CODING: Words stricken are deletions; words underlined are additions.





                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    

                            CHAMBER ACTION
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10                                                                

11  Senator Clary moved the following amendment:

12

13         Senate Amendment (with title amendment) 

14         Delete everything after the enacting clause,

15

16  and insert:

17         Section 1.  The Department of Children and Family

18  Services and the Agency for Health Care Administration shall,

19  by October 1, 1999, develop a system to allow unborn children

20  of Medicaid-eligible mothers to be issued a Medicaid number

21  that shall be used for billing purposes and for monitoring of

22  care for the child beginning with the child's date of birth.

23         Section 2.  Paragraphs (e) and (f) of subsection (3)

24  and paragraphs (a) and (b) of subsection (7) of section 20.43,

25  Florida Statutes, 1998 Supplement, are amended, and paragraphs

26  (h), (i), and (j) are added to subsection (3) of that section,

27  to read:

28         20.43  Department of Health.--There is created a

29  Department of Health.

30         (3)  The following divisions of the Department of

31  Health are established:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (e)  Division of Children's Medical Services Network.

 2         (f)  Division of Emergency Medical Services and

 3  Community Health Resources Local Health Planning, Education,

 4  and Workforce Development.

 5         (h)  Division of Children's Medical Services Prevention

 6  and Intervention.

 7         (i)  Division of Information Resource Management.

 8         (j)  Division of Health Awareness and Tobacco.

 9         (7)  To protect and improve the public health, the

10  department may use state or federal funds to:

11         (a)  Provide incentives, including, but not limited to,

12  the promotional items listed in paragraph (b), food and

13  including food coupons, and or payment for travel expenses,

14  for encouraging healthy lifestyle and disease prevention

15  behaviors and patient compliance with medical treatment, such

16  as tuberculosis therapy and smoking cessation programs. Such

17  incentives shall be intended to cause individuals to take

18  action to improve their health. Any incentive for food, food

19  coupons, or travel expenses may not exceed the limitations in

20  s. 112.061.

21         (b)  Plan and conduct health education campaigns for

22  the purpose of protecting or improving public health. The

23  department may purchase promotional items, such as, but not

24  limited to, t-shirts, hats, sports items such as water bottles

25  and sweat bands, calendars, nutritional charts, baby bibs,

26  growth charts, and other items printed with health-promotion

27  messages, and advertising, such as space on billboards or in

28  publications or radio or television time, for health

29  information and promotional messages that recognize that the

30  following behaviors, among others, are detrimental to public

31  health: unprotected sexual intercourse, other than with one's

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  spouse; cigarette and cigar smoking, use of smokeless tobacco

 2  products, and exposure to environmental tobacco smoke; alcohol

 3  consumption or other substance abuse during pregnancy; alcohol

 4  abuse or other substance abuse; lack of exercise and poor diet

 5  and nutrition habits; and failure to recognize and address a

 6  genetic tendency to suffer from sickle-cell anemia, diabetes,

 7  high blood pressure, cardiovascular disease, or cancer. For

 8  purposes of activities under this paragraph, the Department of

 9  Health may establish requirements for local matching funds or

10  in-kind contributions to create and distribute advertisements,

11  in either print or electronic format, which are concerned with

12  each of the targeted behaviors, establish an independent

13  evaluation and feedback system for the public health

14  communication campaign, and monitor and evaluate the efforts

15  to determine which of the techniques and methodologies are

16  most effective.

17         Section 3.  Paragraphs (l), (p), and (s) of subsection

18  (2) of section 110.205, Florida Statutes, are amended to read:

19         110.205  Career service; exemptions.--

20         (2)  EXEMPT POSITIONS.--The exempt positions which are

21  not covered by this part include the following, provided that

22  no position, except for positions established for a limited

23  period of time pursuant to paragraph (h), shall be exempted if

24  the position reports to a position in the career service:

25         (l)  All assistant division director, deputy division

26  director, and bureau chief positions in any department, and

27  those positions determined by the department to have

28  managerial responsibilities comparable to such positions,

29  which positions include, but are not limited to, positions in

30  the Department of Health, the Department of Children and

31  Family Services, and Rehabilitative Services and the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Department of Corrections that are assigned primary duties of

 2  serving as the superintendent of an institution: positions in

 3  the Department of Transportation that are assigned primary

 4  duties of serving as regional toll managers and managers of

 5  offices as defined in s. 20.23(3)(d)3. and (4)(d); positions

 6  in the Department of Environmental Protection that are

 7  assigned the duty of an Environmental Administrator or program

 8  administrator; and positions in the Department of Health and

 9  Rehabilitative Services that are assigned the duties duty of

10  an Environmental Administrator, Assistant County Health

11  Department Director, and County Health Department Financial

12  Administrator. Unless otherwise fixed by law, the department

13  shall set the salary and benefits of these positions in

14  accordance with the rules established for the Selected Exempt

15  Service.

16         (p)  The staff directors, assistant staff directors,

17  district program managers, district program coordinators,

18  district subdistrict administrators, district administrative

19  services directors, district attorneys, county health

20  department directors, county health department administrators,

21  and the Deputy Director of Central Operations Services of the

22  Department of Children and Family Health and Rehabilitative

23  Services and the county health department directors and county

24  health department administrators of the Department of Health.

25  Unless otherwise fixed by law, the department shall establish

26  the salary range and benefits for these positions in

27  accordance with the rules of the Selected Exempt Service.

28         (s)  The executive director of each board or commission

29  established within the Department of Business and Professional

30  Regulation or the Department of Health. Unless otherwise fixed

31  by law, the department shall establish the salary and benefits

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  for these positions in accordance with the rules established

 2  for the Selected Exempt Service.

 3         Section 4.  Subsection (15) of section 120.80, Florida

 4  Statutes, 1998 Supplement, is amended to read:

 5         120.80  Exceptions and special requirements;

 6  agencies.--

 7         (15)  DEPARTMENT OF HEALTH.--Notwithstanding s.

 8  120.57(1)(a), formal hearings may not be conducted by the

 9  Secretary of Health, the director of the Agency for Health

10  Care Administration, or a board or member of a board within

11  the Department of Health or the Agency for Health Care

12  Administration for matters relating to the regulation of

13  professions, as defined by part II of chapter 455.

14  Notwithstanding s. 120.57(1)(a), hearings conducted within the

15  Department of Health in execution of the Special Supplemental

16  Nutrition Program for Women, Infants, and Children; Child Care

17  Food Program; Children's Medical Services Program; and the

18  exemption from disqualification reviews for certified nurse

19  assistants program need not be conducted by an administrative

20  law judge assigned by the division. The Department of Health

21  may contract with the Department of Children and Family

22  Services for a hearing officer in these matters.

23         Section 5.  Subsection (1) of section 154.504, Florida

24  Statutes, 1998 Supplement, is amended to read:

25         154.504  Eligibility and benefits.--

26         (1)  Any county or counties may apply for a primary

27  care for children and families challenge grant to provide

28  primary health care services to children and families with

29  incomes of up to 150 percent of the federal poverty level.

30  Participants shall pay no monthly premium for participation,

31  but shall be required to pay a copayment at the time a service

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  is provided. Copayments may be paid from sources other than

 2  the participant, including, but not limited to, the child's or

 3  parent's employer, or other private sources. Providers may

 4  enter into contracts pursuant to As used in s. 766.1115,

 5  provided copayments, the term "copayment" may not be

 6  considered and may not be used as compensation for services to

 7  health care providers, and all funds generated from copayments

 8  shall be used by the governmental contractor and all other

 9  provisions in s. 766.1115 are met.

10         Section 6.  Subsection (3) is added to section 287.155,

11  Florida Statutes, to read:

12         287.155  Motor vehicles; purchase by Division of

13  Universities, Department of Health and Rehabilitative

14  Services, Department of Juvenile Justice, and Department of

15  Corrections.--

16         (3)  The Department of Health is authorized, subject to

17  the approval of the Department of Management Services, to

18  purchase automobiles, trucks, and other automotive equipment

19  for use by county health departments.

20         Section 7.  Subsection (3) of section 372.6672, Florida

21  Statutes, 1998 Supplement, is amended to read:

22         372.6672  Alligator management and trapping program

23  implementation; commission authority.--

24         (3)  The powers and duties of the commission hereunder

25  shall not be construed so as to supersede the regulatory

26  authority or lawful responsibility of the Department of Health

27  and Rehabilitative Services, the Department of Agriculture and

28  Consumer Services, or any local governmental entity regarding

29  the processing or handling of food products, but shall be

30  deemed supplemental thereto.

31         Section 8.  Paragraph (h) of subsection (3) of section

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  381.004, Florida Statutes, 1998 Supplement, is amended to

 2  read:

 3         381.004  Testing for human immunodeficiency virus.--

 4         (3)  HUMAN IMMUNODEFICIENCY VIRUS TESTING; INFORMED

 5  CONSENT; RESULTS; COUNSELING; CONFIDENTIALITY.--

 6         (h)  Notwithstanding the provisions of paragraph (a),

 7  informed consent is not required:

 8         1.  When testing for sexually transmissible diseases is

 9  required by state or federal law, or by rule including the

10  following situations:

11         a.  HIV testing pursuant to s. 796.08 of persons

12  convicted of prostitution or of procuring another to commit

13  prostitution.

14         b.  Testing for HIV by a medical examiner in accordance

15  with s. 406.11.

16         2.  Those exceptions provided for blood, plasma,

17  organs, skin, semen, or other human tissue pursuant to s.

18  381.0041.

19         3.  For the performance of an HIV-related test by

20  licensed medical personnel in bona fide medical emergencies

21  when the test results are necessary for medical diagnostic

22  purposes to provide appropriate emergency care or treatment to

23  the person being tested and the patient is unable to consent,

24  as supported by documentation in the medical record.

25  Notification of test results in accordance with paragraph (c)

26  is required.

27         4.  For the performance of an HIV-related test by

28  licensed medical personnel for medical diagnosis of acute

29  illness where, in the opinion of the attending physician,

30  obtaining informed consent would be detrimental to the

31  patient, as supported by documentation in the medical record,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  and the test results are necessary for medical diagnostic

 2  purposes to provide appropriate care or treatment to the

 3  person being tested. Notification of test results in

 4  accordance with paragraph (c) is required if it would not be

 5  detrimental to the patient.  This subparagraph does not

 6  authorize the routine testing of patients for HIV infection

 7  without informed consent.

 8         5.  When HIV testing is performed as part of an autopsy

 9  for which consent was obtained pursuant to s. 872.04.

10         6.  For the performance of an HIV test upon a defendant

11  pursuant to the victim's request in a prosecution for any type

12  of sexual battery where a blood sample is taken from the

13  defendant voluntarily, pursuant to court order for any

14  purpose, or pursuant to the provisions of s. 775.0877, s.

15  951.27, or s. 960.003; however, the results of any HIV test

16  performed shall be disclosed solely to the victim and the

17  defendant, except as provided in ss. 775.0877, 951.27, and

18  960.003.

19         7.  When an HIV test is mandated by court order.

20         8.  For epidemiological research pursuant to s.

21  381.0032, for research consistent with institutional review

22  boards created by 45 C.F.R. part 46, or for the performance of

23  an HIV-related test for the purpose of research, if the

24  testing is performed in a manner by which the identity of the

25  test subject is not known and may not be retrieved by the

26  researcher.

27         9.  When human tissue is collected lawfully without the

28  consent of the donor for corneal removal as authorized by s.

29  732.9185 or enucleation of the eyes as authorized by s.

30  732.919.

31         10.  For the performance of an HIV test upon an

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  individual who comes into contact with medical personnel in

 2  such a way that a significant exposure has occurred during the

 3  course of employment or within the scope of practice and where

 4  a blood sample is available that was taken from that

 5  individual voluntarily by medical personnel for other

 6  purposes.  "Medical personnel" includes a licensed or

 7  certified health care professional; an employee of a health

 8  care professional, health care facility, or blood bank; and a

 9  paramedic or emergency medical technician as defined in s.

10  401.23.

11         a.  Prior to performance of an HIV test on a

12  voluntarily obtained blood sample, the individual from whom

13  the blood was obtained shall be requested to consent to the

14  performance of the test and to the release of the results.

15  The individual's refusal to consent and all information

16  concerning the performance of an HIV test and any HIV test

17  result shall be documented only in the medical personnel's

18  record unless the individual gives written consent to entering

19  this information on the individual's medical record.

20         b.  Reasonable attempts to locate the individual and to

21  obtain consent shall be made and all attempts must be

22  documented. If the individual cannot be found, an HIV test may

23  be conducted on the available blood sample. If the individual

24  does not voluntarily consent to the performance of an HIV

25  test, the individual shall be informed that an HIV test will

26  be performed, and counseling shall be furnished as provided in

27  this section.  However, HIV testing shall be conducted only

28  after a licensed physician documents, in the medical record of

29  the medical personnel, that there has been a significant

30  exposure and that, in the physician's medical judgment, the

31  information is medically necessary to determine the course of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  treatment for the medical personnel.

 2         c.  Costs of any HIV test of a blood sample performed

 3  with or without the consent of the individual, as provided in

 4  this subparagraph, shall be borne by the medical personnel or

 5  the employer of the medical personnel. However, costs of

 6  testing or treatment not directly related to the initial HIV

 7  tests or costs of subsequent testing or treatment shall not be

 8  borne by the medical personnel or the employer of the medical

 9  personnel.

10         d.  In order to utilize the provisions of this

11  subparagraph, the medical personnel must either be tested for

12  HIV pursuant to this section or provide the results of an HIV

13  test taken within 6 months prior to the significant exposure

14  if such test results are negative.

15         e.  A person who receives the results of an HIV test

16  pursuant to this subparagraph shall maintain the

17  confidentiality of the information received and of the persons

18  tested.  Such confidential information is exempt from s.

19  119.07(1).

20         f.  If the source of the exposure will not voluntarily

21  submit to HIV testing and a blood sample is not available, the

22  medical personnel or the employer of such person acting on

23  behalf of the employee may seek a court order directing the

24  source of the exposure to submit to HIV testing.  A sworn

25  statement by a physician licensed under chapter 458 or chapter

26  459 that a significant exposure has occurred and that, in the

27  physician's medical judgment, testing is medically necessary

28  to determine the course of treatment constitutes probable

29  cause for the issuance of an order by the court.  The results

30  of the test shall be released to the source of the exposure

31  and to the person who experienced the exposure.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         11.  For the performance of an HIV test upon an

 2  individual who comes into contact with medical personnel in

 3  such a way that a significant exposure has occurred during the

 4  course of employment or within the scope of practice of the

 5  medical personnel while the medical personnel provides

 6  emergency medical treatment to the individual; or who comes

 7  into contact with nonmedical personnel in such a way that a

 8  significant exposure has occurred while the nonmedical

 9  personnel provides emergency medical assistance during a

10  medical emergency.  For the purposes of this subparagraph, a

11  medical emergency means an emergency medical condition outside

12  of a hospital or health care facility that provides physician

13  care. The test may be performed only during the course of

14  treatment for the medical emergency.

15         a.  An individual who is capable of providing consent

16  shall be requested to consent to an HIV test prior to the

17  testing. The individual's refusal to consent, and all

18  information concerning the performance of an HIV test and its

19  result, shall be documented only in the medical personnel's

20  record unless the individual gives written consent to entering

21  this information on the individual's medical record.

22         b.  HIV testing shall be conducted only after a

23  licensed physician documents, in the medical record of the

24  medical personnel or nonmedical personnel, that there has been

25  a significant exposure and that, in the physician's medical

26  judgment, the information is medically necessary to determine

27  the course of treatment for the medical personnel or

28  nonmedical personnel.

29         c.  Costs of any HIV test performed with or without the

30  consent of the individual, as provided in this subparagraph,

31  shall be borne by the medical personnel or the employer of the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  medical personnel or nonmedical personnel. However, costs of

 2  testing or treatment not directly related to the initial HIV

 3  tests or costs of subsequent testing or treatment shall not be

 4  borne by the medical personnel or the employer of the medical

 5  personnel or nonmedical personnel.

 6         d.  In order to utilize the provisions of this

 7  subparagraph, the medical personnel or nonmedical personnel

 8  shall be tested for HIV pursuant to this section or shall

 9  provide the results of an HIV test taken within 6 months prior

10  to the significant exposure if such test results are negative.

11         e.  A person who receives the results of an HIV test

12  pursuant to this subparagraph shall maintain the

13  confidentiality of the information received and of the persons

14  tested.  Such confidential information is exempt from s.

15  119.07(1).

16         f.  If the source of the exposure will not voluntarily

17  submit to HIV testing and a blood sample was not obtained

18  during treatment for the medical emergency, the medical

19  personnel, the employer of the medical personnel acting on

20  behalf of the employee, or the nonmedical personnel may seek a

21  court order directing the source of the exposure to submit to

22  HIV testing.  A sworn statement by a physician licensed under

23  chapter 458 or chapter 459 that a significant exposure has

24  occurred and that, in the physician's medical judgment,

25  testing is medically necessary to determine the course of

26  treatment constitutes probable cause for the issuance of an

27  order by the court.  The results of the test shall be released

28  to the source of the exposure and to the person who

29  experienced the exposure.

30         12.  For the performance of an HIV test by the medical

31  examiner or attending physician upon an a deceased individual

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  who is the source of a significant exposure to medical

 2  personnel or nonmedical personnel who provided emergency

 3  medical assistance and who expired or could not be

 4  resuscitated while receiving during treatment for the medical

 5  emergency medical assistance or care and who was the source of

 6  a significant exposure to medical or nonmedical personnel

 7  providing such assistance or care.

 8         a.  HIV testing may be conducted only after a licensed

 9  physician documents in the medical record of the medical

10  personnel or nonmedical personnel that there has been a

11  significant exposure and that, in the physician's medical

12  judgment, the information is medically necessary to determine

13  the course of treatment for the medical personnel or

14  nonmedical personnel.

15         b.  Costs of any HIV test performed under this

16  subparagraph may not be charged to the deceased or to the

17  family of the deceased person.

18         c.  For the provisions of this subparagraph to be

19  applicable, the medical personnel or nonmedical personnel must

20  be tested for HIV under this section or must provide the

21  results of an HIV test taken within 6 months before the

22  significant exposure if such test results are negative.

23         d.  A person who receives the results of an HIV test

24  pursuant to this subparagraph shall comply with paragraph (e).

25         13.  For the performance of an HIV-related test

26  medically indicated by licensed medical personnel for medical

27  diagnosis of a hospitalized infant as necessary to provide

28  appropriate care and treatment of the infant when, after a

29  reasonable attempt, a parent cannot be contacted to provide

30  consent. The medical records of the infant shall reflect the

31  reason consent of the parent was not initially obtained.  Test

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  results shall be provided to the parent when the parent is

 2  located.

 3         14.  For the performance of HIV testing conducted to

 4  monitor the clinical progress of a patient previously

 5  diagnosed to be HIV positive.

 6         15.  For the performance of repeated HIV testing

 7  conducted to monitor possible conversion from a significant

 8  exposure.

 9         Section 9.  Subsection (7) is added to section

10  381.0051, Florida Statutes, to read:

11         381.0051  Family planning.--

12         (7)  RULES.--The Department of Health may adopt rules

13  to implement this section.

14         Section 10.  Subsection (16) is added to section

15  381.006, Florida Statutes, 1998 Supplement, to read:

16         381.006  Environmental health.--The department shall

17  conduct an environmental health program as part of fulfilling

18  the state's public health mission. The purpose of this program

19  is to detect and prevent disease caused by natural and manmade

20  factors in the environment.  The environmental health program

21  shall include, but not be limited to:

22         (16)  A group-care-facilities function, where a

23  group-care facility means any public or private school,

24  housing, building or buildings, section of a building, or

25  distinct part of a building or other place, whether operated

26  for profit or not, which undertakes, through its ownership or

27  management, to provide one or more personal services, care,

28  protection, and supervision to persons who require such

29  services and who are not related to the owner or

30  administrator. The department may adopt rules necessary to

31  protect the health and safety of residents, staff, and patrons

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  of group-care facilities, such as child care facilities,

 2  family day-care homes, assisted-living facilities, adult

 3  day-care centers, adult family-care homes, hospices,

 4  residential treatment facilities, crisis-stabilization units,

 5  pediatric extended-care centers, intermediate-care facilities

 6  for the developmentally disabled, group-care homes, and,

 7  jointly with the Department of Education, private and public

 8  schools. These rules may include provisions relating to

 9  operation and maintenance of facilities, buildings, grounds,

10  equipment, furnishings, and occupant-space requirements;

11  lighting; heating, cooling, and ventilation; water supply,

12  plumbing; sewage; sanitary facilities; insect and rodent

13  control; garbage; safety; personnel health, hygiene, and work

14  practices; and other matters the department finds are

15  appropriate or necessary to protect the safety and health of

16  the residents, staff, or patrons. The department may not adopt

17  rules that conflict with rules adopted by the licensing or

18  certifying agency. The department may enter and inspect at

19  reasonable hours to determine compliance with applicable

20  statutes or rules. In addition to any sanctions that the

21  department may impose for violations of rules adopted under

22  this section, the department shall also report such violations

23  to any agency responsible for licensing or certifying the

24  group-care facility. The licensing or certifying agency may

25  also impose any sanction based solely on the findings of the

26  department.

27

28  The department may adopt rules to carry out the provisions of

29  this section.

30         Section 11.  Subsection (1) of section 381.0061,

31  Florida Statutes, is amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         381.0061  Administrative fines.--

 2         (1)  In addition to any administrative action

 3  authorized by chapter 120 or by other law, the department may

 4  impose a fine, which shall not exceed $500 for each violation,

 5  for a violation of s. 381.006(16), s. 381.0065, s. 381.0066,

 6  s. 381.0072, or part III of chapter 489, for a violation of

 7  any rule adopted under this chapter, or for a violation of any

 8  of the provisions of chapter 386.  Notice of intent to impose

 9  such fine shall be given by the department to the alleged

10  violator.  Each day that a violation continues may constitute

11  a separate violation.

12         Section 12.  Subsections (2), (3), (4), and (5) of

13  section 381.0062, Florida Statutes, 1998 Supplement, are

14  amended to read:

15         381.0062  Supervision; private and certain public water

16  systems.--

17         (2)  DEFINITIONS.--As used in this section:

18         (a)  "Contaminant" means any physical, biological,

19  chemical, or radiological substance or matter in water.

20         (b)  "Department" means the Department of Health,

21  including the county health departments.

22         (c)  "Florida Safe Drinking Water Act" means part VI of

23  chapter 403.

24         (d)  "Health hazard" means any condition, contaminant,

25  device, or practice in a water system or its operation which

26  will create or has the potential to create an acute or chronic

27  threat to the health and well-being of the water consumer.

28         (e)  "Limited use commercial public water system" means

29  a public water system not covered or included in the Florida

30  Safe Drinking Water Act, which serves one or more

31  nonresidential establishments and provides piped water.

                                  16
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (f)  "Limited use community public water system" means

 2  a public water system not covered or included in the Florida

 3  Safe Drinking Water Act, which serves five or more private

 4  residences or two or more rental residences, and provides

 5  piped water.

 6         (g)  "Maximum contaminant level" means the maximum

 7  permissible level of a contaminant in potable water delivered

 8  to consumers.

 9         (h)  "Multi-family water system" means a water system

10  that provides piped water to three or four residences, one of

11  which may be a rental residence.

12         (i)(h)  "Person" means an individual, public or private

13  corporation, company, association, partnership, municipality,

14  agency of the state, district, federal, or any other legal

15  entity, or its legal representative, agent, or assignee.

16         (j)(i)  "Potable water" means water that is

17  satisfactory for human consumption, dermal contact, culinary

18  purposes, or dishwashing as approved by the department.

19         (k)(j)  "Private water system" means a water system

20  that provides piped water for one or two no more than four

21  nonrental residences, one of which may be a rental residence.

22         (l)(k)  "Public consumption" means oral ingestion or

23  physical contact with water by a person for any purpose other

24  than cleaning work areas or simple handwashing.  Examples of

25  public consumption include, when making food or beverages

26  available to the general public, water used for washing food,

27  cooking utensils, or food service areas and water used for

28  preparing food or beverages; washing surfaces accessed by

29  children as in a child care center or similar setting; washing

30  medical instruments or surfaces accessed by a patient; any

31  water usage in health care facilities; emergency washing

                                  17
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  devices such as eye washing sinks; washing in food processing

 2  plants or establishments like slaughterhouses and

 3  packinghouses; and water used in schools.

 4         (m)(l)  "Public water system" means a water system that

 5  is not included or covered under the Florida Safe Drinking

 6  Water Act, provides piped water to the public, and is not a

 7  private or multi-family water system. For purposes of this

 8  section, public water systems are classified as limited use

 9  community or limited use commercial.

10         (n)(m)  "Supplier of water" means the person, company,

11  or corporation that owns or operates a limited use community

12  or limited use commercial public water system, a multi-family

13  water system, or a private water system.

14         (o)(n)  "Variance" means a sanction from the department

15  affording a supplier of water an extended time to correct a

16  maximum contaminant level violation caused by the raw water or

17  to deviate from construction standards established by rule of

18  the department.

19         (3)  SUPERVISION.--The department and its agents shall

20  have general supervision and control over all private water

21  systems, multi-family water systems, and public water systems

22  not covered or included in the Florida Safe Drinking Water Act

23  (part VI of chapter 403), and over those aspects of the public

24  water supply program for which it has the duties and

25  responsibilities provided for in part VI of chapter 403.  The

26  department shall:

27         (a)  Administer and enforce the provisions of this

28  section and all rules and orders adopted or issued under this

29  section, including water quality and monitoring standards.

30         (b)  Require any person wishing to construct, modify,

31  or operate a limited use community or limited use commercial

                                  18
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  public water system or a multi-family private water system to

 2  first make application to and obtain approval from the

 3  department on forms adopted by rule of the department.

 4         (c)  Review and act upon any application for the

 5  construction, modification, operation, or change of ownership

 6  of, and conduct surveillance, enforcement, and compliance

 7  investigations of, limited use community and limited use

 8  commercial public water systems, and multi-family private

 9  water systems.

10         (d)  Require a fee from the supplier of water in an

11  amount sufficient to cover the costs of reviewing and acting

12  upon any application for the construction, modification, or

13  operation of a limited use community and limited use

14  commercial public water system, of not less than $10 or more

15  than $90 annually.

16         (e)  Require a fee from the supplier of water in an

17  amount sufficient to cover the costs of reviewing and acting

18  upon any application for the construction or change of

19  ownership of a multi-family private water system serving more

20  than one residence, of not less than $10 or more than $90.

21         (f)  Require a fee from the supplier of water in an

22  amount sufficient to cover the costs of sample collection,

23  review of analytical results, health-risk interpretations, and

24  coordination with other agencies when such work is not

25  included in paragraphs (b) and (c) and is requested by the

26  supplier of water, of not less than $10 or more than $90.

27         (g)  Require suppliers of water to collect samples of

28  water, to submit such samples to a department-certified

29  drinking water laboratory for contaminant analysis, and to

30  keep sampling records as required by rule of the department.

31         (h)  Require all fees collected by the department in

                                  19
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  accordance with the provisions of this section to be deposited

 2  in an appropriate trust fund of the department, and used

 3  exclusively for the payment of costs incurred in the

 4  administration of this section.

 5         (i)  Prohibit any supplier of water from, intentionally

 6  or otherwise, introducing any contaminant which poses a health

 7  hazard into a drinking water system.

 8         (j)  Require suppliers of water to give public notice

 9  of water problems and corrective measures under the conditions

10  specified by rule of the department.

11         (k)  Require a fee to cover the cost of reinspection of

12  any system regulated under this section, which may not be less

13  than $25 or more than $40.

14         (4)  RIGHT OF ENTRY.--For purposes of this section,

15  department personnel may enter, at any reasonable time and if

16  they have reasonable cause to believe a violation of this

17  section is occurring or about to occur, upon any and all parts

18  of the premises of such limited use public and multi-family

19  private drinking water systems serving more than one

20  residence, to make an examination and investigation to

21  determine the sanitary and safety conditions of such systems.

22  Any person who interferes with, hinders, or opposes any

23  employee of the department in the discharge of his or her

24  duties pursuant to the provisions of this section is subject

25  to the penalties provided in s. 381.0025.

26         (5)  ENFORCEMENT AND PENALTIES.--

27         (a)  Any person who constructs, modifies, or operates a

28  limited use community or limited use commercial public water

29  system, a multi-family water system, or a private water

30  system, without first complying with the requirements of this

31  section, who operates a water system in violation of

                                  20
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  department order, or who maintains or operates a water system

 2  after revocation of the permit is guilty of a misdemeanor of

 3  the second degree, punishable as provided in s. 775.082 or s.

 4  775.083.

 5         (b)  This section and rules adopted pursuant to this

 6  section may be enforced by injunction or restraining order

 7  granted by a circuit court as provided in s. 381.0012(2).

 8         (c)  Additional remedies available to county health

 9  department staff through any county or municipal ordinance may

10  be applied, over and above the penalties set forth in this

11  section, to any violation of this section or the rules adopted

12  pursuant to this section.

13         Section 13.  Subsections (3) and (7) of section 381.90,

14  Florida Statutes, are amended to read:

15         381.90  Health Information Systems Council; legislative

16  intent; creation, appointment, duties.--

17         (3)  The council shall be composed of the following

18  members or their senior executive-level designees:

19         (a)  The secretary of the Department of Health;

20         (b)  The secretary of the Department of Business and

21  Professional Regulation;

22         (c)  The secretary of the Department of Children and

23  Family Services;

24         (d)  The director of the Agency for Health Care

25  Administration;

26         (e)  The secretary of the Department of Corrections;

27         (f)  The Attorney General;

28         (g)  The executive director of the Correctional Medical

29  Authority;

30         (h)  Two members representing county health

31  departments, one from a small county and one from a large

                                  21
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  county, appointed by the Governor; and

 2         (i)  A representative from the Florida Association of

 3  Counties;.

 4         (j)  The State Treasurer and Insurance Commissioner;

 5         (k)  A representative from the Florida Healthy Kids

 6  Corporation;

 7         (l)  A representative from a school of public health

 8  chosen by the Board of Regents;

 9         (m)  The Commissioner of Education;

10         (n)  The Secretary of the Department of Elderly

11  Affairs; and

12         (o)  The Secretary of the Department of Juvenile

13  Justice.

14

15  Representatives of the Federal Government may serve without

16  voting rights.

17         (7)  The council's duties and responsibilities include,

18  but are not limited to, the following:

19         (a)  By March 1 of each year, to develop and approve a

20  strategic plan pursuant to the requirements set forth in s.

21  186.022(9). Copies of the plan shall be transmitted

22  electronically or in writing to the Executive Office of the

23  Governor, the Speaker of the House of Representatives, and the

24  President of the Senate.

25         (b)  To develop a mission statement, goals, and plan of

26  action, based on the guiding principles specified in s.

27  282.3032, for the identification, collection, standardization,

28  sharing, and coordination of health-related data across

29  federal, state, and local government and private-sector

30  entities.

31         (c)  To develop a review process to ensure cooperative

                                  22
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  planning among agencies that collect or maintain

 2  health-related data. The council shall submit a report on the

 3  implementation of this requirement to the Executive Office of

 4  the Governor, the President of the Senate, and the Speaker of

 5  the House of Representatives by January 1, 2000.

 6         (d)(c)  To create ad hoc issue-oriented technical

 7  workgroups, on an as-needed basis, to make recommendations to

 8  the council.

 9         Section 14.  Subsection (10) of section 382.003,

10  Florida Statutes, is amended, and subsection (11) is added to

11  that section, to read:

12         382.003  Powers and duties of the department.--The

13  department may:

14         (10)  Adopt, promulgate, and enforce rules necessary

15  for the creation, issuance, recording, rescinding,

16  maintenance, and processing of vital records and for carrying

17  out the provisions of ss. 382.004-382.014 and ss.

18  382.016-382.019.

19         (11)  By rule require that forms, documents, and

20  information submitted to the department in the creation or

21  amendment of a vital record be under oath.

22         Section 15.  Subsection (3) of section 382.004, Florida

23  Statutes, is amended to read:

24         382.004  Reproduction and destruction of records.--

25         (3)  Photographs, microphotographs, or reproductions of

26  any record in the form of film, prints, or electronically

27  produced certifications made in compliance with the provisions

28  of this chapter and certified by the department shall have the

29  same force and effect as the originals thereof, shall be

30  treated as originals for the purpose of their admissibility in

31  any court or case, and shall be prima facie evidence in all

                                  23
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  courts and cases of the facts stated therein.

 2         Section 16.  Subsection (1) of section 382.008, Florida

 3  Statutes, 1998 Supplement, is amended to read:

 4         382.008  Death and fetal death registration.--

 5         (1)  A certificate for each death and fetal death which

 6  occurs in this state shall be filed on a form prescribed by

 7  the department with the local registrar of the district in

 8  which the death occurred within 5 days after such death and

 9  prior to final disposition, and shall be registered by such

10  registrar if it has been completed and filed in accordance

11  with this chapter or adopted rules. The certificate shall

12  include the decedent's social security number, if available.

13  Disclosure of social security numbers obtained through this

14  requirement shall be limited to the purpose of administration

15  of the Title IV-D program for child support enforcement and as

16  otherwise provided by law. In addition, each certificate of

17  death or fetal death:

18         (a)  If requested by the informant, shall include

19  aliases or "also known as" (AKA) names of a decedent in

20  addition to the decedent's name of record.  Aliases shall be

21  entered on the face of the death certificate in the space

22  provided for name if there is sufficient space.  If there is

23  not sufficient space, aliases may be recorded on the back of

24  the certificate and shall be considered part of the official

25  record of death;

26         (b)  If the place of death is unknown, shall be

27  registered in the registration district in which the dead body

28  or fetus is found within 5 days after such occurrence; and

29         (c)  If death occurs in a moving conveyance, shall be

30  registered in the registration district in which the dead body

31  was first removed from such conveyance.

                                  24
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         Section 17.  Subsections (1), (2), and (4) of section

 2  382.013, Florida Statutes, 1998 Supplement, are amended to

 3  read:

 4         382.013  Birth registration.--A certificate for each

 5  live birth that occurs in this state shall be filed within 5

 6  days after such birth with the local registrar of the district

 7  in which the birth occurred and shall be registered by the

 8  local registrar if the certificate has been completed and

 9  filed in accordance with this chapter and adopted rules. The

10  information regarding registered births shall be used for

11  comparison with information in the state case registry, as

12  defined in chapter 61.

13         (1)  FILING.--

14         (a)  If a birth occurs in a hospital, birth center, or

15  other health care facility, or en route thereto, the person in

16  charge of the facility shall be responsible for preparing the

17  certificate, certifying the facts of the birth, and filing the

18  certificate with the local registrar.  Within 48 hours after

19  the birth, the physician, midwife, or person in attendance

20  during or immediately after the delivery shall provide the

21  facility with the medical information required by the birth

22  certificate.

23         (b)  If a birth occurs outside a facility and a

24  physician licensed in this state, a certified nurse midwife, a

25  midwife licensed in this state, or a public health nurse

26  employed by the department was in attendance during or

27  immediately after the delivery, that person shall prepare and

28  file the certificate.

29         (c)  If a birth occurs outside a facility and the

30  delivery is not attended by one of the persons described in

31  paragraph (b), the person in attendance, the mother, or the

                                  25
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  father shall report the birth to the registrar and provide

 2  proof of the facts of birth. The department may require such

 3  documents to be presented and such proof to be filed as it

 4  deems necessary and sufficient to establish the truth of the

 5  facts to be recorded by the certificate and may withhold

 6  registering the birth until its requirements are met. the

 7  child is not taken to the facility within 3 days after

 8  delivery, the certificate shall be prepared and filed by one

 9  of the following persons in the indicated order of priority:

10         1.  The physician or midwife in attendance during or

11  immediately after the birth.

12         2.  In the absence of persons described in subparagraph

13  1., any other person in attendance during or immediately after

14  the birth.

15         3.  In the absence of persons described in subparagraph

16  2., the father or mother.

17         4.  In the absence of the father and the inability of

18  the mother, the person in charge of the premises where the

19  birth occurred.

20         (d)(c)  If a birth occurs in a moving conveyance and

21  the child is first removed from the conveyance in this state,

22  the birth shall be filed and registered in this state and the

23  place to which the child is first removed shall be considered

24  the place of birth.

25         (e)(d)  The mother or the father At least one of the

26  parents of the child shall attest to the accuracy of the

27  personal data entered on the certificate in time to permit the

28  timely registration of the certificate.

29         (f)(e)  If a certificate of live birth is incomplete,

30  the local registrar shall immediately notify the health care

31  facility or person filing the certificate and shall require

                                  26
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  the completion of the missing items of information if they can

 2  be obtained prior to issuing certified copies of the birth

 3  certificate.

 4         (g)(f)  Regardless of any plan to place a child for

 5  adoption after birth, the information on the birth certificate

 6  as required by this section must be as to the child's birth

 7  parents unless and until an application for a new birth record

 8  is made under s. 63.152.

 9         (2)  PATERNITY.--

10         (a)  If the mother is married at the time of birth, the

11  name of the husband shall be entered on the birth certificate

12  as the father of the child, unless paternity has been

13  determined otherwise by a court of competent jurisdiction.

14         (b)  Notwithstanding paragraph (a), if the husband of

15  the mother dies while the mother is pregnant but before the

16  birth of the child, the name of the deceased husband shall be

17  entered on the birth certificate as the father of the child,

18  unless paternity has been determined otherwise by a court of

19  competent jurisdiction.

20         (c)  If the mother is not married at the time of birth,

21  the name of the father may not be entered on the birth

22  certificate without the execution of a consenting affidavit

23  signed by both the mother and the person to be named as the

24  father.  After giving notice orally or through the use of

25  video or audio equipment, and in writing, of the alternatives

26  to, the legal consequences of, and the rights, including, if

27  one parent is a minor, any rights afforded due to minority

28  status, and responsibilities that arise from signing an

29  acknowledgment of paternity, the facility shall provide the

30  mother and the person to be named as the father with the

31  affidavit, as well as information provided by the Title IV-D

                                  27
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  agency established pursuant to s. 409.2557, regarding the

 2  benefits of voluntary establishment of paternity. Upon request

 3  of the mother and the person to be named as the father, the

 4  facility shall assist in the execution of the affidavit.

 5         (d)  If the paternity of the child is determined by a

 6  court of competent jurisdiction as provided under s. 382.015,

 7  the name of the father and the surname of the child shall be

 8  entered on the certificate in accordance with the finding and

 9  order of the court.  If the court fails to specify a surname

10  for the child, the surname shall be entered in accordance with

11  subsection (3).

12         (e)  If the father is not named on the certificate, no

13  other information about the father shall be entered on the

14  certificate.

15         (4)  UNDETERMINED PARENTAGE.--The person having custody

16  of a child of undetermined parentage shall register a birth

17  certificate shall be registered for every child of

18  undetermined parentage showing all known or approximate facts

19  relating to the birth.  To assist in later determination,

20  information concerning the place and circumstances under which

21  the child was found shall be included on the portion of the

22  birth certificate relating to marital status and medical

23  details.  In the event the child is later identified to the

24  satisfaction of the department, a new birth certificate shall

25  be prepared which shall bear the same number as the original

26  birth certificate, and the original certificate shall be

27  sealed and filed, shall be confidential and exempt from the

28  provisions of s. 119.07(1), and shall not be opened to

29  inspection by, nor shall certified copies of the same be

30  issued except by court order to, any person other than the

31  registrant if of legal age.

                                  28
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         Section 18.  Section 382.015, Florida Statutes, is

 2  amended to read:

 3         382.015  New certificates of live birth; duty of clerks

 4  of court and department.--The clerk of the court in which any

 5  proceeding for adoption, annulment of an adoption, affirmation

 6  of parental status, or determination of paternity is to be

 7  registered, shall within 30 days after the final disposition,

 8  forward to the department a certified court-certified copy of

 9  the court order decree, or a report of the proceedings upon a

10  form to be furnished by the department, together with

11  sufficient information to identify the original birth

12  certificate and to enable the preparation of a new birth

13  certificate.

14         (1)  ADOPTION AND ANNULMENT OF ADOPTION.--

15         (a)  Upon receipt of the report or certified copy of an

16  adoption decree, together with the information necessary to

17  identify the original certificate of live birth, and establish

18  a new certificate, the department shall prepare and file a new

19  birth certificate, absent objection by the court decreeing the

20  adoption, the adoptive parents, or the adoptee if of legal

21  age. The certificate shall bear the same file number as the

22  original birth certificate.  All names and identifying

23  information relating to the adoptive parents entered on the

24  new certificate shall refer to the adoptive parents, but

25  nothing in the certificate shall refer to or designate the

26  parents as being adoptive.  All other items not affected by

27  adoption shall be copied as on the original certificate,

28  including the date of registration and filing.

29         (b)  Upon receipt of the report or certified copy of an

30  annulment-of-adoption decree, together with the sufficient

31  information to identify the original certificate of live

                                  29
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  birth, the department shall, if a new certificate of birth was

 2  filed following an adoption report or decree, remove the new

 3  certificate and restore the original certificate to its

 4  original place in the files, and the certificate so removed

 5  shall be sealed by the department.

 6         (c)  Upon receipt of a report or certified copy of an

 7  adoption decree or annulment-of-adoption decree for a person

 8  born in another state, the department shall forward the report

 9  or decree to the state of the registrant's birth.  If the

10  adoptee was born in Canada, the department shall send a copy

11  of the report or decree to the appropriate birth registration

12  authority in Canada.

13         (2)  DETERMINATION OF PATERNITY.--

14         (a)  Upon receipt of the report or a certified copy of

15  a final decree of determination of paternity, or upon written

16  request and receipt of a consenting affidavit signed by both

17  parents acknowledging the paternity of the registrant,

18  together with sufficient information to identify the original

19  certificate of live birth, the department shall prepare and

20  file a new birth certificate which shall bear the same file

21  number as the original birth certificate.  If paternity has

22  been established pursuant to court order, The registrant's

23  name shall be entered as decreed by the court.  Otherwise, the

24  surname of the registrant may be changed from that shown on

25  the original birth certificate at the request of the parents

26  or the registrant if of legal age. The names and identifying

27  information of the parents shall be entered as of the date of

28  the registrant's birth.

29         (b)  If the parents marry each other at any time after

30  the registrant's birth, the department shall, upon request of

31  the parents or registrant if of legal age and proof of the

                                  30
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  marriage, amend the certificate with regard to the parent's

 2  marital status as though the parents were married at the time

 3  of birth.

 4         (c)  If a father's name is already listed on the birth

 5  certificate, the birth certificate may only be amended to add

 6  a different father's name upon court order.  If a change in

 7  the registrant's surname is also desired, such change must be

 8  included in the court order determining paternity or the name

 9  must be changed pursuant to s. 68.07.

10         (3)  AFFIRMATION OF PARENTAL STATUS.--Upon receipt of

11  an order of affirmation of parental status issued pursuant to

12  s. 742.16, together with sufficient information to identify

13  the original certificate of live birth, the department shall

14  prepare and file a new birth certificate which shall bear the

15  same file number as the original birth certificate.  The names

16  and identifying information of the registrant's parents

17  entered on the new certificate shall be the commissioning

18  couple, but the new certificate may not make reference to or

19  designate the parents as the commissioning couple.

20         (4)  SUBSTITUTION OF NEW CERTIFICATE OF BIRTH FOR

21  ORIGINAL.--When a new certificate of birth is prepared, the

22  department shall substitute the new certificate of birth for

23  the original certificate on file.  All copies of the original

24  certificate of live birth in the custody of a local registrar

25  or other state custodian of vital records shall be forwarded

26  to the State Registrar.  Thereafter, when a certified copy of

27  the certificate of birth of such person or portion thereof is

28  issued, it shall be a copy of the new certificate of birth or

29  portion thereof, except when a court order requires issuance

30  of a certified copy of the original certificate of birth. In

31  an adoption, change in paternity, affirmation of parental

                                  31
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  status, undetermined parentage, or court-ordered substitution,

 2  the department shall place the original certificate of birth

 3  and all papers pertaining thereto under seal, not to be broken

 4  except by order of a court of competent jurisdiction or as

 5  otherwise provided by law.

 6         (5)  FORM.--Except for certificates of foreign birth

 7  which are registered as provided in s. 382.017, and delayed

 8  certificates of birth which are registered as provided in ss.

 9  382.019 and 382.0195, all original, new, or amended

10  certificates of live birth shall be identical in form,

11  regardless of the marital status of the parents or the fact

12  that the registrant is adopted or of undetermined parentage.

13         (6)  RULES.--The department shall adopt and enforce all

14  rules necessary for carrying out the provisions of this

15  section.

16         Section 19.  Subsections (3), (4), and (5) are added to

17  section 382.016, Florida Statutes, to read:

18         382.016  Amendment of records.--

19         (3)  Upon written request and receipt of an affidavit

20  signed by the mother and father acknowledging the paternity of

21  a registrant born out of wedlock, together with sufficient

22  information to identify the original certificate of live

23  birth, the department shall prepare a new birth certificate,

24  which shall bear the same file number as the original birth

25  certificate. The names and identifying information of the

26  parents shall be entered as of the date of the registrant's

27  birth. The surname of the registrant may be changed from that

28  shown on the original birth certificate at the request of the

29  mother and father of the registrant, or the registrant if of

30  legal age. If the mother and father marry each other at any

31  time after the registrant's birth, the department shall, upon

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  the request of the mother and father or registrant if of legal

 2  age and proof of the marriage, amend the certificate with

 3  regard to the parents' marital status as though the parents

 4  were married at the time of birth.

 5         (4)  When a new certificate of birth is prepared

 6  pursuant to subsection (3), the department shall substitute

 7  the new certificate of birth for the original certificate on

 8  file. All copies of the original certificate of live birth in

 9  the custody of a local registrar or other state custodian of

10  vital records shall be forwarded to the State Registrar.

11  Thereafter, when a certified copy of the certificate of birth

12  or portion thereof is issued, it shall be a copy of the new

13  certificate of birth or portion thereof, except when a court

14  order requires issuance of a certified copy of the original

15  certificate of birth. The department shall place the original

16  certificate of birth and all papers pertaining thereto under

17  seal, not to be broken except by order of a court of competent

18  jurisdiction or as otherwise provided by law.

19         (5)  If a father's name is listed on the birth

20  certificate, the birth certificate may only be amended to

21  remove the father's name or to add a different father's name

22  upon court order. If a change in the registrant's surname is

23  also desired, such change must be included in the court order

24  or the name must be changed pursuant to s. 68.07.

25         Section 20.  Section 382.019, Florida Statutes, is

26  amended to read:

27         382.019  Delayed registration; administrative

28  procedures.--

29         (1)  Registration after 1 year is a delayed

30  registration, and the department may, upon receipt of an

31  application and the fee required under s. 382.0255, and proof

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  of the birth, death, or fetal death as prescribed by this

 2  section or rule, register a delayed certificate if the

 3  department does not already have a certificate of the birth,

 4  death, or fetal death on file.

 5         (2)  The department may require such supporting

 6  documents to be presented and such proof to be filed as it

 7  deems necessary and sufficient to establish the truth of the

 8  facts to be recorded by the certificate, and may withhold

 9  registering the birth, death, or fetal death certificate until

10  its requirements are met.

11         (3)  Certificates registered under this section are

12  admissible as prima facie evidence of the facts recited

13  therein with like force and effect as other vital records

14  received or admitted in evidence.

15         (4)  A delayed certificate of birth filed under this

16  section shall include a summary statement of the evidence

17  submitted in support of the delayed registration.

18         (5)  A delayed certificate of birth submitted for

19  registration under this section shall be signed before a

20  notarizing official by the registrant if of legal age, or by

21  the parent or guardian of a minor registrant.

22         (6)  A person may not establish more than one birth

23  certificate, and a delayed certificate of birth may not be

24  registered for a deceased person.

25         (7)  A delayed death or fetal death record shall be

26  registered on a certificate of death or fetal death and marked

27  "delayed."

28         (8)  In addition to the rulemaking authority found at

29  s. 382.003(10), the department may, by rule, provide for the

30  dismissal of an application that is not pursued within 1 year.

31         Section 21.  Subsections (1) and (2) of section

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  382.025, Florida Statutes, are amended to read:

 2         382.025  Certified copies of vital records;

 3  confidentiality; research.--

 4         (1)  BIRTH RECORDS.--Except for birth records over 100

 5  years old which are not under seal pursuant to court order,

 6  all birth records of this state shall be confidential and are

 7  exempt from the provisions of s. 119.07(1).

 8         (a)  Certified copies of the original birth certificate

 9  or a new or amended certificate, or affidavits thereof, are

10  confidential and exempt from the provisions of s. 119.07(1)

11  and, upon receipt of a request and payment of the fee

12  prescribed in s. 382.0255, shall be issued only as authorized

13  by the department and in the form prescribed by the

14  department, and only:

15         1.  To the registrant, if of legal age;

16         2.  To the registrant's parent or guardian or other

17  legal representative;

18         3.  Upon receipt of the registrant's death certificate,

19  to the registrant's spouse or to the registrant's child,

20  grandchild, or sibling, if of legal age, or to the legal

21  representative of any of such persons;

22         4.  To any person if the birth record is over 100 years

23  old and not under seal pursuant to court order;

24         5.  To a law enforcement agency for official purposes;

25         6.  To any agency of the state or the United States for

26  official purposes upon approval of the department; or

27         7.  Upon order of any court of competent jurisdiction.

28         (b)  To protect the integrity of vital records and

29  prevent the fraudulent use of the birth certificates of

30  deceased persons, the department shall match birth and death

31  certificates and post the fact of death to the appropriate

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  birth certificate.  Except for a commemorative birth

 2  certificate, any A certification of a birth certificate of a

 3  deceased registrant shall be marked "deceased." In the case of

 4  a commemorative birth certificate, such indication of death

 5  shall be made on the back of the certificate.

 6         (c)  The department shall issue, upon request and upon

 7  payment of an additional fee as prescribed under s. 382.0255,

 8  a commemorative birth certificate representing that the birth

 9  of the person named thereon is recorded in the office of the

10  registrar. The certificate issued under this paragraph shall

11  be in a form consistent with the need to protect the integrity

12  of vital records but shall be suitable for display.  It may

13  bear the seal of the state printed thereon and may be signed

14  by the Governor.

15         (2)  OTHER RECORDS.--

16         (a)  The department shall authorize the issuance of a

17  certified copy of all or part of any marriage, dissolution of

18  marriage, or death or fetal death certificate, excluding that

19  portion which is confidential and exempt from the provisions

20  of s. 119.07(1) as provided under s. 382.008, to any person

21  requesting it upon receipt of a request and payment of the fee

22  prescribed by this section.  A certification of the death or

23  fetal death certificate which includes the confidential

24  portions shall be issued only:

25         1.  To the registrant's spouse or parent, or to the

26  registrant's child, grandchild, or sibling, if of legal age,

27  or to any person family member who provides a will that has

28  been executed pursuant to s. 732.502, insurance policy, or

29  other document that demonstrates his or her the family

30  member's interest in the estate of the registrant, or to any

31  person who provides documentation that he or she is acting on

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  behalf of any of them;

 2         2.  To any agency of the state or local government or

 3  the United States for official purposes upon approval of the

 4  department; or

 5         3.  Upon order of any court of competent jurisdiction.

 6         (b)  All portions of a certificate of death shall cease

 7  to be exempt from the provisions of s. 119.07(1) 50 years

 8  after the date of death.

 9         (c)  The department shall issue, upon request and upon

10  payment of an additional fee prescribed by this section, a

11  commemorative marriage license representing that the marriage

12  of the persons named thereon is recorded in the office of the

13  registrar.  The certificate issued under this paragraph shall

14  be in a form consistent with the need to protect the integrity

15  of vital records but shall be suitable for display.  It may

16  bear the seal of the state printed thereon and may be signed

17  by the Governor.

18         Section 22.  Subsection (2) of section 382.0255,

19  Florida Statutes, is amended to read:

20         382.0255  Fees.--

21         (2)  The fee charged for each request for a

22  certification of a birth record issued by the department or by

23  the local registrar shall be subject to an additional fee of

24  $4 which shall be deposited in the appropriate departmental

25  trust fund. On a quarterly basis, the department shall

26  transfer $2 of this additional fee to the General Revenue Fund

27  and $1.50 to the Child Welfare Training Trust Fund created in

28  s. 402.40. Fifty cents of the fee shall be available for

29  appropriation to the department for administration of this

30  chapter.

