Senate Bill 2220e1

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    CS for SB 2220                                 First Engrossed



  1                      A bill to be entitled

  2         An act relating to health care; providing for

  3         the issuance of Medicaid numbers to certain

  4         children; amending s. 20.43, F.S.; revising

  5         powers and the internal structure of the

  6         department; amending s. 110.205, F.S.;

  7         exempting certain positions from career

  8         service; amending s. 120.80, F.S.; exempting

  9         certain hearings within the department from the

10         requirement of being conducted by an

11         administrative law judge from the Division of

12         Administrative Hearings; amending s. 154.504,

13         F.S.; revising standards for eligibility to

14         participate in a primary care for children and

15         families challenge grant; amending s. 287.155,

16         F.S.; authorizing the department to purchase

17         vehicles and automotive equipment for county

18         health departments; amending s. 372.6672, F.S.;

19         deleting an obsolete reference to the

20         Department of Health and Rehabilitative

21         Services; amending s. 381.004, F.S.;

22         prescribing conditions under which an HIV test

23         may be performed without obtaining consent;

24         amending s. 381.0051, F.S.; authorizing the

25         Department of Health to adopt rules to

26         implement the Comprehensive Family Planning

27         Act; amending s. 381.006, F.S.; providing the

28         department with rule authority relating to

29         inspection of certain group care facilities;

30         amending s. 381.0061, F.S.; providing the

31         department with authority to impose certain


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    CS for SB 2220                                 First Engrossed



  1         fines; amending s. 381.0062, F.S.; redefining

  2         the term "private water system" and defining

  3         the term "multi-family water system"; providing

  4         that either type of system may include a rental

  5         residence in its service; regulating

  6         multi-family systems; amending s. 381.90, F.S.;

  7         revising membership of the Health Information

  8         Systems Council; prescribing its duties with

  9         respect to developing a review process;

10         requiring a report; amending s. 382.003, F.S.;

11         revising powers and duties of the department

12         with respect to vital records; providing for

13         forms and documents to be submitted under oath;

14         amending s. 382.004, F.S.; restating the

15         admissibility of copies of records; amending s.

16         382.008, F.S.; deleting provisions relating to

17         restriction on disclosure of a decedent's

18         social security number; amending s. 382.013,

19         F.S.; revising provisions relating to who must

20         file a birth registration; amending s. 382.015,

21         F.S.; revising provisions relating to issuance

22         of new birth certificates upon determination of

23         paternity; amending s. 382.016, F.S.;

24         prescribing procedures for amending records;

25         amending s. 382.019, F.S.; providing for

26         dismissal of an application for delayed

27         registration which is not actively pursued;

28         amending s. 382.025, F.S.; exempting certain

29         birth records from confidentiality

30         requirements; amending s. 382.0255, F.S.;

31         revising provisions relating to disposition of


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    CS for SB 2220                                 First Engrossed



  1         the additional fee imposed on certification of

  2         birth records; amending s. 383.14, F.S.;

  3         conforming a reference to the name of a

  4         program; amending s. 385.202, F.S.; deleting

  5         provisions relating to reimbursing hospitals

  6         reporting information for the statewide cancer

  7         registry; amending s. 385.203, F.S.;

  8         establishing requirements and membership for

  9         the Diabetes Advisory Council; amending s.

10         391.028, F.S.; revising provisions relating to

11         administration of the Children's Medical

12         Services program; amending s. 391.0315, F.S.;

13         revising standards for benefits provided under

14         the program for certain children; amending s.

15         392.69, F.S.; providing for an advisory board

16         for the A. G. Holley State Hospital; amending

17         s. 401.25, F.S.; providing qualifications for

18         licensure as basic or advanced life support

19         service; amending s. 401.27, F.S.; providing

20         standards for certification of emergency

21         medical technicians and paramedics; creating s.

22         401.2701, F.S.; establishing criteria for

23         emergency medical services training programs;

24         creating s. 401.2715, F.S.; providing for

25         recertification training of emergency medical

26         technicians and paramedics; providing for fees;

27         amending s. 401.30, F.S.; providing for use and

28         maintenance of records; amending s. 401.35,

29         F.S.; providing rulemaking authority; amending

30         s. 409.9126, F.S.; revising requirements for

31         capitation payments to Children's Medical


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    CS for SB 2220                                 First Engrossed



  1         Services programs; amending s. 465.019, F.S.;

  2         revising definitions; amending s. 499.005,

  3         F.S.; revising the elements of certain offenses

  4         relating to purchase or receipt of legend

  5         drugs, recordkeeping with respect to drugs,

  6         cosmetics, and household products, and permit

  7         and registration requirements; amending s.

  8         499.007, F.S.; revising conditions under which

  9         a drug is considered misbranded; amending s.

10         499.028, F.S.; providing an exemption from the

11         prohibition against possession of a drug

12         sample; amending s. 499.069, F.S.; providing

13         penalties for certain violations of s. 499.005,

14         F.S.; amending s. 742.10, F.S.; revising

15         procedures relating to establishing paternity

16         for children born out of wedlock; amending ss.

17         39.303, 385.203, 391.021, 391.221, 391.222,

18         391.223, F.S., to conform to the renaming of

19         the Division of Children's Medical Services;

20         repealing s. 381.731(3), F.S., relating to the

21         date for submission of a report; repealing s.

22         383.307(5), F.S., relating to licensure of

23         birth center staff and consultants; repealing

24         s. 404.20(7), F.S., relating to transportation

25         of radioactive materials; repealing s.

26         409.9125, F.S., relating to the study of

27         Medicaid alternative networks; naming a certain

28         building in Jacksonville the "Wilson T. Sowder,

29         M.D., Building"; naming a certain building in

30         Tampa the "William G. 'Doc' Myers, M.D.,

31         Building"; naming the department headquarters


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    CS for SB 2220                                 First Engrossed



  1         building the "Charlton E. Prather, M.D.,

  2         Building"; authorizing the Department of Health

  3         to become an accrediting authority for

  4         environmental laboratory standards; providing

  5         intent and rulemaking authority for the

  6         Department of Health to implement standards of

  7         the National Environmental Laboratory

  8         Accreditation Program Accreditation Program;

  9         amending s. 381.0022, F.S.; authorizing the

10         Department of Health to share certain

11         information on Medicaid recipients regarding

12         payment for services; amending s. 383.011,

13         F.S.; amending requirements for rules relating

14         to the Child Care Food Program; amending s.

15         468.304, F.S.; revising the application fees to

16         be paid for radiologic technology certification

17         examination; amending s. 468.306, F.S.;

18         revising certain fees for radiologic technology

19         certification examination; amending s. 468.309,

20         F.S.; amending the timing of biennial

21         certification renewal for radiologic

22         technologists; amending ss. 455.57 and 455.565,

23         F.S.; ensuring that an intern in a hospital is

24         not subject to the credentialing or profiling

25         laws; providing for clinical trials to be

26         conducted on the use of the drug Secretin by a

27         nonprofit provider; requiring a report;

28         providing an appropriation; amending s.

29         232.435, F.S.; correcting a reference; amending

30         s. 381.026, F.S.; providing a definition;

31         amending s. 381.0261, F.S.; providing that the


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    CS for SB 2220                                 First Engrossed



  1         Department of Health or a regulatory board,

  2         rather than the Agency for Health Care

  3         Administration, may impose an administrative

  4         fine against any health care provider who fails

  5         to make available to patients a summary of

  6         their rights as required by law; amending s.

  7         409.906, F.S.; authorizing the Agency for

  8         Health Care Administration to develop a

  9         certified-match program for Healthy Start

10         services under certain circumstances; amending

11         s. 409.910, F.S.; providing for use of Medicare

12         standard billing formats for certain

13         data-exchange purposes; creating s. 409.9101,

14         F.S.; providing a short title; providing

15         legislative intent relating to Medicaid estate

16         recovery; requiring certain notice of

17         administration of the estate of a deceased

18         Medicaid recipient; providing that receipt of

19         Medicaid benefits creates a claim and interest

20         by the agency against an estate; specifying the

21         right of the agency to amend the amount of its

22         claim based on medical claims submitted by

23         providers subsequent to the agency's initial

24         claim calculation; providing the basis of

25         calculation of the amount of the agency's

26         claim; specifying a claim's class standing;

27         providing circumstances for nonenforcement of

28         claims; providing criteria for use in

29         considering hardship requests; providing for

30         recovery when estate assets result from a claim

31         against a third party; providing for estate


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    CS for SB 2220                                 First Engrossed



  1         recovery in instances involving real property;

  2         providing agency rulemaking authority; amending

  3         s. 409.912, F.S.; eliminating a requirement

  4         that a Medicaid provider service network

  5         demonstration project be located in Orange

  6         County; amending s. 409.913, F.S.; revising

  7         provisions relating to the agency's authority

  8         to withhold Medicaid payments pending

  9         completion of certain legal proceedings;

10         providing for disbursement of withheld Medicaid

11         provider payments; creating s. 409.9131, F.S.;

12         providing legislative findings and intent

13         relating to integrity of the Medicaid program;

14         providing definitions; authorizing onsite

15         reviews of physician records by the agency;

16         requiring notice for such reviews; requiring

17         notice of due process rights in certain

18         circumstances; specifying procedures for

19         determinations of overpayment; requiring a

20         study of certain statistical models used by the

21         agency; requiring a report; amending s.

22         455.501, F.S.; redefining the terms "health

23         care practitioner" and "licensee"; amending s.

24         455.507, F.S.; revising provisions relating to

25         good standing of members of the Armed Forces

26         with administrative boards to provide

27         applicability to the department when there is

28         no board; providing gender neutral language;

29         amending s. 455.521, F.S.; providing powers and

30         duties of the department for the professions,

31         rather than boards, under its jurisdiction;


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    CS for SB 2220                                 First Engrossed



  1         amending s. 455.557, F.S.; revising the

  2         credentials collection program for health care

  3         practitioners; revising and providing

  4         definitions; providing requirements for health

  5         care practitioners and the Department of Health

  6         under the program; renaming the advisory

  7         council and abolishing it at a future date;

  8         prohibiting duplication of data available from

  9         the department; authorizing collection of

10         certain other information; revising

11         requirements for registration of credentials

12         verification organizations; providing for

13         biennial renewal of registration; providing

14         grounds for suspension or revocation of

15         registration; revising liability insurance

16         requirements; revising rulemaking authority;

17         specifying authority of the department after

18         the council is abolished; amending s. 455.564,

19         F.S.; prescribing the expiration date of an

20         incomplete license application; revising the

21         form and style of licenses; providing authority

22         to the department when there is no board to

23         adopt rules; revising and providing

24         requirements relating to obtaining continuing

25         education credit in risk management; correcting

26         a reference; amending s. 455.5651, F.S.;

27         prohibiting inclusion of certain information in

28         practitioner profiles; amending s. 455.567,

29         F.S.; defining sexual misconduct and

30         prohibiting it in the practice of a health care

31         profession; providing penalties; amending s.


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    CS for SB 2220                                 First Engrossed



  1         455.574, F.S.; revising provisions relating to

  2         review of an examination after failure to pass

  3         it; amending s. 455.587, F.S.; providing

  4         authority to the department when there is no

  5         board to determine by rule the amount of

  6         license fees for the profession regulated;

  7         providing for a fee for issuance of a wall

  8         certificate to certain licensees or for a

  9         duplicate wall certificate; amending s.

10         455.601, F.S.; providing, for purposes of

11         workers' compensation, a rebuttable presumption

12         relating to blood-borne infections; amending s.

13         455.604, F.S.; requiring instruction on human

14         immunodeficiency virus and acquired immune

15         deficiency syndrome as a condition of licensure

16         and relicensure to practice dietetics and

17         nutrition or nutrition counseling; amending s.

18         455.607, F.S.; correcting a reference; amending

19         s. 455.624, F.S.; revising and providing

20         grounds for discipline; providing penalties;

21         providing for assessment of certain costs;

22         amending s. 455.664, F.S.; requiring additional

23         health care practitioners to include a certain

24         statement in advertisements for free or

25         discounted services; correcting terminology;

26         amending s. 455.667, F.S.; authorizing the

27         department to obtain patient records, billing

28         records, insurance information, provider

29         contracts, and all attachments thereto under

30         certain circumstances for purposes of

31         disciplinary proceedings; providing for charges


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    CS for SB 2220                                 First Engrossed



  1         for making reports or records available for

  2         digital scanning; amending s. 455.687, F.S.;

  3         providing for the suspension or restriction of

  4         the license of any health care practitioner who

  5         tests positive for drugs under certain

  6         circumstances; amending s. 455.694, F.S.;

  7         providing financial responsibility requirements

  8         for midwives; creating s. 455.712, F.S.;

  9         providing requirements for active status

10         licensure of certain business establishments;

11         amending s. 457.102, F.S.; defining the term

12         "prescriptive rights" with respect to

13         acupuncture; amending s. 458.307, F.S.;

14         correcting terminology and a reference;

15         removing an obsolete date; amending s. 458.309,

16         F.S.; providing for registration and inspection

17         of certain offices performing levels 2 and 3

18         surgery; amending s. 458.311, F.S.; revising

19         provisions relating to licensure as a physician

20         by examination; eliminating an obsolete

21         provision relating to licensure of medical

22         students from Nicaragua and another provision

23         relating to taking the examination without

24         applying for a license; amending s. 458.3115,

25         F.S.; updating terminology; amending s.

26         458.313, F.S.; revising provisions relating to

27         licensure by endorsement; repealing provisions

28         relating to reactivation of certain licenses

29         issued by endorsement; amending s. 458.315,

30         F.S.; providing additional requirements for

31         recipients of a temporary certificate for


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    CS for SB 2220                                 First Engrossed



  1         practice in areas of critical need; amending s.

  2         458.3165, F.S.; prescribing authorized

  3         employment for holders of public psychiatry

  4         certificates; correcting a reference; amending

  5         s. 458.317, F.S.; providing for conversion of

  6         an active license to a limited license for a

  7         specified purpose; amending s. 458.319, F.S.;

  8         revising requirements for submitting

  9         fingerprints to the department for renewal of

10         licensure as a physician; amending s. 458.331,

11         F.S.; providing grounds for discipline;

12         providing penalties; amending s. 458.347, F.S.;

13         revising provisions relating to temporary

14         licensure as a physician assistant; amending s.

15         459.005, F.S.; providing for registration and

16         inspection of certain offices performing levels

17         2 and 3 surgery; amending s. 459.0075, F.S.;

18         providing for conversion of an active license

19         to a limited license for a specified purpose;

20         amending s. 459.008, F.S.; revising

21         requirements for submitting fingerprints to the

22         department for renewal of licensure as an

23         osteopathic physician; amending s. 459.015,

24         F.S.; revising and providing grounds for

25         discipline; providing penalties; amending s.

26         460.402, F.S.; providing an exemption from

27         regulation under ch. 460, F.S., relating to

28         chiropractic, for certain students; amending s.

29         460.403, F.S.; defining the term

30         "community-based internship" for purposes of

31         ch. 460, F.S.; redefining the terms "direct


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    CS for SB 2220                                 First Engrossed



  1         supervision" and "registered chiropractic

  2         assistant"; amending s. 460.406, F.S.; revising

  3         requirements for licensure as a chiropractic

  4         physician by examination to remove a provision

  5         relating to a training program; amending s.

  6         460.407, F.S.; revising requirements for

  7         submitting fingerprints to the department for

  8         renewal of licensure as a chiropractic

  9         physician; amending s. 460.413, F.S.;

10         increasing the administrative fine; conforming

11         cross-references; amending s. 460.4165, F.S.;

12         revising requirements for certification of

13         chiropractic physician's assistants; providing

14         for supervision of registered chiropractic

15         physician's assistants; providing for biennial

16         renewal; providing fees; providing

17         applicability to current certificateholders;

18         amending s. 460.4166, F.S.; authorizing

19         registered chiropractic assistants to be under

20         the direct supervision of a certified

21         chiropractic physician's assistant; amending s.

22         461.003, F.S.; defining the term "certified

23         podiatric X-ray assistant" and the term "direct

24         supervision" with respect thereto; redefining

25         the term "practice of podiatric medicine";

26         amending s. 461.006, F.S.; revising the

27         residency requirement to practice podiatric

28         medicine; amending s. 461.007, F.S.; revising

29         requirements for renewal of license to practice

30         podiatric medicine; revising requirements for

31         submitting fingerprints to the department for


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    CS for SB 2220                                 First Engrossed



  1         renewal of licensure; amending s. 461.013,

  2         F.S.; revising and providing grounds for

  3         discipline; providing penalties; creating s.

  4         461.0135, F.S.; providing requirements for

  5         operation of X-ray machines by certified

  6         podiatric X-ray assistants; amending s.

  7         464.008, F.S.; providing for remediation upon

  8         failure to pass the examination to practice

  9         nursing a specified number of times; amending

10         s. 464.022, F.S.; providing an exemption from

11         regulation relating to remedial courses;

12         amending s. 465.003, F.S.; defining the term

13         "data communication device"; revising the

14         definition of the term "practice of the

15         profession of pharmacy"; amending s.  465.016,

16         F.S.; authorizing the redispensing of unused or

17         returned unit-dose medication by correctional

18         facilities under certain conditions; providing

19         a ground for which a pharmacist may be subject

20         to discipline by the Board of Pharmacy;

21         increasing the administrative fine; amending

22         ss. 465.014, 465.015, 465.0196, 468.812,

23         499.003, F.S.; correcting cross-references, to

24         conform; creating the Task Force for the Study

25         of Collaborative Drug Therapy Management;

26         providing for staff support from the

27         department; providing for participation by

28         specified associations and entities; providing

29         responsibilities; requiring a report to the

30         Legislature; amending s. 466.021, F.S.;

31         revising requirements relating to dental work


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    CS for SB 2220                                 First Engrossed



  1         orders required of unlicensed persons; amending

  2         s. 468.1155, F.S.; revising requirements for

  3         provisional licensure to practice

  4         speech-language pathology or audiology;

  5         amending s. 468.1215, F.S.; revising

  6         requirements for certification as a

  7         speech-language pathologist or audiologist

  8         assistant; amending s. 468.307, F.S.;

  9         authorizing the issuance of subcategory

10         certificates in the field of radiologic

11         technology; amending s. 468.506, F.S.;

12         correcting references; amending s. 468.701,

13         F.S.; revising and removing definitions;

14         amending s. 468.703, F.S.; replacing the

15         Council of Athletic Training with a Board of

16         Athletic Training; providing for appointment of

17         board members and their successors; providing

18         for staggering of terms; providing for

19         applicability of other provisions of law

20         relating to activities of regulatory boards;

21         providing for the board's headquarters;

22         amending ss. 468.705, 468.707, 468.709,

23         468.711, 468.719, 468.721, F.S., relating to

24         rulemaking authority, licensure by examination,

25         fees, continuing education, disciplinary

26         actions, and certain regulatory transition;

27         transferring to the board certain duties of the

28         department relating to regulation of athletic

29         trainers; amending s. 20.43, F.S.; placing the

30         board under the Division of Medical Quality

31         Assurance of the department; providing for


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    CS for SB 2220                                 First Engrossed



  1         termination of the council and the terms of

  2         council members; authorizing consideration of

  3         former council members for appointment to the

  4         board; amending s. 468.805, F.S.; revising

  5         grandfathering provisions for the practice of

  6         orthotics, prosthetics, or pedorthics; amending

  7         s. 468.806, F.S.; providing for approval of

  8         continuing education providers; amending s.

  9         478.42, F.S.; redefining the term "electrolysis

10         or electrology"; amending s. 483.041, F.S.,

11         redefining the terms "clinical laboratory" and

12         "licensed practitioner" and defining the term

13         "clinical laboratory examination"; amending s.

14         483.803, F.S.; redefining the terms "clinical

15         laboratory examination" and "licensed

16         practitioner of the healing arts"; revising a

17         reference; amending s. 483.807, F.S.; revising

18         provisions relating to fees for approval as a

19         laboratory training program; amending s.

20         483.809, F.S.; revising requirements relating

21         to examination of clinical laboratory personnel

22         for licensure and to registration of clinical

23         laboratory trainees; amending s. 483.812, F.S.;

24         revising qualification requirements for

25         licensure of public health laboratory

26         scientists; amending s. 483.813, F.S.;

27         eliminating a provision authorizing conditional

28         licensure of clinical laboratory personnel for

29         a specified period; amending s. 483.821, F.S.;

30         authorizing continuing education or retraining

31         for candidates who fail an examination a


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    CS for SB 2220                                 First Engrossed



  1         specified number of times; amending s. 483.824,

  2         F.S.; revising qualifications of clinical

  3         laboratory directors; amending s. 483.825,

  4         F.S.; revising and providing grounds for

  5         discipline; providing penalties; amending s.

  6         483.901, F.S.; correcting a reference;

  7         eliminating a provision authorizing temporary

  8         licensure as a medical physicist; correcting

  9         the name of a trust fund; amending s. 484.007,

10         F.S.; revising requirements for opticians who

11         supervise apprentices; amending s. 484.0512,

12         F.S.; requiring sellers of hearing aids to

13         refund within a specified period all moneys

14         required to be refunded under trial-period

15         provisions; amending s. 484.053, F.S.;

16         increasing the penalty applicable to prohibited

17         acts relating to the dispensing of hearing

18         aids; amending s. 484.056, F.S.; providing that

19         violation of trial-period requirements is a

20         ground for disciplinary action; providing

21         penalties; amending ss. 486.041, 486.081,

22         486.103, and 486.107, F.S.; eliminating

23         provisions authorizing issuance of a temporary

24         permit to work as a physical therapist or

25         physical therapist assistant; amending s.

26         490.005, F.S.; revising educational

27         requirements for licensure as a psychologist by

28         examination; changing a date, to defer certain

29         educational requirements; amending s. 490.006,

30         F.S.; providing additional requirements for

31         licensure as a psychologist by endorsement;


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    CS for SB 2220                                 First Engrossed



  1         amending s. 490.0085, F.S.; correcting the name

  2         of a trust fund;  amending s. 491.0045, F.S.;

  3         revising requirements for registration as a

  4         clinical social worker intern, marriage and

  5         family therapist intern, or mental health

  6         counselor intern; amending s. 491.0046, F.S.;

  7         revising requirements for provisional licensure

  8         of clinical social workers, marriage and family

  9         therapists, and mental health counselors;

10         amending s. 491.005, F.S.; revising

11         requirements for licensure of clinical social

12         workers, marriage and family therapists, and

13         mental health counselors; providing for

14         certification of education of interns;

15         providing rulemaking authority to implement

16         education and experience requirements for

17         licensure as a clinical social worker, marriage

18         and family therapist, or mental health

19         counselor; revising future licensure

20         requirements for mental health counselors and

21         providing rulemaking authority for

22         implementation thereof; amending s. 491.006,

23         F.S.; revising requirements for licensure or

24         certification by endorsement; amending s.

25         491.0085, F.S.; requiring laws and rules

26         courses and providing for approval thereof,

27         including providers and programs; correcting

28         the name of a trust fund; amending s. 491.014,

29         F.S.; revising an exemption from regulation

30         relating to certain temporally limited

31         services; amending s. 499.012, F.S.; redefining


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    CS for SB 2220                                 First Engrossed



  1         the term "wholesale distribution," relating to

  2         the distribution of prescription drugs, to

  3         provide for the exclusion of certain

  4         activities; amending ss. 626.883, 641.316,

  5         F.S.; requiring payments to a health care

  6         provider by a fiscal intermediary to include an

  7         explanation of services provided; creating a

  8         Task Force on Telehealth; providing its duties;

  9         requiring a report; amending s. 468.352, F.S.;

10         redefining the term "board"; amending s.

11         468.353, F.S.; conforming provision; providing

12         for the adoption of rules; amending s. 468.354,

13         F.S.; creating the Board of Respiratory Care;

14         providing for membership, powers, and duties;

15         amending s. 468.355, F.S.; providing for

16         periodic rather than annual review of certain

17         examinations and standards; amending s.

18         458.357, F.S.; conforming provisions; deleting

19         obsolete provisions; amending s. 468.364, F.S.;

20         deleting an examination fee; amending s.

21         468.365, F.S.; conforming provisions; amending

22         s. 464.016, F.S., providing that the use of the

23         title "nurse" without being licensed or

24         certified is a crime; amending s. 458.3115,

25         F.S.; revising requirements with respect to

26         eligibility of certain foreign-licensed

27         physicians to take and pass standardized

28         examinations; amending s. 458.3124, F.S.;

29         changing the date by which application for a

30         restricted license must be submitted; amending

31         s. 301, ch. 98-166, Laws of Florida;


                                  18

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    CS for SB 2220                                 First Engrossed



  1         prescribing fees for foreign-licensed

  2         physicians taking a certain examination;

  3         providing for a detailed study and analysis of

  4         clinical laboratory services for kidney

  5         dialysis patients; amending s. 455.651, F.S.;

  6         providing for treble damages, reasonable

  7         attorney fees, and costs for improper

  8         disclosure of confidential information;

  9         amending ss. 641.261 and 641.411, F.S.;

10         conforming references and cross-references;

11         amending s. 733.212, F.S.; establishing the

12         agency as a reasonably ascertainable creditor

13         with respect to administration of certain

14         estates; requiring that a task force be

15         appointed to review sources of revenue for the

16         trust fund; providing for appointments of its

17         members and specifying topics to be studied;

18         providing for its staffing; providing for

19         meetings; requiring a report and

20         recommendations; creating s. 395.40, F.S.;

21         declaring legislative findings and intent with

22         respect to creation of a statewide inclusive

23         trauma system, as defined; amending s. 395.401,

24         F.S.; deleting the definitions of the terms

25         "local trauma agency" and "regional trauma

26         agency"; defining the terms "trauma agency" and

27         "trauma alert victim"; prescribing duties of

28         the Department of Health with respect to

29         implementation of inclusive trauma systems and

30         trauma agency plans; amending s. 395.402, F.S.;

31         removing legislative findings; prescribing


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    CS for SB 2220                                 First Engrossed



  1         duties of the department with respect to

  2         assignment of counties to trauma service areas;

  3         amending s. 395.4045, F.S.; prescribing

  4         transport requirements for emergency medical

  5         services providers; creating ss. 458.351 and

  6         459.026, F.S.; requiring reports to the

  7         Department of Health of adverse incidents in

  8         specified settings; providing for review of

  9         such incidents and initiation of disciplinary

10         proceedings, where appropriate; authorizing

11         department access to certain records and

12         preserving exemption from public access

13         thereto; providing rulemaking authority;

14         requiring the Department of Health to establish

15         standards for compressed air used in

16         recreational sport diving; providing that

17         certain persons and entities are exempt from

18         compliance with such standards; providing for

19         testing compressed air; requiring that test

20         results be provided to the department;

21         requiring that persons or entities selling

22         compressed air post a certificate of testing in

23         a conspicuous location; providing a penalty;

24         authorizing rules; creating the Minority HIV

25         and AIDS Task Force within the Department of

26         Health; requiring the task force to develop

27         recommendations on ways to strengthen HIV and

28         AIDS prevention and treatment programs in

29         minority communities; requiring the Secretary

30         of Health to appoint the members of the task

31         force; requiring that the task force include


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    CS for SB 2220                                 First Engrossed



  1         representatives of certain groups and

  2         organizations; providing for the members to

  3         serve without compensation; requiring a report

  4         to the Legislature; providing for the task

  5         force to be abolished on a specified date;

  6         requiring that the Department of Health develop

  7         and implement a statewide HIV and AIDS

  8         prevention campaign that is directed to

  9         minorities; providing requirements for the

10         campaign; requiring the department to establish

11         positions within the department for regional

12         and statewide coordinators; requiring that the

13         department conduct a Black Leadership

14         Conference on HIV and AIDS by a specified date;

15         providing an appropriation; amending s. 20.41,

16         F.S.; providing that area agencies on aging are

17         subject to ch. 119 and ss. 286.011-286.012,

18         F.S., as specified; creating part XV of chapter

19         468, F.S.; providing definitions; requiring

20         that the Department of Health maintain a state

21         registry of certified nursing assistants;

22         authorizing the department to contract for

23         examination services; providing requirements

24         for obtaining certification as a certified

25         nursing assistant; requiring that the

26         department adopt rules governing initial

27         certification; specifying grounds for which the

28         department may deny, suspend, or revoke a

29         person's certification; authorizing the

30         department to exempt an applicant or

31         certificateholder from disqualification of


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    CS for SB 2220                                 First Engrossed



  1         certification; providing requirements for

  2         records and meetings held for disciplinary

  3         actions; exempting an employer from liability

  4         for terminating a certified nursing assistant

  5         under certain circumstances; providing

  6         penalties; providing for background screening;

  7         providing rulemaking authority; requiring

  8         persons who employ certified nursing assistants

  9         to make certain reports to the Department of

10         Health; requiring that the department update

11         the certified nursing assistant registry;

12         providing for future repeal of such provisions;

13         amending s. 400.211, F.S.; deleting obsolete

14         provisions with respect to the regulation of

15         certified nursing assistants; amending s.

16         409.912, F.S.; requiring the Agency for Health

17         Care Administration to enter into agreements

18         with certain organizations for purposes of

19         providing vision screening; providing effective

20         dates.

21

22  Be It Enacted by the Legislature of the State of Florida:

23

24         Section 1.  The Department of Children and Family

25  Services and the Agency for Health Care Administration shall,

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

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

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

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

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

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


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    CS for SB 2220                                 First Engrossed



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

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

  3  to read:

  4         20.43  Department of Health.--There is created a

  5  Department of Health.

  6         (3)  The following divisions of the Department of

  7  Health are established:

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

  9         (f)  Division of Emergency Medical Services and

10  Community Health Resources Local Health Planning, Education,

11  and Workforce Development.

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

13  and Intervention.

14         (i)  Division of Information Resource Management.

15         (j)  Division of Health Awareness and Tobacco.

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

17  department may use state or federal funds to:

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

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

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

21  for encouraging healthy lifestyle and disease prevention

22  behaviors and patient compliance with medical treatment, such

23  as tuberculosis therapy and smoking cessation programs. Such

24  incentives shall be intended to cause individuals to take

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

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

27  s. 112.061.

28         (b)  Plan and conduct health education campaigns for

29  the purpose of protecting or improving public health. The

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

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


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    CS for SB 2220                                 First Engrossed



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

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

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

  4  publications or radio or television time, for health

  5  information and promotional messages that recognize that the

  6  following behaviors, among others, are detrimental to public

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

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

  9  products, and exposure to environmental tobacco smoke; alcohol

10  consumption or other substance abuse during pregnancy; alcohol

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

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

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

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

15  purposes of activities under this paragraph, the Department of

16  Health may establish requirements for local matching funds or

17  in-kind contributions to create and distribute advertisements,

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

19  each of the targeted behaviors, establish an independent

20  evaluation and feedback system for the public health

21  communication campaign, and monitor and evaluate the efforts

22  to determine which of the techniques and methodologies are

23  most effective.

