportionate share
16 payment for statutorily defined teaching hospitals:
17
18 TAP = THAF x A
19
20 Where:
21 TAP = total additional payment.
22 THAF = teaching hospital allocation factor.
23 A = amount appropriated for a teaching hospital
24 disproportionate share program.
25
26 (3) The Health Care Cost Containment Board shall
27 report to the department the statutory teaching hospital
28 allocation fraction prior to October 1 of each year.
29 Section 25. Subsection (9) of section 395.403, Florida
30 Statutes, and sections 407.61, 408.003, 408.072, and 408.085,
31 Florida Statutes, are repealed.
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1 Section 26. The repeal of laws governing the review of
2 hospital budgets and related penalties contained in this act
3 operates retroactively and applies to any hospital budget
4 prepared for a fiscal year that ended during the 1995 calendar
5 year.
6 Section 27. Subsection (6) of section 381.026, Florida
7 Statutes, is amended to read:
8 381.026 Florida Patient's Bill of Rights and
9 Responsibilities.--
10 (6) SUMMARY OF RIGHTS AND RESPONSIBILITIES.--Any
11 health care provider who treats a patient in an office or any
12 health care facility licensed under chapter 395 that provides
13 emergency services and care or outpatient services and care to
14 a patient, or admits and treats a patient, shall adopt and
15 make available to the patient public, in writing, a statement
16 of the rights and responsibilities of patients, including:
17
18 SUMMARY OF THE FLORIDA PATIENT'S BILL
19 OF RIGHTS AND RESPONSIBILITIES
20
21 Florida law requires that your health care provider or
22 health care facility recognize your rights while you are
23 receiving medical care and that you respect the health care
24 provider's or health care facility's right to expect certain
25 behavior on the part of patients. You may request a copy of
26 the full text of this law from your health care provider or
27 health care facility. A summary of your rights and
28 responsibilities follows:
29 A patient has the right to be treated with courtesy and
30 respect, with appreciation of his or her individual dignity,
31 and with protection of his or her need for privacy.
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1 A patient has the right to a prompt and reasonable
2 response to questions and requests.
3 A patient has the right to know who is providing
4 medical services and who is responsible for his or her care.
5 A patient has the right to know what patient support
6 services are available, including whether an interpreter is
7 available if he or she does not speak English.
8 A patient has the right to know what rules and
9 regulations apply to his or her conduct.
10 A patient has the right to be given by the health care
11 provider information concerning diagnosis, planned course of
12 treatment, alternatives, risks, and prognosis.
13 A patient has the right to refuse any treatment, except
14 as otherwise provided by law.
15 A patient has the right to be given, upon request, full
16 information and necessary counseling on the availability of
17 known financial resources for his or her care.
18 A patient who is eligible for Medicare has the right to
19 know, upon request and in advance of treatment, whether the
20 health care provider or health care facility accepts the
21 Medicare assignment rate.
22 A patient has the right to receive, upon request, prior
23 to treatment, a reasonable estimate of charges for medical
24 care.
25 A patient has the right to receive a copy of a
26 reasonably clear and understandable, itemized bill and, upon
27 request, to have the charges explained.
28 A patient has the right to impartial access to medical
29 treatment or accommodations, regardless of race, national
30 origin, religion, physical handicap, or source of payment.
31
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1 A patient has the right to treatment for any emergency
2 medical condition that will deteriorate from failure to
3 provide treatment.
4 A patient has the right to know if medical treatment is
5 for purposes of experimental research and to give his or her
6 consent or refusal to participate in such experimental
7 research.
8 A patient has the right to express grievances regarding
9 any violation of his or her rights, as stated in Florida law,
10 through the grievance procedure of the health care provider or
11 health care facility which served him or her and to the
12 appropriate state licensing agency.
13 A patient is responsible for providing to the health
14 care provider, to the best of his or her knowledge, accurate
15 and complete information about present complaints, past
16 illnesses, hospitalizations, medications, and other matters
17 relating to his or her health.
18 A patient is responsible for reporting unexpected
19 changes in his or her condition to the health care provider.
20 A patient is responsible for reporting to the health
21 care provider whether he or she comprehends a contemplated
22 course of action and what is expected of him or her.
23 A patient is responsible for following the treatment
24 plan recommended by the health care provider.
25 A patient is responsible for keeping appointments and,
26 when he or she is unable to do so for any reason, for
27 notifying the health care provider or health care facility.
28 A patient is responsible for his or her actions if he
29 or she refuses treatment or does not follow the health care
30 provider's instructions.
31
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1 A patient is responsible for assuring that the
2 financial obligations of his or her health care are fulfilled
3 as promptly as possible.
4 A patient is responsible for following health care
5 facility rules and regulations affecting patient care and
6 conduct.
7 Section 28. Section 381.0261, Florida Statutes, is
8 amended to read:
9 381.0261 Distribution of Summary of patient's bill of
10 rights; distribution; penalty.--
11 (1) The Agency for Health Care Administration
12 Department of Health and Rehabilitative Services shall have
13 printed and made continuously available to health care
14 facilities licensed under chapter 395, physicians licensed
15 under chapter 458, osteopathic physicians licensed under
16 chapter 459, and podiatrists licensed under chapter 461 a
17 summary of the Florida Patient's Bill of Rights and
18 Responsibilities. In adopting and making available to
19 patients public the summary of the Florida Patient's Bill of
20 Rights and Responsibilities, health care providers and health
21 care facilities are not limited to the format in which the
22 Agency for Health Care Administration Department of Health and
23 Rehabilitative Services prints and distributes the summary.
24 (2) Health care providers and health care facilities,
25 if requested, shall inform patients of the address and
26 telephone number of each state agency responsible for
27 responding to patient complaints about a health care provider
28 or health care facility's alleged noncompliance with state
29 licensing requirements established pursuant to law.
30 (3) Health care facilities shall adopt policies and
31 procedures to ensure that inpatients are provided the
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1 opportunity during the course of admission to receive
2 information regarding their rights and how to file complaints
3 with the facility and appropriate state agencies.
4 (4) An administrative fine may be imposed by the
5 agency when any health care provider or health care facility
6 fails to make available to patients a summary of their rights,
7 pursuant to s. 381.026 and this section. Initial nonwillful
8 violations shall be subject to corrective action and shall not
9 be subject to an administrative fine. The agency may levy a
10 fine against a health care facility of up to $5,000 for
11 nonwillful violations and up to $25,000 for intentional and
12 willful violations. The agency may levy a fine against a
13 health care provider of up to $100 for nonwillful violations
14 and up to $500 for willful violations. Each intentional and
15 willful violation constitutes a separate violation and is
16 subject to a separate fine.