31         Section 23.  Paragraph (e) of subsection (3) and

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  subsection (5) of section 383.14, Florida Statutes, are

 2  amended to read:

 3         383.14  Screening for metabolic disorders, other

 4  hereditary and congenital disorders, and environmental risk

 5  factors.--

 6         (3)  DEPARTMENT OF HEALTH; POWERS AND DUTIES.--The

 7  department shall administer and provide certain services to

 8  implement the provisions of this section and shall:

 9         (e)  Supply the necessary dietary treatment products

10  where practicable for diagnosed cases of phenylketonuria and

11  other metabolic diseases for as long as medically indicated

12  when the products are not otherwise available. Provide

13  nutrition education and supplemental foods to those families

14  eligible for the Special Supplemental Nutrition Food Program

15  for Women, Infants, and Children as provided in s. 383.011.

16

17  All provisions of this subsection must be coordinated with the

18  provisions and plans established under this chapter, chapter

19  411, and Pub. L. No. 99-457.

20         (5)  ADVISORY COUNCIL.--There is established a Genetics

21  and Infant Screening Advisory Council made up of 12 members

22  appointed by the Secretary of Health.  The council shall be

23  composed of two consumer members, three practicing

24  pediatricians, at least one of whom must be a pediatric

25  hematologist, one representative from each of the four medical

26  schools in the state, the Secretary of Health or his or her

27  designee, one representative from the Department of Health

28  representing Division of Children's Medical Services, and one

29  representative from the Developmental Services Program Office

30  of the Department of Children and Family Services. All

31  appointments shall be for a term of 4 years.  The chairperson

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  of the council shall be elected from the membership of the

 2  council and shall serve for a period of 2 years.  The council

 3  shall meet at least semiannually or upon the call of the

 4  chairperson.  The council may establish ad hoc or temporary

 5  technical advisory groups to assist the council with specific

 6  topics which come before the council.  Council members shall

 7  serve without pay. Pursuant to the provisions of s. 112.061,

 8  the council members are entitled to be reimbursed for per diem

 9  and travel expenses.  It is the purpose of the council to

10  advise the department about:

11         (a)  Conditions for which testing should be included

12  under the screening program and the genetics program;

13         (b)  Procedures for collection and transmission of

14  specimens and recording of results; and

15         (c)  Methods whereby screening programs and genetics

16  services for children now provided or proposed to be offered

17  in the state may be more effectively evaluated, coordinated,

18  and consolidated.

19         Section 24.  Subsection (4) of section 385.202, Florida

20  Statutes, is amended to read:

21         385.202  Statewide cancer registry.--

22         (4)  Funds appropriated for this section shall be used

23  for establishing, administering, compiling, processing, and

24  providing biometric and statistical analyses to the reporting

25  facilities.  Funds may also be used to ensure the quality and

26  accuracy of the information reported and to provide management

27  information to the reporting facilities.  Such reporting

28  hospitals shall be reimbursed for reasonable costs.

29         Section 25.  Section 385.203, Florida Statutes, is

30  amended to read:

31         385.203  Diabetes Advisory Council; creation; function;

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  membership.--

 2         (1)  To guide a statewide comprehensive approach to

 3  diabetes prevention, diagnosis, education, care, treatment,

 4  impact, and costs thereof, there is created a Diabetes

 5  Advisory Council that serves as the advisory unit to the

 6  diabetes centers, the Board of Regents, and the Department of

 7  Health, other governmental agencies, professional and other

 8  organizations, and the general public.  The council shall:

 9         (a)  Provide statewide leadership to continuously

10  improve the lives of Floridians with diabetes and reduce the

11  burden of diabetes.

12         (b)  Serve as a forum for the discussion and study of

13  issues related to the public health approach for the delivery

14  of health care services to persons with diabetes.

15         (b)  Provide advice and consultation to the deans of

16  the medical schools in which are located diabetes centers, and

17  by June 30 of each year, the council shall submit written

18  recommendations to the deans regarding the need for diabetes

19  education, treatment, and research activities to promote the

20  prevention and control of diabetes.

21         (c)  By June 30 of each year, meet with the Secretary

22  of Health or his or her designee to make specific

23  recommendations regarding the public health aspects of the

24  prevention and control of diabetes.

25         (2)  The members of the council shall be appointed by

26  the Governor with advice from nominations by the Board of

27  Regents, the Board of Trustees of the University of Miami, and

28  the Secretary of Health. Members shall serve 4-year terms or

29  until their successors are appointed or qualified.

30         (3)  The council shall be composed of 25 18 citizens of

31  the state who have knowledge of, or work in the area of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  diabetes mellitus as follows:

 2         (a)  Five interested citizens, three of whom are

 3  affected by diabetes.

 4         (b)  Twenty members, who must include one

 5  representative from each of the following areas: nursing with

 6  diabetes-educator certification; dietary with diabetes

 7  educator certification; podiatry; opthalmology or optometry;

 8  psychology; pharmacy; adult endocrinology; pediatric

 9  endocrinology; the American Diabetes Association (ADA); the

10  Juvenile Diabetes Foundation (JDF); a community health center;

11  a county health department; an American Diabetes

12  Association-recognized community education program; each

13  medical school in the state; an osteopathic medical school;

14  the insurance industry; a Children's Medical Services diabetes

15  regional program; and an employer.

16         (c)  One or more representatives from the Department of

17  Health, who shall serve on the council as ex officio members.

18  four practicing physicians; one representative from each

19  medical school; seven interested citizens, at least three of

20  whom shall be persons who have or have had diabetes mellitus

21  or who have a child with diabetes mellitus; the Secretary of

22  Health or his or her designee; one representative from the

23  Division of Children's Medical Services of the Department of

24  Health; and one professor of nutrition.

25         (4)(a)  The council shall annually elect from its

26  members a chair and vice chair a secretary.  The council shall

27  meet at the chair's discretion; however, at least three

28  meetings shall be held each year.

29         (b)  In conducting its meetings, the council shall use

30  accepted rules of procedure.  A majority of the members of the

31  council constitutes a quorum, and action by a majority of a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  quorum is necessary for the council to take any official

 2  action.  The Department of Health secretary shall keep a

 3  complete record of the proceedings of each meeting.  The

 4  record shall show the names of the members present and the

 5  actions taken.  The records shall be kept on file with the

 6  department, and these and other documents about matters within

 7  the jurisdiction of the council may be inspected by members of

 8  the council.

 9         (5)  Members of the council shall serve without

10  remuneration but may be reimbursed for per diem and travel

11  expenses as provided in s. 112.061, to the extent resources

12  are available.

13         (6)  The department shall serve as an intermediary for

14  the council if the council coordinates, applies for, or

15  accepts any grants, funds, gifts, or services made available

16  to it by any agency or department of the Federal Government,

17  or any private agency or individual, for assistance in the

18  operation of the council or the diabetes centers established

19  in the various medical schools.

20         Section 26.  Section 391.028, Florida Statutes, 1998

21  Supplement, is amended to read:

22         391.028  Administration.--The Children's Medical

23  Services program shall have a central office and area offices.

24         (1)  The Director of the Division of Children's Medical

25  Services must be a physician licensed under chapter 458 or

26  chapter 459 who has specialized training and experience in the

27  provision of health care to children and who has recognized

28  skills in leadership and the promotion of children's health

29  programs. The division director shall be the deputy secretary

30  and the Deputy State Health Officer for Children's Medical

31  Services and is appointed by and reports to the secretary. The

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  director may appoint division directors subject to the

 2  approval of the secretary.

 3         (2)  The division director shall designate Children's

 4  Medical Services area offices to perform operational

 5  activities, including, but not limited to:

 6         (a)  Providing case management services for the

 7  network.

 8         (b)  Providing local oversight of the program.

 9         (c)  Determining an individual's medical and financial

10  eligibility for the program.

11         (d)  Participating in the determination of a level of

12  care and medical complexity for long-term care services.

13         (e)  Authorizing services in the program and developing

14  spending plans.

15         (f)  Participating in the development of treatment

16  plans.

17         (g)  Taking part in the resolution of complaints and

18  grievances from participants and health care providers.

19         (3)  Each Children's Medical Services area office shall

20  be directed by a physician licensed under chapter 458 or

21  chapter 459 who has specialized training and experience in the

22  provision of health care to children.  The director of a

23  Children's Medical Services area office shall be appointed by

24  the division director from the active panel of Children's

25  Medical Services physician consultants.

26         Section 27.  Section 391.0315, Florida Statutes, 1998

27  Supplement, is amended to read:

28         391.0315  Benefits.--Benefits provided under the

29  program for children with special health care needs shall be

30  the same benefits provided to children as specified in ss.

31  409.905 and 409.906. The department may offer additional

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  benefits for early intervention services, respite services,

 2  genetic testing, genetic and nutritional counseling, and

 3  parent support services, if such services are determined to be

 4  medically necessary. No child or person determined eligible

 5  for the program who is eligible under Title XIX or Title XXI

 6  of the Social Security Act shall receive any service other

 7  than an initial health care screening or treatment of an

 8  emergency medical condition as defined in s. 395.002, until

 9  such child or person is enrolled in Medicaid or a Title XXI

10  program.

11         Section 28.  Subsection (3) of section 392.69, Florida

12  Statutes, is amended, and subsection (4) is added to that

13  section, to read:

14         392.69  Appropriation, sinking, and maintenance trust

15  funds; additional powers of the department.--

16         (3)  In the execution of its public health program

17  functions, notwithstanding s. 216.292(5)(b), the department is

18  hereby authorized to use any sums of money which it may

19  heretofore have saved or which it may hereafter save from its

20  regular operating appropriation, or use any sums of money

21  acquired by gift or grant, or any sums of money it may acquire

22  by the issuance of revenue certificates of the hospital to

23  match or supplement any state or federal funds, or any moneys

24  received by said department by gift or otherwise, for the

25  construction or maintenance of additional facilities or

26  improvement to existing facilities, as the department deems

27  necessary.

28         (4)  The department shall appoint an advisory board,

29  which shall meet quarterly to review and make recommendations

30  relating to patient care at A. G. Holley State Hospital.

31  Members shall be appointed for terms of 3 years, with such

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  appointments being staggered so that terms of no more than two

 2  members expire in any one year. Members shall serve without

 3  compensation, but they are entitled to be reimbursed for per

 4  diem and travel expenses under s. 112.061.

 5         Section 29.  Subsection (7) of section 401.25, Florida

 6  Statutes, is added to read:

 7         401.25  Licensure as a basic life support or an

 8  advanced life support service.--

 9         (7)(a)  Each permitted basic life support ambulance not

10  specifically exempted from this part, when transporting a

11  person who is sick, injured, wounded, incapacitated, or

12  helpless, must be occupied by at least two persons: one

13  patient attendant who is a certified emergency medical

14  technician, certified paramedic, or licensed physician; and

15  one ambulance driver who meets the requirements of s. 401.281.

16  This paragraph does not apply to interfacility transfers

17  governed by s. 401.252(1).

18         (b)  Each permitted advanced life support ambulance not

19  specifically exempted from this part, when transporting a

20  person who is sick, injured, wounded, incapacitated, or

21  helpless must be occupied by at least two persons: one who is

22  a certified paramedic or licensed physician; and one who is a

23  certified emergency medical technician, certified paramedic,

24  or licensed physician who also meets the requirements of s.

25  401.281 for drivers. The person with the highest medical

26  certifications shall be in charge of patient care. This

27  paragraph does not apply to interfacility transfers governed

28  by s. 401.252(1).

29         Section 30.  Subsection (3) of section 401.27, Florida

30  Statutes, is amended to read:

31         401.27  Personnel; standards and certification.--

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (3)  Any person who desires to be certified or

 2  recertified as an emergency medical technician or paramedic

 3  must apply to the department under oath on forms provided by

 4  the department which shall contain such information as the

 5  department reasonably requires, which may include affirmative

 6  evidence of ability to comply with applicable laws and rules.

 7  The department shall determine whether the applicant meets the

 8  requirements specified in this section and in rules of the

 9  department and shall issue a certificate to any person who

10  meets such requirements.

11         Section 31.  Section 401.2701, Florida Statutes, is

12  created to read:

13         401.2701  Emergency medical services training

14  programs.--

15         (1)  Any private or public institution in Florida

16  desiring to conduct an approved program for the education of

17  emergency medical technicians and paramedics shall:

18         (a)  Submit a completed application on a form provided

19  by the department, which must include:

20         1.  Evidence that the institution is in compliance with

21  all applicable requirements of the Department of Education.

22         2.  Evidence of an affiliation agreement with a

23  hospital that has an emergency department staffed by at least

24  one physician and one registered nurse.

25         3.  Evidence of an affiliation agreement with a current

26  Florida-licensed emergency medical services provider. Such

27  agreement shall include, at a minimum, a commitment by the

28  provider to conduct the field experience portion of the

29  education program.

30         4.  Documentation verifying faculty, including:

31         a.  A medical director who is a licensed physician

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  meeting the applicable requirements for emergency medical

 2  services medical directors as outlined in this chapter and

 3  rules of the department. The medical director shall have the

 4  duty and responsibility of certifying that graduates have

 5  successfully completed all phases of the education program and

 6  are proficient in basic or advanced life support techniques,

 7  as applicable.

 8         b.  A program director responsible for the operation,

 9  organization, periodic review, administration, development,

10  and approval of the program.

11         5.  Documentation verifying that the curriculum:

12         a.  Meets the course guides and instructor's lesson

13  plans in the most recent Emergency Medical Technician-Basic

14  National Standard Curricula for emergency medical technician

15  programs and Emergency Medical Technician-Paramedic National

16  Standard Curricula for paramedic programs.

17         b.  Includes 2 hours of instruction on the trauma

18  scorecard methodologies for assessment of adult trauma

19  patients and pediatric trauma patients as specified by the

20  department by rule.

21         c.  Includes 4 hours of instruction on HIV/AIDS

22  training consistent with the requirements of chapter 381.

23         6.  Evidence of sufficient medical and educational

24  equipment to meet emergency medical services training program

25  needs.

26         (b)  Receive a scheduled site visit from the department

27  to the applicant's institution. Such site visit shall be

28  conducted within 30 days after notification to the institution

29  that the application was accepted. During the site visit, the

30  department must determine the applicant's compliance with the

31  following criteria:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         1.  Emergency medical technician programs must be a

 2  minimum of 110 hours, with at least 20 hours of supervised

 3  clinical supervision, including 10 hours in a hospital

 4  emergency department.

 5         2.  Paramedic programs must be available only to

 6  Florida-certified emergency medical technicians or an

 7  emergency medical technician applicant who will obtain Florida

 8  certification prior to completion of phase one of the

 9  paramedic program. Paramedic programs must be a minimum of 700

10  hours of didactic and skills practice components, with the

11  skills laboratory student-to-instructor ratio not exceeding

12  six to one. Paramedic programs must provide a field internship

13  experience aboard an advanced life support permitted

14  ambulance.

15         (2)  After completion of the site visit, the department

16  shall prepare a report which shall be provided to the

17  institution. Upon completion of the report, the application

18  shall be deemed complete and the provisions of s. 120.60,

19  shall apply.

20         (3)  If the program is approved, the department must

21  issue the institution a 2-year certificate of approval as an

22  emergency medical technician training program or a paramedic

23  training program. If the application is denied, the department

24  must notify the applicant of any areas of strength, areas

25  needing improvement, and any suggested means of improvement of

26  the program. A denial notification shall be provided to the

27  applicant so as to allow the applicant 5 days prior to the

28  expiration of the application processing time in s. 120.60 to

29  advise the department in writing of its intent to submit a

30  plan of correction. Such intent notification shall provide the

31  time for application processing in s. 120.60. The plan of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  correction must be submitted to the department within 30 days

 2  of the notice. The department shall advise the applicant of

 3  its approval or denial of the plan of correction within 30

 4  days of receipt. The denial of the plan of correction or

 5  denial of the application may be reviewed as provided in

 6  chapter 120.

 7         (4)  Approved emergency medical services training

 8  programs must maintain records and reports that must be made

 9  available to the department, upon written request. Such

10  records must include student applications, records of

11  attendance, records of participation in hospital clinic and

12  field training, medical records, course objectives and

13  outlines, class schedules, learning objectives, lesson plans,

14  number of applicants, number of students accepted, admission

15  requirements, description of qualifications, duties and

16  responsibilities of faculty, and correspondence.

17         (5)  Each approved program must notify the department

18  within 30 days of any change in the professional or employment

19  status of faculty. Each approved program must require its

20  students to pass a comprehensive final written and practical

21  examination evaluating the skills described in the current

22  United States Department of Transportation EMT-Basic or

23  EMT-Paramedic, National Standard Curriculum. Each approved

24  program must issue a certificate of completion to program

25  graduates within 14 days of completion.

26         Section 32.  Section 401.2715, Florida Statutes, is

27  created to read:

28         401.2715  Recertification training of emergency medical

29  technicians and paramedics.--

30         (1)  The department shall establish by rule criteria

31  for all emergency medical technician and paramedic

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  recertification training. The rules shall provide that all

 2  recertification training equals at least 30 hours, includes

 3  the performance parameters for adult and pediatric emergency

 4  medical clinical care, and is documented through a system of

 5  recordkeeping.

 6         (2)  Any individual, institution, school, corporation,

 7  or governmental entity may conduct emergency medical

 8  technician or paramedic recertification training upon

 9  application to the department and payment of a nonrefundable

10  fee to be deposited into the Emergency Medical Services Trust

11  Fund. Institutions conducting department-approved educational

12  programs as provided in this chapter and licensed ambulance

13  services are exempt from the application process and payment

14  of fees. The department shall adopt rules for the application

15  and payment of a fee not to exceed the actual cost of

16  administering this approval process.

17         (3)  To be eligible for recertification as provided in

18  s. 401.27, certified emergency medical technicians and

19  paramedics must provide proof of completion of training

20  conducted pursuant to this section. The department shall

21  accept the written affirmation of a licensee's or a

22  department-approved educational program's medical director as

23  documentation that the certificateholder has completed a

24  minimum of 30 hours of recertification training as provided

25  herein.

26         Section 33.  Present subsections (2), (3), and (4) of

27  section 401.30, Florida Statutes, 1998 Supplement, are

28  renumbered as subsections (3), (4), and (5), respectively, and

29  a new subsection (2) is added to said section, to read:

30         401.30  Records.--

31         (2)  Each licensee must provide the receiving hospital

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  with a copy of an individual patient care record for each

 2  patient who is transported to the hospital. The information

 3  contained in the record and the method and timeframe for

 4  providing the record shall be prescribed by rule of the

 5  department.

 6         (3)(2)  Reports to the department from licensees which

 7  cover statistical data are public records, except that the

 8  names of patients and other patient-identifying information

 9  contained in such reports are confidential and exempt from the

10  provisions of s. 119.07(1).  Any record furnished by a

11  licensee at the request of the department must be a true and

12  certified copy of the original record and may not be altered

13  or have information deleted.

14         (4)(3)  Records of emergency calls which contain

15  patient examination or treatment information are confidential

16  and exempt from the provisions of s. 119.07(1) and may not be

17  disclosed without the consent of the person to whom they

18  pertain, but appropriate limited disclosure may be made

19  without such consent:

20         (a)  To the person's guardian, to the next of kin if

21  the person is deceased, or to a parent if the person is a

22  minor;

23         (b)  To hospital personnel for use in conjunction with

24  the treatment of the patient;

25         (c)  To the department;

26         (d)  To the service medical director;

27         (e)  For use in a critical incident stress debriefing.

28  Any such discussions during a critical incident stress

29  debriefing shall be considered privileged communication under

30  s. 90.503;

31         (f)  In any civil or criminal action, unless otherwise

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  prohibited by law, upon the issuance of a subpoena from a

 2  court of competent jurisdiction and proper notice by the party

 3  seeking such records, to the patient or his or her legal

 4  representative; or

 5         (g)  To a local trauma agency or a regional trauma

 6  agency, or a panel or committee assembled by such an agency to

 7  assist the agency in performing quality assurance activities

 8  in accordance with a plan approved under s. 395.401. Records

 9  obtained under this paragraph are confidential and exempt from

10  s. 119.07(1) and s. 24(a), Art. I of the State Constitution.

11

12  This subsection does not prohibit the department or a licensee

13  from providing information to any law enforcement agency or

14  any other regulatory agency responsible for the regulation or

15  supervision of emergency medical services and personnel.

16         (5)(4)  The department shall adopt and enforce all

17  rules necessary to administer this section.

18         Section 34.  Paragraph (l) is added to subsection (1)

19  of section 401.35, Florida Statutes, and paragraph (i) is

20  added to subsection (2) of said section, to read:

21         401.35  Rules.--The department shall adopt rules

22  necessary to carry out the purposes of this part.

23         (1)  The rules must provide at least minimum standards

24  governing:

25         (l)  Licensees' security and storage of controlled

26  substances, medications, and fluids, not inconsistent with the

27  provisions of chapter 499 or chapter 893.

28         (2)  The rules must establish application requirements

29  for licensure and certification.  Pursuant thereto, the

30  department must develop application forms for basic life

31  support services and advanced life support services.  An

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  application for each respective service license must include,

 2  but is not limited to:

 3         (i)  An oath, upon forms provided by the department

 4  which shall contain such information as the department

 5  reasonably requires, which may include affirmative evidence of

 6  ability to comply with applicable laws and rules.

 7         Section 35.  Subsection (3) of section 409.9126,

 8  Florida Statutes, 1998 Supplement, is amended to read:

 9         409.9126  Children with special health care needs.--

10         (3)  Services provided through the Children's Medical

11  Services network shall be reimbursed on a fee-for-service

12  basis and shall utilize a primary care case management

13  process. Beginning July 1, 1999, the Florida Medicaid program

14  shall phase in by geographical area, capitation payments to

15  Children's Medical Services for services provided to Medicaid

16  children with special healthcare needs. By January 1, 2001,

17  the Agency for Health Care Administration shall make

18  capitation payments for Children's Medical Services enrollees

19  statewide, to the extent provided by federal law. However,

20  effective July 1, 1999, reimbursement to the Children's

21  Medical Services program for services provided to

22  Medicaid-eligible children with special health care needs

23  through the Children's Medical Services network shall be on a

24  capitated basis.

25         Section 36.  Paragraph (a) of subsection (2) of section

26  465.019, Florida Statutes, 1998 Supplement, is amended to

27  read:

28         465.019  Institutional pharmacies; permits.--

29         (2)  The following classes of institutional pharmacies

30  are established:

31         (a)  "Class I institutional pharmacies" are those

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  institutional pharmacies in which all medicinal drugs are

 2  administered from individual prescription containers to the

 3  individual patient and in which medicinal drugs are not

 4  dispensed on the premises, except that nursing homes licensed

 5  under part II of chapter 400 may purchase medical oxygen for

 6  administration to residents. No medicinal drugs may be

 7  dispensed in a Class I institutional pharmacy.

 8         Section 37.  Subsections (14), (15), (16), (19), and

 9  (22) of section 499.005, Florida Statutes, 1998 Supplement,

10  are amended, and subsection (24) is added to that section, to

11  read:

12         499.005  Prohibited acts.--It is unlawful to perform or

13  cause the performance of any of the following acts in this

14  state:

15         (14)  The purchase or receipt of a legend drug from a

16  person that is not authorized under this chapter the law of

17  the state in which the person resides to distribute legend

18  drugs.

19         (15)  The sale or transfer of a legend drug to a person

20  that is not authorized under the law of the jurisdiction in

21  which the person receives the drug resides to purchase or

22  possess legend drugs.

23         (16)  The purchase or receipt of a compressed medical

24  gas from a person that is not authorized under this chapter

25  the law of the state in which the person resides to distribute

26  compressed medical gases.

27         (19)  Providing the department with false or fraudulent

28  records, or making false or fraudulent statements, regarding

29  any matter within the provisions of this chapter a drug,

30  device, or cosmetic.

31         (22)  Failure to obtain a permit or registration, or

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  operating without a valid permit when a permit or registration

 2  is, as required by ss. 499.001-499.081 for that activity.

 3         (24)  The distribution of a legend device to the

 4  patient or ultimate consumer without a prescription or order

 5  from a practitioner licensed by law to use or prescribe the

 6  device.

 7         Section 38.  Subsection (13) of section 499.007,

 8  Florida Statutes, is amended to read:

 9         499.007  Misbranded drug or device.--A drug or device

10  is misbranded:

11         (13)  If it is a drug that is subject to paragraph

12  (12)(a), and if, at any time before it is dispensed, its label

13  fails to bear the statement:

14         (a)  "Caution:  Federal Law Prohibits Dispensing

15  Without Prescription"; or

16         (b)  "Rx Only";

17         (c)  The prescription symbol followed by the word

18  "Only"; or

19         (d)(b)  "Caution:  State Law Prohibits Dispensing

20  Without Prescription."

21

22  A drug dispensed by filling or refilling a written or oral

23  prescription of a practitioner licensed by law to prescribe

24  such drug is exempt from the requirements of this section,

25  except subsections (1), (8), (10), and (11) and the packaging

26  requirements of subsections (6) and (7), if the drug bears a

27  label that contains the name and address of the dispenser or

28  seller, the prescription number and the date the prescription

29  was written or filled, the name of the prescriber and the name

30  of the patient, and the directions for use and cautionary

31  statements.  This exemption does not apply to any drug

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  dispensed in the course of the conduct of a business of

 2  dispensing drugs pursuant to diagnosis by mail or to any drug

 3  dispensed in violation of subsection (12).  The department

 4  may, by rule, exempt drugs subject to ss. 499.062-499.064 from

 5  subsection (12) if compliance with that subsection is not

 6  necessary to protect the public health, safety, and welfare.

 7         Section 39.  Subsection (15) of section 499.028,

 8  Florida Statutes, is amended to read:

 9         499.028  Drug samples or complimentary drugs; starter

10  packs; permits to distribute.--

11         (15)  A person may not possess a prescription drug

12  sample unless:

13         (a)  The drug sample was prescribed to her or him as

14  evidenced by the label required in s. 465.0276(5).

15         (b)  She or he is the employee of a complimentary drug

16  distributor that holds a permit issued under ss.

17  499.001-499.081.

18         (c)  She or he is a person to whom prescription drug

19  samples may be distributed pursuant to this section.

20         (d)  He or she is an officer or employee of a federal,

21  state, or local government acting within the scope of his or

22  her employment.

23         Section 40.  Subsection (1) of section 499.069, Florida

24  Statutes, is amended to read:

25         499.069  Punishment for violations of s. 499.005;

26  dissemination of false advertisement.--

27         (1)  Any person who violates any of the provisions of

28  s. 499.005 is guilty of a misdemeanor of the second degree,

29  punishable as provided in s. 775.082 or s. 775.083; but, if

30  the violation is committed after a conviction of such person

31  under this section has become final, such person is guilty of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  a misdemeanor of the first degree, punishable as provided in

 2  s. 775.082 or s. 775.083 or as otherwise provided in ss.

 3  499.001-499.081, except that any person who violates

 4  subsection (8), subsection (10), subsection (14), subsection

 5  (15), subsection (16), or subsection (17) of s. 499.005 is

 6  guilty of a felony of the third degree, punishable as provided

 7  in s. 775.082, s. 775.083, or s. 775.084, or as otherwise

 8  provided in ss. 499.001-499.081.

 9         Section 41.  Subsection (1) of section 742.10, Florida

10  Statutes, is amended to read:

11         742.10  Establishment of paternity for children born

12  out of wedlock.--

13         (1)  This chapter provides the primary jurisdiction and

14  procedures for the determination of paternity for children

15  born out of wedlock. When the establishment of paternity has

16  been raised and determined within an adjudicatory hearing

17  brought under the statutes governing inheritance, or

18  dependency under workers' compensation or similar compensation

19  programs, or when an affidavit acknowledging paternity or a

20  stipulation of paternity is executed by both parties and filed

21  with the clerk of the court, or when a consenting affidavit as

22  provided for in s. 382.013 or s. 382.016 s. 382.015 is

23  executed by both parties, it shall constitute the

24  establishment of paternity for purposes of this chapter. If no

25  adjudicatory proceeding was held, a voluntary acknowledgment

26  of paternity shall create a rebuttable presumption, as defined

27  by s. 90.304, of paternity and is subject to the right of any

28  signatory to rescind the acknowledgment within 60 days of the

29  date the acknowledgment was signed or the date of an

30  administrative or judicial proceeding relating to the child,

31  including a proceeding to establish a support order, in which

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  the signatory is a party, whichever is earlier.  Both parents

 2  are required to provide their social security numbers on any

 3  acknowledgment of paternity, consent affidavit, or stipulation

 4  of paternity. Except for consenting affidavits under seal

 5  pursuant to ss. s. 382.015 and 382.016, the Office of Vital

 6  Statistics shall provide certified copies of affidavits to the

 7  Title IV-D agency upon request.

 8         Section 42.  Section 39.303, Florida Statutes, 1998

 9  Supplement, is amended to read:

10         39.303  Child protection teams; services; eligible

11  cases.--The Division of Children's Medical Services of the

12  Department of Health shall develop, maintain, and coordinate

13  the services of one or more multidisciplinary child protection

14  teams in each of the service districts of the Department of

15  Children and Family Services.  Such teams may be composed of

16  representatives of appropriate health, mental health, social

17  service, legal service, and law enforcement agencies. The

18  Legislature finds that optimal coordination of child

19  protection teams and sexual abuse treatment programs requires

20  collaboration between the Department of Health and the

21  Department of Children and Family Services. The two

22  departments shall maintain an interagency agreement that

23  establishes protocols for oversight and operations of child

24  protection teams and sexual abuse treatment programs. The

25  Secretary of Health and the director of Deputy Secretary for

26  Children's Medical Services, in consultation with the

27  Secretary of Children and Family Services, shall maintain the

28  responsibility for the screening, employment, and, if

29  necessary, the termination of child protection team medical

30  directors, at headquarters and in the 15 districts. Child

31  protection team medical directors shall be responsible for

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  oversight of the teams in the districts.

 2         (1)  The Department of Health shall utilize and convene

 3  the teams to supplement the assessment and protective

 4  supervision activities of the family safety and preservation

 5  program of the Department of Children and Family Services.

 6  Nothing in this section shall be construed to remove or reduce

 7  the duty and responsibility of any person to report pursuant

 8  to this chapter all suspected or actual cases of child abuse,

 9  abandonment, or neglect or sexual abuse of a child.  The role

10  of the teams shall be to support activities of the program and

11  to provide services deemed by the teams to be necessary and

12  appropriate to abused, abandoned, and neglected children upon

13  referral.  The specialized diagnostic assessment, evaluation,

14  coordination, consultation, and other supportive services that

15  a child protection team shall be capable of providing include,

16  but are not limited to, the following:

17         (a)  Medical diagnosis and evaluation services,

18  including provision or interpretation of X rays and laboratory

19  tests, and related services, as needed, and documentation of

20  findings relative thereto.

21         (b)  Telephone consultation services in emergencies and

22  in other situations.

23         (c)  Medical evaluation related to abuse, abandonment,

24  or neglect, as defined by policy or rule of the Department of

25  Health.

26         (d)  Such psychological and psychiatric diagnosis and

27  evaluation services for the child or the child's parent or

28  parents, legal custodian or custodians, or other caregivers,

29  or any other individual involved in a child abuse,

30  abandonment, or neglect case, as the team may determine to be

31  needed.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (e)  Expert medical, psychological, and related

 2  professional testimony in court cases.

 3         (f)  Case staffings to develop treatment plans for

 4  children whose cases have been referred to the team.  A child

 5  protection team may provide consultation with respect to a

 6  child who is alleged or is shown to be abused, abandoned, or

 7  neglected, which consultation shall be provided at the request

 8  of a representative of the family safety and preservation

 9  program or at the request of any other professional involved

10  with a child or the child's parent or parents, legal custodian

11  or custodians, or other caregivers.  In every such child

12  protection team case staffing, consultation, or staff activity

13  involving a child, a family safety and preservation program

14  representative shall attend and participate.

15         (g)  Case service coordination and assistance,

16  including the location of services available from other public

17  and private agencies in the community.

18         (h)  Such training services for program and other

19  employees of the Department of Children and Family Services,

20  employees of the Department of Health, and other medical

21  professionals as is deemed appropriate to enable them to

22  develop and maintain their professional skills and abilities

23  in handling child abuse, abandonment, and neglect cases.

24         (i)  Educational and community awareness campaigns on

25  child abuse, abandonment, and neglect in an effort to enable

26  citizens more successfully to prevent, identify, and treat

27  child abuse, abandonment, and neglect in the community.

28         (2)  The child abuse, abandonment, and neglect cases

29  that are appropriate for referral by the family safety and

30  preservation program to child protection teams of the

31  Department of Health for support services as set forth in

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  subsection (1) include, but are not limited to, cases

 2  involving:

 3         (a)  Bruises, burns, or fractures in a child under the

 4  age of 3 years or in a nonambulatory child of any age.

 5         (b)  Unexplained or implausibly explained bruises,

 6  burns, fractures, or other injuries in a child of any age.

 7         (c)  Sexual abuse of a child in which vaginal or anal

 8  penetration is alleged or in which other unlawful sexual

 9  conduct has been determined to have occurred.

10         (d)  Venereal disease, or any other sexually

11  transmitted disease, in a prepubescent child.

12         (e)  Reported malnutrition of a child and failure of a

13  child to thrive.

14         (f)  Reported medical, physical, or emotional neglect

15  of a child.

16         (g)  Any family in which one or more children have been

17  pronounced dead on arrival at a hospital or other health care

18  facility, or have been injured and later died, as a result of

19  suspected abuse, abandonment, or neglect, when any sibling or

20  other child remains in the home.

21         (h)  Symptoms of serious emotional problems in a child

22  when emotional or other abuse, abandonment, or neglect is

23  suspected.

24         (3)  In all instances in which a child protection team

25  is providing certain services to abused, abandoned, or

26  neglected children, other offices and units of the Department

27  of Health, and offices and units of the Department of Children

28  and Family Services, shall avoid duplicating the provision of

29  those services.

30         Section 43.  Subsection (3) of section 385.203, Florida

31  Statutes, is amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         385.203  Diabetes Advisory Council; creation; function;

 2  membership.--

 3         (3)  The council shall be composed of 18 citizens of

 4  the state as follows:  four practicing physicians; one

 5  representative from each medical school; seven interested

 6  citizens, at least three of whom shall be persons who have or

 7  have had diabetes mellitus or who have a child with diabetes

 8  mellitus; the Secretary of Health or his or her designee; one

 9  representative from the Division of Children's Medical

10  Services of the Department of Health who represents Children's

11  Medical Services; and one professor of nutrition.

12         Section 44.  Subsection (8) of section 391.021, Florida

13  Statutes, 1998 Supplement, is amended to read:

14         391.021  Definitions.--When used in this act, unless

15  the context clearly indicates otherwise:

16         (8)  "Program" means the Children's Medical Services

17  program established in the Division of Children's Medical

18  Services of the department.

19         Section 45.  Paragraph (b) of subsection (1) of section

20  391.221, Florida Statutes, 1998 Supplement, is amended to

21  read:

22         391.221  Statewide Children's Medical Services Network

23  Advisory Council.--

24         (1)  The secretary of the department may appoint a

25  Statewide Children's Medical Services Network Advisory Council

26  for the purpose of acting as an advisory body to the

27  department.  Specifically, the duties of the council shall

28  include, but not be limited to:

29         (b)  Making recommendations to the director of the

30  Division of Children's Medical Services concerning the

31  selection of health care providers for the Children's Medical

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Services network.

 2         Section 46.  Subsection (1) of section 391.222, Florida

 3  Statutes, 1998 Supplement, is amended to read:

 4         391.222  Cardiac Advisory Council.--

 5         (1)  The secretary of the department may appoint a

 6  Cardiac Advisory Council for the purpose of acting as the

 7  advisory body to the Department of Health Division of

 8  Children's Medical Services in the delivery of cardiac

 9  services to children. Specifically, the duties of the council

10  shall include, but not be limited to:

11         (a)  Recommending standards for personnel and

12  facilities rendering cardiac services for the Division of

13  Children's Medical Services;

14         (b)  Receiving reports of the periodic review of

15  cardiac personnel and facilities to determine if established

16  standards for the Division of Children's Medical Services

17  cardiac services are met;

18         (c)  Making recommendations to the division director as

19  to the approval or disapproval of reviewed personnel and

20  facilities;

21         (d)  Making recommendations as to the intervals for

22  reinspection of approved personnel and facilities; and

23         (e)  Providing input to the Division of Children's

24  Medical Services on all aspects of Children's Medical Services

25  cardiac programs, including the rulemaking process.

26         Section 47.  Section 391.223, Florida Statutes, 1998

27  Supplement, is amended to read:

28         391.223  Technical advisory panels.--The secretary of

29  the department may establish technical advisory panels to

30  assist the Division of Children's Medical Services in

31  developing specific policies and procedures for the Children's

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Medical Services program.

 2         Section 48.  Subsection (3) of section 381.731, Florida

 3  Statutes, as amended by section 2 of chapter 98-224, Laws of

 4  Florida, is repealed.

 5         Section 49.  Subsection (5) of section 383.307, Florida

 6  Statutes, is repealed.

 7         Section 50.  Subsection (7) of section 404.20, Florida

 8  Statutes, is repealed.

 9         Section 51.  Section 409.9125, Florida Statutes, is

10  repealed.

11         Section 52.  The building that is known as the "1911

12  State Board of Health Building" which is part of a

13  multi-building complex with the address of 1217 Pearl Street,

14  Jacksonville, Florida, shall be known as the "Wilson T.

15  Sowder, M.D., Building."

16         Section 53.  The building authorized by chapter 98-307,

17  Laws of Florida, which will be located at the University of

18  South Florida which will house laboratory facilities for the

19  Department of Health shall be known as the "William G. 'Doc'

20  Myers, M.D., Building."

21         Section 54.  The Department of Health headquarters

22  building which will comprise approximately 100,000 square feet

23  which is authorized by Specific Appropriation 1986 in the

24  1998-1999 General Appropriations Act shall be known as the "E.

25  Charlton Prather, M.D., Building."

26         Section 55.  The Department of Health may apply for and

27  become a National Environmental Laboratory Accreditation

28  Program accrediting authority. The department, as an

29  accrediting entity, may adopt rules pursuant to sections

30  120.536(1) and 120.54, Florida Statutes, to implement

31  standards of the National Environmental Laboratory

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Accreditation Program, including requirements for proficiency

 2  testing providers and other rules that are not inconsistent

 3  with this section, including rules pertaining to fees,

 4  application procedures, standards applicable to environmental

 5  or public water supply laboratories, and compliance.

 6         Section 56.  Section 381.0022, Florida Statutes, 1998

 7  Supplement, is amended to read:

 8         381.0022  Sharing confidential or exempt information.--

 9         (1)  Notwithstanding any other provision of law to the

10  contrary, the Department of Health and the Department of

11  Children and Family Services may share confidential

12  information or information exempt from disclosure under

13  chapter 119 on any individual who is or has been the subject

14  of a program within the jurisdiction of each agency.

15  Information so exchanged remains confidential or exempt as

16  provided by law.

17         (2)  Notwithstanding any other provision of law to the

18  contrary, the Department of Health may share confidential

19  information or information exempt from disclosure under

20  chapter 119 on any individual who is or has been a Medicaid

21  recipient and is or was the subject of a program within the

22  jurisdiction of the Department of Health, for the purpose of

23  requesting, receiving, or auditing payment for services.

24  Information so exchanged remains confidential or exempt as

25  provided by law.

26         Section 57.  Paragraph (c) of subsection (2) of section

27  383.011, Florida Statutes, 1998 Supplement, is amended to

28  read:

29         383.011  Administration of maternal and child health

30  programs.--

31         (2)  The Department of Health shall follow federal

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  requirements and may adopt any rules necessary for the

 2  implementation of the maternal and child health care program,

 3  the WIC program, and the Child Care Food Program.

 4         (c)  With respect to the Child Care Food Program, the

 5  department shall adopt rules that interpret and implement

 6  relevant federal regulations, including 7 C.F.R. part 226. The

 7  rules may must address at least those program requirements and

 8  procedures identified in paragraph (1)(i).

 9         Section 58.  Section 468.304, Florida Statutes, 1998

10  Supplement, is amended to read:

11         468.304  Certification examination; admission.--The

12  department shall admit to examination for certification any

13  applicant who pays to the department a nonrefundable fee not

14  to exceed $100 plus the actual per-applicant cost to the

15  department for purchasing the examination from a national

16  organization and submits satisfactory evidence, verified by

17  oath or affirmation, that she or he:

18         (1)  Is at least 18 years of age at the time of

19  application;

20         (2)  Is a high school graduate or has successfully

21  completed the requirements for a graduate equivalency diploma

22  (GED) or its equivalent;

23         (3)  Is of good moral character; and

24         (4)(a)  Has successfully completed an educational

25  program, which program may be established in a hospital

26  licensed pursuant to chapter 395 or in an accredited

27  postsecondary academic institution which is subject to

28  approval by the department as maintaining a satisfactory

29  standard; or

30         (b)1.  With respect to an applicant for a basic X-ray

31  machine operator's certificate, has completed a course of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  study approved by the department with appropriate study

 2  material provided the applicant by the department;

 3         2.  With respect to an applicant for a basic X-ray

 4  machine operator-podiatric medicine certificate, has completed

 5  a course of study approved by the department, provided that

 6  such course of study shall be limited to that information

 7  necessary to perform radiographic procedures within the scope

 8  of practice of a podiatric physician licensed pursuant to

 9  chapter 461;

10         3.  With respect only to an applicant for a general

11  radiographer's certificate who is a basic X-ray machine

12  operator certificateholder, has completed an educational

13  program or a 2-year training program that takes into account

14  the types of procedures and level of supervision usually and

15  customarily practiced in a hospital, which educational or

16  training program complies with the rules of the department; or

17         4.  With respect only to an applicant for a nuclear

18  medicine technologist's certificate who is a general

19  radiographer certificateholder, has completed an educational

20  program or a 2-year training program that takes into account

21  the types of procedures and level of supervision usually and

22  customarily practiced in a hospital, which educational or

23  training program complies with the rules of the department.

24

25  No application for a limited computed tomography certificate

26  shall be accepted.  All persons holding valid computed

27  tomography certificates as of October 1, 1984, are subject to

28  the provisions of s. 468.309.

29         Section 59.  Subsection (4) of section 468.306, Florida

30  Statutes, 1998 Supplement, is amended to read:

31         468.306  Examinations.--All applicants, except those

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  certified pursuant to s. 468.3065, shall be required to pass

 2  an examination.  The department is authorized to develop or

 3  use examinations for each type of certificate.

 4         (4)  A nonrefundable fee not to exceed $75 plus the

 5  actual per-applicant cost for purchasing the examination from

 6  a national organization shall be charged for any subsequent

 7  examination.

 8         Section 60.  Paragraph (a) of subsection (1) of section

 9  468.309, Florida Statutes, is amended to read:

10         468.309  Certificate; duration; renewal; reversion to

11  inactive status.--

12         (1)(a)  A radiologic technologist's certificate issued

13  in accordance with this part automatically expires as

14  specified in rules adopted by the department which establish a

15  procedure for the biennial renewal of certificates on December

16  31 of the year following the year of issuance. A certificate

17  shall be renewed by the department for a period of 2 years

18  upon payment of a renewal fee in an amount not to exceed $75

19  and upon submission of a renewal application containing such

20  information as the department deems necessary to show that the

21  applicant for renewal is a radiologic technologist in good

22  standing and has completed any continuing education

23  requirements that which may be established by the department

24  establishes.

25         Section 61.  Subsection (1) of section 455.565, Florida

26  Statutes, 1998 Supplement, is amended to read:

27         455.565  Designated health care professionals;

28  information required for licensure.--

29         (1)  Each person who applies for initial licensure as a

30  physician under chapter 458, chapter 459, chapter 460, or

31  chapter 461, except a person applying for registration

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  pursuant to ss. 458.345 and 459.021 must, at the time of

 2  application, and each physician who applies for license

 3  renewal under chapter 458, chapter 459, chapter 460, or

 4  chapter 461, except a person registered pursuant to ss.

 5  458.345 and 459.021 must, in conjunction with the renewal of

 6  such license and under procedures adopted by the Department of

 7  Health, and in addition to any other information that may be

 8  required from the applicant, furnish the following information

 9  to the Department of Health:

10         (a)1.  The name of each medical school that the

11  applicant has attended, with the dates of attendance and the

12  date of graduation, and a description of all graduate medical

13  education completed by the applicant, excluding any coursework

14  taken to satisfy medical licensure continuing education

15  requirements.

16         2.  The name of each hospital at which the applicant

17  has privileges.

18         3.  The address at which the applicant will primarily

19  conduct his or her practice.

20         4.  Any certification that the applicant has received

21  from a specialty board that is recognized by the board to

22  which the applicant is applying.

23         5.  The year that the applicant began practicing

24  medicine.

25         6.  Any appointment to the faculty of a medical school

26  which the applicant currently holds and an indication as to

27  whether the applicant has had the responsibility for graduate

28  medical education within the most recent 10 years.

29         7.  A description of any criminal offense of which the

30  applicant has been found guilty, regardless of whether

31  adjudication of guilt was withheld, or to which the applicant

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  has pled guilty or nolo contendere.  A criminal offense

 2  committed in another jurisdiction which would have been a

 3  felony or misdemeanor if committed in this state must be

 4  reported. If the applicant indicates that a criminal offense

 5  is under appeal and submits a copy of the notice for appeal of

 6  that criminal offense, the department must state that the

 7  criminal offense is under appeal if the criminal offense is

 8  reported in the applicant's profile. If the applicant

 9  indicates to the department that a criminal offense is under

10  appeal, the applicant must, upon disposition of the appeal,

11  submit to the department a copy of the final written order of

12  disposition.

13         8.  A description of any final disciplinary action

14  taken within the previous 10 years against the applicant by

15  the agency regulating the profession that the applicant is or

16  has been licensed to practice, whether in this state or in any

17  other jurisdiction, by a specialty board that is recognized by

18  the American Board of Medical Specialities, the American

19  Osteopathic Association, or a similar national organization,

20  or by a licensed hospital, health maintenance organization,

21  prepaid health clinic, ambulatory surgical center, or nursing

22  home.  Disciplinary action includes resignation from or

23  nonrenewal of medical staff membership or the restriction of

24  privileges at a licensed hospital, health maintenance

25  organization, prepaid health clinic, ambulatory surgical

26  center, or nursing home taken in lieu of or in settlement of a

27  pending disciplinary case related to competence or character.

28  If the applicant indicates that the disciplinary action is

29  under appeal and submits a copy of the document initiating an

30  appeal of the disciplinary action, the department must state

31  that the disciplinary action is under appeal if the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  disciplinary action is reported in the applicant's profile.

 2         (b)  In addition to the information required under

 3  paragraph (a), each applicant who seeks licensure under

 4  chapter 458, chapter 459, or chapter 461, and who has

 5  practiced previously in this state or in another jurisdiction

 6  or a foreign country must provide the information required of

 7  licensees under those chapters pursuant to s. 455.697.  An

 8  applicant for licensure under chapter 460 who has practiced

 9  previously in this state or in another jurisdiction or a

10  foreign country must provide the same information as is

11  required of licensees under chapter 458, pursuant to s.

12  455.697.

13         Section 62.  (1)  The Division of Children's Medical

14  Services of the Department of Health shall contract with a

15  private nonprofit provider affiliated with a teaching hospital

16  to conduct clinical trials, approved by a federally-sanctioned

17  institutional review board within the teaching hospital, on

18  the use of the drug Secretin to treat autism.

19         (2)  The private nonprofit provider shall report its

20  findings to the Division of Children's Medical Services, the

21  President of the Senate, the Speaker of the House of

22  Representatives, and other appropriate bodies.

23         Section 63.  The sum of $50,000 is appropriated to the

24  Division of Children's Medical Services of the Department of

25  Health from the General Revenue Fund for the purpose of

26  implementing this act.

27         Section 64.  Paragraph (b) of subsection (3) of section

28  232.435, Florida Statutes, is amended to read:

29         232.435  Extracurricular athletic activities; athletic

30  trainers.--

31         (3)

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (b)  If a school district uses the services of an

 2  athletic trainer who is not a teacher athletic trainer or a

 3  teacher apprentice trainer within the requirements of this

 4  section, such athletic trainer must be licensed as required by

 5  part XIII XIV of chapter 468.

 6         Section 65.  Subsection (2) of section 381.026, Florida

 7  Statutes, 1998 Supplement, is amended to read:

 8         381.026  Florida Patient's Bill of Rights and

 9  Responsibilities.--

10         (2)  DEFINITIONS.--As used in this section and s.

11  381.0261, the term:

12         (a)  "Department" means the Department of Health.

13         (b)(a)  "Health care facility" means a facility

14  licensed under chapter 395.

15         (c)(b)  "Health care provider" means a physician

16  licensed under chapter 458, an osteopathic physician licensed

17  under chapter 459, or a podiatric physician licensed under

18  chapter 461.

19         (d)(c)  "Responsible provider" means a health care

20  provider who is primarily responsible for patient care in a

21  health care facility or provider's office.

22         Section 66.  Subsection (4) of section 381.0261,

23  Florida Statutes, 1998 Supplement, is amended to read:

24         381.0261  Summary of patient's bill of rights;

25  distribution; penalty.--

26         (4)(a)  An administrative fine may be imposed by the

27  Agency for Health Care Administration when any health care

28  provider or health care facility fails to make available to

29  patients a summary of their rights, pursuant to s. 381.026 and

30  this section. Initial nonwillful violations shall be subject

31  to corrective action and shall not be subject to an

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  administrative fine. The Agency for Health Care Administration

 2  may levy a fine against a health care facility of up to $5,000

 3  for nonwillful violations, and up to $25,000 for intentional

 4  and willful violations. Each intentional and willful violation

 5  constitutes a separate violation and is subject to a separate

 6  fine.

 7         (b)  An administrative fine may be imposed by the

 8  appropriate regulatory board, or the department if there is no

 9  board, when any health care provider fails to make available

10  to patients a summary of their rights, pursuant to s. 381.026

11  and this section. Initial nonwillful violations shall be

12  subject to corrective action and shall not be subject to an

13  administrative fine. The appropriate regulatory board or

14  department agency may levy a fine against a health care

15  provider of up to $100 for nonwillful violations and up to

16  $500 for willful violations. Each intentional and willful

17  violation constitutes a separate violation and is subject to a

18  separate fine.

19         Section 67.  Subsection (11) of section 409.906,

20  Florida Statutes, 1998 Supplement, is amended to read:

21         409.906  Optional Medicaid services.--Subject to

22  specific appropriations, the agency may make payments for

23  services which are optional to the state under Title XIX of

24  the Social Security Act and are furnished by Medicaid

25  providers to recipients who are determined to be eligible on

26  the dates on which the services were provided.  Any optional

27  service that is provided shall be provided only when medically

28  necessary and in accordance with state and federal law.

29  Nothing in this section shall be construed to prevent or limit

30  the agency from adjusting fees, reimbursement rates, lengths

31  of stay, number of visits, or number of services, or making

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  any other adjustments necessary to comply with the

 2  availability of moneys and any limitations or directions

 3  provided for in the General Appropriations Act or chapter 216.

 4  Optional services may include:

 5         (11)  HEALTHY START SERVICES.--The agency may pay for a

 6  continuum of risk-appropriate medical and psychosocial

 7  services for the Healthy Start program in accordance with a

 8  federal waiver. The agency may not implement the federal

 9  waiver unless the waiver permits the state to limit enrollment

10  or the amount, duration, and scope of services to ensure that

11  expenditures will not exceed funds appropriated by the

12  Legislature or available from local sources. If the Health

13  Care Financing Administration does not approve a federal

14  waiver for Healthy Start services, the agency, in consultation

15  with the Department of Health and the Florida Association of

16  Healthy Start Coalitions, is authorized to establish a

17  Medicaid certified-match program for Healthy Start services.

18  Participation in the Healthy Start certified-match program

19  shall be voluntary and reimbursement shall be limited to the

20  federal Medicaid share to Medicaid-enrolled Healthy Start

21  coalitions for services provided to Medicaid recipients. The

22  agency shall take no action to implement a certified-match

23  program without ensuring that the amendment and review

24  requirements of ss. 216.177 and 216.181 have been met.