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

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

26         110.205  Career service; exemptions.--

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

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

29  no position, except for positions established for a limited

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

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


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    CS for SB 2220                                 First Engrossed



  1         (l)  All assistant division director, deputy division

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

  3  those positions determined by the department to have

  4  managerial responsibilities comparable to such positions,

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

  6  the Department of Health, the Department of Children and

  7  Family Services, and Rehabilitative Services and the

  8  Department of Corrections that are assigned primary duties of

  9  serving as the superintendent of an institution: positions in

10  the Department of Transportation that are assigned primary

11  duties of serving as regional toll managers and managers of

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

13  in the Department of Environmental Protection that are

14  assigned the duty of an Environmental Administrator or program

15  administrator; and positions in the Department of Health and

16  Rehabilitative Services that are assigned the duties duty of

17  an Environmental Administrator, Assistant County Health

18  Department Director, and County Health Department Financial

19  Administrator. Unless otherwise fixed by law, the department

20  shall set the salary and benefits of these positions in

21  accordance with the rules established for the Selected Exempt

22  Service.

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

24  district program managers, district program coordinators,

25  district subdistrict administrators, district administrative

26  services directors, district attorneys, county health

27  department directors, county health department administrators,

28  and the Deputy Director of Central Operations Services of the

29  Department of Children and Family Health and Rehabilitative

30  Services and the county health department directors and county

31  health department administrators of the Department of Health.


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    CS for SB 2220                                 First Engrossed



  1  Unless otherwise fixed by law, the department shall establish

  2  the salary range and benefits for these positions in

  3  accordance with the rules of the Selected Exempt Service.

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

  5  established within the Department of Business and Professional

  6  Regulation or the Department of Health. Unless otherwise fixed

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

  8  for these positions in accordance with the rules established

  9  for the Selected Exempt Service.

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

11  Statutes, 1998 Supplement, is amended to read:

12         120.80  Exceptions and special requirements;

13  agencies.--

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

15  120.57(1)(a), formal hearings may not be conducted by the

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

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

18  the Department of Health or the Agency for Health Care

19  Administration for matters relating to the regulation of

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

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

22  Department of Health in execution of the Special Supplemental

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

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

25  exemption from disqualification reviews for certified nurse

26  assistants program need not be conducted by an administrative

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

28  may contract with the Department of Children and Family

29  Services for a hearing officer in these matters.

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

31  Statutes, 1998 Supplement, is amended to read:


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    CS for SB 2220                                 First Engrossed



  1         154.504  Eligibility and benefits.--

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

  3  care for children and families challenge grant to provide

  4  primary health care services to children and families with

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

  6  Participants shall pay no monthly premium for participation,

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

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

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

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

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

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

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

14  health care providers, and all funds generated from copayments

15  shall be used by the governmental contractor and all other

16  provisions in s. 766.1115 are met.

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

18  Florida Statutes, to read:

19         287.155  Motor vehicles; purchase by Division of

20  Universities, Department of Health and Rehabilitative

21  Services, Department of Juvenile Justice, and Department of

22  Corrections.--

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

24  the approval of the Department of Management Services, to

25  purchase automobiles, trucks, and other automotive equipment

26  for use by county health departments.

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

28  Statutes, 1998 Supplement, is amended to read:

29         372.6672  Alligator management and trapping program

30  implementation; commission authority.--

31


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    CS for SB 2220                                 First Engrossed



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

  2  shall not be construed so as to supersede the regulatory

  3  authority or lawful responsibility of the Department of Health

  4  and Rehabilitative Services, the Department of Agriculture and

  5  Consumer Services, or any local governmental entity regarding

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

  7  deemed supplemental thereto.

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

  9  381.004, Florida Statutes, 1998 Supplement, is amended to

10  read:

11         381.004  Testing for human immunodeficiency virus.--

12         (3)  HUMAN IMMUNODEFICIENCY VIRUS TESTING; INFORMED

13  CONSENT; RESULTS; COUNSELING; CONFIDENTIALITY.--

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

15  informed consent is not required:

16         1.  When testing for sexually transmissible diseases is

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

18  following situations:

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

20  convicted of prostitution or of procuring another to commit

21  prostitution.

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

23  with s. 406.11.

24         2.  Those exceptions provided for blood, plasma,

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

26  381.0041.

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

28  licensed medical personnel in bona fide medical emergencies

29  when the test results are necessary for medical diagnostic

30  purposes to provide appropriate emergency care or treatment to

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


                                  28

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    CS for SB 2220                                 First Engrossed



  1  as supported by documentation in the medical record.

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

  3  is required.

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

  5  licensed medical personnel for medical diagnosis of acute

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

  7  obtaining informed consent would be detrimental to the

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

  9  and the test results are necessary for medical diagnostic

10  purposes to provide appropriate care or treatment to the

11  person being tested. Notification of test results in

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

13  detrimental to the patient.  This subparagraph does not

14  authorize the routine testing of patients for HIV infection

15  without informed consent.

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

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

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

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

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

21  defendant voluntarily, pursuant to court order for any

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

23  951.27, or s. 960.003; however, the results of any HIV test

24  performed shall be disclosed solely to the victim and the

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

26  960.003.

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

28         8.  For epidemiological research pursuant to s.

29  381.0032, for research consistent with institutional review

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

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


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    CS for SB 2220                                 First Engrossed



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

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

  3  researcher.

  4         9.  When human tissue is collected lawfully without the

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

  6  732.9185 or enucleation of the eyes as authorized by s.

  7  732.919.

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

  9  individual who comes into contact with medical personnel in

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

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

12  a blood sample is available that was taken from that

13  individual voluntarily by medical personnel for other

14  purposes.  "Medical personnel" includes a licensed or

15  certified health care professional; an employee of a health

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

17  paramedic or emergency medical technician as defined in s.

18  401.23.

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

20  voluntarily obtained blood sample, the individual from whom

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

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

23  The individual's refusal to consent and all information

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

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

26  record unless the individual gives written consent to entering

27  this information on the individual's medical record.

28         b.  Reasonable attempts to locate the individual and to

29  obtain consent shall be made and all attempts must be

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

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


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    CS for SB 2220                                 First Engrossed



  1  does not voluntarily consent to the performance of an HIV

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

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

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

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

  6  the medical personnel, that there has been a significant

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

  8  information is medically necessary to determine the course of

  9  treatment for the medical personnel.

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

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

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

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

14  testing or treatment not directly related to the initial HIV

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

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

17  personnel.

18         d.  In order to utilize the provisions of this

19  subparagraph, the medical personnel must either be tested for

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

21  test taken within 6 months prior to the significant exposure

22  if such test results are negative.

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

24  pursuant to this subparagraph shall maintain the

25  confidentiality of the information received and of the persons

26  tested.  Such confidential information is exempt from s.

27  119.07(1).

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

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

30  medical personnel or the employer of such person acting on

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


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    CS for SB 2220                                 First Engrossed



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

  2  statement by a physician licensed under chapter 458 or chapter

  3  459 that a significant exposure has occurred and that, in the

  4  physician's medical judgment, testing is medically necessary

  5  to determine the course of treatment constitutes probable

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

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

  8  and to the person who experienced the exposure.

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

10  individual who comes into contact with medical personnel in

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

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

13  medical personnel while the medical personnel provides

14  emergency medical treatment to the individual; or who comes

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

16  significant exposure has occurred while the nonmedical

17  personnel provides emergency medical assistance during a

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

19  medical emergency means an emergency medical condition outside

20  of a hospital or health care facility that provides physician

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

22  treatment for the medical emergency.

23         a.  An individual who is capable of providing consent

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

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

26  information concerning the performance of an HIV test and its

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

28  record unless the individual gives written consent to entering

29  this information on the individual's medical record.

30         b.  HIV testing shall be conducted only after a

31  licensed physician documents, in the medical record of the


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    CS for SB 2220                                 First Engrossed



  1  medical personnel or nonmedical personnel, that there has been

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

  3  judgment, the information is medically necessary to determine

  4  the course of treatment for the medical personnel or

  5  nonmedical personnel.

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

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

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

  9  medical personnel or nonmedical personnel. However, costs of

10  testing or treatment not directly related to the initial HIV

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

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

13  personnel or nonmedical personnel.

14         d.  In order to utilize the provisions of this

15  subparagraph, the medical personnel or nonmedical personnel

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

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

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

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

20  pursuant to this subparagraph shall maintain the

21  confidentiality of the information received and of the persons

22  tested.  Such confidential information is exempt from s.

23  119.07(1).

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

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

26  during treatment for the medical emergency, the medical

27  personnel, the employer of the medical personnel acting on

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

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

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

31  chapter 458 or chapter 459 that a significant exposure has


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    CS for SB 2220                                 First Engrossed



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

  2  testing is medically necessary to determine the course of

  3  treatment constitutes probable cause for the issuance of an

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

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

  6  experienced the exposure.

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

  8  examiner or attending physician upon an a deceased individual

  9  who is the source of a significant exposure to medical

10  personnel or nonmedical personnel who provided emergency

11  medical assistance and who expired or could not be

12  resuscitated while receiving during treatment for the medical

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

14  a significant exposure to medical or nonmedical personnel

15  providing such assistance or care.

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

17  physician documents in the medical record of the medical

18  personnel or nonmedical personnel that there has been a

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

20  judgment, the information is medically necessary to determine

21  the course of treatment for the medical personnel or

22  nonmedical personnel.

23         b.  Costs of any HIV test performed under this

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

25  family of the deceased person.

26         c.  For the provisions of this subparagraph to be

27  applicable, the medical personnel or nonmedical personnel must

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

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

30  significant exposure if such test results are negative.

31


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    CS for SB 2220                                 First Engrossed



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

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

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

  4  medically indicated by licensed medical personnel for medical

  5  diagnosis of a hospitalized infant as necessary to provide

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

  7  reasonable attempt, a parent cannot be contacted to provide

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

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

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

11  located.

12         14.  For the performance of HIV testing conducted to

13  monitor the clinical progress of a patient previously

14  diagnosed to be HIV positive.

15         15.  For the performance of repeated HIV testing

16  conducted to monitor possible conversion from a significant

17  exposure.

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

19  381.0051, Florida Statutes, to read:

20         381.0051  Family planning.--

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

22  to implement this section.

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

24  381.006, Florida Statutes, 1998 Supplement, to read:

25         381.006  Environmental health.--The department shall

26  conduct an environmental health program as part of fulfilling

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

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

29  factors in the environment.  The environmental health program

30  shall include, but not be limited to:

31


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    CS for SB 2220                                 First Engrossed



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

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

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

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

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

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

  7  protection, and supervision to persons who require such

  8  services and who are not related to the owner or

  9  administrator. The department may adopt rules necessary to

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

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

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

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

14  residential treatment facilities, crisis-stabilization units,

15  pediatric extended-care centers, intermediate-care facilities

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

17  jointly with the Department of Education, private and public

18  schools. These rules may include provisions relating to

19  operation and maintenance of facilities, buildings, grounds,

20  equipment, furnishings, and occupant-space requirements;

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

22  plumbing; sewage; sanitary facilities; insect and rodent

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

24  practices; and other matters the department finds are

25  appropriate or necessary to protect the safety and health of

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

27  rules that conflict with rules adopted by the licensing or

28  certifying agency. The department may enter and inspect at

29  reasonable hours to determine compliance with applicable

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

31  department may impose for violations of rules adopted under


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    CS for SB 2220                                 First Engrossed



  1  this section, the department shall also report such violations

  2  to any agency responsible for licensing or certifying the

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

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

  5  department.

  6

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

  8  this section.

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

10  Florida Statutes, is amended to read:

11         381.0061  Administrative fines.--

12         (1)  In addition to any administrative action

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

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

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

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

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

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

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

20  violator.  Each day that a violation continues may constitute

21  a separate violation.

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

23  section 381.0062, Florida Statutes, 1998 Supplement, are

24  amended to read:

25         381.0062  Supervision; private and certain public water

26  systems.--

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

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

29  chemical, or radiological substance or matter in water.

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

31  including the county health departments.


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    CS for SB 2220                                 First Engrossed



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

  2  chapter 403.

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

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

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

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

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

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

  9  Safe Drinking Water Act, which serves one or more

10  nonresidential establishments and provides piped water.

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

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

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

14  residences or two or more rental residences, and provides

15  piped water.

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

17  permissible level of a contaminant in potable water delivered

18  to consumers.

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

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

21  which may be a rental residence.

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

23  corporation, company, association, partnership, municipality,

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

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

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

27  satisfactory for human consumption, dermal contact, culinary

28  purposes, or dishwashing as approved by the department.

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

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

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


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    CS for SB 2220                                 First Engrossed



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

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

  3  than cleaning work areas or simple handwashing.  Examples of

  4  public consumption include, when making food or beverages

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

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

  7  preparing food or beverages; washing surfaces accessed by

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

  9  medical instruments or surfaces accessed by a patient; any

10  water usage in health care facilities; emergency washing

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

12  plants or establishments like slaughterhouses and

13  packinghouses; and water used in schools.

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

15  is not included or covered under the Florida Safe Drinking

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

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

18  section, public water systems are classified as limited use

19  community or limited use commercial.

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

21  or corporation that owns or operates a limited use community

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

23  water system, or a private water system.

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

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

26  maximum contaminant level violation caused by the raw water or

27  to deviate from construction standards established by rule of

28  the department.

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

30  have general supervision and control over all private water

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


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    CS for SB 2220                                 First Engrossed



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

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

  3  water supply program for which it has the duties and

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

  5  department shall:

  6         (a)  Administer and enforce the provisions of this

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

  8  section, including water quality and monitoring standards.

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

10  or operate a limited use community or limited use commercial

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

12  first make application to and obtain approval from the

13  department on forms adopted by rule of the department.

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

15  construction, modification, operation, or change of ownership

16  of, and conduct surveillance, enforcement, and compliance

17  investigations of, limited use community and limited use

18  commercial public water systems, and multi-family private

19  water systems.

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

21  amount sufficient to cover the costs of reviewing and acting

22  upon any application for the construction, modification, or

23  operation of a limited use community and limited use

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

25  than $90 annually.

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

27  amount sufficient to cover the costs of reviewing and acting

28  upon any application for the construction or change of

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

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

31


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    CS for SB 2220                                 First Engrossed



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

  2  amount sufficient to cover the costs of sample collection,

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

  4  coordination with other agencies when such work is not

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

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

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

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

  9  drinking water laboratory for contaminant analysis, and to

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

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

12  accordance with the provisions of this section to be deposited

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

14  exclusively for the payment of costs incurred in the

15  administration of this section.

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

17  or otherwise, introducing any contaminant which poses a health

18  hazard into a drinking water system.

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

20  of water problems and corrective measures under the conditions

21  specified by rule of the department.

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

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

24  than $25 or more than $40.

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

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

27  they have reasonable cause to believe a violation of this

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

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

30  private drinking water systems serving more than one

31  residence, to make an examination and investigation to


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    CS for SB 2220                                 First Engrossed



  1  determine the sanitary and safety conditions of such systems.

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

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

  4  duties pursuant to the provisions of this section is subject

  5  to the penalties provided in s. 381.0025.

  6         (5)  ENFORCEMENT AND PENALTIES.--

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

  8  limited use community or limited use commercial public water

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

10  system, without first complying with the requirements of this

11  section, who operates a water system in violation of

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

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

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

15  775.083.

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

17  section may be enforced by injunction or restraining order

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

19         (c)  Additional remedies available to county health

20  department staff through any county or municipal ordinance may

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

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

23  pursuant to this section.

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

25  Florida Statutes, are amended to read:

26         381.90  Health Information Systems Council; legislative

27  intent; creation, appointment, duties.--

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

29  members or their senior executive-level designees:

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

31


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    CS for SB 2220                                 First Engrossed



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

  2  Professional Regulation;

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

  4  Family Services;

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

  6  Administration;

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

  8         (f)  The Attorney General;

  9         (g)  The executive director of the Correctional Medical

10  Authority;

11         (h)  Two members representing county health

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

13  county, appointed by the Governor; and

14         (i)  A representative from the Florida Association of

15  Counties;.

16         (j)  The State Treasurer and Insurance Commissioner;

17         (k)  A representative from the Florida Healthy Kids

18  Corporation;

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

20  chosen by the Board of Regents;

21         (m)  The Commissioner of Education;

22         (n)  The Secretary of the Department of Elderly

23  Affairs; and

24         (o)  The Secretary of the Department of Juvenile

25  Justice.

26

27  Representatives of the Federal Government may serve without

28  voting rights.

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

30  but are not limited to, the following:

31


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    CS for SB 2220                                 First Engrossed



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

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

  3  186.022(9). Copies of the plan shall be transmitted

  4  electronically or in writing to the Executive Office of the

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

  6  President of the Senate.

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

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

  9  282.3032, for the identification, collection, standardization,

10  sharing, and coordination of health-related data across

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

12  entities.

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

14  planning among agencies that collect or maintain

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

16  implementation of this requirement to the Executive Office of

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

18  the House of Representatives by January 1, 2000.

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

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

21  the council.

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

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

24  that section, to read:

25         382.003  Powers and duties of the department.--The

26  department may:

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

28  for the creation, issuance, recording, rescinding,

29  maintenance, and processing of vital records and for carrying

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

31  382.016-382.019.


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    CS for SB 2220                                 First Engrossed



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

  2  information submitted to the department in the creation or

  3  amendment of a vital record be under oath.

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

  5  Statutes, is amended to read:

  6         382.004  Reproduction and destruction of records.--

  7         (3)  Photographs, microphotographs, or reproductions of

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

  9  produced certifications made in compliance with the provisions

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

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

12  treated as originals for the purpose of their admissibility in

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

14  courts and cases of the facts stated therein.

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

16  Statutes, 1998 Supplement, is amended to read:

17         382.008  Death and fetal death registration.--

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

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

20  the department with the local registrar of the district in

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

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

23  registrar if it has been completed and filed in accordance

24  with this chapter or adopted rules. The certificate shall

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

26  Disclosure of social security numbers obtained through this

27  requirement shall be limited to the purpose of administration

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

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

30  death or fetal death:

31


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    CS for SB 2220                                 First Engrossed



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

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

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

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

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

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

  7  the certificate and shall be considered part of the official

  8  record of death;

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

10  registered in the registration district in which the dead body

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

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

13  registered in the registration district in which the dead body

14  was first removed from such conveyance.

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

16  382.013, Florida Statutes, 1998 Supplement, are amended to

17  read:

18         382.013  Birth registration.--A certificate for each

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

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

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

22  local registrar if the certificate has been completed and

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

24  information regarding registered births shall be used for

25  comparison with information in the state case registry, as

26  defined in chapter 61.

27         (1)  FILING.--

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

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

30  charge of the facility shall be responsible for preparing the

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


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    CS for SB 2220                                 First Engrossed



  1  certificate with the local registrar.  Within 48 hours after

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

  3  during or immediately after the delivery shall provide the

  4  facility with the medical information required by the birth

  5  certificate.

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

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

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

  9  employed by the department was in attendance during or

10  immediately after the delivery, that person shall prepare and

11  file the certificate.

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

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

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

15  father shall report the birth to the registrar and provide

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

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

18  deems necessary and sufficient to establish the truth of the

19  facts to be recorded by the certificate and may withhold

20  registering the birth until its requirements are met. the

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

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

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

24         1.  The physician or midwife in attendance during or

25  immediately after the birth.

26         2.  In the absence of persons described in subparagraph

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

28  the birth.

29         3.  In the absence of persons described in subparagraph

30  2., the father or mother.

31


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    CS for SB 2220                                 First Engrossed



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

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

  3  birth occurred.

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

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

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

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

  8  the place of birth.

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

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

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

12  timely registration of the certificate.

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

14  the local registrar shall immediately notify the health care

15  facility or person filing the certificate and shall require

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

17  be obtained prior to issuing certified copies of the birth

18  certificate.

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

20  adoption after birth, the information on the birth certificate

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

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

23  is made under s. 63.152.

24         (2)  PATERNITY.--

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

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

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

28  determined otherwise by a court of competent jurisdiction.

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

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

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


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    CS for SB 2220                                 First Engrossed



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

  2  unless paternity has been determined otherwise by a court of

  3  competent jurisdiction.

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

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

  6  certificate without the execution of a consenting affidavit

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

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

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

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

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

12  status, and responsibilities that arise from signing an

13  acknowledgment of paternity, the facility shall provide the

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

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

16  agency established pursuant to s. 409.2557, regarding the

17  benefits of voluntary establishment of paternity. Upon request

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

19  facility shall assist in the execution of the affidavit.

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

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

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

23  entered on the certificate in accordance with the finding and

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

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

26  subsection (3).

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

28  other information about the father shall be entered on the

29  certificate.

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

31  of a child of undetermined parentage shall register a birth


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    CS for SB 2220                                 First Engrossed



  1  certificate shall be registered for every child of

  2  undetermined parentage showing all known or approximate facts

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

  4  information concerning the place and circumstances under which

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

  6  birth certificate relating to marital status and medical

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

  8  satisfaction of the department, a new birth certificate shall

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

10  birth certificate, and the original certificate shall be

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

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

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

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

15  registrant if of legal age.

16         Section 18.  Section 382.015, Florida Statutes, is

17  amended to read:

18         382.015  New certificates of live birth; duty of clerks

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

20  proceeding for adoption, annulment of an adoption, affirmation

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

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

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

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

25  form to be furnished by the department, together with

26  sufficient information to identify the original birth

27  certificate and to enable the preparation of a new birth

28  certificate.

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

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

31  adoption decree, together with the information necessary to


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    CS for SB 2220                                 First Engrossed



  1  identify the original certificate of live birth, and establish

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

  3  birth certificate, absent objection by the court decreeing the

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

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

  6  original birth certificate.  All names and identifying

  7  information relating to the adoptive parents entered on the

  8  new certificate shall refer to the adoptive parents, but

  9  nothing in the certificate shall refer to or designate the

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

11  adoption shall be copied as on the original certificate,

12  including the date of registration and filing.

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

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

15  information to identify the original certificate of live

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

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

18  certificate and restore the original certificate to its

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

20  shall be sealed by the department.

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

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

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

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

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

26  of the report or decree to the appropriate birth registration

27  authority in Canada.

28         (2)  DETERMINATION OF PATERNITY.--

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

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

31  request and receipt of a consenting affidavit signed by both


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    CS for SB 2220                                 First Engrossed



  1  parents acknowledging the paternity of the registrant,

  2  together with sufficient information to identify the original

  3  certificate of live birth, the department shall prepare and

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

  5  number as the original birth certificate.  If paternity has

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

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

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

  9  the original birth certificate at the request of the parents

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

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

12  the registrant's birth.

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

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

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

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

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

18  of birth.

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

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

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

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

23  included in the court order determining paternity or the name

24  must be changed pursuant to s. 68.07.

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

26  an order of affirmation of parental status issued pursuant to

27  s. 742.16, together with sufficient information to identify

28  the original certificate of live birth, the department shall

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

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

31  and identifying information of the registrant's parents


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    CS for SB 2220                                 First Engrossed



  1  entered on the new certificate shall be the commissioning

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

  3  designate the parents as the commissioning couple.

  4         (4)  SUBSTITUTION OF NEW CERTIFICATE OF BIRTH FOR

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

  6  department shall substitute the new certificate of birth for

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

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

  9  or other state custodian of vital records shall be forwarded

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

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

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

13  portion thereof, except when a court order requires issuance

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

15  an adoption, change in paternity, affirmation of parental

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

17  the department shall place the original certificate of birth

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

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

20  otherwise provided by law.

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

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

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

24  382.019 and 382.0195, all original, new, or amended

25  certificates of live birth shall be identical in form,

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

27  that the registrant is adopted or of undetermined parentage.

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

29  rules necessary for carrying out the provisions of this

30  section.

31


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    CS for SB 2220                                 First Engrossed



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

  2  section 382.016, Florida Statutes, to read:

  3         382.016  Amendment of records.--

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

  5  signed by the mother and father acknowledging the paternity of

  6  a registrant born out of wedlock, together with sufficient

  7  information to identify the original certificate of live

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

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

10  certificate. The names and identifying information of the

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

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

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

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

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

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

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

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

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

20  were married at the time of birth.

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

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

23  the new certificate of birth for the original certificate on

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

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

26  vital records shall be forwarded to the State Registrar.

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

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

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

30  order requires issuance of a certified copy of the original

31  certificate of birth. The department shall place the original


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    CS for SB 2220                                 First Engrossed



  1  certificate of birth and all papers pertaining thereto under

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

  3  jurisdiction or as otherwise provided by law.

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

  5  certificate, the birth certificate may only be amended to

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

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

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

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

10         Section 20.  Section 382.019, Florida Statutes, is

11  amended to read:

12         382.019  Delayed registration; administrative

13  procedures.--

14         (1)  Registration after 1 year is a delayed

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

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

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

18  section or rule, register a delayed certificate if the

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

20  death, or fetal death on file.

21         (2)  The department may require such supporting

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

23  deems necessary and sufficient to establish the truth of the

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

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

26  its requirements are met.

27         (3)  Certificates registered under this section are

28  admissible as prima facie evidence of the facts recited

29  therein with like force and effect as other vital records

30  received or admitted in evidence.

31


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    CS for SB 2220                                 First Engrossed



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

  2  section shall include a summary statement of the evidence

  3  submitted in support of the delayed registration.

  4         (5)  A delayed certificate of birth submitted for

  5  registration under this section shall be signed before a

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

  7  the parent or guardian of a minor registrant.

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

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

10  registered for a deceased person.

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

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

13  "delayed."

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

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

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

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

18  382.025, Florida Statutes, are amended to read:

19         382.025  Certified copies of vital records;

20  confidentiality; research.--

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

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

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

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

25         (a)  Certified copies of the original birth certificate

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

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

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

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

30  by the department and in the form prescribed by the

31  department, and only:


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    CS for SB 2220                                 First Engrossed



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

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

  3  legal representative;

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

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

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

  7  representative of any of such persons;

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

  9  old and not under seal pursuant to court order;

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

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

12  official purposes upon approval of the department; or

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

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

15  prevent the fraudulent use of the birth certificates of

16  deceased persons, the department shall match birth and death

17  certificates and post the fact of death to the appropriate

18  birth certificate.  Except for a commemorative birth

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

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

21  a commemorative birth certificate, such indication of death

22  shall be made on the back of the certificate.

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

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

25  a commemorative birth certificate representing that the birth

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

27  registrar. The certificate issued under this paragraph shall

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

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

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

31  by the Governor.


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    CS for SB 2220                                 First Engrossed



  1         (2)  OTHER RECORDS.--

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

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

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

  5  portion which is confidential and exempt from the provisions

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

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

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

  9  fetal death certificate which includes the confidential

10  portions shall be issued only:

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

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

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

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

15  other document that demonstrates his or her the family

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

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

18  behalf of any of them;

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

20  the United States for official purposes upon approval of the

21  department; or

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

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

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

25  after the date of death.

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

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

28  commemorative marriage license representing that the marriage

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

30  registrar.  The certificate issued under this paragraph shall

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


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    CS for SB 2220                                 First Engrossed



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

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

  3  by the Governor.

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

  5  Florida Statutes, is amended to read:

  6         382.0255  Fees.--

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

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

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

10  $4 which shall be deposited in the appropriate departmental

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

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

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

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

15  appropriation to the department for administration of this

16  chapter.

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

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

19  amended to read:

20         383.14  Screening for metabolic disorders, other

21  hereditary and congenital disorders, and environmental risk

22  factors.--

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

24  department shall administer and provide certain services to

25  implement the provisions of this section and shall:

26         (e)  Supply the necessary dietary treatment products

27  where practicable for diagnosed cases of phenylketonuria and

28  other metabolic diseases for as long as medically indicated

29  when the products are not otherwise available. Provide

30  nutrition education and supplemental foods to those families

31


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    CS for SB 2220                                 First Engrossed



  1  eligible for the Special Supplemental Nutrition Food Program

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

  3

  4  All provisions of this subsection must be coordinated with the

  5  provisions and plans established under this chapter, chapter

  6  411, and Pub. L. No. 99-457.

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

  8  and Infant Screening Advisory Council made up of 12 members

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

10  composed of two consumer members, three practicing

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

12  hematologist, one representative from each of the four medical

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

14  designee, one representative from the Department of Health

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

16  representative from the Developmental Services Program Office

17  of the Department of Children and Family Services. All

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

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

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

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

22  chairperson.  The council may establish ad hoc or temporary

23  technical advisory groups to assist the council with specific

24  topics which come before the council.  Council members shall

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

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

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

28  advise the department about:

29         (a)  Conditions for which testing should be included

30  under the screening program and the genetics program;

31


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    CS for SB 2220                                 First Engrossed



  1         (b)  Procedures for collection and transmission of

  2  specimens and recording of results; and

  3         (c)  Methods whereby screening programs and genetics

  4  services for children now provided or proposed to be offered

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

  6  and consolidated.

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

  8  Statutes, is amended to read:

  9         385.202  Statewide cancer registry.--

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

11  for establishing, administering, compiling, processing, and

12  providing biometric and statistical analyses to the reporting

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

14  accuracy of the information reported and to provide management

15  information to the reporting facilities.  Such reporting

16  hospitals shall be reimbursed for reasonable costs.

17         Section 25.  Section 385.203, Florida Statutes, is

18  amended to read:

19         385.203  Diabetes Advisory Council; creation; function;

20  membership.--

21         (1)  To guide a statewide comprehensive approach to

22  diabetes prevention, diagnosis, education, care, treatment,

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

24  Advisory Council that serves as the advisory unit to the

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

26  Health, other governmental agencies, professional and other

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

28         (a)  Provide statewide leadership to continuously

29  improve the lives of Floridians with diabetes and reduce the

30  burden of diabetes.

31


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    CS for SB 2220                                 First Engrossed



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

  2  issues related to the public health approach for the delivery

  3  of health care services to persons with diabetes.

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

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

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

  7  recommendations to the deans regarding the need for diabetes

  8  education, treatment, and research activities to promote the

  9  prevention and control of diabetes.

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

11  of Health or his or her designee to make specific

12  recommendations regarding the public health aspects of the

13  prevention and control of diabetes.

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

15  the Governor with advice from nominations by the Board of

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

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

18  until their successors are appointed or qualified.

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

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

21  diabetes mellitus as follows:

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

23  affected by diabetes.