17 (5) In determining the amount of fine to be levied for
18 a violation, as provided in subsection (4), the following
19 factors shall be considered:
20 (a) The scope and severity of the violation, including
21 the number of patients found to not have received notice of
22 patient rights, and whether the failure to provide notice to
23 patients was willful.
24 (b) Actions taken by the health care provider or
25 health care facility to correct the violations or to remedy
26 complaints.
27 (c) Any previous violations of this section by the
28 health care provider or health care facility.
29 Section 29. Subsections (2) and (15) of section
30 395.002, Florida Statutes, are repealed:
31 395.002 Definitions.--As used in this chapter:
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1 (2) "Adverse or untoward incident," for purposes of
2 reporting to the agency, means an event over which health care
3 personnel could exercise control, which is probably associated
4 in whole or in part with medical intervention rather than the
5 condition for which such intervention occurred, and which
6 causes injury to a patient, and which:
7 (a) Is not consistent with or expected to be a
8 consequence of such medical intervention;
9 (b) Occurs as a result of medical intervention to
10 which the patient has not given his or her informed consent;
11 (c) Occurs as the result of any other action or lack
12 of any other action on the part of the hospital or personnel
13 of the hospital;
14 (d) Results in a surgical procedure being performed on
15 the wrong patient; or
16 (e) Results in a surgical procedure being performed
17 that is unrelated to the patient's diagnosis or medical needs.
18 (15) "Injury," for purposes of reporting to the
19 agency, means any of the following outcomes if caused by an
20 adverse or untoward incident:
21 (a) Death;
22 (b) Brain damage;
23 (c) Spinal damage;
24 (d) Permanent disfigurement;
25 (e) Fracture or dislocation of bones or joints;
26 (f) Any condition requiring definitive or specialized
27 medical attention which is not consistent with the routine
28 management of the patient's case or patient's preexisting
29 physical condition;
30 (g) Any condition requiring surgical intervention to
31 correct or control;
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1 (h) Any condition resulting in transfer of the
2 patient, within or outside the facility, to a unit providing a
3 more acute level of care;
4 (i) Any condition that extends the patient's length of
5 stay; or
6 (j) Any condition that results in a limitation of
7 neurological, physical, or sensory function which continues
8 after discharge from the facility.
9 Section 30. Present subsections (3), (4), (5), and (7)
10 of section 395.0193, Florida Statutes, are amended, present
11 subsections (6), (7), (8), and (9) are renumbered as
12 subsections (7), (8), (9), and (10), respectively, and a new
13 subsection (6) is added to that section, to read:
14 395.0193 Licensed facilities; peer review;
15 disciplinary powers; agency or partnership with physicians.--
16 (3) If reasonable belief exists that conduct by a
17 staff member or physician who delivers health care services at
18 the licensed facility may constitute one or more grounds for
19 discipline as provided in this subsection, a peer review panel
20 shall investigate and determine whether grounds for discipline
21 exist with respect to such staff member or physician. The
22 governing board of any licensed facility, after considering
23 the recommendations of its peer review panel, shall suspend,
24 deny, revoke, or curtail the privileges, or reprimand,
25 counsel, or require education, of any such staff member or
26 physician after a final determination has been made that one
27 or more of the following grounds exist:
28 (a) Incompetence.
29 (b) Being found to be a habitual user of intoxicants
30 or drugs to the extent that he or she is deemed dangerous to
31 himself, herself, or others.
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1 (c) Mental or physical impairment which may adversely
2 affect patient care.
3 (d) Being found liable by a court of competent
4 jurisdiction for medical negligence or malpractice involving
5 negligent conduct.
6 (e) One or more settlements exceeding $10,000 for
7 medical negligence or malpractice involving negligent conduct
8 by the staff member.
9 (f) Medical negligence other than as specified in
10 paragraph (d) or paragraph (e).
11 (g) Failure to comply with the policies, procedures,
12 or directives of the risk management program or any quality
13 assurance committees of any licensed facility.
14
15 However, the grounds specified in paragraphs (a)-(g) are not
16 the only grounds for discipline of a practitioner. procedures
17 for such actions shall comply with the standards outlined by
18 the Joint Commission on Accreditation of Healthcare
19 Organizations, the American Osteopathic Association, the
20 Commission on Accreditation of Rehabilitation Facilities, the
21 Accreditation Association for Ambulatory Health Care, Inc.,
22 and the "Medicare/Medicaid Conditions of Participation," and
23 rules of the agency and the department. The procedures shall
24 be adopted pursuant to hospital bylaws.
25 (4) Pursuant to ss. 458.337 and 459.016, any
26 disciplinary actions taken under subsection (3) shall be
27 reported in writing to the Division of Health Quality
28 Assurance of the agency within 30 working days after its
29 initial occurrence, regardless of the pendency of appeals to
30 the governing board of the hospital. The notification shall
31 identify the disciplined practitioner, the action taken, and
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1 the reason for such action. All final disciplinary actions
2 taken under subsection (3), if different than those which were
3 reported to the agency within 30 days after the initial
4 occurrence, shall be reported within 10 working days to the
5 Division of Health Quality Assurance of the agency in writing
6 and shall specify the disciplinary action taken and the
7 specific grounds therefor. The division shall review each
8 report and determine whether it potentially involved conduct
9 by the licensee that is subject to disciplinary action, in
10 which case s. 455.225 shall apply. The reports are not report
11 shall not be subject to inspection under s. 119.07(1) even if
12 the division's investigation results in a finding of probable
13 cause.
14 (5) There shall be no monetary liability on the part
15 of, and no cause of action for damages against, any licensed
16 facility, its governing board or governing board members, peer
17 review panel, medical staff, or disciplinary body, or its
18 agents, investigators, witnesses, or employees; a committee of
19 a hospital, a physician-hospital organization, a
20 provider-sponsored organization, or an integrated delivery
21 system;, or any other person, for any action taken without
22 intentional fraud in carrying out the provisions of this
23 section.
24 (6) For a single incident or series of isolated
25 incidents that are nonwillful violations of the reporting
26 requirements of this section, the agency shall first seek to
27 obtain corrective action by the facility. If correction is not
28 demonstrated within the timeframe established by the agency or
29 if there is a pattern of nonwillful violations of this
30 section, the agency may impose an administrative fine, not to
31 exceed $5,000 for any violation of the reporting requirements
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1 of this section. The administrative fine for repeated
2 nonwillful violations shall not exceed $10,000 for any
3 violation. The administrative fine for each intentional and
4 willful violation may not exceed $25,000 per violation, per
5 day. The fine for an intentional and willful violation of this
6 section may not exceed $250,000. In determining the amount of
7 fine to be levied, the agency shall be guided by s.
8 395.1065(2)(b).