25         Section 68.  Subsection (21) of section 409.910,

26  Florida Statutes, 1998 Supplement, is renumbered as subsection

27  (22), and a new subsection (21) is added to that section to

28  read:

29         409.910  Responsibility for payments on behalf of

30  Medicaid-eligible persons when other parties are liable.--

31         (21)  Entities providing health insurance as defined in

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  s. 624.603, and health maintenance organizations as defined in

 2  chapter 641, requiring tape or electronic billing formats from

 3  the agency shall accept Medicaid billings that are prepared

 4  using the current Medicare standard billing format. If the

 5  insurance entity or health maintenance organization is unable

 6  to use the agency format, the entity shall accept paper claims

 7  from the agency in lieu of tape or electronic billing,

 8  provided that these claims are prepared using current Medicare

 9  standard billing formats.

10         Section 69.  Section 409.9101, Florida Statutes, is

11  created to read:

12         409.9101  Recovery for payments made on behalf of

13  Medicaid-eligible persons.--

14         (1)  This section may be cited as the "Medicaid Estate

15  Recovery Act."

16         (2)  It is the intent of the Legislature by this

17  section to supplement Medicaid funds that are used to provide

18  medical services to eligible persons. Medicaid estate recovery

19  shall generally be accomplished through the filing of claims

20  against the estates of deceased Medicaid recipients. The

21  recoveries shall be made pursuant to federal authority in s.

22  13612 of the Omnibus Budget Reconciliation Act of 1993, which

23  amends s. 1917(b)(1) of the Social Security Act (42 U.S.C. s.

24  1396p(b)(1)).

25         (3)  Pursuant to s. 733.212(4)(a), the personal

26  representative of the estate of the decedent shall serve the

27  agency with a copy of the notice of administration of the

28  estate within 3 months after the first publication of the

29  notice, unless the agency has already filed a claim pursuant

30  to this section.

31         (4)  The acceptance of public medical assistance, as

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  defined by Title XIX (Medicaid) of the Social Security Act,

 2  including mandatory and optional supplemental payments under

 3  the Social Security Act, shall create a claim, as defined in

 4  s. 731.201, in favor of the agency as an interested person as

 5  defined in s. 731.201. The claim amount is calculated as the

 6  total amount paid to or for the benefit of the recipient for

 7  medical assistance on behalf of the recipient after he or she

 8  reached 55 years of age. There is no claim under this section

 9  against estates of recipients who had not yet reached 55 years

10  of age.

11         (5)  At the time of filing the claim, the agency may

12  reserve the right to amend the claim amounts based on medical

13  claims submitted by providers subsequent to the agency's

14  initial claim calculation.

15         (6)  The claim of the agency shall be the current total

16  allowable amount of Medicaid payments as denoted in the

17  agency's provider payment processing system at the time the

18  agency's claim or amendment is filed. The agency's provider

19  processing system reports shall be admissible as prima facie

20  evidence in substantiating the agency's claim.

21         (7)  The claim of the agency under this section shall

22  constitute a Class 3 claim under s. 733.707(1)(c), as provided

23  in s. 414.28(1).

24         (8)  The claim created under this section shall not be

25  enforced if the recipient is survived by:

26         (a)  A spouse;

27         (b)  A child or children under 21 years of age; or

28         (c)  A child or children who are blind or permanently

29  and totally disabled pursuant to the eligibility requirements

30  of Title XIX of the Social Security Act.

31         (9)  In accordance with s. 4, Art. X of the State

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Constitution, no claim under this section shall be enforced

 2  against any property that is determined to be the homestead of

 3  the deceased Medicaid recipient and is determined to be exempt

 4  from the claims of creditors of the deceased Medicaid

 5  recipient.

 6         (10)  The agency shall not recover from an estate if

 7  doing so would cause undue hardship for the qualified heirs,

 8  as defined in s. 731.201. The personal representative of an

 9  estate and any heir may request that the agency waive recovery

10  of any or all of the debt when recovery would create a

11  hardship. A hardship does not exist solely because recovery

12  will prevent any heirs from receiving an anticipated

13  inheritance. The following criteria shall be considered by the

14  agency in reviewing a hardship request:

15         (a)  The heir:

16         1.  Currently resides in the residence of the decedent;

17         2.  Resided there at the time of the death of the

18  decedent;

19         3.  Has made the residence his or her primary residence

20  for the 12 months immediately preceding the death of the

21  decedent; and

22         4.  Owns no other residence;

23         (b)  The heir would be deprived of food, clothing,

24  shelter, or medical care necessary for the maintenance of life

25  or health;

26         (c)  The heir can document that he or she provided

27  full-time care to the recipient which delayed the recipient's

28  entry into a nursing home. The heir must be either the

29  decedent's sibling or the son or daughter of the decedent and

30  must have resided with the recipient for at least 1 year prior

31  to the recipient's death; or

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 1         (d)  The cost involved in the sale of the property

 2  would be equal to or greater than the value of the property.

 3         (11)  Instances arise in Medicaid estate-recovery cases

 4  where the assets include a settlement of a claim against a

 5  liable third party. The agency's claim under s. 409.910 must

 6  be satisfied prior to including the settlement proceeds as

 7  estate assets. The remaining settlement proceeds shall be

 8  included in the estate and be available to satisfy the

 9  Medicaid estate-recovery claim. The Medicaid estate-recovery

10  share shall be one-half of the settlement proceeds included in

11  the estate. Nothing in this subsection is intended to limit

12  the agency's rights against other assets in the estate not

13  related to the settlement. However, in no circumstances shall

14  the agency's recovery exceed the total amount of Medicaid

15  medical assistance provided to the recipient.

16         (12)  In instances where there are no liquid assets to

17  satisfy the Medicaid estate-recovery claim, if there is

18  nonhomestead real property and the costs of sale will not

19  exceed the proceeds, the property shall be sold to satisfy the

20  Medicaid estate-recovery claim. Real property shall not be

21  transferred to the agency in any instance.

22         (13)  The agency is authorized to adopt rules to

23  implement the provisions of this section.

24         Section 70.  Paragraph (d) of subsection (3) of section

25  409.912, Florida Statutes, 1998 Supplement, is amended to

26  read:

27         409.912  Cost-effective purchasing of health care.--The

28  agency shall purchase goods and services for Medicaid

29  recipients in the most cost-effective manner consistent with

30  the delivery of quality medical care.  The agency shall

31  maximize the use of prepaid per capita and prepaid aggregate

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                                                  SENATE AMENDMENT

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    Amendment No.    





 1  fixed-sum basis services when appropriate and other

 2  alternative service delivery and reimbursement methodologies,

 3  including competitive bidding pursuant to s. 287.057, designed

 4  to facilitate the cost-effective purchase of a case-managed

 5  continuum of care. The agency shall also require providers to

 6  minimize the exposure of recipients to the need for acute

 7  inpatient, custodial, and other institutional care and the

 8  inappropriate or unnecessary use of high-cost services.

 9         (3)  The agency may contract with:

10         (d)  No more than four provider service networks for

11  demonstration projects to test Medicaid direct contracting.

12  One demonstration project must be located in Orange County.

13  The demonstration projects may be reimbursed on a

14  fee-for-service or prepaid basis.  A provider service network

15  which is reimbursed by the agency on a prepaid basis shall be

16  exempt from parts I and III of chapter 641, but must meet

17  appropriate financial reserve, quality assurance, and patient

18  rights requirements as established by the agency.  The agency

19  shall award contracts on a competitive bid basis and shall

20  select bidders based upon price and quality of care. Medicaid

21  recipients assigned to a demonstration project shall be chosen

22  equally from those who would otherwise have been assigned to

23  prepaid plans and MediPass.  The agency is authorized to seek

24  federal Medicaid waivers as necessary to implement the

25  provisions of this section.  A demonstration project awarded

26  pursuant to this paragraph shall be for 2 years from the date

27  of implementation.

28         Section 71.  Paragraph (a) of subsection (24) of

29  section 409.913, Florida Statutes, is amended to read:

30         409.913  Oversight of the integrity of the Medicaid

31  program.--The agency shall operate a program to oversee the

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 1  activities of Florida Medicaid recipients, and providers and

 2  their representatives, to ensure that fraudulent and abusive

 3  behavior and neglect of recipients occur to the minimum extent

 4  possible, and to recover overpayments and impose sanctions as

 5  appropriate.

 6         (24)(a)  The agency may withhold Medicaid payments, in

 7  whole or in part, to a provider upon receipt of reliable

 8  evidence that the circumstances giving rise to the need for a

 9  withholding of payments involve fraud or willful

10  misrepresentation under the Medicaid program, or a crime

11  committed while rendering goods or services to Medicaid

12  recipients, up to the amount of the overpayment as determined

13  by final agency audit report, pending completion of legal

14  proceedings under this section. If the agency withholds

15  payments under this section, the Medicaid payment may not be

16  reduced by more than 10 percent. If it is has been determined

17  that fraud, willful misrepresentation, or a crime did not

18  occur an overpayment has not occurred, the payments withheld

19  must be paid to the provider within 14 60 days after such

20  determination with interest at the rate of 10 percent a year.

21  Any money withheld in accordance with this paragraph shall be

22  placed in a suspended account, readily accessible to the

23  agency, so that any payment ultimately due the provider shall

24  be made within 14 days. Furthermore, the authority to withhold

25  payments under this paragraph shall not apply to physicians

26  whose alleged overpayments are being determined by

27  administrative proceedings pursuant to chapter 120. If the

28  amount of the alleged overpayment exceeds $75,000, the agency

29  may reduce the Medicaid payments by up to $25,000 per month.

30         Section 72.  Section 409.9131, Florida Statutes, is

31  created to read:

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 1         409.9131  Special provisions relating to integrity of

 2  the Medicaid program.--

 3         (1)  LEGISLATIVE FINDINGS AND INTENT.--It is the intent

 4  of the Legislature that physicians, as defined in this

 5  section, be subject to Medicaid fraud and abuse investigations

 6  in accordance with the provisions set forth in this section as

 7  a supplement to the provisions contained in s. 409.913.  If a

 8  conflict exists between the provisions of this section and s.

 9  409.913, it is the intent of the Legislature that the

10  provisions of this section shall control.

11         (2)  DEFINITIONS.--For purposes of this section, the

12  term:

13         (a)  "Active practice" means a physician must have

14  regularly provided medical care and treatment to patients

15  within the past 2 years.

16         (b)  "Medical necessity" or "medically necessary" means

17  any goods or services necessary to palliate the effects of a

18  terminal condition or to prevent, diagnose, correct, cure,

19  alleviate, or preclude deterioration of a condition that

20  threatens life, causes pain or suffering, or results in

21  illness or infirmity, which goods or services are provided in

22  accordance with generally accepted standards of medical

23  practice.  For purposes of determining Medicaid reimbursement,

24  the agency is the final arbiter of medical necessity.  In

25  making determinations of medical necessity, the agency must,

26  to the maximum extent possible, use a physician in active

27  practice, either employed by or under contract with the

28  agency, of the same specialty or subspecialty as the physician

29  under review.  Such determination must be based upon the

30  information available at the time the goods or services were

31  provided.

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 1         (c)  "Peer" means a Florida licensed physician who is,

 2  to the maximum extent possible, of the same specialty or

 3  subspecialty, licensed under the same chapter, and in active

 4  practice.

 5         (d)  "Peer review" means an evaluation of the

 6  professional practices of a Medicaid physician provider by a

 7  peer or peers in order to assess the medical necessity,

 8  appropriateness, and quality of care provided, as such care is

 9  compared to that customarily furnished by the physician's

10  peers and to recognized health care standards, and to

11  determine whether the documentation in the physician's records

12  is adequate.

13         (e)  "Physician" means a person licensed to practice

14  medicine under chapter 458 or a person licensed to practice

15  osteopathic medicine under chapter 459.

16         (f)  "Professional services" means procedures provided

17  to a Medicaid recipient, either directly by or under the

18  supervision of a physician who is a registered provider for

19  the Medicaid program.

20         (3)  ONSITE RECORDS REVIEW.--As specified in s.

21  409.913(8), the agency may investigate, review, or analyze a

22  physician's medical records concerning Medicaid patients. The

23  physician must make such records available to the agency

24  during normal business hours. The agency must provide notice

25  to the physician at least 24 hours before such visit. The

26  agency and physician shall make every effort to set a mutually

27  agreeable time for the agency's visit during normal business

28  hours and within the 24-hour period. If such a time cannot be

29  agreed upon, the agency may set the time.

30         (4)  NOTICE OF DUE PROCESS RIGHTS REQUIRED.--Whenever

31  the agency seeks an administrative remedy against a physician

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 1  pursuant to this section or s. 409.913, the physician must be

 2  advised of his or her rights to due process under chapter 120.

 3  This provision shall not limit or hinder the agency's ability

 4  to pursue any remedy available to it under s. 409.913 or other

 5  applicable law.

 6         (5)  DETERMINATIONS OF OVERPAYMENT.--In making a

 7  determination of overpayment to a physician, the agency must:

 8         (a)  Use accepted and valid auditing, accounting,

 9  analytical, statistical, or peer-review methods, or

10  combinations thereof. Appropriate statistical methods may

11  include, but are not limited to, sampling and extension to the

12  population, parametric and nonparametric statistics, tests of

13  hypotheses, other generally accepted statistical methods,

14  review of medical records, and a consideration of the

15  physician's client case mix. Before performing a review of the

16  physician's Medicaid records, however, the agency shall make

17  every effort to consider the physician's patient case mix,

18  including, but not limited to, patient age and whether

19  individual patients are clients of the Children's Medical

20  Services network established in chapter 391. In meeting its

21  burden of proof in any administrative or court proceeding, the

22  agency may introduce the results of such statistical methods

23  and its other audit findings as evidence of overpayment.

24         (b)  Refer all physician service claims for peer review

25  when the agency's preliminary analysis indicates a potential

26  overpayment, and before any formal proceedings are initiated

27  against the physician, except as required by s. 409.913.

28         (c)  By March 1, 2000, the agency shall study and

29  report to the Legislature on its current statistical model

30  used to calculate overpayments and advise the Legislature

31  what, if any, changes, improvements, or other modifications

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    Bill No. CS for SB 2220

    Amendment No.    





 1  should be made to the statistical model. Such review shall

 2  include, but not be limited to, a review of the

 3  appropriateness of including physician specialty and case-mix

 4  parameters within the statistical model.

 5         Section 73.  Subsections (4) and (6) of section

 6  455.501, Florida Statutes, are amended to read:

 7         455.501  Definitions.--As used in this part, the term:

 8         (4)  "Health care practitioner" means any person

 9  licensed under s. 400.211; chapter 457; chapter 458; chapter

10  459; chapter 460; chapter 461; chapter 462; chapter 463;

11  chapter 464; chapter 465; chapter 466; chapter 467; part I,

12  part II, part III, part V, or part X, part XIII, or part XIV

13  of chapter 468; chapter 478; chapter 480; part III or part IV

14  of chapter 483; chapter 484; chapter 486; chapter 490; or

15  chapter 491.

16         (6)  "Licensee" means any person or entity issued a

17  permit, registration, certificate, or license by the

18  department.

19         Section 74.  Section 455.507, Florida Statutes, is

20  amended to read:

21         455.507  Members of Armed Forces in good standing with

22  administrative boards or department.--

23         (1)  Any member of the Armed Forces of the United

24  States now or hereafter on active duty who, at the time of his

25  becoming such a member, was in good standing with any

26  administrative board of the state, or the department when

27  there is no board, and was entitled to practice or engage in

28  his or her profession or vocation in the state shall be kept

29  in good standing by such administrative board, or the

30  department when there is no board, without registering, paying

31  dues or fees, or performing any other act on his or her part

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                                                  SENATE AMENDMENT

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 1  to be performed, as long as he or she is a member of the Armed

 2  Forces of the United States on active duty and for a period of

 3  6 months after his discharge from active duty as a member of

 4  the Armed Forces of the United States, provided he or she is

 5  not engaged in his or her licensed profession or vocation in

 6  the private sector for profit.

 7         (2)  The boards listed in s. ss. 20.165 and 20.43, or

 8  the department when there is no board, shall adopt rules

 9  exempting the spouses of members of the Armed Forces of the

10  United States from licensure renewal provisions, but only in

11  cases of absence from the state because of their spouses'

12  duties with the Armed Forces.

13         Section 75.  Section 455.521, Florida Statutes, 1998

14  Supplement, is amended to read:

15         455.521  Department; powers and duties.--The

16  department, for the professions boards under its jurisdiction,

17  shall:

18         (1)  Adopt rules establishing a procedure for the

19  biennial renewal of licenses; however, the department may

20  issue up to a 4-year license to selected licensees

21  notwithstanding any other provisions of law to the contrary.

22  Fees for such renewal shall not exceed the fee caps for

23  individual professions on an annualized basis as authorized by

24  law.

25         (2)  Appoint the executive director of each board,

26  subject to the approval of the board.

27         (3)  Submit an annual budget to the Legislature at a

28  time and in the manner provided by law.

29         (4)  Develop a training program for persons newly

30  appointed to membership on any board. The program shall

31  familiarize such persons with the substantive and procedural

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 1  laws and rules and fiscal information relating to the

 2  regulation of the appropriate profession and with the

 3  structure of the department.

 4         (5)  Adopt rules pursuant to ss. 120.536(1) and 120.54

 5  to implement the provisions of this part.

 6         (6)  Establish by rules procedures by which the

 7  department shall use the expert or technical advice of the

 8  appropriate board for the purposes of investigation,

 9  inspection, evaluation of applications, other duties of the

10  department, or any other areas the department may deem

11  appropriate.

12         (7)  Require all proceedings of any board or panel

13  thereof and all formal or informal proceedings conducted by

14  the department, an administrative law judge, or a hearing

15  officer with respect to licensing or discipline to be

16  electronically recorded in a manner sufficient to assure the

17  accurate transcription of all matters so recorded.

18         (8)  Select only those investigators, or consultants

19  who undertake investigations, who meet criteria established

20  with the advice of the respective boards.

21         (9)  Allow applicants for new or renewal licenses and

22  current licensees to be screened by the Title IV-D child

23  support agency pursuant to s. 409.2598 to assure compliance

24  with a support obligation. The purpose of this subsection is

25  to promote the public policy of this state as established in

26  s. 409.2551. The department shall, when directed by the court,

27  suspend or deny the license of any licensee found to have a

28  delinquent support obligation. The department shall issue or

29  reinstate the license without additional charge to the

30  licensee when notified by the court that the licensee has

31  complied with the terms of the court order. The department

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  shall not be held liable for any license denial or suspension

 2  resulting from the discharge of its duties under this

 3  subsection.

 4         Section 76.  Section 455.557, Florida Statutes, 1998

 5  Supplement, is amended to read:

 6         455.557  Standardized credentialing for health care

 7  practitioners.--

 8         (1)  INTENT.--The Legislature recognizes that an

 9  efficient and effective health care practitioner credentialing

10  program helps to ensure access to quality health care and also

11  recognizes that health care practitioner credentialing

12  activities have increased significantly as a result of health

13  care reform and recent changes in health care delivery and

14  reimbursement systems. Moreover, the resulting duplication of

15  health care practitioner credentialing activities is

16  unnecessarily costly and cumbersome for both the practitioner

17  and the entity granting practice privileges. Therefore, it is

18  the intent of this section that a mandatory credentials

19  collection verification program be established which provides

20  that, once a health care practitioner's core credentials data

21  are collected, validated, maintained, and stored, they need

22  not be collected again, except for corrections, updates, and

23  modifications thereto. Participation Mandatory credentialing

24  under this section shall initially include those individuals

25  licensed under chapter 458, chapter 459, chapter 460, or

26  chapter 461. However, the department shall, with the approval

27  of the applicable board, include other professions under the

28  jurisdiction of the Division of Medical Quality Assurance in

29  this credentialing program, provided they meet the

30  requirements of s. 455.565.

31         (2)  DEFINITIONS.--As used in this section, the term:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

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 1         (a)  "Advisory council" or "council" means the

 2  Credentials Verification Advisory Council.

 3         (b)  "Applicant" means an individual applying for

 4  licensure or a current licensee applying for credentialing.

 5         (b)(c)  "Certified" or "accredited," as applicable,

 6  means approved by a quality assessment program, from the

 7  National Committee for Quality Assurance, the Joint Commission

 8  on Accreditation of Healthcare Organizations, the American

 9  Accreditation HealthCare Commission/URAC Utilization Review

10  Accreditation Commission, or any such other nationally

11  recognized and accepted organization authorized by the

12  department, used to assess and certify any credentials

13  verification program, entity, or organization that verifies

14  the credentials of any health care practitioner.

15         (c)(d)  "Core credentials data" means the following

16  data: current name, any former name, and any alias, any

17  professional education, professional training, peer

18  references, licensure, current Drug Enforcement Administration

19  certification, social security number, specialty board

20  certification, Educational Commission for Foreign Medical

21  Graduates certification information, hospital or affiliations,

22  managed care organization affiliations, other institutional

23  affiliations, professional society memberships, evidence of

24  professional liability coverage or evidence of financial

25  responsibility as required by s. 458.320 or s. 459.0085

26  insurance, history of claims, suits, judgments, or

27  settlements, final disciplinary action reported pursuant to s.

28  455.565(1)(a)8., and Medicare or Medicaid sanctions, civil or

29  criminal law violations, practitioner profiling data, special

30  conditions of impairment, or regulatory exemptions not

31  previously reported to the department in accordance with both

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  s. 455.565 and the initial licensure reporting requirements

 2  specified in the applicable practice act.

 3         (d)(e)  "Credential" or "credentialing" means the

 4  process of assessing and verifying validating the

 5  qualifications of a licensed health care practitioner or

 6  applicant for licensure as a health care practitioner.

 7         (e)(f)  "Credentials verification organization entity"

 8  means any program, entity, or organization that is organized

 9  and certified or accredited as a credentials verification

10  organization for the express purpose of collecting, verifying,

11  maintaining, storing, and providing to health care entities a

12  health care practitioner's total core credentials data,

13  including all corrections, updates, and modifications thereto,

14  as authorized by the health care practitioner and in

15  accordance with the provisions of this including all

16  corrections, updates, and modifications thereto, as authorized

17  by the health care practitioner and in accordance with the

18  provisions of this section. The division, once certified,

19  shall be considered a credentials verification entity for all

20  health care practitioners.

21         (f)(g)  "Department" means the Department of Health,

22  Division of Medical Quality Assurance.

23         (g)(h)  "Designated credentials verification

24  organization entity" means the credentials verification

25  program, entity, or organization organized and certified or

26  accredited for the express purpose of collecting, verifying,

27  maintaining, storing, and providing to health care entities a

28  health care practitioner's total core credentials data,

29  including all corrections, updates, and modifications thereto,

30  which is selected by the health care practitioner as the

31  credentials verification entity for all inquiries into his or

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 1  her credentials, if the health care practitioner chooses to

 2  make such a designation. Notwithstanding any such designation

 3  by a health care practitioner, the division, once certified,

 4  shall also be considered a designated credentials verification

 5  entity for that health care practitioner.

 6         (h)  "Drug Enforcement Administration certification"

 7  means certification issued by the Drug Enforcement

 8  Administration for purposes of administration or prescription

 9  of controlled substances. Submission of such certification

10  under this section must include evidence that the

11  certification is current and must also include all current

12  addresses to which the certificate is issued.

13         (i)  "Division" means the Division of Medical Quality

14  Assurance within the Department of Health.

15         (i)(j)  "Health care entity" means:

16         1.  Any health care facility or other health care

17  organization licensed or certified to provide approved medical

18  and allied health services in this state Florida; or

19         2.  Any entity licensed by the Department of Insurance

20  as a prepaid health care plan or health maintenance

21  organization or as an insurer to provide coverage for health

22  care services through a network of providers; or

23         3.  Any accredited medical school in this state.

24         (j)(k)  "Health care practitioner" means any person

25  licensed, or, for credentialing purposes only, any person

26  applying for licensure, under chapter 458, chapter 459,

27  chapter 460, or chapter 461 or any person licensed or applying

28  for licensure under a chapter subsequently made subject to

29  this section by the department with the approval of the

30  applicable board, except a person registered or applying for

31  registration pursuant to s. 458.345 or s. 459.021.

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 1         (k)  "Hospital or other institutional affiliations"

 2  means each hospital or other institution for which the health

 3  care practitioner or applicant has provided medical services.

 4  Submission of such information under this section must

 5  include, for each hospital or other institution, the name and

 6  address of the hospital or institution, the staff status of

 7  the health care practitioner or applicant at that hospital or

 8  institution, and the dates of affiliation with that hospital

 9  or institution.

10         (l)  "National accrediting organization" means an

11  organization that awards accreditation or certification to

12  hospitals, managed care organizations, credentials

13  verification organizations, or other health care

14  organizations, including, but not limited to, the Joint

15  Commission on Accreditation of Healthcare Organizations, the

16  American Accreditation HealthCare Commission/URAC, and the

17  National Committee for Quality Assurance.

18         (m)  "Professional training" means any internship,

19  residency, or fellowship relating to the profession for which

20  the health care practitioner is licensed or seeking licensure.

21         (n)  "Specialty board certification" means

22  certification in a specialty issued by a specialty board

23  recognized by the board in this state that regulates the

24  profession for which the health care practitioner is licensed

25  or seeking licensure.

26         (m)  "Primary source verification" means verification

27  of professional qualifications based on evidence obtained

28  directly from the issuing source of the applicable

29  qualification.

30         (n)  "Recredentialing" means the process by which a

31  credentials verification entity verifies the credentials of a

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 1  health care practitioner whose core credentials data,

 2  including all corrections, updates, and modifications thereto,

 3  are currently on file with the entity.

 4         (o)  "Secondary source verification" means confirmation

 5  of a professional qualification by means other than primary

 6  source verification, as outlined and approved by national

 7  accrediting organizations.

 8         (3)  STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.--

 9         (a)  Every health care practitioner shall:

10         1.  Report all core credentials data to the department

11  which is not already on file with the department, either by

12  designating a credentials verification organization to submit

13  the data or by submitting the data directly.

14         2.  Notify the department within 45 days of any

15  corrections, updates, or modifications to the core credentials

16  data either through his or her designated credentials

17  verification organization or by submitting the data directly.

18  Corrections, updates, and modifications to the core

19  credentials data provided the department under this section

20  shall comply with the updating requirements of s. 455.565(3)

21  related to profiling.

22         (b)(a)  In accordance with the provisions of this

23  section, The department shall:

24         1.  Maintain a complete, current file of core

25  credentials data on each health care practitioner, which shall

26  include all updates provided in accordance with subparagraph

27  (3)(a)2.

28         2.  Release the core credentials data that is otherwise

29  confidential or exempt from the provisions of chapter 119 and

30  s. 24(a), Art. I of the State Constitution and any

31  corrections, updates, and modifications thereto, if authorized

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    Bill No. CS for SB 2220

    Amendment No.    





 1  by the health care practitioner.

 2         3.  Charge a fee to access the core credentials data,

 3  which may not exceed the actual cost, including prorated setup

 4  and operating costs, pursuant to the requirements of chapter

 5  119. The actual cost shall be set in consultation with the

 6  advisory council.

 7         4.  Develop, in consultation with the advisory council,

 8  standardized forms to be used by the health care practitioner

 9  or designated credentials verification organization for the

10  initial reporting of core credentials data, for the health

11  care practitioner to authorize the release of core credentials

12  data, and for the subsequent reporting of corrections,

13  updates, and modifications thereto develop standardized forms

14  necessary for the creation of a standardized system as well as

15  guidelines for collecting, verifying, maintaining, storing,

16  and providing core credentials data on health care

17  practitioners through credentials verification entities,

18  except as otherwise provided in this section, for the purpose

19  of eliminating duplication. Once the core credentials data are

20  submitted, the health care practitioner is not required to

21  resubmit this initial data when applying for practice

22  privileges with health care entities. However, as provided in

23  paragraph (d), each health care practitioner is responsible

24  for providing any corrections, updates, and modifications to

25  his or her core credentials data, to ensure that all

26  credentialing data on the practitioner remains current.

27  Nothing in this paragraph prevents the designated credentials

28  verification entity from obtaining all necessary attestation

29  and release form signatures and dates.

30         5.(b)  Establish There is established a Credentials

31  Verification Advisory Council, consisting of 13 members, to

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 1  assist the department as provided in this section with the

 2  development of guidelines for establishment of the

 3  standardized credentials verification program. The secretary,

 4  or his or her designee, shall serve as one member and chair of

 5  the council and shall appoint the remaining 12 members. Except

 6  for any initial lesser term required to achieve staggering,

 7  such appointments shall be for 4-year staggered terms, with

 8  one 4-year reappointment, as applicable. Three members shall

 9  represent hospitals, and two members shall represent health

10  maintenance organizations. One member shall represent health

11  insurance entities. One member shall represent the credentials

12  verification industry. Two members shall represent physicians

13  licensed under chapter 458. One member shall represent

14  osteopathic physicians licensed under chapter 459. One member

15  shall represent chiropractic physicians licensed under chapter

16  460. One member shall represent podiatric physicians licensed

17  under chapter 461.

18         (c)  A registered credentials verification organization

19  may be designated by a health care practitioner to assist the

20  health care practitioner to comply with the requirements of

21  subsection (3)(a)2. A designated credentials verification

22  organization shall:

23         1.  Timely comply with the requirements of subsection

24  (3)(a)2., pursuant to rules adopted by the department.

25         2.  Not provide the health care practitioner's core

26  data, including all corrections, updates, and modifications,

27  without the authorization of the practitioner.

28         (c)  The department, in consultation with the advisory

29  council, shall develop standard forms for the initial

30  reporting of core credentials data for credentialing purposes

31  and for the subsequent reporting of corrections, updates, and

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

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 1  modifications thereto for recredentialing purposes.

 2         (d)  Each health care practitioner licensed under

 3  chapter 458, chapter 459, chapter 460, or chapter 461, or any

 4  person licensed under a chapter subsequently made subject to

 5  this section, must report any action or information as defined

 6  in paragraph (2)(d), including any correction, update, or

 7  modification thereto, as soon as possible but not later than

 8  30 days after such action occurs or such information is known,

 9  to the department or his or her designated credentials

10  verification entity, if any, who must report it to the

11  department. In addition, a licensee must update, at least

12  quarterly, his or her data on a form prescribed by the

13  department.

14         (e)  An individual applying for licensure under chapter

15  458, chapter 459, chapter 460, or chapter 461, or any person

16  applying for licensure under a chapter subsequently made

17  subject to this section, must submit the individual's initial

18  core credentials data to a credentials verification entity, if

19  such information has not already been submitted to the

20  department or the appropriate licensing board or to any other

21  credentials verification entity.

22         (f)  Applicants may decide which credentials

23  verification entity they want to process and store their core

24  credentials data; however, such data shall at all times be

25  maintained by the department. An applicant may choose not to

26  designate a credentials verification entity, provided the

27  applicant has a written agreement with the health care entity

28  or entities that are responsible for his or her credentialing.

29  In addition, any licensee may choose to move his or her core

30  credentials data from one credentials verification entity to

31  another.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (g)  Any health care entity that employs, contracts

 2  with, or allows health care practitioners to treat its

 3  patients must use the designated credentials verification

 4  entity to obtain core credentials data on a health care

 5  practitioner applying for privileges with that entity, if the

 6  health care practitioner has made such a designation, or may

 7  use the division in lieu thereof as the designated credentials

 8  verification entity required for obtaining core credentials

 9  data on such health care practitioner. Any additional

10  information required by the health care entity's credentialing

11  process may be collected from the primary source of that

12  information either by the health care entity or its contractee

13  or by the designated credentials verification entity.

14         (h)  Nothing in this section may be construed to

15  restrict the right of any health care entity to request

16  additional information necessary for credentialing.

17         (i)  Nothing in this section may be construed to

18  restrict access to the National Practitioner Data Bank by the

19  department, any health care entity, or any credentials

20  verification entity.

21         (d)(j)  Nothing in This section shall not may be

22  construed to restrict in any way the authority of the health

23  care entity to credential and to approve or deny an

24  application for hospital staff membership, clinical

25  privileges, or managed care network participation.

26         (4)  DELEGATION BY CONTRACT.--A health care entity may

27  contract with any credentials verification entity to perform

28  the functions required under this section. The submission of

29  an application for health care privileges with a health care

30  entity shall constitute authorization for the health care

31  entity to access the applicant's core credentials data with

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  the department or the applicant's designated credentials

 2  verification entity, if the applicant has made such a

 3  designation.

 4         (5)  AVAILABILITY OF DATA COLLECTED.--

 5         (a)  The department shall make available to a health

 6  care entity or credentials verification entity registered with

 7  the department all core credentials data it collects on any

 8  licensee that is otherwise confidential and exempt from the

 9  provisions of chapter 119 and s. 24(a), Art. I of the State

10  Constitution, including corrections, updates, and

11  modifications thereto, if a health care entity submits proof

12  of the licensee's current pending application for purposes of

13  credentialing the applicant based on the core credentials data

14  maintained by the department.

15         (b)  Each credentials verification entity shall make

16  available to a health care entity the licensee has authorized

17  to receive the data, and to the department at the credentials

18  verification entity's actual cost of providing the data, all

19  core credentials data it collects on any licensee, including

20  all corrections, updates, and modifications thereto.

21         (c)  The department shall charge health care entities

22  and other credentials verification entities a reasonable fee,

23  pursuant to the requirements of chapter 119, to access all

24  credentialing data it maintains on applicants and licensees.

25  The fee shall be set in consultation with the advisory council

26  and may not exceed the actual cost of providing the data.

27         (4)(6)  DUPLICATION OF DATA PROHIBITED.--

28         (a)  A health care entity or credentials verification

29  organization is prohibited from collecting or attempting may

30  not collect or attempt to collect duplicate core credentials

31  data from any individual health care practitioner or from any

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  primary source if the information is available from already on

 2  file with the department or with any credentials verification

 3  entity. This section shall not be construed to restrict the

 4  right of any health care entity or credentials verification

 5  organization to collect additional information from the health

 6  care practitioner which is not included in the core

 7  credentials data file. This section shall not be construed to

 8  prohibit a health care entity or credentials verification

 9  organization from obtaining all necessary attestation and

10  release form signatures and dates.

11         (b)  Effective July 1, 2002, a state agency in this

12  state which credentials health care practitioners may not

13  collect or attempt to collect duplicate core credentials data

14  from any individual health care practitioner if the

15  information is already available from the department. This

16  section shall not be construed to restrict the right of any

17  such state agency to request additional information not

18  included in the core credential data file, but which is deemed

19  necessary for the agency's specific credentialing purposes.

20         (b)  A credentials verification entity other than the

21  department may not attempt to collect duplicate core

22  credentials data from any individual health care practitioner

23  if the information is already on file with another credentials

24  verification entity or with the appropriate licensing board of

25  another state, provided the other state's credentialing

26  program meets national standards and is certified or

27  accredited, as outlined by national accrediting organizations,

28  and agrees to provide all data collected under such program on

29  that health care practitioner.

30         (7)  RELIABILITY OF DATA.--Any credentials verification

31  entity may rely upon core credentials data, including all

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  corrections, updates, and modifications thereto, from the

 2  department if the department certifies that the information

 3  was obtained in accordance with primary source verification

 4  procedures; and the department may rely upon core credentials

 5  data, including all corrections, updates, and modifications

 6  thereto, from any credentials verification entity if the

 7  designated credentials verification entity certifies that the

 8  information was obtained in accordance with primary source

 9  verification procedures.

10         (5)(8)  STANDARDS AND REGISTRATION.--

11         (a)  The department's credentials verification

12  procedures must meet national standards, as outlined by

13  national accrediting organizations.

14         (b)  Any credentials verification organization entity

15  that does business in this state Florida must be fully

16  accredited or certified as a credentials verification

17  organization meet national standards, as outlined by a

18  national accrediting organization as specified in paragraph

19  (2)(b) organizations, and must register with the department.

20  The department may charge a reasonable registration fee, set

21  in consultation with the advisory council, not to exceed an

22  amount sufficient to cover its actual expenses in providing

23  and enforcing for such registration. The department shall

24  establish by rule for biennial renewal of such registration.

25  Failure by a registered Any credentials verification

26  organization to maintain full accreditation or certification,

27  to provide data as authorized by the health care practitioner,

28  to report to the department changes, updates, and

29  modifications to a health care practitioner's records within

30  the time period specified in subparagraph (3)(a)2., or to

31  comply with the prohibition against collection of duplicate

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  core credentials data from a practitioner may result in denial

 2  of an application for renewal of registration or in revocation

 3  or suspension of a registration entity that fails to meet the

 4  standards required to be certified or accredited, fails to

 5  register with the department, or fails to provide data

 6  collected on a health care practitioner may not be selected as

 7  the designated credentials verification entity for any health

 8  care practitioner.

 9         (6)(9)  LIABILITY.--No civil, criminal, or

10  administrative action may be instituted, and there shall be no

11  liability, against any registered credentials verification

12  organization or health care entity on account of its reliance

13  on any data obtained directly from the department a

14  credentials verification entity.

15         (10)  REVIEW.--Before releasing a health care

16  practitioner's core credentials data from its data bank, a

17  designated credentials verification entity other than the

18  department must provide the practitioner up to 30 days to

19  review such data and make any corrections of fact.

20         (11)  VALIDATION OF CREDENTIALS.--Except as otherwise

21  acceptable to the health care entity and applicable certifying

22  or accrediting organization listed in paragraph (2)(c), the

23  department and all credentials verification entities must

24  perform primary source verification of all credentialing

25  information submitted to them pursuant to this section;

26  however, secondary source verification may be utilized if

27  there is a documented attempt to contact primary sources. The

28  validation procedures used by the department and credentials

29  verification entities must meet the standards established by

30  rule pursuant to this section.

31         (7)(12)  LIABILITY INSURANCE REQUIREMENTS.--The

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  department, in consultation with the Credentials Verification

 2  Advisory Council, shall establish the minimum liability

 3  insurance requirements for Each credentials verification

 4  organization entity doing business in this state shall

 5  maintain liability insurance appropriate to meet the

 6  certification or accreditation requirements established in

 7  this section.

 8         (8)(13)  RULES.--The department, in consultation with

 9  the advisory council applicable board, shall adopt rules

10  necessary to develop and implement the standardized core

11  credentials data collection verification program established

12  by this section.

13         (9)  COUNCIL ABOLISHED; DEPARTMENT AUTHORITY.--The

14  council shall be abolished October 1, 1999. After the council

15  is abolished, all duties of the department required under this

16  section to be in consultation with the council may be carried

17  out by the department on its own.

18         Section 77.  Subsections (1), (2), (6), (7), (8), and

19  (9) of section 455.564, Florida Statutes, 1998 Supplement, are

20  amended to read:

21         455.564  Department; general licensing provisions.--

22         (1)  Any person desiring to be licensed in a profession

23  within the jurisdiction of the department shall apply to the

24  department in writing to take the licensure examination.  The

25  application shall be made on a form prepared and furnished by

26  the department and shall require the social security number of

27  the applicant.  The form shall be supplemented as needed to

28  reflect any material change in any circumstance or condition

29  stated in the application which takes place between the

30  initial filing of the application and the final grant or

31  denial of the license and which might affect the decision of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  the department. An incomplete application shall expire 1 year

 2  after initial filing. In order to further the economic

 3  development goals of the state, and notwithstanding any law to

 4  the contrary, the department may enter into an agreement with

 5  the county tax collector for the purpose of appointing the

 6  county tax collector as the department's agent to accept

 7  applications for licenses and applications for renewals of

 8  licenses. The agreement must specify the time within which the

 9  tax collector must forward any applications and accompanying

10  application fees to the department.

11         (2)  Before the issuance of any license, the department

12  may charge an initial license fee as determined by rule of the

13  applicable board or, if no such board exists, by rule of the

14  department.  Upon receipt of the appropriate license fee, the

15  department shall issue a license to any person certified by

16  the appropriate board, or its designee, as having met the

17  licensure requirements imposed by law or rule. The license

18  licensee shall consist of be issued a wallet-size

19  identification card and a wall card measuring 6 1/2 inches by

20  5 inches. In addition to the two-part license, the department,

21  at the time of initial licensure, shall issue a wall

22  certificate suitable for conspicuous display, which shall be

23  no smaller than 8 1/2  inches by 14 inches. The licensee shall

24  surrender to the department the wallet-size identification

25  card, the wall card, and the wall certificate, if one has been

26  issued by the department, if the licensee's license is

27  suspended or revoked. The department shall promptly return the

28  wallet-size identification card and the wall certificate to

29  the licensee upon reinstatement of a suspended or revoked

30  license.

31         (6)  As a condition of renewal of a license, the Board

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  of Medicine, the Board of Osteopathic Medicine, the Board of

 2  Chiropractic Medicine, and the Board of Podiatric Medicine

 3  shall each require licensees which they respectively regulate

 4  to periodically demonstrate their professional competency by

 5  completing at least 40 hours of continuing education every 2

 6  years, which may include up to 1 hour of risk management or

 7  cost containment and up to 2 hours of other topics related to

 8  the applicable medical specialty, if required by board rule.

 9  The boards may require by rule that up to 1 hour of the

10  required 40 or more hours be in the area of risk management or

11  cost containment. This provision shall not be construed to

12  limit the number of hours that a licensee may obtain in risk

13  management or cost containment to be credited toward

14  satisfying the 40 or more required hours. This provision shall

15  not be construed to require the boards to impose any

16  requirement on licensees except for the completion of at least

17  40 hours of continuing education every 2 years. Each of such

18  boards shall determine whether any specific continuing

19  education course requirements not otherwise mandated by law

20  shall be mandated and shall approve criteria for, and the

21  content of, any continuing education course mandated by such

22  board. Notwithstanding any other provision of law, the board,

23  or the department when there is no board, may approve by rule

24  alternative methods of obtaining continuing education credits

25  in risk management. The alternative methods may include

26  attending a board meeting at which another a licensee is

27  disciplined, serving as a volunteer expert witness for the

28  department in a disciplinary case, or serving as a member of a

29  probable cause panel following the expiration of a board

30  member's term. Other boards within the Division of Medical

31  Quality Assurance, or the department if there is no board, may

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  adopt rules granting continuing education hours in risk

 2  management for attending a board meeting at which another

 3  licensee is disciplined, serving as a volunteer expert witness

 4  for the department in a disciplinary case, or serving as a

 5  member of a probable cause panel following the expiration of a

 6  board member's term.

 7         (7)  The respective boards within the jurisdiction of

 8  the department, or the department when there is no board, may

 9  adopt rules to provide for the use of approved videocassette

10  courses, not to exceed 5 hours per subject, to fulfill the

11  continuing education requirements of the professions they

12  regulate. Such rules shall provide for prior board approval of

13  the board, or the department when there is no board, of the

14  criteria for and content of such courses and shall provide for

15  a videocassette course validation form to be signed by the

16  vendor and the licensee and submitted to the department, along

17  with the license renewal application, for continuing education

18  credit.

19         (8)  Any board that currently requires continuing

20  education for renewal of a license, or the department if there

21  is no board, shall adopt rules to establish the criteria for

22  continuing education courses.  The rules may provide that up

23  to a maximum of 25 percent of the required continuing

24  education hours can be fulfilled by the performance of pro

25  bono services to the indigent or to underserved populations or

26  in areas of critical need within the state where the licensee

27  practices. The board, or the department if there is no board,

28  must require that any pro bono services be approved in advance

29  in order to receive credit for continuing education under this

30  subsection. The standard for determining indigency shall be

31  that recognized by the Federal Poverty Income Guidelines

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  produced by the United States Department of Health and Human

 2  Services.  The rules may provide for approval by the board, or

 3  the department if there is no board, that a part of the

 4  continuing education hours can be fulfilled by performing

 5  research in critical need areas or for training leading to

 6  advanced professional certification.  The board, or the

 7  department if there is no board, may make rules to define

 8  underserved and critical need areas.  The department shall

 9  adopt rules for administering continuing education

10  requirements adopted by the boards or the department if there

11  is no board.

12         (9)  Notwithstanding any law to the contrary, an

13  elected official who is licensed under a practice act

14  administered by the Division of Medical Health Quality

15  Assurance may hold employment for compensation with any public

16  agency concurrent with such public service.  Such dual service

17  must be disclosed according to any disclosure required by

18  applicable law.

19         Section 78.  Present subsections (5), (6), and (7) of

20  section 455.5651, Florida Statutes, 1998 Supplement, are

21  renumbered as subsections (6), (7), and (8), respectively, and

22  a new subsection (5) is added to that section, to read:

23         455.5651  Practitioner profile; creation.--

24         (5)  The Department of Health may not include

25  disciplinary action taken by a licensed hospital or an

26  ambulatory surgical center in the practitioner profile.

27         Section 79.  Section 455.567, Florida Statutes, is

28  amended to read:

29         455.567  Sexual misconduct; disqualification for

30  license, certificate, or registration.--

31         (1)  Sexual misconduct in the practice of a health care

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  profession means violation of the professional relationship

 2  through which the health care practitioner uses such

 3  relationship to engage or attempt to engage the patient or

 4  client, or an immediate family member of the patient or client

 5  in, or to induce or attempt to induce such person to engage

 6  in, verbal or physical sexual activity outside the scope of

 7  the professional practice of such health care profession.

 8  Sexual misconduct in the practice of a health care profession

 9  is prohibited.

10         (2)  Each board within the jurisdiction of the

11  department, or the department if there is no board, shall

12  refuse to admit a candidate to any examination and refuse to

13  issue a license, certificate, or registration to any applicant

14  if the candidate or applicant has:

15         (a)(1)  Had any license, certificate, or registration

16  to practice any profession or occupation revoked or

17  surrendered based on a violation of sexual misconduct in the

18  practice of that profession under the laws of any other state

19  or any territory or possession of the United States and has

20  not had that license, certificate, or registration reinstated

21  by the licensing authority of the jurisdiction that revoked

22  the license, certificate, or registration; or

23         (b)(2)  Committed any act in any other state or any

24  territory or possession of the United States which if

25  committed in this state would constitute sexual misconduct.

26

27  For purposes of this subsection, a licensing authority's

28  acceptance of a candidate's relinquishment of a license which

29  is offered in response to or in anticipation of the filing of

30  administrative charges against the candidate's license

31  constitutes the surrender of the license.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         Section 80.  Subsection (2) of section 455.574, Florida

 2  Statutes, 1998 Supplement, is amended to read:

 3         455.574  Department of Health; examinations.--

 4         (2)  For each examination developed by the department

 5  or a contracted vendor, the board, or the department when

 6  there is no board, shall adopt rules providing for

 7  reexamination of any applicants who failed an examination

 8  developed by the department or a contracted vendor. If both a

 9  written and a practical examination are given, an applicant

10  shall be required to retake only the portion of the

11  examination on which the applicant failed to achieve a passing

12  grade, if the applicant successfully passes that portion

13  within a reasonable time, as determined by rule of the board,

14  or the department when there is no board, of passing the other

15  portion. Except for national examinations approved and

16  administered pursuant to this section, the department shall

17  provide procedures for applicants who fail an examination

18  developed by the department or a contracted vendor to review

19  their examination questions, answers, papers, grades, and

20  grading key for the questions the candidate answered

21  incorrectly or, if not feasible, the parts of the examination

22  failed. Applicants shall bear the actual cost for the

23  department to provide examination review pursuant to this

24  subsection. An applicant may waive in writing the

25  confidentiality of the applicant's examination grades.

26         Section 81.  Subsection (1) of section 455.587, Florida

27  Statutes, is amended, present subsections (2) through (7) are

28  renumbered as subsections (3) through (8), respectively, and a

29  new subsection (2) is added to that section, to read:

30         455.587  Fees; receipts; disposition for boards within

31  the department.--

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (1)  Each board within the jurisdiction of the

 2  department, or the department when there is no board, shall

 3  determine by rule the amount of license fees for the its

 4  profession it regulates, based upon long-range estimates

 5  prepared by the department of the revenue required to

 6  implement laws relating to the regulation of professions by

 7  the department and the board.  Each board, or the department

 8  if there is no board, shall ensure that license fees are

 9  adequate to cover all anticipated costs and to maintain a

10  reasonable cash balance, as determined by rule of the agency,

11  with advice of the applicable board. If sufficient action is

12  not taken by a board within 1 year after notification by the

13  department that license fees are projected to be inadequate,

14  the department shall set license fees on behalf of the

15  applicable board to cover anticipated costs and to maintain

16  the required cash balance. The department shall include

17  recommended fee cap increases in its annual report to the

18  Legislature.  Further, it is the legislative intent that no

19  regulated profession operate with a negative cash balance. The

20  department may provide by rule for advancing sufficient funds

21  to any profession operating with a negative cash balance. The

22  advancement may be for a period not to exceed 2 consecutive

23  years, and the regulated profession must pay interest.

24  Interest shall be calculated at the current rate earned on

25  investments of a trust fund used by the department to

26  implement this part. Interest earned shall be allocated to the

27  various funds in accordance with the allocation of investment

28  earnings during the period of the advance.

29         (2)  Each board, or the department if there is no

30  board, may charge a fee not to exceed $25, as determined by

31  rule, for the issuance of a wall certificate pursuant to s.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  455.564(2) requested by a licensee who was licensed prior to

 2  July 1, 1998, or for the issuance of a duplicate wall

 3  certificate requested by any licensee.

 4         Section 82.  Section 455.601, Florida Statutes, is

 5  amended to read:

 6         455.601  Hepatitis B or human immunodeficiency

 7  carriers.--

 8         (1)  The department and each appropriate board within

 9  the Division of Medical Quality Assurance shall have the

10  authority to establish procedures to handle, counsel, and

11  provide other services to health care professionals within

12  their respective boards who are infected with hepatitis B or

13  the human immunodeficiency virus.

14         (2)  Any person licensed by the department and any

15  other person employed by a health care facility who contracts

16  a blood-borne infection shall have a rebuttable presumption

17  that the illness was contracted in the course and scope of his

18  or her employment, provided that the person, as soon as

19  practicable, reports to the person's supervisor or the

20  facility's risk manager any significant exposure, as that term

21  is defined in s. 381.004(2)(c), to blood or body fluids. The

22  employer may test the blood or body fluid to determine if it

23  is infected with the same disease contracted by the employee.

24  The employer may rebut the presumption by the preponderance of

25  the evidence. Except as expressly provided in this subsection,

26  there shall be no presumption that a blood-borne infection is

27  a job-related injury or illness.

28         Section 83.  Subsections (1) and (6) of section

29  455.604, Florida Statutes, 1998 Supplement, are amended to

30  read:

31         455.604  Requirement for instruction for certain

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  licensees on human immunodeficiency virus and acquired immune

 2  deficiency syndrome.--

 3         (1)  The appropriate board shall require each person

 4  licensed or certified under chapter 457; chapter 458; chapter

 5  459; chapter 460; chapter 461; chapter 463; chapter 464;

 6  chapter 465; chapter 466; part II, part III, or part V, or

 7  part X of chapter 468; or chapter 486 to complete a continuing

 8  educational course, approved by the board, on human

 9  immunodeficiency virus and acquired immune deficiency syndrome

10  as part of biennial relicensure or recertification. The course

11  shall consist of education on the modes of transmission,

12  infection control procedures, clinical management, and

13  prevention of human immunodeficiency virus and acquired immune

14  deficiency syndrome. Such course shall include information on

15  current Florida law on acquired immune deficiency syndrome and

16  its impact on testing, confidentiality of test results,

17  treatment of patients, and any protocols and procedures

18  applicable to human immunodeficiency virus counseling and

19  testing, reporting, the offering of HIV testing to pregnant

20  women, and partner notification issues pursuant to ss. 381.004

21  and 384.25.

22         (6)  The board shall require as a condition of granting

23  a license under the chapters and parts specified in subsection

24  (1) that an applicant making initial application for licensure

25  complete an educational course acceptable to the board on

26  human immunodeficiency virus and acquired immune deficiency

27  syndrome. An applicant who has not taken a course at the time

28  of licensure shall, upon an affidavit showing good cause, be

29  allowed 6 months to complete this requirement.

30         Section 84.  Subsection (1) of section 455.607, Florida

31  Statutes, is amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         455.607  Athletic trainers and massage therapists;

 2  requirement for instruction on human immunodeficiency virus

 3  and acquired immune deficiency syndrome.--

 4         (1)  The board, or the department where there is no

 5  board, shall require each person licensed or certified under

 6  part XIII XIV of chapter 468 or chapter 480 to complete a

 7  continuing educational course approved by the board, or the

 8  department where there is no board, on human immunodeficiency

 9  virus and acquired immune deficiency syndrome as part of

10  biennial relicensure or recertification.  The course shall

11  consist of education on modes of transmission, infection

12  control procedures, clinical management, and prevention of

13  human immunodeficiency virus and acquired immune deficiency

14  syndrome, with an emphasis on appropriate behavior and

15  attitude change.