24         (b)  Twenty members, who must include one

25  representative from each of the following areas: nursing with

26  diabetes-educator certification; dietary with diabetes

27  educator certification; podiatry; opthalmology or optometry;

28  psychology; pharmacy; adult endocrinology; pediatric

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

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

31  a county health department; an American Diabetes


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    CS for SB 2220                                 First Engrossed



  1  Association-recognized community education program; each

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

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

  4  regional program; and an employer.

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

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

  7  four practicing physicians; one representative from each

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

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

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

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

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

13  Health; and one professor of nutrition.

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

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

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

17  meetings shall be held each year.

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

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

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

21  quorum is necessary for the council to take any official

22  action.  The Department of Health secretary shall keep a

23  complete record of the proceedings of each meeting.  The

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

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

26  department, and these and other documents about matters within

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

28  the council.

29         (5)  Members of the council shall serve without

30  remuneration but may be reimbursed for per diem and travel

31


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    CS for SB 2220                                 First Engrossed



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

  2  are available.

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

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

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

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

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

  8  operation of the council or the diabetes centers established

  9  in the various medical schools.

10         Section 26.  Section 391.028, Florida Statutes, 1998

11  Supplement, is amended to read:

12         391.028  Administration.--The Children's Medical

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

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

15  Services must be a physician licensed under chapter 458 or

16  chapter 459 who has specialized training and experience in the

17  provision of health care to children and who has recognized

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

19  programs. The division director shall be the deputy secretary

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

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

22  director may appoint division directors subject to the

23  approval of the secretary.

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

25  Medical Services area offices to perform operational

26  activities, including, but not limited to:

27         (a)  Providing case management services for the

28  network.

29         (b)  Providing local oversight of the program.

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

31  eligibility for the program.


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    CS for SB 2220                                 First Engrossed



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

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

  3         (e)  Authorizing services in the program and developing

  4  spending plans.

  5         (f)  Participating in the development of treatment

  6  plans.

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

  8  grievances from participants and health care providers.

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

10  be directed by a physician licensed under chapter 458 or

11  chapter 459 who has specialized training and experience in the

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

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

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

15  Medical Services physician consultants.

16         Section 27.  Section 391.0315, Florida Statutes, 1998

17  Supplement, is amended to read:

18         391.0315  Benefits.--Benefits provided under the

19  program for children with special health care needs shall be

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

21  409.905 and 409.906. The department may offer additional

22  benefits for early intervention services, respite services,

23  genetic testing, genetic and nutritional counseling, and

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

25  medically necessary. No child or person determined eligible

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

27  of the Social Security Act shall receive any service other

28  than an initial health care screening or treatment of an

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

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

31  program.


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    CS for SB 2220                                 First Engrossed



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

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

  3  section, to read:

  4         392.69  Appropriation, sinking, and maintenance trust

  5  funds; additional powers of the department.--

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

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

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

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

10  regular operating appropriation, or use any sums of money

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

12  by the issuance of revenue certificates of the hospital to

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

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

15  construction or maintenance of additional facilities or

16  improvement to existing facilities, as the department deems

17  necessary.

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

19  which shall meet quarterly to review and make recommendations

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

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

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

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

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

25  diem and travel expenses under s. 112.061.

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

27  Statutes, is added to read:

28         401.25  Licensure as a basic life support or an

29  advanced life support service.--

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

31  specifically exempted from this part, when transporting a


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    CS for SB 2220                                 First Engrossed



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

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

  3  patient attendant who is a certified emergency medical

  4  technician, certified paramedic, or licensed physician; and

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

  6  This paragraph does not apply to interfacility transfers

  7  governed by s. 401.252(1).

  8         (b)  Each permitted advanced life support ambulance not

  9  specifically exempted from this part, when transporting a

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

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

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

13  certified emergency medical technician, certified paramedic,

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

15  401.281 for drivers. The person with the highest medical

16  certifications shall be in charge of patient care. This

17  paragraph does not apply to interfacility transfers governed

18  by s. 401.252(1).

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

20  Statutes, is amended to read:

21         401.27  Personnel; standards and certification.--

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

23  recertified as an emergency medical technician or paramedic

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

25  the department which shall contain such information as the

26  department reasonably requires, which may include affirmative

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

28  The department shall determine whether the applicant meets the

29  requirements specified in this section and in rules of the

30  department and shall issue a certificate to any person who

31  meets such requirements.


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    CS for SB 2220                                 First Engrossed



  1         Section 31.  Section 401.2701, Florida Statutes, is

  2  created to read:

  3         401.2701  Emergency medical services training

  4  programs.--

  5         (1)  Any private or public institution in Florida

  6  desiring to conduct an approved program for the education of

  7  emergency medical technicians and paramedics shall:

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

  9  by the department, which must include:

10         1.  Evidence that the institution is in compliance with

11  all applicable requirements of the Department of Education.

12         2.  Evidence of an affiliation agreement with a

13  hospital that has an emergency department staffed by at least

14  one physician and one registered nurse.

15         3.  Evidence of an affiliation agreement with a current

16  Florida-licensed emergency medical services provider. Such

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

18  provider to conduct the field experience portion of the

19  education program.

20         4.  Documentation verifying faculty, including:

21         a.  A medical director who is a licensed physician

22  meeting the applicable requirements for emergency medical

23  services medical directors as outlined in this chapter and

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

25  duty and responsibility of certifying that graduates have

26  successfully completed all phases of the education program and

27  are proficient in basic or advanced life support techniques,

28  as applicable.

29         b.  A program director responsible for the operation,

30  organization, periodic review, administration, development,

31  and approval of the program.


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    CS for SB 2220                                 First Engrossed



  1         5.  Documentation verifying that the curriculum:

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

  3  plans in the most recent Emergency Medical Technician-Basic

  4  National Standard Curricula for emergency medical technician

  5  programs and Emergency Medical Technician-Paramedic National

  6  Standard Curricula for paramedic programs.

  7         b.  Includes 2 hours of instruction on the trauma

  8  scorecard methodologies for assessment of adult trauma

  9  patients and pediatric trauma patients as specified by the

10  department by rule.

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

12  training consistent with the requirements of chapter 381.

13         6.  Evidence of sufficient medical and educational

14  equipment to meet emergency medical services training program

15  needs.

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

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

18  conducted within 30 days after notification to the institution

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

20  department must determine the applicant's compliance with the

21  following criteria:

22         1.  Emergency medical technician programs must be a

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

24  clinical supervision, including 10 hours in a hospital

25  emergency department.

26         2.  Paramedic programs must be available only to

27  Florida-certified emergency medical technicians or an

28  emergency medical technician applicant who will obtain Florida

29  certification prior to completion of phase one of the

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

31  hours of didactic and skills practice components, with the


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    CS for SB 2220                                 First Engrossed



  1  skills laboratory student-to-instructor ratio not exceeding

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

  3  experience aboard an advanced life support permitted

  4  ambulance.

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

  6  shall prepare a report which shall be provided to the

  7  institution. Upon completion of the report, the application

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

  9  shall apply.

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

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

12  emergency medical technician training program or a paramedic

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

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

15  needing improvement, and any suggested means of improvement of

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

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

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

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

20  plan of correction. Such intent notification shall provide the

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

22  correction must be submitted to the department within 30 days

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

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

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

26  denial of the application may be reviewed as provided in

27  chapter 120.

28         (4)  Approved emergency medical services training

29  programs must maintain records and reports that must be made

30  available to the department, upon written request. Such

31  records must include student applications, records of


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    CS for SB 2220                                 First Engrossed



  1  attendance, records of participation in hospital clinic and

  2  field training, medical records, course objectives and

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

  4  number of applicants, number of students accepted, admission

  5  requirements, description of qualifications, duties and

  6  responsibilities of faculty, and correspondence.

  7         (5)  Each approved program must notify the department

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

  9  status of faculty. Each approved program must require its

10  students to pass a comprehensive final written and practical

11  examination evaluating the skills described in the current

12  United States Department of Transportation EMT-Basic or

13  EMT-Paramedic, National Standard Curriculum. Each approved

14  program must issue a certificate of completion to program

15  graduates within 14 days of completion.

16         Section 32.  Section 401.2715, Florida Statutes, is

17  created to read:

18         401.2715  Recertification training of emergency medical

19  technicians and paramedics.--

20         (1)  The department shall establish by rule criteria

21  for all emergency medical technician and paramedic

22  recertification training. The rules shall provide that all

23  recertification training equals at least 30 hours, includes

24  the performance parameters for adult and pediatric emergency

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

26  recordkeeping.

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

28  or governmental entity may conduct emergency medical

29  technician or paramedic recertification training upon

30  application to the department and payment of a nonrefundable

31  fee to be deposited into the Emergency Medical Services Trust


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    CS for SB 2220                                 First Engrossed



  1  Fund. Institutions conducting department-approved educational

  2  programs as provided in this chapter and licensed ambulance

  3  services are exempt from the application process and payment

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

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

  6  administering this approval process.

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

  8  s. 401.27, certified emergency medical technicians and

  9  paramedics must provide proof of completion of training

10  conducted pursuant to this section. The department shall

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

12  department-approved educational program's medical director as

13  documentation that the certificateholder has completed a

14  minimum of 30 hours of recertification training as provided

15  herein.

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

17  section 401.30, Florida Statutes, 1998 Supplement, are

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

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

20         401.30  Records.--

21         (2)  Each licensee must provide the receiving hospital

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

23  patient who is transported to the hospital. The information

24  contained in the record and the method and timeframe for

25  providing the record shall be prescribed by rule of the

26  department.

27         (3)(2)  Reports to the department from licensees which

28  cover statistical data are public records, except that the

29  names of patients and other patient-identifying information

30  contained in such reports are confidential and exempt from the

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


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    CS for SB 2220                                 First Engrossed



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

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

  3  or have information deleted.

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

  5  patient examination or treatment information are confidential

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

  7  disclosed without the consent of the person to whom they

  8  pertain, but appropriate limited disclosure may be made

  9  without such consent:

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

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

12  minor;

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

14  the treatment of the patient;

15         (c)  To the department;

16         (d)  To the service medical director;

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

18  Any such discussions during a critical incident stress

19  debriefing shall be considered privileged communication under

20  s. 90.503;

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

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

23  court of competent jurisdiction and proper notice by the party

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

25  representative; or

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

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

28  assist the agency in performing quality assurance activities

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

30  obtained under this paragraph are confidential and exempt from

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


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    CS for SB 2220                                 First Engrossed



  1

  2  This subsection does not prohibit the department or a licensee

  3  from providing information to any law enforcement agency or

  4  any other regulatory agency responsible for the regulation or

  5  supervision of emergency medical services and personnel.

  6         (5)(4)  The department shall adopt and enforce all

  7  rules necessary to administer this section.

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

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

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

11         401.35  Rules.--The department shall adopt rules

12  necessary to carry out the purposes of this part.

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

14  governing:

15         (l)  Licensees' security and storage of controlled

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

17  provisions of chapter 499 or chapter 893.

18         (2)  The rules must establish application requirements

19  for licensure and certification.  Pursuant thereto, the

20  department must develop application forms for basic life

21  support services and advanced life support services.  An

22  application for each respective service license must include,

23  but is not limited to:

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

25  which shall contain such information as the department

26  reasonably requires, which may include affirmative evidence of

27  ability to comply with applicable laws and rules.

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

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

30         409.9126  Children with special health care needs.--

31


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    CS for SB 2220                                 First Engrossed



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

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

  3  basis and shall utilize a primary care case management

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

  5  shall phase in by geographical area, capitation payments to

  6  Children's Medical Services for services provided to Medicaid

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

  8  the Agency for Health Care Administration shall make

  9  capitation payments for Children's Medical Services enrollees

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

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

12  Medical Services program for services provided to

13  Medicaid-eligible children with special health care needs

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

15  capitated basis.

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

17  465.019, Florida Statutes, 1998 Supplement, is amended to

18  read:

19         465.019  Institutional pharmacies; permits.--

20         (2)  The following classes of institutional pharmacies

21  are established:

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

23  institutional pharmacies in which all medicinal drugs are

24  administered from individual prescription containers to the

25  individual patient and in which medicinal drugs are not

26  dispensed on the premises, except that nursing homes licensed

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

28  administration to residents. No medicinal drugs may be

29  dispensed in a Class I institutional pharmacy.

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

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


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    CS for SB 2220                                 First Engrossed



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

  2  read:

  3         499.005  Prohibited acts.--It is unlawful to perform or

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

  5  state:

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

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

  8  the state in which the person resides to distribute legend

  9  drugs.

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

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

12  which the person receives the drug resides to purchase or

13  possess legend drugs.

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

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

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

17  compressed medical gases.

18         (19)  Providing the department with false or fraudulent

19  records, or making false or fraudulent statements, regarding

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

21  device, or cosmetic.

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

23  operating without a valid permit when a permit or registration

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

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

26  patient or ultimate consumer without a prescription or order

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

28  device.

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

30  Florida Statutes, is amended to read:

31


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    CS for SB 2220                                 First Engrossed



  1         499.007  Misbranded drug or device.--A drug or device

  2  is misbranded:

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

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

  5  fails to bear the statement:

  6         (a)  "Caution:  Federal Law Prohibits Dispensing

  7  Without Prescription"; or

  8         (b)  "Rx Only";

  9         (c)  The prescription symbol followed by the word

10  "Only"; or

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

12  Without Prescription."

13

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

15  prescription of a practitioner licensed by law to prescribe

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

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

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

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

20  seller, the prescription number and the date the prescription

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

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

23  statements.  This exemption does not apply to any drug

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

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

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

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

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

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

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

31  Florida Statutes, is amended to read:


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    CS for SB 2220                                 First Engrossed



  1         499.028  Drug samples or complimentary drugs; starter

  2  packs; permits to distribute.--

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

  4  sample unless:

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

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

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

  8  distributor that holds a permit issued under ss.

  9  499.001-499.081.

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

11  samples may be distributed pursuant to this section.

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

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

14  her employment.

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

16  Statutes, is amended to read:

17         499.069  Punishment for violations of s. 499.005;

18  dissemination of false advertisement.--

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

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

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

22  the violation is committed after a conviction of such person

23  under this section has become final, such person is guilty of

24  a misdemeanor of the first degree, punishable as provided in

25  s. 775.082 or s. 775.083 or as otherwise provided in ss.

26  499.001-499.081, except that any person who violates

27  subsection (8), subsection (10), subsection (14), subsection

28  (15), subsection (16), or subsection (17) of s. 499.005 is

29  guilty of a felony of the third degree, punishable as provided

30  in s. 775.082, s. 775.083, or s. 775.084, or as otherwise

31  provided in ss. 499.001-499.081.


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    CS for SB 2220                                 First Engrossed



  1         Section 41.  Subsection (1) of section 742.10, Florida

  2  Statutes, is amended to read:

  3         742.10  Establishment of paternity for children born

  4  out of wedlock.--

  5         (1)  This chapter provides the primary jurisdiction and

  6  procedures for the determination of paternity for children

  7  born out of wedlock. When the establishment of paternity has

  8  been raised and determined within an adjudicatory hearing

  9  brought under the statutes governing inheritance, or

10  dependency under workers' compensation or similar compensation

11  programs, or when an affidavit acknowledging paternity or a

12  stipulation of paternity is executed by both parties and filed

13  with the clerk of the court, or when a consenting affidavit as

14  provided for in s. 382.013 or s. 382.016 s. 382.015 is

15  executed by both parties, it shall constitute the

16  establishment of paternity for purposes of this chapter. If no

17  adjudicatory proceeding was held, a voluntary acknowledgment

18  of paternity shall create a rebuttable presumption, as defined

19  by s. 90.304, of paternity and is subject to the right of any

20  signatory to rescind the acknowledgment within 60 days of the

21  date the acknowledgment was signed or the date of an

22  administrative or judicial proceeding relating to the child,

23  including a proceeding to establish a support order, in which

24  the signatory is a party, whichever is earlier.  Both parents

25  are required to provide their social security numbers on any

26  acknowledgment of paternity, consent affidavit, or stipulation

27  of paternity. Except for consenting affidavits under seal

28  pursuant to ss. s. 382.015 and 382.016, the Office of Vital

29  Statistics shall provide certified copies of affidavits to the

30  Title IV-D agency upon request.

31


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    CS for SB 2220                                 First Engrossed



  1         Section 42.  Section 39.303, Florida Statutes, 1998

  2  Supplement, is amended to read:

  3         39.303  Child protection teams; services; eligible

  4  cases.--The Division of Children's Medical Services of the

  5  Department of Health shall develop, maintain, and coordinate

  6  the services of one or more multidisciplinary child protection

  7  teams in each of the service districts of the Department of

  8  Children and Family Services.  Such teams may be composed of

  9  representatives of appropriate health, mental health, social

10  service, legal service, and law enforcement agencies. The

11  Legislature finds that optimal coordination of child

12  protection teams and sexual abuse treatment programs requires

13  collaboration between the Department of Health and the

14  Department of Children and Family Services. The two

15  departments shall maintain an interagency agreement that

16  establishes protocols for oversight and operations of child

17  protection teams and sexual abuse treatment programs. The

18  Secretary of Health and the director of Deputy Secretary for

19  Children's Medical Services, in consultation with the

20  Secretary of Children and Family Services, shall maintain the

21  responsibility for the screening, employment, and, if

22  necessary, the termination of child protection team medical

23  directors, at headquarters and in the 15 districts. Child

24  protection team medical directors shall be responsible for

25  oversight of the teams in the districts.

26         (1)  The Department of Health shall utilize and convene

27  the teams to supplement the assessment and protective

28  supervision activities of the family safety and preservation

29  program of the Department of Children and Family Services.

30  Nothing in this section shall be construed to remove or reduce

31  the duty and responsibility of any person to report pursuant


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    CS for SB 2220                                 First Engrossed



  1  to this chapter all suspected or actual cases of child abuse,

  2  abandonment, or neglect or sexual abuse of a child.  The role

  3  of the teams shall be to support activities of the program and

  4  to provide services deemed by the teams to be necessary and

  5  appropriate to abused, abandoned, and neglected children upon

  6  referral.  The specialized diagnostic assessment, evaluation,

  7  coordination, consultation, and other supportive services that

  8  a child protection team shall be capable of providing include,

  9  but are not limited to, the following:

10         (a)  Medical diagnosis and evaluation services,

11  including provision or interpretation of X rays and laboratory

12  tests, and related services, as needed, and documentation of

13  findings relative thereto.

14         (b)  Telephone consultation services in emergencies and

15  in other situations.

16         (c)  Medical evaluation related to abuse, abandonment,

17  or neglect, as defined by policy or rule of the Department of

18  Health.

19         (d)  Such psychological and psychiatric diagnosis and

20  evaluation services for the child or the child's parent or

21  parents, legal custodian or custodians, or other caregivers,

22  or any other individual involved in a child abuse,

23  abandonment, or neglect case, as the team may determine to be

24  needed.

25         (e)  Expert medical, psychological, and related

26  professional testimony in court cases.

27         (f)  Case staffings to develop treatment plans for

28  children whose cases have been referred to the team.  A child

29  protection team may provide consultation with respect to a

30  child who is alleged or is shown to be abused, abandoned, or

31  neglected, which consultation shall be provided at the request


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    CS for SB 2220                                 First Engrossed



  1  of a representative of the family safety and preservation

  2  program or at the request of any other professional involved

  3  with a child or the child's parent or parents, legal custodian

  4  or custodians, or other caregivers.  In every such child

  5  protection team case staffing, consultation, or staff activity

  6  involving a child, a family safety and preservation program

  7  representative shall attend and participate.

  8         (g)  Case service coordination and assistance,

  9  including the location of services available from other public

10  and private agencies in the community.

11         (h)  Such training services for program and other

12  employees of the Department of Children and Family Services,

13  employees of the Department of Health, and other medical

14  professionals as is deemed appropriate to enable them to

15  develop and maintain their professional skills and abilities

16  in handling child abuse, abandonment, and neglect cases.

17         (i)  Educational and community awareness campaigns on

18  child abuse, abandonment, and neglect in an effort to enable

19  citizens more successfully to prevent, identify, and treat

20  child abuse, abandonment, and neglect in the community.

21         (2)  The child abuse, abandonment, and neglect cases

22  that are appropriate for referral by the family safety and

23  preservation program to child protection teams of the

24  Department of Health for support services as set forth in

25  subsection (1) include, but are not limited to, cases

26  involving:

27         (a)  Bruises, burns, or fractures in a child under the

28  age of 3 years or in a nonambulatory child of any age.

29         (b)  Unexplained or implausibly explained bruises,

30  burns, fractures, or other injuries in a child of any age.

31


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    CS for SB 2220                                 First Engrossed



  1         (c)  Sexual abuse of a child in which vaginal or anal

  2  penetration is alleged or in which other unlawful sexual

  3  conduct has been determined to have occurred.

  4         (d)  Venereal disease, or any other sexually

  5  transmitted disease, in a prepubescent child.

  6         (e)  Reported malnutrition of a child and failure of a

  7  child to thrive.

  8         (f)  Reported medical, physical, or emotional neglect

  9  of a child.

10         (g)  Any family in which one or more children have been

11  pronounced dead on arrival at a hospital or other health care

12  facility, or have been injured and later died, as a result of

13  suspected abuse, abandonment, or neglect, when any sibling or

14  other child remains in the home.

15         (h)  Symptoms of serious emotional problems in a child

16  when emotional or other abuse, abandonment, or neglect is

17  suspected.

18         (3)  In all instances in which a child protection team

19  is providing certain services to abused, abandoned, or

20  neglected children, other offices and units of the Department

21  of Health, and offices and units of the Department of Children

22  and Family Services, shall avoid duplicating the provision of

23  those services.

24         Section 43.  Subsection (3) of section 385.203, Florida

25  Statutes, is amended to read:

26         385.203  Diabetes Advisory Council; creation; function;

27  membership.--

28         (3)  The council shall be composed of 18 citizens of

29  the state as follows:  four practicing physicians; one

30  representative from each medical school; seven interested

31  citizens, at least three of whom shall be persons who have or


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  1  have had diabetes mellitus or who have a child with diabetes

  2  mellitus; the Secretary of Health or his or her designee; one

  3  representative from the Division of Children's Medical

  4  Services of the Department of Health who represents Children's

  5  Medical Services; and one professor of nutrition.

  6         Section 44.  Subsection (8) of section 391.021, Florida

  7  Statutes, 1998 Supplement, is amended to read:

  8         391.021  Definitions.--When used in this act, unless

  9  the context clearly indicates otherwise:

10         (8)  "Program" means the Children's Medical Services

11  program established in the Division of Children's Medical

12  Services of the department.

13         Section 45.  Paragraph (b) of subsection (1) of section

14  391.221, Florida Statutes, 1998 Supplement, is amended to

15  read:

16         391.221  Statewide Children's Medical Services Network

17  Advisory Council.--

18         (1)  The secretary of the department may appoint a

19  Statewide Children's Medical Services Network Advisory Council

20  for the purpose of acting as an advisory body to the

21  department.  Specifically, the duties of the council shall

22  include, but not be limited to:

23         (b)  Making recommendations to the director of the

24  Division of Children's Medical Services concerning the

25  selection of health care providers for the Children's Medical

26  Services network.

27         Section 46.  Subsection (1) of section 391.222, Florida

28  Statutes, 1998 Supplement, is amended to read:

29         391.222  Cardiac Advisory Council.--

30         (1)  The secretary of the department may appoint a

31  Cardiac Advisory Council for the purpose of acting as the


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  1  advisory body to the Department of Health Division of

  2  Children's Medical Services in the delivery of cardiac

  3  services to children. Specifically, the duties of the council

  4  shall include, but not be limited to:

  5         (a)  Recommending standards for personnel and

  6  facilities rendering cardiac services for the Division of

  7  Children's Medical Services;

  8         (b)  Receiving reports of the periodic review of

  9  cardiac personnel and facilities to determine if established

10  standards for the Division of Children's Medical Services

11  cardiac services are met;

12         (c)  Making recommendations to the division director as

13  to the approval or disapproval of reviewed personnel and

14  facilities;

15         (d)  Making recommendations as to the intervals for

16  reinspection of approved personnel and facilities; and

17         (e)  Providing input to the Division of Children's

18  Medical Services on all aspects of Children's Medical Services

19  cardiac programs, including the rulemaking process.

20         Section 47.  Section 391.223, Florida Statutes, 1998

21  Supplement, is amended to read:

22         391.223  Technical advisory panels.--The secretary of

23  the department may establish technical advisory panels to

24  assist the Division of Children's Medical Services in

25  developing specific policies and procedures for the Children's

26  Medical Services program.

27         Section 48.  Subsection (3) of section 381.731, Florida

28  Statutes, as amended by section 2 of chapter 98-224, Laws of

29  Florida, is repealed.

30         Section 49.  Subsection (5) of section 383.307, Florida

31  Statutes, is repealed.


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  1         Section 50.  Subsection (7) of section 404.20, Florida

  2  Statutes, is repealed.

  3         Section 51.  Section 409.9125, Florida Statutes, is

  4  repealed.

  5         Section 52.  The building that is known as the "1911

  6  State Board of Health Building" which is part of a

  7  multi-building complex with the address of 1217 Pearl Street,

  8  Jacksonville, Florida, shall be known as the "Wilson T.

  9  Sowder, M.D., Building."

10         Section 53.  The building authorized by chapter 98-307,

11  Laws of Florida, which will be located at the University of

12  South Florida which will house laboratory facilities for the

13  Department of Health shall be known as the "William G. 'Doc'

14  Myers, M.D., Building."

15         Section 54.  The Department of Health headquarters

16  building which will comprise approximately 100,000 square feet

17  which is authorized by Specific Appropriation 1986 in the

18  1998-1999 General Appropriations Act shall be known as the "E.

19  Charlton Prather, M.D., Building."

20         Section 55.  The Department of Health may apply for and

21  become a National Environmental Laboratory Accreditation

22  Program accrediting authority. The department, as an

23  accrediting entity, may adopt rules pursuant to sections

24  120.536(1) and 120.54, Florida Statutes, to implement

25  standards of the National Environmental Laboratory

26  Accreditation Program, including requirements for proficiency

27  testing providers and other rules that are not inconsistent

28  with this section, including rules pertaining to fees,

29  application procedures, standards applicable to environmental

30  or public water supply laboratories, and compliance.

31


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  1         Section 56.  Section 381.0022, Florida Statutes, 1998

  2  Supplement, is amended to read:

  3         381.0022  Sharing confidential or exempt information.--

  4         (1)  Notwithstanding any other provision of law to the

  5  contrary, the Department of Health and the Department of

  6  Children and Family Services may share confidential

  7  information or information exempt from disclosure under

  8  chapter 119 on any individual who is or has been the subject

  9  of a program within the jurisdiction of each agency.

10  Information so exchanged remains confidential or exempt as

11  provided by law.

12         (2)  Notwithstanding any other provision of law to the

13  contrary, the Department of Health may share confidential

14  information or information exempt from disclosure under

15  chapter 119 on any individual who is or has been a Medicaid

16  recipient and is or was the subject of a program within the

17  jurisdiction of the Department of Health, for the purpose of

18  requesting, receiving, or auditing payment for services.

19  Information so exchanged remains confidential or exempt as

20  provided by law.

21         Section 57.  Paragraph (c) of subsection (2) of section

22  383.011, Florida Statutes, 1998 Supplement, is amended to

23  read:

24         383.011  Administration of maternal and child health

25  programs.--

26         (2)  The Department of Health shall follow federal

27  requirements and may adopt any rules necessary for the

28  implementation of the maternal and child health care program,

29  the WIC program, and the Child Care Food Program.

30         (c)  With respect to the Child Care Food Program, the

31  department shall adopt rules that interpret and implement


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  1  relevant federal regulations, including 7 C.F.R. part 226. The

  2  rules may must address at least those program requirements and

  3  procedures identified in paragraph (1)(i).

  4         Section 58.  Section 468.304, Florida Statutes, 1998

  5  Supplement, is amended to read:

  6         468.304  Certification examination; admission.--The

  7  department shall admit to examination for certification any

  8  applicant who pays to the department a nonrefundable fee not

  9  to exceed $100 plus the actual per-applicant cost to the

10  department for purchasing the examination from a national

11  organization and submits satisfactory evidence, verified by

12  oath or affirmation, that she or he:

13         (1)  Is at least 18 years of age at the time of

14  application;

15         (2)  Is a high school graduate or has successfully

16  completed the requirements for a graduate equivalency diploma

17  (GED) or its equivalent;

18         (3)  Is of good moral character; and

19         (4)(a)  Has successfully completed an educational

20  program, which program may be established in a hospital

21  licensed pursuant to chapter 395 or in an accredited

22  postsecondary academic institution which is subject to

23  approval by the department as maintaining a satisfactory

24  standard; or

25         (b)1.  With respect to an applicant for a basic X-ray

26  machine operator's certificate, has completed a course of

27  study approved by the department with appropriate study

28  material provided the applicant by the department;

29         2.  With respect to an applicant for a basic X-ray

30  machine operator-podiatric medicine certificate, has completed

31  a course of study approved by the department, provided that


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  1  such course of study shall be limited to that information

  2  necessary to perform radiographic procedures within the scope

  3  of practice of a podiatric physician licensed pursuant to

  4  chapter 461;

  5         3.  With respect only to an applicant for a general

  6  radiographer's certificate who is a basic X-ray machine

  7  operator certificateholder, has completed an educational

  8  program or a 2-year training program that takes into account

  9  the types of procedures and level of supervision usually and

10  customarily practiced in a hospital, which educational or

11  training program complies with the rules of the department; or

12         4.  With respect only to an applicant for a nuclear

13  medicine technologist's certificate who is a general

14  radiographer certificateholder, has completed an educational

15  program or a 2-year training program that takes into account

16  the types of procedures and level of supervision usually and

17  customarily practiced in a hospital, which educational or

18  training program complies with the rules of the department.

19

20  No application for a limited computed tomography certificate

21  shall be accepted.  All persons holding valid computed

22  tomography certificates as of October 1, 1984, are subject to

23  the provisions of s. 468.309.

24         Section 59.  Subsection (4) of section 468.306, Florida

25  Statutes, 1998 Supplement, is amended to read:

26         468.306  Examinations.--All applicants, except those

27  certified pursuant to s. 468.3065, shall be required to pass

28  an examination.  The department is authorized to develop or

29  use examinations for each type of certificate.

30         (4)  A nonrefundable fee not to exceed $75 plus the

31  actual per-applicant cost for purchasing the examination from


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  1  a national organization shall be charged for any subsequent

  2  examination.