9 (8)(7) The investigations, proceedings, and records of
10 the peer review panel, a committee of a hospital, a
11 physician-hospital organization, a provider-sponsored
12 organization, an integrated delivery system, a disciplinary
13 board, or a governing board, or agent thereof with whom there
14 is a specific written contract for that purpose, as described
15 in this section shall not be subject to discovery or
16 introduction into evidence in any civil or administrative
17 action against a provider of professional health services
18 arising out of the matters which are the subject of evaluation
19 and review by such group or its agent, and a person who was in
20 attendance at a meeting of such group or its agent may not be
21 permitted or required to testify in any such civil or
22 administrative action as to any evidence or other matters
23 produced or presented during the proceedings of such group or
24 its agent or as to any findings, recommendations, evaluations,
25 opinions, or other actions of such group or its agent or any
26 members thereof. However, information, documents, or records
27 otherwise available from original sources are not to be
28 construed as immune from discovery or use in any such civil or
29 administrative action merely because they were presented
30 during proceedings of such group, and any person who testifies
31 before such group or who is a member of such group may not be
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1 prevented from testifying as to matters within his or her
2 knowledge, but such witness may not be asked about his or her
3 testimony before such a group or opinions formed by him or her
4 as a result of such group hearings.
5 Section 31. Section 395.0197, Florida Statutes, is
6 amended to read:
7 395.0197 Internal risk management program.--
8 (1) Every licensed facility shall, as a part of its
9 administrative functions, establish an internal risk
10 management program that includes all of the following
11 components:
12 (a) The investigation and analysis of the frequency
13 and causes of general categories and specific types of adverse
14 incidents causing injury to patients.
15 (b) The development of appropriate measures to
16 minimize the risk of injuries and adverse incidents to
17 patients, including, but not limited to:
18 1. Risk management and risk prevention education and
19 training of all nonphysician personnel as follows:
20 a. Such education and training of all nonphysician
21 personnel as part of their initial orientation; and
22 b. At least 1 hour of such education and training
23 annually for all nonphysician personnel of the licensed
24 facility working in clinical areas and providing patient care.
25 2. A prohibition, except when emergency circumstances
26 require otherwise, against a staff member of the licensed
27 facility attending a patient in the recovery room, unless the
28 staff member is authorized to attend the patient in the
29 recovery room and is in the company of at least one other
30 person. However, a licensed facility hospital is exempt from
31 the two-person requirement if it has:
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1 a. Live visual observation;
2 b. Electronic observation; or
3 c. Any other reasonable measure taken to ensure
4 patient protection and privacy.
5 (c) The analysis of patient grievances that relate to
6 patient care and the quality of medical services.
7 (d) The development and implementation of an incident
8 reporting system based upon the affirmative duty of all health
9 care providers and all agents and employees of the licensed
10 health care facility to report adverse incidents to the risk
11 manager, or to his or her designee, within 3 business days
12 after its occurrence.
13 (2) The internal risk management program is the
14 responsibility of the governing board of the health care
15 facility. Each licensed facility shall hire a risk manager,
16 licensed under part IX of chapter 626, who is responsible for
17 implementation and oversight of such facility's internal risk
18 management program as required by this section. A risk
19 manager must not be made responsible for more than four
20 internal risk management programs in separate licensed
21 facilities, unless the facilities are under one corporate
22 ownership or the risk management programs are in rural
23 hospitals.
24 (3) In addition to the programs mandated by this
25 section, other innovative approaches intended to reduce the
26 frequency and severity of medical malpractice and patient
27 injury claims shall be encouraged and their implementation and
28 operation facilitated. Such additional approaches may include
29 extending internal risk management programs to health care
30 providers' offices and the assuming of provider liability by a
31
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1 licensed health care facility for acts or omissions occurring
2 within the licensed facility.
3 (4) The agency shall, after consulting with the
4 Department of Insurance, adopt rules governing the
5 establishment of internal risk management programs to meet the
6 needs of individual licensed facilities. Each internal risk
7 management program shall include the use of incident reports
8 to be filed with an individual of responsibility who is
9 competent in risk management techniques in the employ of each
10 licensed facility, such as an insurance coordinator, or who is
11 retained by the licensed facility as a consultant. The
12 individual responsible for the risk management program shall
13 have free access to all medical records of the licensed
14 facility. The incident reports are part of the workpapers of
15 the attorney defending the licensed facility in litigation
16 relating to the licensed facility and are subject to
17 discovery, but are not admissible as evidence in court. A
18 person filing an incident report is not subject to civil suit
19 by virtue of such incident report. As a part of each internal
20 risk management program, the incident reports shall be used to
21 develop categories of incidents which identify problem areas.
22 Once identified, procedures shall be adjusted to correct the
23 problem areas.
24 (5) For purposes of reporting to the agency pursuant
25 to this section, the term "adverse incident" means an event
26 over which health care personnel could exercise control and
27 which is associated in whole or in part with medical
28 intervention, rather than the condition for which such
29 intervention occurred, and which:
30 (a) Results in one of the following injuries:
31 1. Death;
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1 2. Brain or spinal damage;
2 3. Permanent disfigurement;
3 4. Fracture or dislocation of bones or joints;
4 5. A resulting limitation of neurological, physical,
5 or sensory function which continues after discharge from the
6 facility;
7 6. Any condition that required specialized medical
8 attention or surgical intervention resulting from nonemergency
9 medical intervention, other than an emergency medical
10 condition, to which the patient has not given his or her
11 informed consent; or
12 7. Any condition that required the transfer of the
13 patient, within or outside the facility, to a unit providing a
14 more acute level of care due to the adverse incident, rather
15 than the patient's condition prior to the adverse incident;
16 (b) Was the performance of a surgical procedure on the
17 wrong patient, a wrong surgical procedure, a wrong-site
18 surgical procedure, or a surgical procedure otherwise
19 unrelated to the patient's diagnosis or medical condition;
20 (c) Required the surgical repair of damage resulting
21 to a patient from a planned surgical procedure, where the
22 damage was not a recognized specific risk, as disclosed to the
23 patient on the informed consent form; or
24 (d) Was a procedure to remove unplanned foreign
25 objects remaining from a surgical procedure.
26 (6)(5)(a) Each licensed facility subject to this
27 section shall submit an annual report to the agency
28 summarizing the incident reports that have been filed in the
29 facility for that year. The report shall include:
30 1. The total number of adverse incidents causing
31 injury to patients.
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1 2. A listing, by category, of the types of operations,
2 diagnostic or treatment procedures, or other actions causing
3 the injuries, and the number of incidents occurring within
4 each category.
5 3. A listing, by category, of the types of injuries
6 caused and the number of incidents occurring within each
7 category.
8 4. A code number using the health care professional's
9 licensure number and a separate code number identifying all
10 other individuals directly involved in adverse incidents
11 causing injury to patients, the relationship of the individual
12 to the licensed facility, and the number of incidents in which
13 each individual has been directly involved. Each licensed
14 facility shall maintain names of the health care professionals
15 and individuals identified by code numbers for purposes of
16 this section.