16         Section 85.  Paragraphs (t), (u), (v), (w), and (x) are

17  added to subsection (1) of section 455.624, Florida Statutes,

18  subsection (2) of that section is amended, present subsection

19  (3) of that section is renumbered as subsection (4) and

20  amended, present subsections (4) and (5) of that subsection

21  are renumbered as subsections (5) and (6), respectively, and a

22  new subsection (3) is added to that section, to read:

23         455.624  Grounds for discipline; penalties;

24  enforcement.--

25         (1)  The following acts shall constitute grounds for

26  which the disciplinary actions specified in subsection (2) may

27  be taken:

28         (t)  Failing to comply with the requirements of ss.

29  381.026 and 381.0261 to provide patients with information

30  about their patient rights and how to file a patient

31  complaint.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (u)  Engaging or attempting to engage a patient or

 2  client in verbal or physical sexual activity. For the purposes

 3  of this section, a patient or client shall be presumed to be

 4  incapable of giving free, full, and informed consent to verbal

 5  or physical sexual activity.

 6         (v)  Failing to comply with the requirements for

 7  profiling and credentialing, including, but not limited to,

 8  failing to provide initial information, failing to timely

 9  provide updated information, or making misleading, untrue,

10  deceptive, or fraudulent representations on a profile,

11  credentialing, or initial or renewal licensure application.

12         (w)  Failing to report to the board, or the department

13  if there is no board, in writing within 30 days after the

14  licensee has been convicted or found guilty of, or entered a

15  plea of nolo contendere to, regardless of adjudication, a

16  crime in any jurisdiction. Convictions, findings,

17  adjudications, and pleas entered into prior to the enactment

18  of this paragraph must be reported in writing to the board, or

19  department if there is no board, on or before October 1, 1999.

20         (x)  Using information about people involved in motor

21  vehicle accidents which has been derived from accident reports

22  made by law enforcement officers or persons involved in

23  accidents pursuant to s. 316.066, or using information

24  published in a newspaper or other news publication or through

25  a radio or television broadcast that has used information

26  gained from such reports, for the purposes of commercial or

27  any other solicitation whatsoever of the people involved in

28  such accidents.

29         (2)  When the board, or the department when there is no

30  board, finds any person guilty of the grounds set forth in

31  subsection (1) or of any grounds set forth in the applicable

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  practice act, including conduct constituting a substantial

 2  violation of subsection (1) or a violation of the applicable

 3  practice act which occurred prior to obtaining a license, it

 4  may enter an order imposing one or more of the following

 5  penalties:

 6         (a)  Refusal to certify, or to certify with

 7  restrictions, an application for a license.

 8         (b)  Suspension or permanent revocation of a license.

 9         (c)  Restriction of practice.

10         (d)  Imposition of an administrative fine not to exceed

11  $10,000 $5,000 for each count or separate offense.

12         (e)  Issuance of a reprimand.

13         (f)  Placement of the licensee on probation for a

14  period of time and subject to such conditions as the board, or

15  the department when there is no board, may specify. Those

16  conditions may include, but are not limited to, requiring the

17  licensee to undergo treatment, attend continuing education

18  courses, submit to be reexamined, work under the supervision

19  of another licensee, or satisfy any terms which are reasonably

20  tailored to the violations found.

21         (g)  Corrective action.

22         (h)  Imposition of an administrative fine in accordance

23  with s. 381.0261 for violations regarding patient rights.

24

25  In determining what action is appropriate, the board, or

26  department when there is no board, must first consider what

27  sanctions are necessary to protect the public or to compensate

28  the patient. Only after those sanctions have been imposed may

29  the disciplining authority consider and include in the order

30  requirements designed to rehabilitate the practitioner. All

31  costs associated with compliance with orders issued under this

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  subsection are the obligation of the practitioner.

 2         (3)  Notwithstanding subsection (2), if the ground for

 3  disciplinary action is the first-time failure of the licensee

 4  to satisfy continuing education requirements established by

 5  the board, or by the department if there is no board, the

 6  board or department, as applicable, shall issue a citation in

 7  accordance with s. 455.617 and assess a fine, as determined by

 8  the board or department by rule. In addition, for each hour of

 9  continuing education not completed or completed late, the

10  board or department, as applicable, may require the licensee

11  to take 1 additional hour of continuing education for each

12  hour not completed or completed late.

13         (4)(3)  In addition to any other discipline imposed

14  pursuant to this section or discipline imposed for a violation

15  of any practice act, the board, or the department when there

16  is no board, may assess costs related to the investigation and

17  prosecution of the case excluding costs associated with an

18  attorney's time. In any case where the board or the department

19  imposes a fine or assessment and the fine or assessment is not

20  paid within a reasonable time, such reasonable time to be

21  prescribed in the rules of the board, or the department when

22  there is no board, or in the order assessing such fines or

23  costs, the department or the Department of Legal Affairs may

24  contract for the collection of, or bring a civil action to

25  recover, the fine or assessment.

26         Section 86.  Section 455.664, Florida Statutes, is

27  amended to read:

28         455.664  Advertisement by a health care practitioner

29  provider of free or discounted services; required

30  statement.--In any advertisement for a free, discounted fee,

31  or reduced fee service, examination, or treatment by a health

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  care practitioner provider licensed under chapter 458, chapter

 2  459, chapter 460, chapter 461, chapter 462, chapter 463,

 3  chapter 464, chapter 465, chapter 466, chapter 467, chapter

 4  478, chapter 483, chapter 484, or chapter 486, chapter 490, or

 5  chapter 491, the following statement shall appear in capital

 6  letters clearly distinguishable from the rest of the text:

 7  THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A

 8  RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR

 9  PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT

10  IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING

11  TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED

12  FEE SERVICE, EXAMINATION, OR TREATMENT. However, the required

13  statement shall not be necessary as an accompaniment to an

14  advertisement of a licensed health care practitioner provider

15  defined by this section if the advertisement appears in a

16  classified directory the primary purpose of which is to

17  provide products and services at free, reduced, or discounted

18  prices to consumers and in which the statement prominently

19  appears in at least one place.

20         Section 87.  Subsections (7) and (16) of section

21  455.667, Florida Statutes, 1998 Supplement, are amended to

22  read:

23         455.667  Ownership and control of patient records;

24  report or copies of records to be furnished.--

25         (7)(a)1.  The department may obtain patient records and

26  insurance information, if the complaint being investigated

27  alleges inadequate medical care based on termination of

28  insurance. The department may obtain patient access these

29  records pursuant to a subpoena without written authorization

30  from the patient if the department and the probable cause

31  panel of the appropriate board, if any, find reasonable cause

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  to believe that a health care practitioner has excessively or

 2  inappropriately prescribed any controlled substance specified

 3  in chapter 893 in violation of this part or any professional

 4  practice act or that a health care practitioner has practiced

 5  his or her profession below that level of care, skill, and

 6  treatment required as defined by this part or any professional

 7  practice act; provided, however, the and also find that

 8  appropriate, reasonable attempts were made to obtain a patient

 9  release.

10         2.  The department may obtain patient records and

11  insurance information pursuant to a subpoena without written

12  authorization from the patient if the department and the

13  probable cause panel of the appropriate board, if any, find

14  reasonable cause to believe that a health care practitioner

15  has provided inadequate medical care based on termination of

16  insurance and also find that appropriate, reasonable attempts

17  were made to obtain a patient release.

18         3.  The department may obtain patient records, billing

19  records, insurance information, provider contracts, and all

20  attachments thereto pursuant to a subpoena without written

21  authorization from the patient if the department and probable

22  cause panel of the appropriate board, if any, find reasonable

23  cause to believe that a health care practitioner has submitted

24  a claim, statement, or bill using a billing code that would

25  result in payment greater in amount than would be paid using a

26  billing code that accurately describes the services performed,

27  requested payment for services that were not performed by that

28  health care practitioner, used information derived from a

29  written report of an automobile accident generated pursuant to

30  chapter 316 to solicit or obtain patients personally or

31  through an agent regardless of whether the information is

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  derived directly from the report or a summary of that report

 2  or from another person, solicited patients fraudulently,

 3  received a kickback as defined in s. 455.657, violated the

 4  patient brokering provisions of s. 817.505, or presented or

 5  caused to be presented a false or fraudulent insurance claim

 6  within the meaning of s. 817.234(1)(a), and also find that,

 7  within the meaning of s. 817.234(1)(a), patient authorization

 8  cannot be obtained because the patient cannot be located or is

 9  deceased, incapacitated, or suspected of being a participant

10  in the fraud or scheme, and if the subpoena is issued for

11  specific and relevant records.

12         (b)  Patient records, billing records, insurance

13  information, provider contracts, and all attachments thereto

14  record obtained by the department pursuant to this subsection

15  shall be used solely for the purpose of the department and the

16  appropriate regulatory board in disciplinary proceedings. The

17  records shall otherwise be confidential and exempt from s.

18  119.07(1). This section does not limit the assertion of the

19  psychotherapist-patient privilege under s. 90.503 in regard to

20  records of treatment for mental or nervous disorders by a

21  medical practitioner licensed pursuant to chapter 458 or

22  chapter 459 who has primarily diagnosed and treated mental and

23  nervous disorders for a period of not less than 3 years,

24  inclusive of psychiatric residency. However, the health care

25  practitioner shall release records of treatment for medical

26  conditions even if the health care practitioner has also

27  treated the patient for mental or nervous disorders. If the

28  department has found reasonable cause under this section and

29  the psychotherapist-patient privilege is asserted, the

30  department may petition the circuit court for an in camera

31  review of the records by expert medical practitioners

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  appointed by the court to determine if the records or any part

 2  thereof are protected under the psychotherapist-patient

 3  privilege.

 4         (16)  A health care practitioner or records owner

 5  furnishing copies of reports or records or making the reports

 6  or records available for digital scanning pursuant to this

 7  section shall charge no more than the actual cost of copying,

 8  including reasonable staff time, or the amount specified in

 9  administrative rule by the appropriate board, or the

10  department when there is no board.

11         Section 88.  Subsection (3) is added to section

12  455.687, Florida Statutes, to read:

13         455.687  Certain health care practitioners; immediate

14  suspension of license.--

15         (3)  The department may issue an emergency order

16  suspending or restricting the license of any health care

17  practitioner as defined in s. 455.501(4) who tests positive

18  for any drug on any government or private-sector preemployment

19  or employer-ordered confirmed drug test, as defined in s.

20  112.0455, when the practitioner does not have a lawful

21  prescription and legitimate medical reason for using such

22  drug. The practitioner shall be given 48 hours from the time

23  of notification to the practitioner of the confirmed test

24  result to produce a lawful prescription for the drug before an

25  emergency order is issued.

26         Section 89.  Section 455.694, Florida Statutes, 1998

27  Supplement, is amended to read:

28         455.694  Financial responsibility requirements for

29  Boards regulating certain health care practitioners.--

30         (1)  As a prerequisite for licensure or license

31  renewal, the Board of Acupuncture, the Board of Chiropractic

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Medicine, the Board of Podiatric Medicine, and the Board of

 2  Dentistry shall, by rule, require that all health care

 3  practitioners licensed under the respective board, and the

 4  Board of Nursing shall, by rule, require that advanced

 5  registered nurse practitioners certified under s. 464.012, and

 6  the department shall, by rule, require that midwives maintain

 7  medical malpractice insurance or provide proof of financial

 8  responsibility in an amount and in a manner determined by the

 9  board or department to be sufficient to cover claims arising

10  out of the rendering of or failure to render professional care

11  and services in this state.

12         (2)  The board or department may grant exemptions upon

13  application by practitioners meeting any of the following

14  criteria:

15         (a)  Any person licensed under chapter 457, chapter

16  460, chapter 461, s. 464.012, or chapter 466, or chapter 467

17  who practices exclusively as an officer, employee, or agent of

18  the Federal Government or of the state or its agencies or its

19  subdivisions.  For the purposes of this subsection, an agent

20  of the state, its agencies, or its subdivisions is a person

21  who is eligible for coverage under any self-insurance or

22  insurance program authorized by the provisions of s.

23  768.28(15) or who is a volunteer under s. 110.501(1).

24         (b)  Any person whose license or certification has

25  become inactive under chapter 457, chapter 460, chapter 461,

26  chapter 464, or chapter 466, or chapter 467 and who is not

27  practicing in this state.  Any person applying for

28  reactivation of a license must show either that such licensee

29  maintained tail insurance coverage which provided liability

30  coverage for incidents that occurred on or after October 1,

31  1993, or the initial date of licensure in this state,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  whichever is later, and incidents that occurred before the

 2  date on which the license became inactive; or such licensee

 3  must submit an affidavit stating that such licensee has no

 4  unsatisfied medical malpractice judgments or settlements at

 5  the time of application for reactivation.

 6         (c)  Any person holding a limited license pursuant to

 7  s. 455.561, and practicing under the scope of such limited

 8  license.

 9         (d)  Any person licensed or certified under chapter

10  457, chapter 460, chapter 461, s. 464.012, or chapter 466, or

11  chapter 467 who practices only in conjunction with his or her

12  teaching duties at an accredited school or in its main

13  teaching hospitals. Such person may engage in the practice of

14  medicine to the extent that such practice is incidental to and

15  a necessary part of duties in connection with the teaching

16  position in the school.

17         (e)  Any person holding an active license or

18  certification under chapter 457, chapter 460, chapter 461, s.

19  464.012, or chapter 466, or chapter 467 who is not practicing

20  in this state.  If such person initiates or resumes practice

21  in this state, he or she must notify the department of such

22  activity.

23         (f)  Any person who can demonstrate to the board or

24  department that he or she has no malpractice exposure in the

25  state.

26         (3)  Notwithstanding the provisions of this section,

27  the financial responsibility requirements of ss. 458.320 and

28  459.0085 shall continue to apply to practitioners licensed

29  under those chapters.

30         Section 90.  Section 455.712, Florida Statutes, is

31  created to read:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         455.712  Business establishments; requirements for

 2  active status licenses.--

 3         (1)  A business establishment regulated by the Division

 4  of Medical Quality Assurance pursuant to this part may provide

 5  regulated services only if the business establishment has an

 6  active status license. A business establishment that provides

 7  regulated services without an active status license is in

 8  violation of this section and s. 455.624, and the board, or

 9  the department if there is no board, may impose discipline on

10  the business establishment.

11         (2)  A business establishment must apply with a

12  complete application, as defined by rule of the board, or the

13  department if there is no board, to renew an active status

14  license before the license expires. If a business

15  establishment fails to renew before the license expires, the

16  license becomes delinquent, except as otherwise provided in

17  statute, in the license cycle following expiration.

18         (3)  A delinquent business establishment must apply

19  with a complete application, as defined by rule of the board,

20  or the department if there is no board, for active status

21  within 6 months after becoming delinquent. Failure of a

22  delinquent business establishment to renew the license within

23  the 6 months after the expiration date of the license renders

24  the license null without any further action by the board or

25  the department. Any subsequent licensure shall be as a result

26  of applying for and meeting all requirements imposed on a

27  business establishment for new licensure.

28         (4)  The status or a change in status of a business

29  establishment license does not alter in any way the right of

30  the board, or of the department if there is no board, to

31  impose discipline or to enforce discipline previously imposed

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  on a business establishment for acts or omissions committed by

 2  the business establishment while holding a license, whether

 3  active or null.

 4         (5)  This section applies to any a business

 5  establishment registered, permitted, or licensed by the

 6  department to do business. Business establishments include,

 7  but are not limited to, dental laboratories, electrology

 8  facilities, massage establishments, pharmacies, and health

 9  care services pools.

10         Section 91.  Subsection (7) is added to section

11  457.102, Florida Statutes, 1998 Supplement, to read:

12         457.102  Definitions.--As used in this chapter:

13         (7)  "Prescriptive rights" means the prescription,

14  administration, and use of needles and devices, restricted

15  devices, and prescription devices that are used in the

16  practice of acupuncture and oriental medicine.

17         Section 92.  Subsections (2) and (4) of section

18  458.307, Florida Statutes, 1998 Supplement, are amended to

19  read:

20         458.307  Board of Medicine.--

21         (2)  Twelve members of the board must be licensed

22  physicians in good standing in this state who are residents of

23  the state and who have been engaged in the active practice or

24  teaching of medicine for at least 4 years immediately

25  preceding their appointment.  One of the physicians must be on

26  the full-time faculty of a medical school in this state, and

27  one of the physicians must be in private practice and on the

28  full-time staff of a statutory teaching hospital in this state

29  as defined in s. 408.07.  At least one of the physicians must

30  be a graduate of a foreign medical school.  The remaining

31  three members must be residents of the state who are not, and

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  never have been, licensed health care practitioners.  One

 2  member must be a health care hospital risk manager licensed

 3  certified under s. 395.10974 part IX of chapter 626.  At least

 4  one member of the board must be 60 years of age or older.

 5         (4)  The board, in conjunction with the department,

 6  shall establish a disciplinary training program for board

 7  members. The program shall provide for initial and periodic

 8  training in the grounds for disciplinary action, the actions

 9  which may be taken by the board and the department, changes in

10  relevant statutes and rules, and any relevant judicial and

11  administrative decisions. After January 1, 1989, No member of

12  the board shall participate on probable cause panels or in

13  disciplinary decisions of the board unless he or she has

14  completed the disciplinary training program.

15         Section 93.  Subsection (3) is added to section

16  458.309, Florida Statutes, 1998 Supplement, to read:

17         458.309  Authority to make rules.--

18         (3)  All physicians who perform level 2 procedures

19  lasting more than 5 minutes and all level 3 surgical

20  procedures in an office setting must register the office with

21  the department unless that office is licensed as a facility

22  pursuant to chapter 395. The department shall inspect the

23  physician's office annually unless the office is accredited by

24  a nationally recognized accrediting agency or an accrediting

25  organization subsequently approved by the Board of Medicine.

26  The actual costs for registration and inspection or

27  accreditation shall be paid by the person seeking to register

28  and operate the office setting in which office surgery is

29  performed.

30         Section 94.  Section 458.311, Florida Statutes, 1998

31  Supplement, is amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         458.311  Licensure by examination; requirements;

 2  fees.--

 3         (1)  Any person desiring to be licensed as a physician,

 4  who does not hold a valid license in any state, shall apply to

 5  the department on forms furnished by the department to take

 6  the licensure examination. The department shall license

 7  examine each applicant who whom the board certifies:

 8         (a)  Has completed the application form and remitted a

 9  nonrefundable application fee not to exceed $500 and an

10  examination fee not to exceed $300 plus the actual per

11  applicant cost to the department for purchase of the

12  examination from the Federation of State Medical Boards of the

13  United States or a similar national organization, which is

14  refundable if the applicant is found to be ineligible to take

15  the examination.

16         (b)  Is at least 21 years of age.

17         (c)  Is of good moral character.

18         (d)  Has not committed any act or offense in this or

19  any other jurisdiction which would constitute the basis for

20  disciplining a physician pursuant to s. 458.331.

21         (e)  For any applicant who has graduated from medical

22  school after October 1, 1992, has completed the equivalent of

23  2 academic years of preprofessional, postsecondary education,

24  as determined by rule of the board, which shall include, at a

25  minimum, courses in such fields as anatomy, biology, and

26  chemistry prior to entering medical school.

27         (f)  Meets one of the following medical education and

28  postgraduate training requirements:

29         1.a.  Is a graduate of an allopathic medical school or

30  allopathic college recognized and approved by an accrediting

31  agency recognized by the United States Office of Education or

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  is a graduate of an allopathic medical school or allopathic

 2  college within a territorial jurisdiction of the United States

 3  recognized by the accrediting agency of the governmental body

 4  of that jurisdiction;

 5         b.  If the language of instruction of the medical

 6  school is other than English, has demonstrated competency in

 7  English through presentation of a satisfactory grade on the

 8  Test of Spoken English of the Educational Testing Service or a

 9  similar test approved by rule of the board; and

10         c.  Has completed an approved residency of at least 1

11  year.

12         2.a.  Is a graduate of an allopathic a foreign medical

13  school registered with the World Health Organization and

14  certified pursuant to s. 458.314 as having met the standards

15  required to accredit medical schools in the United States or

16  reasonably comparable standards;

17         b.  If the language of instruction of the foreign

18  medical school is other than English, has demonstrated

19  competency in English through presentation of the Educational

20  Commission for Foreign Medical Graduates English proficiency

21  certificate or by a satisfactory grade on the Test of Spoken

22  English of the Educational Testing Service or a similar test

23  approved by rule of the board; and

24         c.  Has completed an approved residency of at least 1

25  year.

26         3.a.  Is a graduate of an allopathic a foreign medical

27  school which has not been certified pursuant to s. 458.314;

28         b.  Has had his or her medical credentials evaluated by

29  the Educational Commission for Foreign Medical Graduates,

30  holds an active, valid certificate issued by that commission,

31  and has passed the examination utilized by that commission;

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  and

 2         c.  Has completed an approved residency of at least 1

 3  year; however, after October 1, 1992, the applicant shall have

 4  completed an approved residency or fellowship of at least 2

 5  years in one specialty area.  However, to be acceptable, the

 6  fellowship experience and training must be counted toward

 7  regular or subspecialty certification by a board recognized

 8  and certified by the American Board of Medical Specialties.

 9         (g)  Has submitted to the department a set of

10  fingerprints on a form and under procedures specified by the

11  department, along with a payment in an amount equal to the

12  costs incurred by the Department of Health for the criminal

13  background check of the applicant.

14         (h)  Has obtained a passing score, as established by

15  rule of the board, on the licensure examination of the United

16  States Medical Licensing Examination (USMLE); or a combination

17  of the United States Medical Licensing Examination (USMLE),

18  the examination of the Federation of State Medical Boards of

19  the United States, Inc. (FLEX), or the examination of the

20  National Board of Medical Examiners up to the year 2000; or

21  for the purpose of examination of any applicant who was

22  licensed on the basis of a state board examination and who is

23  currently licensed in at least one other jurisdiction of the

24  United States or Canada, and who has practiced pursuant to

25  such licensure for a period of at least 10 years, use of the

26  Special Purpose Examination of the Federation of State Medical

27  Boards of the United States (SPEX) upon receipt of a passing

28  score as established by rule of the board. However, for the

29  purpose of examination of any applicant who was licensed on

30  the basis of a state board examination prior to 1974, who is

31  currently licensed in at least three other jurisdictions of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  the United States or Canada, and who has practiced pursuant to

 2  such licensure for a period of at least 20 years, this

 3  paragraph does not apply.

 4         (2)  As prescribed by board rule, the board may require

 5  an applicant who does not pass the national licensing

 6  examination after five attempts to complete additional

 7  remedial education or training.  The board shall prescribe the

 8  additional requirements in a manner that permits the applicant

 9  to complete the requirements and be reexamined within 2 years

10  after the date the applicant petitions the board to retake the

11  examination a sixth or subsequent time.

12         (3)  Notwithstanding the provisions of subparagraph

13  (1)(f)3., a graduate of a foreign medical school need not

14  present the certificate issued by the Educational Commission

15  for Foreign Medical Graduates or pass the examination utilized

16  by that commission if the graduate:

17         (a)  Has received a bachelor's degree from an

18  accredited United States college or university.

19         (b)  Has studied at a medical school which is

20  recognized by the World Health Organization.

21         (c)  Has completed all of the formal requirements of

22  the foreign medical school, except the internship or social

23  service requirements, and has passed part I of the National

24  Board of Medical Examiners examination or the Educational

25  Commission for Foreign Medical Graduates examination

26  equivalent.

27         (d)  Has completed an academic year of supervised

28  clinical training in a hospital affiliated with a medical

29  school approved by the Council on Medical Education of the

30  American Medical Association and upon completion has passed

31  part II of the National Board of Medical Examiners examination

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  or the Educational Commission for Foreign Medical Graduates

 2  examination equivalent.

 3         (4)  The department and the board shall assure that

 4  applicants for licensure meet the criteria in subsection (1)

 5  through an investigative process.  When the investigative

 6  process is not completed within the time set out in s.

 7  120.60(1) and the department or board has reason to believe

 8  that the applicant does not meet the criteria, the secretary

 9  or the secretary's designee may issue a 90-day licensure delay

10  which shall be in writing and sufficient to notify the

11  applicant of the reason for the delay.  The provisions of this

12  subsection shall control over any conflicting provisions of s.

13  120.60(1).

14         (5)  The board may not certify to the department for

15  licensure any applicant who is under investigation in another

16  jurisdiction for an offense which would constitute a violation

17  of this chapter until such investigation is completed. Upon

18  completion of the investigation, the provisions of s. 458.331

19  shall apply. Furthermore, the department may not issue an

20  unrestricted license to any individual who has committed any

21  act or offense in any jurisdiction which would constitute the

22  basis for disciplining a physician pursuant to s. 458.331.

23  When the board finds that an individual has committed an act

24  or offense in any jurisdiction which would constitute the

25  basis for disciplining a physician pursuant to s. 458.331,

26  then the board may enter an order imposing one or more of the

27  terms set forth in subsection (9).

28         (6)  Each applicant who passes the examination and

29  meets the requirements of this chapter shall be licensed as a

30  physician, with rights as defined by law.

31         (7)  Upon certification by the board, the department

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  shall impose conditions, limitations, or restrictions on a

 2  license by examination if the applicant is on probation in

 3  another jurisdiction for an act which would constitute a

 4  violation of this chapter.

 5         (8)  When the board determines that any applicant for

 6  licensure by examination has failed to meet, to the board's

 7  satisfaction, each of the appropriate requirements set forth

 8  in this section, it may enter an order requiring one or more

 9  of the following terms:

10         (a)  Refusal to certify to the department an

11  application for licensure, certification, or registration;

12         (b)  Certification to the department of an application

13  for licensure, certification, or registration with

14  restrictions on the scope of practice of the licensee; or

15         (c)  Certification to the department of an application

16  for licensure, certification, or registration with placement

17  of the physician on probation for a period of time and subject

18  to such conditions as the board may specify, including, but

19  not limited to, requiring the physician to submit to

20  treatment, attend continuing education courses, submit to

21  reexamination, or work under the supervision of another

22  physician.

23         (9)(a)  Notwithstanding any of the provisions of this

24  section, an applicant who, at the time of his or her medical

25  education, was a citizen of the country of Nicaragua and, at

26  the time of application for licensure under this subsection,

27  is either a citizen of the country of Nicaragua or a citizen

28  of the United States may make initial application to the

29  department on or before July 1, 1992, for licensure subject to

30  this subsection and may reapply pursuant to board rule.  Upon

31  receipt of such application, the department shall issue a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  2-year restricted license to any applicant therefor upon the

 2  applicant's successful completion of the licensure examination

 3  as described in paragraph (1)(a) and who the board certifies

 4  has met the following requirements:

 5         1.  Is a graduate of a World Health Organization

 6  recognized foreign medical institution located in a country in

 7  the Western Hemisphere.

 8         2.  Received a medical education which has been

 9  determined by the board to be substantially similar, at the

10  time of the applicant's graduation, to approved United States

11  medical programs.

12         3.  Practiced medicine in the country of Nicaragua for

13  a period of 1 year prior to residing in the United States and

14  has lawful employment authority in the United States.

15         4.  Has had his or her medical education verified by

16  the Florida Board of Medicine.

17         5.  Successfully completed the Educational Commission

18  for Foreign Medical Graduates Examination or Foreign Medical

19  Graduate Examination in the Medical Sciences or successfully

20  completed a course developed for the University of Miami for

21  physician training equivalent to the course developed for such

22  purposes pursuant to chapter 74-105, Laws of Florida.  No

23  person shall be permitted to enroll in the physician training

24  course until he or she has been certified by the board as

25  having met the requirements of this paragraph or conditionally

26  certified by the board as having substantially complied with

27  the requirements of this paragraph. Any person conditionally

28  certified by the board shall be required to establish, to the

29  board's satisfaction, full compliance with all the

30  requirements of this paragraph prior to completion of the

31  physician training course and shall not be permitted to sit

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  for the licensure examination unless the board certifies that

 2  all of the requirements of this paragraph have been met.

 3

 4  However, applicants eligible for licensure under s. 455.581 or

 5  subsection (9), 1988 Supplement to the Florida Statutes 1987,

 6  as amended by s. 18, chapter 89-162, Laws of Florida, and ss.

 7  5 and 42, chapter 89-374, Laws of Florida, and renumbered as

 8  subsection (8) by s. 5, chapter 89-374, Laws of Florida, shall

 9  not be eligible to apply under this subsection.

10         (b)  The holder of a restricted license issued pursuant

11  to this subsection may practice medicine for the first year

12  only under the direct supervision, as defined by board rule,

13  of a board-approved physician.

14         (c)  Upon recommendation of the supervising physician

15  and demonstration of clinical competency to the satisfaction

16  of the board that the holder of a restricted license issued

17  pursuant to this subsection has practiced for 1 year under

18  direct supervision, such licenseholder shall work for 1 year

19  under general supervision, as defined by board rule, of a

20  Florida-licensed physician in an area of critical need as

21  determined by the board.  Prior to commencing such

22  supervision, the supervising physician shall notify the board.

23         (d)  Upon completion of the 1 year of work under

24  general supervision and demonstration to the board that the

25  holder of the restricted license has satisfactorily completed

26  the requirements of this subsection, and has not committed any

27  act or is not under investigation for any act which would

28  constitute a violation of this chapter, the department shall

29  issue an unrestricted license to such licenseholder.

30         (e)  Rules necessary to implement and carry out the

31  provisions of this subsection shall be promulgated by the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  board.

 2         (10)  Notwithstanding any other provision of this

 3  section, the department shall examine any person who meets the

 4  criteria set forth in sub-subparagraph (1)(f)1.a.,

 5  sub-subparagraphs (1)(f)3.a. and b., or subsection (3), if the

 6  person:

 7         (a)  Submits proof of successful completion of Steps I

 8  and II of the United States Medical Licensing Examination or

 9  the equivalent, as defined by rule of the board;

10         (b)  Is participating in an allocated slot in an

11  allopathic training program in this state on a full-time basis

12  at the time of examination;

13         (c)  Makes a written request to the department that he

14  or she be administered the examination without applying for a

15  license as a physician in this state; and

16         (d)  Remits a nonrefundable administration fee, not to

17  exceed $50, and an examination fee, not to exceed $300, plus

18  the actual cost per person to the department for the purchase

19  of the examination from the Federation of State Medical Boards

20  of the United States or a similar national organization.  The

21  examination fee is refundable if the person is found to be

22  ineligible to take the examination.

23         Section 95.  Section 458.3115, Florida Statutes, 1998

24  Supplement, is amended to read:

25         458.3115  Restricted license; certain foreign-licensed

26  physicians; United States Medical Licensing Examination

27  (USMLE) or agency-developed examination; restrictions on

28  practice; full licensure.--

29         (1)(a)  Notwithstanding any other provision of law, the

30  department agency shall provide procedures under which certain

31  physicians who are or were foreign-licensed and have practiced

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  medicine no less than 2 years may take the USMLE or an

 2  agency-developed examination developed by the department, in

 3  consultation with the board, to qualify for a restricted

 4  license to practice medicine in this state. The

 5  department-developed agency and board-developed examination

 6  shall test the same areas of medical knowledge as the

 7  Federation of State Medical Boards of the United States, Inc.

 8  (FLEX) previously administered by the Florida Board of

 9  Medicine to grant medical licensure in Florida. The

10  department-developed agency-developed examination must be made

11  available no later than December 31, 1998, to a physician who

12  qualifies for licensure. A person who is eligible to take and

13  elects to take the department-developed agency and

14  board-developed examination, who has previously passed part 1

15  or part 2 of the previously administered FLEX shall not be

16  required to retake or pass the equivalent parts of the

17  department-developed agency-developed examination, and may sit

18  for the department-developed agency and board-developed

19  examination five times within 5 years.

20         (b)  A person who is eligible to take and elects to

21  take the USMLE who has previously passed part 1 or part 2 of

22  the previously administered FLEX shall not be required to

23  retake or pass the equivalent parts of the USMLE up to the

24  year 2000.

25         (c)  A person shall be eligible to take such

26  examination for restricted licensure if the person:

27         1.  Has taken, upon approval by the board, and

28  completed, in November 1990 or November 1992, one of the

29  special preparatory medical update courses authorized by the

30  board and the University of Miami Medical School and

31  subsequently passed the final course examination; upon

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  approval by the board to take the course completed in 1990 or

 2  in 1992, has a certificate of successful completion of that

 3  course from the University of Miami or the Stanley H. Kaplan

 4  course; or can document to the department that he or she was

 5  one of the persons who took and successfully completed the

 6  Stanley H. Kaplan course that was approved by the board of

 7  Medicine and supervised by the University of Miami. At a

 8  minimum, the documentation must include class attendance

 9  records and the test score on the final course examination;

10         2.  Applies to the department agency and submits an

11  application fee that is nonrefundable and equivalent to the

12  fee required for full licensure;

13         3.  Documents no less than 2 years of the active

14  practice of medicine in another jurisdiction;

15         4.  Submits an examination fee that is nonrefundable

16  and equivalent to the fee required for full licensure plus the

17  actual per-applicant cost to the department agency to provide

18  either examination described in this section;

19         5.  Has not committed any act or offense in this or any

20  other jurisdiction that would constitute a substantial basis

21  for disciplining a physician under this chapter or part II of

22  chapter 455; and

23         6.  Is not under discipline, investigation, or

24  prosecution in this or any other jurisdiction for an act that

25  would constitute a violation of this chapter or part II of

26  chapter 455 and that substantially threatened or threatens the

27  public health, safety, or welfare.

28         (d)  Every person eligible for restricted licensure

29  under this section may sit for the USMLE or the

30  department-developed agency and board-developed examination

31  five times within 5 calendar years.  Applicants desiring to

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  use portions of the FLEX and the USMLE may do so up to the

 2  year 2000.  However, notwithstanding subparagraph (c)3.,

 3  applicants applying under this section who fail the

 4  examination up to a total of five times will only be required

 5  to pay the examination fee required for full licensure for the

 6  second and subsequent times they take the examination.

 7         (e)  The department Agency for Health Care

 8  Administration and the board shall be responsible for working

 9  with one or more organizations to offer a medical refresher

10  course designed to prepare applicants to take either licensure

11  examination described in this section.  The organizations may

12  develop the medical refresher course, purchase such a course,

13  or contract for such a course from a private organization that

14  specializes in developing such courses.

15         (f)  The course shall require no less than two 16-week

16  semesters of 16 contact hours per week for a total of 256

17  contact hours per student for each semester. The cost is to be

18  paid by the students taking the course.

19         (2)(a)  Before the department agency may issue a

20  restricted license to an applicant under this section, the

21  applicant must have passed either of the two examinations

22  described in this section.  However, the board may impose

23  reasonable restrictions on the applicant's license to

24  practice.  These restrictions may include, but are not limited

25  to:

26         1.  Periodic and random department agency audits of the

27  licensee's patient records and review of those records by the

28  board or the department agency.

29         2.  Periodic appearances of the licensee before the

30  board or the department agency.

31         3.  Submission of written reports to the board or the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  department agency.

 2         (b)  A restricted licensee under this section shall

 3  practice under the supervision of a full licensee approved by

 4  the board with the first year of the licensure period being

 5  under direct supervision as defined by board rule and the

 6  second year being under indirect supervision as defined by

 7  board rule.

 8         (c)  The board may adopt rules necessary to implement

 9  this subsection.

10         (3)(a)  A restricted license issued by the department

11  agency under this section is valid for 2 years unless sooner

12  revoked or suspended, and a restricted licensee is subject to

13  the requirements of this chapter, part II of chapter 455, and

14  any other provision of law not in conflict with this section.

15  Upon expiration of such restricted license, a restricted

16  licensee shall become a full licensee if the restricted

17  licensee:

18         1.  Is not under discipline, investigation, or

19  prosecution for a violation which poses a substantial threat

20  to the public health, safety, or welfare; and

21         2.  Pays all renewal fees required of a full licensee.

22         (b)  The department agency shall renew a restricted

23  license under this section upon payment of the same fees

24  required for renewal for a full license if the restricted

25  licensee is under discipline, investigation, or prosecution

26  for a violation which posed or poses a substantial threat to

27  the public health, safety, or welfare and the board has not

28  permanently revoked the restricted license. A restricted

29  licensee who has renewed such restricted license shall become

30  eligible for full licensure when the licensee is no longer

31  under discipline, investigation, or prosecution.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (4)  The board shall adopt rules necessary to carry out

 2  the provisions of this section.

 3         Section 96.  Subsections (1), (2), and (8) of section

 4  458.313, Florida Statutes, are amended to read:

 5         458.313  Licensure by endorsement; requirements;

 6  fees.--

 7         (1)  The department shall issue a license by

 8  endorsement to any applicant who, upon applying to the

 9  department on forms furnished by the department and remitting

10  a fee set by the board not to exceed $500 set by the board,

11  the board certifies:

12         (a)  Has met the qualifications for licensure in s.

13  458.311(1)(b)-(g) or in s. 458.311(1)(b)-(e) and (g) and (3);

14         (b)  Prior to January 1, 2000, has obtained a passing

15  score, as established by rule of the board, on the licensure

16  examination of the Federation of State Medical Boards of the

17  United States, Inc. (FLEX), on or of the United States Medical

18  Licensing Examination (USMLE), or on the examination of the

19  National Board of Medical Examiners, or on a combination

20  thereof, and on or after January 1, 2000, has obtained a

21  passing score on the United States Medical Licensing

22  Examination (USMLE) provided the board certifies as eligible

23  for licensure by endorsement any applicant who took the

24  required examinations more than 10 years prior to application;

25  and

26         (c)  Has submitted evidence of the active licensed

27  practice of medicine in another jurisdiction, for at least 2

28  of the immediately preceding 4 years, or evidence of

29  successful completion of either a board-approved postgraduate

30  training program within 2 years preceding filing of an

31  application, or a board-approved clinical competency

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  examination, within the year preceding the filing of an

 2  application for licensure.  For purposes of this paragraph,

 3  "active licensed practice of medicine" means that practice of

 4  medicine by physicians, including those employed by any

 5  governmental entity in community or public health, as defined

 6  by this chapter, medical directors under s. 641.495(11) who

 7  are practicing medicine, and those on the active teaching

 8  faculty of an accredited medical school.

 9         (2)(a)  As prescribed by board rule, the board may

10  require an applicant who does not pass the licensing

11  examination after five attempts to complete additional

12  remedial education or training.  The board shall prescribe the

13  additional requirements in a manner that permits the applicant

14  to complete the requirements and be reexamined within 2 years

15  after the date the applicant petitions the board to retake the

16  examination a sixth or subsequent time.

17         (b)  The board may require an applicant for licensure

18  by endorsement to take and pass the appropriate licensure

19  examination prior to certifying the applicant as eligible for

20  licensure.

21         (8)  The department shall reactivate the license of any

22  physician whose license has become void by failure to practice

23  in Florida for a period of 1 year within 3 years after

24  issuance of the license by endorsement, if the physician was

25  issued a license by endorsement prior to 1989, has actively

26  practiced medicine in another state for the last 4 years,

27  applies for licensure before October 1, 1998, pays the

28  applicable fees, and otherwise meets any continuing education

29  requirements for reactivation of the license as determined by

30  the board.

31         Section 97.  Subsection (1) of section 458.315, Florida

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Statutes, is amended to read:

 2         458.315  Temporary certificate for practice in areas of

 3  critical need.--Any physician who is licensed to practice in

 4  any other state, whose license is currently valid, and who

 5  pays an application fee of $300 may be issued a temporary

 6  certificate to practice in communities of Florida where there

 7  is a critical need for physicians.  A certificate may be

 8  issued to a physician who will be employed by a county health

 9  department, correctional facility, community health center

10  funded by s. 329, s. 330, or s. 340 of the United States

11  Public Health Services Act, or other entity that provides

12  health care to indigents and that is approved by the State

13  Health Officer.  The Board of Medicine may issue this

14  temporary certificate with the following restrictions:

15         (1)  The board shall determine the areas of critical

16  need, and the physician so certified may practice in any of

17  those areas only in that specific area for a time to be

18  determined by the board.  Such areas shall include, but not be

19  limited to, health professional shortage areas designated by

20  the United States Department of Health and Human Services.

21         (a)  A recipient of a temporary certificate for

22  practice in areas of critical need may use the license to work

23  for any approved employer in any area of critical need

24  approved by the board.

25         (b)  The recipient of a temporary certificate for

26  practice in areas of critical need shall, within 30 days after

27  accepting employment, notify the board of all approved

28  institutions in which the licensee practices and of all

29  approved institutions where practice privileges have been

30  denied.

31         Section 98.  Section 458.3165, Florida Statutes, is

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  amended to read:

 2         458.3165  Public psychiatry certificate.--The board

 3  shall issue a public psychiatry certificate to an individual

 4  who remits an application fee not to exceed $300, as set by

 5  the board, who is a board-certified psychiatrist, who is

 6  licensed to practice medicine without restriction in another

 7  state, and who meets the requirements in s. 458.311(1)(a)-(g)

 8  and (5). A recipient of a public psychiatry certificate may

 9  use the certificate to work at any public mental health

10  facility or program funded in part or entirely by state funds.

11         (1)  Such certificate shall:

12         (a)  Authorize the holder to practice only in a public

13  mental health facility or program funded in part or entirely

14  by state funds.

15         (b)  Be issued and renewable biennially if the

16  secretary of the Department of Health and Rehabilitative

17  Services and the chair of the department of psychiatry at one

18  of the public medical schools or the chair of the department

19  of psychiatry at the accredited medical school at the

20  University of Miami recommend in writing that the certificate

21  be issued or renewed.

22         (c)  Automatically expire if the holder's relationship

23  with a public mental health facility or program expires.

24         (d)  Not be issued to a person who has been adjudged

25  unqualified or guilty of any of the prohibited acts in this

26  chapter.

27         (2)  The board may take disciplinary action against a

28  certificateholder for noncompliance with any part of this

29  section or for any reason for which a regular licensee may be

30  subject to discipline.

31         Section 99.  Subsection (4) is added to section

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  458.317, Florida Statutes, 1998 Supplement, to read:

 2         458.317  Limited licenses.--

 3         (4)  Any person holding an active license to practice

 4  medicine in the state may convert that license to a limited

 5  license for the purpose of providing volunteer, uncompensated

 6  care for low-income Floridians. The applicant must submit a

 7  statement from the employing agency or institution stating

 8  that he or she will not receive compensation for any service

 9  involving the practice of medicine. The application and all

10  licensure fees, including neurological injury compensation

11  assessments, shall be waived.

12         Section 100.  Paragraph (mm) is added to subsection (1)

13  of section 458.331, Florida Statutes, 1998 Supplement, and

14  subsection (2) of that section is amended to read:

15         458.331  Grounds for disciplinary action; action by the

16  board and department.--

17         (1)  The following acts shall constitute grounds for

18  which the disciplinary actions specified in subsection (2) may

19  be taken:

20         (mm)  Failing to comply with the requirements of ss.

21  381.026 and 381.0261 to provide patients with information

22  about their patient rights and how to file a patient

23  complaint.

24         (2)  When the board finds any person guilty of any of

25  the grounds set forth in subsection (1), including conduct

26  that would constitute a substantial violation of subsection

27  (1) which occurred prior to licensure, it may enter an order

28  imposing one or more of the following penalties:

29         (a)  Refusal to certify, or certification with

30  restrictions, to the department an application for licensure,

31  certification, or registration.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (b)  Revocation or suspension of a license.

 2         (c)  Restriction of practice.

 3         (d)  Imposition of an administrative fine not to exceed

 4  $10,000 $5,000 for each count or separate offense.

 5         (e)  Issuance of a reprimand.

 6         (f)  Placement of the physician on probation for a

 7  period of time and subject to such conditions as the board may

 8  specify, including, but not limited to, requiring the

 9  physician to submit to treatment, to attend continuing

10  education courses, to submit to reexamination, or to work

11  under the supervision of another physician.

12         (g)  Issuance of a letter of concern.

13         (h)  Corrective action.

14         (i)  Refund of fees billed to and collected from the

15  patient.

16         (j)  Imposition of an administrative fine in accordance

17  with s. 381.0261 for violations regarding patient rights.

18

19  In determining what action is appropriate, the board must

20  first consider what sanctions are necessary to protect the

21  public or to compensate the patient.  Only after those

22  sanctions have been imposed may the disciplining authority

23  consider and include in the order requirements designed to

24  rehabilitate the physician.  All costs associated with

25  compliance with orders issued under this subsection are the

26  obligation of the physician.

27         Section 101.  Subsection (7) of section 458.347,

28  Florida Statutes, 1998 Supplement, is amended to read:

29         458.347  Physician assistants.--

30         (7)  PHYSICIAN ASSISTANT LICENSURE.--

31         (a)  Any person desiring to be licensed as a physician

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    Bill No. CS for SB 2220

    Amendment No.    





 1  assistant must apply to the department.  The department shall

 2  issue a license to any person certified by the council as

 3  having met the following requirements:

 4         1.  Is at least 18 years of age.

 5         2.  Has satisfactorily passed a proficiency examination

 6  by an acceptable score established by the National Commission

 7  on Certification of Physician Assistants.  If an applicant

 8  does not hold a current certificate issued by the National

 9  Commission on Certification of Physician Assistants and has

10  not actively practiced as a physician assistant within the

11  immediately preceding 4 years, the applicant must retake and

12  successfully complete the entry-level examination of the

13  National Commission on Certification of Physician Assistants

14  to be eligible for licensure.

15         3.  Has completed the application form and remitted an

16  application fee not to exceed $300 as set by the boards. An

17  application for licensure made by a physician assistant must

18  include:

19         a.  A certificate of completion of a physician

20  assistant training program specified in subsection (6).

21         b.  A sworn statement of any prior felony convictions.

22         c.  A sworn statement of any previous revocation or

23  denial of licensure or certification in any state.

24         d.  Two letters of recommendation.

25         (b)1.  Notwithstanding subparagraph (a)2. and

26  sub-subparagraph (a)3.a., the department shall examine each

27  applicant who the Board of Medicine certifies:

28         a.  Has completed the application form and remitted a

29  nonrefundable application fee not to exceed $500 and an

30  examination fee not to exceed $300, plus the actual cost to

31  the department to provide the examination.  The examination

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    Bill No. CS for SB 2220

    Amendment No.    





 1  fee is refundable if the applicant is found to be ineligible

 2  to take the examination.  The department shall not require the

 3  applicant to pass a separate practical component of the

 4  examination. For examinations given after July 1, 1998,

 5  competencies measured through practical examinations shall be

 6  incorporated into the written examination through a

 7  multiple-choice format. The department shall translate the

 8  examination into the native language of any applicant who

 9  requests and agrees to pay all costs of such translation,

10  provided that the translation request is filed with the board

11  office no later than 9 months before the scheduled examination

12  and the applicant remits translation fees as specified by the

13  department no later than 6 months before the scheduled

14  examination, and provided that the applicant demonstrates to

15  the department the ability to communicate orally in basic

16  English. If the applicant is unable to pay translation costs,

17  the applicant may take the next available examination in

18  English if the applicant submits a request in writing by the

19  application deadline and if the applicant is otherwise

20  eligible under this section. To demonstrate the ability to

21  communicate orally in basic English, a passing score or grade

22  is required, as determined by the department or organization

23  that developed it, on one of the following English

24  examinations:

25         (I)  The test for spoken English (TSE) by the

26  Educational Testing Service (ETS);

27         (II)  The test of English as a foreign language

28  (TOEFL), by ETS;

29         (III)  A high school or college level English course;

30         (IV)  The English examination for citizenship,

31  Immigration and Naturalization Service.

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    Bill No. CS for SB 2220

    Amendment No.    





 1

 2  A notarized copy of an Educational Commission for Foreign

 3  Medical Graduates (ECFMG) certificate may also be used to

 4  demonstrate the ability to communicate in basic English.

 5         b.  Is an unlicensed physician who graduated from a

 6  foreign medical school listed with the World Health

 7  Organization who has not previously taken and failed the

 8  examination of the National Commission on Certification of

 9  Physician Assistants and who has been certified by the Board

10  of Medicine as having met the requirements for licensure as a

11  medical doctor by examination as set forth in s. 458.311(1),

12  (3), (4), and (5), with the exception that the applicant is

13  not required to have completed an approved residency of at

14  least 1 year and the applicant is not required to have passed

15  the licensing examination specified under s. 458.311 or hold a

16  valid, active certificate issued by the Educational Commission

17  for Foreign Medical Graduates.

18         c.  Was eligible and made initial application for

19  certification as a physician assistant in this state between

20  July 1, 1990, and June 30, 1991.

21         d.  Was a resident of this state on July 1, 1990, or

22  was licensed or certified in any state in the United States as

23  a physician assistant on July 1, 1990.

24         2.  The department may grant temporary licensure to an

25  applicant who meets the requirements of subparagraph 1.

26  Between meetings of the council, the department may grant

27  temporary licensure to practice based on the completion of all

28  temporary licensure requirements.  All such administratively

29  issued licenses shall be reviewed and acted on at the next

30  regular meeting of the council.  A temporary license expires

31  30 days after upon receipt and notice of scores to the

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    Bill No. CS for SB 2220

    Amendment No.    





 1  licenseholder from the first available examination specified

 2  in subparagraph 1. following licensure by the department.  An

 3  applicant who fails the proficiency examination is no longer

 4  temporarily licensed, but may apply for a one-time extension

 5  of temporary licensure after reapplying for the next available

 6  examination. Extended licensure shall expire upon failure of

 7  the licenseholder to sit for the next available examination or

 8  upon receipt and notice of scores to the licenseholder from

 9  such examination.

10         3.  Notwithstanding any other provision of law, the

11  examination specified pursuant to subparagraph 1. shall be

12  administered by the department only five times.  Applicants

13  certified by the board for examination shall receive at least

14  6 months' notice of eligibility prior to the administration of

15  the initial examination. Subsequent examinations shall be

16  administered at 1-year intervals following the reporting of

17  the scores of the first and subsequent examinations.  For the

18  purposes of this paragraph, the department may develop,

19  contract for the development of, purchase, or approve an

20  examination, including a practical component, that adequately

21  measures an applicant's ability to practice with reasonable

22  skill and safety.  The minimum passing score on the

23  examination shall be established by the department, with the

24  advice of the board.  Those applicants failing to pass that

25  examination or any subsequent examination shall receive notice

26  of the administration of the next examination with the notice

27  of scores following such examination.  Any applicant who

28  passes the examination and meets the requirements of this

29  section shall be licensed as a physician assistant with all

30  rights defined thereby.

31         (c)  The license must be renewed biennially.  Each

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    Bill No. CS for SB 2220

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 1  renewal must include:

 2         1.  A renewal fee not to exceed $500 as set by the

 3  boards.

 4         2.  A sworn statement of no felony convictions in the

 5  previous 2 years.

 6         (d)  Each licensed physician assistant shall biennially

 7  complete 100 hours of continuing medical education or shall

 8  hold a current certificate issued by the National Commission

 9  on Certification of Physician Assistants.

10         (e)  Upon employment as a physician assistant, a

11  licensed physician assistant must notify the department in

12  writing within 30 days after such employment or after any

13  subsequent changes in the supervising physician. The

14  notification must include the full name, Florida medical

15  license number, specialty, and address of the supervising

16  physician.

17         (f)  Notwithstanding subparagraph (a)2., the department

18  may grant to a recent graduate of an approved program, as

19  specified in subsection (6), who expects to take the first

20  examination administered by the National Commission on

21  Certification of Physician Assistants available for

22  registration after the applicant's graduation, a temporary

23  license. The temporary license shall to expire 30 days after

24  upon receipt of scores of the proficiency examination

25  administered by the National Commission on Certification of

26  Physician Assistants.  Between meetings of the council, the

27  department may grant a temporary license to practice based on

28  the completion of all temporary licensure requirements.  All

29  such administratively issued licenses shall be reviewed and

30  acted on at the next regular meeting of the council. The

31  recent graduate may be licensed prior to employment, but must

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    Bill No. CS for SB 2220

    Amendment No.    





 1  comply with paragraph (e). An applicant who has passed the

 2  proficiency examination may be granted permanent licensure. An

 3  applicant failing the proficiency examination is no longer

 4  temporarily licensed, but may reapply for a 1-year extension

 5  of temporary licensure.  An applicant may not be granted more

 6  than two temporary licenses and may not be licensed as a

 7  physician assistant until he or she passes the examination

 8  administered by the National Commission on Certification of

 9  Physician Assistants. As prescribed by board rule, the council

10  may require an applicant who does not pass the licensing

11  examination after five or more attempts to complete additional

12  remedial education or training. The council shall prescribe

13  the additional requirements in a manner that permits the

14  applicant to complete the requirements and be reexamined

15  within 2 years after the date the applicant petitions the

16  council to retake the examination a sixth or subsequent time.