  3         Section 60.  Paragraph (a) of subsection (1) of section

  4  468.309, Florida Statutes, is amended to read:

  5         468.309  Certificate; duration; renewal; reversion to

  6  inactive status.--

  7         (1)(a)  A radiologic technologist's certificate issued

  8  in accordance with this part automatically expires as

  9  specified in rules adopted by the department which establish a

10  procedure for the biennial renewal of certificates on December

11  31 of the year following the year of issuance. A certificate

12  shall be renewed by the department for a period of 2 years

13  upon payment of a renewal fee in an amount not to exceed $75

14  and upon submission of a renewal application containing such

15  information as the department deems necessary to show that the

16  applicant for renewal is a radiologic technologist in good

17  standing and has completed any continuing education

18  requirements that which may be established by the department

19  establishes.

20         Section 61.  Subsection (1) of section 455.565, Florida

21  Statutes, 1998 Supplement, is amended to read:

22         455.565  Designated health care professionals;

23  information required for licensure.--

24         (1)  Each person who applies for initial licensure as a

25  physician under chapter 458, chapter 459, chapter 460, or

26  chapter 461, except a person applying for registration

27  pursuant to ss. 458.345 and 459.021 must, at the time of

28  application, and each physician who applies for license

29  renewal under chapter 458, chapter 459, chapter 460, or

30  chapter 461, except a person registered pursuant to ss.

31  458.345 and 459.021 must, in conjunction with the renewal of


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  1  such license and under procedures adopted by the Department of

  2  Health, and in addition to any other information that may be

  3  required from the applicant, furnish the following information

  4  to the Department of Health:

  5         (a)1.  The name of each medical school that the

  6  applicant has attended, with the dates of attendance and the

  7  date of graduation, and a description of all graduate medical

  8  education completed by the applicant, excluding any coursework

  9  taken to satisfy medical licensure continuing education

10  requirements.

11         2.  The name of each hospital at which the applicant

12  has privileges.

13         3.  The address at which the applicant will primarily

14  conduct his or her practice.

15         4.  Any certification that the applicant has received

16  from a specialty board that is recognized by the board to

17  which the applicant is applying.

18         5.  The year that the applicant began practicing

19  medicine.

20         6.  Any appointment to the faculty of a medical school

21  which the applicant currently holds and an indication as to

22  whether the applicant has had the responsibility for graduate

23  medical education within the most recent 10 years.

24         7.  A description of any criminal offense of which the

25  applicant has been found guilty, regardless of whether

26  adjudication of guilt was withheld, or to which the applicant

27  has pled guilty or nolo contendere.  A criminal offense

28  committed in another jurisdiction which would have been a

29  felony or misdemeanor if committed in this state must be

30  reported. If the applicant indicates that a criminal offense

31  is under appeal and submits a copy of the notice for appeal of


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  1  that criminal offense, the department must state that the

  2  criminal offense is under appeal if the criminal offense is

  3  reported in the applicant's profile. If the applicant

  4  indicates to the department that a criminal offense is under

  5  appeal, the applicant must, upon disposition of the appeal,

  6  submit to the department a copy of the final written order of

  7  disposition.

  8         8.  A description of any final disciplinary action

  9  taken within the previous 10 years against the applicant by

10  the agency regulating the profession that the applicant is or

11  has been licensed to practice, whether in this state or in any

12  other jurisdiction, by a specialty board that is recognized by

13  the American Board of Medical Specialities, the American

14  Osteopathic Association, or a similar national organization,

15  or by a licensed hospital, health maintenance organization,

16  prepaid health clinic, ambulatory surgical center, or nursing

17  home.  Disciplinary action includes resignation from or

18  nonrenewal of medical staff membership or the restriction of

19  privileges at a licensed hospital, health maintenance

20  organization, prepaid health clinic, ambulatory surgical

21  center, or nursing home taken in lieu of or in settlement of a

22  pending disciplinary case related to competence or character.

23  If the applicant indicates that the disciplinary action is

24  under appeal and submits a copy of the document initiating an

25  appeal of the disciplinary action, the department must state

26  that the disciplinary action is under appeal if the

27  disciplinary action is reported in the applicant's profile.

28         (b)  In addition to the information required under

29  paragraph (a), each applicant who seeks licensure under

30  chapter 458, chapter 459, or chapter 461, and who has

31  practiced previously in this state or in another jurisdiction


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  1  or a foreign country must provide the information required of

  2  licensees under those chapters pursuant to s. 455.697.  An

  3  applicant for licensure under chapter 460 who has practiced

  4  previously in this state or in another jurisdiction or a

  5  foreign country must provide the same information as is

  6  required of licensees under chapter 458, pursuant to s.

  7  455.697.

  8         Section 62.  (1)  The Division of Children's Medical

  9  Services of the Department of Health shall contract with a

10  private nonprofit provider affiliated with a teaching hospital

11  to conduct clinical trials, approved by a federally-sanctioned

12  institutional review board within the teaching hospital, on

13  the use of the drug Secretin to treat autism.

14         (2)  The private nonprofit provider shall report its

15  findings to the Division of Children's Medical Services, the

16  President of the Senate, the Speaker of the House of

17  Representatives, and other appropriate bodies.

18         Section 63.  The sum of $50,000 is appropriated to the

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

20  Health from the General Revenue Fund for the purpose of

21  implementing this act.

22         Section 64.  Paragraph (b) of subsection (3) of section

23  232.435, Florida Statutes, is amended to read:

24         232.435  Extracurricular athletic activities; athletic

25  trainers.--

26         (3)

27         (b)  If a school district uses the services of an

28  athletic trainer who is not a teacher athletic trainer or a

29  teacher apprentice trainer within the requirements of this

30  section, such athletic trainer must be licensed as required by

31  part XIII XIV of chapter 468.


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  1         Section 65.  Subsection (2) of section 381.026, Florida

  2  Statutes, 1998 Supplement, is amended to read:

  3         381.026  Florida Patient's Bill of Rights and

  4  Responsibilities.--

  5         (2)  DEFINITIONS.--As used in this section and s.

  6  381.0261, the term:

  7         (a)  "Department" means the Department of Health.

  8         (b)(a)  "Health care facility" means a facility

  9  licensed under chapter 395.

10         (c)(b)  "Health care provider" means a physician

11  licensed under chapter 458, an osteopathic physician licensed

12  under chapter 459, or a podiatric physician licensed under

13  chapter 461.

14         (d)(c)  "Responsible provider" means a health care

15  provider who is primarily responsible for patient care in a

16  health care facility or provider's office.

17         Section 66.  Subsection (4) of section 381.0261,

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

19         381.0261  Summary of patient's bill of rights;

20  distribution; penalty.--

21         (4)(a)  An administrative fine may be imposed by the

22  Agency for Health Care Administration when any health care

23  provider or health care facility fails to make available to

24  patients a summary of their rights, pursuant to s. 381.026 and

25  this section. Initial nonwillful violations shall be subject

26  to corrective action and shall not be subject to an

27  administrative fine. The Agency for Health Care Administration

28  may levy a fine against a health care facility of up to $5,000

29  for nonwillful violations, and up to $25,000 for intentional

30  and willful violations. Each intentional and willful violation

31


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  1  constitutes a separate violation and is subject to a separate

  2  fine.

  3         (b)  An administrative fine may be imposed by the

  4  appropriate regulatory board, or the department if there is no

  5  board, when any health care provider fails to make available

  6  to patients a summary of their rights, pursuant to s. 381.026

  7  and this section. Initial nonwillful violations shall be

  8  subject to corrective action and shall not be subject to an

  9  administrative fine. The appropriate regulatory board or

10  department agency may levy a fine against a health care

11  provider of up to $100 for nonwillful violations and up to

12  $500 for willful violations. Each intentional and willful

13  violation constitutes a separate violation and is subject to a

14  separate fine.

15         Section 67.  Subsection (11) of section 409.906,

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

17         409.906  Optional Medicaid services.--Subject to

18  specific appropriations, the agency may make payments for

19  services which are optional to the state under Title XIX of

20  the Social Security Act and are furnished by Medicaid

21  providers to recipients who are determined to be eligible on

22  the dates on which the services were provided.  Any optional

23  service that is provided shall be provided only when medically

24  necessary and in accordance with state and federal law.

25  Nothing in this section shall be construed to prevent or limit

26  the agency from adjusting fees, reimbursement rates, lengths

27  of stay, number of visits, or number of services, or making

28  any other adjustments necessary to comply with the

29  availability of moneys and any limitations or directions

30  provided for in the General Appropriations Act or chapter 216.

31  Optional services may include:


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  1         (11)  HEALTHY START SERVICES.--The agency may pay for a

  2  continuum of risk-appropriate medical and psychosocial

  3  services for the Healthy Start program in accordance with a

  4  federal waiver. The agency may not implement the federal

  5  waiver unless the waiver permits the state to limit enrollment

  6  or the amount, duration, and scope of services to ensure that

  7  expenditures will not exceed funds appropriated by the

  8  Legislature or available from local sources. If the Health

  9  Care Financing Administration does not approve a federal

10  waiver for Healthy Start services, the agency, in consultation

11  with the Department of Health and the Florida Association of

12  Healthy Start Coalitions, is authorized to establish a

13  Medicaid certified-match program for Healthy Start services.

14  Participation in the Healthy Start certified-match program

15  shall be voluntary and reimbursement shall be limited to the

16  federal Medicaid share to Medicaid-enrolled Healthy Start

17  coalitions for services provided to Medicaid recipients. The

18  agency shall take no action to implement a certified-match

19  program without ensuring that the amendment and review

20  requirements of ss. 216.177 and 216.181 have been met.

21         Section 68.  Subsection (21) of section 409.910,

22  Florida Statutes, 1998 Supplement, is renumbered as subsection

23  (22), and a new subsection (21) is added to that section to

24  read:

25         409.910  Responsibility for payments on behalf of

26  Medicaid-eligible persons when other parties are liable.--

27         (21)  Entities providing health insurance as defined in

28  s. 624.603, and health maintenance organizations as defined in

29  chapter 641, requiring tape or electronic billing formats from

30  the agency shall accept Medicaid billings that are prepared

31  using the current Medicare standard billing format. If the


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  1  insurance entity or health maintenance organization is unable

  2  to use the agency format, the entity shall accept paper claims

  3  from the agency in lieu of tape or electronic billing,

  4  provided that these claims are prepared using current Medicare

  5  standard billing formats.

  6         Section 69.  Section 409.9101, Florida Statutes, is

  7  created to read:

  8         409.9101  Recovery for payments made on behalf of

  9  Medicaid-eligible persons.--

10         (1)  This section may be cited as the "Medicaid Estate

11  Recovery Act."

12         (2)  It is the intent of the Legislature by this

13  section to supplement Medicaid funds that are used to provide

14  medical services to eligible persons. Medicaid estate recovery

15  shall generally be accomplished through the filing of claims

16  against the estates of deceased Medicaid recipients. The

17  recoveries shall be made pursuant to federal authority in s.

18  13612 of the Omnibus Budget Reconciliation Act of 1993, which

19  amends s. 1917(b)(1) of the Social Security Act (42 U.S.C. s.

20  1396p(b)(1)).

21         (3)  Pursuant to s. 733.212(4)(a), the personal

22  representative of the estate of the decedent shall serve the

23  agency with a copy of the notice of administration of the

24  estate within 3 months after the first publication of the

25  notice, unless the agency has already filed a claim pursuant

26  to this section.

27         (4)  The acceptance of public medical assistance, as

28  defined by Title XIX (Medicaid) of the Social Security Act,

29  including mandatory and optional supplemental payments under

30  the Social Security Act, shall create a claim, as defined in

31  s. 731.201, in favor of the agency as an interested person as


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  1  defined in s. 731.201. The claim amount is calculated as the

  2  total amount paid to or for the benefit of the recipient for

  3  medical assistance on behalf of the recipient after he or she

  4  reached 55 years of age. There is no claim under this section

  5  against estates of recipients who had not yet reached 55 years

  6  of age.

  7         (5)  At the time of filing the claim, the agency may

  8  reserve the right to amend the claim amounts based on medical

  9  claims submitted by providers subsequent to the agency's

10  initial claim calculation.

11         (6)  The claim of the agency shall be the current total

12  allowable amount of Medicaid payments as denoted in the

13  agency's provider payment processing system at the time the

14  agency's claim or amendment is filed. The agency's provider

15  processing system reports shall be admissible as prima facie

16  evidence in substantiating the agency's claim.

17         (7)  The claim of the agency under this section shall

18  constitute a Class 3 claim under s. 733.707(1)(c), as provided

19  in s. 414.28(1).

20         (8)  The claim created under this section shall not be

21  enforced if the recipient is survived by:

22         (a)  A spouse;

23         (b)  A child or children under 21 years of age; or

24         (c)  A child or children who are blind or permanently

25  and totally disabled pursuant to the eligibility requirements

26  of Title XIX of the Social Security Act.

27         (9)  In accordance with s. 4, Art. X of the State

28  Constitution, no claim under this section shall be enforced

29  against any property that is determined to be the homestead of

30  the deceased Medicaid recipient and is determined to be exempt

31


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  1  from the claims of creditors of the deceased Medicaid

  2  recipient.

  3         (10)  The agency shall not recover from an estate if

  4  doing so would cause undue hardship for the qualified heirs,

  5  as defined in s. 731.201. The personal representative of an

  6  estate and any heir may request that the agency waive recovery

  7  of any or all of the debt when recovery would create a

  8  hardship. A hardship does not exist solely because recovery

  9  will prevent any heirs from receiving an anticipated

10  inheritance. The following criteria shall be considered by the

11  agency in reviewing a hardship request:

12         (a)  The heir:

13         1.  Currently resides in the residence of the decedent;

14         2.  Resided there at the time of the death of the

15  decedent;

16         3.  Has made the residence his or her primary residence

17  for the 12 months immediately preceding the death of the

18  decedent; and

19         4.  Owns no other residence;

20         (b)  The heir would be deprived of food, clothing,

21  shelter, or medical care necessary for the maintenance of life

22  or health;

23         (c)  The heir can document that he or she provided

24  full-time care to the recipient which delayed the recipient's

25  entry into a nursing home. The heir must be either the

26  decedent's sibling or the son or daughter of the decedent and

27  must have resided with the recipient for at least 1 year prior

28  to the recipient's death; or

29         (d)  The cost involved in the sale of the property

30  would be equal to or greater than the value of the property.

31


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  1         (11)  Instances arise in Medicaid estate-recovery cases

  2  where the assets include a settlement of a claim against a

  3  liable third party. The agency's claim under s. 409.910 must

  4  be satisfied prior to including the settlement proceeds as

  5  estate assets. The remaining settlement proceeds shall be

  6  included in the estate and be available to satisfy the

  7  Medicaid estate-recovery claim. The Medicaid estate-recovery

  8  share shall be one-half of the settlement proceeds included in

  9  the estate. Nothing in this subsection is intended to limit

10  the agency's rights against other assets in the estate not

11  related to the settlement. However, in no circumstances shall

12  the agency's recovery exceed the total amount of Medicaid

13  medical assistance provided to the recipient.

14         (12)  In instances where there are no liquid assets to

15  satisfy the Medicaid estate-recovery claim, if there is

16  nonhomestead real property and the costs of sale will not

17  exceed the proceeds, the property shall be sold to satisfy the

18  Medicaid estate-recovery claim. Real property shall not be

19  transferred to the agency in any instance.

20         (13)  The agency is authorized to adopt rules to

21  implement the provisions of this section.

22         Section 70.  Paragraph (d) of subsection (3) of section

23  409.912, Florida Statutes, 1998 Supplement, is amended to

24  read:

25         409.912  Cost-effective purchasing of health care.--The

26  agency shall purchase goods and services for Medicaid

27  recipients in the most cost-effective manner consistent with

28  the delivery of quality medical care.  The agency shall

29  maximize the use of prepaid per capita and prepaid aggregate

30  fixed-sum basis services when appropriate and other

31  alternative service delivery and reimbursement methodologies,


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  1  including competitive bidding pursuant to s. 287.057, designed

  2  to facilitate the cost-effective purchase of a case-managed

  3  continuum of care. The agency shall also require providers to

  4  minimize the exposure of recipients to the need for acute

  5  inpatient, custodial, and other institutional care and the

  6  inappropriate or unnecessary use of high-cost services.

  7         (3)  The agency may contract with:

  8         (d)  No more than four provider service networks for

  9  demonstration projects to test Medicaid direct contracting.

10  One demonstration project must be located in Orange County.

11  The demonstration projects may be reimbursed on a

12  fee-for-service or prepaid basis.  A provider service network

13  which is reimbursed by the agency on a prepaid basis shall be

14  exempt from parts I and III of chapter 641, but must meet

15  appropriate financial reserve, quality assurance, and patient

16  rights requirements as established by the agency.  The agency

17  shall award contracts on a competitive bid basis and shall

18  select bidders based upon price and quality of care. Medicaid

19  recipients assigned to a demonstration project shall be chosen

20  equally from those who would otherwise have been assigned to

21  prepaid plans and MediPass.  The agency is authorized to seek

22  federal Medicaid waivers as necessary to implement the

23  provisions of this section.  A demonstration project awarded

24  pursuant to this paragraph shall be for 2 years from the date

25  of implementation.

26         Section 71.  Paragraph (a) of subsection (24) of

27  section 409.913, Florida Statutes, is amended to read:

28         409.913  Oversight of the integrity of the Medicaid

29  program.--The agency shall operate a program to oversee the

30  activities of Florida Medicaid recipients, and providers and

31  their representatives, to ensure that fraudulent and abusive


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  1  behavior and neglect of recipients occur to the minimum extent

  2  possible, and to recover overpayments and impose sanctions as

  3  appropriate.

  4         (24)(a)  The agency may withhold Medicaid payments, in

  5  whole or in part, to a provider upon receipt of reliable

  6  evidence that the circumstances giving rise to the need for a

  7  withholding of payments involve fraud or willful

  8  misrepresentation under the Medicaid program, or a crime

  9  committed while rendering goods or services to Medicaid

10  recipients, up to the amount of the overpayment as determined

11  by final agency audit report, pending completion of legal

12  proceedings under this section. If the agency withholds

13  payments under this section, the Medicaid payment may not be

14  reduced by more than 10 percent. If it is has been determined

15  that fraud, willful misrepresentation, or a crime did not

16  occur an overpayment has not occurred, the payments withheld

17  must be paid to the provider within 14 60 days after such

18  determination with interest at the rate of 10 percent a year.

19  Any money withheld in accordance with this paragraph shall be

20  placed in a suspended account, readily accessible to the

21  agency, so that any payment ultimately due the provider shall

22  be made within 14 days. Furthermore, the authority to withhold

23  payments under this paragraph shall not apply to physicians

24  whose alleged overpayments are being determined by

25  administrative proceedings pursuant to chapter 120. If the

26  amount of the alleged overpayment exceeds $75,000, the agency

27  may reduce the Medicaid payments by up to $25,000 per month.

28         Section 72.  Section 409.9131, Florida Statutes, is

29  created to read:

30         409.9131  Special provisions relating to integrity of

31  the Medicaid program.--


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  1         (1)  LEGISLATIVE FINDINGS AND INTENT.--It is the intent

  2  of the Legislature that physicians, as defined in this

  3  section, be subject to Medicaid fraud and abuse investigations

  4  in accordance with the provisions set forth in this section as

  5  a supplement to the provisions contained in s. 409.913.  If a

  6  conflict exists between the provisions of this section and s.

  7  409.913, it is the intent of the Legislature that the

  8  provisions of this section shall control.

  9         (2)  DEFINITIONS.--For purposes of this section, the

10  term:

11         (a)  "Active practice" means a physician must have

12  regularly provided medical care and treatment to patients

13  within the past 2 years.

14         (b)  "Medical necessity" or "medically necessary" means

15  any goods or services necessary to palliate the effects of a

16  terminal condition or to prevent, diagnose, correct, cure,

17  alleviate, or preclude deterioration of a condition that

18  threatens life, causes pain or suffering, or results in

19  illness or infirmity, which goods or services are provided in

20  accordance with generally accepted standards of medical

21  practice.  For purposes of determining Medicaid reimbursement,

22  the agency is the final arbiter of medical necessity.  In

23  making determinations of medical necessity, the agency must,

24  to the maximum extent possible, use a physician in active

25  practice, either employed by or under contract with the

26  agency, of the same specialty or subspecialty as the physician

27  under review.  Such determination must be based upon the

28  information available at the time the goods or services were

29  provided.

30         (c)  "Peer" means a Florida licensed physician who is,

31  to the maximum extent possible, of the same specialty or


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  1  subspecialty, licensed under the same chapter, and in active

  2  practice.

  3         (d)  "Peer review" means an evaluation of the

  4  professional practices of a Medicaid physician provider by a

  5  peer or peers in order to assess the medical necessity,

  6  appropriateness, and quality of care provided, as such care is

  7  compared to that customarily furnished by the physician's

  8  peers and to recognized health care standards, and to

  9  determine whether the documentation in the physician's records

10  is adequate.

11         (e)  "Physician" means a person licensed to practice

12  medicine under chapter 458 or a person licensed to practice

13  osteopathic medicine under chapter 459.

14         (f)  "Professional services" means procedures provided

15  to a Medicaid recipient, either directly by or under the

16  supervision of a physician who is a registered provider for

17  the Medicaid program.

18         (3)  ONSITE RECORDS REVIEW.--As specified in s.

19  409.913(8), the agency may investigate, review, or analyze a

20  physician's medical records concerning Medicaid patients. The

21  physician must make such records available to the agency

22  during normal business hours. The agency must provide notice

23  to the physician at least 24 hours before such visit. The

24  agency and physician shall make every effort to set a mutually

25  agreeable time for the agency's visit during normal business

26  hours and within the 24-hour period. If such a time cannot be

27  agreed upon, the agency may set the time.

28         (4)  NOTICE OF DUE PROCESS RIGHTS REQUIRED.--Whenever

29  the agency seeks an administrative remedy against a physician

30  pursuant to this section or s. 409.913, the physician must be

31  advised of his or her rights to due process under chapter 120.


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  1  This provision shall not limit or hinder the agency's ability

  2  to pursue any remedy available to it under s. 409.913 or other

  3  applicable law.

  4         (5)  DETERMINATIONS OF OVERPAYMENT.--In making a

  5  determination of overpayment to a physician, the agency must:

  6         (a)  Use accepted and valid auditing, accounting,

  7  analytical, statistical, or peer-review methods, or

  8  combinations thereof. Appropriate statistical methods may

  9  include, but are not limited to, sampling and extension to the

10  population, parametric and nonparametric statistics, tests of

11  hypotheses, other generally accepted statistical methods,

12  review of medical records, and a consideration of the

13  physician's client case mix. Before performing a review of the

14  physician's Medicaid records, however, the agency shall make

15  every effort to consider the physician's patient case mix,

16  including, but not limited to, patient age and whether

17  individual patients are clients of the Children's Medical

18  Services network established in chapter 391. In meeting its

19  burden of proof in any administrative or court proceeding, the

20  agency may introduce the results of such statistical methods

21  and its other audit findings as evidence of overpayment.

22         (b)  Refer all physician service claims for peer review

23  when the agency's preliminary analysis indicates a potential

24  overpayment, and before any formal proceedings are initiated

25  against the physician, except as required by s. 409.913.

26         (c)  By March 1, 2000, the agency shall study and

27  report to the Legislature on its current statistical model

28  used to calculate overpayments and advise the Legislature

29  what, if any, changes, improvements, or other modifications

30  should be made to the statistical model. Such review shall

31  include, but not be limited to, a review of the


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  1  appropriateness of including physician specialty and case-mix

  2  parameters within the statistical model.

  3         Section 73.  Subsections (4) and (6) of section

  4  455.501, Florida Statutes, are amended to read:

  5         455.501  Definitions.--As used in this part, the term:

  6         (4)  "Health care practitioner" means any person

  7  licensed under chapter 457; chapter 458; chapter 459; chapter

  8  460; chapter 461; chapter 462; chapter 463; chapter 464;

  9  chapter 465; chapter 466; chapter 467; part I, part II, part

10  III, part V, or part X, part XIII, or part XIV of chapter 468;

11  chapter 478; chapter 480; part III or part IV of chapter 483;

12  chapter 484; chapter 486; chapter 490; or chapter 491.

13         (6)  "Licensee" means any person or entity issued a

14  permit, registration, certificate, or license by the

15  department.

16         Section 74.  Section 455.507, Florida Statutes, is

17  amended to read:

18         455.507  Members of Armed Forces in good standing with

19  administrative boards or department.--

20         (1)  Any member of the Armed Forces of the United

21  States now or hereafter on active duty who, at the time of his

22  becoming such a member, was in good standing with any

23  administrative board of the state, or the department when

24  there is no board, and was entitled to practice or engage in

25  his or her profession or vocation in the state shall be kept

26  in good standing by such administrative board, or the

27  department when there is no board, without registering, paying

28  dues or fees, or performing any other act on his or her part

29  to be performed, as long as he or she is a member of the Armed

30  Forces of the United States on active duty and for a period of

31  6 months after his discharge from active duty as a member of


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    CS for SB 2220                                 First Engrossed



  1  the Armed Forces of the United States, provided he or she is

  2  not engaged in his or her licensed profession or vocation in

  3  the private sector for profit.

  4         (2)  The boards listed in s. ss. 20.165 and 20.43, or

  5  the department when there is no board, shall adopt rules

  6  exempting the spouses of members of the Armed Forces of the

  7  United States from licensure renewal provisions, but only in

  8  cases of absence from the state because of their spouses'

  9  duties with the Armed Forces.

10         Section 75.  Section 455.521, Florida Statutes, 1998

11  Supplement, is amended to read:

12         455.521  Department; powers and duties.--The

13  department, for the professions boards under its jurisdiction,

14  shall:

15         (1)  Adopt rules establishing a procedure for the

16  biennial renewal of licenses; however, the department may

17  issue up to a 4-year license to selected licensees

18  notwithstanding any other provisions of law to the contrary.

19  Fees for such renewal shall not exceed the fee caps for

20  individual professions on an annualized basis as authorized by

21  law.

22         (2)  Appoint the executive director of each board,

23  subject to the approval of the board.

24         (3)  Submit an annual budget to the Legislature at a

25  time and in the manner provided by law.

26         (4)  Develop a training program for persons newly

27  appointed to membership on any board. The program shall

28  familiarize such persons with the substantive and procedural

29  laws and rules and fiscal information relating to the

30  regulation of the appropriate profession and with the

31  structure of the department.


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  1         (5)  Adopt rules pursuant to ss. 120.536(1) and 120.54

  2  to implement the provisions of this part.

  3         (6)  Establish by rules procedures by which the

  4  department shall use the expert or technical advice of the

  5  appropriate board for the purposes of investigation,

  6  inspection, evaluation of applications, other duties of the

  7  department, or any other areas the department may deem

  8  appropriate.

  9         (7)  Require all proceedings of any board or panel

10  thereof and all formal or informal proceedings conducted by

11  the department, an administrative law judge, or a hearing

12  officer with respect to licensing or discipline to be

13  electronically recorded in a manner sufficient to assure the

14  accurate transcription of all matters so recorded.

15         (8)  Select only those investigators, or consultants

16  who undertake investigations, who meet criteria established

17  with the advice of the respective boards.

18         (9)  Allow applicants for new or renewal licenses and

19  current licensees to be screened by the Title IV-D child

20  support agency pursuant to s. 409.2598 to assure compliance

21  with a support obligation. The purpose of this subsection is

22  to promote the public policy of this state as established in

23  s. 409.2551. The department shall, when directed by the court,

24  suspend or deny the license of any licensee found to have a

25  delinquent support obligation. The department shall issue or

26  reinstate the license without additional charge to the

27  licensee when notified by the court that the licensee has

28  complied with the terms of the court order. The department

29  shall not be held liable for any license denial or suspension

30  resulting from the discharge of its duties under this

31  subsection.


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  1         Section 76.  Section 455.557, Florida Statutes, 1998

  2  Supplement, is amended to read:

  3         455.557  Standardized credentialing for health care

  4  practitioners.--

  5         (1)  INTENT.--The Legislature recognizes that an

  6  efficient and effective health care practitioner credentialing

  7  program helps to ensure access to quality health care and also

  8  recognizes that health care practitioner credentialing

  9  activities have increased significantly as a result of health

10  care reform and recent changes in health care delivery and

11  reimbursement systems. Moreover, the resulting duplication of

12  health care practitioner credentialing activities is

13  unnecessarily costly and cumbersome for both the practitioner

14  and the entity granting practice privileges. Therefore, it is

15  the intent of this section that a mandatory credentials

16  collection verification program be established which provides

17  that, once a health care practitioner's core credentials data

18  are collected, validated, maintained, and stored, they need

19  not be collected again, except for corrections, updates, and

20  modifications thereto. Participation Mandatory credentialing

21  under this section shall initially include those individuals

22  licensed under chapter 458, chapter 459, chapter 460, or

23  chapter 461. However, the department shall, with the approval

24  of the applicable board, include other professions under the

25  jurisdiction of the Division of Medical Quality Assurance in

26  this credentialing program, provided they meet the

27  requirements of s. 455.565.

28         (2)  DEFINITIONS.--As used in this section, the term:

29         (a)  "Advisory council" or "council" means the

30  Credentials Verification Advisory Council.

31


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  1         (b)  "Applicant" means an individual applying for

  2  licensure or a current licensee applying for credentialing.

  3         (b)(c)  "Certified" or "accredited," as applicable,

  4  means approved by a quality assessment program, from the

  5  National Committee for Quality Assurance, the Joint Commission

  6  on Accreditation of Healthcare Organizations, the American

  7  Accreditation HealthCare Commission/URAC Utilization Review

  8  Accreditation Commission, or any such other nationally

  9  recognized and accepted organization authorized by the

10  department, used to assess and certify any credentials

11  verification program, entity, or organization that verifies

12  the credentials of any health care practitioner.

13         (c)(d)  "Core credentials data" means the following

14  data: current name, any former name, and any alias, any

15  professional education, professional training, peer

16  references, licensure, current Drug Enforcement Administration

17  certification, social security number, specialty board

18  certification, Educational Commission for Foreign Medical

19  Graduates certification information, hospital or affiliations,

20  managed care organization affiliations, other institutional

21  affiliations, professional society memberships, evidence of

22  professional liability coverage or evidence of financial

23  responsibility as required by s. 458.320 or s. 459.0085

24  insurance, history of claims, suits, judgments, or

25  settlements, final disciplinary action reported pursuant to s.

26  455.565(1)(a)8., and Medicare or Medicaid sanctions, civil or

27  criminal law violations, practitioner profiling data, special

28  conditions of impairment, or regulatory exemptions not

29  previously reported to the department in accordance with both

30  s. 455.565 and the initial licensure reporting requirements

31  specified in the applicable practice act.