17 5. A description of all malpractice claims filed
18 against the licensed facility, including the total number of
19 pending and closed claims and the nature of the incident which
20 led to, the persons involved in, and the status and
21 disposition of each claim. Each report shall update status and
22 disposition for all prior reports.
23 6. A report of all disciplinary actions pertaining to
24 patient care taken against any medical staff member, including
25 the nature and cause of the action.
26 (b) The information reported to the agency pursuant to
27 paragraph (a) which relates to persons licensed under chapter
28 458, chapter 459, chapter 461, or chapter 466 shall be
29 reviewed by the agency. The agency shall determine whether
30 any of the incidents potentially involved conduct by a health
31
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1 care professional who is subject to disciplinary action, in
2 which case the provisions of s. 455.225 shall apply.
3 (c) The report submitted to the agency shall also
4 contain the name and license number of the risk manager of the
5 licensed facility, a copy of its policy and procedures which
6 govern the measures taken by the facility and its risk manager
7 to reduce the risk of injuries and adverse or untoward
8 incidents, and the results of such measures. The annual
9 report is confidential and is not available to the public
10 pursuant to s. 119.07(1) or any other law providing access to
11 public records. The annual report is not discoverable or
12 admissible in any civil or administrative action, except in
13 disciplinary proceedings by the agency or the appropriate
14 regulatory board. The annual report is not available to the
15 public as part of the record of investigation for and
16 prosecution in disciplinary proceedings made available to the
17 public by the agency or the appropriate regulatory board.
18 However, the agency or the appropriate regulatory board shall
19 make available, upon written request by a health care
20 professional against whom probable cause has been found, any
21 such records which form the basis of the determination of
22 probable cause.
23 (7) The licensed facility shall notify the agency no
24 later than 1 business day after the risk manager or his or her
25 designee has received a report pursuant to paragraph (1)(d)
26 and can determine within 1 business day that any of the
27 following adverse incidents has occurred, whether occurring in
28 the licensed facility or arising from health care prior to
29 admission in the licensed facility:
30 (a) The death of a patient;
31 (b) Brain or spinal damage to a patient;
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1 (c) The performance of a surgical procedure on the
2 wrong patient;
3 (d) The performance of a wrong-site surgical
4 procedure; or
5 (e) The performance of a wrong surgical procedure.
6
7 The notification must be made in writing and be provided by
8 facsimile device or overnight mail delivery. The notification
9 must include information regarding the identity of the
10 affected patient, the type of adverse incident, the initiation
11 of an investigation by the facility, and whether the events
12 causing or resulting in the adverse incident represent a
13 potential risk to other patients.
14 (8)(6) Any of the following adverse incidents, whether
15 occurring in the licensed facility or arising from health care
16 prior to admission in the licensed facility, shall be reported
17 by the facility to the agency within 15 calendar days after
18 its occurrence: If an adverse or untoward incident, whether
19 occurring in the licensed facility or arising from health care
20 prior to admission in the licensed facility, results in:
21 (a) The death of a patient;
22 (b) Brain or spinal damage to a patient;
23 (c) The performance of a surgical procedure on the
24 wrong patient; or
25 (d) The performance of a wrong-site surgical
26 procedure;
27 (e) The performance of a wrong surgical procedure;
28 (f) The performance of a surgical procedure that is
29 medically unnecessary or otherwise unrelated to the patient's
30 diagnosis or medical condition;
31
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1 (g) The surgical repair of damage resulting to a
2 patient from a planned surgical procedure, where the damage is
3 not a recognized specific risk, as disclosed to the patient on
4 the informed consent form; or
5 (h) The performance of procedures to remove unplanned
6 foreign objects remaining from a surgical procedure.
7 (d) A surgical procedure unrelated to the patient's
8 diagnosis or medical needs being performed on any patient,
9 including the surgical repair of injuries or damage resulting
10 from the planned surgical procedure, wrong site or wrong
11 procedure surgeries, and procedures to remove foreign objects
12 remaining from surgical procedures,
13
14 the licensed facility shall report this incident to the agency
15 within 15 calendar days after its occurrence. The agency may
16 grant extensions to this reporting requirement for more than
17 15 days upon justification submitted in writing by the
18 facility administrator to the agency. The agency may require
19 an additional, final report. These reports shall not be
20 available to the public pursuant to s. 119.07(1) or any other
21 law providing access to public records, nor be discoverable or
22 admissible in any civil or administrative action, except in
23 disciplinary proceedings by the agency or the appropriate
24 regulatory board, nor shall they be available to the public as
25 part of the record of investigation for and prosecution in
26 disciplinary proceedings made available to the public by the
27 agency or the appropriate regulatory board. However, the
28 agency or the appropriate regulatory board shall make
29 available, upon written request by a health care professional
30 against whom probable cause has been found, any such records
31 which form the basis of the determination of probable cause.
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1 The agency may investigate, as it deems appropriate, any such
2 incident and prescribe measures that must or may be taken in
3 response to the incident. The agency shall review each
4 incident and determine whether it potentially involved conduct
5 by the health care professional who is subject to disciplinary
6 action, in which case the provisions of s. 455.225 shall
7 apply.
8 (9)(7) The internal risk manager of each licensed
9 facility shall:
10 (a)(b) Investigate every allegation of sexual
11 misconduct which is made against a member of the facility's
12 personnel who has direct patient contact, when the allegation
13 is that the sexual misconduct occurred at the facility or on
14 the grounds of the facility; and
15 (b)(c) Report every allegation of sexual misconduct to
16 the administrator of the licensed facility; and.
17 (c)(a) Notify the family or guardian of the victim, if
18 a minor, that an allegation of sexual misconduct has been made
19 and that an investigation is being conducted.;
20 (10)(8) Any witness who witnessed or who possesses
21 actual knowledge of the act that is the basis of an allegation
22 of sexual abuse shall:
23 (a) Notify the local police; and
24 (b) Notify the hospital risk manager and the
25 administrator.
26
27 For purposes of this subsection, "sexual abuse" means acts of
28 a sexual nature committed for the sexual gratification of
29 anyone upon, or in the presence of, a vulnerable adult,
30 without the vulnerable adult's informed consent, or a minor.
31 "Sexual abuse" includes, but is not limited to, the acts
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1 defined in s. 794.011(1)(h), fondling, exposure of a
2 vulnerable adult's or minor's sexual organs, or the use of the
3 vulnerable adult or minor to solicit for or engage in
4 prostitution or sexual performance. "Sexual abuse" does not
5 include any act intended for a valid medical purpose or any
6 act which may reasonably be construed to be a normal
7 caregiving action.