17         (g)  The Board of Medicine may impose any of the

18  penalties specified in ss. 455.624 and 458.331(2) upon a

19  physician assistant if the physician assistant or the

20  supervising physician has been found guilty of or is being

21  investigated for any act that constitutes a violation of this

22  chapter or part II of chapter 455.

23         Section 102.  Section 459.005, Florida Statutes, 1998

24  Supplement, is amended to read:

25         459.005  Rulemaking authority.--

26         (1)  The board has authority to adopt rules pursuant to

27  ss. 120.536(1) and 120.54 to implement the provisions of this

28  chapter conferring duties upon it.

29         (2)  All physicians who perform level 2 procedures

30  lasting more than 5 minutes and all level 3 surgical

31  procedures in an office setting must register the office with

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  the department unless that office is licensed as a facility

 2  pursuant to chapter 395. The department shall inspect the

 3  physician's office annually unless the office is accredited by

 4  a nationally recognized accrediting agency or an accrediting

 5  organization subsequently approved by the Board of Osteopathic

 6  Medicine. The actual costs for registration and inspection or

 7  accreditation shall be paid by the person seeking to register

 8  and operate the office setting in which office surgery is

 9  performed.

10         Section 103.  Subsection (7) is added to section

11  459.0075, Florida Statutes, to read:

12         459.0075  Limited licenses.--

13         (7)  Any person holding an active license to practice

14  osteopathic medicine in the state may convert that license to

15  a limited license for the purpose of providing volunteer,

16  uncompensated care for low-income Floridians. The applicant

17  must submit a statement from the employing agency or

18  institution stating that he or she will not receive

19  compensation for any service involving the practice of

20  osteopathic medicine. The application and all licensure fees,

21  including neurological injury compensation assessments, shall

22  be waived.

23         Section 104.  Paragraph (oo) is added to subsection (1)

24  of section 459.015, Florida Statutes, 1998 Supplement, and

25  subsection (2) of that section is amended to read:

26         459.015  Grounds for disciplinary action by the

27  board.--

28         (1)  The following acts shall constitute grounds for

29  which the disciplinary actions specified in subsection (2) may

30  be taken:

31         (oo)  Failing to comply with the requirements of ss.

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    Bill No. CS for SB 2220

    Amendment No.    





 1  381.026 and 381.0261 to provide patients with information

 2  about their patient rights and how to file a patient

 3  complaint.

 4         (2)  When the board finds any person guilty of any of

 5  the grounds set forth in subsection (1), it may enter an order

 6  imposing one or more of the following penalties:

 7         (a)  Refusal to certify, or certify with restrictions,

 8  to the department an application for certification, licensure,

 9  renewal, or reactivation.

10         (b)  Revocation or suspension of a license or

11  certificate.

12         (c)  Restriction of practice.

13         (d)  Imposition of an administrative fine not to exceed

14  $10,000 $5,000 for each count or separate offense.

15         (e)  Issuance of a reprimand.

16         (f)  Issuance of a letter of concern.

17         (g)  Placement of the osteopathic physician on

18  probation for a period of time and subject to such conditions

19  as the board may specify, including, but not limited to,

20  requiring the osteopathic physician to submit to treatment,

21  attend continuing education courses, submit to reexamination,

22  or work under the supervision of another osteopathic

23  physician.

24         (h)  Corrective action.

25         (i)  Refund of fees billed to and collected from the

26  patient.

27         (j)  Imposition of an administrative fine in accordance

28  with s. 381.0261 for violations regarding patient rights.

29

30  In determining what action is appropriate, the board must

31  first consider what sanctions are necessary to protect the

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    Amendment No.    





 1  public or to compensate the patient.  Only after those

 2  sanctions have been imposed may the disciplining authority

 3  consider and include in the order requirements designed to

 4  rehabilitate the physician.  All costs associated with

 5  compliance with orders issued under this subsection are the

 6  obligation of the physician.

 7         Section 105.  Subsection (6) is added to section

 8  460.402, Florida Statutes, to read:

 9         460.402  Exceptions.--The provisions of this chapter

10  shall not apply to:

11         (6)  A chiropractic student enrolled in a chiropractic

12  college accredited by the Council on Chiropractic Education

13  and participating in a community-based internship under the

14  direct supervision of a doctor of chiropractic medicine who is

15  credentialed as an adjunct faculty member of a chiropractic

16  college in which the student is enrolled.

17         Section 106.  Present subsections (4) through (10) of

18  section 460.403, Florida Statutes, 1998 Supplement, are

19  renumbered as subsections (5) through (11), respectively, a

20  new subsection (4) is added to that section, and present

21  subsections (6) and (9) are amended, to read:

22         460.403  Definitions.--As used in this chapter, the

23  term:

24         (4)  "Community-based internship" means a program in

25  which a student enrolled in the last year of a chiropractic

26  college accredited by the Council on Chiropractic Education is

27  approved to obtain required pregraduation clinical experience

28  in a chiropractic clinic or practice under the direct

29  supervision of a doctor of chiropractic medicine approved as

30  an adjunct faculty member of the chiropractic college in which

31  the student is enrolled, according to the teaching protocols

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    Bill No. CS for SB 2220

    Amendment No.    





 1  for the clinical practice requirements of the college.

 2         (7)(6)  "Direct supervision" means responsible

 3  supervision and control, with the licensed chiropractic

 4  physician assuming legal liability for the services rendered

 5  by a registered chiropractic assistant or a chiropractic

 6  student enrolled in a community-based intern program.  Except

 7  in cases of emergency, direct supervision shall require the

 8  physical presence of the licensed chiropractic physician for

 9  consultation and direction of the actions of the registered

10  chiropractic assistant or a chiropractic student enrolled in a

11  community-based intern program.  The board shall further

12  establish rules as to what constitutes responsible direct

13  supervision of a registered chiropractic assistant.

14         (10)(9)  "Registered chiropractic assistant" means a

15  person who is registered by the board to perform chiropractic

16  services under the direct supervision of a chiropractic

17  physician or certified chiropractic physician's assistant.

18         Section 107.  Subsection (1) of section 460.406,

19  Florida Statutes, 1998 Supplement, is amended to read:

20         460.406  Licensure by examination.--

21         (1)  Any person desiring to be licensed as a

22  chiropractic physician shall apply to the department to take

23  the licensure examination. There shall be an application fee

24  set by the board not to exceed $100 which shall be

25  nonrefundable.  There shall also be an examination fee not to

26  exceed $500 plus the actual per applicant cost to the

27  department for purchase of portions of the examination from

28  the National Board of Chiropractic Examiners or a similar

29  national organization, which may be refundable if the

30  applicant is found ineligible to take the examination.  The

31  department shall examine each applicant who the board

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    Bill No. CS for SB 2220

    Amendment No.    





 1  certifies has:

 2         (a)  Completed the application form and remitted the

 3  appropriate fee.

 4         (b)  Submitted proof satisfactory to the department

 5  that he or she is not less than 18 years of age.

 6         (c)  Submitted proof satisfactory to the department

 7  that he or she is a graduate of a chiropractic college which

 8  is accredited by or has status with the Council on

 9  Chiropractic Education or its predecessor agency. However, any

10  applicant who is a graduate of a chiropractic college that was

11  initially accredited by the Council on Chiropractic Education

12  in 1995, who graduated from such college within the 4 years

13  immediately preceding such accreditation, and who is otherwise

14  qualified shall be eligible to take the examination.  No

15  application for a license to practice chiropractic medicine

16  shall be denied solely because the applicant is a graduate of

17  a chiropractic college that subscribes to one philosophy of

18  chiropractic medicine as distinguished from another.

19         (d)1.  For an applicant who has matriculated in a

20  chiropractic college prior to July 2, 1990, completed at least

21  2 years of residence college work, consisting of a minimum of

22  one-half the work acceptable for a bachelor's degree granted

23  on the basis of a 4-year period of study, in a college or

24  university accredited by an accrediting agency recognized and

25  approved by the United States Department of Education.

26  However, prior to being certified by the board to sit for the

27  examination, each applicant who has matriculated in a

28  chiropractic college after July 1, 1990, shall have been

29  granted a bachelor's degree, based upon 4 academic years of

30  study, by a college or university accredited by a regional

31  accrediting agency which is a member of the Commission on

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    Bill No. CS for SB 2220

    Amendment No.    





 1  Recognition of Postsecondary Accreditation.

 2         2.  Effective July 1, 2000, completed, prior to

 3  matriculation in a chiropractic college, at least 3 years of

 4  residence college work, consisting of a minimum of 90 semester

 5  hours leading to a bachelor's degree in a liberal arts college

 6  or university accredited by an accrediting agency recognized

 7  and approved by the United States Department of Education.

 8  However, prior to being certified by the board to sit for the

 9  examination, each applicant who has matriculated in a

10  chiropractic college after July 1, 2000, shall have been

11  granted a bachelor's degree from an institution holding

12  accreditation for that degree from a regional accrediting

13  agency which is recognized by the United States Department of

14  Education.  The applicant's chiropractic degree must consist

15  of credits earned in the chiropractic program and may not

16  include academic credit for courses from the bachelor's

17  degree.

18         (e)  Completed not less than a 3-month training program

19  in this state of not less than 300 hours with a chiropractic

20  physician licensed in this state. The chiropractic physician

21  candidate may perform all services offered by the licensed

22  chiropractic physician, but must be under the supervision of

23  the licensed chiropractic physician until the results of the

24  first licensure examination for which the candidate has

25  qualified have been received, at which time the candidate's

26  training program shall be terminated. However, an applicant

27  who has practiced chiropractic medicine in any other state,

28  territory, or jurisdiction of the United States or any foreign

29  national jurisdiction for at least 5 years as a licensed

30  chiropractic physician need not be required to complete the

31  3-month training program as a requirement for licensure.

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 1         (e)(f)  Successfully completed the National Board of

 2  Chiropractic Examiners certification examination in parts I

 3  and II and clinical competency, with a score approved by the

 4  board, within 10 years immediately preceding application to

 5  the department for licensure.

 6         (f)(g)  Submitted to the department a set of

 7  fingerprints on a form and under procedures specified by the

 8  department, along with payment in an amount equal to the costs

 9  incurred by the Department of Health for the criminal

10  background check of the applicant.

11         Section 108.  Paragraphs (p) and (dd) of subsection (1)

12  and paragraph (b) of subsection (2) of section 460.413,

13  Florida Statutes, 1998 Supplement, are amended to read:

14         460.413  Grounds for disciplinary action; action by the

15  board.--

16         (1)  The following acts shall constitute grounds for

17  which the disciplinary actions specified in subsection (2) may

18  be taken:

19         (p)  Prescribing, dispensing, or administering any

20  medicinal drug except as authorized by s. 460.403(9)(c)2. s.

21  460.403(8)(c)2., performing any surgery, or practicing

22  obstetrics.

23         (dd)  Using acupuncture without being certified

24  pursuant to s. 460.403(9)(f) s. 460.403(8)(f).

25         (2)  When the board finds any person guilty of any of

26  the grounds set forth in subsection (1), it may enter an order

27  imposing one or more of the following penalties:

28         (d)  Imposition of an administrative fine not to exceed

29  $10,000 $2,000 for each count or separate offense.

30

31  In determining what action is appropriate, the board must

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    Bill No. CS for SB 2220

    Amendment No.    





 1  first consider what sanctions are necessary to protect the

 2  public or to compensate the patient. Only after those

 3  sanctions have been imposed may the disciplining authority

 4  consider and include in the order requirements designed to

 5  rehabilitate the chiropractic physician. All costs associated

 6  with compliance with orders issued under this subsection are

 7  the obligation of the chiropractic physician.

 8         Section 109.  Section 460.4165, Florida Statutes, is

 9  amended to read:

10         460.4165  Certified chiropractic physician's

11  assistants.--

12         (1)  LEGISLATIVE INTENT.--The purpose of this section

13  is to encourage the more effective utilization of the skills

14  of chiropractic physicians by enabling them to delegate health

15  care tasks to qualified assistants when such delegation is

16  consistent with the patient's health and welfare and to allow

17  for innovative development of programs for the education of

18  physician's assistants.

19         (2)  PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN'S

20  ASSISTANT.--Notwithstanding any other provision of law, a

21  certified chiropractic physician's assistant may perform

22  chiropractic services in the specialty area or areas for which

23  the certified chiropractic physician's assistant is trained or

24  experienced when such services are rendered under the

25  supervision of a licensed chiropractic physician or group of

26  chiropractic physicians certified by the board.  Any certified

27  chiropractic physician's assistant certified under this

28  section to perform services may perform those services only:

29         (a)  In the office of the chiropractic physician to

30  whom the certified chiropractic physician's assistant has been

31  assigned, in which office such physician maintains her or his

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    Bill No. CS for SB 2220

    Amendment No.    





 1  primary practice;

 2         (b)  Under indirect supervision of When the

 3  chiropractic physician to whom she or he is assigned as

 4  defined by rule of the board is present;

 5         (c)  In a hospital in which the chiropractic physician

 6  to whom she or he is assigned is a member of the staff; or

 7         (d)  On calls outside of the said office of the

 8  chiropractic physician to whom she or he is assigned, on the

 9  direct order of the chiropractic physician to whom she or he

10  is assigned.

11         (3)  THIRD-PARTY PAYOR.  This chapter does not prevent

12  third-party payors from reimbursing employers of chiropractic

13  physicians' assistants for covered services rendered by

14  certified chiropractic physicians' assistants.

15         (4)(3)  PERFORMANCE BY TRAINEES.--Notwithstanding any

16  other provision of law, a trainee may perform chiropractic

17  services when such services are rendered within the scope of

18  an approved program.

19         (5)(4)  PROGRAM APPROVAL.--The department shall issue

20  certificates of approval for programs for the education and

21  training of certified chiropractic physician's assistants

22  which meet board standards.  Any basic program curriculum

23  certified by the board shall cover a period of 24 months. The

24  curriculum must consist of at least 200 didactic classroom

25  hours during those 24 months.

26         (a)  In developing criteria for program approval, the

27  board shall give consideration to, and encourage, the

28  utilization of equivalency and proficiency testing and other

29  mechanisms whereby full credit is given to trainees for past

30  education and experience in health fields.

31         (b)  The board shall create groups of specialty

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  classifications of training for certified chiropractic

 2  physician's assistants.  These classifications shall reflect

 3  the training and experience of the certified chiropractic

 4  physician's assistant. The certified chiropractic physician's

 5  assistant may receive training in one or more such

 6  classifications, which shall be shown on the certificate

 7  issued.

 8         (c)  The board shall adopt and publish standards to

 9  ensure that such programs operate in a manner which does not

10  endanger the health and welfare of the patients who receive

11  services within the scope of the program.  The board shall

12  review the quality of the curricula, faculties, and facilities

13  of such programs; issue certificates of approval; and take

14  whatever other action is necessary to determine that the

15  purposes of this section are being met.

16         (6)(5)  APPLICATION APPROVAL.--Any person desiring to

17  be licensed as a certified chiropractic physician's assistant

18  must apply to the department. The department shall issue a

19  certificate to any person certified by the board as having met

20  the following requirements:

21         (a)  Is at least 18 years of age.

22         (b)  Is a graduate of an approved program or its

23  equivalent and is fully certified by reason of experience and

24  education, as defined by board rule, to perform chiropractic

25  services under the responsible supervision of a licensed

26  chiropractic physician and when the board is satisfied that

27  the public will be adequately protected by the arrangement

28  proposed in the application.

29         (c)  Has completed the application form and remitted an

30  application fee set by the board pursuant to this section. An

31  application for certification made by a chiropractic

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    Bill No. CS for SB 2220

    Amendment No.    





 1  physician's assistant must include:

 2         1.  A certificate of completion of a physician's

 3  assistant training program specified in subsection (5).

 4         2.  A sworn statement of any prior felony conviction in

 5  any jurisdiction.

 6         3.  A sworn statement of any previous revocation or

 7  denial of licensure or certification in any state or

 8  jurisdiction.

 9         (a)  The board shall adopt rules for the consideration

10  of applications by a licensed chiropractic physician or a

11  group of licensed chiropractic physicians to supervise

12  certified chiropractic physician's assistants.  Each

13  application made by a chiropractic physician or group of

14  chiropractic physicians shall include all of the following:

15         1.  The qualifications, including related experience,

16  of the certified chiropractic physician's assistant intended

17  to be employed.

18         2.  The professional background and specialty of the

19  chiropractic physician or the group of chiropractic

20  physicians.

21         3.  A description by the chiropractic physician of her

22  or his practice, or by the chiropractic physicians of their

23  practice, and of the way in which the assistant or assistants

24  are to be utilized.

25

26  The board shall certify an application by a licensed

27  chiropractic physician to supervise a certified chiropractic

28  physician's assistant when the proposed assistant is a

29  graduate of an approved program or its equivalent and is fully

30  qualified by reason of experience and education to perform

31  chiropractic services under the responsible supervision of a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  licensed chiropractic physician and when the board is

 2  satisfied that the public will be adequately protected by the

 3  arrangement proposed in the application.

 4         (b)  The board shall certify no more than two certified

 5  chiropractic physician's assistants for any chiropractic

 6  physician practicing alone; no more than four chiropractic

 7  physician's assistants for two chiropractic physicians

 8  practicing together formally or informally; or no more than a

 9  ratio of two certified chiropractic physician's assistants to

10  three chiropractic physicians in any group of chiropractic

11  physicians practicing together formally or informally.

12         (7)(6)  PENALTY.--Any person who has not been certified

13  by the board and approved by the department and who represents

14  herself or himself as a certified chiropractic physician's

15  assistant or who uses any other term in indicating or implying

16  that she or he is a certified chiropractic physician's

17  assistant is guilty of a felony of the third degree,

18  punishable as provided in s. 775.082 or s. 775.084 or by a

19  fine not exceeding $5,000.

20         (8)(7)  REVOCATION OF APPROVAL.--The certificate of

21  approval to supervise a certified chiropractic physician's

22  assistant held by any chiropractic physician or group of

23  chiropractic physicians may be revoked when the board

24  determines that the intent of this section is not being

25  carried out.

26         (9)(8)  FEES.--

27         (a)  A fee not to exceed $100 set by the board shall

28  accompany the application by a chiropractic physician for

29  authorization to supervise a certified chiropractic

30  physician's assistant.

31         (b)  Upon approval of an application for certification

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  of a certified chiropractic physician's assistant in a

 2  specialty area, the applicant shall be charged an initial

 3  certification fee for the first biennium not to exceed $250;

 4  and a biennial renewal fee not to exceed $250 shall accompany

 5  each application for renewal of the certified chiropractic

 6  physician's assistant certificate.

 7         (10)(9)  EXISTING PROGRAMS.--Nothing in this section

 8  shall be construed to eliminate or supersede existing laws

 9  relating to other paramedical professions or services.  It is

10  the intent of this section to supplement all such existing

11  programs relating to the certification and the practice of

12  paramedical professions as may be authorized by law.

13         (11)(10)  LIABILITY.--Each chiropractic physician or

14  group of chiropractic physicians utilizing certified

15  chiropractic physician's assistants shall be liable for any

16  act or omission of any physician's assistant acting under her

17  or his or its supervision and control.

18         (12)  SUPERVISION OF REGISTERED CHIROPRACTIC

19  ASSISTANT.--A certified chiropractic physician's assistant may

20  directly supervise a registered chiropractic assistant and

21  other persons who are not licensed as chiropractic physicians

22  who are employed or supervised by the chiropractic physician

23  to whom the certified chiropractic physician's assistant is

24  assigned.

25         (13)  CERTIFIED CHIROPRACTIC ASSISTANT CERTIFICATION

26  RENEWAL.--The certification must be renewed biennially.

27         (a)  Each renewal must include:

28         1.  A renewal fee as set by board pursuant to this

29  section.

30         2.  A sworn statement of no felony convictions in the

31  previous 2 years in any jurisdiction.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (b)  Each certified chiropractic physician's assistant

 2  shall biennially complete 24 hours of continuing education

 3  courses sponsored by chiropractic colleges accredited by the

 4  Council on Chiropractic Education and approved by the board.

 5  The board shall approve those courses that build upon the

 6  basic courses required for the practice of chiropractic

 7  medicine, and the board may also approve courses in adjunctive

 8  modalities. The board may make exception from the requirements

 9  of this section in emergency or hardship cases. The board may

10  adopt rules within the requirements of this section which are

11  necessary for its implementation.

12         (c)  Upon employment as a certified chiropractic

13  physician's assistant, a certified chiropractic physician's

14  assistant must notify the department in writing within 30 days

15  after such employment or any change of the supervising

16  chiropractic physician. The notification must include the full

17  name, Florida chiropractic medical license number, specialty,

18  and address of the supervising chiropractic physician.

19         Section 110.  Persons holding certificates as certified

20  chiropractic physicians' assistants on the effective date of

21  this act need not reapply for certification, but must comply

22  with biennial renewal requirements as provided in section

23  460.4165(6), Florida Statutes. The requirement for completion

24  of the continuing education requirements for biennial renewal

25  of the certificate shall not take effect until the beginning

26  of the next biennial renewal period following the effective

27  date of this act.

28         Section 111.  Section 460.4166, Florida Statutes, 1998

29  Supplement, is amended to read:

30         460.4166  Registered chiropractic assistants.--

31         (1)  DEFINITION.--As used in this section, "registered

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  chiropractic assistant" means a professional, multiskilled

 2  person dedicated to assisting in all aspects of chiropractic

 3  medical practice under the direct supervision and

 4  responsibility of a chiropractic physician or certified

 5  chiropractic physician's assistant.  A registered chiropractic

 6  assistant assists with patient care management, executes

 7  administrative and clinical procedures, and often performs

 8  managerial and supervisory functions. Competence in the field

 9  also requires that a registered chiropractic assistant adhere

10  to ethical and legal standards of professional practice,

11  recognize and respond to emergencies, and demonstrate

12  professional characteristics.

13         (2)  DUTIES.--Under the direct supervision and

14  responsibility of a licensed chiropractic physician or

15  certified chiropractic physician's assistant, a registered

16  chiropractic assistant may:

17         (a)  Perform clinical procedures, which include:

18         1.  Preparing patients for the chiropractic physician's

19  care.

20         2.  Taking vital signs.

21         3.  Observing and reporting patients' signs or

22  symptoms.

23         (b)  Administer basic first aid.

24         (c)  Assist with patient examinations or treatments

25  other than manipulations or adjustments.

26         (d)  Operate office equipment.

27         (e)  Collect routine laboratory specimens as directed

28  by the chiropractic physician or certified chiropractic

29  physician's assistant.

30         (f)  Administer nutritional supplements as directed by

31  the chiropractic physician or certified chiropractic

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  physician's assistant.

 2         (g)  Perform office procedures required by the

 3  chiropractic physician or certified chiropractic physician's

 4  assistant under direct supervision of the chiropractic

 5  physician or certified chiropractic physician's assistant.

 6         (3)  REGISTRATION.--Registered chiropractic assistants

 7  may be registered by the board for a biennial fee not to

 8  exceed $25.

 9         Section 112.  Section 461.003, Florida Statutes, 1998

10  Supplement, is amended to read:

11         461.003  Definitions.--As used in this chapter:

12         (1)  "Department" means the Department of Health.

13         (1)(2)  "Board" means the Board of Podiatric Medicine

14  as created in this chapter.

15         (2)  "Certified podiatric X-ray assistant" means a

16  person who is employed by and under the direct supervision of

17  a licensed podiatric physician to perform only those

18  radiographic functions that are within the scope of practice

19  of a podiatric physician licensed under this chapter. For

20  purposes of this subsection, the term "direct supervision"

21  means supervision whereby a podiatric physician orders the X

22  ray, remains on the premises while the X ray is being

23  performed and exposed, and approves the work performed before

24  dismissal of the patient.

25         (3)  "Department" means the Department of Health.

26         (3)  "Practice of podiatric medicine" means the

27  diagnosis or medical, surgical, palliative, and mechanical

28  treatment of ailments of the human foot and leg.  The surgical

29  treatment of ailments of the human foot and leg shall be

30  limited anatomically to that part below the anterior tibial

31  tubercle.  The practice of podiatric medicine shall include

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  the amputation of the toes or other parts of the foot but

 2  shall not include the amputation of the foot or leg in its

 3  entirety.  A podiatric physician may prescribe drugs that

 4  relate specifically to the scope of practice authorized

 5  herein.

 6         (4)  "Podiatric physician" means any person licensed to

 7  practice podiatric medicine pursuant to this chapter.

 8         (5)  "Practice of podiatric medicine" means the

 9  diagnosis or medical, surgical, palliative, and mechanical

10  treatment of ailments of the human foot and leg.  The surgical

11  treatment of ailments of the human foot and leg shall be

12  limited anatomically to that part below the anterior tibial

13  tubercle.  The practice of podiatric medicine shall include

14  the amputation of the toes or other parts of the foot but

15  shall not include the amputation of the foot or leg in its

16  entirety.  A podiatric physician may prescribe drugs that

17  relate specifically to the scope of practice authorized

18  herein.

19         Section 113.  Paragraph (d) of subsection (1) of

20  section 461.006, Florida Statutes, 1998 Supplement, is amended

21  to read:

22         461.006  Licensure by examination.--

23         (1)  Any person desiring to be licensed as a podiatric

24  physician shall apply to the department to take the licensure

25  examination. The department shall examine each applicant who

26  the board certifies:

27         (d)  Beginning October 1, 1995, Has satisfactorily

28  completed one of the following clinical experience

29  requirements:

30         1.  One year of residency in a residency program

31  approved by the board, and if it has been 4 or more years

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    Amendment No.    





 1  since the completion of that residency, active licensed

 2  practice of podiatric medicine in another jurisdiction for at

 3  least 2 of the immediately preceding 4 years, or successful

 4  completion of a board-approved postgraduate program or

 5  board-approved course within the year preceding the filing of

 6  the application. For the purpose of this subparagraph, "active

 7  licensed practice" means the licensed practice of podiatric

 8  medicine as defined in s. 461.003(5) by podiatric physicians,

 9  including podiatric physicians employed by any governmental

10  entity, on the active teaching faculty of an accredited school

11  of podiatric medicine, or practicing administrative podiatric

12  medicine.

13         2.  Ten years of continuous, active licensed practice

14  of podiatric medicine in another state immediately preceding

15  the submission of the application and completion of at least

16  the same continuing educational requirements during those 10

17  years as are required of podiatric physicians licensed in this

18  state.

19         Section 114.  Subsection (1) of section 461.007,

20  Florida Statutes, 1998 Supplement, is amended to read:

21         461.007  Renewal of license.--

22         (1)  The department shall renew a license upon receipt

23  of the renewal application and a fee not to exceed $350 set by

24  the board, and evidence that the applicant has actively

25  practiced podiatric medicine or has been on the active

26  teaching faculty of an accredited school of podiatric medicine

27  for at least 2 years of the immediately preceding 4 years. If

28  the licensee has not actively practiced podiatric medicine for

29  at least 2 years of the immediately preceding 4 years, the

30  board shall require that the licensee successfully complete a

31  board-approved course prior to renewal of the license. For

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  purposes of this subsection, "actively practiced podiatric

 2  medicine" means the licensed practice of podiatric medicine as

 3  defined in s. 461.003(5) by podiatric physicians, including

 4  podiatric physicians employed by any governmental entity, on

 5  the active teaching faculty of an accredited school of

 6  podiatric medicine, or practicing administrative podiatric

 7  medicine. An applicant for a renewed license must also submit

 8  the information required under s. 455.565 to the department on

 9  a form and under procedures specified by the department, along

10  with payment in an amount equal to the costs incurred by the

11  Department of Health for the statewide criminal background

12  check of the applicant. The applicant must submit a set of

13  fingerprints to the Department of Health on a form and under

14  procedures specified by the department, along with payment in

15  an amount equal to the costs incurred by the department for a

16  national criminal background check of the applicant for the

17  initial renewal of his or her license after January 1, 2000.

18  If the applicant fails to submit either the information

19  required under s. 455.565 or a set of fingerprints to the

20  department as required by this section, the department shall

21  issue a notice of noncompliance, and the applicant will be

22  given 30 additional days to comply. If the applicant fails to

23  comply within 30 days after the notice of noncompliance is

24  issued, the department or board, as appropriate, may issue a

25  citation to the applicant and may fine the applicant up to $50

26  for each day that the applicant is not in compliance with the

27  requirements of s. 455.565. The citation must clearly state

28  that the applicant may choose, in lieu of accepting the

29  citation, to follow the procedure under s. 455.621. If the

30  applicant disputes the matter in the citation, the procedures

31  set forth in s. 455.621 must be followed. However, if the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  applicant does not dispute the matter in the citation with the

 2  department within 30 days after the citation is served, the

 3  citation becomes a final order and constitutes discipline.

 4  Service of a citation may be made by personal service or

 5  certified mail, restricted delivery, to the subject at the

 6  applicant's last known address. If an applicant has submitted

 7  fingerprints to the department for a national criminal history

 8  check upon initial licensure and is renewing his or her

 9  license for the first time, then the applicant need only

10  submit the information and fee required for a statewide

11  criminal history check.

12         Section 115.  Paragraph (bb) is added to subsection (1)

13  of section 461.013, Florida Statutes, 1998 Supplement, and

14  subsection (2) of that section is amended, to read:

15         461.013  Grounds for disciplinary action; action by the

16  board; investigations by department.--

17         (1)  The following acts shall constitute grounds for

18  which the disciplinary actions specified in subsection (2) may

19  be taken:

20         (bb)  Failing to comply with the requirements of ss.

21  381.026 and 381.0261 to provide patients with information

22  about their patient rights and how to file a patient

23  complaint.

24         (2)  When the board finds any person guilty of any of

25  the grounds set forth in subsection (1), it may enter an order

26  imposing one or more of the following penalties:

27         (a)  Refusal to certify to the department an

28  application for licensure.

29         (b)  Revocation or suspension of a license.

30         (c)  Restriction of practice.

31         (d)  Imposition of an administrative fine not to exceed

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    Amendment No.    





 1  $10,000 $1,000 for each count or separate offense.

 2         (e)  Issuance of a reprimand.

 3         (f)  Placing the podiatric physician on probation for a

 4  period of time and subject to such conditions as the board may

 5  specify, including requiring the podiatric physician to submit

 6  to treatment, to attend continuing education courses, to

 7  submit to reexamination, and to work under the supervision of

 8  another podiatric physician.

 9         (g)  Imposition of an administrative fine in accordance

10  with s. 381.0261 for violations regarding patient rights.

11         Section 116.  Section 461.0135, Florida Statutes, is

12  created to read:

13         461.0135  Operation of X-ray machines by podiatric

14  X-ray assistants.--A licensed podiatric physician may utilize

15  an X-ray machine, expose X-ray films, and interpret or read

16  such films. The provision of part IV of chapter 468 to the

17  contrary notwithstanding, a licensed podiatric physician may

18  authorize or direct a certified podiatric X-ray assistant to

19  operate such equipment and expose such films under the

20  licensed podiatric physician's direction and supervision,

21  pursuant to rules adopted by the board in accordance with s.

22  461.004, which ensures that such certified podiatric X-ray

23  assistant is competent to operate such equipment in a safe and

24  efficient manner by reason of training, experience, and

25  passage of a board-approved course which includes an

26  examination. The board shall issue a certificate to an

27  individual who successfully completes the board-approved

28  course and passes the examination to be administered by the

29  training authority upon completion of such course.

30         Section 117.  Subsection (3) is added to section

31  464.008, Florida Statutes, to read:

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 1         464.008  Licensure by examination.--

 2         (3)  Any applicant who fails the examination three

 3  consecutive times, regardless of the jurisdiction in which the

 4  examination is taken, shall be required to complete a

 5  board-approved remedial course before the applicant will be

 6  approved for reexamination. After taking the remedial course,

 7  the applicant may be approved to retake the examination up to

 8  three additional times before the applicant is required to

 9  retake remediation. The applicant shall apply for

10  reexamination within 6 months after completion of remediation.

11  The board shall by rule establish guidelines for remedial

12  courses.

13         Section 118.  Subsection (13) is added to section

14  464.022, Florida Statutes, to read:

15         464.022  Exceptions.--No provision of this chapter

16  shall be construed to prohibit:

17         (13)  The practice of nursing by individuals enrolled

18  in board-approved remedial courses.

19         Section 119.  Subsection (12) of section 465.003,

20  Florida Statutes, is amended, subsections (4) through (14) of

21  said section are renumbered as subsections (5) through (15),

22  respectively, and a new subsection (4) is added to said

23  section, to read:

24         465.003  Definitions.--As used in this chapter, the

25  term:

26         (4)  "Data communication device" means an electronic

27  device that receives electronic information from one source

28  and transmits or routes it to another, including, but not

29  limited to, any such bridge, router, switch, or gateway.

30         (13)(12)  "Practice of the profession of pharmacy"

31  includes compounding, dispensing, and consulting concerning

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 1  contents, therapeutic values, and uses of any medicinal drug;

 2  and consulting concerning therapeutic values and interactions

 3  of patent or proprietary preparations, whether pursuant to

 4  prescriptions or in the absence and entirely independent of

 5  such prescriptions or orders; and other pharmaceutical

 6  services. For purposes of this subsection, "other

 7  pharmaceutical services" means the monitoring of the patient's

 8  drug therapy and assisting the patient in the management of

 9  his or her drug therapy, and includes review of the patient's

10  drug therapy and communication with the patient's prescribing

11  health care provider as licensed under chapter 458, chapter

12  459, chapter 461, or chapter 466, or similar statutory

13  provision in another jurisdiction, or such provider's agent or

14  such other persons as specifically authorized by the patient,

15  regarding the drug therapy. However, nothing in this

16  subsection may be interpreted to permit an alteration of a

17  prescriber's directions, the diagnosis or treatment of any

18  disease, the initiation of any drug therapy, the practice of

19  medicine, or the practice of osteopathic medicine, unless

20  otherwise permitted by law. "Practice of the profession of

21  pharmacy" The phrase also includes any other act, service,

22  operation, research, or transaction incidental to, or forming

23  a part of, any of the foregoing acts, requiring, involving, or

24  employing the science or art of any branch of the

25  pharmaceutical profession, study, or training, and shall

26  expressly permit a pharmacist to transmit information from

27  persons authorized to prescribe medicinal drugs to their

28  patients.

29         Section 120.  Paragraph (l) of subsection (1) and

30  paragraph (c) of subsection (2) of section 465.016, Florida

31  Statutes, are amended, and paragraph (q) is added to

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    Bill No. CS for SB 2220

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 1  subsection (1) of that section, to read:

 2         465.016  Disciplinary actions.--

 3         (1)  The following acts shall be grounds for

 4  disciplinary action set forth in this section:

 5         (l)  Placing in the stock of any pharmacy any part of

 6  any prescription compounded or dispensed which is returned by

 7  a patient; however, in a hospital, nursing home, correctional

 8  facility, or extended care facility in which unit-dose

 9  medication is dispensed to inpatients, each dose being

10  individually sealed and the individual unit dose or unit-dose

11  system labeled with the name of the drug, dosage strength,

12  manufacturer's control number, and expiration date, if any,

13  the unused unit dose of medication may be returned to the

14  pharmacy for redispensing.  Each pharmacist shall maintain

15  appropriate records for any unused or returned medicinal

16  drugs.

17         (q)  Using or releasing a patient's records except as

18  authorized by this chapter and chapter 455.

19         (2)  When the board finds any person guilty of any of

20  the grounds set forth in subsection (1), it may enter an order

21  imposing one or more of the following penalties:

22         (c)  Imposition of an administrative fine not to exceed

23  $5,000 $1,000 for each count or separate offense.

24         Section 121.  Section 465.014, Florida Statutes, is

25  amended to read:

26         465.014  Pharmacy technician.--No person other than a

27  licensed pharmacist or pharmacy intern may engage in the

28  practice of the profession of pharmacy, except that a licensed

29  pharmacist may delegate to nonlicensed pharmacy technicians

30  those duties, tasks, and functions which do not fall within

31  the purview of s. 465.003(13)(12).  All such delegated acts

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 1  shall be performed under the direct supervision of a licensed

 2  pharmacist who shall be responsible for all such acts

 3  performed by persons under his or her supervision.  A pharmacy

 4  technician, under the supervision of a pharmacist, may

 5  initiate or receive communications with a practitioner or his

 6  or her agent, on behalf of a patient, regarding refill

 7  authorization requests.  No licensed pharmacist shall

 8  supervise more than one pharmacy technician unless otherwise

 9  permitted by the guidelines adopted by the board.  The board

10  shall establish guidelines to be followed by licensees or

11  permittees in determining the circumstances under which a

12  licensed pharmacist may supervise more than one but not more

13  than three pharmacy technicians.

14         Section 122.  Paragraph (c) of subsection (2) of

15  section 465.015, Florida Statutes, is amended to read:

16         465.015  Violations and penalties.--

17         (2)  It is unlawful for any person:

18         (c)  To sell or dispense drugs as defined in s.

19  465.003(8)(7) without first being furnished with a

20  prescription.

21         Section 123.  Section 465.0196, Florida Statutes, is

22  amended to read:

23         465.0196  Special pharmacy permits.--Any person

24  desiring a permit to operate a pharmacy which does not fall

25  within the definitions set forth in s. 465.003(11)(10)(a)1.,

26  2., and 3. shall apply to the department for a special

27  pharmacy permit.  If the board certifies that the application

28  complies with the applicable laws and rules of the board

29  governing the practice of the profession of pharmacy, the

30  department shall issue the permit.  No permit shall be issued

31  unless a licensed pharmacist is designated to undertake the

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    Bill No. CS for SB 2220

    Amendment No.    





 1  professional supervision of the compounding and dispensing of

 2  all drugs dispensed by the pharmacy.  The licensed pharmacist

 3  shall be responsible for maintaining all drug records and for

 4  providing for the security of the area in the facility in

 5  which the compounding, storing, and dispensing of medicinal

 6  drugs occurs.  The permittee shall notify the department

 7  within 10 days of any change of the licensed pharmacist

 8  responsible for such duties.

 9         Section 124.  Subsection (3) of section 468.812,

10  Florida Statutes, is amended to read:

11         468.812  Exemptions from licensure.--

12         (3)  The provisions of this act relating to orthotics

13  or pedorthics do not apply to any licensed pharmacist or to

14  any person acting under the supervision of a licensed

15  pharmacist.  The practice of orthotics or pedorthics by a

16  pharmacist or any of the pharmacist's employees acting under

17  the supervision of a pharmacist shall be construed to be

18  within the meaning of the term "practice of the profession of

19  pharmacy" as set forth in s. 465.003(13)(12), and shall be

20  subject to regulation in the same manner as any other pharmacy

21  practice.  The Board of Pharmacy shall develop rules regarding

22  the practice of orthotics and pedorthics by a pharmacist.  Any

23  pharmacist or person under the supervision of a pharmacist

24  engaged in the practice of orthotics or pedorthics shall not

25  be precluded from continuing that practice pending adoption of

26  these rules.

27         Section 125.  Subsection (19) of section 499.003,

28  Florida Statutes, is amended to read:

29         499.003  Definitions of terms used in ss.

30  499.001-499.081.--As used in ss. 499.001-499.081, the term:

31         (19)  "Legend drug," "prescription drug," or "medicinal

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                                                  SENATE AMENDMENT

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    Amendment No.    





 1  drug" means any drug, including, but not limited to, finished

 2  dosage forms, or active ingredients subject to, defined by, or

 3  described by s. 503(b) of the Federal Food, Drug, and Cosmetic

 4  Act or s. 465.003(8)(7), s. 499.007(12), or s. 499.0122(1)(b)

 5  or (c).

 6         Section 126.  (1)  There is created within the

 7  Department of Health a Task Force for the Study of

 8  Collaborative Drug Therapy Management. The department shall

 9  provide staff support for the task force. The task force shall

10  consist of not more than 13 members nominated by the

11  associations and entities named in this section and appointed

12  by the Secretary of Health. Members of the task force shall

13  not receive compensation, per diem, or reimbursement for

14  travel expenses for service on the task force. Participation

15  in the task force is optional and at the discretion of each

16  identified group or entity. The task force shall include:

17         (a)  One representative from each of the following

18  associations:

19         1.  Florida Society of Health-System Pharmacists.

20         2.  Florida Pharmacy Association.

21         3.  Florida Medical Association.

22         4.  Florida Osteopathic Medical Association.

23         5.  Florida Retail Federation.

24         6.  Florida Nurses Association.

25         7.  Florida Academy of Family Physicians.

26         8.  Pharmaceutical Research Manufacturing Association.

27         9.  American Society of Consultant Pharmacists.

28         10.  American Society of Health-System Pharmacists.

29         (b)  One representative from each of the following

30  entities:

31         1.  Department of Health.

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    Bill No. CS for SB 2220

    Amendment No.    





 1         2.  Board of Medicine, which representative must be a

 2  member of the board who is licensed under chapter 458, Florida

 3  Statutes.

 4         3.  Board of Osteopathic Medicine, which representative

 5  must be a member of the board who is licensed under chapter

 6  459, Florida Statutes.

 7         4.  Board of Pharmacy, which representative must be a

 8  member of the board who is licensed under chapter 465, Florida

 9  Statutes.

10         5.  Agency for Health Care Administration.

11         (2)  The task force shall hold its first meeting no

12  later than August 1, 1999, and shall report its findings to

13  the President of the Senate, the Speaker of the House of

14  Representatives, and the chairs of the applicable legislative

15  committees of substance not later than December 31, 1999. All

16  task force meetings must be held in Tallahassee at the

17  department in order to minimize costs to the state.

18         (3)  The task force shall be charged with the

19  responsibility to:

20         (a)  Determine the states in which collaborative drug

21  therapy management has been enacted by law or administrative

22  rule and summarize the content of all such laws and rules.

23         (b)  Receive testimony from interested parties and

24  identify the extent to which collaborative drug therapy

25  management is currently being practiced in this state and

26  other states.

27         (c)  Determine the efficacy of collaborative drug

28  therapy management in improving health care outcomes of

29  patients.

30         Section 127.  Section 466.021, Florida Statutes, is

31  amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         466.021  Employment of unlicensed persons by dentist;

 2  penalty.--Every duly licensed dentist who uses the services of

 3  any unlicensed person for the purpose of constructing,

 4  altering, repairing, or duplicating any denture, partial

 5  denture, bridge splint, or orthodontic or prosthetic appliance

 6  shall be required to furnish such unlicensed person with a

 7  written work order in such form as prescribed shall be

 8  approved by rule of the board department. This form shall be

 9  supplied to the dentist by the department at a cost not to

10  exceed that of printing and handling. The work order blanks

11  shall be assigned to individual dentists and are not

12  transferable. This form shall be dated and signed by such

13  dentist and shall include the patient's name or number with

14  sufficient descriptive information to clearly identify the

15  case for each separate and individual piece of work. A; said

16  work order shall be made in duplicate form, the duplicate copy

17  of such work order shall to be retained in a permanent file in

18  the dentist's office for a period of 2 years, and the original

19  work order shall to be retained in a permanent file for a

20  period of 2 years by such said unlicensed person in her or his

21  place of business. Such permanent file of work orders to be

22  kept by such dentist or by such unlicensed person shall be

23  open to inspection at any reasonable time by the department or

24  its duly constituted agent. Failure of the dentist to keep

25  such permanent records of such said work orders shall subject

26  the dentist to suspension or revocation of her or his license

27  to practice dentistry. Failure of such unlicensed person to

28  have in her or his possession a work order as required by this

29  section above defined shall be admissible evidence of a

30  violation of this chapter and shall constitute a misdemeanor

31  of the second degree, punishable as provided in s. 775.082 or

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  s. 775.083. Nothing in this section shall preclude a

 2  registered dental laboratory from working for another

 3  registered dental laboratory, provided that such work is

 4  performed pursuant to written authorization, in a form to be

 5  prescribed by rule of the board department, which evidences

 6  that the originating laboratory has obtained a valid work

 7  order and which sets forth the work to be performed.

 8  Furthermore, nothing in this section shall preclude a

 9  registered laboratory from providing its services to dentists

10  licensed and practicing in another state, provided that such

11  work is requested or otherwise authorized in written form

12  which clearly identifies the name and address of the

13  requesting dentist and which sets forth the work to be

14  performed.

15         Section 128.  Paragraph (b) of subsection (2),

16  paragraph (b) of subsection (3), and subsection (4) of section

17  468.1155, Florida Statutes, are amended to read:

18         468.1155  Provisional license; requirements.--

19         (2)  The department shall issue a provisional license

20  to practice speech-language pathology to each applicant who

21  the board certifies has:

22         (b)  Received a master's degree or doctoral degree with

23  a major emphasis in speech-language pathology from an

24  institution of higher learning which, at the time the

25  applicant was enrolled and graduated, was accredited by an

26  accrediting agency recognized by the Commission on Recognition

27  of Postsecondary Accreditation or from an institution which is

28  publicly recognized as a member in good standing with the

29  Association of Universities and Colleges of Canada.  An

30  applicant who graduated from a program at a university or

31  college outside the United States or Canada must present

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  documentation of the determination of equivalency to standards

 2  established by the Commission on Recognition of Postsecondary

 3  Accreditation in order to qualify.  The applicant must have

 4  completed 60 semester hours that include:

 5         1.  Fundamental information applicable to the normal

 6  development and use of speech, hearing, and language;

 7  information about training in management of speech, hearing,

 8  and language disorders; and information supplementary to these

 9  fields.

10         2.  Six semester hours in audiology.

11         3.  Thirty of the required 60 semester hours in courses

12  acceptable toward a graduate degree by the college or

13  university in which these courses were taken, of which 24

14  semester hours must be in speech-language pathology.

15         (3)  The department shall issue a provisional license

16  to practice audiology to each applicant who the board

17  certifies has:

18         (b)  Received a master's degree or doctoral degree with

19  a major emphasis in audiology from an institution of higher

20  learning which at the time the applicant was enrolled and

21  graduated was accredited by an accrediting agency recognized

22  by the Commission on Recognition of Postsecondary

23  Accreditation or from an institution which is publicly

24  recognized as a member in good standing with the Association

25  of Universities and Colleges of Canada.  An applicant who

26  graduated from a program at a university or college outside

27  the United States or Canada must present documentation of the

28  determination of equivalency to standards established by the

29  Commission on Recognition of Postsecondary Accreditation in

30  order to qualify.  The applicant must have completed 60

31  semester hours that include:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         1.  Fundamental information applicable to the normal

 2  development and use of speech, hearing, and language;

 3  information about training in management of speech, hearing,

 4  and language disorders; and information supplementary to these

 5  fields.

 6         2.  Six semester hours in speech-language pathology.

 7         3.  Thirty of the required 60 semester hours in courses

 8  acceptable toward a graduate degree by the college or

 9  university in which these courses were taken, of which 24

10  semester hours must be in audiology.

11         (4)  An applicant for a provisional license who has

12  received a master's degree or doctoral degree with a major

13  emphasis in speech-language pathology as provided in

14  subsection (2), or audiology as provided in subsection (3),

15  and who seeks licensure in the area in which the applicant is

16  not currently licensed, must have completed 30 semester hours

17  in courses acceptable toward a graduate degree and 200

18  supervised clinical clock hours in the second discipline from

19  an accredited institution.

20         Section 129.  Section 468.1215, Florida Statutes, is

21  amended to read:

22         468.1215  Speech-language pathology assistant and

23  audiology assistant; certification.--

24         (1)  A person desiring to be certified as a

25  speech-language pathology assistant or audiology assistant

26  shall apply to the department.

27         (1)(2)  The department shall issue a certificate as a

28  speech-language pathology assistant or as an audiology

29  assistant to each applicant who the board certifies has:

30         (a)  Completed the application form and remitted the

31  required fees, including a nonrefundable application fee.

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    Bill No. CS for SB 2220

    Amendment No.    





 1         (b)  Earned a bachelor's degree from a college or

 2  university accredited by a regional association of colleges

 3  and schools recognized by the Department of Education which

 4  includes at least 24 semester hours of coursework as approved

 5  by the board at an institution accredited by an accrediting

 6  agency recognized by the Commission on Recognition of

 7  Postsecondary Accreditation.

 8         (2)  The department shall issue a certificate as an

 9  audiology assistant to each applicant who the board certifies

10  has:

11         (a)  Completed the application form and remitted the

12  required fees, including a nonrefundable application fee.

13         (b)  Completed at least 24 semester hours of coursework

14  as approved by the board at an institution accredited by an

15  accrediting agency recognized by the Commission on Recognition

16  of Postsecondary Accreditation.

17         (3)  The board, by rule, shall establish minimum

18  education and on-the-job training and supervision requirements

19  for certification as a speech-language pathology assistant or

20  audiology assistant.

21         (4)  The provisions of this section shall not apply to

22  any student, intern, or trainee performing speech-language

23  pathology or audiology services while completing the

24  supervised clinical clock hours as required in s. 468.1155.

25         Section 130.  Subsection (1) of section 468.307,

26  Florida Statutes, 1998 Supplement, is amended to read:

27         468.307  Certificate; issuance; possession; display.--

28         (1)  The department shall issue a certificate to each

29  candidate who has met the requirements of ss. 468.304 and

30  468.306 or has qualified under s. 468.3065. The department may

31  by rule establish a subcategory of a certificate issued under

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  this part limiting the certificateholder to a specific

 2  procedure or specific type of equipment.

 3         Section 131.  Section 468.506, Florida Statutes, 1998

 4  Supplement, is amended to read:

 5         468.506  Dietetics and Nutrition Practice

 6  Council.--There is created the Dietetics and Nutrition

 7  Practice Council under the supervision of the board.  The

 8  council shall consist of four persons licensed under this part

 9  and one consumer who is 60 years of age or older.  Council

10  members shall be appointed by the board. Licensed members

11  shall be appointed based on the proportion of licensees within

12  each of the respective disciplines.  Members shall be

13  appointed for 4-year staggered terms.  In order to be eligible

14  for appointment, each licensed member must have been a

15  licensee under this part for at least 3 years prior to his or

16  her appointment.  No council member shall serve more than two

17  successive terms.  The board may delegate such powers and

18  duties to the council as it may deem proper to carry out the

19  operations and procedures necessary to effectuate the

20  provisions of this part.  However, the powers and duties

21  delegated to the council by the board must encompass both

22  dietetics and nutrition practice and nutrition counseling. Any

23  time there is a vacancy on the council, any professional

24  association composed of persons licensed under this part may

25  recommend licensees to fill the vacancy to the board in a

26  number at least twice the number of vacancies to be filled,

27  and the board may appoint from the submitted list, in its

28  discretion, any of those persons so recommended.  Any

29  professional association composed of persons licensed under

30  this part may file an appeal regarding a council appointment

31  with the secretary director of the department agency, whose

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  decision shall be final.  The board shall fix council members'

 2  compensation and pay their expenses in the same manner as

 3  provided in s. 455.534.

 4         Section 132.  Section 468.701, Florida Statutes, 1998

 5  Supplement, is amended to read:

 6         468.701  Definitions.--As used in this part, the term:

 7         (1)  "Athlete" means a person who participates in an

 8  athletic activity.

 9         (2)  "Athletic activity" means the participation in an

10  activity, conducted by an educational institution, a

11  professional athletic organization, or an amateur athletic

12  organization, involving exercises, sports, games, or

13  recreation requiring any of the physical attributes of

14  strength, agility, flexibility, range of motion, speed, and

15  stamina.

16         (3)  "Athletic injury" means an injury sustained which

17  affects the athlete's ability to participate or perform in

18  athletic activity.

19         (4)  "Athletic trainer" means a person licensed under

20  this part.

21         (5)  "Athletic training" means the recognition,

22  prevention, and treatment of athletic injuries.

23         (6)  "Board Council" means the Board Council of

24  Athletic Training.

25         (7)  "Department" means the Department of Health.

26         (8)  "Direct supervision" means the physical presence

27  of the supervisor on the premises so that the supervisor is

28  immediately available to the trainee when needed.

29         (9)  "Secretary" means the Secretary of Health.

30         (9)(10)  "Supervision" means the easy availability of

31  the supervisor to the athletic trainer, which includes the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  ability to communicate by telecommunications.