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  1         (d)(e)  "Credential" or "credentialing" means the

  2  process of assessing and verifying validating the

  3  qualifications of a licensed health care practitioner or

  4  applicant for licensure as a health care practitioner.

  5         (e)(f)  "Credentials verification organization entity"

  6  means any program, entity, or organization that is organized

  7  and certified or accredited as a credentials verification

  8  organization for the express purpose of collecting, verifying,

  9  maintaining, storing, and providing to health care entities a

10  health care practitioner's total core credentials data,

11  including all corrections, updates, and modifications thereto,

12  as authorized by the health care practitioner and in

13  accordance with the provisions of this including all

14  corrections, updates, and modifications thereto, as authorized

15  by the health care practitioner and in accordance with the

16  provisions of this section. The division, once certified,

17  shall be considered a credentials verification entity for all

18  health care practitioners.

19         (f)(g)  "Department" means the Department of Health,

20  Division of Medical Quality Assurance.

21         (g)(h)  "Designated credentials verification

22  organization entity" means the credentials verification

23  program, entity, or organization organized and certified or

24  accredited for the express purpose of collecting, verifying,

25  maintaining, storing, and providing to health care entities a

26  health care practitioner's total core credentials data,

27  including all corrections, updates, and modifications thereto,

28  which is selected by the health care practitioner as the

29  credentials verification entity for all inquiries into his or

30  her credentials, if the health care practitioner chooses to

31  make such a designation. Notwithstanding any such designation


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  1  by a health care practitioner, the division, once certified,

  2  shall also be considered a designated credentials verification

  3  entity for that health care practitioner.

  4         (h)  "Drug Enforcement Administration certification"

  5  means certification issued by the Drug Enforcement

  6  Administration for purposes of administration or prescription

  7  of controlled substances. Submission of such certification

  8  under this section must include evidence that the

  9  certification is current and must also include all current

10  addresses to which the certificate is issued.

11         (i)  "Division" means the Division of Medical Quality

12  Assurance within the Department of Health.

13         (i)(j)  "Health care entity" means:

14         1.  Any health care facility or other health care

15  organization licensed or certified to provide approved medical

16  and allied health services in this state Florida; or

17         2.  Any entity licensed by the Department of Insurance

18  as a prepaid health care plan or health maintenance

19  organization or as an insurer to provide coverage for health

20  care services through a network of providers; or

21         3.  Any accredited medical school in this state.

22         (j)(k)  "Health care practitioner" means any person

23  licensed, or, for credentialing purposes only, any person

24  applying for licensure, under chapter 458, chapter 459,

25  chapter 460, or chapter 461 or any person licensed or applying

26  for licensure under a chapter subsequently made subject to

27  this section by the department with the approval of the

28  applicable board, except a person registered or applying for

29  registration pursuant to s. 458.345 or s. 459.021.

30         (k)  "Hospital or other institutional affiliations"

31  means each hospital or other institution for which the health


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  1  care practitioner or applicant has provided medical services.

  2  Submission of such information under this section must

  3  include, for each hospital or other institution, the name and

  4  address of the hospital or institution, the staff status of

  5  the health care practitioner or applicant at that hospital or

  6  institution, and the dates of affiliation with that hospital

  7  or institution.

  8         (l)  "National accrediting organization" means an

  9  organization that awards accreditation or certification to

10  hospitals, managed care organizations, credentials

11  verification organizations, or other health care

12  organizations, including, but not limited to, the Joint

13  Commission on Accreditation of Healthcare Organizations, the

14  American Accreditation HealthCare Commission/URAC, and the

15  National Committee for Quality Assurance.

16         (m)  "Professional training" means any internship,

17  residency, or fellowship relating to the profession for which

18  the health care practitioner is licensed or seeking licensure.

19         (n)  "Specialty board certification" means

20  certification in a specialty issued by a specialty board

21  recognized by the board in this state that regulates the

22  profession for which the health care practitioner is licensed

23  or seeking licensure.

24         (m)  "Primary source verification" means verification

25  of professional qualifications based on evidence obtained

26  directly from the issuing source of the applicable

27  qualification.

28         (n)  "Recredentialing" means the process by which a

29  credentials verification entity verifies the credentials of a

30  health care practitioner whose core credentials data,

31


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  1  including all corrections, updates, and modifications thereto,

  2  are currently on file with the entity.

  3         (o)  "Secondary source verification" means confirmation

  4  of a professional qualification by means other than primary

  5  source verification, as outlined and approved by national

  6  accrediting organizations.

  7         (3)  STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.--

  8         (a)  Every health care practitioner shall:

  9         1.  Report all core credentials data to the department

10  which is not already on file with the department, either by

11  designating a credentials verification organization to submit

12  the data or by submitting the data directly.

13         2.  Notify the department within 45 days of any

14  corrections, updates, or modifications to the core credentials

15  data either through his or her designated credentials

16  verification organization or by submitting the data directly.

17  Corrections, updates, and modifications to the core

18  credentials data provided the department under this section

19  shall comply with the updating requirements of s. 455.565(3)

20  related to profiling.

21         (b)(a)  In accordance with the provisions of this

22  section, The department shall:

23         1.  Maintain a complete, current file of core

24  credentials data on each health care practitioner, which shall

25  include all updates provided in accordance with subparagraph

26  (3)(a)2.

27         2.  Release the core credentials data that is otherwise

28  confidential or exempt from the provisions of chapter 119 and

29  s. 24(a), Art. I of the State Constitution and any

30  corrections, updates, and modifications thereto, if authorized

31  by the health care practitioner.


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  1         3.  Charge a fee to access the core credentials data,

  2  which may not exceed the actual cost, including prorated setup

  3  and operating costs, pursuant to the requirements of chapter

  4  119. The actual cost shall be set in consultation with the

  5  advisory council.

  6         4.  Develop, in consultation with the advisory council,

  7  standardized forms to be used by the health care practitioner

  8  or designated credentials verification organization for the

  9  initial reporting of core credentials data, for the health

10  care practitioner to authorize the release of core credentials

11  data, and for the subsequent reporting of corrections,

12  updates, and modifications thereto develop standardized forms

13  necessary for the creation of a standardized system as well as

14  guidelines for collecting, verifying, maintaining, storing,

15  and providing core credentials data on health care

16  practitioners through credentials verification entities,

17  except as otherwise provided in this section, for the purpose

18  of eliminating duplication. Once the core credentials data are

19  submitted, the health care practitioner is not required to

20  resubmit this initial data when applying for practice

21  privileges with health care entities. However, as provided in

22  paragraph (d), each health care practitioner is responsible

23  for providing any corrections, updates, and modifications to

24  his or her core credentials data, to ensure that all

25  credentialing data on the practitioner remains current.

26  Nothing in this paragraph prevents the designated credentials

27  verification entity from obtaining all necessary attestation

28  and release form signatures and dates.

29         5.(b)  Establish There is established a Credentials

30  Verification Advisory Council, consisting of 13 members, to

31  assist the department as provided in this section with the


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  1  development of guidelines for establishment of the

  2  standardized credentials verification program. The secretary,

  3  or his or her designee, shall serve as one member and chair of

  4  the council and shall appoint the remaining 12 members. Except

  5  for any initial lesser term required to achieve staggering,

  6  such appointments shall be for 4-year staggered terms, with

  7  one 4-year reappointment, as applicable. Three members shall

  8  represent hospitals, and two members shall represent health

  9  maintenance organizations. One member shall represent health

10  insurance entities. One member shall represent the credentials

11  verification industry. Two members shall represent physicians

12  licensed under chapter 458. One member shall represent

13  osteopathic physicians licensed under chapter 459. One member

14  shall represent chiropractic physicians licensed under chapter

15  460. One member shall represent podiatric physicians licensed

16  under chapter 461.

17         (c)  A registered credentials verification organization

18  may be designated by a health care practitioner to assist the

19  health care practitioner to comply with the requirements of

20  subsection (3)(a)2. A designated credentials verification

21  organization shall:

22         1.  Timely comply with the requirements of subsection

23  (3)(a)2., pursuant to rules adopted by the department.

24         2.  Not provide the health care practitioner's core

25  data, including all corrections, updates, and modifications,

26  without the authorization of the practitioner.

27         (c)  The department, in consultation with the advisory

28  council, shall develop standard forms for the initial

29  reporting of core credentials data for credentialing purposes

30  and for the subsequent reporting of corrections, updates, and

31  modifications thereto for recredentialing purposes.


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  1         (d)  Each health care practitioner licensed under

  2  chapter 458, chapter 459, chapter 460, or chapter 461, or any

  3  person licensed under a chapter subsequently made subject to

  4  this section, must report any action or information as defined

  5  in paragraph (2)(d), including any correction, update, or

  6  modification thereto, as soon as possible but not later than

  7  30 days after such action occurs or such information is known,

  8  to the department or his or her designated credentials

  9  verification entity, if any, who must report it to the

10  department. In addition, a licensee must update, at least

11  quarterly, his or her data on a form prescribed by the

12  department.

13         (e)  An individual applying for licensure under chapter

14  458, chapter 459, chapter 460, or chapter 461, or any person

15  applying for licensure under a chapter subsequently made

16  subject to this section, must submit the individual's initial

17  core credentials data to a credentials verification entity, if

18  such information has not already been submitted to the

19  department or the appropriate licensing board or to any other

20  credentials verification entity.

21         (f)  Applicants may decide which credentials

22  verification entity they want to process and store their core

23  credentials data; however, such data shall at all times be

24  maintained by the department. An applicant may choose not to

25  designate a credentials verification entity, provided the

26  applicant has a written agreement with the health care entity

27  or entities that are responsible for his or her credentialing.

28  In addition, any licensee may choose to move his or her core

29  credentials data from one credentials verification entity to

30  another.

31


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  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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  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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  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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  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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  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


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  1         (7)(12)  LIABILITY INSURANCE REQUIREMENTS.--The

  2  department, in consultation with the Credentials Verification

  3  Advisory Council, shall establish the minimum liability

  4  insurance requirements for Each credentials verification

  5  organization entity doing business in this state shall

  6  maintain liability insurance appropriate to meet the

  7  certification or accreditation requirements established in

  8  this section.

  9         (8)(13)  RULES.--The department, in consultation with

10  the advisory council applicable board, shall adopt rules

11  necessary to develop and implement the standardized core

12  credentials data collection verification program established

13  by this section.

14         (9)  COUNCIL ABOLISHED; DEPARTMENT AUTHORITY.--The

15  council shall be abolished October 1, 1999. After the council

16  is abolished, all duties of the department required under this

17  section to be in consultation with the council may be carried

18  out by the department on its own.

19         Section 77.  Subsections (1), (2), (6), (7), (8), and

20  (9) of section 455.564, Florida Statutes, 1998 Supplement, are

21  amended to read:

22         455.564  Department; general licensing provisions.--

23         (1)  Any person desiring to be licensed in a profession

24  within the jurisdiction of the department shall apply to the

25  department in writing to take the licensure examination.  The

26  application shall be made on a form prepared and furnished by

27  the department and shall require the social security number of

28  the applicant.  The form shall be supplemented as needed to

29  reflect any material change in any circumstance or condition

30  stated in the application which takes place between the

31  initial filing of the application and the final grant or


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  1  denial of the license and which might affect the decision of

  2  the department. An incomplete application shall expire 1 year

  3  after initial filing. In order to further the economic

  4  development goals of the state, and notwithstanding any law to

  5  the contrary, the department may enter into an agreement with

  6  the county tax collector for the purpose of appointing the

  7  county tax collector as the department's agent to accept

  8  applications for licenses and applications for renewals of

  9  licenses. The agreement must specify the time within which the

10  tax collector must forward any applications and accompanying

11  application fees to the department.

12         (2)  Before the issuance of any license, the department

13  may charge an initial license fee as determined by rule of the

14  applicable board or, if no such board exists, by rule of the

15  department.  Upon receipt of the appropriate license fee, the

16  department shall issue a license to any person certified by

17  the appropriate board, or its designee, as having met the

18  licensure requirements imposed by law or rule. The license

19  licensee shall consist of be issued a wallet-size

20  identification card and a wall card measuring 6 1/2 inches by

21  5 inches. In addition to the two-part license, the department,

22  at the time of initial licensure, shall issue a wall

23  certificate suitable for conspicuous display, which shall be

24  no smaller than 8 1/2  inches by 14 inches. The licensee shall

25  surrender to the department the wallet-size identification

26  card, the wall card, and the wall certificate, if one has been

27  issued by the department, if the licensee's license is

28  suspended or revoked. The department shall promptly return the

29  wallet-size identification card and the wall certificate to

30  the licensee upon reinstatement of a suspended or revoked

31  license.


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    CS for SB 2220                                 First Engrossed



  1         (6)  As a condition of renewal of a license, the Board

  2  of Medicine, the Board of Osteopathic Medicine, the Board of

  3  Chiropractic Medicine, and the Board of Podiatric Medicine

  4  shall each require licensees which they respectively regulate

  5  to periodically demonstrate their professional competency by

  6  completing at least 40 hours of continuing education every 2

  7  years, which may include up to 1 hour of risk management or

  8  cost containment and up to 2 hours of other topics related to

  9  the applicable medical specialty, if required by board rule.

10  The boards may require by rule that up to 1 hour of the

11  required 40 or more hours be in the area of risk management or

12  cost containment. This provision shall not be construed to

13  limit the number of hours that a licensee may obtain in risk

14  management or cost containment to be credited toward

15  satisfying the 40 or more required hours. This provision shall

16  not be construed to require the boards to impose any

17  requirement on licensees except for the completion of at least

18  40 hours of continuing education every 2 years. Each of such

19  boards shall determine whether any specific continuing

20  education course requirements not otherwise mandated by law

21  shall be mandated and shall approve criteria for, and the

22  content of, any continuing education course mandated by such

23  board. Notwithstanding any other provision of law, the board,

24  or the department when there is no board, may approve by rule

25  alternative methods of obtaining continuing education credits

26  in risk management. The alternative methods may include

27  attending a board meeting at which another a licensee is

28  disciplined, serving as a volunteer expert witness for the

29  department in a disciplinary case, or serving as a member of a

30  probable cause panel following the expiration of a board

31  member's term. Other boards within the Division of Medical


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  1  Quality Assurance, or the department if there is no board, may

  2  adopt rules granting continuing education hours in risk

  3  management for attending a board meeting at which another

  4  licensee is disciplined, serving as a volunteer expert witness

  5  for the department in a disciplinary case, or serving as a

  6  member of a probable cause panel following the expiration of a

  7  board member's term.

  8         (7)  The respective boards within the jurisdiction of

  9  the department, or the department when there is no board, may

10  adopt rules to provide for the use of approved videocassette

11  courses, not to exceed 5 hours per subject, to fulfill the

12  continuing education requirements of the professions they

13  regulate. Such rules shall provide for prior board approval of

14  the board, or the department when there is no board, of the

15  criteria for and content of such courses and shall provide for

16  a videocassette course validation form to be signed by the

17  vendor and the licensee and submitted to the department, along

18  with the license renewal application, for continuing education

19  credit.

20         (8)  Any board that currently requires continuing

21  education for renewal of a license, or the department if there

22  is no board, shall adopt rules to establish the criteria for

23  continuing education courses.  The rules may provide that up

24  to a maximum of 25 percent of the required continuing

25  education hours can be fulfilled by the performance of pro

26  bono services to the indigent or to underserved populations or

27  in areas of critical need within the state where the licensee

28  practices. The board, or the department if there is no board,

29  must require that any pro bono services be approved in advance

30  in order to receive credit for continuing education under this

31  subsection. The standard for determining indigency shall be


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  1  that recognized by the Federal Poverty Income Guidelines

  2  produced by the United States Department of Health and Human

  3  Services.  The rules may provide for approval by the board, or

  4  the department if there is no board, that a part of the

  5  continuing education hours can be fulfilled by performing

  6  research in critical need areas or for training leading to

  7  advanced professional certification.  The board, or the

  8  department if there is no board, may make rules to define

  9  underserved and critical need areas.  The department shall

10  adopt rules for administering continuing education

11  requirements adopted by the boards or the department if there

12  is no board.

13         (9)  Notwithstanding any law to the contrary, an

14  elected official who is licensed under a practice act

15  administered by the Division of Medical Health Quality

16  Assurance may hold employment for compensation with any public

17  agency concurrent with such public service.  Such dual service

18  must be disclosed according to any disclosure required by

19  applicable law.

20         Section 78.  Present subsections (5), (6), and (7) of

21  section 455.5651, Florida Statutes, 1998 Supplement, are

22  renumbered as subsections (6), (7), and (8), respectively, and

23  a new subsection (5) is added to that section, to read:

24         455.5651  Practitioner profile; creation.--

25         (5)  The Department of Health may not include

26  disciplinary action taken by a licensed hospital or an

27  ambulatory surgical center in the practitioner profile.

28         Section 79.  Section 455.567, Florida Statutes, is

29  amended to read:

30         455.567  Sexual misconduct; disqualification for

31  license, certificate, or registration.--


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  1         (1)  Sexual misconduct in the practice of a health care

  2  profession means violation of the professional relationship

  3  through which the health care practitioner uses such

  4  relationship to engage or attempt to engage the patient or

  5  client, or an immediate family member of the patient or client

  6  in, or to induce or attempt to induce such person to engage

  7  in, verbal or physical sexual activity outside the scope of

  8  the professional practice of such health care profession.

  9  Sexual misconduct in the practice of a health care profession

10  is prohibited.

11         (2)  Each board within the jurisdiction of the

12  department, or the department if there is no board, shall

13  refuse to admit a candidate to any examination and refuse to

14  issue a license, certificate, or registration to any applicant

15  if the candidate or applicant has:

16         (a)(1)  Had any license, certificate, or registration

17  to practice any profession or occupation revoked or

18  surrendered based on a violation of sexual misconduct in the

19  practice of that profession under the laws of any other state

20  or any territory or possession of the United States and has

21  not had that license, certificate, or registration reinstated

22  by the licensing authority of the jurisdiction that revoked

23  the license, certificate, or registration; or

24         (b)(2)  Committed any act in any other state or any

25  territory or possession of the United States which if

26  committed in this state would constitute sexual misconduct.

27

28  For purposes of this subsection, a licensing authority's

29  acceptance of a candidate's relinquishment of a license which

30  is offered in response to or in anticipation of the filing of

31


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  1  administrative charges against the candidate's license

  2  constitutes the surrender of the license.

  3         Section 80.  Subsection (2) of section 455.574, Florida

  4  Statutes, 1998 Supplement, is amended to read:

  5         455.574  Department of Health; examinations.--

  6         (2)  For each examination developed by the department

  7  or a contracted vendor, the board, or the department when

  8  there is no board, shall adopt rules providing for

  9  reexamination of any applicants who failed an examination

10  developed by the department or a contracted vendor. If both a

11  written and a practical examination are given, an applicant

12  shall be required to retake only the portion of the

13  examination on which the applicant failed to achieve a passing

14  grade, if the applicant successfully passes that portion

15  within a reasonable time, as determined by rule of the board,

16  or the department when there is no board, of passing the other

17  portion. Except for national examinations approved and

18  administered pursuant to this section, the department shall

19  provide procedures for applicants who fail an examination

20  developed by the department or a contracted vendor to review

21  their examination questions, answers, papers, grades, and

22  grading key for the questions the candidate answered

23  incorrectly or, if not feasible, the parts of the examination

24  failed. Applicants shall bear the actual cost for the

25  department to provide examination review pursuant to this

26  subsection. An applicant may waive in writing the

27  confidentiality of the applicant's examination grades.

28         Section 81.  Subsection (1) of section 455.587, Florida

29  Statutes, is amended, present subsections (2) through (7) are

30  renumbered as subsections (3) through (8), respectively, and a

31  new subsection (2) is added to that section, to read:


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  1         455.587  Fees; receipts; disposition for boards within

  2  the department.--

  3         (1)  Each board within the jurisdiction of the

  4  department, or the department when there is no board, shall

  5  determine by rule the amount of license fees for the its

  6  profession it regulates, based upon long-range estimates

  7  prepared by the department of the revenue required to

  8  implement laws relating to the regulation of professions by

  9  the department and the board.  Each board, or the department

10  if there is no board, shall ensure that license fees are

11  adequate to cover all anticipated costs and to maintain a

12  reasonable cash balance, as determined by rule of the agency,

13  with advice of the applicable board. If sufficient action is

14  not taken by a board within 1 year after notification by the

15  department that license fees are projected to be inadequate,

16  the department shall set license fees on behalf of the

17  applicable board to cover anticipated costs and to maintain

18  the required cash balance. The department shall include

19  recommended fee cap increases in its annual report to the

20  Legislature.  Further, it is the legislative intent that no

21  regulated profession operate with a negative cash balance. The

22  department may provide by rule for advancing sufficient funds

23  to any profession operating with a negative cash balance. The

24  advancement may be for a period not to exceed 2 consecutive

25  years, and the regulated profession must pay interest.

26  Interest shall be calculated at the current rate earned on

27  investments of a trust fund used by the department to

28  implement this part. Interest earned shall be allocated to the

29  various funds in accordance with the allocation of investment

30  earnings during the period of the advance.

31


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  1         (2)  Each board, or the department if there is no

  2  board, may charge a fee not to exceed $25, as determined by

  3  rule, for the issuance of a wall certificate pursuant to s.

  4  455.564(2) requested by a licensee who was licensed prior to

  5  July 1, 1998, or for the issuance of a duplicate wall

  6  certificate requested by any licensee.

  7         Section 82.  Section 455.601, Florida Statutes, is

  8  amended to read:

  9         455.601  Hepatitis B or human immunodeficiency

10  carriers.--

11         (1)  The department and each appropriate board within

12  the Division of Medical Quality Assurance shall have the

13  authority to establish procedures to handle, counsel, and

14  provide other services to health care professionals within

15  their respective boards who are infected with hepatitis B or

16  the human immunodeficiency virus.

17         (2)  Any person licensed by the department and any

18  other person employed by a health care facility who contracts

19  a blood-borne infection shall have a rebuttable presumption

20  that the illness was contracted in the course and scope of his

21  or her employment, provided that the person, as soon as

22  practicable, reports to the person's supervisor or the

23  facility's risk manager any significant exposure, as that term

24  is defined in s. 381.004(2)(c), to blood or body fluids. The

25  employer may test the blood or body fluid to determine if it

26  is infected with the same disease contracted by the employee.

27  The employer may rebut the presumption by the preponderance of

28  the evidence. Except as expressly provided in this subsection,

29  there shall be no presumption that a blood-borne infection is

30  a job-related injury or illness.

31


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  1         Section 83.  Subsections (1) and (6) of section

  2  455.604, Florida Statutes, 1998 Supplement, are amended to

  3  read:

  4         455.604  Requirement for instruction for certain

  5  licensees on human immunodeficiency virus and acquired immune

  6  deficiency syndrome.--

  7         (1)  The appropriate board shall require each person

  8  licensed or certified under chapter 457; chapter 458; chapter

  9  459; chapter 460; chapter 461; chapter 463; chapter 464;

10  chapter 465; chapter 466; part II, part III, or part V, or

11  part X of chapter 468; or chapter 486 to complete a continuing

12  educational course, approved by the board, on human

13  immunodeficiency virus and acquired immune deficiency syndrome

14  as part of biennial relicensure or recertification. The course

15  shall consist of education on the modes of transmission,

16  infection control procedures, clinical management, and

17  prevention of human immunodeficiency virus and acquired immune

18  deficiency syndrome. Such course shall include information on

19  current Florida law on acquired immune deficiency syndrome and

20  its impact on testing, confidentiality of test results,

21  treatment of patients, and any protocols and procedures

22  applicable to human immunodeficiency virus counseling and

23  testing, reporting, the offering of HIV testing to pregnant

24  women, and partner notification issues pursuant to ss. 381.004

25  and 384.25.

26         (6)  The board shall require as a condition of granting

27  a license under the chapters and parts specified in subsection

28  (1) that an applicant making initial application for licensure

29  complete an educational course acceptable to the board on

30  human immunodeficiency virus and acquired immune deficiency

31  syndrome. An applicant who has not taken a course at the time


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  1  of licensure shall, upon an affidavit showing good cause, be

  2  allowed 6 months to complete this requirement.

  3         Section 84.  Subsection (1) of section 455.607, Florida

  4  Statutes, is amended to read:

  5         455.607  Athletic trainers and massage therapists;

  6  requirement for instruction on human immunodeficiency virus

  7  and acquired immune deficiency syndrome.--

  8         (1)  The board, or the department where there is no

  9  board, shall require each person licensed or certified under

10  part XIII XIV of chapter 468 or chapter 480 to complete a

11  continuing educational course approved by the board, or the

12  department where there is no board, on human immunodeficiency

13  virus and acquired immune deficiency syndrome as part of

14  biennial relicensure or recertification.  The course shall

15  consist of education on modes of transmission, infection

16  control procedures, clinical management, and prevention of

17  human immunodeficiency virus and acquired immune deficiency

18  syndrome, with an emphasis on appropriate behavior and

19  attitude change.

20         Section 85.  Paragraphs (t), (u), (v), (w), and (x) are

21  added to subsection (1) of section 455.624, Florida Statutes,

22  subsection (2) of that section is amended, present subsection

23  (3) of that section is renumbered as subsection (4) and

24  amended, present subsections (4) and (5) of that subsection

25  are renumbered as subsections (5) and (6), respectively, and a

26  new subsection (3) is added to that section, to read:

27         455.624  Grounds for discipline; penalties;

28  enforcement.--

29         (1)  The following acts shall constitute grounds for

30  which the disciplinary actions specified in subsection (2) may

31  be taken:


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  1         (t)  Failing to comply with the requirements of ss.

  2  381.026 and 381.0261 to provide patients with information

  3  about their patient rights and how to file a patient

  4  complaint.

  5         (u)  Engaging or attempting to engage a patient or

  6  client in verbal or physical sexual activity. For the purposes

  7  of this section, a patient or client shall be presumed to be

  8  incapable of giving free, full, and informed consent to verbal

  9  or physical sexual activity.

10         (v)  Failing to comply with the requirements for

11  profiling and credentialing, including, but not limited to,

12  failing to provide initial information, failing to timely

13  provide updated information, or making misleading, untrue,

14  deceptive, or fraudulent representations on a profile,

15  credentialing, or initial or renewal licensure application.

16         (w)  Failing to report to the board, or the department

17  if there is no board, in writing within 30 days after the

18  licensee has been convicted or found guilty of, or entered a

19  plea of nolo contendere to, regardless of adjudication, a

20  crime in any jurisdiction. Convictions, findings,

21  adjudications, and pleas entered into prior to the enactment

22  of this paragraph must be reported in writing to the board, or

23  department if there is no board, on or before October 1, 1999.

24         (x)  Using information about people involved in motor

25  vehicle accidents which has been derived from accident reports

26  made by law enforcement officers or persons involved in

27  accidents pursuant to s. 316.066, or using information

28  published in a newspaper or other news publication or through

29  a radio or television broadcast that has used information

30  gained from such reports, for the purposes of commercial or

31


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  1  any other solicitation whatsoever of the people involved in

  2  such accidents.

  3         (2)  When the board, or the department when there is no

  4  board, finds any person guilty of the grounds set forth in

  5  subsection (1) or of any grounds set forth in the applicable

  6  practice act, including conduct constituting a substantial

  7  violation of subsection (1) or a violation of the applicable

  8  practice act which occurred prior to obtaining a license, it

  9  may enter an order imposing one or more of the following

10  penalties:

11         (a)  Refusal to certify, or to certify with

12  restrictions, an application for a license.

13         (b)  Suspension or permanent revocation of a license.

14         (c)  Restriction of practice.

15         (d)  Imposition of an administrative fine not to exceed

16  $10,000 $5,000 for each count or separate offense.

17         (e)  Issuance of a reprimand.

18         (f)  Placement of the licensee on probation for a

19  period of time and subject to such conditions as the board, or

20  the department when there is no board, may specify. Those

21  conditions may include, but are not limited to, requiring the

22  licensee to undergo treatment, attend continuing education

23  courses, submit to be reexamined, work under the supervision

24  of another licensee, or satisfy any terms which are reasonably

25  tailored to the violations found.

26         (g)  Corrective action.

27         (h)  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, or

31  department when there is no board, must first consider what


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  1  sanctions are necessary to protect the public or to compensate

  2  the patient. Only after those sanctions have been imposed may

  3  the disciplining authority consider and include in the order

  4  requirements designed to rehabilitate the practitioner. All

  5  costs associated with compliance with orders issued under this

  6  subsection are the obligation of the practitioner.

  7         (3)  Notwithstanding subsection (2), if the ground for

  8  disciplinary action is the first-time failure of the licensee

  9  to satisfy continuing education requirements established by

10  the board, or by the department if there is no board, the

11  board or department, as applicable, shall issue a citation in

12  accordance with s. 455.617 and assess a fine, as determined by

13  the board or department by rule. In addition, for each hour of

14  continuing education not completed or completed late, the

15  board or department, as applicable, may require the licensee

16  to take 1 additional hour of continuing education for each

17  hour not completed or completed late.

18         (4)(3)  In addition to any other discipline imposed

19  pursuant to this section or discipline imposed for a violation

20  of any practice act, the board, or the department when there

21  is no board, may assess costs related to the investigation and

22  prosecution of the case excluding costs associated with an

23  attorney's time. In any case where the board or the department

24  imposes a fine or assessment and the fine or assessment is not

25  paid within a reasonable time, such reasonable time to be

26  prescribed in the rules of the board, or the department when

27  there is no board, or in the order assessing such fines or

28  costs, the department or the Department of Legal Affairs may

29  contract for the collection of, or bring a civil action to

30  recover, the fine or assessment.

31


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  1         Section 86.  Section 455.664, Florida Statutes, is

  2  amended to read:

  3         455.664  Advertisement by a health care practitioner

  4  provider of free or discounted services; required

  5  statement.--In any advertisement for a free, discounted fee,

  6  or reduced fee service, examination, or treatment by a health

  7  care practitioner provider licensed under chapter 458, chapter

  8  459, chapter 460, chapter 461, chapter 462, chapter 463,

  9  chapter 464, chapter 465, chapter 466, chapter 467, chapter

10  478, chapter 483, chapter 484, or chapter 486, chapter 490, or

11  chapter 491, the following statement shall appear in capital

12  letters clearly distinguishable from the rest of the text:

13  THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A

14  RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR

15  PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT

16  IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING

17  TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED

18  FEE SERVICE, EXAMINATION, OR TREATMENT. However, the required

19  statement shall not be necessary as an accompaniment to an

20  advertisement of a licensed health care practitioner provider

21  defined by this section if the advertisement appears in a

22  classified directory the primary purpose of which is to

23  provide products and services at free, reduced, or discounted

24  prices to consumers and in which the statement prominently

25  appears in at least one place.