8 (11)(9) A person who, with malice or with intent to
9 discredit or harm a licensed facility or any person, makes a
10 false allegation of sexual misconduct against a member of a
11 licensed facility's personnel is guilty of a misdemeanor of
12 the second degree, punishable as provided in s. 775.082 or s.
13 775.083.
14 (12)(10) In addition to any penalty imposed pursuant
15 to this section, the agency shall require a written plan of
16 correction from the facility. For a single incident or series
17 of isolated incidents that are nonwillful violations of the
18 reporting requirements of this section, the agency shall first
19 seek to obtain corrective action by the facility. If the
20 correction is not demonstrated within the timeframe
21 established by the agency or if there is a pattern of
22 nonwillful violations of this section, the agency may impose
23 an administrative fine, not to exceed $5,000 for any violation
24 of the reporting requirements of this section. The
25 administrative fine for repeated nonwillful violations shall
26 not exceed $10,000 for any violation. The administrative fine
27 for each intentional and willful violation may not exceed
28 $25,000 per violation, per day. The fine for an intentional
29 and willful violation of this section may not exceed $250,000.
30 In determining the amount of fine to be levied, the agency
31 shall be guided by s. 395.1065(2)(b). The provisions of this
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1 subsection do not apply to the notice requirement under
2 subsection (7) may impose an administrative fine, not to
3 exceed $5,000, for any violation of the reporting requirements
4 of this section.
5 (13)(11) The agency shall have access to all licensed
6 facility records necessary to carry out the provisions of this
7 section. The records obtained by the agency under subsection
8 (6), subsection (8), or subsection (9) are not available to
9 the public under s. 119.07(1), nor shall they be discoverable
10 or admissible in any civil or administrative action, except in
11 disciplinary proceedings by the agency or the appropriate
12 regulatory board, nor shall records obtained pursuant to s.
13 455.223 be available to the public as part of the record of
14 investigation for and prosecution in disciplinary proceedings
15 made available to the public by the agency or the appropriate
16 regulatory board. However, the agency or the appropriate
17 regulatory board shall make available, upon written request by
18 a health care professional against whom probable cause has
19 been found, any such records which form the basis of the
20 determination of probable cause, except that, with respect to
21 medical review committee records, s. 766.101 controls.
22 (14)(12) The meetings of the committees and governing
23 board of a licensed facility held solely for the purpose of
24 achieving the objectives of risk management as provided by
25 this section shall not be open to the public under the
26 provisions of chapter 286. The records of such meetings are
27 confidential and exempt from s. 119.07(1), except as provided
28 in subsection (13)(11).
29 (15)(13) The agency shall review, as part of its
30 licensure inspection process, the internal risk management
31 program at each licensed facility regulated by this section to
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1 determine whether the program meets standards established in
2 statutes and rules, whether the program is being conducted in
3 a manner designed to reduce adverse incidents, and whether the
4 program is appropriately reporting incidents under subsections
5 (5), and (6), (7), and (8).
6 (16)(14) There shall be no monetary liability on the
7 part of, and no cause of action for damages shall arise
8 against, any risk manager, licensed under part IX of chapter
9 626, for the implementation and oversight of the internal risk
10 management program in a facility licensed under this chapter
11 or chapter 390 as required by this section, for any act or
12 proceeding undertaken or performed within the scope of the
13 functions of such internal risk management program if the risk
14 manager acts without intentional fraud.
15 (17)(15) If the agency, through its receipt of the
16 annual reports prescribed in subsection (6)(5) or through any
17 investigation, has a reasonable belief that conduct by a staff
18 member or employee of a licensed facility is grounds for
19 disciplinary action by the appropriate regulatory board, the
20 agency shall report this fact to such regulatory board.
21 (18)(16) The agency shall annually publish a report
22 summarizing the information contained in the annual incident
23 reports submitted by licensed facilities pursuant to
24 subsection (6), and any serious incident reports submitted by
25 licensed facilities, and disciplinary actions reported to the
26 agency pursuant to s. 395.0193. The report must, at a minimum,
27 summarize:
28 (a) Adverse and serious incidents, by service district
29 of the department as defined in s. 20.19, by category of
30 reported incident, and by type of professional involved.
31
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1 (b) Types of malpractice claims filed, by service
2 district of the department as defined in s. 20.19, and by type
3 of professional involved.
4 (c) Disciplinary actions taken against professionals,
5 by service district of the department as defined in s. 20.19,
6 and by type of professional involved.
7 Section 32. Effective January 1, 1999, section
8 626.941, Florida Statutes, is renumbered as section 395.10971,
9 Florida Statutes.
10 Section 33. Effective January 1, 1999, section
11 626.942, Florida Statutes, is renumbered as section 395.10972,
12 Florida Statutes, and amended to read:
13 395.10972 626.942 Health Care Risk Manager Advisory
14 Council.--The Director of Health Care Administration Insurance
15 Commissioner may appoint a five-member advisory council to
16 advise the agency department on matters pertaining to health
17 care risk managers. The members of the council shall serve at
18 the pleasure of the director Insurance Commissioner. The
19 council shall designate a chair. The council shall meet at
20 the call of the director Insurance Commissioner or at those
21 times as may be required by rule of the agency department.
22 The members of the advisory council shall receive no
23 compensation for their services, but shall be reimbursed for
24 travel expenses as provided in s. 112.061. The council shall
25 consist of individuals representing the following areas:
26 (1) Two shall be active health care risk managers.
27 (2) One shall be an active hospital administrator.
28 (3) One shall be an employee of an insurer or
29 self-insurer of medical malpractice coverage.
30 (4) One shall be a representative of the
31 health-care-consuming public.
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1 Section 34. Effective January 1, 1999, section
2 626.943, Florida Statutes, is renumbered as section 395.10973,
3 Florida Statutes, and amended to read:
4 395.10973 626.943 Powers and duties of the agency
5 department.--It is the function of the agency department to:
6 (1) Adopt Promulgate rules necessary to carry out the
7 duties conferred upon it under this part to protect the public
8 health, safety, and welfare.
9 (2) Develop, impose, and enforce specific standards
10 within the scope of the general qualifications established by
11 this part which must be met by individuals in order to receive
12 licenses as health care risk managers. These standards shall
13 be designed to ensure that health care risk managers are
14 individuals of good character and otherwise suitable and, by
15 training or experience in the field of health care risk
16 management, qualified in accordance with the provisions of
17 this part to serve as health care risk managers, within
18 statutory requirements.
19 (3) Develop a method for determining whether an
20 individual meets the standards set forth in s. 395.10974 s.
21 626.944.
22 (4) Issue licenses, beginning on June 1, 1986, to
23 qualified individuals meeting the standards set forth in s.
24 395.10974 s. 626.944.