 2         Section 133.  Section 468.703, Florida Statutes, 1998

 3  Supplement, is amended to read:

 4         468.703  Board Council of Athletic Training.--

 5         (1)  The Board Council of Athletic Training is created

 6  within the department and shall consist of nine seven members

 7  to be appointed by the Governor and confirmed by the Senate

 8  secretary.

 9         (2)  Five Four members of the board must council shall

10  be licensed athletic trainers. One member of the board must

11  council shall be a physician licensed under chapter 458 or

12  chapter 459. One member of the board must council shall be a

13  physician licensed under chapter 460. Two members One member

14  of the board shall be consumer members, each of whom must

15  council shall be a resident of this state who has never worked

16  as an athletic trainer, who has no financial interest in the

17  practice of athletic training, and who has never been a

18  licensed health care practitioner as defined in s. 455.501(4).

19  Members of the council shall serve staggered 4-year terms as

20  determined by rule of the department; however, no member may

21  serve more than two consecutive terms.

22         (3)  For the purpose of staggering terms, the Governor

23  shall appoint the initial members of the board as follows:

24         (a)  Three members for terms of 2 years each.

25         (b)  Three members for terms of 3 years each.

26         (c)  Three members for terms of 4 years each.

27         (4)  As the terms of the members expire, the Governor

28  shall appoint successors for terms of 4 years and such members

29  shall serve until their successors are appointed.

30         (5)  All provisions of part II of chapter 455 relating

31  to activities of the board shall apply.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (6)  The board shall maintain its official headquarters

 2  in Tallahassee.

 3         (3)  The council shall advise and assist the department

 4  in:

 5         (a)  Developing rules relating to licensure

 6  requirements, the licensure examination, continuing education

 7  requirements, fees, records and reports to be filed by

 8  licensees, and any other requirements necessary to regulate

 9  the practice of athletic training.

10         (b)  Monitoring the practice of athletic training in

11  other jurisdictions.

12         (c)  Educating the public about the role of athletic

13  trainers.

14         (d)  Collecting and reviewing data regarding the

15  licensed practice of athletic training.

16         (e)  Addressing concerns and problems of athletic

17  trainers in order to promote improved safety in the practice

18  of athletic training.

19         (4)  Members of the council shall be entitled to

20  compensation and reimbursement for expenses in the same manner

21  as board members are compensated and reimbursed under s.

22  455.534.

23         Section 134.  Section 468.705, Florida Statutes, 1998

24  Supplement, is amended to read:

25         468.705  Rulemaking authority.--The board department is

26  authorized to adopt rules pursuant to ss. 120.536(1) and

27  120.54 to implement provisions of this part conferring duties

28  upon it. Such rules shall include, but not be limited to, the

29  allowable scope of practice regarding the use of equipment,

30  procedures, and medication, and requirements for a written

31  protocol between the athletic trainer and a supervising

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  physician, licensure requirements, licensure examination,

 2  continuing education requirements, fees, records, and reports

 3  to be filed by licensees, protocols, and any other

 4  requirements necessary to regulate the practice of athletic

 5  training.

 6         Section 135.  Section 468.707, Florida Statutes, 1998

 7  Supplement, is amended to read:

 8         468.707  Licensure by examination; requirements.--

 9         (1)  Any person desiring to be licensed as an athletic

10  trainer shall apply to the department on a form approved by

11  the department.

12         (a)  The department shall license each applicant who:

13         1.  Has completed the application form and remitted the

14  required fees.

15         2.  Is at least 21 years of age.

16         3.  Has obtained a baccalaureate degree from a college

17  or university accredited by an accrediting agency recognized

18  and approved by the United States Department of Education or

19  the Commission on Recognition of Postsecondary Accreditation,

20  or approved by the board department.

21         4.  Has completed coursework from a college or

22  university accredited by an accrediting agency recognized and

23  approved by the United States Department of Education or the

24  Commission on Recognition of Postsecondary Accreditation, or

25  approved by the board department, in each of the following

26  areas, as provided by rule: health, human anatomy,

27  kinesiology/biomechanics, human physiology, physiology of

28  exercise, basic athletic training, and advanced athletic

29  training.

30         5.  Has current certification in standard first aid and

31  cardiovascular pulmonary resuscitation from the American Red

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Cross or an equivalent certification as determined by the

 2  board department.

 3         6.  Has, within 2 of the preceding 5 years, attained a

 4  minimum of 800 hours of athletic training experience under the

 5  direct supervision of a licensed athletic trainer or an

 6  athletic trainer certified by the National Athletic Trainers'

 7  Association or a comparable national athletic standards

 8  organization.

 9         7.  Has passed an examination administered or approved

10  by the board department.

11         (b)  The department shall also license each applicant

12  who:

13         1.  Has completed the application form and remitted the

14  required fees no later than October 1, 1996.

15         2.  Is at least 21 years of age.

16         3.  Has current certification in standard first aid and

17  cardiovascular pulmonary resuscitation from the American Red

18  Cross or an equivalent certification as determined by the

19  board department.

20         4.a.  Has practiced athletic training for at least 3 of

21  the 5 years preceding application; or

22         b.  Is currently certified by the National Athletic

23  Trainers' Association or a comparable national athletic

24  standards organization.

25         (2)  Pursuant to the requirements of s. 455.607

26  455.604, each applicant shall complete a continuing education

27  course on human immunodeficiency virus and acquired immune

28  deficiency syndrome as part of initial licensure.

29         Section 136.  Section 468.709, Florida Statutes, is

30  amended to read:

31         468.709  Fees.--

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (1)  The board department shall, by rule, establish

 2  fees for the following purposes:

 3         (a)  An application fee, not to exceed $100.

 4         (b)  An examination fee, not to exceed $200.

 5         (c)  An initial licensure fee, not to exceed $200.

 6         (d)  A biennial renewal fee, not to exceed $200.

 7         (e)  An inactive fee, not to exceed $100.

 8         (f)  A delinquent fee, not to exceed $100.

 9         (g)  A reactivation fee, not to exceed $100.

10         (h)  A voluntary inactive fee, not to exceed $100.

11         (2)  The board department shall establish fees at a

12  level, not to exceed the statutory fee cap, that is adequate

13  to ensure the continued operation of the regulatory program

14  under this part. The board department shall neither set nor

15  maintain the fees at a level that will substantially exceed

16  this need.

17         Section 137.  Subsections (2) and (3) of section

18  468.711, Florida Statutes, 1998 Supplement, are amended to

19  read:

20         468.711  Renewal of license; continuing education.--

21         (2)  The board department may, by rule, prescribe

22  continuing education requirements, not to exceed 24 hours

23  biennially. The criteria for continuing education shall be

24  approved by the board department and shall include 4 hours in

25  standard first aid and cardiovascular pulmonary resuscitation

26  from the American Red Cross or equivalent training as

27  determined by board department.

28         (3)  Pursuant to the requirements of s. 455.607

29  455.604, each licensee shall complete a continuing education

30  course on human immunodeficiency virus and acquired immune

31  deficiency syndrome as part of biennial relicensure.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         Section 138.  Subsection (2) of section 468.719,

 2  Florida Statutes, 1998 Supplement, is amended to read:

 3         468.719  Disciplinary actions.--

 4         (2)  When the board department finds any person guilty

 5  of any of the acts set forth in subsection (1), the board

 6  department may enter an order imposing one or more of the

 7  penalties provided in s. 455.624.

 8         Section 139.  Section 468.721, Florida Statutes, is

 9  amended to read:

10         468.721  Saving clause.--

11         (1)  An athletic trainer registration which is valid on

12  October 1, 1995, shall become for all purposes an athletic

13  trainer license as required by this part, subject to any

14  disciplinary or administrative action pending on October 1,

15  1995, and shall be subject to all the same terms and

16  conditions as athletic trainer licenses issued after October

17  1, 1995. The department shall retain jurisdiction to impose

18  discipline for any violation of this part which occurred prior

19  to October 1, 1995, but is discovered after October 1, 1995,

20  under the terms of this part prior to October 1, 1995.

21         (2)  No judicial or administrative proceeding pending

22  on July 1, 1995, shall be abated as a result of enactment of

23  any provision of this act.

24         (3)  Rules adopted by the department relating to the

25  regulation registration of athletic trainers under this part

26  prior to July 1, 1999, shall remain in effect until the board

27  department adopts rules relating to the regulation licensure

28  of athletic trainers under this part which supersede such

29  earlier rules.

30         Section 140.  Paragraph (g) of subsection (3) of

31  section 20.43, Florida Statutes, 1998 Supplement, is amended

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 1  to read:

 2         20.43  Department of Health.--There is created a

 3  Department of Health.

 4         (3)  The following divisions of the Department of

 5  Health are established:

 6         (g)  Division of Medical Quality Assurance, which is

 7  responsible for the following boards and professions

 8  established within the division:

 9         1.  Nursing assistants, as provided under s. 400.211.

10         2.  Health care services pools, as provided under s.

11  402.48.

12         3.  The Board of Acupuncture, created under chapter

13  457.

14         4.  The Board of Medicine, created under chapter 458.

15         5.  The Board of Osteopathic Medicine, created under

16  chapter 459.

17         6.  The Board of Chiropractic Medicine, created under

18  chapter 460.

19         7.  The Board of Podiatric Medicine, created under

20  chapter 461.

21         8.  Naturopathy, as provided under chapter 462.

22         9.  The Board of Optometry, created under chapter 463.

23         10.  The Board of Nursing, created under chapter 464.

24         11.  The Board of Pharmacy, created under chapter 465.

25         12.  The Board of Dentistry, created under chapter 466.

26         13.  Midwifery, as provided under chapter 467.

27         14.  The Board of Speech-Language Pathology and

28  Audiology, created under part I of chapter 468.

29         15.  The Board of Nursing Home Administrators, created

30  under part II of chapter 468.

31         16.  The Board of Occupational Therapy, created under

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 1  part III of chapter 468.

 2         17.  Respiratory therapy, as provided under part V of

 3  chapter 468.

 4         18.  Dietetics and nutrition practice, as provided

 5  under part X of chapter 468.

 6         19.  The Board of Athletic Training trainers, created

 7  as provided under part XIII of chapter 468.

 8         20.  The Board of Orthotists and Prosthetists, created

 9  under part XIV of chapter 468.

10         21.  Electrolysis, as provided under chapter 478.

11         22.  The Board of Massage Therapy, created under

12  chapter 480.

13         23.  The Board of Clinical Laboratory Personnel,

14  created under part III of chapter 483.

15         24.  Medical physicists, as provided under part IV of

16  chapter 483.

17         25.  The Board of Opticianry, created under part I of

18  chapter 484.

19         26.  The Board of Hearing Aid Specialists, created

20  under part II of chapter 484.

21         27.  The Board of Physical Therapy Practice, created

22  under chapter 486.

23         28.  The Board of Psychology, created under chapter

24  490.

25         29.  School psychologists, as provided under chapter

26  490.

27         30.  The Board of Clinical Social Work, Marriage and

28  Family Therapy, and Mental Health Counseling, created under

29  chapter 491.

30

31  The department may contract with the Agency for Health Care

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 1  Administration who shall provide consumer complaint,

 2  investigative, and prosecutorial services required by the

 3  Division of Medical Quality Assurance, councils, or boards, as

 4  appropriate.

 5         Section 141.  The Council of Athletic Training and the

 6  terms of all council members are terminated on July 1, 1999.

 7  However, such termination in no way precludes the Governor

 8  from considering any former council member for appointment to

 9  the Board of Athletic Training created by this act.

10         Section 142.  Section 468.805, Florida Statutes, is

11  amended to read:

12         468.805  Grandfathering Licensure without examination;

13  provisional licensure.--

14         (1)  A person who has practiced orthotics, prosthetics,

15  or pedorthics in this state for the required period since July

16  1, 1990, who, before March 1, 1998, applies to the department

17  for a license to practice orthotics, prosthetics, or

18  pedorthics, may be licensed as a prosthetist, orthotist,

19  prosthetist-orthotist, orthotic fitter, orthotic fitter

20  assistant, or pedorthist, as determined from the person's

21  experience, certification, and educational preparation,

22  without meeting the educational requirements set forth in s.

23  468.803, upon receipt of the application fee and licensing fee

24  and after the board has completed an investigation into the

25  applicant's background and experience. The board shall require

26  an application fee not to exceed $500, which shall be

27  nonrefundable. The board shall complete its investigation

28  within 6 months after receipt of the completed application.

29  The period of experience required for licensure under this

30  section subsection is 5 years for a prosthetist; 2 years for

31  an orthotic fitter, an orthotic fitter assistant, or a

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 1  pedorthist; and 5 years for an orthotist whose scope of

 2  practice is defined under s. 468.80(7).

 3         (2)(a)  A person who has received certification as an

 4  orthotist, a prosthetist, or a prosthetist-orthotist from a

 5  national certifying body and who has practiced orthotics or

 6  prosthetics in this state for at least 2 years but less than 5

 7  years is eligible for a provisional license.

 8         (b)  An applicant for provisional licensure shall

 9  submit proof that he or she has been actively practicing as a

10  nationally certified orthotist, prosthetist, or

11  prosthetist-orthotist, an application fee, and a provisional

12  license fee.

13         (c)  A provisional licensee is required to practice

14  under supervision of a fully licensed orthotist, prosthetist,

15  or prosthetist-orthotist for up to 3 years in order to meet

16  the 5-year experience requirement of subsection (1) to be

17  licensed as an orthotist, prosthetist, or

18  prosthetist-orthotist.

19         (d)  After appropriate investigation, the board shall

20  license as an orthotist, prosthetist, or prosthetist-orthotist

21  the provisional licensee who has successfully completed the

22  period of experience required and otherwise meets the

23  requirements of subsection (1).

24         (e)  The board shall require an application fee, not to

25  exceed $500, which is nonrefundable, and a provisional

26  licensure fee, not to exceed $500.

27         (3)  An applicant who has received certification as an

28  orthotist, a prosthetist, a prosthetist-orthotist, or a

29  pedorthist from a national certifying body which requires the

30  successful completion of an examination, may be licensed under

31  this section without taking an additional examination. An

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 1  applicant who has not received certification from a national

 2  certifying body which requires the successful completion of an

 3  examination shall be required to take an examination as

 4  determined by the board. This examination shall be designed to

 5  determine if the applicant has the minimum qualifications

 6  needed to be licensed under this section. The board may charge

 7  an examination fee and the actual per applicant cost to the

 8  department for purchase or development of the examination.

 9         (4)  An applicant who successfully completed prior to

10  March 1, 1998, at least one-half of the examination required

11  for national certification and successfully completed the

12  remaining portion of the examination and became certified

13  prior to July 1, 1998, shall be considered as nationally

14  certified by March 1, 1998, for purposes of this section.

15         (5)(4)  This section is repealed July 1, 2002.

16         Section 143.  Subsection (3) of section 468.806,

17  Florida Statutes, is amended to read:

18         468.806  Biennial renewal of license.--

19         (3)  The board may by rule prescribe continuing

20  education requirements and approve course criteria, not to

21  exceed 30 hours biennially, as a condition for license

22  renewal. The board shall establish a procedure for approving

23  continuing education courses and providers and may set a fee

24  for continuing education course and provider approval.

25         Section 144.  Subsection (5) of section 478.42, Florida

26  Statutes, is amended to read:

27         478.42  Definitions.--As used in this chapter, the

28  term:

29         (5)  "Electrolysis or electrology" means the permanent

30  removal of hair by destroying introducing, into and beneath

31  the skin, ionizing (galvanic current) or nonionizing radiation

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 1  (thermolysis or high-frequency current) to destroy the

 2  hair-producing cells of the skin and vascular system, using

 3  equipment and needle-type epilation devices approved by the

 4  board which have been cleared by and that are registered with

 5  the United States Food and Drug Administration and that are

 6  used pursuant to protocols approved by the council and the

 7  board.

 8         Section 145.  Section 483.041, Florida Statutes, is

 9  amended to read:

10         483.041  Definitions.--As used in this part, the term:

11         (1)  "Agency" means the Agency for Health Care

12  Administration.

13         (2)  "Clinical laboratory" means the physical location

14  in which one or more of the following services a laboratory

15  where examinations are performed on materials or specimens

16  taken from the human body to provide information or materials

17  for use in the diagnosis, prevention, or treatment of a

18  disease or the identification or assessment of a medical or

19  physical condition.

20         (a)  Clinical laboratory services are the examinations

21  of fluids or other materials taken from the human body.

22         (b)  Anatomic laboratory services are the examinations

23  of tissue taken from the human body.

24         (c)  Cytology laboratory services are the examinations

25  of cells from individual tissues or fluid taken from the human

26  body.

27         (3)  "Clinical laboratory examination" means a

28  procedure performed to deliver the services defined in

29  subsection (2), including the oversight or interpretation

30  thereof.

31         (4)(3)  "Clinical laboratory proficiency testing

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 1  program" means a program approved by the agency for evaluating

 2  the performance of clinical laboratories.

 3         (5)(4)  "Collection station" or "branch office" means a

 4  facility operated by a clinical laboratory where materials or

 5  specimens are withdrawn or collected from patients or

 6  assembled after being withdrawn or collected from patients

 7  elsewhere, for subsequent delivery to another location for

 8  examination.

 9         (6)(5)  "Hospital laboratory" means a laboratory

10  located in a hospital licensed under chapter 395 that provides

11  services solely to that hospital and that is owned by the

12  hospital and governed by the hospital medical staff or

13  governing board.

14         (7)(6)  "Licensed practitioner" means a physician

15  licensed under chapter 458, chapter 459, chapter 460, or

16  chapter 461; a dentist licensed under chapter 466; a person

17  licensed under chapter 462; or an advanced registered nurse

18  practitioner licensed under chapter 464 or a duly licensed

19  practitioner from another state licensed under similar

20  statutes who orders examinations on materials or specimens for

21  non residents of the State of Florida, but who reside in the

22  same state as the requesting licensed practitioner.

23         (8)(7)  "Person" means the State of Florida or any

24  individual, firm, partnership, association, corporation,

25  county, municipality, political subdivision, or other entity,

26  whether organized for profit or not.

27         (9)(8)  "Validation inspection" means an inspection of

28  a clinical laboratory by the agency to assess whether a review

29  by an accrediting organization has adequately evaluated the

30  clinical laboratory according to state standards.

31         (10)(9)  "Waived test" means a test that the federal

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 1  Health Care Financing Administration has determined qualifies

 2  for a certificate of waiver under the federal Clinical

 3  Laboratory Improvement Amendments of 1988, and the federal

 4  rules adopted thereunder.

 5         Section 146.  Subsections (2), (3), and (7) of section

 6  483.803, Florida Statutes, are amended to read:

 7         483.803  Definitions.--As used in this part, the term:

 8         (2)  "Clinical laboratory" means a clinical laboratory

 9  as defined in s. 483.041(2).

10         (3)  "Clinical laboratory examination" means a clinical

11  laboratory examination as defined in s. 483.041 an examination

12  performed on materials or specimens of the human body to

13  provide information or materials for use in the diagnosis,

14  prevention, or treatment of a disease or the identification or

15  assessment of a medical or physical condition.

16         (7)  "Licensed practitioner of the healing arts" means

17  a physician licensed under pursuant to chapter 458, chapter

18  459, or chapter 460, or chapter 461; a dentist licensed under

19  pursuant to chapter 466; or a person licensed under pursuant

20  to chapter 461 or chapter 462.

21         Section 147.  Subsection (9) of section 483.807,

22  Florida Statutes, 1998 Supplement, is amended to read:

23         483.807  Fees; establishment; disposition.--

24         (9)  The initial application and renewal fee for

25  approval as a laboratory training program may not exceed $300.

26  The fee for late filing of a renewal application shall be $50.

27         Section 148.  Subsections (2) and (3) of section

28  483.809, Florida Statutes, are amended to read:

29         483.809  Licensure; examinations; registration of

30  trainees; approval of curricula.--

31         (2)  EXAMINATIONS.--The department shall conduct

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 1  examinations required by board rules to determine in part the

 2  qualification of clinical laboratory personnel for licensure.

 3  The board by rule may designate a An approved national

 4  certification examination that may be accepted in lieu of

 5  state examination for clinical laboratory personnel or public

 6  health scientists.

 7         (3)  REGISTRATION OF TRAINEES.--The department shall

 8  provide for annual registration of clinical laboratory

 9  trainees who are enrolled in a training program employed by

10  laboratories approved pursuant to s. 483.811, which

11  registration may not be renewed except upon special

12  authorization of the board.

13         Section 149.  Section 483.812, Florida Statutes, is

14  amended to read:

15         483.812  Public health laboratory scientists;

16  licensure.--

17         (1)  Applicants at the director level in the category

18  of public health shall qualify under s. 483.824.

19         (2)(1)  Applicants at the director and supervisor level

20  in the category of public health who are certified registered

21  by the National Registry in of Clinical Chemistry

22  Certification or the American Society for of Microbiology,

23  licensed as a technologist, and have 5 years of pertinent

24  clinical laboratory experience may qualify under board rules

25  by passing the state-administered appropriate supervision and

26  administration examination.

27         (3)(2)(a)  A technologist applicant for licensure in

28  the category of public health microbiology, with a

29  baccalaureate degree in one of the biological sciences from an

30  accredited institution, may use the American Society for of

31  Microbiology or the National Registry in of Microbiology

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 1  Certification in Public Health Microbiology to qualify for a

 2  technologist license in public health microbiology.  Such a

 3  technologist may work in a public health microbiology

 4  laboratory.

 5         (b)  A technologist applicant for licensure in the

 6  category of public health chemistry, with a baccalaureate

 7  degree in one of the chemical, biological, or physical

 8  sciences from an accredited institution, may use the National

 9  Registry of Clinical Chemistry Certification to qualify for a

10  technologist license in public health chemistry.  Such a

11  technologist may work in a public health chemistry laboratory.

12         (c)  A technician applicant for licensure in the

13  category of public health, with a baccalaureate degree in one

14  of the chemical or biological sciences from an accredited

15  institution, may obtain a 2-year one-time, 3-year, conditional

16  public health technician license, which may be renewed once

17  pending national certification by the American Society of

18  Microbiology or the National Registry of Clinical Chemistry

19  Certification. Such a technician may perform testing only

20  under the direct supervision of a licensed pathologist,

21  director, supervisor, or technologist.

22         (4)(3)  A person licensed by the Board of Clinical

23  Laboratory Personnel may work in a public health laboratory at

24  the appropriate level and specialty.

25         Section 150.  Section 483.813, Florida Statutes, is

26  amended to read:

27         483.813  Clinical laboratory personnel license.--A

28  person may not conduct a clinical laboratory examination or

29  report the results of such examination unless such person is

30  licensed under this part to perform such procedures. However,

31  this provision does not apply to any practitioner of the

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 1  healing arts authorized to practice in this state or to

 2  persons engaged in testing performed by laboratories regulated

 3  under s. 483.035(1) or exempt from regulation under s.

 4  483.031(2). The department may grant a temporary license to

 5  any candidate it deems properly qualified, for a period not to

 6  exceed 1 year, or a conditional license for a period not to

 7  exceed 3 years.

 8         Section 151.  Subsection (3) is added to section

 9  483.821, Florida Statutes, to read:

10         483.821  Periodic demonstration of competency;

11  continuing education or reexamination.--

12         (3)  The board may, by rule, provide for continuing

13  education or retraining requirements for candidates failing an

14  examination two or more times.

15         Section 152.  Section 483.824, Florida Statutes, is

16  amended to read:

17         483.824  Qualifications of clinical laboratory

18  director.--A clinical laboratory director must have 4 years of

19  clinical laboratory experience with 2 years of experience in

20  the speciality to be directed or be nationally board certified

21  in the specialty to be directed, and must meet one of the

22  following requirements:

23         (1)  Be a physician licensed under chapter 458 or

24  chapter 459;

25         (2)  Hold an earned doctoral degree in a chemical,

26  physical, or biological science from a regionally accredited

27  institution and be nationally certified; or

28         (3)  For the subspecialty of oral pathology, be a

29  physician licensed under chapter 458 or chapter 459 or a

30  dentist licensed under chapter 466.

31         Section 153.  Section 483.825, Florida Statutes, is

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    Bill No. CS for SB 2220

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 1  amended to read:

 2         483.825  Grounds for disciplinary action.--The

 3  following acts constitute grounds for which disciplinary

 4  actions specified in s. 483.827 may be taken against

 5  applicants, registrants, and licensees under this part:

 6         (1)  Attempting to obtain, obtaining, or renewing a

 7  license or registration under this part by bribery, by

 8  fraudulent misrepresentation, or through an error of the

 9  department or the board.

10         (2)  Engaging in or attempting to engage in, or

11  representing herself or himself as entitled to perform, any

12  clinical laboratory procedure or category of procedures not

13  authorized pursuant to her or his license.

14         (3)  Demonstrating incompetence or making consistent

15  errors in the performance of clinical laboratory examinations

16  or procedures or erroneous reporting.

17         (4)  Performing a test and rendering a report thereon

18  to a person not authorized by law to receive such services.

19         (5)  Has been convicted or found guilty of, or entered

20  a plea of nolo contendere to, regardless of adjudication, a

21  crime in any jurisdiction which directly relates to the

22  activities of clinical laboratory personnel or involves moral

23  turpitude or fraudulent or dishonest dealing. The record of a

24  conviction certified or authenticated in such form as to be

25  admissible in evidence under the laws of the state shall be

26  admissible as prima facie evidence of such guilt. Having been

27  convicted of a felony or of any crime involving moral

28  turpitude under the laws of any state or of the United States.

29  The record of conviction or a certified copy thereof shall be

30  conclusive evidence of such conviction.

31         (6)  Having been adjudged mentally or physically

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 1  incompetent.

 2         (7)  Violating or aiding and abetting in the violation

 3  of any provision of this part or the rules adopted hereunder.

 4         (8)  Reporting a test result when no laboratory test

 5  was performed on a clinical specimen.

 6         (9)  Knowingly advertising false services or

 7  credentials.

 8         (10)  Having a license revoked, suspended, or otherwise

 9  acted against, including the denial of licensure, by the

10  licensing authority of another jurisdiction. The licensing

11  authority's acceptance of a relinquishment of a license,

12  stipulation, consent order, or other settlement, offered in

13  response to or in anticipation of the filing of administrative

14  charges against the licensee, shall be construed as action

15  against the licensee.

16         (11)  Failing to report to the board, in writing,

17  within 30 days that an if action under subsection (5),

18  subsection (6), or subsection (10) has been taken against the

19  licensee or one's license to practice as clinical laboratory

20  personnel in another state, territory, or country, or other

21  jurisdiction.

22         (12)  Being unable to perform or report clinical

23  laboratory examinations with reasonable skill and safety to

24  patients by reason of illness or use of alcohol, drugs,

25  narcotics, chemicals, or any other type of material or as a

26  result of any mental or physical condition.  In enforcing this

27  subsection, the department shall have, upon a finding of the

28  secretary or his or her designee that probable cause exists to

29  believe that the licensee is unable to practice because of the

30  reasons stated in this subsection, the authority to issue an

31  order to compel a licensee to submit to a mental or physical

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    Amendment No.    





 1  examination by physicians designated by the department.  If

 2  the licensee refuses to comply with such order, the

 3  department's order directing such examination may be enforced

 4  by filing a petition for enforcement in the circuit court

 5  where the licensee resides or does business.  The department

 6  shall be entitled to the summary procedure provided in s.

 7  51.011.  A licensee affected under this subsection shall at

 8  reasonable intervals be afforded an opportunity to demonstrate

 9  that he or she can resume competent practice with reasonable

10  skill and safety to patients.

11         (13)  Delegating professional responsibilities to a

12  person when the licensee delegating such responsibilities

13  knows, or has reason to know, that such person is not

14  qualified by training, experience, or licensure to perform

15  them.

16         (14)  Violating a previous order of the board entered

17  in a disciplinary proceeding.

18         (15)  Failing to report to the department a person or

19  other licensee who the licensee knows is in violation of this

20  chapter or the rules of the department or board adopted

21  hereunder.

22         (16)  Making or filing a report which the licensee

23  knows to be false, intentionally or negligently failing to

24  file a report or record required by state or federal law,

25  willfully impeding or obstructing such filing or inducing

26  another person to do so, including, but not limited to,

27  impeding an agent of the state from obtaining a report or

28  record for investigative purposes. Such reports or records

29  shall include only those generated in the capacity as a

30  licensed clinical laboratory personnel.

31         (17)  Paying or receiving any commission, bonus,

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 1  kickback, or rebate, or engaging in any split-fee arrangement

 2  in any form whatsoever with a physician, organization, agency,

 3  or person, either directly or indirectly for patients referred

 4  to providers of health care goods and services including, but

 5  not limited to, hospitals, nursing homes, clinical

 6  laboratories, ambulatory surgical centers, or pharmacies. The

 7  provisions of this subsection shall not be construed to

 8  prevent a clinical laboratory professional from receiving a

 9  fee for professional consultation services.

10         (18)  Exercising influence on a patient or client in

11  such a manner as to exploit the patient or client for the

12  financial gain of the licensee or other third party, which

13  shall include, but not be limited to, the promoting, selling,

14  or withholding of services, goods, appliances, referrals, or

15  drugs.

16         (19)  Practicing or offering to practice beyond the

17  scope permitted by law or rule, or accepting or performing

18  professional services or responsibilities which the licensee

19  knows or has reason to know that he or she is not competent to

20  perform.

21         (20)  Misrepresenting or concealing a material fact at

22  any time during any phase of the licensing, investigative, or

23  disciplinary process, procedure, or proceeding.

24         (21)  Improperly interfering with an investigation or

25  any disciplinary proceeding.

26         (22)  Engaging in or attempting to engage in sexual

27  misconduct, causing undue embarrassment or using disparaging

28  language or language of a sexual nature towards a patient,

29  exploiting superior/subordinate, professional/patient,

30  instructor/student relationships for personal gain, sexual

31  gratification, or advantage.

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 1         Section 154.  Paragraph (g) of subsection (4) and

 2  subsections (6) and (8) of section 483.901, Florida Statutes,

 3  1998 Supplement, are amended to read:

 4         483.901  Medical physicists; definitions; licensure.--

 5         (4)  COUNCIL.--The Advisory Council of Medical

 6  Physicists is created in the Department of Health to advise

 7  the department in regulating the practice of medical physics

 8  in this state.

 9         (g)  If a vacancy on the council occurs, the secretary

10  director shall appoint a member to serve for a 4-year term.

11         (6)  LICENSE REQUIRED.--An individual may not engage in

12  the practice of medical physics, including the specialties of

13  diagnostic radiological physics, therapeutic radiological

14  physics, medical nuclear radiological physics, or medical

15  health physics, without a license issued by the department for

16  the appropriate specialty.

17         (a)  The department shall adopt rules to administer

18  this section which specify license application and renewal

19  fees, continuing education requirements, and standards for

20  practicing medical physics.  The council shall recommend to

21  the department continuing education requirements that shall be

22  a condition of license renewal.  The department shall require

23  a minimum of 24 hours per biennium of continuing education

24  offered by an organization recommended by the council and

25  approved by the department.  The department, upon

26  recommendation of the council, may adopt rules to specify

27  continuing education requirements for persons who hold a

28  license in more than one specialty.

29         (b)  In order to apply for a medical physicist license

30  in one or more specialties, a person must file an individual

31  application for each specialty with the department.  The

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 1  application must be on a form prescribed by the department and

 2  must be accompanied by a nonrefundable application fee for

 3  each specialty.

 4         (c)  The department may issue a license to an eligible

 5  applicant if the applicant meets all license requirements.  At

 6  any time before the department issues a license, the applicant

 7  may request in writing that the application be withdrawn.  To

 8  reapply, the applicant must submit a new application and an

 9  additional nonrefundable application fee and must meet all

10  current licensure requirements.

11         (d)  The department shall review each completed

12  application for a license which the department receives.

13         (e)  On receipt of an application and fee as specified

14  in this section, the department may issue a license to

15  practice medical physics in this state:

16         1.  Until October 1, 1998, to a person who meets any of

17  the following requirements:

18         a.  Earned from an accredited college or university a

19  doctoral degree in physics, medical physics, biophysics,

20  radiological physics, medical health physics, or nuclear

21  engineering and has at least 2 years' experience in the

22  practice of the medical physics specialty for which

23  application is made.

24         b.  Earned from an accredited college or university a

25  master's degree in physics, medical physics, biophysics,

26  radiological physics, medical health physics, or nuclear

27  engineering and has at least 3 years' experience in the

28  practice of the medical physics specialty for which

29  application is made.

30         c.  Earned from an accredited college or university a

31  bachelor's degree in physics and has at least 5 years'

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 1  experience in the practice of the medical physics specialty

 2  for which application is made.

 3         d.  Has at least 8 years' experience in the practice of

 4  the medical physics specialty for which application is made, 2

 5  years of which must have been earned within the 4 years

 6  immediately preceding application for licensure.

 7         e.  Is board certified in the medical physics specialty

 8  in which the applicant applies to practice by the American

 9  Board of Radiology for diagnostic radiological physics,

10  therapeutic radiological physics, or medical nuclear

11  radiological physics; by the American Board of Medical Physics

12  or the Canadian Board of Medical Physics for diagnostic

13  radiological physics, therapeutic radiological physics, or

14  medical nuclear radiological physics; or by the American Board

15  of Health Physics or an equivalent certifying body approved by

16  the agency.

17         2.  On or after October 1, 1997, to a person who is

18  board certified in the medical physics specialty in which the

19  applicant applies to practice by the American Board of

20  Radiology for diagnostic radiological physics, therapeutic

21  radiological physics, or medical nuclear radiological physics;

22  by the American Board of Medical Physics for diagnostic

23  radiological physics, therapeutic radiological physics, or

24  medical nuclear radiological physics; or by the American Board

25  of Health Physics or an equivalent certifying body approved by

26  the department.

27         (f)  A licensee shall:

28         1.  Display the license in a place accessible to the

29  public; and

30         2.  Report immediately any change in the licensee's

31  address or name to the department.

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 1         (g)  The following acts are grounds for which the

 2  disciplinary actions in paragraph (h) may be taken:

 3         1.  Obtaining or attempting to obtain a license by

 4  bribery, fraud, knowing misrepresentation, or concealment of

 5  material fact or through an error of the department.

 6         2.  Having a license denied, revoked, suspended, or

 7  otherwise acted against in another jurisdiction.

 8         3.  Being convicted or found guilty of, or entering a

 9  plea of nolo contendere to, regardless of adjudication, a

10  crime in any jurisdiction which relates to the practice of, or

11  the ability to practice, the profession of medical physics.

12         4.  Willfully failing to file a report or record

13  required for medical physics or willfully impeding or

14  obstructing the filing of a report or record required by this

15  section or inducing another person to do so.

16         5.  Making misleading, deceptive, or fraudulent

17  representations in or related to the practice of medical

18  physics.

19         6.  Willfully failing to report any known violation of

20  this section or any rule adopted thereunder.

21         7.  Willfully or repeatedly violating a rule adopted

22  under this section or an order of the department.

23         8.  Failing to perform any statutory or legal

24  obligation placed upon a licensee.

25         9.  Aiding, assisting, procuring, employing, or

26  advising any unlicensed person to practice medical physics

27  contrary to this section or any rule adopted thereunder.

28         10.  Delegating or contracting for the performance of

29  professional responsibilities by a person when the licensee

30  delegating or contracting such responsibilities knows, or has

31  reason to know, such person is not qualified by training,

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 1  experience, and authorization to perform them.

 2         11.  Practicing or offering to practice beyond the

 3  scope permitted by law or accepting and performing

 4  professional responsibilities the licensee knows, or has

 5  reason to know, the licensee is not competent to perform.

 6         12.  Gross or repeated malpractice or the inability to

 7  practice medical physics with reasonable skill and safety.

 8         13.  Judicially determined mental incompetency.

 9         14.  Being unable to practice medical physics with

10  reasonable skill and safety because of a mental or physical

11  condition or illness or the use of alcohol, controlled

12  substances, or any other substance which impairs one's ability

13  to practice.

14         a.  The department may, upon probable cause, compel a

15  licensee to submit to a mental or physical examination by

16  physicians designated by the department.  The cost of an

17  examination shall be borne by the licensee, and the licensee's

18  failure to submit to such an examination constitutes an

19  admission of the allegations against the licensee, consequent

20  upon which a default and a final order may be entered without

21  the taking of testimony or presentation of evidence, unless

22  the failure was due to circumstances beyond the licensee's

23  control.

24         b.  A licensee who is disciplined under this

25  subparagraph shall, at reasonable intervals, be afforded an

26  opportunity to demonstrate that the licensee can resume the

27  practice of medical physics with reasonable skill and safety.

28         c.  With respect to any proceeding under this

29  subparagraph, the record of proceedings or the orders entered

30  by the department may not be used against a licensee in any

31  other proceeding.

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 1         (h)  When the department finds any person guilty of any

 2  of the grounds set forth in paragraph (g), including conduct

 3  that would constitute a substantial violation of paragraph (g)

 4  which occurred prior to licensure, it may enter an order

 5  imposing one or more of the following penalties:

 6         1.  Deny the application for licensure.

 7         2.  Revoke or suspend the license.

 8         3.  Impose an administrative fine for each count or

 9  separate offense.

10         4.  Place the licensee on probation for a specified

11  time and subject the licensee to such conditions as the

12  department determines necessary, including requiring

13  treatment, continuing education courses, or working under the

14  monitoring or supervision of another licensee.

15         5.  Restrict a licensee's practice.

16         6.  Issue a reprimand to the licensee.

17         (i)  The department may not issue or reinstate a

18  license to a person it has deemed unqualified until it is

19  satisfied that such person has complied with the terms and

20  conditions of the final order and that the licensee can safely

21  practice medical physics.

22         (j)  The department may issue a temporary license to an

23  applicant pending completion of the application process for

24  board certification.

25         (j)(k)  Upon receipt of a complete application and the

26  fee set forth by rule, the department may issue a

27  physicist-in-training certificate to a person qualified to

28  practice medical physics under direct supervision. The

29  department may establish by rule requirements for initial

30  certification and renewal of a physicist-in-training

31  certificate.

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 1         (8)  DISPOSITION OF FEES.--The department shall deposit

 2  all funds received into the Medical Quality Assurance Health

 3  Care Trust Fund.

 4         Section 155.  Paragraph (d) of subsection (1) of

 5  section 484.007, Florida Statutes, is amended to read:

 6         484.007  Licensure of opticians; permitting of optical

 7  establishments.--

 8         (1)  Any person desiring to practice opticianry shall

 9  apply to the department, upon forms prescribed by it, to take

10  a licensure examination. The department shall examine each

11  applicant who the board certifies:

12         (d)1.  Has received an associate degree, or its

13  equivalent, in opticianry from an educational institution the

14  curriculum of which is accredited by an accrediting agency

15  recognized and approved by the United States Department of

16  Education or the Council on Postsecondary Education or

17  approved by the board;

18         2.  Is an individual licensed to practice the

19  profession of opticianry pursuant to a regulatory licensing

20  law of another state, territory, or jurisdiction of the United

21  States, who has actively practiced in such other state,

22  territory, or jurisdiction for more than 3 years immediately

23  preceding application, and who meets the examination

24  qualifications as provided in this subsection;

25         3.  Is an individual who has actively practiced in

26  another state, territory, or jurisdiction of the United States

27  for more than 5 years immediately preceding application and

28  who provides tax or business records, affidavits, or other

29  satisfactory documentation of such practice and who meets the

30  examination qualifications as provided in this subsection; or

31         4.  Has registered as an apprentice with the department

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 1  and paid a registration fee not to exceed $60, as set by rule

 2  of the board. The apprentice shall complete 6,240 hours of

 3  training under the supervision of an optician licensed in this

 4  state for at least 1 year or of, a physician, or an

 5  optometrist licensed under the laws of this state. These

 6  requirements must be met within 5 years after the date of

 7  registration. However, any time spent in a recognized school

 8  may be considered as part of the apprenticeship program

 9  provided herein. The board may establish administrative

10  processing fees sufficient to cover the cost of administering

11  apprentice rules as promulgated by the board.

12         Section 156.  Subsection (3) is added to section

13  484.0512, Florida Statutes, to read:

14         484.0512  Thirty-day trial period; purchaser's right to

15  cancel; notice; refund; cancellation fee.--

16         (3)  Within 30 days after the return or attempted

17  return of the hearing aid, the seller shall refund all moneys

18  that must be refunded to a purchaser pursuant to this section.

19         Section 157.  Section 484.053, Florida Statutes, is

20  amended to read:

21         484.053  Prohibitions; penalties.--

22         (1)  A person may not:

23         (a)  Practice dispensing hearing aids unless the person

24  is a licensed hearing aid specialist;

25         (b)  Use the name or title "hearing aid specialist"

26  when the person has not been licensed under this part;

27         (c)  Present as her or his own the license of another;

28         (d)  Give false, incomplete, or forged evidence to the

29  board or a member thereof for the purposes of obtaining a

30  license;

31         (e)  Use or attempt to use a hearing aid specialist

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 1  license that is delinquent or has been suspended, revoked, or

 2  placed on inactive or delinquent status;

 3         (f)  Knowingly employ unlicensed persons in the

 4  practice of dispensing hearing aids; or

 5         (g)  Knowingly conceal information relative to

 6  violations of this part.

 7         (2)  Any person who violates any of the provisions of

 8  this section is guilty of a felony misdemeanor of the third

 9  second degree, punishable as provided in s. 775.082 or s.

10  775.083.

11         (3)  If a person licensed under this part allows the

12  sale of a hearing aid by an unlicensed person not registered

13  as a trainee or fails to comply with the requirements of s.

14  484.0445(2) relating to supervision of trainees, the board

15  shall, upon determination of that violation, order the full

16  refund of moneys paid by the purchaser upon return of the

17  hearing aid to the seller's place of business.

18         Section 158.  Paragraph (a) of subsection (1) of

19  section 484.056, Florida Statutes, 1998 Supplement, is amended

20  to read:

21         484.056  Disciplinary proceedings.--

22         (1)  The following acts relating to the practice of

23  dispensing hearing aids shall be grounds for both disciplinary

24  action against a hearing aid specialist as set forth in this

25  section and cease and desist or other related action by the

26  department as set forth in s. 455.637 against any person

27  owning or operating a hearing aid establishment who engages

28  in, aids, or abets any such violation:

29         (a)  Violation of any provision of s. 455.624(1), s.

30  484.0512, or s. 484.053.

31         Section 159.  Section 486.041, Florida Statutes, is

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  amended to read:

 2         486.041  Physical therapist; application for license;

 3  fee; temporary permit.--

 4         (1)  A person who desires to be licensed as a physical

 5  therapist shall apply to the department in writing on a form

 6  furnished by the department.  She or he shall embody in that

 7  application evidence under oath, satisfactory to the board, of

 8  possession of the qualifications preliminary to examination

 9  required by s. 486.031. The applicant shall pay to the

10  department at the time of filing the application a fee not to

11  exceed $100, as fixed by the board.

12         (2)  If a person desires to practice physical therapy

13  before becoming licensed through examination, she or he shall

14  apply for a temporary permit in accordance with rules adopted

15  pursuant to this chapter.

16         (a)  A temporary permit shall only be issued for a

17  limited period of time, not to exceed 1 year, and shall not be

18  renewable. A temporary permit shall automatically expire if an

19  applicant fails the examination.

20         (b)  An applicant for licensure by examination and

21  practicing under a temporary permit shall do so only under the

22  direct supervision of a licensed physical therapist.

23         Section 160.  Section 486.081, Florida Statutes, is

24  amended to read:

25         486.081  Physical therapist; issuance of license

26  without examination to person passing examination of another

27  authorized examining board; temporary permit; fee.--

28         (1)  The board may cause a license to be issued through

29  the department without examination to any applicant who

30  presents evidence satisfactory to the board of having passed

31  the American Registry Examination prior to 1971 or an

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 1  examination in physical therapy before a similar lawfully

 2  authorized examining board of another state, the District of

 3  Columbia, a territory, or a foreign country, if the standards

 4  for licensure in physical therapy in such other state,

 5  district, territory, or foreign country are determined by the

 6  board to be as high as those of this state, as established by

 7  rules adopted pursuant to this chapter. Any person who holds a

 8  license pursuant to this section may use the words "physical

 9  therapist" or "physiotherapist," or the letters "P.T.," in

10  connection with her or his name or place of business to denote

11  her or his licensure hereunder.

12         (2)  At the time of making application for licensure

13  without examination pursuant to the terms of this section, the

14  applicant shall pay to the department a fee not to exceed $175

15  as fixed by the board, no part of which will be returned.

16         (3)  If a person desires to practice physical therapy

17  before becoming licensed through endorsement, she or he shall

18  apply to the board for a temporary permit in accordance with

19  rules adopted pursuant to this chapter. A temporary permit

20  shall only be issued for a limited period of time, not to

21  exceed 1 year, and shall not be renewable.

22         Section 161.  Section 486.103, Florida Statutes, is

23  amended to read:

24         486.103  Physical therapist assistant; application for

25  license; fee; temporary permit.--

26         (1)  A person who desires to be licensed as a physical

27  therapist assistant shall apply to the department in writing

28  on a form furnished by the department.  She or he shall embody

29  in that application evidence under oath, satisfactory to the

30  board, of possession of the qualifications preliminary to

31  examination required by s. 486.104. The applicant shall pay to

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    Bill No. CS for SB 2220

    Amendment No.    





 1  the department at the time of filing the application a fee not

 2  to exceed $100, as fixed by the board.

 3         (2)  If a person desires to work as a physical

 4  therapist assistant before being licensed through examination,

 5  she or he shall apply for a temporary permit in accordance

 6  with rules adopted pursuant to this chapter.

 7         (a)  A temporary permit shall only be issued for a

 8  limited period of time, not to exceed 1 year, and shall not be

 9  renewable. A temporary permit shall automatically expire if an

10  applicant fails the examination.

11         (b)  An applicant for licensure by examination who is

12  practicing under a temporary permit shall do so only under the

13  direct supervision of a licensed physical therapist.

14         Section 162.  Section 486.107, Florida Statutes, is

15  amended to read:

16         486.107  Physical therapist assistant; issuance of

17  license without examination to person licensed in another

18  jurisdiction; temporary permit; fee.--

19         (1)  The board may cause a license to be issued through

20  the department without examination to any applicant who

21  presents evidence to the board, under oath, of licensure in

22  another state, the District of Columbia, or a territory, if

23  the standards for registering as a physical therapist

24  assistant or licensing of a physical therapist assistant, as

25  the case may be, in such other state are determined by the

26  board to be as high as those of this state, as established by

27  rules adopted pursuant to this chapter. Any person who holds a

28  license pursuant to this section may use the words "physical

29  therapist assistant," or the letters "P.T.A.," in connection

30  with her or his name to denote licensure hereunder.

31         (2)  At the time of making application for licensing

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    Amendment No.    





 1  without examination pursuant to the terms of this section, the

 2  applicant shall pay to the department a fee not to exceed $175

 3  as fixed by the board, no part of which will be returned.

 4         (3)  If a person desires to work as a physical

 5  therapist assistant before being licensed through endorsement,

 6  she or he shall apply for a temporary permit in accordance

 7  with rules adopted pursuant to this chapter.  A temporary

 8  permit shall only be issued for a limited period of time, not

 9  to exceed 1 year, and shall not be renewable.

10         Section 163.  Paragraph (b) of subsection (1) of

11  section 490.005, Florida Statutes, 1998 Supplement, is amended

12  to read:

13         490.005  Licensure by examination.--

14         (1)  Any person desiring to be licensed as a

15  psychologist shall apply to the department to take the

16  licensure examination. The department shall license each

17  applicant who the board certifies has:

18         (b)  Submitted proof satisfactory to the board that the

19  applicant has:

20         1.  Received doctoral-level psychological education, as

21  defined in s. 490.003(3);

22         2.  Received the equivalent of a doctoral-level

23  psychological education, as defined in s. 490.003(3), from a

24  program at a school or university located outside the United

25  States of America and Canada, which was officially recognized

26  by the government of the country in which it is located as an

27  institution or program to train students to practice

28  professional psychology.  The burden of establishing that the

29  requirements of this provision have been met shall be upon the

30  applicant;

31         3.  Received and submitted to the board, prior to July

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  1, 1999, certification of an augmented doctoral-level

 2  psychological education from the program director of a

 3  doctoral-level psychology program accredited by a programmatic

 4  agency recognized and approved by the United States Department

 5  of Education; or

 6         4.  Received and submitted to the board, prior to

 7  August 31, 2001 July 1, 2001, certification of a

 8  doctoral-level program that at the time the applicant was

 9  enrolled and graduated maintained a standard of education and

10  training comparable to the standard of training of programs

11  accredited by a programmatic agency recognized and approved by

12  the United States Department of Education, as such

13  comparability was determined by the Board of Psychological

14  Examiners immediately prior to the amendment of s. 490.005,

15  Florida Statutes, 1994 Supplement, by s. 5, chapter 95-279,

16  Laws of Florida. Such certification of comparability shall be

17  provided by the program director of a doctoral-level

18  psychology program accredited by a programmatic agency

19  recognized and approved by the United States Department of

20  Education.

21         Section 164.  Subsection (1) of section 490.006,

22  Florida Statutes, is amended to read:

23         490.006  Licensure by endorsement.--

24         (1)  The department shall license a person as a

25  psychologist or school psychologist who, upon applying to the

26  department and remitting the appropriate fee, demonstrates to

27  the department or, in the case of psychologists, to the board

28  that the applicant:

29         (a)  Holds a valid license or certificate in another

30  state to practice psychology or school psychology, as

31  applicable, provided that, when the applicant secured such

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    Amendment No.    





 1  license or certificate, the requirements were substantially

 2  equivalent to or more stringent than those set forth in this

 3  chapter at that time; and, if no Florida law existed at that

 4  time, then the requirements in the other state must have been

 5  substantially equivalent to or more stringent than those set

 6  forth in this chapter at the present time; or

 7         (b)  Is a diplomate in good standing with the American

 8  Board of Professional Psychology, Inc.; or

 9         (c)  Possesses a doctoral degree in psychology as

10  described in s. 490.003 and has at least 20 years of

11  experience as a licensed psychologist in any jurisdiction or

12  territory of the United States within 25 years preceding the

13  date of application.

14         Section 165.  Subsection (2) of section 490.0085,

15  Florida Statutes, is amended to read:

16         490.0085  Continuing education; approval of providers,

17  programs, and courses; proof of completion.--

18         (2)  The department or, in the case of psychologists,

19  the board has the authority to set a fee not to exceed $500

20  for each applicant who applies for or renews provider status.

21  Such fees shall be deposited into the Medical Quality

22  Assurance Health Care Trust Fund.

23         Section 166.  Section 491.0045, Florida Statutes, is

24  amended to read:

25         491.0045  Intern registration; requirements.--

26         (1)  Effective January 1, 1998, an individual who

27  intends to practice in Florida to satisfy the postgraduate or

28  post-master's level experience requirements, as specified in

29  s. 491.005(1)(c), (3)(c), or (4)(c), must register as an

30  intern in the profession for which he or she is seeking

31  licensure prior to commencing the post-master's experience

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    Bill No. CS for SB 2220

    Amendment No.    





 1  requirement or an individual who intends to satisfy part of

 2  the required graduate-level practicum, internship, or field

 3  experience, outside the academic arena for any profession,

 4  must register as an intern in the profession for which he or

 5  she is seeking licensure prior to commencing the practicum,

 6  internship, or field experience.

 7         (2)  The department shall register as a clinical social

 8  worker intern, marriage and family therapist intern, or mental

 9  health counselor intern each applicant who the board certifies

10  has:

11         (a)  Completed the application form and remitted a

12  nonrefundable application fee not to exceed $200, as set by

13  board rule;

14         (b)1.  Completed the education requirements as

15  specified in s. 491.005(1)(c), (3)(c), or (4)(c) for the

16  profession for which he or she is applying for licensure, if

17  needed; and

18         2.  Submitted an acceptable supervision plan, as

19  determined by the board, for meeting the practicum,

20  internship, or field work required for licensure that was not

21  satisfied in his or her graduate program.

22         (c)  Identified a qualified supervisor.

23         (3)  An individual registered under this section must

24  remain under supervision until he or she is in receipt of a

25  license or a letter from the department stating that he or she

26  is licensed to practice the profession for which he or she

27  applied.

28         (4)  An individual who has applied for intern

29  registration on or before December 31, 2001, and has satisfied

30  the education requirements of s. 491.005 that are in effect

31  through December 31, 2000, will have met the educational

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  requirements for licensure for the profession for which he or

 2  she has applied.