26         Section 87.  Subsections (7) and (16) of section

27  455.667, Florida Statutes, 1998 Supplement, are amended to

28  read:

29         455.667  Ownership and control of patient records;

30  report or copies of records to be furnished.--

31


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  1         (7)(a)1.  The department may obtain patient records and

  2  insurance information, if the complaint being investigated

  3  alleges inadequate medical care based on termination of

  4  insurance. The department may obtain patient access these

  5  records pursuant to a subpoena without written authorization

  6  from the patient if the department and the probable cause

  7  panel of the appropriate board, if any, find reasonable cause

  8  to believe that a health care practitioner has excessively or

  9  inappropriately prescribed any controlled substance specified

10  in chapter 893 in violation of this part or any professional

11  practice act or that a health care practitioner has practiced

12  his or her profession below that level of care, skill, and

13  treatment required as defined by this part or any professional

14  practice act; provided, however, the and also find that

15  appropriate, reasonable attempts were made to obtain a patient

16  release.

17         2.  The department may obtain patient records and

18  insurance information pursuant to a subpoena without written

19  authorization from the patient if the department and the

20  probable cause panel of the appropriate board, if any, find

21  reasonable cause to believe that a health care practitioner

22  has provided inadequate medical care based on termination of

23  insurance and also find that appropriate, reasonable attempts

24  were made to obtain a patient release.

25         3.  The department may obtain patient records, billing

26  records, insurance information, provider contracts, and all

27  attachments thereto pursuant to a subpoena without written

28  authorization from the patient if the department and probable

29  cause panel of the appropriate board, if any, find reasonable

30  cause to believe that a health care practitioner has submitted

31  a claim, statement, or bill using a billing code that would


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    CS for SB 2220                                 First Engrossed



  1  result in payment greater in amount than would be paid using a

  2  billing code that accurately describes the services performed,

  3  requested payment for services that were not performed by that

  4  health care practitioner, used information derived from a

  5  written report of an automobile accident generated pursuant to

  6  chapter 316 to solicit or obtain patients personally or

  7  through an agent regardless of whether the information is

  8  derived directly from the report or a summary of that report

  9  or from another person, solicited patients fraudulently,

10  received a kickback as defined in s. 455.657, violated the

11  patient brokering provisions of s. 817.505, or presented or

12  caused to be presented a false or fraudulent insurance claim

13  within the meaning of s. 817.234(1)(a), and also find that,

14  within the meaning of s. 817.234(1)(a), patient authorization

15  cannot be obtained because the patient cannot be located or is

16  deceased, incapacitated, or suspected of being a participant

17  in the fraud or scheme, and if the subpoena is issued for

18  specific and relevant records.

19         (b)  Patient records, billing records, insurance

20  information, provider contracts, and all attachments thereto

21  record obtained by the department pursuant to this subsection

22  shall be used solely for the purpose of the department and the

23  appropriate regulatory board in disciplinary proceedings. The

24  records shall otherwise be confidential and exempt from s.

25  119.07(1). This section does not limit the assertion of the

26  psychotherapist-patient privilege under s. 90.503 in regard to

27  records of treatment for mental or nervous disorders by a

28  medical practitioner licensed pursuant to chapter 458 or

29  chapter 459 who has primarily diagnosed and treated mental and

30  nervous disorders for a period of not less than 3 years,

31  inclusive of psychiatric residency. However, the health care


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  1  practitioner shall release records of treatment for medical

  2  conditions even if the health care practitioner has also

  3  treated the patient for mental or nervous disorders. If the

  4  department has found reasonable cause under this section and

  5  the psychotherapist-patient privilege is asserted, the

  6  department may petition the circuit court for an in camera

  7  review of the records by expert medical practitioners

  8  appointed by the court to determine if the records or any part

  9  thereof are protected under the psychotherapist-patient

10  privilege.

11         (16)  A health care practitioner or records owner

12  furnishing copies of reports or records or making the reports

13  or records available for digital scanning pursuant to this

14  section shall charge no more than the actual cost of copying,

15  including reasonable staff time, or the amount specified in

16  administrative rule by the appropriate board, or the

17  department when there is no board.

18         Section 88.  Subsection (3) is added to section

19  455.687, Florida Statutes, to read:

20         455.687  Certain health care practitioners; immediate

21  suspension of license.--

22         (3)  The department may issue an emergency order

23  suspending or restricting the license of any health care

24  practitioner as defined in s. 455.501(4) who tests positive

25  for any drug on any government or private-sector preemployment

26  or employer-ordered confirmed drug test, as defined in s.

27  112.0455, when the practitioner does not have a lawful

28  prescription and legitimate medical reason for using such

29  drug. The practitioner shall be given 48 hours from the time

30  of notification to the practitioner of the confirmed test

31


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  1  result to produce a lawful prescription for the drug before an

  2  emergency order is issued.

  3         Section 89.  Section 455.694, Florida Statutes, 1998

  4  Supplement, is amended to read:

  5         455.694  Financial responsibility requirements for

  6  Boards regulating certain health care practitioners.--

  7         (1)  As a prerequisite for licensure or license

  8  renewal, the Board of Acupuncture, the Board of Chiropractic

  9  Medicine, the Board of Podiatric Medicine, and the Board of

10  Dentistry shall, by rule, require that all health care

11  practitioners licensed under the respective board, and the

12  Board of Nursing shall, by rule, require that advanced

13  registered nurse practitioners certified under s. 464.012, and

14  the department shall, by rule, require that midwives maintain

15  medical malpractice insurance or provide proof of financial

16  responsibility in an amount and in a manner determined by the

17  board or department to be sufficient to cover claims arising

18  out of the rendering of or failure to render professional care

19  and services in this state.

20         (2)  The board or department may grant exemptions upon

21  application by practitioners meeting any of the following

22  criteria:

23         (a)  Any person licensed under chapter 457, chapter

24  460, chapter 461, s. 464.012, or chapter 466, or chapter 467

25  who practices exclusively as an officer, employee, or agent of

26  the Federal Government or of the state or its agencies or its

27  subdivisions.  For the purposes of this subsection, an agent

28  of the state, its agencies, or its subdivisions is a person

29  who is eligible for coverage under any self-insurance or

30  insurance program authorized by the provisions of s.

31  768.28(15) or who is a volunteer under s. 110.501(1).


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  1         (b)  Any person whose license or certification has

  2  become inactive under chapter 457, chapter 460, chapter 461,

  3  chapter 464, or chapter 466, or chapter 467 and who is not

  4  practicing in this state.  Any person applying for

  5  reactivation of a license must show either that such licensee

  6  maintained tail insurance coverage which provided liability

  7  coverage for incidents that occurred on or after October 1,

  8  1993, or the initial date of licensure in this state,

  9  whichever is later, and incidents that occurred before the

10  date on which the license became inactive; or such licensee

11  must submit an affidavit stating that such licensee has no

12  unsatisfied medical malpractice judgments or settlements at

13  the time of application for reactivation.

14         (c)  Any person holding a limited license pursuant to

15  s. 455.561, and practicing under the scope of such limited

16  license.

17         (d)  Any person licensed or certified under chapter

18  457, chapter 460, chapter 461, s. 464.012, or chapter 466, or

19  chapter 467 who practices only in conjunction with his or her

20  teaching duties at an accredited school or in its main

21  teaching hospitals. Such person may engage in the practice of

22  medicine to the extent that such practice is incidental to and

23  a necessary part of duties in connection with the teaching

24  position in the school.

25         (e)  Any person holding an active license or

26  certification under chapter 457, chapter 460, chapter 461, s.

27  464.012, or chapter 466, or chapter 467 who is not practicing

28  in this state.  If such person initiates or resumes practice

29  in this state, he or she must notify the department of such

30  activity.

31


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  1         (f)  Any person who can demonstrate to the board or

  2  department that he or she has no malpractice exposure in the

  3  state.

  4         (3)  Notwithstanding the provisions of this section,

  5  the financial responsibility requirements of ss. 458.320 and

  6  459.0085 shall continue to apply to practitioners licensed

  7  under those chapters.

  8         Section 90.  Section 455.712, Florida Statutes, is

  9  created to read:

10         455.712  Business establishments; requirements for

11  active status licenses.--

12         (1)  A business establishment regulated by the Division

13  of Medical Quality Assurance pursuant to this part may provide

14  regulated services only if the business establishment has an

15  active status license. A business establishment that provides

16  regulated services without an active status license is in

17  violation of this section and s. 455.624, and the board, or

18  the department if there is no board, may impose discipline on

19  the business establishment.

20         (2)  A business establishment must apply with a

21  complete application, as defined by rule of the board, or the

22  department if there is no board, to renew an active status

23  license before the license expires. If a business

24  establishment fails to renew before the license expires, the

25  license becomes delinquent, except as otherwise provided in

26  statute, in the license cycle following expiration.

27         (3)  A delinquent business establishment must apply

28  with a complete application, as defined by rule of the board,

29  or the department if there is no board, for active status

30  within 6 months after becoming delinquent. Failure of a

31  delinquent business establishment to renew the license within


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    CS for SB 2220                                 First Engrossed



  1  the 6 months after the expiration date of the license renders

  2  the license null without any further action by the board or

  3  the department. Any subsequent licensure shall be as a result

  4  of applying for and meeting all requirements imposed on a

  5  business establishment for new licensure.

  6         (4)  The status or a change in status of a business

  7  establishment license does not alter in any way the right of

  8  the board, or of the department if there is no board, to

  9  impose discipline or to enforce discipline previously imposed

10  on a business establishment for acts or omissions committed by

11  the business establishment while holding a license, whether

12  active or null.

13         (5)  This section applies to any a business

14  establishment registered, permitted, or licensed by the

15  department to do business. Business establishments include,

16  but are not limited to, dental laboratories, electrology

17  facilities, massage establishments, pharmacies, and health

18  care services pools.

19         Section 91.  Subsection (7) is added to section

20  457.102, Florida Statutes, 1998 Supplement, to read:

21         457.102  Definitions.--As used in this chapter:

22         (7)  "Prescriptive rights" means the prescription,

23  administration, and use of needles and devices, restricted

24  devices, and prescription devices that are used in the

25  practice of acupuncture and oriental medicine.

26         Section 92.  Subsections (2) and (4) of section

27  458.307, Florida Statutes, 1998 Supplement, are amended to

28  read:

29         458.307  Board of Medicine.--

30         (2)  Twelve members of the board must be licensed

31  physicians in good standing in this state who are residents of


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  1  the state and who have been engaged in the active practice or

  2  teaching of medicine for at least 4 years immediately

  3  preceding their appointment.  One of the physicians must be on

  4  the full-time faculty of a medical school in this state, and

  5  one of the physicians must be in private practice and on the

  6  full-time staff of a statutory teaching hospital in this state

  7  as defined in s. 408.07.  At least one of the physicians must

  8  be a graduate of a foreign medical school.  The remaining

  9  three members must be residents of the state who are not, and

10  never have been, licensed health care practitioners.  One

11  member must be a health care hospital risk manager licensed

12  certified under s. 395.10974 part IX of chapter 626.  At least

13  one member of the board must be 60 years of age or older.

14         (4)  The board, in conjunction with the department,

15  shall establish a disciplinary training program for board

16  members. The program shall provide for initial and periodic

17  training in the grounds for disciplinary action, the actions

18  which may be taken by the board and the department, changes in

19  relevant statutes and rules, and any relevant judicial and

20  administrative decisions. After January 1, 1989, No member of

21  the board shall participate on probable cause panels or in

22  disciplinary decisions of the board unless he or she has

23  completed the disciplinary training program.

24         Section 93.  Subsection (3) is added to section

25  458.309, Florida Statutes, 1998 Supplement, to read:

26         458.309  Authority to make rules.--

27         (3)  All physicians who perform level 2 procedures

28  lasting more than 5 minutes and all level 3 surgical

29  procedures in an office setting must register the office with

30  the department unless that office is licensed as a facility

31  pursuant to chapter 395. The department shall inspect the


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    CS for SB 2220                                 First Engrossed



  1  physician's office annually unless the office is accredited by

  2  a nationally recognized accrediting agency or an accrediting

  3  organization subsequently approved by the Board of Medicine.

  4  The actual costs for registration and inspection or

  5  accreditation shall be paid by the person seeking to register

  6  and operate the office setting in which office surgery is

  7  performed.

  8         Section 94.  Section 458.311, Florida Statutes, 1998

  9  Supplement, is amended to read:

10         458.311  Licensure by examination; requirements;

11  fees.--

12         (1)  Any person desiring to be licensed as a physician,

13  who does not hold a valid license in any state, shall apply to

14  the department on forms furnished by the department to take

15  the licensure examination. The department shall license

16  examine each applicant who whom the board certifies:

17         (a)  Has completed the application form and remitted a

18  nonrefundable application fee not to exceed $500 and an

19  examination fee not to exceed $300 plus the actual per

20  applicant cost to the department for purchase of the

21  examination from the Federation of State Medical Boards of the

22  United States or a similar national organization, which is

23  refundable if the applicant is found to be ineligible to take

24  the examination.

25         (b)  Is at least 21 years of age.

26         (c)  Is of good moral character.

27         (d)  Has not committed any act or offense in this or

28  any other jurisdiction which would constitute the basis for

29  disciplining a physician pursuant to s. 458.331.

30         (e)  For any applicant who has graduated from medical

31  school after October 1, 1992, has completed the equivalent of


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  1  2 academic years of preprofessional, postsecondary education,

  2  as determined by rule of the board, which shall include, at a

  3  minimum, courses in such fields as anatomy, biology, and

  4  chemistry prior to entering medical school.

  5         (f)  Meets one of the following medical education and

  6  postgraduate training requirements:

  7         1.a.  Is a graduate of an allopathic medical school or

  8  allopathic college recognized and approved by an accrediting

  9  agency recognized by the United States Office of Education or

10  is a graduate of an allopathic medical school or allopathic

11  college within a territorial jurisdiction of the United States

12  recognized by the accrediting agency of the governmental body

13  of that jurisdiction;

14         b.  If the language of instruction of the medical

15  school is other than English, has demonstrated competency in

16  English through presentation of a satisfactory grade on the

17  Test of Spoken English of the Educational Testing Service or a

18  similar test approved by rule of the board; and

19         c.  Has completed an approved residency of at least 1

20  year.

21         2.a.  Is a graduate of an allopathic a foreign medical

22  school registered with the World Health Organization and

23  certified pursuant to s. 458.314 as having met the standards

24  required to accredit medical schools in the United States or

25  reasonably comparable standards;

26         b.  If the language of instruction of the foreign

27  medical school is other than English, has demonstrated

28  competency in English through presentation of the Educational

29  Commission for Foreign Medical Graduates English proficiency

30  certificate or by a satisfactory grade on the Test of Spoken

31


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  1  English of the Educational Testing Service or a similar test

  2  approved by rule of the board; and

  3         c.  Has completed an approved residency of at least 1

  4  year.

  5         3.a.  Is a graduate of an allopathic a foreign medical

  6  school which has not been certified pursuant to s. 458.314;

  7         b.  Has had his or her medical credentials evaluated by

  8  the Educational Commission for Foreign Medical Graduates,

  9  holds an active, valid certificate issued by that commission,

10  and has passed the examination utilized by that commission;

11  and

12         c.  Has completed an approved residency of at least 1

13  year; however, after October 1, 1992, the applicant shall have

14  completed an approved residency or fellowship of at least 2

15  years in one specialty area.  However, to be acceptable, the

16  fellowship experience and training must be counted toward

17  regular or subspecialty certification by a board recognized

18  and certified by the American Board of Medical Specialties.

19         (g)  Has submitted to the department a set of

20  fingerprints on a form and under procedures specified by the

21  department, along with a payment in an amount equal to the

22  costs incurred by the Department of Health for the criminal

23  background check of the applicant.

24         (h)  Has obtained a passing score, as established by

25  rule of the board, on the licensure examination of the United

26  States Medical Licensing Examination (USMLE); or a combination

27  of the United States Medical Licensing Examination (USMLE),

28  the examination of the Federation of State Medical Boards of

29  the United States, Inc. (FLEX), or the examination of the

30  National Board of Medical Examiners up to the year 2000; or

31  for the purpose of examination of any applicant who was


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  1  licensed on the basis of a state board examination and who is

  2  currently licensed in at least one other jurisdiction of the

  3  United States or Canada, and who has practiced pursuant to

  4  such licensure for a period of at least 10 years, use of the

  5  Special Purpose Examination of the Federation of State Medical

  6  Boards of the United States (SPEX) upon receipt of a passing

  7  score as established by rule of the board. However, for the

  8  purpose of examination of any applicant who was licensed on

  9  the basis of a state board examination prior to 1974, who is

10  currently licensed in at least three other jurisdictions of

11  the United States or Canada, and who has practiced pursuant to

12  such licensure for a period of at least 20 years, this

13  paragraph does not apply.

14         (2)  As prescribed by board rule, the board may require

15  an applicant who does not pass the national licensing

16  examination after five attempts to complete additional

17  remedial education or training.  The board shall prescribe the

18  additional requirements in a manner that permits the applicant

19  to complete the requirements and be reexamined within 2 years

20  after the date the applicant petitions the board to retake the

21  examination a sixth or subsequent time.

22         (3)  Notwithstanding the provisions of subparagraph

23  (1)(f)3., a graduate of a foreign medical school need not

24  present the certificate issued by the Educational Commission

25  for Foreign Medical Graduates or pass the examination utilized

26  by that commission if the graduate:

27         (a)  Has received a bachelor's degree from an

28  accredited United States college or university.

29         (b)  Has studied at a medical school which is

30  recognized by the World Health Organization.

31


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  1         (c)  Has completed all of the formal requirements of

  2  the foreign medical school, except the internship or social

  3  service requirements, and has passed part I of the National

  4  Board of Medical Examiners examination or the Educational

  5  Commission for Foreign Medical Graduates examination

  6  equivalent.

  7         (d)  Has completed an academic year of supervised

  8  clinical training in a hospital affiliated with a medical

  9  school approved by the Council on Medical Education of the

10  American Medical Association and upon completion has passed

11  part II of the National Board of Medical Examiners examination

12  or the Educational Commission for Foreign Medical Graduates

13  examination equivalent.

14         (4)  The department and the board shall assure that

15  applicants for licensure meet the criteria in subsection (1)

16  through an investigative process.  When the investigative

17  process is not completed within the time set out in s.

18  120.60(1) and the department or board has reason to believe

19  that the applicant does not meet the criteria, the secretary

20  or the secretary's designee may issue a 90-day licensure delay

21  which shall be in writing and sufficient to notify the

22  applicant of the reason for the delay.  The provisions of this

23  subsection shall control over any conflicting provisions of s.

24  120.60(1).

25         (5)  The board may not certify to the department for

26  licensure any applicant who is under investigation in another

27  jurisdiction for an offense which would constitute a violation

28  of this chapter until such investigation is completed. Upon

29  completion of the investigation, the provisions of s. 458.331

30  shall apply. Furthermore, the department may not issue an

31  unrestricted license to any individual who has committed any


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  1  act or offense in any jurisdiction which would constitute the

  2  basis for disciplining a physician pursuant to s. 458.331.

  3  When the board finds that an individual has committed an act

  4  or offense in any jurisdiction which would constitute the

  5  basis for disciplining a physician pursuant to s. 458.331,

  6  then the board may enter an order imposing one or more of the

  7  terms set forth in subsection (9).

  8         (6)  Each applicant who passes the examination and

  9  meets the requirements of this chapter shall be licensed as a

10  physician, with rights as defined by law.

11         (7)  Upon certification by the board, the department

12  shall impose conditions, limitations, or restrictions on a

13  license by examination if the applicant is on probation in

14  another jurisdiction for an act which would constitute a

15  violation of this chapter.

16         (8)  When the board determines that any applicant for

17  licensure by examination has failed to meet, to the board's

18  satisfaction, each of the appropriate requirements set forth

19  in this section, it may enter an order requiring one or more

20  of the following terms:

21         (a)  Refusal to certify to the department an

22  application for licensure, certification, or registration;

23         (b)  Certification to the department of an application

24  for licensure, certification, or registration with

25  restrictions on the scope of practice of the licensee; or

26         (c)  Certification to the department of an application

27  for licensure, certification, or registration with placement

28  of the physician on probation for a period of time and subject

29  to such conditions as the board may specify, including, but

30  not limited to, requiring the physician to submit to

31  treatment, attend continuing education courses, submit to


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  1  reexamination, or work under the supervision of another

  2  physician.

  3         (9)(a)  Notwithstanding any of the provisions of this

  4  section, an applicant who, at the time of his or her medical

  5  education, was a citizen of the country of Nicaragua and, at

  6  the time of application for licensure under this subsection,

  7  is either a citizen of the country of Nicaragua or a citizen

  8  of the United States may make initial application to the

  9  department on or before July 1, 1992, for licensure subject to

10  this subsection and may reapply pursuant to board rule.  Upon

11  receipt of such application, the department shall issue a

12  2-year restricted license to any applicant therefor upon the

13  applicant's successful completion of the licensure examination

14  as described in paragraph (1)(a) and who the board certifies

15  has met the following requirements:

16         1.  Is a graduate of a World Health Organization

17  recognized foreign medical institution located in a country in

18  the Western Hemisphere.

19         2.  Received a medical education which has been

20  determined by the board to be substantially similar, at the

21  time of the applicant's graduation, to approved United States

22  medical programs.

23         3.  Practiced medicine in the country of Nicaragua for

24  a period of 1 year prior to residing in the United States and

25  has lawful employment authority in the United States.

26         4.  Has had his or her medical education verified by

27  the Florida Board of Medicine.

28         5.  Successfully completed the Educational Commission

29  for Foreign Medical Graduates Examination or Foreign Medical

30  Graduate Examination in the Medical Sciences or successfully

31  completed a course developed for the University of Miami for


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  1  physician training equivalent to the course developed for such

  2  purposes pursuant to chapter 74-105, Laws of Florida.  No

  3  person shall be permitted to enroll in the physician training

  4  course until he or she has been certified by the board as

  5  having met the requirements of this paragraph or conditionally

  6  certified by the board as having substantially complied with

  7  the requirements of this paragraph. Any person conditionally

  8  certified by the board shall be required to establish, to the

  9  board's satisfaction, full compliance with all the

10  requirements of this paragraph prior to completion of the

11  physician training course and shall not be permitted to sit

12  for the licensure examination unless the board certifies that

13  all of the requirements of this paragraph have been met.

14

15  However, applicants eligible for licensure under s. 455.581 or

16  subsection (9), 1988 Supplement to the Florida Statutes 1987,

17  as amended by s. 18, chapter 89-162, Laws of Florida, and ss.

18  5 and 42, chapter 89-374, Laws of Florida, and renumbered as

19  subsection (8) by s. 5, chapter 89-374, Laws of Florida, shall

20  not be eligible to apply under this subsection.

21         (b)  The holder of a restricted license issued pursuant

22  to this subsection may practice medicine for the first year

23  only under the direct supervision, as defined by board rule,

24  of a board-approved physician.

25         (c)  Upon recommendation of the supervising physician

26  and demonstration of clinical competency to the satisfaction

27  of the board that the holder of a restricted license issued

28  pursuant to this subsection has practiced for 1 year under

29  direct supervision, such licenseholder shall work for 1 year

30  under general supervision, as defined by board rule, of a

31  Florida-licensed physician in an area of critical need as


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  1  determined by the board.  Prior to commencing such

  2  supervision, the supervising physician shall notify the board.

  3         (d)  Upon completion of the 1 year of work under

  4  general supervision and demonstration to the board that the

  5  holder of the restricted license has satisfactorily completed

  6  the requirements of this subsection, and has not committed any

  7  act or is not under investigation for any act which would

  8  constitute a violation of this chapter, the department shall

  9  issue an unrestricted license to such licenseholder.

10         (e)  Rules necessary to implement and carry out the

11  provisions of this subsection shall be promulgated by the

12  board.

13         (10)  Notwithstanding any other provision of this

14  section, the department shall examine any person who meets the

15  criteria set forth in sub-subparagraph (1)(f)1.a.,

16  sub-subparagraphs (1)(f)3.a. and b., or subsection (3), if the

17  person:

18         (a)  Submits proof of successful completion of Steps I

19  and II of the United States Medical Licensing Examination or

20  the equivalent, as defined by rule of the board;

21         (b)  Is participating in an allocated slot in an

22  allopathic training program in this state on a full-time basis

23  at the time of examination;

24         (c)  Makes a written request to the department that he

25  or she be administered the examination without applying for a

26  license as a physician in this state; and

27         (d)  Remits a nonrefundable administration fee, not to

28  exceed $50, and an examination fee, not to exceed $300, plus

29  the actual cost per person to the department for the purchase

30  of the examination from the Federation of State Medical Boards

31  of the United States or a similar national organization.  The


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  1  examination fee is refundable if the person is found to be

  2  ineligible to take the examination.

  3         Section 95.  Section 458.3115, Florida Statutes, 1998

  4  Supplement, is 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)(a)  Notwithstanding any other provision of law, the

10  department agency shall provide procedures under which certain

11  physicians who are or were foreign-licensed and have practiced

12  medicine no less than 2 years may take the USMLE or an

13  agency-developed examination developed by the department, in

14  consultation with the board, to qualify for a restricted

15  license to practice medicine in this state. The

16  department-developed agency and board-developed examination

17  shall test the same areas of medical knowledge as the

18  Federation of State Medical Boards of the United States, Inc.

19  (FLEX) previously administered by the Florida Board of

20  Medicine to grant medical licensure in Florida. The

21  department-developed agency-developed examination must be made

22  available no later than December 31, 1998, to a physician who

23  qualifies for licensure. A person who is eligible to take and

24  elects to take the department-developed agency and

25  board-developed examination, who has previously passed part 1

26  or part 2 of the previously administered FLEX shall not be

27  required to retake or pass the equivalent parts of the

28  department-developed agency-developed examination, and may sit

29  for the department-developed agency and board-developed

30  examination five times within 5 years.

31


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  1         (b)  A person who is eligible to take and elects to

  2  take the USMLE who has previously passed part 1 or part 2 of

  3  the previously administered FLEX shall not be required to

  4  retake or pass the equivalent parts of the USMLE up to the

  5  year 2000.

  6         (c)  A person shall be eligible to take such

  7  examination for restricted licensure if the person:

  8         1.  Has taken, upon approval by the board, and

  9  completed, in November 1990 or November 1992, one of the

10  special preparatory medical update courses authorized by the

11  board and the University of Miami Medical School and

12  subsequently passed the final course examination; upon

13  approval by the board to take the course completed in 1990 or

14  in 1992, has a certificate of successful completion of that

15  course from the University of Miami or the Stanley H. Kaplan

16  course; or can document to the department that he or she was

17  one of the persons who took and successfully completed the

18  Stanley H. Kaplan course that was approved by the board of

19  Medicine and supervised by the University of Miami. At a

20  minimum, the documentation must include class attendance

21  records and the test score on the final course examination;

22         2.  Applies to the department agency and submits an

23  application fee that is nonrefundable and equivalent to the

24  fee required for full licensure;

25         3.  Documents no less than 2 years of the active

26  practice of medicine in any another jurisdiction;

27         4.  Submits an examination fee that is nonrefundable

28  and equivalent to the fee required for full licensure plus the

29  actual per-applicant cost to the department agency to provide

30  either examination described in this section;

31


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  1         5.  Has not committed any act or offense in this or any

  2  other jurisdiction that would constitute a substantial basis

  3  for disciplining a physician under this chapter or part II of

  4  chapter 455; and

  5         6.  Is not under discipline, investigation, or

  6  prosecution in this or any other jurisdiction for an act that

  7  would constitute a violation of this chapter or part II of

  8  chapter 455 and that substantially threatened or threatens the

  9  public health, safety, or welfare.

10         (d)  Every person eligible for restricted licensure

11  under this section may sit for the USMLE or the

12  department-developed agency and board-developed examination

13  five times within 5 calendar years.  Applicants desiring to

14  use portions of the FLEX and the USMLE may do so up to the

15  year 2000.  However, notwithstanding subparagraph (c)3.,

16  applicants applying under this section who fail the

17  examination up to a total of five times will only be required

18  to pay the examination fee required for full licensure for the

19  second and subsequent times they take the examination.

20         (e)  The department Agency for Health Care

21  Administration and the board shall be responsible for working

22  with one or more organizations to offer a medical refresher

23  course designed to prepare applicants to take either licensure

24  examination described in this section.  The organizations may

25  develop the medical refresher course, purchase such a course,

26  or contract for such a course from a private organization that

27  specializes in developing such courses.

28         (f)  The course shall require no less than two 16-week

29  semesters of 16 contact hours per week for a total of 256

30  contact hours per student for each semester. The cost is to be

31  paid by the students taking the course.


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  1         (2)(a)  Before the department agency may issue a

  2  restricted license to an applicant under this section, the

  3  applicant must have passed either of the two examinations

  4  described in this section.  However, the board may impose

  5  reasonable restrictions on the applicant's license to

  6  practice.  These restrictions may include, but are not limited

  7  to:

  8         1.  Periodic and random department agency audits of the

  9  licensee's patient records and review of those records by the

10  board or the department agency.

11         2.  Periodic appearances of the licensee before the

12  board or the department agency.

13         3.  Submission of written reports to the board or the

14  department agency.

15         (b)  A restricted licensee under this section shall

16  practice under the supervision of a full licensee approved by

17  the board with the first year of the licensure period being

18  under direct supervision as defined by board rule and the

19  second year being under indirect supervision as defined by

20  board rule.

21         (c)  The board may adopt rules necessary to implement

22  this subsection.

23         (3)(a)  A restricted license issued by the department

24  agency under this section is valid for 2 years unless sooner

25  revoked or suspended, and a restricted licensee is subject to

26  the requirements of this chapter, part II of chapter 455, and

27  any other provision of law not in conflict with this section.

28  Upon expiration of such restricted license, a restricted

29  licensee shall become a full licensee if the restricted

30  licensee:

31


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    CS for SB 2220                                 First Engrossed



  1         1.  Is not under discipline, investigation, or

  2  prosecution for a violation which poses a substantial threat

  3  to the public health, safety, or welfare; and

  4         2.  Pays all renewal fees required of a full licensee.