25 (5) Receive, investigate, and take appropriate action
26 with respect to any charge or complaint filed with the agency
27 department to the effect that a certified health care risk
28 manager has failed to comply with the requirements or
29 standards adopted by rule by the agency department or to
30 comply with the provisions of this part.
31
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1 (6) Establish procedures for providing the Department
2 of Health and Rehabilitative Services with periodic reports on
3 persons certified or disciplined by the agency department
4 under this part.
5 (7) Develop a model risk management program for health
6 care facilities which will satisfy the requirements of s.
7 395.0197.
8 Section 35. Effective January 1, 1999, section
9 626.944, Florida Statutes, is renumbered as section 395.10974,
10 Florida Statutes, and amended to read:
11 395.10974 626.944 Qualifications for health care risk
12 managers.--
13 (1) Any person desiring to be licensed as a health
14 care risk manager shall submit an application on a form
15 provided by the agency department. In order to qualify, the
16 applicant shall submit evidence satisfactory to the agency
17 department which demonstrates the applicant's competence, by
18 education or experience, in the following areas:
19 (a) Applicable standards of health care risk
20 management.
21 (b) Applicable federal, state, and local health and
22 safety laws and rules.
23 (c) General risk management administration.
24 (d) Patient care.
25 (e) Medical care.
26 (f) Personal and social care.
27 (g) Accident prevention.
28 (h) Departmental organization and management.
29 (i) Community interrelationships.
30 (j) Medical terminology.
31
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1 The agency department may require such additional information,
2 from the applicant or any other person, as may be reasonably
3 required to verify the information contained in the
4 application.
5 (2) The agency department shall not grant or issue a
6 license as a health care risk manager to any individual unless
7 from the application it affirmatively appears that the
8 applicant:
9 (a) Is 18 years of age or over;
10 (b) Is a high school graduate or equivalent; and
11 (c)1. Has fulfilled the requirements of a 1-year
12 program or its equivalent in health care risk management
13 training which may be developed or approved by the agency
14 department;
15 2. Has completed 2 years of college-level studies
16 which would prepare the applicant for health care risk
17 management, to be further defined by rule; or
18 3. Has obtained 1 year of practical experience in
19 health care risk management.
20 (3) The agency department shall issue a license,
21 beginning on June 1, 1986, to practice health care risk
22 management to any applicant who qualifies under this section
23 and submits an application fee of not more than $75, a
24 fingerprinting fee of not more than $75, and a license fee of
25 not more than $100. The agency shall by rule establish fees
26 and procedures for the issuance and cancellation of licenses.
27 the license fee as set forth in s. 624.501. Licenses shall be
28 issued and canceled in the same manner as provided in part I
29 of this chapter.
30 (4) The agency department shall renew a health care
31 risk manager license upon receipt of a biennial renewal
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1 application and fees. The agency shall by rule establish a
2 procedure for the biennial renewal of licenses in accordance
3 with procedures prescribed in s. 626.381 for agents in
4 general.
5 Section 36. Effective January 1, 1999, section
6 626.945, Florida Statutes, is renumbered as section 395.10975,
7 Florida Statutes, and amended to read:
8 395.10975 626.945 Grounds for denial, suspension, or
9 revocation of a health care risk manager's license;
10 administrative fine.--
11 (1) The agency department may, in its discretion,
12 deny, suspend, revoke, or refuse to renew or continue the
13 license of any health care risk manager or applicant, if it
14 finds that as to such applicant or licensee any one or more of
15 the following grounds exist:
16 (a) Any cause for which issuance of the license could
17 have been refused had it then existed and been known to the
18 agency department.
19 (b) Giving false or forged evidence to the agency
20 department for the purpose of obtaining a license.
21 (c) Having been found guilty of, or having pleaded
22 guilty or nolo contendere to, a crime in this state or any
23 other state relating to the practice of risk management or the
24 ability to practice risk management, whether or not a judgment
25 or conviction has been entered.
26 (d) Having been found guilty of, or having pleaded
27 guilty or nolo contendere to, a felony, or a crime involving
28 moral turpitude punishable by imprisonment of 1 year or more
29 under the law of the United States, under the law of any
30 state, or under the law of any other country, without regard
31
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1 to whether a judgment of conviction has been entered by the
2 court having jurisdiction of such cases.
3 (e) Making or filing a report or record which the
4 licensee knows to be false; or intentionally failing to file a
5 report or record required by state or federal law; or
6 willfully impeding or obstructing, or inducing another person
7 to impede or obstruct, the filing of a report or record
8 required by state or federal law. Such reports or records
9 shall include only those which are signed in the capacity of a
10 licensed health care risk manager.
11 (f) Fraud or deceit, negligence, incompetence, or
12 misconduct in the practice of health care risk management.
13 (g) Violation of any provision of this part or any
14 other law applicable to the business of health care risk
15 management.
16 (h) Violation of any lawful order or rule of the
17 agency department or failure to comply with a lawful subpoena
18 issued by the department.
19 (i) Practicing with a revoked or suspended health care
20 risk manager license.
21 (j) Repeatedly acting in a manner inconsistent with
22 the health and safety of the patients of the licensed facility
23 in which the licensee is the health care risk manager.
24 (k) Being unable to practice health care risk
25 management with reasonable skill and safety to patients by
26 reason of illness; drunkenness; or use of drugs, narcotics,
27 chemicals, or any other material or substance or as a result
28 of any mental or physical condition. Any person affected
29 under this paragraph shall have the opportunity, at reasonable
30 intervals, to demonstrate that he or she can resume the
31
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1 competent practices of health care risk manager with
2 reasonable skill and safety to patients.
3 (l) Willfully permitting unauthorized disclosure of
4 information relating to a patient or a patient's records.
5 (m) Discriminating in respect to patients, employees,
6 or staff on account of race, religion, color, sex, or national
7 origin.
8 (2) If the agency department finds that one or more of
9 the grounds set forth in subsection (1) exist, it may, in lieu
10 of or in addition to suspension or revocation, enter an order
11 imposing one or more of the following penalties:
12 (a) Imposition of an administrative fine not to exceed
13 $2,500 for each count or separate offense.
14 (b) Issuance of a reprimand.
15 (c) Placement of the licensee on probation for a
16 period of time and subject to such conditions as the agency
17 department may specify, including requiring the licensee to
18 attend continuing education courses or to work under the
19 supervision of another licensee.
20 (3) The agency department may reissue the license of a
21 disciplined licensee in accordance with the provisions of this
22 part.
23 Section 37. Subsection (7) of section 394.4787,
24 Florida Statutes, is amended to read:
25 394.4787 Definitions.--As used in this section and ss.
26 394.4786, 394.4788, and 394.4789:
27 (7) "Specialty psychiatric hospital" means a hospital
28 licensed by the agency pursuant to s. 395.002(25) s.