 3         (5)  Individuals who have commenced the experience

 4  requirement as specified in s. 491.005(1)(c), (3)(c), or

 5  (4)(c) but failed to register as required by subsection (1)

 6  shall register with the department before January 1, 2000.

 7  Individuals who fail to comply with this subsection shall not

 8  be granted a license, and any time spent by the individual

 9  completing the experience requirement prior to registering as

10  an intern shall not count toward completion of such

11  requirement.

12         Section 167.  Subsections (1) and (2) of section

13  491.0046, Florida Statutes, are amended to read:

14         491.0046  Provisional license; requirements.--

15         (1)  An individual applying for licensure by

16  examination who has satisfied the clinical experience

17  requirements of s. 491.005 or an individual applying for

18  licensure by endorsement pursuant to s. 491.006 intending to

19  provide clinical social work, marriage and family therapy, or

20  mental health counseling services in Florida while satisfying

21  coursework or examination requirements for licensure must be

22  provisionally licensed in the profession for which he or she

23  is seeking licensure prior to beginning practice.

24         (2)  The department shall issue a provisional clinical

25  social worker license, provisional marriage and family

26  therapist license, or provisional mental health counselor

27  license to each applicant who the board certifies has:

28         (a)  Completed the application form and remitted a

29  nonrefundable application fee not to exceed $100, as set by

30  board rule; and

31         (b)1.  Earned a graduate degree in social work, a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  graduate degree with a major emphasis in marriage and family

 2  therapy or a closely related field, or a graduate degree in a

 3  major related to the practice of mental health counseling;

 4  and, and satisfied the clinical experience requirements for

 5  licensure pursuant to s. 491.005; or

 6         2.  Been approved for examination under the provisions

 7  for licensure by endorsement pursuant to s. 491.006.

 8         (c)  Has met the following minimum coursework

 9  requirements:

10         1.  For clinical social work, a minimum of 15 semester

11  hours or 22 quarter hours of the coursework required by s.

12  491.005(1)(b)2.b.

13         2.  For marriage and family therapy, ten of the courses

14  required by s. 491.005(3)(b)1.a.-c., as determined by the

15  board, and at least 6 semester hours or 9 quarter hours of the

16  course credits must have been completed in the area of

17  marriage and family systems, theories, or techniques.

18         3.  For mental health counseling, a minimum of seven of

19  the courses required under s. 491.005(b)1.a.-c.

20         Section 168.  Section 491.005, Florida Statutes, is

21  amended to read:

22         491.005  Licensure by examination.--

23         (1)  CLINICAL SOCIAL WORK.--Upon verification of

24  documentation and payment of a fee not to exceed $200, as set

25  by board rule, plus the actual per applicant cost to the

26  department for purchase of the examination from the American

27  Association of State Social Worker's Boards or a similar

28  national organization, the department shall issue a license as

29  a clinical social worker to an applicant who the board

30  certifies:

31         (a)  Has made application therefor and paid the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  appropriate fee.

 2         (b)1.  Has received a doctoral degree in social work

 3  from a graduate school of social work which at the time the

 4  applicant graduated was accredited by an accrediting agency

 5  recognized by the United States Department of Education or has

 6  received a master's degree in social work from a graduate

 7  school of social work which at the time the applicant

 8  graduated:

 9         a.  Was accredited by the Council on Social Work

10  Education;

11         b.  Was accredited by the Canadian Association of

12  Schools of Social Work; or

13         c.  Has been determined to have been a program

14  equivalent to programs approved by the Council on Social Work

15  Education by the Foreign Equivalency Determination Service of

16  the Council on Social Work Education.  An applicant who

17  graduated from a program at a university or college outside of

18  the United States or Canada must present documentation of the

19  equivalency determination from the council in order to

20  qualify.

21         2.  The applicant's graduate program must have

22  emphasized direct clinical patient or client health care

23  services, including, but not limited to, coursework in

24  clinical social work, psychiatric social work, medical social

25  work, social casework, psychotherapy, or group therapy.  The

26  applicant's graduate program must have included all of the

27  following coursework:

28         a.  A supervised field placement which was part of the

29  applicant's advanced concentration in direct practice, during

30  which the applicant provided clinical services directly to

31  clients.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         b.  Completion of 24 semester hours or 32 37 quarter

 2  hours in theory of human behavior and practice methods as

 3  courses in clinically oriented services, including a minimum

 4  of one course in psychopathology, and no more than one course

 5  in research, taken in a school of social work accredited or

 6  approved pursuant to subparagraph 1.

 7         3.  If the course title which appears on the

 8  applicant's transcript does not clearly identify the content

 9  of the coursework, the applicant shall be required to provide

10  additional documentation, including, but not limited to, a

11  syllabus or catalog description published for the course.

12         (c)  Has had not less than 2 years of clinical social

13  work experience, which took place subsequent to completion of

14  a graduate degree in social work at an institution meeting the

15  accreditation requirements of this section, under the

16  supervision of a licensed clinical social worker or the

17  equivalent who is a qualified supervisor as determined by the

18  board. An individual who intends to practice in Florida to

19  satisfy clinical experience requirements must register

20  pursuant to s. 491.0045 prior to commencing practice.  If the

21  applicant's graduate program was not a program which

22  emphasized direct clinical patient or client health care

23  services as described in subparagraph (b)2. s. 491.003, the

24  supervised experience requirement must take place after the

25  applicant has completed a minimum of 15 semester hours or 22

26  quarter hours of the coursework required.  A doctoral

27  internship may be applied toward the clinical social work

28  experience requirement. The experience requirement may be met

29  by work performed on or off the premises of the supervising

30  clinical social worker or the equivalent, provided the

31  off-premises work is not the independent private practice

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  rendering of clinical social work that does not have a

 2  licensed mental health professional, as determined by the

 3  board, on the premises at the same time the intern is

 4  providing services.

 5         (d)  Has passed a theory and practice examination

 6  provided by the department for this purpose.

 7         (e)  Has demonstrated, in a manner designated by rule

 8  of the board, knowledge of the laws and rules governing the

 9  practice of clinical social work, marriage and family therapy,

10  and mental health counseling.

11         (2)  CLINICAL SOCIAL WORK.--

12         (a)  Notwithstanding the provisions of paragraph

13  (1)(b), coursework which was taken at a baccalaureate level

14  shall not be considered toward completion of education

15  requirements for licensure unless an official of the graduate

16  program certifies in writing on the graduate school's

17  stationery that a specific course, which students enrolled in

18  the same graduate program were ordinarily required to complete

19  at the graduate level, was waived or exempted based on

20  completion of a similar course at the baccalaureate level.  If

21  this condition is met, the board shall apply the baccalaureate

22  course named toward the education requirements.

23         (b)  An applicant from a master's or doctoral program

24  in social work which did not emphasize direct patient or

25  client services may complete the clinical curriculum content

26  requirement by returning to a graduate program accredited by

27  the Council on Social Work Education or the Canadian

28  Association of Schools of Social Work, or to a clinical social

29  work graduate program with comparable standards, in order to

30  complete the education requirements for examination.  However,

31  a maximum of 6 semester or 9 quarter hours of the clinical

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  curriculum content requirement may be completed by credit

 2  awarded for independent study coursework as defined by board

 3  rule.

 4         (3)  MARRIAGE AND FAMILY THERAPY.-- Upon verification

 5  of documentation and payment of a fee not to exceed $200, as

 6  set by board rule, plus the actual cost to the department for

 7  the purchase of the examination from the Association of

 8  Marital and Family Therapy Regulatory Board, or similar

 9  national organization, the department shall issue a license as

10  a marriage and family therapist to an applicant who the board

11  certifies:

12         (a)  Has made application therefor and paid the

13  appropriate fee.

14         (b)1.  Has a minimum of a master's degree with major

15  emphasis in marriage and family therapy, or a closely related

16  field, and has completed all of the following requirements:

17         a.  Twenty-seven semester hours or 41 quarter hours of

18  graduate coursework, which must include a minimum of 2

19  semester hours or 3 quarter hours of graduate-level course

20  credits in each of the following nine areas: dynamics of

21  marriage and family systems; marriage therapy and counseling

22  theory and techniques; family therapy and counseling theory

23  and techniques; individual human development theories

24  throughout the life cycle; personality theory;

25  psychopathology; human sexuality theory and counseling

26  techniques; general counseling theory and techniques; and

27  psychosocial theory. Content may be combined, provided no more

28  than two of the nine content areas are included in any one

29  graduate-level course and the applicant can document that the

30  equivalent of 2 semester hours of coursework was devoted to

31  each content area. Courses in research, evaluation, appraisal,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  assessment, or testing theories and procedures; thesis or

 2  dissertation work; or practicums, internships, or fieldwork

 3  may not be applied toward this requirement.

 4         b.  A minimum of one graduate-level course of 2

 5  semester hours or 3 quarter hours in legal, ethical, and

 6  professional standards issues in the practice of marriage and

 7  family therapy or a course determined by the board to be

 8  equivalent.

 9         c.  A minimum of one graduate-level course of 2

10  semester hours or 3 quarter hours in diagnosis, appraisal,

11  assessment, and testing for individual or interpersonal

12  disorder or dysfunction; and a minimum of one 2-semester-hour

13  or 3-quarter-hour graduate-level course in behavioral research

14  which focuses on the interpretation and application of

15  research data as it applies to clinical practice.  Credit for

16  thesis or dissertation work, practicums, internships, or

17  fieldwork may not be applied toward this requirement.

18         d.  A minimum of one supervised clinical practicum,

19  internship, or field experience in a marriage and family

20  counseling setting, during which the student provided 180

21  direct client contact hours of marriage and family therapy

22  services under the supervision of an individual who met the

23  requirements for supervision under paragraph (c).  This

24  requirement may be met by a supervised practice experience

25  which took place outside the academic arena, but which is

26  certified as equivalent to a graduate-level practicum or

27  internship program which required a minimum of 180 direct

28  client contact hours of marriage and family therapy services

29  currently offered within an academic program of a college or

30  university accredited by an accrediting agency approved by the

31  United States Department of Education, or an institution which

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  is publicly recognized as a member in good standing with the

 2  Association of Universities and Colleges of Canada or a

 3  training institution accredited by the Commission on

 4  Accreditation for Marriage and Family Therapy Education

 5  recognized by the United States Department of Education.

 6  Certification shall be required from an official of such

 7  college, university, or training institution.

 8         2.  If the course title which appears on the

 9  applicant's transcript does not clearly identify the content

10  of the coursework, the applicant shall be required to provide

11  additional documentation, including, but not limited to, a

12  syllabus or catalog description published for the course.

13

14  The required master's degree must have been received in an

15  institution of higher education which at the time the

16  applicant graduated was:  fully accredited by a regional

17  accrediting body recognized by the Commission on Recognition

18  of Postsecondary Accreditation; publicly recognized as a

19  member in good standing with the Association of Universities

20  and Colleges of Canada; or an institution of higher education

21  located outside the United States and Canada, which at the

22  time the applicant was enrolled and at the time the applicant

23  graduated maintained a standard of training substantially

24  equivalent to the standards of training of those institutions

25  in the United States which are accredited by a regional

26  accrediting body recognized by the Commission on Recognition

27  of Postsecondary Accreditation.  Such foreign education and

28  training must have been received in an institution or program

29  of higher education officially recognized by the government of

30  the country in which it is located as an institution or

31  program to train students to practice as professional marriage

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  and family therapists or psychotherapists.  The burden of

 2  establishing that the requirements of this provision have been

 3  met shall be upon the applicant, and the board shall require

 4  documentation, such as, but not limited to, an evaluation by a

 5  foreign equivalency determination service, as evidence that

 6  the applicant's graduate degree program and education were

 7  equivalent to an accredited program in this country.  An

 8  applicant with a master's degree from a program which did not

 9  emphasize marriage and family therapy may complete the

10  coursework requirement in a training institution fully

11  accredited by the Commission on Accreditation for Marriage and

12  Family Therapy Education recognized by the United States

13  Department of Education.

14         (c)  Has had not less than 2 years of clinical

15  experience during which 50 percent of the applicant's clients

16  were receiving marriage and family therapy services, which

17  must be at the post-master's level under the supervision of a

18  licensed marriage and family therapist with at least 5 years

19  of experience, or the equivalent, who is a qualified

20  supervisor as determined by the board.  An individual who

21  intends to practice in Florida to satisfy the clinical

22  experience requirements must register pursuant to s. 491.0045

23  prior to commencing practice.  If a graduate has a master's

24  degree with a major emphasis in marriage and family therapy or

25  a closely related field that did not include all the

26  coursework required under sub-subparagraphs (b)1.a.-c., credit

27  for the post-master's level clinical experience shall not

28  commence until the applicant has completed a minimum of 10 of

29  the courses required under sub-subparagraphs (b)1.a.-c., as

30  determined by the board, and at least 6 semester hours or 9

31  quarter hours of the course credits must have been completed

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  in the area of marriage and family systems, theories, or

 2  techniques. Within the 3 years of required experience, the

 3  applicant shall provide direct individual, group, or family

 4  therapy and counseling, to include the following categories of

 5  cases:  unmarried dyads, married couples, separating and

 6  divorcing couples, and family groups including children.  A

 7  doctoral internship may be applied toward the clinical

 8  experience requirement.  The clinical experience requirement

 9  may be met by work performed on or off the premises of the

10  supervising marriage and family therapist or the equivalent,

11  provided the off-premises work is not the independent private

12  practice rendering of marriage and family therapy services

13  that does not have a licensed mental health professional, as

14  determined by the board, on the premises at the same time the

15  intern is providing services.

16         (d)  Has passed a theory and practice examination

17  provided by the department for this purpose.

18         (e)  Has demonstrated, in a manner designated by rule

19  of the board, knowledge of the laws and rules governing the

20  practice of clinical social work, marriage and family therapy,

21  and mental health counseling.

22         (f)  For the purposes of dual licensure, the department

23  shall license as a marriage and family therapist any person

24  who meets the requirements of s. 491.0057. Fees for dual

25  licensure shall not exceed those stated in this subsection.

26         (4)  MENTAL HEALTH COUNSELING.--Upon verification of

27  documentation and payment of a fee not to exceed $200, as set

28  by board rule, plus the actual per applicant cost to the

29  department for purchase of the examination from the

30  Professional Examination Service for the National Academy of

31  Certified Clinical Mental Health Counselors or a similar

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  national organization, the department shall issue a license as

 2  a mental health counselor to an applicant who the board

 3  certifies:

 4         (a)  Has made application therefor and paid the

 5  appropriate fee.

 6         (b)1.  Has received a minimum of an earned master's

 7  degree with a major related to the practice of mental health

 8  counseling, and has completed all of the following

 9  requirements:

10         a.  Twenty-one semester hours or 32 quarter hours of

11  graduate coursework, which must include a minimum of 2

12  semester hours or 3 quarter hours of graduate-level coursework

13  in each of the following seven content areas:  counseling

14  theories and practice; human development theories; personality

15  theory; psychopathology or abnormal psychology; human

16  sexuality theories; group theories and practice; and

17  individual evaluation and assessment.  Content may be

18  combined, provided no more than two of the seven content areas

19  are included in any one graduate-level course and the

20  applicant can document that the equivalent of 2 semester hours

21  of content was devoted to each content area.  Courses in

22  research, thesis or dissertation work, practicums,

23  internships, or fieldwork may not be applied toward this

24  requirement.

25         b.  A minimum of one 2-semester-hour or 3-quarter-hour

26  graduate-level course in research or in career or vocational

27  counseling. Credit for thesis or dissertation work,

28  practicums, internships, or fieldwork may not be applied

29  toward this requirement.

30         c.  A minimum of 2 semester hours or 3 quarter hours of

31  graduate-level coursework in legal, ethical, and professional

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  standards issues in the practice of mental health counseling,

 2  which includes goals and objectives of professional counseling

 3  organizations, codes of ethics, legal considerations,

 4  standards of preparation, certifications and licensing, and

 5  the role identity of counselors.  Courses in research, thesis

 6  or dissertation work, practicums, internships, or fieldwork

 7  may not be applied toward this requirement.

 8         d.  A minimum of one supervised practicum, internship,

 9  or field experience in a counseling setting.  This requirement

10  may be met by a supervised practice experience which takes

11  place outside the academic arena, but which is certified as

12  equivalent to a graduate-level practicum in a clinical mental

13  health counseling setting currently offered within an academic

14  program of a college or university accredited by an

15  accrediting agency approved by the United States Department of

16  Education. Such certification shall be required from an

17  official of such college or university.

18         2.  If the course title which appears on the

19  applicant's transcript does not clearly identify the content

20  of the coursework, the applicant shall be required to provide

21  additional documentation, including, but not limited to, a

22  syllabus or catalog description published for the course.

23

24  Except as provided in sub-subparagraph 1.d., education and

25  training in mental health counseling must have been received

26  in an institution of higher education which at the time the

27  applicant graduated was:  fully accredited by a regional

28  accrediting body recognized by the Commission on Recognition

29  of Postsecondary Accreditation; publicly recognized as a

30  member in good standing with the Association of Universities

31  and Colleges of Canada; or an institution of higher education

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  located outside the United States and Canada, which at the

 2  time the applicant was enrolled and at the time the applicant

 3  graduated maintained a standard of training substantially

 4  equivalent to the standards of training of those institutions

 5  in the United States which are accredited by a regional

 6  accrediting body recognized by the Commission on Recognition

 7  of Postsecondary Accreditation. Such foreign education and

 8  training must have been received in an institution or program

 9  of higher education officially recognized by the government of

10  the country in which it is located as an institution or

11  program to train students to practice as mental health

12  counselors.  The burden of establishing that the requirements

13  of this provision have been met shall be upon the applicant,

14  and the board shall require documentation, such as, but not

15  limited to, an evaluation by a foreign equivalency

16  determination service, as evidence that the applicant's

17  graduate degree program and education were equivalent to an

18  accredited program in this country.

19         (c)  Has had not less than 2 years of clinical

20  experience in mental health counseling, which must be at the

21  post-master's level under the supervision of a licensed mental

22  health counselor or the equivalent who is a qualified

23  supervisor as determined by the board.  An individual who

24  intends to practice in Florida to satisfy the clinical

25  experience requirements must register pursuant to s. 491.0045

26  prior to commencing practice.  If a graduate has a master's

27  degree with a major related to the practice of mental health

28  counseling which did not include all the coursework required

29  under sub-subparagraphs (b)1.a.-c., credit for the

30  post-master's level clinical experience shall not commence

31  until the applicant has completed a minimum of seven of the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  courses required under sub-subparagraphs (b)1.a.-c., as

 2  determined by the board, one of which must be a course in

 3  psychopathology or abnormal psychology. A doctoral internship

 4  may be applied toward the clinical experience requirement. The

 5  clinical experience requirement may be met by work performed

 6  on or off the premises of the supervising mental health

 7  counselor or the equivalent, provided the off-premises work is

 8  not the independent private practice rendering of services

 9  that does not have a licensed mental health professional, as

10  determined by the board, on the premises at the same time the

11  intern is providing services.

12         (d)  Has passed a theory and practice examination

13  provided by the department for this purpose.

14         (e)  Has demonstrated, in a manner designated by rule

15  of the board, knowledge of the laws and rules governing the

16  practice of clinical social work, marriage and family therapy,

17  and mental health counseling.

18         (5)  INTERNSHIP.--An individual who is registered as an

19  intern and has satisfied all of the educational requirements

20  for the profession for which the applicant seeks licensure

21  shall be certified as having met the educational requirements

22  for licensure under this section.

23         (6)  RULES.--The board may adopt rules necessary to

24  implement any education or experience requirement of this

25  section for licensure as a clinical social worker, marriage

26  and family therapist, or mental health counselor.

27         Section 169.  Effective January 1, 2001, paragraph (b)

28  of subsection (4) of section 491.005, Florida Statutes, as

29  amended by section 13 of chapter 97-198 and section 205 of

30  chapter 97-264, Laws of Florida, and as amended by this act,

31  is amended, and subsection (6) of that section, as created by

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  this act, is reenacted, to read:

 2         491.005  Licensure by examination.--

 3         (4)  MENTAL HEALTH COUNSELING.--Upon verification of

 4  documentation and payment of a fee not to exceed $200, as set

 5  by board rule, plus the actual per applicant cost to the

 6  department for purchase of the examination from the

 7  Professional Examination Service for the National Academy of

 8  Certified Clinical Mental Health Counselors or a similar

 9  national organization, the department shall issue a license as

10  a mental health counselor to an applicant who the board

11  certifies:

12         (b)1.  Has a minimum of an earned master's degree from

13  a mental health counseling program accredited by the Council

14  for the Accreditation of Counseling and Related Educational

15  Programs that consists of at least 60 semester hours or 80

16  quarter hours of clinical and didactic instruction, including

17  a course in human sexuality and a course in substance abuse.

18  If the master's degree is earned from a program related to the

19  practice of mental health counseling that is not accredited by

20  the Council for the Accreditation of Counseling and Related

21  Educational Programs, then the coursework and practicum,

22  internship, or fieldwork must consist of at least 60 semester

23  hours or 80 quarter hours and meet the following requirements:

24         a.  Thirty-three Thirty-six semester hours or 44 48

25  quarter hours of graduate coursework, which must include a

26  minimum of 3 semester hours or 4 quarter hours of

27  graduate-level coursework in each of the following 11 12

28  content areas: counseling theories and practice; human growth

29  and development; diagnosis and treatment of psychopathology;

30  human sexuality; group theories and practice; individual

31  evaluation and assessment; career and lifestyle assessment;

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  research and program evaluation; social and cultural

 2  foundations; foundations of mental health counseling;

 3  counseling in community settings; and substance abuse. Courses

 4  in research, thesis or dissertation work, practicums,

 5  internships, or fieldwork may not be applied toward this

 6  requirement.

 7         b.  A minimum of 3 semester hours or 4 quarter hours of

 8  graduate-level coursework in legal, ethical, and professional

 9  standards issues in the practice of mental health counseling,

10  which includes goals, objectives, and practices of

11  professional counseling organizations, codes of ethics, legal

12  considerations, standards of preparation, certifications and

13  licensing, and the role identity and professional obligations

14  of mental health counselors. Courses in research, thesis or

15  dissertation work, practicums, internships, or fieldwork may

16  not be applied toward this requirement.

17         c.  The equivalent, as determined by the board, of at

18  least 1,000 hours of university-sponsored supervised clinical

19  practicum, internship, or field experience as required in the

20  accrediting standards of the Council for Accreditation of

21  Counseling and Related Educational Programs for mental health

22  counseling programs. If the academic practicum, internship, or

23  field experience was less than 1,000 hours, experience gained

24  outside the academic arena in clinical mental health settings

25  under the supervision of a qualified supervisor as determined

26  by the board may be applied. This experience may not be used

27  to satisfy the post-master's clinical experience requirement.

28         2.  If the course title which appears on the

29  applicant's transcript does not clearly identify the content

30  of the coursework, the applicant shall be required to provide

31  additional documentation, including, but not limited to, a

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 1  syllabus or catalog description published for the course.

 2

 3  Education and training in mental health counseling must have

 4  been received in an institution of higher education which at

 5  the time the applicant graduated was: fully accredited by a

 6  regional accrediting body recognized by the Commission on

 7  Recognition of Postsecondary Accreditation; publicly

 8  recognized as a member in good standing with the Association

 9  of Universities and Colleges of Canada; or an institution of

10  higher education located outside the United States and Canada,

11  which at the time the applicant was enrolled and at the time

12  the applicant graduated maintained a standard of training

13  substantially equivalent to the standards of training of those

14  institutions in the United States which are accredited by a

15  regional accrediting body recognized by the Commission on

16  Recognition of Postsecondary Accreditation. Such foreign

17  education and training must have been received in an

18  institution or program of higher education officially

19  recognized by the government of the country in which it is

20  located as an institution or program to train students to

21  practice as mental health counselors. The burden of

22  establishing that the requirements of this provision have been

23  met shall be upon the applicant, and the board shall require

24  documentation, such as, but not limited to, an evaluation by a

25  foreign equivalency determination service, as evidence that

26  the applicant's graduate degree program and education were

27  equivalent to an accredited program in this country.

28         (6)  RULES.--The board may adopt rules necessary to

29  implement any education or experience requirement of this

30  section for licensure as a clinical social worker, marriage

31  and family therapist, or mental health counselor.

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    Amendment No.    





 1         Section 170.  Paragraph (b) of subsection (1) of

 2  section 491.006, Florida Statutes, is amended to read:

 3         491.006  Licensure or certification by endorsement.--

 4         (1)  The department shall license or grant a

 5  certificate to a person in a profession regulated by this

 6  chapter who, upon applying to the department and remitting the

 7  appropriate fee, demonstrates to the board that he or she:

 8         (b)1.  Holds an active valid license to practice and

 9  has actively practiced the profession for which licensure is

10  applied in another state for 3 of the last 5 years immediately

11  preceding licensure.

12         2.  Meets the education requirements of this chapter

13  for the profession for which licensure is applied.

14         3.  Has passed a substantially equivalent licensing

15  examination in another state or has passed the licensure

16  examination in this state in the profession for which the

17  applicant seeks licensure.

18         4.  Holds a license in good standing, is not under

19  investigation for an act which would constitute a violation of

20  this chapter, and has not been found to have committed any act

21  which would constitute a violation of this chapter.

22         Section 171.  Section 491.0085, Florida Statutes, is

23  amended to read:

24         491.0085  Continuing education and laws and rules

25  courses; approval of providers, programs, and courses; proof

26  of completion.--

27         (1)  Continuing education providers, programs, and

28  courses and laws and rules courses and their providers and

29  programs shall be approved by the department or the board.

30         (2)  The department or the board has the authority to

31  set a fee not to exceed $200 for each applicant who applies

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 1  for or renews provider status.  Such fees shall be deposited

 2  into the Medical Quality Assurance Health Care Trust Fund.

 3         (3)  Proof of completion of the required number of

 4  hours of continuing education and completion of the laws and

 5  rules course shall be submitted to the department or the board

 6  in the manner and time specified by rule and on forms provided

 7  by the department or the board.

 8         (4)  The department or the board shall adopt rules and

 9  guidelines to administer and enforce the provisions of this

10  section.

11         Section 172.  Paragraph (d) of subsection (4) of

12  section 491.014, Florida Statutes, 1998 Supplement, is amended

13  to read:

14         491.014  Exemptions.--

15         (4)  No person shall be required to be licensed,

16  provisionally licensed, registered, or certified under this

17  chapter who:

18         (d)  Is not a resident of this state but offers

19  services in this state, provided:

20         1.  Such services are performed for no more than 5 days

21  in any month and no more than 15 days in any calendar year;

22  and

23         2.  Such nonresident is licensed or certified to

24  practice the services provided by a state or territory of the

25  United States or by a foreign country or province.

26         Section 173.  Paragraph (a) of subsection (1) and

27  subsection (5) of section 499.012, Florida Statutes, 1998

28  Supplement, are amended to read:

29         499.012  Wholesale distribution; definitions; permits;

30  general requirements.--

31         (1)  As used in this section, the term:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

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 1         (a)  "Wholesale distribution" means distribution of

 2  prescription drugs to persons other than a consumer or

 3  patient, but does not include:

 4         1.  Any of the following activities, which is not a

 5  violation of s. 499.005(21) if such activity is conducted in

 6  accordance with s. 499.014:

 7         a.  The purchase or other acquisition by a hospital or

 8  other health care entity that is a member of a group

 9  purchasing organization of a prescription drug for its own use

10  from the group purchasing organization or from other hospitals

11  or health care entities that are members of that organization.

12         b.  The sale, purchase, or trade of a prescription drug

13  or an offer to sell, purchase, or trade a prescription drug by

14  a charitable organization described in s. 501(c)(3) of the

15  Internal Revenue Code of 1986, as amended and revised, to a

16  nonprofit affiliate of the organization to the extent

17  otherwise permitted by law.

18         c.  The sale, purchase, or trade of a prescription drug

19  or an offer to sell, purchase, or trade a prescription drug

20  among hospitals or other health care entities that are under

21  common control. For purposes of this section, "common control"

22  means the power to direct or cause the direction of the

23  management and policies of a person or an organization,

24  whether by ownership of stock, by voting rights, by contract,

25  or otherwise.

26         d.  The sale, purchase, trade, or other transfer of a

27  prescription drug from or for any federal, state, or local

28  government agency or any entity eligible to purchase

29  prescription drugs at public health services prices pursuant

30  to s. 602 of Pub. L. No. 102-585 to a contract provider or its

31  subcontractor for eligible patients of the agency or entity

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 1  under the following conditions:

 2         (I)  The agency or entity must obtain written

 3  authorization for the sale, purchase, trade, or other transfer

 4  of a prescription drug under this sub-subparagraph from the

 5  Secretary of Health or his or her designee.

 6         (II)  The contract provider or subcontractor must be

 7  authorized by law to administer or dispense prescription

 8  drugs.

 9         (III)  In the case of a subcontractor, the agency or

10  entity must be a party to and execute the subcontract.

11         (IV)  A contract provider or subcontractor must

12  maintain separate and apart from other prescription drug

13  inventory any prescription drugs of the agency or entity in

14  its possession.

15         (V)  The contract provider and subcontractor must

16  maintain and produce immediately for inspection all records of

17  movement or transfer of all the prescription drugs belonging

18  to the agency or entity, including, but not limited to, the

19  records of receipt and disposition of prescription drugs.

20  Each contractor and subcontractor dispensing or administering

21  these drugs must maintain and produce records documenting the

22  dispensing or administration.  Records that are required to be

23  maintained include, but are not limited to, a perpetual

24  inventory itemizing drugs received and drugs dispensed by

25  prescription number or administered by patient identifier,

26  which must be submitted to the agency or entity quarterly.

27         (VI)  The contract provider or subcontractor may

28  administer or dispense the prescription drugs only to the

29  eligible patients of the agency or entity or must return the

30  prescription drugs for or to the agency or entity.  The

31  contract provider or subcontractor must require proof from

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

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 1  each person seeking to fill a prescription or obtain treatment

 2  that the person is an eligible patient of the agency or entity

 3  and must, at a minimum, maintain a copy of this proof as part

 4  of the records of the contractor or subcontractor required

 5  under sub-sub-subparagraph (V).

 6         (VII)  The prescription drugs transferred pursuant to

 7  this sub-subparagraph may not be billed to Medicaid.

 8         (VIII)  In addition to the departmental inspection

 9  authority set forth in s. 499.051, the establishment of the

10  contract provider and subcontractor and all records pertaining

11  to prescription drugs subject to this sub-subparagraph shall

12  be subject to inspection by the agency or entity.  All records

13  relating to prescription drugs of a manufacturer under this

14  sub-subparagraph shall be subject to audit by the manufacturer

15  of those drugs, without identifying individual patient

16  information.

17         2.  Any of the following activities, which is not a

18  violation of s. 499.005(21) if such activity is conducted in

19  accordance with rules established by the department:

20         a.  The sale, purchase, or trade of a prescription drug

21  among federal, state, or local government health care entities

22  that are under common control and are authorized to purchase

23  such prescription drug.

24         b.  The sale, purchase, or trade of a prescription drug

25  or an offer to sell, purchase, or trade a prescription drug

26  for emergency medical reasons.; For purposes of this

27  sub-subparagraph subparagraph, the term "emergency medical

28  reasons" includes transfers of prescription drugs by a retail

29  pharmacy to another retail pharmacy to alleviate a temporary

30  shortage.

31         c.  The transfer purchase or acquisition of a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  prescription drug acquired by a medical director on behalf of

 2  a licensed an emergency medical services provider to that

 3  medical director for use by emergency medical services

 4  provider and its transport vehicles for use in accordance with

 5  the provider's license under providers acting within the scope

 6  of their professional practice pursuant to chapter 401.

 7         d.  The revocation of a sale or the return of a

 8  prescription drug to the person's prescription drug wholesale

 9  supplier.

10         e.  The donation of a prescription drug by a health

11  care entity to a charitable organization that has been granted

12  an exemption under s. 501(c)(3) of the Internal Revenue Code

13  of 1986, as amended, and that is authorized to possess

14  prescription drugs.

15         f.  The transfer of a prescription drug by a person

16  authorized to purchase or receive prescription drugs to a

17  person licensed or permitted to handle reverse distributions

18  or destruction under the laws of the jurisdiction in which the

19  person handling the reverse distribution or destruction

20  receives the drug.

21         3.  The dispensing of a prescription drug pursuant to a

22  prescription;

23         3.4.  The distribution of prescription drug samples by

24  manufacturers' representatives or distributors'

25  representatives conducted in accordance with s. 499.028.; or

26         4.5.  The sale, purchase, or trade of blood and blood

27  components intended for transfusion.  As used in this

28  subparagraph section, the term "blood" means whole blood

29  collected from a single donor and processed either for

30  transfusion or further manufacturing, and the term "blood

31  components" means that part of the blood separated by physical

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  or mechanical means.

 2         5.  The lawful dispensing of a prescription drug in

 3  accordance with chapter 465.

 4         (5)  The department may adopt rules governing the

 5  recordkeeping, storage, and handling with respect to each of

 6  the distributions of prescription drugs specified in

 7  subparagraphs (1)(a)1.-4. (1)(a)1., 2., 4., and 5.

 8         Section 174.  Subsection (6) is added to section

 9  626.883, Florida Statutes, to read:

10         626.883  Administrator as intermediary; collections

11  held in fiduciary capacity; establishment of account;

12  disbursement; payments on behalf of insurer.--

13         (6)  All payments to a health care provider by a fiscal

14  intermediary for noncapitated providers must include an

15  explanation of services being reimbursed which includes, at a

16  minimum, the patient's name, the date of service, the

17  procedure code, the amount of reimbursement, and the

18  identification of the plan on whose behalf the payment is

19  being made. For capitated providers, the statement of services

20  must include the number of patients covered by the contract,

21  the rate per patient, the total amount of the payment, and the

22  identification of the plan on whose behalf the payment is

23  being made.

24         Section 175.  Paragraph (a) of subsection (2) of

25  section 641.316, Florida Statutes, 1998 Supplement, is amended

26  to read:

27         641.316  Fiscal intermediary services.--

28         (2)(a)  The term "fiduciary" or "fiscal intermediary

29  services" means reimbursements received or collected on behalf

30  of health care professionals for services rendered, patient

31  and provider accounting, financial reporting and auditing,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  receipts and collections management, compensation and

 2  reimbursement disbursement services, or other related

 3  fiduciary services pursuant to health care professional

 4  contracts with health maintenance organizations. All payments

 5  to a health care provider by a fiscal intermediary for

 6  noncapitated providers must include an explanation of services

 7  being reimbursed which includes, at a minimum, the patient's

 8  name, the date of service, the procedure code, the amount of

 9  reimbursement, and the identification of the plan on whose

10  behalf the payment is being made. For capitated providers, the

11  statement of services must include the number of patients

12  covered by the contract, the rate per patient, the total

13  amount of the payment, and the identification of the plan on

14  whose behalf the payment is being made.

15         Section 176.  Task Force on Telehealth.--

16         (1)  Because telecommunications technology has made it

17  possible to provide a wide range of health care services

18  across state lines between healthcare practitioners and

19  patients, it is the intent of the Legislature to protect the

20  health and safety of all patients in this state receiving

21  services by means of such technology and to ensure the

22  accountability of the healthcare profession with respect to

23  unsafe and incompetent practitioners using such technology to

24  provide health care services to patients in this state.

25         (2)  The Secretary of Health shall appoint a task force

26  consisting of representatives from the affected medical and

27  allied health professions and other affected health care

28  industries.

29         (3)  The task force shall address the following:

30         (a)  Identification of various electronic

31  communications or telecommunications technologies currently

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                                                  SENATE AMENDMENT

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    Amendment No.    





 1  used within the state and by other states to provide

 2  healthcare information.

 3         (b)  Identification of laws, regulations, and

 4  reimbursement practices that serve as barriers to

 5  implementation of electronic communications related to health

 6  care.

 7         (c)  Recommendation of the appropriate level of

 8  regulation of health care professionals necessary to protect

 9  the health and safety of patients in this state, including

10  analysis of existing provisions governing in-state

11  professionals such as licensing, financial responsibility, and

12  medical malpractice insurance requirements.

13         (d)  Potential preemption of state regulation by the

14  Commerce Clause of the United States Constitution.

15         (e)  The effect of telehealth on access to health care

16  in rural and underserved areas.

17         (f)  Potential antitrust concerns.

18         (g)  The effect of regulations by other states or

19  jurisdictions on health care professionals in this state who

20  provide consultative services through telehealth to entities

21  and patients outside the state.

22         (h)  Research on other public and private data and

23  initiatives related to telehealth.

24         (i)  Any other issue affecting the health, safety, and

25  welfare of patients through telehealth identified by the task

26  force.

27         (4)  The task force shall submit a report of its

28  findings and recommendations by January 1, 2000, to the

29  Governor, the President of the Senate, and the Speaker of the

30  House of Representatives.

31         Section 177.  Subsection (1) of section 468.352,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Florida Statutes, is amended to read:

 2         468.352  Definitions.--As used in this part, unless the

 3  context otherwise requires, the term:

 4         (1)  "Board" means the Board of Respiratory Care

 5  Medicine.

 6         Section 178.  Section 468.353, Florida Statutes, is

 7  amended to read:

 8         468.353  Board of Respiratory Care Medicine; powers and

 9  duties.--

10         (1)  The board, with the assistance of the Advisory

11  Council on Respiratory Care, is authorized to establish

12  minimum standards for the delivery of respiratory care

13  services and to adopt those rules necessary to administer this

14  part.

15         (2)  The board may administer oaths, summon witnesses,

16  and take testimony in all matters relating to its duties under

17  this part.

18         (3)  The board may adopt rules to administer this part,

19  including rules governing the investigation, inspection, and

20  review of schools and colleges that offer courses in

21  respiratory care in order to ascertain their compliance with

22  standards established by the board or appropriate accrediting

23  agencies delegate such powers and duties to the council as it

24  may deem proper.

25         Section 179.  Section 468.354, Florida Statutes, is

26  amended to read:

27         468.354  Board of Advisory Council on Respiratory Care;

28  organization; function.--

29         (1)  There is created within the department, the Board

30  of Advisory Council on Respiratory Care, composed of seven

31  members appointed by the Governor and confirmed by the Senate

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    Bill No. CS for SB 2220

    Amendment No.    





 1  under the supervision of the board.

 2         (2)  The board council shall consist of five members

 3  appointed by the board and shall include:

 4         (a)  A registered respiratory therapist.

 5         (b)  A certified respiratory therapist care

 6  practitioner.

 7         (c)  A respiratory care professional from each of the

 8  following areas:

 9         1.  Respiratory care education.

10         2.  Respiratory care management and supervision.

11         3.  Homecare/subacute Cardiopulmonary diagnostics.

12         (d)  Two consumer members, who are residents of this

13  state and have never been licensed as health care

14  practitioners.

15

16  Each member of the council shall be a respiratory care

17  professional on the board must have who has been actively

18  engaged in the delivery of respiratory care services in this

19  state for at least 4 consecutive years prior to appointment.

20         (3)(a)  Except as provided in paragraph (b), the term

21  of office for each board council member shall be 4 years.  No

22  member shall serve for more than two consecutive terms.  Any

23  time there is a vacancy to be filled on the council, all

24  professional organizations dealing with respiratory therapy

25  incorporated within the state as not for profit which register

26  their interest with the board shall recommend at least twice

27  as many persons to fill the vacancy to the council as the

28  number of vacancies to be filled, and the Governor board may

29  appoint from the submitted list, in his its discretion, any of

30  those persons so recommended.  The Governor board shall,

31  insofar as possible, appoint persons from different

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    Bill No. CS for SB 2220

    Amendment No.    





 1  geographical areas.

 2         (b)  In order To achieve staggering of terms, within

 3  120 days after July 1, 1999, October 1, 1984, the Governor

 4  board shall appoint the board members of the council as

 5  follows:

 6         1.  Two members One member shall be appointed for terms

 7  a term of 2 years.

 8         2.  Two members shall be appointed for terms of 3

 9  years.

10         3.  Three Two members shall be appointed for terms of 4

11  years.

12         (c)  All provisions of part II of chapter 455, relating

13  to boards apply to this part.

14         (4)(a)  The board council shall annually elect from

15  among its members a chair and vice chair.

16         (b)  The board council shall meet at least twice a year

17  and shall hold such additional meetings as are deemed

18  necessary by the board.  Four Three members of the council

19  constitute a quorum.

20         (c)  Unless otherwise provided by law, a board council

21  member shall be compensated $50 for each day he or she attends

22  an official board meeting of the council and for each day he

23  or she participates in any other board business involving the

24  council.  A board council member shall also be entitled to

25  reimbursement for expenses pursuant to s. 112.061. Travel out

26  of the state shall require the prior approval of the secretary

27  of the department.

28         (5)(a)  The board may council shall recommend to the

29  department a code of ethics for those persons licensed

30  pursuant to this part.

31         (b)  The council shall make recommendations to the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  department for the approval of continuing education courses.

 2         Section 180.  Section 468.355, Florida Statutes, is

 3  amended to read:

 4         468.355  Eligibility for licensure; temporary

 5  licensure.--

 6         (1)  To be eligible for licensure by the board as a

 7  respiratory care practitioner, an applicant must:

 8         (a)  Be at least 18 years old.

 9         (b)  Possess a high school diploma or a graduate

10  equivalency diploma.

11         (c)  Meet at least one of the following criteria:

12         1.  The applicant has successfully completed a training

13  program for respiratory therapy technicians or respiratory

14  therapists approved by the Commission on Accreditation of

15  Allied Health Education Programs, or the equivalent thereof,

16  as accepted by the board.

17         2.  The applicant is currently a "Certified Respiratory

18  Therapy Technician" certified by the National Board for

19  Respiratory Care, or the equivalent thereof, as accepted by

20  the board.

21         3.  The applicant is currently a "Registered

22  Respiratory Therapist" registered by the National Board for

23  Respiratory Care, or the equivalent thereof, as accepted by

24  the board.

25         4.  The applicant is currently employed in this state

26  as a respiratory care practitioner or respiratory therapist on

27  October 1, 1984.

28

29  The criteria set forth in subparagraphs 2. and 3.

30  notwithstanding, the board shall periodically annually review

31  the examinations and standards of the National Board for

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Respiratory Care and may reject those examinations and

 2  standards if they are deemed inappropriate.

 3         (2)  To be eligible for licensure by the board as a

 4  respiratory therapist, an applicant must:

 5         (a)  Be at least 18 years old.

 6         (b)  Possess a high school diploma or a graduate

 7  equivalency diploma.

 8         (c)  Meet at least one of the following criteria:

 9         1.  The applicant has successfully completed a training

10  program for respiratory therapists approved by the Commission

11  on Accreditation of Allied Health Education Programs, or the

12  equivalent thereof, as accepted by the board.

13         2.  The applicant is currently a "Registered

14  Respiratory Therapist" registered by the National Board for

15  Respiratory Care, or the equivalent thereof, as accepted by

16  the board.

17

18  The criteria set forth in subparagraphs 1. and 2.

19  notwithstanding, the board shall periodically annually review

20  the examinations and standards of the National Board for

21  Respiratory Care and may reject those examinations and

22  standards if they are deemed inappropriate.

23         (3)  With respect to the delivery of respiratory care

24  services, the board shall establish procedures for temporary

25  licensure of eligible individuals entering the state and

26  temporary licensure of those persons who have graduated from a

27  program approved by the board.  Such temporary licensure shall

28  be for a period not to exceed 1 year.

29         Section 181.  Section 468.357, Florida Statutes, is

30  amended to read:

31         468.357  Licensure by examination.--

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (1)  A person who desires to be licensed as a

 2  respiratory care practitioner may submit an application to the

 3  department to take the examination, in accordance with board

 4  rule to be administered by the department.

 5         (a)  The department shall examine Each applicant may

 6  take the examination who is determined by the board to have:

 7         1.  Completed the application form and remitted the

 8  applicable fee set by the board;

 9         2.  Submitted required documentation as required in s.

10  468.355; and

11         3.  Remitted an examination fee set by the examination

12  provider board.

13         (b)  The department shall conduct Examinations for

14  licensure of respiratory care practitioners must be conducted

15  no less than two times a year in such geographical locations

16  or by such methods as are deemed advantageous to the majority

17  of the applicants.

18         (c)  The examination given for respiratory care

19  practitioners shall be the same as that given by the National

20  Board for Respiratory Care for entry-level certification of

21  respiratory therapy technicians.  However, an equivalent

22  examination may be accepted by the board in lieu of that

23  examination.

24         (2)  Each applicant who passes the examination shall be

25  entitled to licensure as a respiratory care practitioner, and

26  the department shall issue a license pursuant to this part to

27  any applicant who successfully completes the examination in

28  accordance with this section.  However, the department shall

29  not issue a license to any applicant who is under

30  investigation in another jurisdiction for an offense which

31  would constitute a violation of this part.  Upon completion of

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    Bill No. CS for SB 2220

    Amendment No.    





 1  such an investigation, if the applicant is found guilty of

 2  such an offense, the applicable provisions of s. 468.365 will

 3  apply.

 4         (3)  Any person who was employed in this state on or

 5  before September 30, 1983, as a respiratory therapy technician

 6  or respiratory therapist, and who has performed services in

 7  such professional capacity for 4 years or more by October 1,

 8  1987, under the supervision of a licensed physician or in a

 9  hospital or licensed health care facility, shall be issued a

10  license without examination, if such person provides

11  acceptable documentation of performance of such services to

12  the board.  Such documentation shall include certification by

13  a physician licensed pursuant to chapter 458 or chapter 459

14  who has direct knowledge of the practice of, or who has

15  supervised, the person.  If such person is not determined to

16  have performed critical care respiratory services for at least

17  4 years, the board may limit the license of such person to the

18  performance of noncritical care respiratory services.

19         Section 182.  Section 468.364, Florida Statutes, 1998

20  Supplement, is amended to read:

21         468.364  Fees; establishment; disposition.--

22         (1)  The board shall establish by rule fees for the

23  following purposes:

24         (a)  Application, a fee not to exceed $50.

25         (b)  Examination, a fee not to exceed $125 plus the

26  actual per applicant cost to the department for purchase of

27  the examination from the National Board for Respiratory Care

28  or a similar national organization.

29         (b)(c)  Initial licensure, a fee not to exceed $200.

30         (c)(d)  Renewal of licensure, a fee not to exceed $200

31  biennially.

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    Bill No. CS for SB 2220

    Amendment No.    





 1         (d)(e)  Renewal of inactive licensure, a fee not to

 2  exceed $50.

 3         (e)(f)  Reactivation, a fee not to exceed $50.

 4         (2)  The fees established pursuant to subsection (1)

 5  shall be based upon the actual costs incurred by the

 6  department in carrying out its responsibilities under this

 7  part.

 8         (3)  All moneys collected by the department under this

 9  part shall be deposited as required by s. 455.587.

10         Section 183.  Paragraph (f) of subsection (1) of

11  section 468.365, Florida Statutes, 1998 Supplement, is amended

12  to read:

13         468.365  Disciplinary grounds and actions.--

14         (1)  The following acts constitute grounds for which

15  the disciplinary actions in subsection (2) may be taken:

16         (f)  Unprofessional conduct, which includes, but is not

17  limited to, any departure from, or failure to conform to,

18  acceptable standards related to the delivery of respiratory

19  care services, as set forth by the board and the Advisory

20  Council on Respiratory Care in rules adopted pursuant to this

21  part.

22         Section 184.  Paragraph (a) of subsection (2) of

23  section 464.016, Florida Statutes, is amended to read:

24         464.016  Violations and penalties.--

25         (2)  Each of the following acts constitutes a

26  misdemeanor of the first degree, punishable as provided in s.

27  775.082 or s. 775.083:

28         (a)  Using the name or title "Nurse," "Registered

29  Nurse," "Licensed Practical Nurse," "Advanced Registered Nurse

30  Practitioner," or any other name or title which implies that a

31  person was licensed or certified as same, unless such person

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  is duly licensed or certified.

 2         Section 185.  Paragraphs (b) and (c) of subsection (1)

 3  of section 458.3115, Florida Statutes, 1998 Supplement, are

 4  amended to read:

 5         458.3115  Restricted license; certain foreign-licensed

 6  physicians; United States Medical Licensing Examination

 7  (USMLE) or agency-developed examination; restrictions on

 8  practice; full licensure.--

 9         (1)

10         (b)  A person who is eligible to take and elects to

11  take the USMLE who has previously passed part 1 or part 2 of

12  the previously administered FLEX shall not be required to

13  retake or pass the equivalent parts of the USMLE up to the

14  year 2002 2000.

15         (c)  A person shall be eligible to take such

16  examination for restricted licensure if the person:

17         1.  Has taken, upon approval by the board, and

18  completed, in November 1990 or November 1992, one of the

19  special preparatory medical update courses authorized by the

20  board and the University of Miami Medical School and

21  subsequently passed the final course examination; upon

22  approval by the board to take the course completed in 1990 or

23  in 1992, has a certificate of successful completion of that

24  course from the University of Miami or the Stanley H. Kaplan

25  course; or can document to the department that he or she was

26  one of the persons who took and successfully completed the

27  Stanley H. Kaplan course that was approved by the Board of

28  Medicine and supervised by the University of Miami. At a

29  minimum, the documentation must include class attendance

30  records and the test score on the final course examination;

31         2.  Applies to the agency and submits an application

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  fee that is nonrefundable and equivalent to the fee required

 2  for full licensure;

 3         3.  Documents no less than 2 years of the active

 4  practice of medicine in any another jurisdiction;

 5         4.  Submits an examination fee that is nonrefundable

 6  and equivalent to the fee required for full licensure plus the

 7  actual per-applicant cost to the agency to provide either

 8  examination described in this section;

 9         5.  Has not committed any act or offense in this or any

10  other jurisdiction that would constitute a substantial basis

11  for disciplining a physician under this chapter or part II of

12  chapter 455; and

13         6.  Is not under discipline, investigation, or

14  prosecution in this or any other jurisdiction for an act that

15  would constitute a violation of this chapter or part II of

16  chapter 455 and that substantially threatened or threatens the

17  public health, safety, or welfare.

18         Section 186.  Subsection (2) of section 458.3124,

19  Florida Statutes, 1998 Supplement, is amended to read:

20         458.3124  Restricted license; certain experienced

21  foreign-trained physicians.--

22         (2)  A person applying for licensure under this section

23  must submit to the Department of Health on or before December

24  31, 2000 1998:

25         (a)  A completed application and documentation required

26  by the Board of Medicine to prove compliance with subsection

27  (1); and

28         (b)  A nonrefundable application fee not to exceed $500

29  and a nonrefundable examination fee not to exceed $300 plus

30  the actual cost to purchase and administer the examination.

31         Section 187.  Effective upon this act becoming a law,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  section 301 of chapter 98-166, Laws of Florida, is amended to

 2  read:

 3         Section 301.  The sum of $1.2 million from the

 4  unallocated balance in the Medical Quality Assurance Trust

 5  Fund is appropriated to the Department of Health to allow the

 6  department to develop the examination required for foreign

 7  licensed physicians in section 458.3115(1)(a), Florida

 8  Statutes, through a contract with the University of South

 9  Florida. The department shall charge examinees a fee not to

10  exceed 25 percent of the cost of the actual costs of the first

11  examination administered pursuant to section 458.3115, Florida

12  Statutes, 1998 Supplement, and a fee not to exceed 75 percent

13  of the actual costs for any subsequent examination

14  administered pursuant to that section.

15         Section 188.  The Agency for Health Care

16  Administration, in conjunction with the Medicare Fraud

17  Division of the Office of the Attorney General, shall conduct

18  a detailed study and analysis of clinical laboratory services

19  for kidney dialysis patients in the State of Florida. The

20  study shall include, but not be limited to, an analysis of the

21  past and present utilization rates of clinical laboratory

22  services for dialysis patients, financial arrangements among

23  kidney dialysis centers, their medical directors, and any

24  business relationships and affiliations with clinical

25  laboratories, any self referral to clinical laboratories, the

26  quality and responsiveness of clinical laboratory services for

27  dialysis patients in Florida, and the average annual revenue

28  for dialysis patients for clinical laboratory services for the

29  past ten years. The agency shall report back to the President

30  of the Senate, Speaker of the House of Representatives, and

31  chairs of the appropriate substantive committees of the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Legislature on its findings no later than February 1, 2000.