  5         (b)  The department agency shall renew a restricted

  6  license under this section upon payment of the same fees

  7  required for renewal for a full license if the restricted

  8  licensee is under discipline, investigation, or prosecution

  9  for a violation which posed or poses a substantial threat to

10  the public health, safety, or welfare and the board has not

11  permanently revoked the restricted license. A restricted

12  licensee who has renewed such restricted license shall become

13  eligible for full licensure when the licensee is no longer

14  under discipline, investigation, or prosecution.

15         (4)  The board shall adopt rules necessary to carry out

16  the provisions of this section.

17         Section 96.  Subsections (1), (2), and (8) of section

18  458.313, Florida Statutes, are amended to read:

19         458.313  Licensure by endorsement; requirements;

20  fees.--

21         (1)  The department shall issue a license by

22  endorsement to any applicant who, upon applying to the

23  department on forms furnished by the department and remitting

24  a fee set by the board not to exceed $500 set by the board,

25  the board certifies:

26         (a)  Has met the qualifications for licensure in s.

27  458.311(1)(b)-(g) or in s. 458.311(1)(b)-(e) and (g) and (3);

28         (b)  Prior to January 1, 2000, has obtained a passing

29  score, as established by rule of the board, on the licensure

30  examination of the Federation of State Medical Boards of the

31  United States, Inc. (FLEX), on or of the United States Medical


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  1  Licensing Examination (USMLE), or on the examination of the

  2  National Board of Medical Examiners, or on a combination

  3  thereof, and on or after January 1, 2000, has obtained a

  4  passing score on the United States Medical Licensing

  5  Examination (USMLE) provided the board certifies as eligible

  6  for licensure by endorsement any applicant who took the

  7  required examinations more than 10 years prior to application;

  8  and

  9         (c)  Has submitted evidence of the active licensed

10  practice of medicine in another jurisdiction, for at least 2

11  of the immediately preceding 4 years, or evidence of

12  successful completion of either a board-approved postgraduate

13  training program within 2 years preceding filing of an

14  application, or a board-approved clinical competency

15  examination, within the year preceding the filing of an

16  application for licensure.  For purposes of this paragraph,

17  "active licensed practice of medicine" means that practice of

18  medicine by physicians, including those employed by any

19  governmental entity in community or public health, as defined

20  by this chapter, medical directors under s. 641.495(11) who

21  are practicing medicine, and those on the active teaching

22  faculty of an accredited medical school.

23         (2)(a)  As prescribed by board rule, the board may

24  require an applicant who does not pass the licensing

25  examination after five attempts to complete additional

26  remedial education or training.  The board shall prescribe the

27  additional requirements in a manner that permits the applicant

28  to complete the requirements and be reexamined within 2 years

29  after the date the applicant petitions the board to retake the

30  examination a sixth or subsequent time.

31


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  1         (b)  The board may require an applicant for licensure

  2  by endorsement to take and pass the appropriate licensure

  3  examination prior to certifying the applicant as eligible for

  4  licensure.

  5         (8)  The department shall reactivate the license of any

  6  physician whose license has become void by failure to practice

  7  in Florida for a period of 1 year within 3 years after

  8  issuance of the license by endorsement, if the physician was

  9  issued a license by endorsement prior to 1989, has actively

10  practiced medicine in another state for the last 4 years,

11  applies for licensure before October 1, 1998, pays the

12  applicable fees, and otherwise meets any continuing education

13  requirements for reactivation of the license as determined by

14  the board.

15         Section 97.  Subsection (1) of section 458.315, Florida

16  Statutes, is amended to read:

17         458.315  Temporary certificate for practice in areas of

18  critical need.--Any physician who is licensed to practice in

19  any other state, whose license is currently valid, and who

20  pays an application fee of $300 may be issued a temporary

21  certificate to practice in communities of Florida where there

22  is a critical need for physicians.  A certificate may be

23  issued to a physician who will be employed by a county health

24  department, correctional facility, community health center

25  funded by s. 329, s. 330, or s. 340 of the United States

26  Public Health Services Act, or other entity that provides

27  health care to indigents and that is approved by the State

28  Health Officer.  The Board of Medicine may issue this

29  temporary certificate with the following restrictions:

30         (1)  The board shall determine the areas of critical

31  need, and the physician so certified may practice in any of


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    CS for SB 2220                                 First Engrossed



  1  those areas only in that specific area for a time to be

  2  determined by the board.  Such areas shall include, but not be

  3  limited to, health professional shortage areas designated by

  4  the United States Department of Health and Human Services.

  5         (a)  A recipient of a temporary certificate for

  6  practice in areas of critical need may use the license to work

  7  for any approved employer in any area of critical need

  8  approved by the board.

  9         (b)  The recipient of a temporary certificate for

10  practice in areas of critical need shall, within 30 days after

11  accepting employment, notify the board of all approved

12  institutions in which the licensee practices and of all

13  approved institutions where practice privileges have been

14  denied.

15         Section 98.  Section 458.3165, Florida Statutes, is

16  amended to read:

17         458.3165  Public psychiatry certificate.--The board

18  shall issue a public psychiatry certificate to an individual

19  who remits an application fee not to exceed $300, as set by

20  the board, who is a board-certified psychiatrist, who is

21  licensed to practice medicine without restriction in another

22  state, and who meets the requirements in s. 458.311(1)(a)-(g)

23  and (5). A recipient of a public psychiatry certificate may

24  use the certificate to work at any public mental health

25  facility or program funded in part or entirely by state funds.

26         (1)  Such certificate shall:

27         (a)  Authorize the holder to practice only in a public

28  mental health facility or program funded in part or entirely

29  by state funds.

30         (b)  Be issued and renewable biennially if the

31  secretary of the Department of Health and Rehabilitative


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  1  Services and the chair of the department of psychiatry at one

  2  of the public medical schools or the chair of the department

  3  of psychiatry at the accredited medical school at the

  4  University of Miami recommend in writing that the certificate

  5  be issued or renewed.

  6         (c)  Automatically expire if the holder's relationship

  7  with a public mental health facility or program expires.

  8         (d)  Not be issued to a person who has been adjudged

  9  unqualified or guilty of any of the prohibited acts in this

10  chapter.

11         (2)  The board may take disciplinary action against a

12  certificateholder for noncompliance with any part of this

13  section or for any reason for which a regular licensee may be

14  subject to discipline.

15         Section 99.  Subsection (4) is added to section

16  458.317, Florida Statutes, 1998 Supplement, to read:

17         458.317  Limited licenses.--

18         (4)  Any person holding an active license to practice

19  medicine in the state may convert that license to a limited

20  license for the purpose of providing volunteer, uncompensated

21  care for low-income Floridians. The applicant must submit a

22  statement from the employing agency or institution stating

23  that he or she will not receive compensation for any service

24  involving the practice of medicine. The application and all

25  licensure fees, including neurological injury compensation

26  assessments, shall be waived.

27         Section 100.  Paragraph (mm) is added to subsection (1)

28  of section 458.331, Florida Statutes, 1998 Supplement, and

29  subsection (2) of that section is amended to read:

30         458.331  Grounds for disciplinary action; action by the

31  board and department.--


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  1         (1)  The following acts shall constitute grounds for

  2  which the disciplinary actions specified in subsection (2) may

  3  be taken:

  4         (mm)  Failing to comply with the requirements of ss.

  5  381.026 and 381.0261 to provide patients with information

  6  about their patient rights and how to file a patient

  7  complaint.

  8         (2)  When the board finds any person guilty of any of

  9  the grounds set forth in subsection (1), including conduct

10  that would constitute a substantial violation of subsection

11  (1) which occurred prior to licensure, it may enter an order

12  imposing one or more of the following penalties:

13         (a)  Refusal to certify, or certification with

14  restrictions, to the department an application for licensure,

15  certification, or registration.

16         (b)  Revocation or suspension of a license.

17         (c)  Restriction of practice.

18         (d)  Imposition of an administrative fine not to exceed

19  $10,000 $5,000 for each count or separate offense.

20         (e)  Issuance of a reprimand.

21         (f)  Placement of the physician on probation for a

22  period of time and subject to such conditions as the board may

23  specify, including, but not limited to, requiring the

24  physician to submit to treatment, to attend continuing

25  education courses, to submit to reexamination, or to work

26  under the supervision of another physician.

27         (g)  Issuance of a letter of concern.

28         (h)  Corrective action.

29         (i)  Refund of fees billed to and collected from the

30  patient.

31


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  1         (j)  Imposition of an administrative fine in accordance

  2  with s. 381.0261 for violations regarding patient rights.

  3

  4  In determining what action is appropriate, the board must

  5  first consider what sanctions are necessary to protect the

  6  public or to compensate the patient.  Only after those

  7  sanctions have been imposed may the disciplining authority

  8  consider and include in the order requirements designed to

  9  rehabilitate the physician.  All costs associated with

10  compliance with orders issued under this subsection are the

11  obligation of the physician.

12         Section 101.  Subsection (7) of section 458.347,

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

14         458.347  Physician assistants.--

15         (7)  PHYSICIAN ASSISTANT LICENSURE.--

16         (a)  Any person desiring to be licensed as a physician

17  assistant must apply to the department.  The department shall

18  issue a license to any person certified by the council as

19  having met the following requirements:

20         1.  Is at least 18 years of age.

21         2.  Has satisfactorily passed a proficiency examination

22  by an acceptable score established by the National Commission

23  on Certification of Physician Assistants.  If an applicant

24  does not hold a current certificate issued by the National

25  Commission on Certification of Physician Assistants and has

26  not actively practiced as a physician assistant within the

27  immediately preceding 4 years, the applicant must retake and

28  successfully complete the entry-level examination of the

29  National Commission on Certification of Physician Assistants

30  to be eligible for licensure.

31


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  1         3.  Has completed the application form and remitted an

  2  application fee not to exceed $300 as set by the boards. An

  3  application for licensure made by a physician assistant must

  4  include:

  5         a.  A certificate of completion of a physician

  6  assistant training program specified in subsection (6).

  7         b.  A sworn statement of any prior felony convictions.

  8         c.  A sworn statement of any previous revocation or

  9  denial of licensure or certification in any state.

10         d.  Two letters of recommendation.

11         (b)1.  Notwithstanding subparagraph (a)2. and

12  sub-subparagraph (a)3.a., the department shall examine each

13  applicant who the Board of Medicine certifies:

14         a.  Has completed the application form and remitted a

15  nonrefundable application fee not to exceed $500 and an

16  examination fee not to exceed $300, plus the actual cost to

17  the department to provide the examination.  The examination

18  fee is refundable if the applicant is found to be ineligible

19  to take the examination.  The department shall not require the

20  applicant to pass a separate practical component of the

21  examination. For examinations given after July 1, 1998,

22  competencies measured through practical examinations shall be

23  incorporated into the written examination through a

24  multiple-choice format. The department shall translate the

25  examination into the native language of any applicant who

26  requests and agrees to pay all costs of such translation,

27  provided that the translation request is filed with the board

28  office no later than 9 months before the scheduled examination

29  and the applicant remits translation fees as specified by the

30  department no later than 6 months before the scheduled

31  examination, and provided that the applicant demonstrates to


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  1  the department the ability to communicate orally in basic

  2  English. If the applicant is unable to pay translation costs,

  3  the applicant may take the next available examination in

  4  English if the applicant submits a request in writing by the

  5  application deadline and if the applicant is otherwise

  6  eligible under this section. To demonstrate the ability to

  7  communicate orally in basic English, a passing score or grade

  8  is required, as determined by the department or organization

  9  that developed it, on one of the following English

10  examinations:

11         (I)  The test for spoken English (TSE) by the

12  Educational Testing Service (ETS);

13         (II)  The test of English as a foreign language

14  (TOEFL), by ETS;

15         (III)  A high school or college level English course;

16         (IV)  The English examination for citizenship,

17  Immigration and Naturalization Service.

18

19  A notarized copy of an Educational Commission for Foreign

20  Medical Graduates (ECFMG) certificate may also be used to

21  demonstrate the ability to communicate in basic English.

22         b.  Is an unlicensed physician who graduated from a

23  foreign medical school listed with the World Health

24  Organization who has not previously taken and failed the

25  examination of the National Commission on Certification of

26  Physician Assistants and who has been certified by the Board

27  of Medicine as having met the requirements for licensure as a

28  medical doctor by examination as set forth in s. 458.311(1),

29  (3), (4), and (5), with the exception that the applicant is

30  not required to have completed an approved residency of at

31  least 1 year and the applicant is not required to have passed


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  1  the licensing examination specified under s. 458.311 or hold a

  2  valid, active certificate issued by the Educational Commission

  3  for Foreign Medical Graduates.

  4         c.  Was eligible and made initial application for

  5  certification as a physician assistant in this state between

  6  July 1, 1990, and June 30, 1991.

  7         d.  Was a resident of this state on July 1, 1990, or

  8  was licensed or certified in any state in the United States as

  9  a physician assistant on July 1, 1990.

10         2.  The department may grant temporary licensure to an

11  applicant who meets the requirements of subparagraph 1.

12  Between meetings of the council, the department may grant

13  temporary licensure to practice based on the completion of all

14  temporary licensure requirements.  All such administratively

15  issued licenses shall be reviewed and acted on at the next

16  regular meeting of the council.  A temporary license expires

17  30 days after upon receipt and notice of scores to the

18  licenseholder from the first available examination specified

19  in subparagraph 1. following licensure by the department.  An

20  applicant who fails the proficiency examination is no longer

21  temporarily licensed, but may apply for a one-time extension

22  of temporary licensure after reapplying for the next available

23  examination. Extended licensure shall expire upon failure of

24  the licenseholder to sit for the next available examination or

25  upon receipt and notice of scores to the licenseholder from

26  such examination.

27         3.  Notwithstanding any other provision of law, the

28  examination specified pursuant to subparagraph 1. shall be

29  administered by the department only five times.  Applicants

30  certified by the board for examination shall receive at least

31  6 months' notice of eligibility prior to the administration of


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  1  the initial examination. Subsequent examinations shall be

  2  administered at 1-year intervals following the reporting of

  3  the scores of the first and subsequent examinations.  For the

  4  purposes of this paragraph, the department may develop,

  5  contract for the development of, purchase, or approve an

  6  examination, including a practical component, that adequately

  7  measures an applicant's ability to practice with reasonable

  8  skill and safety.  The minimum passing score on the

  9  examination shall be established by the department, with the

10  advice of the board.  Those applicants failing to pass that

11  examination or any subsequent examination shall receive notice

12  of the administration of the next examination with the notice

13  of scores following such examination.  Any applicant who

14  passes the examination and meets the requirements of this

15  section shall be licensed as a physician assistant with all

16  rights defined thereby.

17         (c)  The license must be renewed biennially.  Each

18  renewal must include:

19         1.  A renewal fee not to exceed $500 as set by the

20  boards.

21         2.  A sworn statement of no felony convictions in the

22  previous 2 years.

23         (d)  Each licensed physician assistant shall biennially

24  complete 100 hours of continuing medical education or shall

25  hold a current certificate issued by the National Commission

26  on Certification of Physician Assistants.

27         (e)  Upon employment as a physician assistant, a

28  licensed physician assistant must notify the department in

29  writing within 30 days after such employment or after any

30  subsequent changes in the supervising physician. The

31  notification must include the full name, Florida medical


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  1  license number, specialty, and address of the supervising

  2  physician.

  3         (f)  Notwithstanding subparagraph (a)2., the department

  4  may grant to a recent graduate of an approved program, as

  5  specified in subsection (6), who expects to take the first

  6  examination administered by the National Commission on

  7  Certification of Physician Assistants available for

  8  registration after the applicant's graduation, a temporary

  9  license. The temporary license shall to expire 30 days after

10  upon receipt of scores of the proficiency examination

11  administered by the National Commission on Certification of

12  Physician Assistants.  Between meetings of the council, the

13  department may grant a temporary license to practice based on

14  the completion of all temporary licensure requirements.  All

15  such administratively issued licenses shall be reviewed and

16  acted on at the next regular meeting of the council. The

17  recent graduate may be licensed prior to employment, but must

18  comply with paragraph (e). An applicant who has passed the

19  proficiency examination may be granted permanent licensure. An

20  applicant failing the proficiency examination is no longer

21  temporarily licensed, but may reapply for a 1-year extension

22  of temporary licensure.  An applicant may not be granted more

23  than two temporary licenses and may not be licensed as a

24  physician assistant until he or she passes the examination

25  administered by the National Commission on Certification of

26  Physician Assistants. As prescribed by board rule, the council

27  may require an applicant who does not pass the licensing

28  examination after five or more attempts to complete additional

29  remedial education or training. The council shall prescribe

30  the additional requirements in a manner that permits the

31  applicant to complete the requirements and be reexamined


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  1  within 2 years after the date the applicant petitions the

  2  council to retake the examination a sixth or subsequent time.

  3         (g)  The Board of Medicine may impose any of the

  4  penalties specified in ss. 455.624 and 458.331(2) upon a

  5  physician assistant if the physician assistant or the

  6  supervising physician has been found guilty of or is being

  7  investigated for any act that constitutes a violation of this

  8  chapter or part II of chapter 455.

  9         Section 102.  Section 459.005, Florida Statutes, 1998

10  Supplement, is amended to read:

11         459.005  Rulemaking authority.--

12         (1)  The board has authority to adopt rules pursuant to

13  ss. 120.536(1) and 120.54 to implement the provisions of this

14  chapter conferring duties upon it.

15         (2)  All physicians who perform level 2 procedures

16  lasting more than 5 minutes and all level 3 surgical

17  procedures in an office setting must register the office with

18  the department unless that office is licensed as a facility

19  pursuant to chapter 395. The department shall inspect the

20  physician's office annually unless the office is accredited by

21  a nationally recognized accrediting agency or an accrediting

22  organization subsequently approved by the Board of Osteopathic

23  Medicine. The actual costs for registration and inspection or

24  accreditation shall be paid by the person seeking to register

25  and operate the office setting in which office surgery is

26  performed.

27         Section 103.  Subsection (7) is added to section

28  459.0075, Florida Statutes, to read:

29         459.0075  Limited licenses.--

30         (7)  Any person holding an active license to practice

31  osteopathic medicine in the state may convert that license to


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  1  a limited license for the purpose of providing volunteer,

  2  uncompensated care for low-income Floridians. The applicant

  3  must submit a statement from the employing agency or

  4  institution stating that he or she will not receive

  5  compensation for any service involving the practice of

  6  osteopathic medicine. The application and all licensure fees,

  7  including neurological injury compensation assessments, shall

  8  be waived.

  9         Section 104.  Paragraph (oo) is added to subsection (1)

10  of section 459.015, Florida Statutes, 1998 Supplement, and

11  subsection (2) of that section is amended to read:

12         459.015  Grounds for disciplinary action by the

13  board.--

14         (1)  The following acts shall constitute grounds for

15  which the disciplinary actions specified in subsection (2) may

16  be taken:

17         (oo)  Failing to comply with the requirements of ss.

18  381.026 and 381.0261 to provide patients with information

19  about their patient rights and how to file a patient

20  complaint.

21         (2)  When the board finds any person guilty of any of

22  the grounds set forth in subsection (1), it may enter an order

23  imposing one or more of the following penalties:

24         (a)  Refusal to certify, or certify with restrictions,

25  to the department an application for certification, licensure,

26  renewal, or reactivation.

27         (b)  Revocation or suspension of a license or

28  certificate.

29         (c)  Restriction of practice.

30         (d)  Imposition of an administrative fine not to exceed

31  $10,000 $5,000 for each count or separate offense.


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  1         (e)  Issuance of a reprimand.

  2         (f)  Issuance of a letter of concern.

  3         (g)  Placement of the osteopathic physician on

  4  probation for a period of time and subject to such conditions

  5  as the board may specify, including, but not limited to,

  6  requiring the osteopathic physician to submit to treatment,

  7  attend continuing education courses, submit to reexamination,

  8  or work under the supervision of another osteopathic

  9  physician.

10         (h)  Corrective action.

11         (i)  Refund of fees billed to and collected from the

12  patient.

13         (j)  Imposition of an administrative fine in accordance

14  with s. 381.0261 for violations regarding patient rights.

15

16  In determining what action is appropriate, the board must

17  first consider what sanctions are necessary to protect the

18  public or to compensate the patient.  Only after those

19  sanctions have been imposed may the disciplining authority

20  consider and include in the order requirements designed to

21  rehabilitate the physician.  All costs associated with

22  compliance with orders issued under this subsection are the

23  obligation of the physician.

24         Section 105.  Subsection (6) is added to section

25  460.402, Florida Statutes, to read:

26         460.402  Exceptions.--The provisions of this chapter

27  shall not apply to:

28         (6)  A chiropractic student enrolled in a chiropractic

29  college accredited by the Council on Chiropractic Education

30  and participating in a community-based internship under the

31  direct supervision of a doctor of chiropractic medicine who is


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  1  credentialed as an adjunct faculty member of a chiropractic

  2  college in which the student is enrolled.

  3         Section 106.  Present subsections (4) through (10) of

  4  section 460.403, Florida Statutes, 1998 Supplement, are

  5  renumbered as subsections (5) through (11), respectively, a

  6  new subsection (4) is added to that section, and present

  7  subsections (6) and (9) are amended, to read:

  8         460.403  Definitions.--As used in this chapter, the

  9  term:

10         (4)  "Community-based internship" means a program in

11  which a student enrolled in the last year of a chiropractic

12  college accredited by the Council on Chiropractic Education is

13  approved to obtain required pregraduation clinical experience

14  in a chiropractic clinic or practice under the direct

15  supervision of a doctor of chiropractic medicine approved as

16  an adjunct faculty member of the chiropractic college in which

17  the student is enrolled, according to the teaching protocols

18  for the clinical practice requirements of the college.

19         (7)(6)  "Direct supervision" means responsible

20  supervision and control, with the licensed chiropractic

21  physician assuming legal liability for the services rendered

22  by a registered chiropractic assistant or a chiropractic

23  student enrolled in a community-based intern program.  Except

24  in cases of emergency, direct supervision shall require the

25  physical presence of the licensed chiropractic physician for

26  consultation and direction of the actions of the registered

27  chiropractic assistant or a chiropractic student enrolled in a

28  community-based intern program.  The board shall further

29  establish rules as to what constitutes responsible direct

30  supervision of a registered chiropractic assistant.

31


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  1         (10)(9)  "Registered chiropractic assistant" means a

  2  person who is registered by the board to perform chiropractic

  3  services under the direct supervision of a chiropractic

  4  physician or certified chiropractic physician's assistant.

  5         Section 107.  Subsection (1) of section 460.406,

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

  7         460.406  Licensure by examination.--

  8         (1)  Any person desiring to be licensed as a

  9  chiropractic physician shall apply to the department to take

10  the licensure examination. There shall be an application fee

11  set by the board not to exceed $100 which shall be

12  nonrefundable.  There shall also be an examination fee not to

13  exceed $500 plus the actual per applicant cost to the

14  department for purchase of portions of the examination from

15  the National Board of Chiropractic Examiners or a similar

16  national organization, which may be refundable if the

17  applicant is found ineligible to take the examination.  The

18  department shall examine each applicant who the board

19  certifies has:

20         (a)  Completed the application form and remitted the

21  appropriate fee.

22         (b)  Submitted proof satisfactory to the department

23  that he or she is not less than 18 years of age.

24         (c)  Submitted proof satisfactory to the department

25  that he or she is a graduate of a chiropractic college which

26  is accredited by or has status with the Council on

27  Chiropractic Education or its predecessor agency. However, any

28  applicant who is a graduate of a chiropractic college that was

29  initially accredited by the Council on Chiropractic Education

30  in 1995, who graduated from such college within the 4 years

31  immediately preceding such accreditation, and who is otherwise


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  1  qualified shall be eligible to take the examination.  No

  2  application for a license to practice chiropractic medicine

  3  shall be denied solely because the applicant is a graduate of

  4  a chiropractic college that subscribes to one philosophy of

  5  chiropractic medicine as distinguished from another.

  6         (d)1.  For an applicant who has matriculated in a

  7  chiropractic college prior to July 2, 1990, completed at least

  8  2 years of residence college work, consisting of a minimum of

  9  one-half the work acceptable for a bachelor's degree granted

10  on the basis of a 4-year period of study, in a college or

11  university accredited by an accrediting agency recognized and

12  approved by the United States Department of Education.

13  However, prior to being certified by the board to sit for the

14  examination, each applicant who has matriculated in a

15  chiropractic college after July 1, 1990, shall have been

16  granted a bachelor's degree, based upon 4 academic years of

17  study, by a college or university accredited by a regional

18  accrediting agency which is a member of the Commission on

19  Recognition of Postsecondary Accreditation.

20         2.  Effective July 1, 2000, completed, prior to

21  matriculation in a chiropractic college, at least 3 years of

22  residence college work, consisting of a minimum of 90 semester

23  hours leading to a bachelor's degree in a liberal arts college

24  or university accredited by an accrediting agency recognized

25  and 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, 2000, shall have been

29  granted a bachelor's degree from an institution holding

30  accreditation for that degree from a regional accrediting

31  agency which is recognized by the United States Department of


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  1  Education.  The applicant's chiropractic degree must consist

  2  of credits earned in the chiropractic program and may not

  3  include academic credit for courses from the bachelor's

  4  degree.

  5         (e)  Completed not less than a 3-month training program

  6  in this state of not less than 300 hours with a chiropractic

  7  physician licensed in this state. The chiropractic physician

  8  candidate may perform all services offered by the licensed

  9  chiropractic physician, but must be under the supervision of

10  the licensed chiropractic physician until the results of the

11  first licensure examination for which the candidate has

12  qualified have been received, at which time the candidate's

13  training program shall be terminated. However, an applicant

14  who has practiced chiropractic medicine in any other state,

15  territory, or jurisdiction of the United States or any foreign

16  national jurisdiction for at least 5 years as a licensed

17  chiropractic physician need not be required to complete the

18  3-month training program as a requirement for licensure.

19         (e)(f)  Successfully completed the National Board of

20  Chiropractic Examiners certification examination in parts I

21  and II and clinical competency, with a score approved by the

22  board, within 10 years immediately preceding application to

23  the department for licensure.

24         (f)(g)  Submitted to the department a set of

25  fingerprints on a form and under procedures specified by the

26  department, along with payment in an amount equal to the costs

27  incurred by the Department of Health for the criminal

28  background check of the applicant.

29         Section 108.  Paragraphs (p) and (dd) of subsection (1)

30  and paragraph (b) of subsection (2) of section 460.413,

31  Florida Statutes, 1998 Supplement, are amended to read:


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  1         460.413  Grounds for disciplinary action; action by the

  2  board.--

  3         (1)  The following acts shall constitute grounds for

  4  which the disciplinary actions specified in subsection (2) may

  5  be taken:

  6         (p)  Prescribing, dispensing, or administering any

  7  medicinal drug except as authorized by s. 460.403(9)(c)2. s.

  8  460.403(8)(c)2., performing any surgery, or practicing

  9  obstetrics.

10         (dd)  Using acupuncture without being certified

11  pursuant to s. 460.403(9)(f) s. 460.403(8)(f).

12         (2)  When the board finds any person guilty of any of

13  the grounds set forth in subsection (1), it may enter an order

14  imposing one or more of the following penalties:

15         (d)  Imposition of an administrative fine not to exceed

16  $10,000 $2,000 for each count or separate offense.

17

18  In determining what action is appropriate, the board must

19  first consider what sanctions are necessary to protect the

20  public or to compensate the patient. Only after those

21  sanctions have been imposed may the disciplining authority

22  consider and include in the order requirements designed to

23  rehabilitate the chiropractic physician. All costs associated

24  with compliance with orders issued under this subsection are

25  the obligation of the chiropractic physician.

26         Section 109.  Section 460.4165, Florida Statutes, is

27  amended to read:

28         460.4165  Certified chiropractic physician's

29  assistants.--

30         (1)  LEGISLATIVE INTENT.--The purpose of this section

31  is to encourage the more effective utilization of the skills


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  1  of chiropractic physicians by enabling them to delegate health

  2  care tasks to qualified assistants when such delegation is

  3  consistent with the patient's health and welfare and to allow

  4  for innovative development of programs for the education of

  5  physician's assistants.

  6         (2)  PERFORMANCE BY CERTIFIED CHIROPRACTIC PHYSICIAN'S

  7  ASSISTANT.--Notwithstanding any other provision of law, a

  8  certified chiropractic physician's assistant may perform

  9  chiropractic services in the specialty area or areas for which

10  the certified chiropractic physician's assistant is trained or

11  experienced when such services are rendered under the

12  supervision of a licensed chiropractic physician or group of

13  chiropractic physicians certified by the board.  Any certified

14  chiropractic physician's assistant certified under this

15  section to perform services may perform those services only:

16         (a)  In the office of the chiropractic physician to

17  whom the certified chiropractic physician's assistant has been

18  assigned, in which office such physician maintains her or his

19  primary practice;

20         (b)  Under indirect supervision of When the

21  chiropractic physician to whom she or he is assigned as

22  defined by rule of the board is present;

23         (c)  In a hospital in which the chiropractic physician

24  to whom she or he is assigned is a member of the staff; or

25         (d)  On calls outside of the said office of the

26  chiropractic physician to whom she or he is assigned, on the

27  direct order of the chiropractic physician to whom she or he

28  is assigned.

29         (3)  THIRD-PARTY PAYOR.  This chapter does not prevent

30  third-party payors from reimbursing employers of chiropractic

31


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  1  physicians' assistants for covered services rendered by

  2  certified chiropractic physicians' assistants.

  3         (4)(3)  PERFORMANCE BY TRAINEES.--Notwithstanding any

  4  other provision of law, a trainee may perform chiropractic

  5  services when such services are rendered within the scope of

  6  an approved program.

  7         (5)(4)  PROGRAM APPROVAL.--The department shall issue

  8  certificates of approval for programs for the education and

  9  training of certified chiropractic physician's assistants

10  which meet board standards.  Any basic program curriculum

11  certified by the board shall cover a period of 24 months. The

12  curriculum must consist of at least 200 didactic classroom

13  hours during those 24 months.

14         (a)  In developing criteria for program approval, the

15  board shall give consideration to, and encourage, the

16  utilization of equivalency and proficiency testing and other

17  mechanisms whereby full credit is given to trainees for past

18  education and experience in health fields.

19         (b)  The board shall create groups of specialty

20  classifications of training for certified chiropractic

21  physician's assistants.  These classifications shall reflect

22  the training and experience of the certified chiropractic

23  physician's assistant. The certified chiropractic physician's

24  assistant may receive training in one or more such

25  classifications, which shall be shown on the certificate

26  issued.