29 395.002(27) as a specialty psychiatric hospital.
30 Section 38. Paragraph (c) of subsection (2) of section
31 395.602, Florida Statutes, is amended to read:
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1 395.602 Rural hospitals.--
2 (2) DEFINITIONS.--As used in this part:
3 (c) "Inactive rural hospital bed" means a licensed
4 acute care hospital bed, as defined in s. 395.002(12) s.
5 395.002(13), that is inactive in that it cannot be occupied by
6 acute care inpatients.
7 Section 39. Paragraph (b) of subsection (1) of section
8 400.051, Florida Statutes, is amended to read:
9 400.051 Homes or institutions exempt from the
10 provisions of this part.--
11 (1) The following shall be exempt from the provisions
12 of this part:
13 (b) Any hospital, as defined in s. 395.002(9) s.
14 395.002(10), that is licensed under chapter 395.
15 Section 40. Subsection (8) of section 409.905, Florida
16 Statutes, is amended to read:
17 409.905 Mandatory Medicaid services.--The agency may
18 make payments for the following services, which are required
19 of the state by Title XIX of the Social Security Act,
20 furnished by Medicaid providers to recipients who are
21 determined to be eligible on the dates on which the services
22 were provided. Any service under this section shall be
23 provided only when medically necessary and in accordance with
24 state and federal law. Nothing in this section shall be
25 construed to prevent or limit the agency from adjusting fees,
26 reimbursement rates, lengths of stay, number of visits, number
27 of services, or any other adjustments necessary to comply with
28 the availability of moneys and any limitations or directions
29 provided for in the General Appropriations Act or chapter 216.
30 (8) NURSING FACILITY SERVICES.--The agency shall pay
31 for 24-hour-a-day nursing and rehabilitative services for a
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1 recipient in a nursing facility licensed under part II of
2 chapter 400 or in a rural hospital, as defined in s. 395.602,
3 or in a Medicare certified skilled nursing facility operated
4 by a hospital, as defined by s. 395.002(9) s. 395.002(10),
5 that is licensed under part I of chapter 395, and in
6 accordance with provisions set forth in s. 409.908(2)(a),
7 which services are ordered by and provided under the direction
8 of a licensed physician. However, if a nursing facility has
9 been destroyed or otherwise made uninhabitable by natural
10 disaster or other emergency and another nursing facility is
11 not available, the agency must pay for similar services
12 temporarily in a hospital licensed under part I of chapter 395
13 provided federal funding is approved and available.
14 Section 41. Paragraph (g) of subsection (1) of section
15 440.13, Florida Statutes, is amended to read:
16 440.13 Medical services and supplies; penalty for
17 violations; limitations.--
18 (1) DEFINITIONS.--As used in this section, the term:
19 (g) "Emergency services and care" means emergency
20 services and care as defined in s. 395.002(9).
21 Section 42. Subsection (9) of section 458.331, Florida
22 Statutes, is amended to read:
23 458.331 Grounds for disciplinary action; action by the
24 board and department.--
25 (9) When an investigation of a physician is
26 undertaken, the department shall promptly furnish to the
27 physician or the physician's attorney a copy of the complaint
28 or document which resulted in the initiation of the
29 investigation. For purposes of this subsection, such
30 documents include, but are not limited to: the pertinent
31 portions of an annual report submitted to the department
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1 pursuant to s. 395.0197(6) s. 395.0197(5)(b); a report of an
2 adverse or untoward incident which is provided to the
3 department pursuant to s. 395.0197(8) the provisions of s.
4 395.0197(6); a report of peer review disciplinary action
5 submitted to the department pursuant to the provisions of s.
6 395.0193(4) or s. 458.337, providing that the investigations,
7 proceedings, and records relating to such peer review
8 disciplinary action shall continue to retain their privileged
9 status even as to the licensee who is the subject of the
10 investigation, as provided by ss. 395.0193(8) 395.0193(7) and
11 458.337(3); a report of a closed claim submitted pursuant to
12 s. 627.912; a presuit notice submitted pursuant to s.
13 766.106(2); and a petition brought under the Florida
14 Birth-Related Neurological Injury Compensation Plan, pursuant
15 to s. 766.305(2). The physician may submit a written response
16 to the information contained in the complaint or document
17 which resulted in the initiation of the investigation within
18 45 days after service to the physician of the complaint or
19 document. The physician's written response shall be considered
20 by the probable cause panel.
21 Section 43. Subsection (9) of section 459.015, Florida
22 Statutes, is amended to read:
23 459.015 Grounds for disciplinary action by the
24 board.--
25 (9) When an investigation of an osteopathic physician
26 is undertaken, the department shall promptly furnish to the
27 osteopathic physician or his or her attorney a copy of the
28 complaint or document which resulted in the initiation of the
29 investigation. For purposes of this subsection, such documents
30 include, but are not limited to: the pertinent portions of an
31 annual report submitted to the department pursuant to s.
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1 395.0197(6) s. 395.0197(5)(b); a report of an adverse or
2 untoward incident which is provided to the department pursuant
3 to s. 395.0197(8) the provisions of s. 395.0197(6); a report
4 of peer review disciplinary action submitted to the department
5 pursuant to the provisions of s. 395.0193(4) or s. 459.016,
6 provided that the investigations, proceedings, and records
7 relating to such peer review disciplinary action shall
8 continue to retain their privileged status even as to the
9 licensee who is the subject of the investigation, as provided
10 by ss. 395.0193(8) 395.0193(7) and 459.016(3); a report of a
11 closed claim submitted pursuant to s. 627.912; a presuit
12 notice submitted pursuant to s. 766.106(2); and a petition
13 brought under the Florida Birth-Related Neurological Injury
14 Compensation Plan, pursuant to s. 766.305(2). The osteopathic
15 physician may submit a written response to the information
16 contained in the complaint or document which resulted in the
17 initiation of the investigation within 45 days after service
18 to the osteopathic physician of the complaint or document. The
19 osteopathic physician's written response shall be considered
20 by the probable cause panel.