 2         Section 189.  Subsection (3) is added to section

 3  455.651, Florida Statutes, 1998 Supplement, to read:

 4         455.651  Disclosure of confidential information.--

 5         (1)  No officer, employee, or person under contract

 6  with the department, or any board therein, or any subject of

 7  an investigation shall convey knowledge or information to any

 8  person who is not lawfully entitled to such knowledge or

 9  information about any public meeting or public record, which

10  at the time such knowledge or information is conveyed is

11  exempt from the provisions of s. 119.01, s. 119.07(1), or s.

12  286.011.

13         (2)  Any person who willfully violates any provision of

14  this section is guilty of a misdemeanor of the first degree,

15  punishable as provided in s. 775.082 or s. 775.083, and may be

16  subject to discipline pursuant to s. 455.624, and, if

17  applicable, shall be removed from office, employment, or the

18  contractual relationship.

19         (3)  Any person injured as a result of a violation of

20  this section shall have a civil cause of action for treble

21  damages, reasonable attorney fees, and costs.

22         Section 190.  Section 641.261, Florida Statutes, is

23  amended to read:

24         641.261  Other reporting requirements.--

25         (1)  Each authorized health maintenance organization

26  shall provide records and information to the Agency for Health

27  Care Administration Department of Health and Rehabilitative

28  Services pursuant to s. 409.910(20) and (21) (22) for the sole

29  purpose of identifying potential coverage for claims filed

30  with the agency Department of Health and Rehabilitative

31  Services and its fiscal agents for payment of medical services

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  under the Medicaid program.

 2         (2)  Any information provided by a health maintenance

 3  organization under this section to the agency Department of

 4  Health and Rehabilitative Services shall not be considered a

 5  violation of any right of confidentiality or contract that the

 6  health maintenance organization may have with covered persons.

 7  The health maintenance organization is immune from any

 8  liability that it may otherwise incur through its release of

 9  information to the agency Department of Health and

10  Rehabilitative Services under this section.

11         Section 191.  Section 641.411, Florida Statutes, is

12  amended to read:

13         641.411  Other reporting requirements.--

14         (1)  Each prepaid health clinic shall provide records

15  and information to the Agency for Health Care Administration

16  Department of Health and Rehabilitative Services pursuant to

17  s. 409.910(20) and (21) (22) for the sole purpose of

18  identifying potential coverage for claims filed with the

19  agency Department of Health and Rehabilitative Services and

20  its fiscal agents for payment of medical services under the

21  Medicaid program.

22         (2)  Any information provided by a prepaid health

23  clinic under this section to the agency Department of Health

24  and Rehabilitative Services shall not be considered a

25  violation of any right of confidentiality or contract that the

26  prepaid health clinic may have with covered persons.  The

27  prepaid health clinic is immune from any liability that it may

28  otherwise incur through its release of information to the

29  agency Department of Health and Rehabilitative Services under

30  this section.

31         Section 192.  Paragraph (a) of subsection (4) of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  section 733.212, Florida Statutes, is amended to read:

 2         733.212  Notice of administration; filing of objections

 3  and claims.--

 4         (4)(a)  The personal representative shall promptly make

 5  a diligent search to determine the names and addresses of

 6  creditors of the decedent who are reasonably ascertainable and

 7  shall serve on those creditors a copy of the notice within 3

 8  months after the first publication of the notice. Under s.

 9  409.9101, the Agency for Health Care Administration is

10  considered a reasonably ascertainable creditor in instances

11  where the decedent had received Medicaid assistance for

12  medical care after reaching 55 years of age. Impracticable and

13  extended searches are not required.  Service is not required

14  on any creditor who has filed a claim as provided in this

15  part; a creditor whose claim has been paid in full; or a

16  creditor whose claim is listed in a personal representative's

17  timely proof of claim if the personal representative notified

18  the creditor of that listing.

19         Section 193.  (1)  There is established a seven-member

20  task force to review sources of funds deposited into the

21  Public Medical Assistance Trust Fund as created by section

22  409.918, Florida Statutes. The task force shall consist of:

23         (a)  Two members appointed by the President of the

24  Senate, one of whom must be a member of the Senate and one of

25  whom must represent a hospital subject to the assessment

26  imposed under section 395.701, Florida Statutes, 1998

27  Supplement, or section 394.4786, Florida Statutes;

28         (b)  Two members appointed by the Speaker of the House

29  of Representatives, one of whom must be a member of the House

30  and one of whom must represent a health care entity subject to

31  the assessment imposed under section 395.7015, Florida

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  Statutes, 1998 Supplement;

 2         (c)  Three members appointed by the Governor, one of

 3  whom must be the Director of the Agency for Health Care

 4  Administration, or his or her designee; one of whom must be a

 5  medical doctor licensed to practice in the state; and one of

 6  whom must be a consumer who has no employment or investment

 7  interest in any health care entity subject to the assessment

 8  imposed for deposit into the Public Medical Assistance Trust

 9  Fund and who is a representative of Florida TaxWatch.

10         (2)  The Governor shall designate the task force chair

11  from among the members.

12         (3)  The task force shall consider and make specific

13  recommendations concerning, but not limited to:

14         (a)  Whether any provisions of sections 395.701,

15  395.7015, and 409.918, Florida Statutes, need to be revised;

16         (b)  Whether the annual assessments imposed by these

17  statutes on the various health care entities are imposed

18  equitably;

19         (c)  Whether additional exemptions from, or inclusions

20  within, the assessments are justified; and

21         (d)  The extent to which modifications to other

22  statutory provisions that require deposit of specified revenue

23  into the Public Medical Assistance Trust Fund, including, but

24  not limited to, sections 210.20, 395.1041, 408.040, and

25  408.08, Florida Statutes, could result in increased revenue

26  for the trust fund.

27

28  The task force shall provide an analysis of the budgetary

29  impact of any recommended exemptions from, inclusions within,

30  or modifications to existing assessments.

31         (4)  The Agency for Health Care Administration shall

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  provide necessary staff support and technical assistance to

 2  the task force.

 3         (5)  The task force shall convene by August 1, 1999,

 4  for its first meeting, and shall submit its findings and

 5  recommendations, including any proposed legislation, to the

 6  President of the Senate, the Speaker of the House of

 7  Representatives, and the Governor by December 1, 1999.

 8         Section 194.  Section 395.40, Florida Statutes, is

 9  created to read:

10         395.40  Legislative findings and intent.--

11         (1)  The Legislature finds that there has been a lack

12  of timely access to trauma care due to the state's fragmented

13  trauma system. This finding is based on the 1999 Trauma System

14  Report on Timely Access to Trauma Care submitted by the

15  department in response to the request of the Legislature.

16         (2)  The Legislature finds that it is necessary to plan

17  for and to establish an inclusive trauma system to meet the

18  needs of trauma victims. An "inclusive trauma system" means a

19  system designed to meet the needs of all injured trauma

20  victims who require care in an acute-care setting and into

21  which every health care provider or facility with resources to

22  care for the injured trauma victim is incorporated. The

23  Legislature deems the benefits of trauma care provided within

24  an inclusive trauma system to be of vital significance to the

25  outcome of a trauma victim.

26         (3)  It is the intent of the Legislature to place

27  primary responsibility for the planning and establishment of a

28  statewide inclusive trauma system with the department. The

29  department shall undertake the implementation of a statewide

30  inclusive trauma system as funding is available.

31         (4)  The Legislature finds that significant benefits

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  are to be obtained by directing the coordination of activities

 2  by several state agencies, relative to access to trauma care

 3  and the provision of trauma care to all trauma victims. It is

 4  the intent of the Legislature that the department, the Agency

 5  for Health Care Administration, the Board of Medicine, and the

 6  Board of Nursing establish interagency teams and agreements

 7  for the development of guidelines, standards, and rules for

 8  those portions of the inclusive state trauma system within the

 9  statutory authority of each agency. This coordinated approach

10  will provide the necessary continuum of care for the trauma

11  victim from injury to final hospital discharge. The department

12  has the leadership responsibility for this activity.

13         (5)  In addition, the agencies listed in subsection (4)

14  should undertake to:

15         (a)  Establish a coordinated methodology for

16  monitoring, evaluating, and enforcing the requirements of the

17  state's inclusive trauma system which recognizes the interests

18  of each agency.

19         (b)  Develop appropriate roles for trauma agencies, to

20  assist in furthering the operation of trauma systems at the

21  regional level. This should include issues of system

22  evaluation as well as managed care.

23         (c)  Develop and submit appropriate requests for

24  waivers of federal requirements which will facilitate the

25  delivery of trauma care.

26         (d)  Develop criteria that will become the future basis

27  for mandatory consultation on the care of trauma victims and

28  mandatory transfer of appropriate trauma victims to trauma

29  centers.

30         (e)  Develop a coordinated approach to the care of the

31  trauma victim. This shall include the movement of the trauma

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  victim through the system of care and the identification of

 2  medical responsibility for each phase of care for

 3  out-of-hospital and in-hospital trauma care.

 4         (f)  Require the medical director of an emergency

 5  medical services provider to have medical accountability for a

 6  trauma victim during interfacility transfer.

 7         (6)  Furthermore, the Legislature encourages the

 8  department to actively foster the provision of trauma care and

 9  serve as a catalyst for improvements in the process and

10  outcome of the provision of trauma care in an inclusive trauma

11  system. Among other considerations, the department is

12  encouraged to:

13         (a)  Promote the development of at least one trauma

14  center in every trauma service area.

15         (b)  Promote the development of a trauma agency for

16  each trauma region.

17         (c)  Update the state trauma system plan by December

18  2000 and at least every 5th year thereafter.

19         Section 195.  Subsection (1) and paragraphs (c) and (n)

20  of subsection (2) of section 395.401, Florida Statutes, 1998

21  Supplement, are amended to read:

22         395.401  Trauma services system plans; verification of

23  trauma centers and pediatric trauma referral centers;

24  procedures; renewal.--

25         (1)  As used in this part, the term:

26         (a)  "Agency" means the Agency for Health Care

27  Administration.

28         (b)  "Charity care" or "uncompensated charity care"

29  means that portion of hospital charges reported to the agency

30  for which there is no compensation for care provided to a

31  patient whose family income for the 12 months preceding the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  determination is less than or equal to 150 percent of the

 2  federal poverty level, unless the amount of hospital charges

 3  due from the patient exceeds 25 percent of the annual family

 4  income. However, in no case shall the hospital charges for a

 5  patient whose family income exceeds four times the federal

 6  poverty level for a family of four be considered charity.

 7         (c)  "Department" means the Department of Health.

 8         (d)  "Level I trauma center" means a hospital that is

 9  determined by the department to be in substantial compliance

10  with trauma center and pediatric trauma referral center

11  verification standards as established by rule of the

12  department, and which:

13         1.  Has formal research and education programs for the

14  enhancement of trauma care.

15         2.  Serves as a resource facility to Level II trauma

16  centers, pediatric trauma referral centers, and community

17  hospitals.

18         3.  Ensures an organized system of trauma care.

19         (e)  "Level II trauma center" means a hospital that is

20  determined by the department to be in substantial compliance

21  with trauma center verification standards as established by

22  rule of the department, and which:

23         1.  Serves as a resource facility to community

24  hospitals.

25         2.  Ensures an organized system of trauma care.

26         (f)  "Local trauma agency" means an agency established

27  and operated by a county or an entity with which the county

28  contracts for the purpose of administrative trauma services.

29         (f)(g)  "Pediatric trauma referral center" means a

30  hospital that is determined to be in substantial compliance

31  with pediatric trauma referral center standards as established

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  by rule of the department.

 2         (h)  "Regional trauma agency" means an agency created

 3  and operated by two or more counties, or an entity with which

 4  two or more counties contract, for the purpose of

 5  administering trauma services.

 6         (g)(i)  "State-approved trauma center" means a hospital

 7  that has successfully completed the state-approved selection

 8  process pursuant to s. 395.4025 and has been approved by the

 9  department to operate as a trauma center in the state.

10         (h)(j)  "State-sponsored trauma center" means a

11  state-approved trauma center that receives state funding for

12  trauma care services.

13         (i)  "Trauma agency" means an agency established and

14  operated by one or more counties, or an entity with which one

15  or more counties contract, for the purpose of administering an

16  inclusive regional trauma system.

17         (j)  "Trauma alert victim" means a person who has

18  incurred a single or multisystem injury due to blunt or

19  penetrating means or burns; who requires immediate medical

20  intervention or treatment; and who meets one or more of the

21  adult or pediatric scorecard criteria established by the

22  department by rule.

23         (k)  "Trauma center" means any hospital that has been

24  determined by the department to be in substantial compliance

25  with trauma center verification standards.

26         (l)  "Trauma scorecard" means a statewide methodology

27  adopted by the department by rule under which a person who has

28  incurred a traumatic injury is graded as to the severity of

29  his or her injuries or illness and which methodology is used

30  as the basis for making destination decisions.

31         (m)  "Trauma victim" means any person who has incurred

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  a single or multisystem life-threatening injury due to blunt

 2  or penetrating means or burns and who requires immediate

 3  medical intervention or treatment.

 4         (2)

 5         (c)  The department shall receive plans for the

 6  implementation of inclusive trauma care systems from local and

 7  regional trauma agencies.  The department may approve or not

 8  approve the local or regional trauma agency plans based on the

 9  conformance of the plan local or regional plans with this

10  section and ss. 395.4015, 395.404, and 395.4045 and the rules

11  adopted by the department pursuant to those sections.  The

12  department shall approve or disapprove the plans within 120

13  days after the date the plans are submitted to the department.

14         (n)  After the submission of the initial local or

15  regional trauma care system plan, each local or regional

16  trauma agency shall, every 5th year, annually submit to the

17  department  for approval an updated plan that which identifies

18  the changes, if any, to be made in the regional trauma care

19  system. The department shall approve or disapprove the updated

20  plan within 120 days after the date the plan is submitted to

21  the department.  At least 60 days before the local or regional

22  trauma agency submits a plan for a trauma care system to the

23  department, the local or regional trauma agency shall hold a

24  public hearing and give adequate notice of the public hearing

25  to all hospitals and other interested parties in the area. A

26  local or regional trauma agency shall submit to the department

27  written notice of its intent to cease operation of the local

28  or regional trauma agency at least 90 days before the date on

29  which the local or regional trauma agency will cease

30  operation.

31         Section 196.  Subsections (1) and (3) of section

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  395.402, Florida Statutes, are amended to read:

 2         395.402  Trauma service areas; number and location of

 3  trauma centers.--

 4         (1)  The Legislature finds that it is appropriate to

 5  recognize as a trauma patient someone with an injury severity

 6  score (ISS) of 9 or greater.  The Legislature also recognizes

 7  that Level I and Level II trauma centers should each be

 8  capable of annually treating a minimum of 1,000 and 500

 9  patients, respectively, with an injury severity score (ISS) of

10  9 or greater. Further, the Legislature finds that, based on

11  the numbers and locations of trauma victims with these injury

12  severity scores, there should be 19 trauma service areas in

13  the state, and, at a minimum, there should be at least one

14  trauma center in each service area.

15         (3)  Trauma service areas are to be used. The

16  department shall periodically review the assignment of the 67

17  counties to trauma service areas. These assignments are made

18  for the purpose of developing a system of trauma centers.

19  Revisions made by the department should take into

20  consideration the recommendations made as part of the regional

21  trauma system plans approved by the department, as well as the

22  recommendations made as part of the state trauma system plan.

23  These areas must, at a minimum, be reviewed in the year 2000

24  and every 5 years thereafter. Until the department completes

25  its initial review, the assignment of counties shall remain as

26  established pursuant to chapter 90-284, Laws of Florida. The

27  following trauma service areas are to be utilized in

28  developing a system of state-sponsored trauma centers. These

29  areas are subject to periodic revision by the Legislature

30  based on recommendations made as part of local or regional

31  trauma plans approved by the department pursuant to s.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  395.401(2).  These areas shall, at a minimum, be reviewed by

 2  the Legislature prior to the next 7-year verification cycle of

 3  state-sponsored trauma centers.

 4         (a)  The following trauma service areas are hereby

 5  established:

 6         1.  Trauma service area 1 shall consist of Escambia,

 7  Okaloosa, Santa Rosa, and Walton Counties.

 8         2.  Trauma service area 2 shall consist of Bay, Gulf,

 9  Holmes, and Washington Counties.

10         3.  Trauma service area 3 shall consist of Calhoun,

11  Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,

12  Taylor, and Wakulla Counties.

13         4.  Trauma service area 4 shall consist of Alachua,

14  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette,

15  Levy, Putnam, Suwannee, and Union Counties.

16         5.  Trauma service area 5 shall consist of Baker, Clay,

17  Duval, Nassau, and St. Johns Counties.

18         6.  Trauma service area 6 shall consist of Citrus,

19  Hernando, and Marion Counties.

20         7.  Trauma service area 7 shall consist of Flagler and

21  Volusia Counties.

22         8.  Trauma service area 8 shall consist of Lake,

23  Orange, Osceola, Seminole, and Sumter Counties.

24         9.  Trauma service area 9 shall consist of Pasco and

25  Pinellas Counties.

26         10.  Trauma service area 10 shall consist of

27  Hillsborough County.

28         11.  Trauma service area 11 shall consist of Hardee,

29  Highlands, and Polk Counties.

30         12.  Trauma service area 12 shall consist of Brevard

31  and Indian River Counties.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         13.  Trauma service area 13 shall consist of DeSoto,

 2  Manatee, and Sarasota Counties.

 3         14.  Trauma service area 14 shall consist of Martin,

 4  Okeechobee, and St. Lucie Counties.

 5         15.  Trauma service area 15 shall consist of Charlotte,

 6  Glades, Hendry, and Lee Counties.

 7         16.  Trauma service area 16 shall consist of Palm Beach

 8  County.

 9         17.  Trauma service area 17 shall consist of Collier

10  County.

11         18.  Trauma service area 18 shall consist of Broward

12  County.

13         19.  Trauma service area 19 shall consist of Dade and

14  Monroe Counties.

15         (b)  Each trauma service area should have at least one

16  Level I or Level II trauma center.

17         (c)  There shall be no more than a total of 44

18  state-sponsored trauma centers in the state.

19         Section 197.  Subsection (1) of section 395.4045,

20  Florida Statutes, is amended to read:

21         395.4045  Emergency medical service providers;

22  transport of trauma victims to trauma centers.--

23         (1)  Each emergency medical services provider licensed

24  under chapter 401 shall transport trauma alert victims to

25  hospitals approved as trauma centers, except as may be

26  provided for either in department-approved local or regional

27  trauma transport protocol or, if no local or regional trauma

28  transport protocol is in effect, as provided for in a

29  department-approved provider's trauma transport protocol.

30  Development of regional trauma protocols shall be through

31  consultation with interested parties, including, but not

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  limited to, each approved trauma center; physicians

 2  specializing in trauma care, emergency care, and surgery in

 3  the region; each trauma system administrator in the region;

 4  and each emergency medical service provider in the region

 5  licensed under chapter 401. Trauma alert victims shall be

 6  identified through the use of a trauma scoring system.  The

 7  department shall specify by rule the subjects to be included

 8  in an emergency medical service provider's trauma transport

 9  protocol and shall approve or disapprove each such protocol.

10         Section 198.  Section 458.351, Florida Statutes, is

11  created to read:

12         458.351  Reports of adverse incidents in office

13  practice settings.--

14         (1)  Any adverse incident that occurs on or after

15  January 1, 2000, in any office maintained by a physician for

16  the practice of medicine which is not licensed under chapter

17  395 must be reported to the department in accordance with the

18  provisions of this section.

19         (2)  Any physician or other licensee under this chapter

20  practicing in this state must notify the department if the

21  physician or licensee was involved in an adverse incident that

22  occurred on or after January 1, 2000, in any office maintained

23  by a physician for the practice of medicine which is not

24  licensed under chapter 395.

25         (3)  The required notification to the department must

26  be submitted in writing by certified mail and postmarked

27  within 15 days after the occurrence of the adverse incident.

28         (4)  For purposes of notification to the department

29  pursuant to this section, the term "adverse incident" means an

30  event over which the physician or licensee could exercise

31  control and which is associated in whole or in part with a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  medical intervention, rather than the condition for which such

 2  intervention occurred, and which results in the following

 3  patient injuries:

 4         (a)  The death of a patient.

 5         (b)  Brain or spinal damage to a patient.

 6         (c)  The performance of a surgical procedure on the

 7  wrong patient.

 8         (d)1.  The performance of a wrong-site surgical

 9  procedure;

10         2.  The performance of a wrong surgical procedure; or

11         3.  The surgical repair of damage to a patient

12  resulting from a planned surgical procedure where the damage

13  is not a recognized specific risk as disclosed to the patient

14  and documented through the informed-consent process

15

16  if it results in: death; brain or spinal damage; permanent

17  disfigurement not to include the incision scar; fracture or

18  dislocation of bones or joints; a limitation of neurological,

19  physical or sensory function; or any condition that required

20  the transfer of the patient.

21         (e)  A procedure to remove unplanned foreign objects

22  remaining from a surgical procedure.

23         (f)  Any condition that required the transfer of a

24  patient to a hospital licensed under chapter 395 from an

25  ambulatory surgical center licensed under chapter 395 or any

26  facility or any office maintained by a physician for the

27  practice of medicine which is not licensed under chapter 395.

28         (5)  The department shall review each incident and

29  determine whether it potentially involved conduct by a health

30  care professional who is subject to disciplinary action, in

31  which case s. 455.621 applies. Disciplinary action, if any,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  shall be taken by the board under which the health care

 2  professional is licensed.

 3         (6)  The board may adopt rules to administer this

 4  section.

 5         Section 199.  Section 459.026, Florida Statutes, is

 6  created to read:

 7         459.026  Reports of adverse incidents in office

 8  practice settings.--

 9         (1)  Any adverse incident that occurs on or after

10  January 1, 2000, in any office maintained by an osteopathic

11  physician for the practice of osteopathic medicine which is

12  not licensed under chapter 395 must be reported to the

13  department in accordance with the provisions of this section.

14         (2)  Any osteopathic physician or other licensee under

15  this chapter practicing in this state must notify the

16  department if the osteopathic physician or licensee was

17  involved in an adverse incident that occurred on or after

18  January 1, 2000, in any office maintained by an osteopathic

19  physician for the practice of osteopathic medicine which is

20  not licensed under chapter 395.

21         (3)  The required notification to the department must

22  be submitted in writing by certified mail and postmarked

23  within 15 days after the occurrence of the adverse incident.

24         (4)  For purposes of notification to the department

25  pursuant to this section, the term "adverse incident" means an

26  event over which the physician or licensee could exercise

27  control and which is associated in whole or in part with a

28  medical intervention, rather than the condition for which such

29  intervention occurred, and which results in the following

30  patient injuries:

31         (a)  The death of a patient.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         (b)  Brain or spinal damage to a patient.

 2         (c)  The performance of a surgical procedure on the

 3  wrong patient.

 4         (d)1.  The performance of a wrong-site surgical

 5  procedure;

 6         2.  The performance of a wrong surgical procedure; or

 7         3.  The surgical repair of damage to a patient

 8  resulting from a planned surgical procedure where the damage

 9  is not a recognized specific risk as disclosed to the patient

10  and documented through the informed-consent process

11

12  if it results in: death; brain or spinal damage; permanent

13  disfigurement not to include the incision scar; fracture or

14  dislocation of bones or joints; a limitation of neurological,

15  physical or sensory function; or any condition that required

16  the transfer of the patient.

17         (e)  A procedure to remove unplanned foreign objects

18  remaining from a surgical procedure.

19         (f)  Any condition that required the transfer of a

20  patient to a hospital licensed under chapter 395 from an

21  ambulatory surgical center licensed under chapter 395 or any

22  facility or any office maintained by a physician for the

23  practice of medicine which is not licensed under chapter 395.

24         (5)  The department shall review each incident and

25  determine whether it potentially involved conduct by a health

26  care professional who is subject to disciplinary action, in

27  which case s. 455.621 applies. Disciplinary action, if any,

28  shall be taken by the board under which the health care

29  professional is licensed.

30         (6)  The board may adopt rules to administer this

31  section.

                                 274
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         Section 200.  (1)  The Department of Health shall

 2  establish maximum allowable levels for contaminants in

 3  compressed air used for recreational sport diving in this

 4  state. In developing the standards, the department must take

 5  into consideration the levels of contaminants allowed by the

 6  Grade "E" Recreational Diving Standards of the Compressed Gas

 7  Association.

 8         (2)  The standards prescribed under this section do not

 9  apply to:

10         (a)  Any person providing compressed air for his or her

11  own use.

12         (b)  Any governmental entity using a governmentally

13  owned compressed air source for work related to the

14  governmental entity.

15         (c)  Foreign registered vessels upon which a compressor

16  is used to provide compressed air for work related to the

17  operation of the vessel.

18         (3)  A person or entity that, for compensation,

19  provides compressed air for recreational sport diving in this

20  state, including compressed air provided as part of a dive

21  package of equipment rental, dive boat rental, or dive boat

22  charter, must ensure that the compressed air is tested

23  quarterly by a laboratory that is accredited by either the

24  American Industrial Hygiene Association or the American

25  Association for Laboratory Accreditation and that the results

26  of such tests are provided quarterly to the Department of

27  Health. In addition, the person or entity must post the

28  certificate issued by the laboratory accredited by the

29  American Industrial Hygiene Association or the American

30  Association for Laboratory Accreditation in a conspicuous

31  location where it can readily be seen by any person purchasing

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  compressed air.

 2         (4)  The Department of Health shall maintain a record

 3  of all quarterly test results provided under this section.

 4         (5)  It is a misdemeanor of the second degree for any

 5  person or entity to provide, for compensation, compressed air

 6  for recreational sport diving in this state, including

 7  compressed air provided as part of a dive package of equipment

 8  rental, dive boat rental, or dive boat charter, without:

 9         (a)  Having received a valid certificate issued by a

10  laboratory accredited by the American Industrial Hygiene

11  Association or the American Association for Laboratory

12  Accreditation which certifies that the compressed air meets

13  the standards for contaminant levels established by the

14  Department of Health.

15         (b)  Posting the certificate issued by a laboratory

16  accredited by the American Industrial Hygiene Association or

17  the American Association for Laboratory Accreditation in a

18  conspicuous location where it can readily be seen by persons

19  purchasing compressed air.

20         (6)  The department shall adopt rules necessary to

21  carry out the provisions of this section, which must include:

22         (a)  Maximum allowable levels of contaminants in

23  compressed air used for sport diving.

24         (b)  Procedures for the submission of test results to

25  the department.

26         (7)  This section shall take effect January 1, 2000.

27         Section 201.  Except as otherwise expressly provided in

28  this act, this act shall take effect July 1, 1999.

29

30

31

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1  ================ T I T L E   A M E N D M E N T ===============

 2  And the title is amended as follows:

 3         Delete everything before the enacting clause,

 4

 5  and insert:

 6                      A bill to be entitled

 7         An act relating to health care; providing for

 8         the issuance of Medicaid numbers to certain

 9         children; amending s. 20.43, F.S.; revising

10         powers and the internal structure of the

11         department; amending s. 110.205, F.S.;

12         exempting certain positions from career

13         service; amending s. 120.80, F.S.; exempting

14         certain hearings within the department from the

15         requirement of being conducted by an

16         administrative law judge from the Division of

17         Administrative Hearings; amending s. 154.504,

18         F.S.; revising standards for eligibility to

19         participate in a primary care for children and

20         families challenge grant; amending s. 287.155,

21         F.S.; authorizing the department to purchase

22         vehicles and automotive equipment for county

23         health departments; amending s. 372.6672, F.S.;

24         deleting an obsolete reference to the

25         Department of Health and Rehabilitative

26         Services; amending s. 381.004, F.S.;

27         prescribing conditions under which an HIV test

28         may be performed without obtaining consent;

29         amending s. 381.0051, F.S.; authorizing the

30         Department of Health to adopt rules to

31         implement the Comprehensive Family Planning

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         Act; amending s. 381.006, F.S.; providing the

 2         department with rule authority relating to

 3         inspection of certain group care facilities;

 4         amending s. 381.0061, F.S.; providing the

 5         department with authority to impose certain

 6         fines; amending s. 381.0062, F.S.; redefining

 7         the term "private water system" and defining

 8         the term "multi-family water system"; providing

 9         that either type of system may include a rental

10         residence in its service; regulating

11         multi-family systems; amending s. 381.90, F.S.;

12         revising membership of the Health Information

13         Systems Council; prescribing its duties with

14         respect to developing a review process;

15         requiring a report; amending s. 382.003, F.S.;

16         revising powers and duties of the department

17         with respect to vital records; providing for

18         forms and documents to be submitted under oath;

19         amending s. 382.004, F.S.; restating the

20         admissibility of copies of records; amending s.

21         382.008, F.S.; deleting provisions relating to

22         restriction on disclosure of a decedent's

23         social security number; amending s. 382.013,

24         F.S.; revising provisions relating to who must

25         file a birth registration; amending s. 382.015,

26         F.S.; revising provisions relating to issuance

27         of new birth certificates upon determination of

28         paternity; amending s. 382.016, F.S.;

29         prescribing procedures for amending records;

30         amending s. 382.019, F.S.; providing for

31         dismissal of an application for delayed

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         registration which is not actively pursued;

 2         amending s. 382.025, F.S.; exempting certain

 3         birth records from confidentiality

 4         requirements; amending s. 382.0255, F.S.;

 5         revising provisions relating to disposition of

 6         the additional fee imposed on certification of

 7         birth records; amending s. 383.14, F.S.;

 8         conforming a reference to the name of a

 9         program; amending s. 385.202, F.S.; deleting

10         provisions relating to reimbursing hospitals

11         reporting information for the statewide cancer

12         registry; amending s. 385.203, F.S.;

13         establishing requirements and membership for

14         the Diabetes Advisory Council; amending s.

15         391.028, F.S.; revising provisions relating to

16         administration of the Children's Medical

17         Services program; amending s. 391.0315, F.S.;

18         revising standards for benefits provided under

19         the program for certain children; amending s.

20         392.69, F.S.; providing for an advisory board

21         for the A. G. Holley State Hospital; amending

22         s. 401.25, F.S.; providing qualifications for

23         licensure as basic or advanced life support

24         service; amending s. 401.27, F.S.; providing

25         standards for certification of emergency

26         medical technicians and paramedics; creating s.

27         401.2701, F.S.; establishing criteria for

28         emergency medical services training programs;

29         creating s. 401.2715, F.S.; providing for

30         recertification training of emergency medical

31         technicians and paramedics; providing for fees;

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         amending s. 401.30, F.S.; providing for use and

 2         maintenance of records; amending s. 401.35,

 3         F.S.; providing rulemaking authority; amending

 4         s. 409.9126, F.S.; revising requirements for

 5         capitation payments to Children's Medical

 6         Services programs; amending s. 465.019, F.S.;

 7         revising definitions; amending s. 499.005,

 8         F.S.; revising the elements of certain offenses

 9         relating to purchase or receipt of legend

10         drugs, recordkeeping with respect to drugs,

11         cosmetics, and household products, and permit

12         and registration requirements; amending s.

13         499.007, F.S.; revising conditions under which

14         a drug is considered misbranded; amending s.

15         499.028, F.S.; providing an exemption from the

16         prohibition against possession of a drug

17         sample; amending s. 499.069, F.S.; providing

18         penalties for certain violations of s. 499.005,

19         F.S.; amending s. 742.10, F.S.; revising

20         procedures relating to establishing paternity

21         for children born out of wedlock; amending ss.

22         39.303, 385.203, 391.021, 391.221, 391.222,

23         391.223, F.S., to conform to the renaming of

24         the Division of Children's Medical Services;

25         repealing s. 381.731(3), F.S., relating to the

26         date for submission of a report; repealing s.

27         383.307(5), F.S., relating to licensure of

28         birth center staff and consultants; repealing

29         s. 404.20(7), F.S., relating to transportation

30         of radioactive materials; repealing s.

31         409.9125, F.S., relating to the study of

                                 280
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         Medicaid alternative networks; naming a certain

 2         building in Jacksonville the "Wilson T. Sowder,

 3         M.D., Building"; naming a certain building in

 4         Tampa the "William G. 'Doc' Myers, M.D.,

 5         Building"; naming the department headquarters

 6         building the "Charlton E. Prather, M.D.,

 7         Building"; authorizing the Department of Health

 8         to become an accrediting authority for

 9         environmental laboratory standards; providing

10         intent and rulemaking authority for the

11         Department of Health to implement standards of

12         the National Environmental Laboratory

13         Accreditation Program Accreditation Program;

14         amending s. 381.0022, F.S.; authorizing the

15         Department of Health to share certain

16         information on Medicaid recipients regarding

17         payment for services; amending s. 383.011,

18         F.S.; amending requirements for rules relating

19         to the Child Care Food Program; amending s.

20         468.304, F.S.; revising the application fees to

21         be paid for radiologic technology certification

22         examination; amending s. 468.306, F.S.;

23         revising certain fees for radiologic technology

24         certification examination; amending s. 468.309,

25         F.S.; amending the timing of biennial

26         certification renewal for radiologic

27         technologists; amending ss. 455.57 and 455.565,

28         F.S.; ensuring that an intern in a hospital is

29         not subject to the credentialing or profiling

30         laws; providing for clinical trials to be

31         conducted on the use of the drug Secretin by a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         nonprofit provider; requiring a report;

 2         providing an appropriation; amending s.

 3         232.435, F.S.; correcting a reference; amending

 4         s. 381.026, F.S.; providing a definition;

 5         amending s. 381.0261, F.S.; providing that the

 6         Department of Health or a regulatory board,

 7         rather than the Agency for Health Care

 8         Administration, may impose an administrative

 9         fine against any health care provider who fails

10         to make available to patients a summary of

11         their rights as required by law; amending s.

12         409.906, F.S.; authorizing the Agency for

13         Health Care Administration to develop a

14         certified-match program for Healthy Start

15         services under certain circumstances; amending

16         s. 409.910, F.S.; providing for use of Medicare

17         standard billing formats for certain

18         data-exchange purposes; creating s. 409.9101,

19         F.S.; providing a short title; providing

20         legislative intent relating to Medicaid estate

21         recovery; requiring certain notice of

22         administration of the estate of a deceased

23         Medicaid recipient; providing that receipt of

24         Medicaid benefits creates a claim and interest

25         by the agency against an estate; specifying the

26         right of the agency to amend the amount of its

27         claim based on medical claims submitted by

28         providers subsequent to the agency's initial

29         claim calculation; providing the basis of

30         calculation of the amount of the agency's

31         claim; specifying a claim's class standing;

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         providing circumstances for nonenforcement of

 2         claims; providing criteria for use in

 3         considering hardship requests; providing for

 4         recovery when estate assets result from a claim

 5         against a third party; providing for estate

 6         recovery in instances involving real property;

 7         providing agency rulemaking authority; amending

 8         s. 409.912, F.S.; eliminating a requirement

 9         that a Medicaid provider service network

10         demonstration project be located in Orange

11         County; amending s. 409.913, F.S.; revising

12         provisions relating to the agency's authority

13         to withhold Medicaid payments pending

14         completion of certain legal proceedings;

15         providing for disbursement of withheld Medicaid

16         provider payments; creating s. 409.9131, F.S.;

17         providing legislative findings and intent

18         relating to integrity of the Medicaid program;

19         providing definitions; authorizing onsite

20         reviews of physician records by the agency;

21         requiring notice for such reviews; requiring

22         notice of due process rights in certain

23         circumstances; specifying procedures for

24         determinations of overpayment; requiring a

25         study of certain statistical models used by the

26         agency; requiring a report; amending s.

27         455.501, F.S.; redefining the terms "health

28         care practitioner" and "licensee"; amending s.

29         455.507, F.S.; revising provisions relating to

30         good standing of members of the Armed Forces

31         with administrative boards to provide

                                 283
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         applicability to the department when there is

 2         no board; providing gender neutral language;

 3         amending s. 455.521, F.S.; providing powers and

 4         duties of the department for the professions,

 5         rather than boards, under its jurisdiction;

 6         amending s. 455.557, F.S.; revising the

 7         credentials collection program for health care

 8         practitioners; revising and providing

 9         definitions; providing requirements for health

10         care practitioners and the Department of Health

11         under the program; renaming the advisory

12         council and abolishing it at a future date;

13         prohibiting duplication of data available from

14         the department; authorizing collection of

15         certain other information; revising

16         requirements for registration of credentials

17         verification organizations; providing for

18         biennial renewal of registration; providing

19         grounds for suspension or revocation of

20         registration; revising liability insurance

21         requirements; revising rulemaking authority;

22         specifying authority of the department after

23         the council is abolished; amending s. 455.564,

24         F.S.; prescribing the expiration date of an

25         incomplete license application; revising the

26         form and style of licenses; providing authority

27         to the department when there is no board to

28         adopt rules; revising and providing

29         requirements relating to obtaining continuing

30         education credit in risk management; correcting

31         a reference; amending s. 455.5651, F.S.;

                                 284
    7:43 AM   04/28/99                              s2220c1c-07j02




                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         prohibiting inclusion of certain information in

 2         practitioner profiles; amending s. 455.567,

 3         F.S.; defining sexual misconduct and

 4         prohibiting it in the practice of a health care

 5         profession; providing penalties; amending s.

 6         455.574, F.S.; revising provisions relating to

 7         review of an examination after failure to pass

 8         it; amending s. 455.587, F.S.; providing

 9         authority to the department when there is no

10         board to determine by rule the amount of

11         license fees for the profession regulated;

12         providing for a fee for issuance of a wall

13         certificate to certain licensees or for a

14         duplicate wall certificate; amending s.

15         455.601, F.S.; providing, for purposes of

16         workers' compensation, a rebuttable presumption

17         relating to blood-borne infections; amending s.

18         455.604, F.S.; requiring instruction on human

19         immunodeficiency virus and acquired immune

20         deficiency syndrome as a condition of licensure

21         and relicensure to practice dietetics and

22         nutrition or nutrition counseling; amending s.

23         455.607, F.S.; correcting a reference; amending

24         s. 455.624, F.S.; revising and providing

25         grounds for discipline; providing penalties;

26         providing for assessment of certain costs;

27         amending s. 455.664, F.S.; requiring additional

28         health care practitioners to include a certain

29         statement in advertisements for free or

30         discounted services; correcting terminology;

31         amending s. 455.667, F.S.; authorizing the

                                 285
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         department to obtain patient records, billing

 2         records, insurance information, provider

 3         contracts, and all attachments thereto under

 4         certain circumstances for purposes of

 5         disciplinary proceedings; providing for charges

 6         for making reports or records available for

 7         digital scanning; amending s. 455.687, F.S.;

 8         providing for the suspension or restriction of

 9         the license of any health care practitioner who

10         tests positive for drugs under certain

11         circumstances; amending s. 455.694, F.S.;

12         providing financial responsibility requirements

13         for midwives; creating s. 455.712, F.S.;

14         providing requirements for active status

15         licensure of certain business establishments;

16         amending s. 457.102, F.S.; defining the term

17         "prescriptive rights" with respect to

18         acupuncture; amending s. 458.307, F.S.;

19         correcting terminology and a reference;

20         removing an obsolete date; amending s. 458.309,

21         F.S.; providing for registration and inspection

22         of certain offices performing levels 2 and 3

23         surgery; amending s. 458.311, F.S.; revising

24         provisions relating to licensure as a physician

25         by examination; eliminating an obsolete

26         provision relating to licensure of medical

27         students from Nicaragua and another provision

28         relating to taking the examination without

29         applying for a license; amending s. 458.3115,

30         F.S.; updating terminology; amending s.

31         458.313, F.S.; revising provisions relating to

                                 286
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         licensure by endorsement; repealing provisions

 2         relating to reactivation of certain licenses

 3         issued by endorsement; amending s. 458.315,

 4         F.S.; providing additional requirements for

 5         recipients of a temporary certificate for

 6         practice in areas of critical need; amending s.

 7         458.3165, F.S.; prescribing authorized

 8         employment for holders of public psychiatry

 9         certificates; correcting a reference; amending

10         s. 458.317, F.S.; providing for conversion of

11         an active license to a limited license for a

12         specified purpose; amending s. 458.319, F.S.;

13         revising requirements for submitting

14         fingerprints to the department for renewal of

15         licensure as a physician; amending s. 458.331,

16         F.S.; providing grounds for discipline;

17         providing penalties; amending s. 458.347, F.S.;

18         revising provisions relating to temporary

19         licensure as a physician assistant; amending s.

20         459.005, F.S.; providing for registration and

21         inspection of certain offices performing levels

22         2 and 3 surgery; amending s. 459.0075, F.S.;

23         providing for conversion of an active license

24         to a limited license for a specified purpose;

25         amending s. 459.008, F.S.; revising

26         requirements for submitting fingerprints to the

27         department for renewal of licensure as an

28         osteopathic physician; amending s. 459.015,

29         F.S.; revising and providing grounds for

30         discipline; providing penalties; amending s.

31         460.402, F.S.; providing an exemption from

                                 287
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         regulation under ch. 460, F.S., relating to

 2         chiropractic, for certain students; amending s.

 3         460.403, F.S.; defining the term

 4         "community-based internship" for purposes of

 5         ch. 460, F.S.; redefining the terms "direct

 6         supervision" and "registered chiropractic

 7         assistant"; amending s. 460.406, F.S.; revising

 8         requirements for licensure as a chiropractic

 9         physician by examination to remove a provision

10         relating to a training program; amending s.

11         460.407, F.S.; revising requirements for

12         submitting fingerprints to the department for

13         renewal of licensure as a chiropractic

14         physician; amending s. 460.413, F.S.;

15         increasing the administrative fine; conforming

16         cross-references; amending s. 460.4165, F.S.;

17         revising requirements for certification of

18         chiropractic physician's assistants; providing

19         for supervision of registered chiropractic

20         physician's assistants; providing for biennial

21         renewal; providing fees; providing

22         applicability to current certificateholders;

23         amending s. 460.4166, F.S.; authorizing

24         registered chiropractic assistants to be under

25         the direct supervision of a certified

26         chiropractic physician's assistant; amending s.

27         461.003, F.S.; defining the term "certified

28         podiatric X-ray assistant" and the term "direct

29         supervision" with respect thereto; redefining

30         the term "practice of podiatric medicine";

31         amending s. 461.006, F.S.; revising the

                                 288
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         residency requirement to practice podiatric

 2         medicine; amending s. 461.007, F.S.; revising

 3         requirements for renewal of license to practice

 4         podiatric medicine; revising requirements for

 5         submitting fingerprints to the department for

 6         renewal of licensure; amending s. 461.013,

 7         F.S.; revising and providing grounds for

 8         discipline; providing penalties; creating s.

 9         461.0135, F.S.; providing requirements for

10         operation of X-ray machines by certified

11         podiatric X-ray assistants; amending s.

12         464.008, F.S.; providing for remediation upon

13         failure to pass the examination to practice

14         nursing a specified number of times; amending

15         s. 464.022, F.S.; providing an exemption from

16         regulation relating to remedial courses;

17         amending s. 465.003, F.S.; defining the term

18         "data communication device"; revising the

19         definition of the term "practice of the

20         profession of pharmacy"; amending s.  465.016,

21         F.S.; authorizing the redispensing of unused or

22         returned unit-dose medication by correctional

23         facilities under certain conditions; providing

24         a ground for which a pharmacist may be subject

25         to discipline by the Board of Pharmacy;

26         increasing the administrative fine; amending

27         ss. 465.014, 465.015, 465.0196, 468.812,

28         499.003, F.S.; correcting cross-references, to

29         conform; creating the Task Force for the Study

30         of Collaborative Drug Therapy Management;

31         providing for staff support from the

                                 289
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         department; providing for participation by

 2         specified associations and entities; providing

 3         responsibilities; requiring a report to the

 4         Legislature; amending s. 466.021, F.S.;

 5         revising requirements relating to dental work

 6         orders required of unlicensed persons; amending

 7         s. 468.1155, F.S.; revising requirements for

 8         provisional licensure to practice

 9         speech-language pathology or audiology;

10         amending s. 468.1215, F.S.; revising

11         requirements for certification as a

12         speech-language pathologist or audiologist

13         assistant; amending s. 468.307, F.S.;

14         authorizing the issuance of subcategory

15         certificates in the field of radiologic

16         technology; amending s. 468.506, F.S.;

17         correcting references; amending s. 468.701,

18         F.S.; revising and removing definitions;

19         amending s. 468.703, F.S.; replacing the

20         Council of Athletic Training with a Board of

21         Athletic Training; providing for appointment of

22         board members and their successors; providing

23         for staggering of terms; providing for

24         applicability of other provisions of law

25         relating to activities of regulatory boards;

26         providing for the board's headquarters;

27         amending ss. 468.705, 468.707, 468.709,

28         468.711, 468.719, 468.721, F.S., relating to

29         rulemaking authority, licensure by examination,

30         fees, continuing education, disciplinary

31         actions, and certain regulatory transition;

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         transferring to the board certain duties of the

 2         department relating to regulation of athletic

 3         trainers; amending s. 20.43, F.S.; placing the

 4         board under the Division of Medical Quality

 5         Assurance of the department; providing for

 6         termination of the council and the terms of

 7         council members; authorizing consideration of

 8         former council members for appointment to the

 9         board; amending s. 468.805, F.S.; revising

10         grandfathering provisions for the practice of

11         orthotics, prosthetics, or pedorthics; amending

12         s. 468.806, F.S.; providing for approval of

13         continuing education providers; amending s.

14         478.42, F.S.; redefining the term "electrolysis

15         or electrology"; amending s. 483.041, F.S.,

16         redefining the terms "clinical laboratory" and

17         "licensed practitioner" and defining the term

18         "clinical laboratory examination"; amending s.

19         483.803, F.S.; redefining the terms "clinical

20         laboratory examination" and "licensed

21         practitioner of the healing arts"; revising a

22         reference; amending s. 483.807, F.S.; revising

23         provisions relating to fees for approval as a

24         laboratory training program; amending s.

25         483.809, F.S.; revising requirements relating

26         to examination of clinical laboratory personnel

27         for licensure and to registration of clinical

28         laboratory trainees; amending s. 483.812, F.S.;

29         revising qualification requirements for

30         licensure of public health laboratory

31         scientists; amending s. 483.813, F.S.;

                                 291
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         eliminating a provision authorizing conditional

 2         licensure of clinical laboratory personnel for

 3         a specified period; amending s. 483.821, F.S.;

 4         authorizing continuing education or retraining

 5         for candidates who fail an examination a

 6         specified number of times; amending s. 483.824,

 7         F.S.; revising qualifications of clinical

 8         laboratory directors; amending s. 483.825,

 9         F.S.; revising and providing grounds for

10         discipline; providing penalties; amending s.

11         483.901, F.S.; correcting a reference;

12         eliminating a provision authorizing temporary

13         licensure as a medical physicist; correcting

14         the name of a trust fund; amending s. 484.007,

15         F.S.; revising requirements for opticians who

16         supervise apprentices; amending s. 484.0512,

17         F.S.; requiring sellers of hearing aids to

18         refund within a specified period all moneys

19         required to be refunded under trial-period

20         provisions; amending s. 484.053, F.S.;

21         increasing the penalty applicable to prohibited

22         acts relating to the dispensing of hearing

23         aids; amending s. 484.056, F.S.; providing that

24         violation of trial-period requirements is a

25         ground for disciplinary action; providing

26         penalties; amending ss. 486.041, 486.081,

27         486.103, and 486.107, F.S.; eliminating

28         provisions authorizing issuance of a temporary

29         permit to work as a physical therapist or

30         physical therapist assistant; amending s.

31         490.005, F.S.; revising educational

                                 292
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         requirements for licensure as a psychologist by

 2         examination; changing a date, to defer certain

 3         educational requirements; amending s. 490.006,

 4         F.S.; providing additional requirements for

 5         licensure as a psychologist by endorsement;

 6         amending s. 490.0085, F.S.; correcting the name

 7         of a trust fund;  amending s. 491.0045, F.S.;

 8         revising requirements for registration as a

 9         clinical social worker intern, marriage and

10         family therapist intern, or mental health

11         counselor intern; amending s. 491.0046, F.S.;

12         revising requirements for provisional licensure

13         of clinical social workers, marriage and family

14         therapists, and mental health counselors;

15         amending s. 491.005, F.S.; revising

16         requirements for licensure of clinical social

17         workers, marriage and family therapists, and

18         mental health counselors; providing for

19         certification of education of interns;

20         providing rulemaking authority to implement

21         education and experience requirements for

22         licensure as a clinical social worker, marriage

23         and family therapist, or mental health

24         counselor; revising future licensure

25         requirements for mental health counselors and

26         providing rulemaking authority for

27         implementation thereof; amending s. 491.006,

28         F.S.; revising requirements for licensure or

29         certification by endorsement; amending s.

30         491.0085, F.S.; requiring laws and rules

31         courses and providing for approval thereof,

                                 293
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         including providers and programs; correcting

 2         the name of a trust fund; amending s. 491.014,

 3         F.S.; revising an exemption from regulation

 4         relating to certain temporally limited

 5         services; amending s. 499.012, F.S.; redefining

 6         the term "wholesale distribution," relating to

 7         the distribution of prescription drugs, to

 8         provide for the exclusion of certain

 9         activities; amending ss. 626.883, 641.316,

10         F.S.; requiring payments to a health care

11         provider by a fiscal intermediary to include an

12         explanation of services provided; creating a

13         Task Force on Telehealth; providing its duties;

14         requiring a report; amending s. 468.352, F.S.;

15         redefining the term "board"; amending s.

16         468.353, F.S.; conforming provision; providing

17         for the adoption of rules; amending s. 468.354,

18         F.S.; creating the Board of Respiratory Care;

19         providing for membership, powers, and duties;

20         amending s. 468.355, F.S.; providing for

21         periodic rather than annual review of certain

22         examinations and standards; amending s.

23         458.357, F.S.; conforming provisions; deleting

24         obsolete provisions; amending s. 468.364, F.S.;

25         deleting an examination fee; amending s.

26         468.365, F.S.; conforming provisions; amending

27         s. 464.016, F.S., providing that the use of the

28         title "nurse" without being licensed or

29         certified is a crime; amending s. 458.3115,

30         F.S.; revising requirements with respect to

31         eligibility of certain foreign-licensed

                                 294
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         physicians to take and pass standardized

 2         examinations; amending s. 458.3124, F.S.;

 3         changing the date by which application for a

 4         restricted license must be submitted; amending

 5         s. 301, ch. 98-166, Laws of Florida;

 6         prescribing fees for foreign-licensed

 7         physicians taking a certain examination;

 8         providing for a detailed study and analysis of

 9         clinical laboratory services for kidney

10         dialysis patients; amending s. 455.651, F.S.;

11         providing for treble damages, reasonable

12         attorney fees, and costs for improper

13         disclosure of confidential information;

14         amending ss. 641.261 and 641.411, F.S.;

15         conforming references and cross-references;

16         amending s. 733.212, F.S.; establishing the

17         agency as a reasonably ascertainable creditor

18         with respect to administration of certain

19         estates; requiring that a task force be

20         appointed to review sources of revenue for the

21         trust fund; providing for appointments of its

22         members and specifying topics to be studied;

23         providing for its staffing; providing for

24         meetings; requiring a report and

25         recommendations; creating s. 395.40, F.S.;

26         declaring legislative findings and intent with

27         respect to creation of a statewide inclusive

28         trauma system, as defined; amending s. 395.401,

29         F.S.; deleting the definitions of the terms

30         "local trauma agency" and "regional trauma

31         agency"; defining the terms "trauma agency" and

                                 295
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2220

    Amendment No.    





 1         "trauma alert victim"; prescribing duties of

 2         the Department of Health with respect to

 3         implementation of inclusive trauma systems and

 4         trauma agency plans; amending s. 395.402, F.S.;

 5         removing legislative findings; prescribing

 6         duties of the department with respect to

 7         assignment of counties to trauma service areas;

 8         amending s. 395.4045, F.S.; prescribing

 9         transport requirements for emergency medical

10         services providers; creating ss. 458.351 and

11         459.026, F.S.; requiring reports to the

12         Department of Health of adverse incidents in

13         specified settings; providing for review of

14         such incidents and initiation of disciplinary

15         proceedings, where appropriate; authorizing

16         department access to certain records and

17         preserving exemption from public access

18         thereto; providing rulemaking authority;

19         requiring the Department of Health to establish

20         standards for compressed air used in

21         recreational sport diving; providing that

22         certain persons and entities are exempt from

23         compliance with such standards; providing for

24         testing compressed air; requiring that test

25         results be provided to the department;

26         requiring that persons or entities selling

27         compressed air post a certificate of testing in

28         a conspicuous location; providing a penalty;

29         authorizing rules; providing effective dates.

30

31

                                 296
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