21 Section 44. Subsection (1) of section 468.505, Florida
22 Statutes, is amended to read:
23 468.505 Exemptions; exceptions.--
24 (1) Nothing in this part may be construed as
25 prohibiting or restricting the practice, services, or
26 activities of:
27 (a) A person licensed in this state under chapter 457,
28 chapter 458, chapter 459, chapter 460, chapter 461, chapter
29 462, chapter 463, chapter 464, chapter 465, chapter 466,
30 chapter 480, chapter 490, or chapter 491, when engaging in the
31 profession or occupation for which he or she is licensed, or
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1 of any person employed by and under the supervision of the
2 licensee when rendering services within the scope of the
3 profession or occupation of the licensee.;
4 (b) A person employed as a dietitian by the government
5 of the United States, if the person engages in dietetics
6 solely under direction or control of the organization by which
7 the person is employed.;
8 (c) A person employed as a cooperative extension home
9 economist.;
10 (d) A person pursuing a course of study leading to a
11 degree in dietetics and nutrition from a program or school
12 accredited pursuant to s. 468.509(2), if the activities and
13 services constitute a part of a supervised course of study and
14 if the person is designated by a title that clearly indicates
15 the person's status as a student or trainee.;
16 (e) A person fulfilling the supervised experience
17 component of s. 468.509, if the activities and services
18 constitute a part of the experience necessary to meet the
19 requirements of s. 468.509.;
20 (f) Any dietitian or nutritionist from another state
21 practicing dietetics or nutrition incidental to a course of
22 study when taking or giving a postgraduate course or other
23 course of study in this state, provided such dietitian or
24 nutritionist is licensed in another jurisdiction or is a
25 registered dietitian or holds an appointment on the faculty of
26 a school accredited pursuant to s. 468.509(2).;
27 (g) A person who markets or distributes food, food
28 materials, or dietary supplements, or any person who engages
29 in the explanation of the use and benefits of those products
30 or the preparation of those products, if that person does not
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1 engage for a fee in dietetics and nutrition practice or
2 nutrition counseling.;
3 (h) A person who markets or distributes food, food
4 materials, or dietary supplements, or any person who engages
5 in the explanation of the use of those products or the
6 preparation of those products, as an employee of an
7 establishment permitted pursuant to chapter 465.;
8 (i) An educator who is in the employ of a nonprofit
9 organization approved by the council; a federal, state,
10 county, or municipal agency, or other political subdivision;
11 an elementary or secondary school; or an accredited
12 institution of higher education the definition of which, as
13 provided in s. 468.509(2), applies to other sections of this
14 part, insofar as the activities and services of the educator
15 are part of such employment.;
16 (j) Any person who provides weight control services or
17 related weight control products, provided the program has been
18 reviewed by, consultation is available from, and no program
19 change can be initiated without prior approval by a licensed
20 dietitian/nutritionist, a dietitian or nutritionist licensed
21 in another state that has licensure requirements considered by
22 the council to be at least as stringent as the requirements
23 for licensure under this part, or a registered dietitian.;
24 (k) A person employed by a hospital licensed under
25 chapter 395, or by a nursing home or assisted living facility
26 licensed under part II or part III of chapter 400, or by a
27 continuing care facility certified under chapter 651, if the
28 person is employed in compliance with the laws and rules
29 adopted thereunder regarding the operation of its dietetic
30 department.;
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1 (l) A person employed by a nursing facility exempt
2 from licensing under s. 395.002(11) s. 395.002(12), or a
3 person exempt from licensing under s. 464.022.; or
4 (m) A person employed as a dietetic technician.
5 Section 45. Effective January 1, 1999, subsection (2)
6 of section 641.55, Florida Statutes, is amended to read:
7 641.55 Internal risk management program.--
8 (2) The risk management program shall be the
9 responsibility of the governing authority or board of the
10 organization. Every organization which has an annual premium
11 volume of $10 million or more and which directly provides
12 health care in a building owned or leased by the organization
13 shall hire a risk manager, certified under ss.
14 395.10971-395.10975 ss. 626.941-626.945, who shall be
15 responsible for implementation of the organization's risk
16 management program required by this section. A part-time risk
17 manager shall not be responsible for risk management programs
18 in more than four organizations or facilities. Every
19 organization which does not directly provide health care in a
20 building owned or leased by the organization and every
21 organization with an annual premium volume of less than $10
22 million shall designate an officer or employee of the
23 organization to serve as the risk manager.
24
25 The gross data compiled under this section or s. 395.0197
26 shall be furnished by the agency upon request to organizations
27 to be utilized for risk management purposes. The agency shall
28 adopt rules necessary to carry out the provisions of this
29 section.
30 Section 46. Paragraph (c) of subsection (4) of section
31 766.1115, Florida Statutes, is amended to read:
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1 766.1115 Health care providers; creation of agency
2 relationship with governmental contractors.--
3 (4) CONTRACT REQUIREMENTS.--A health care provider
4 that executes a contract with a governmental contractor to
5 deliver health care services on or after April 17, 1992, as an
6 agent of the governmental contractor is an agent for purposes
7 of s. 768.28(9), while acting within the scope of duties
8 pursuant to the contract, if the contract complies with the
9 requirements of this section. A health care provider under
10 contract with the state may not be named as a defendant in any
11 action arising out of the medical care or treatment provided
12 on or after April 17, 1992, pursuant to contracts entered into
13 under this section. The contract must provide that:
14 (c) Adverse incidents and information on treatment
15 outcomes must be reported by any health care provider to the
16 governmental contractor if such incidents and information
17 pertain to a patient treated pursuant to the contract. The
18 health care provider shall annually submit an adverse incident
19 report that includes all information required by s.
20 395.0197(6)(a) s. 395.0197(5)(a), unless the adverse incident
21 involves a result described by s. 395.0197(8) s. 395.0197(6),
22 in which case it shall be reported within 15 days after of the
23 occurrence of such incident. If an incident involves a
24 professional licensed by the Department of Health Business and
25 Professional Regulation or a facility licensed by the Agency
26 for Health Care Administration Department of Health and
27 Rehabilitative Services, the governmental contractor shall
28 submit such incident reports to the appropriate department or
29 agency, which shall review each incident and determine whether
30 it involves conduct by the licensee that is subject to
31 disciplinary action. All patient medical records and any
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1 identifying information contained in adverse incident reports
2 and treatment outcomes which are obtained by governmental
3 entities pursuant to this paragraph are confidential and
4 exempt from the provisions of s. 119.07(1) and s. 24(a), Art.
5 I of the State Constitution.
6
7 A governmental contractor that is also a health care provider
8 is not required to enter into a contract under this section
9 with respect to the health care services delivered by its
10 employees.
11 Section 47. Effective January 1, 1999, all powers,
12 duties and functions, rules, records, personnel, property, and
13 unexpended balances of appropriations, allocations, or other
14 funds of the Department of Insurance related to the health
15 care risk manager licensure program, as established in part IX
16 of chapter 626, Florida Statutes, are transferred by a type
17 two transfer, as defined in section 20.06(2), Florida
18 Statutes, from the Department of Insurance to the Agency for
19 Health Care Administration.
20 Section 48. There is hereby appropriated from the
21 Health Care Trust Fund to the Agency for Health Care
22 Administration, one full-time position and $100,281 in a lump
23 sum to administer the provisions of this act.
24 Section 49. Except as otherwise expressly provided in
25 this act, this act shall take effect July 1 of the year in
26 which enacted.
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