27         (c)  The board shall adopt and publish standards to

28  ensure that such programs operate in a manner which does not

29  endanger the health and welfare of the patients who receive

30  services within the scope of the program.  The board shall

31  review the quality of the curricula, faculties, and facilities


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  1  of such programs; issue certificates of approval; and take

  2  whatever other action is necessary to determine that the

  3  purposes of this section are being met.

  4         (6)(5)  APPLICATION APPROVAL.--Any person desiring to

  5  be licensed as a certified chiropractic physician's assistant

  6  must apply to the department. The department shall issue a

  7  certificate to any person certified by the board as having met

  8  the following requirements:

  9         (a)  Is at least 18 years of age.

10         (b)  Is a graduate of an approved program or its

11  equivalent and is fully certified by reason of experience and

12  education, as defined by board rule, to perform chiropractic

13  services under the responsible supervision of a licensed

14  chiropractic physician and when the board is satisfied that

15  the public will be adequately protected by the arrangement

16  proposed in the application.

17         (c)  Has completed the application form and remitted an

18  application fee set by the board pursuant to this section. An

19  application for certification made by a chiropractic

20  physician's assistant must include:

21         1.  A certificate of completion of a physician's

22  assistant training program specified in subsection (5).

23         2.  A sworn statement of any prior felony conviction in

24  any jurisdiction.

25         3.  A sworn statement of any previous revocation or

26  denial of licensure or certification in any state or

27  jurisdiction.

28         (a)  The board shall adopt rules for the consideration

29  of applications by a licensed chiropractic physician or a

30  group of licensed chiropractic physicians to supervise

31  certified chiropractic physician's assistants.  Each


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  1  application made by a chiropractic physician or group of

  2  chiropractic physicians shall include all of the following:

  3         1.  The qualifications, including related experience,

  4  of the certified chiropractic physician's assistant intended

  5  to be employed.

  6         2.  The professional background and specialty of the

  7  chiropractic physician or the group of chiropractic

  8  physicians.

  9         3.  A description by the chiropractic physician of her

10  or his practice, or by the chiropractic physicians of their

11  practice, and of the way in which the assistant or assistants

12  are to be utilized.

13

14  The board shall certify an application by a licensed

15  chiropractic physician to supervise a certified chiropractic

16  physician's assistant when the proposed assistant is a

17  graduate of an approved program or its equivalent and is fully

18  qualified by reason of experience and education to perform

19  chiropractic services under the responsible supervision of a

20  licensed chiropractic physician and when the board is

21  satisfied that the public will be adequately protected by the

22  arrangement proposed in the application.

23         (b)  The board shall certify no more than two certified

24  chiropractic physician's assistants for any chiropractic

25  physician practicing alone; no more than four chiropractic

26  physician's assistants for two chiropractic physicians

27  practicing together formally or informally; or no more than a

28  ratio of two certified chiropractic physician's assistants to

29  three chiropractic physicians in any group of chiropractic

30  physicians practicing together formally or informally.

31


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  1         (7)(6)  PENALTY.--Any person who has not been certified

  2  by the board and approved by the department and who represents

  3  herself or himself as a certified chiropractic physician's

  4  assistant or who uses any other term in indicating or implying

  5  that she or he is a certified chiropractic physician's

  6  assistant is guilty of a felony of the third degree,

  7  punishable as provided in s. 775.082 or s. 775.084 or by a

  8  fine not exceeding $5,000.

  9         (8)(7)  REVOCATION OF APPROVAL.--The certificate of

10  approval to supervise a certified chiropractic physician's

11  assistant held by any chiropractic physician or group of

12  chiropractic physicians may be revoked when the board

13  determines that the intent of this section is not being

14  carried out.

15         (9)(8)  FEES.--

16         (a)  A fee not to exceed $100 set by the board shall

17  accompany the application by a chiropractic physician for

18  authorization to supervise a certified chiropractic

19  physician's assistant.

20         (b)  Upon approval of an application for certification

21  of a certified chiropractic physician's assistant in a

22  specialty area, the applicant shall be charged an initial

23  certification fee for the first biennium not to exceed $250;

24  and a biennial renewal fee not to exceed $250 shall accompany

25  each application for renewal of the certified chiropractic

26  physician's assistant certificate.

27         (10)(9)  EXISTING PROGRAMS.--Nothing in this section

28  shall be construed to eliminate or supersede existing laws

29  relating to other paramedical professions or services.  It is

30  the intent of this section to supplement all such existing

31


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  1  programs relating to the certification and the practice of

  2  paramedical professions as may be authorized by law.

  3         (11)(10)  LIABILITY.--Each chiropractic physician or

  4  group of chiropractic physicians utilizing certified

  5  chiropractic physician's assistants shall be liable for any

  6  act or omission of any physician's assistant acting under her

  7  or his or its supervision and control.

  8         (12)  SUPERVISION OF REGISTERED CHIROPRACTIC

  9  ASSISTANT.--A certified chiropractic physician's assistant may

10  directly supervise a registered chiropractic assistant and

11  other persons who are not licensed as chiropractic physicians

12  who are employed or supervised by the chiropractic physician

13  to whom the certified chiropractic physician's assistant is

14  assigned.

15         (13)  CERTIFIED CHIROPRACTIC ASSISTANT CERTIFICATION

16  RENEWAL.--The certification must be renewed biennially.

17         (a)  Each renewal must include:

18         1.  A renewal fee as set by board pursuant to this

19  section.

20         2.  A sworn statement of no felony convictions in the

21  previous 2 years in any jurisdiction.

22         (b)  Each certified chiropractic physician's assistant

23  shall biennially complete 24 hours of continuing education

24  courses sponsored by chiropractic colleges accredited by the

25  Council on Chiropractic Education and approved by the board.

26  The board shall approve those courses that build upon the

27  basic courses required for the practice of chiropractic

28  medicine, and the board may also approve courses in adjunctive

29  modalities. The board may make exception from the requirements

30  of this section in emergency or hardship cases. The board may

31


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  1  adopt rules within the requirements of this section which are

  2  necessary for its implementation.

  3         (c)  Upon employment as a certified chiropractic

  4  physician's assistant, a certified chiropractic physician's

  5  assistant must notify the department in writing within 30 days

  6  after such employment or any change of the supervising

  7  chiropractic physician. The notification must include the full

  8  name, Florida chiropractic medical license number, specialty,

  9  and address of the supervising chiropractic physician.

10         Section 110.  Persons holding certificates as certified

11  chiropractic physicians' assistants on the effective date of

12  this act need not reapply for certification, but must comply

13  with biennial renewal requirements as provided in section

14  460.4165(6), Florida Statutes. The requirement for completion

15  of the continuing education requirements for biennial renewal

16  of the certificate shall not take effect until the beginning

17  of the next biennial renewal period following the effective

18  date of this act.

19         Section 111.  Section 460.4166, Florida Statutes, 1998

20  Supplement, is amended to read:

21         460.4166  Registered chiropractic assistants.--

22         (1)  DEFINITION.--As used in this section, "registered

23  chiropractic assistant" means a professional, multiskilled

24  person dedicated to assisting in all aspects of chiropractic

25  medical practice under the direct supervision and

26  responsibility of a chiropractic physician or certified

27  chiropractic physician's assistant.  A registered chiropractic

28  assistant assists with patient care management, executes

29  administrative and clinical procedures, and often performs

30  managerial and supervisory functions. Competence in the field

31  also requires that a registered chiropractic assistant adhere


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  1  to ethical and legal standards of professional practice,

  2  recognize and respond to emergencies, and demonstrate

  3  professional characteristics.

  4         (2)  DUTIES.--Under the direct supervision and

  5  responsibility of a licensed chiropractic physician or

  6  certified chiropractic physician's assistant, a registered

  7  chiropractic assistant may:

  8         (a)  Perform clinical procedures, which include:

  9         1.  Preparing patients for the chiropractic physician's

10  care.

11         2.  Taking vital signs.

12         3.  Observing and reporting patients' signs or

13  symptoms.

14         (b)  Administer basic first aid.

15         (c)  Assist with patient examinations or treatments

16  other than manipulations or adjustments.

17         (d)  Operate office equipment.

18         (e)  Collect routine laboratory specimens as directed

19  by the chiropractic physician or certified chiropractic

20  physician's assistant.

21         (f)  Administer nutritional supplements as directed by

22  the chiropractic physician or certified chiropractic

23  physician's assistant.

24         (g)  Perform office procedures required by the

25  chiropractic physician or certified chiropractic physician's

26  assistant under direct supervision of the chiropractic

27  physician or certified chiropractic physician's assistant.

28         (3)  REGISTRATION.--Registered chiropractic assistants

29  may be registered by the board for a biennial fee not to

30  exceed $25.

31


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  1         Section 112.  Section 461.003, Florida Statutes, 1998

  2  Supplement, is amended to read:

  3         461.003  Definitions.--As used in this chapter:

  4         (1)  "Department" means the Department of Health.

  5         (1)(2)  "Board" means the Board of Podiatric Medicine

  6  as created in this chapter.

  7         (2)  "Certified podiatric X-ray assistant" means a

  8  person who is employed by and under the direct supervision of

  9  a licensed podiatric physician to perform only those

10  radiographic functions that are within the scope of practice

11  of a podiatric physician licensed under this chapter. For

12  purposes of this subsection, the term "direct supervision"

13  means supervision whereby a podiatric physician orders the X

14  ray, remains on the premises while the X ray is being

15  performed and exposed, and approves the work performed before

16  dismissal of the patient.

17         (3)  "Department" means the Department of Health.

18         (3)  "Practice of podiatric medicine" means the

19  diagnosis or medical, surgical, palliative, and mechanical

20  treatment of ailments of the human foot and leg.  The surgical

21  treatment of ailments of the human foot and leg shall be

22  limited anatomically to that part below the anterior tibial

23  tubercle.  The practice of podiatric medicine shall include

24  the amputation of the toes or other parts of the foot but

25  shall not include the amputation of the foot or leg in its

26  entirety.  A podiatric physician may prescribe drugs that

27  relate specifically to the scope of practice authorized

28  herein.

29         (4)  "Podiatric physician" means any person licensed to

30  practice podiatric medicine pursuant to this chapter.

31


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  1         (5)  "Practice of podiatric medicine" means the

  2  diagnosis or medical, surgical, palliative, and mechanical

  3  treatment of ailments of the human foot and leg.  The surgical

  4  treatment of ailments of the human foot and leg shall be

  5  limited anatomically to that part below the anterior tibial

  6  tubercle.  The practice of podiatric medicine shall include

  7  the amputation of the toes or other parts of the foot but

  8  shall not include the amputation of the foot or leg in its

  9  entirety.  A podiatric physician may prescribe drugs that

10  relate specifically to the scope of practice authorized

11  herein.

12         Section 113.  Paragraph (d) of subsection (1) of

13  section 461.006, Florida Statutes, 1998 Supplement, is amended

14  to read:

15         461.006  Licensure by examination.--

16         (1)  Any person desiring to be licensed as a podiatric

17  physician shall apply to the department to take the licensure

18  examination. The department shall examine each applicant who

19  the board certifies:

20         (d)  Beginning October 1, 1995, Has satisfactorily

21  completed one of the following clinical experience

22  requirements:

23         1.  One year of residency in a residency program

24  approved by the board, and if it has been 4 or more years

25  since the completion of that residency, active licensed

26  practice of podiatric medicine in another jurisdiction for at

27  least 2 of the immediately preceding 4 years, or successful

28  completion of a board-approved postgraduate program or

29  board-approved course within the year preceding the filing of

30  the application. For the purpose of this subparagraph, "active

31  licensed practice" means the licensed practice of podiatric


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  1  medicine as defined in s. 461.003(5) by podiatric physicians,

  2  including podiatric physicians employed by any governmental

  3  entity, on the active teaching faculty of an accredited school

  4  of podiatric medicine, or practicing administrative podiatric

  5  medicine.

  6         2.  Ten years of continuous, active licensed practice

  7  of podiatric medicine in another state immediately preceding

  8  the submission of the application and completion of at least

  9  the same continuing educational requirements during those 10

10  years as are required of podiatric physicians licensed in this

11  state.

12         Section 114.  Subsection (1) of section 461.007,

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

14         461.007  Renewal of license.--

15         (1)  The department shall renew a license upon receipt

16  of the renewal application and a fee not to exceed $350 set by

17  the board, and evidence that the applicant has actively

18  practiced podiatric medicine or has been on the active

19  teaching faculty of an accredited school of podiatric medicine

20  for at least 2 years of the immediately preceding 4 years. If

21  the licensee has not actively practiced podiatric medicine for

22  at least 2 years of the immediately preceding 4 years, the

23  board shall require that the licensee successfully complete a

24  board-approved course prior to renewal of the license. For

25  purposes of this subsection, "actively practiced podiatric

26  medicine" means the licensed practice of podiatric medicine as

27  defined in s. 461.003(5) by podiatric physicians, including

28  podiatric physicians employed by any governmental entity, on

29  the active teaching faculty of an accredited school of

30  podiatric medicine, or practicing administrative podiatric

31  medicine. An applicant for a renewed license must also submit


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  1  the information required under s. 455.565 to the department on

  2  a form and under procedures specified by the department, along

  3  with payment in an amount equal to the costs incurred by the

  4  Department of Health for the statewide criminal background

  5  check of the applicant. The applicant must submit a set of

  6  fingerprints to the Department of Health on a form and under

  7  procedures specified by the department, along with payment in

  8  an amount equal to the costs incurred by the department for a

  9  national criminal background check of the applicant for the

10  initial renewal of his or her license after January 1, 2000.

11  If the applicant fails to submit either the information

12  required under s. 455.565 or a set of fingerprints to the

13  department as required by this section, the department shall

14  issue a notice of noncompliance, and the applicant will be

15  given 30 additional days to comply. If the applicant fails to

16  comply within 30 days after the notice of noncompliance is

17  issued, the department or board, as appropriate, may issue a

18  citation to the applicant and may fine the applicant up to $50

19  for each day that the applicant is not in compliance with the

20  requirements of s. 455.565. The citation must clearly state

21  that the applicant may choose, in lieu of accepting the

22  citation, to follow the procedure under s. 455.621. If the

23  applicant disputes the matter in the citation, the procedures

24  set forth in s. 455.621 must be followed. However, if the

25  applicant does not dispute the matter in the citation with the

26  department within 30 days after the citation is served, the

27  citation becomes a final order and constitutes discipline.

28  Service of a citation may be made by personal service or

29  certified mail, restricted delivery, to the subject at the

30  applicant's last known address. If an applicant has submitted

31  fingerprints to the department for a national criminal history


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  1  check upon initial licensure and is renewing his or her

  2  license for the first time, then the applicant need only

  3  submit the information and fee required for a statewide

  4  criminal history check.

  5         Section 115.  Paragraph (bb) is added to subsection (1)

  6  of section 461.013, Florida Statutes, 1998 Supplement, and

  7  subsection (2) of that section is amended, to read:

  8         461.013  Grounds for disciplinary action; action by the

  9  board; investigations by department.--

10         (1)  The following acts shall constitute grounds for

11  which the disciplinary actions specified in subsection (2) may

12  be taken:

13         (bb)  Failing to comply with the requirements of ss.

14  381.026 and 381.0261 to provide patients with information

15  about their patient rights and how to file a patient

16  complaint.

17         (2)  When the board finds any person guilty of any of

18  the grounds set forth in subsection (1), it may enter an order

19  imposing one or more of the following penalties:

20         (a)  Refusal to certify to the department an

21  application for licensure.

22         (b)  Revocation or suspension of a license.

23         (c)  Restriction of practice.

24         (d)  Imposition of an administrative fine not to exceed

25  $10,000 $1,000 for each count or separate offense.

26         (e)  Issuance of a reprimand.

27         (f)  Placing the podiatric physician on probation for a

28  period of time and subject to such conditions as the board may

29  specify, including requiring the podiatric physician to submit

30  to treatment, to attend continuing education courses, to

31


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  1  submit to reexamination, and to work under the supervision of

  2  another podiatric physician.

  3         (g)  Imposition of an administrative fine in accordance

  4  with s. 381.0261 for violations regarding patient rights.

  5         Section 116.  Section 461.0135, Florida Statutes, is

  6  created to read:

  7         461.0135  Operation of X-ray machines by podiatric

  8  X-ray assistants.--A licensed podiatric physician may utilize

  9  an X-ray machine, expose X-ray films, and interpret or read

10  such films. The provision of part IV of chapter 468 to the

11  contrary notwithstanding, a licensed podiatric physician may

12  authorize or direct a certified podiatric X-ray assistant to

13  operate such equipment and expose such films under the

14  licensed podiatric physician's direction and supervision,

15  pursuant to rules adopted by the board in accordance with s.

16  461.004, which ensures that such certified podiatric X-ray

17  assistant is competent to operate such equipment in a safe and

18  efficient manner by reason of training, experience, and

19  passage of a board-approved course which includes an

20  examination. The board shall issue a certificate to an

21  individual who successfully completes the board-approved

22  course and passes the examination to be administered by the

23  training authority upon completion of such course.

24         Section 117.  Subsection (3) is added to section

25  464.008, Florida Statutes, to read:

26         464.008  Licensure by examination.--

27         (3)  Any applicant who fails the examination three

28  consecutive times, regardless of the jurisdiction in which the

29  examination is taken, shall be required to complete a

30  board-approved remedial course before the applicant will be

31  approved for reexamination. After taking the remedial course,


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  1  the applicant may be approved to retake the examination up to

  2  three additional times before the applicant is required to

  3  retake remediation. The applicant shall apply for

  4  reexamination within 6 months after completion of remediation.

  5  The board shall by rule establish guidelines for remedial

  6  courses.

  7         Section 118.  Subsection (13) is added to section

  8  464.022, Florida Statutes, to read:

  9         464.022  Exceptions.--No provision of this chapter

10  shall be construed to prohibit:

11         (13)  The practice of nursing by individuals enrolled

12  in board-approved remedial courses.

13         Section 119.  Subsection (12) of section 465.003,

14  Florida Statutes, is amended, subsections (4) through (14) of

15  said section are renumbered as subsections (5) through (15),

16  respectively, and a new subsection (4) is added to said

17  section, to read:

18         465.003  Definitions.--As used in this chapter, the

19  term:

20         (4)  "Data communication device" means an electronic

21  device that receives electronic information from one source

22  and transmits or routes it to another, including, but not

23  limited to, any such bridge, router, switch, or gateway.

24         (13)(12)  "Practice of the profession of pharmacy"

25  includes compounding, dispensing, and consulting concerning

26  contents, therapeutic values, and uses of any medicinal drug;

27  and consulting concerning therapeutic values and interactions

28  of patent or proprietary preparations, whether pursuant to

29  prescriptions or in the absence and entirely independent of

30  such prescriptions or orders; and other pharmaceutical

31  services. For purposes of this subsection, "other


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  1  pharmaceutical services" means the monitoring of the patient's

  2  drug therapy and assisting the patient in the management of

  3  his or her drug therapy, and includes review of the patient's

  4  drug therapy and communication with the patient's prescribing

  5  health care provider as licensed under chapter 458, chapter

  6  459, chapter 461, or chapter 466, or similar statutory

  7  provision in another jurisdiction, or such provider's agent or

  8  such other persons as specifically authorized by the patient,

  9  regarding the drug therapy. However, nothing in this

10  subsection may be interpreted to permit an alteration of a

11  prescriber's directions, the diagnosis or treatment of any

12  disease, the initiation of any drug therapy, the practice of

13  medicine, or the practice of osteopathic medicine, unless

14  otherwise permitted by law. "Practice of the profession of

15  pharmacy" The phrase also includes any other act, service,

16  operation, research, or transaction incidental to, or forming

17  a part of, any of the foregoing acts, requiring, involving, or

18  employing the science or art of any branch of the

19  pharmaceutical profession, study, or training, and shall

20  expressly permit a pharmacist to transmit information from

21  persons authorized to prescribe medicinal drugs to their

22  patients.

23         Section 120.  Paragraph (l) of subsection (1) and

24  paragraph (c) of subsection (2) of section 465.016, Florida

25  Statutes, are amended, and paragraph (q) is added to

26  subsection (1) of that section, to read:

27         465.016  Disciplinary actions.--

28         (1)  The following acts shall be grounds for

29  disciplinary action set forth in this section:

30         (l)  Placing in the stock of any pharmacy any part of

31  any prescription compounded or dispensed which is returned by


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  1  a patient; however, in a hospital, nursing home, correctional

  2  facility, or extended care facility in which unit-dose

  3  medication is dispensed to inpatients, each dose being

  4  individually sealed and the individual unit dose or unit-dose

  5  system labeled with the name of the drug, dosage strength,

  6  manufacturer's control number, and expiration date, if any,

  7  the unused unit dose of medication may be returned to the

  8  pharmacy for redispensing.  Each pharmacist shall maintain

  9  appropriate records for any unused or returned medicinal

10  drugs.

11         (q)  Using or releasing a patient's records except as

12  authorized by this chapter and chapter 455.

13         (2)  When the board finds any person guilty of any of

14  the grounds set forth in subsection (1), it may enter an order

15  imposing one or more of the following penalties:

16         (c)  Imposition of an administrative fine not to exceed

17  $5,000 $1,000 for each count or separate offense.

18         Section 121.  Section 465.014, Florida Statutes, is

19  amended to read:

20         465.014  Pharmacy technician.--No person other than a

21  licensed pharmacist or pharmacy intern may engage in the

22  practice of the profession of pharmacy, except that a licensed

23  pharmacist may delegate to nonlicensed pharmacy technicians

24  those duties, tasks, and functions which do not fall within

25  the purview of s. 465.003(13)(12).  All such delegated acts

26  shall be performed under the direct supervision of a licensed

27  pharmacist who shall be responsible for all such acts

28  performed by persons under his or her supervision.  A pharmacy

29  technician, under the supervision of a pharmacist, may

30  initiate or receive communications with a practitioner or his

31  or her agent, on behalf of a patient, regarding refill


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  1  authorization requests.  No licensed pharmacist shall

  2  supervise more than one pharmacy technician unless otherwise

  3  permitted by the guidelines adopted by the board.  The board

  4  shall establish guidelines to be followed by licensees or

  5  permittees in determining the circumstances under which a

  6  licensed pharmacist may supervise more than one but not more

  7  than three pharmacy technicians.

  8         Section 122.  Paragraph (c) of subsection (2) of

  9  section 465.015, Florida Statutes, is amended to read:

10         465.015  Violations and penalties.--

11         (2)  It is unlawful for any person:

12         (c)  To sell or dispense drugs as defined in s.

13  465.003(8)(7) without first being furnished with a

14  prescription.

15         Section 123.  Section 465.0196, Florida Statutes, is

16  amended to read:

17         465.0196  Special pharmacy permits.--Any person

18  desiring a permit to operate a pharmacy which does not fall

19  within the definitions set forth in s. 465.003(11)(10)(a)1.,

20  2., and 3. shall apply to the department for a special

21  pharmacy permit.  If the board certifies that the application

22  complies with the applicable laws and rules of the board

23  governing the practice of the profession of pharmacy, the

24  department shall issue the permit.  No permit shall be issued

25  unless a licensed pharmacist is designated to undertake the

26  professional supervision of the compounding and dispensing of

27  all drugs dispensed by the pharmacy.  The licensed pharmacist

28  shall be responsible for maintaining all drug records and for

29  providing for the security of the area in the facility in

30  which the compounding, storing, and dispensing of medicinal

31  drugs occurs.  The permittee shall notify the department


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  1  within 10 days of any change of the licensed pharmacist

  2  responsible for such duties.

  3         Section 124.  Subsection (3) of section 468.812,

  4  Florida Statutes, is amended to read:

  5         468.812  Exemptions from licensure.--

  6         (3)  The provisions of this act relating to orthotics

  7  or pedorthics do not apply to any licensed pharmacist or to

  8  any person acting under the supervision of a licensed

  9  pharmacist.  The practice of orthotics or pedorthics by a

10  pharmacist or any of the pharmacist's employees acting under

11  the supervision of a pharmacist shall be construed to be

12  within the meaning of the term "practice of the profession of

13  pharmacy" as set forth in s. 465.003(13)(12), and shall be

14  subject to regulation in the same manner as any other pharmacy

15  practice.  The Board of Pharmacy shall develop rules regarding

16  the practice of orthotics and pedorthics by a pharmacist.  Any

17  pharmacist or person under the supervision of a pharmacist

18  engaged in the practice of orthotics or pedorthics shall not

19  be precluded from continuing that practice pending adoption of

20  these rules.

21         Section 125.  Subsection (19) of section 499.003,

22  Florida Statutes, is amended to read:

23         499.003  Definitions of terms used in ss.

24  499.001-499.081.--As used in ss. 499.001-499.081, the term:

25         (19)  "Legend drug," "prescription drug," or "medicinal

26  drug" means any drug, including, but not limited to, finished

27  dosage forms, or active ingredients subject to, defined by, or

28  described by s. 503(b) of the Federal Food, Drug, and Cosmetic

29  Act or s. 465.003(8)(7), s. 499.007(12), or s. 499.0122(1)(b)

30  or (c).

31


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    CS for SB 2220                                 First Engrossed



  1         Section 126.  (1)  There is created within the

  2  Department of Health a Task Force for the Study of

  3  Collaborative Drug Therapy Management. The department shall

  4  provide staff support for the task force. The task force shall

  5  consist of not more than 13 members nominated by the

  6  associations and entities named in this section and appointed

  7  by the Secretary of Health. Members of the task force shall

  8  not receive compensation, per diem, or reimbursement for

  9  travel expenses for service on the task force. Participation

10  in the task force is optional and at the discretion of each

11  identified group or entity. The task force shall include:

12         (a)  One representative from each of the following

13  associations:

14         1.  Florida Society of Health-System Pharmacists.

15         2.  Florida Pharmacy Association.

16         3.  Florida Medical Association.

17         4.  Florida Osteopathic Medical Association.

18         5.  Florida Retail Federation.

19         6.  Florida Nurses Association.

20         7.  Florida Academy of Family Physicians.

21         8.  Pharmaceutical Research Manufacturing Association.

22         9.  American Society of Consultant Pharmacists.

23         10.  American Society of Health-System Pharmacists.

24         (b)  One representative from each of the following

25  entities:

26         1.  Department of Health.

27         2.  Board of Medicine, which representative must be a

28  member of the board who is licensed under chapter 458, Florida

29  Statutes.

30

31


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    CS for SB 2220                                 First Engrossed



  1         3.  Board of Osteopathic Medicine, which representative

  2  must be a member of the board who is licensed under chapter

  3  459, Florida Statutes.

  4         4.  Board of Pharmacy, which representative must be a

  5  member of the board who is licensed under chapter 465, Florida

  6  Statutes.

  7         5.  Agency for Health Care Administration.

  8         (2)  The task force shall hold its first meeting no

  9  later than August 1, 1999, and shall report its findings to

10  the President of the Senate, the Speaker of the House of

11  Representatives, and the chairs of the applicable legislative

12  committees of substance not later than December 31, 1999. All

13  task force meetings must be held in Tallahassee at the

14  department in order to minimize costs to the state.

15         (3)  The task force shall be charged with the

16  responsibility to:

17         (a)  Determine the states in which collaborative drug

18  therapy management has been enacted by law or administrative

19  rule and summarize the content of all such laws and rules.

20         (b)  Receive testimony from interested parties and

21  identify the extent to which collaborative drug therapy

22  management is currently being practiced in this state and

23  other states.

24         (c)  Determine the efficacy of collaborative drug

25  therapy management in improving health care outcomes of

26  patients.

27         Section 127.  Section 466.021, Florida Statutes, is

28  amended to read:

29         466.021  Employment of unlicensed persons by dentist;

30  penalty.--Every duly licensed dentist who uses the services of

31  any unlicensed person for the purpose of constructing,


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    CS for SB 2220                                 First Engrossed



  1  altering, repairing, or duplicating any denture, partial

  2  denture, bridge splint, or orthodontic or prosthetic appliance

  3  shall be required to furnish such unlicensed person with a

  4  written work order in such form as prescribed shall be

  5  approved by rule of the board department. This form shall be

  6  supplied to the dentist by the department at a cost not to

  7  exceed that of printing and handling. The work order blanks

  8  shall be assigned to individual dentists and are not

  9  transferable. This form shall be dated and signed by such

10  dentist and shall include the patient's name or number with

11  sufficient descriptive information to clearly identify the

12  case for each separate and individual piece of work. A; said

13  work order shall be made in duplicate form, the duplicate copy

14  of such work order shall to be retained in a permanent file in

15  the dentist's office for a period of 2 years, and the original

16  work order shall to be retained in a permanent file for a

17  period of 2 years by such said unlicensed person in her or his

18  place of business. Such permanent file of work orders to be

19  kept by such dentist or by such unlicensed person shall be

20  open to inspection at any reasonable time by the department or

21  its duly constituted agent. Failure of the dentist to keep

22  such permanent records of such said work orders shall subject

23  the dentist to suspension or revocation of her or his license

24  to practice dentistry. Failure of such unlicensed person to

25  have in her or his possession a work order as required by this

26  section above defined shall be admissible evidence of a

27  violation of this chapter and shall constitute a misdemeanor

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

29  s. 775.083. Nothing in this section shall preclude a

30  registered dental laboratory from working for another

31  registered dental laboratory, provided that such work is


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    CS for SB 2220                                 First Engrossed



  1  performed pursuant to written authorization, in a form to be

  2  prescribed by rule of the board department, which evidences

  3  that the originating laboratory has obtained a valid work

  4  order and which sets forth the work to be performed.

  5  Furthermore, nothing in this section shall preclude a

  6  registered laboratory from providing its services to dentists

  7  licensed and practicing in another state, provided that such

  8  work is requested or otherwise authorized in written form

  9  which clearly identifies the name and address of the

10  requesting dentist and which sets forth the work to be

11  performed.

12         Section 128.  Paragraph (b) of subsection (2),

13  paragraph (b) of subsection (3), and subsection (4) of section

14  468.1155, Florida Statutes, are amended to read:

15         468.1155  Provisional license; requirements.--

16         (2)  The department shall issue a provisional license

17  to practice speech-language pathology to each applicant who

18  the board certifies has:

19         (b)  Received a master's degree or doctoral degree with

20  a major emphasis in speech-language pathology from an

21  institution of higher learning which, at the time the

22  applicant was enrolled and graduated, was accredited by an

23  accrediting agency recognized by the Commission on Recognition

24  of Postsecondary Accreditation or from an institution which is

25  publicly recognized as a member in good standing with the

26  Association of Universities and Colleges of Canada.  An

27  applicant who graduated from a program at a university or

28  college outside the United States or Canada must present

29  documentation of the determination of equivalency to standards

30  established by the Commission on Recognition of Postsecondary

31


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    CS for SB 2220                                 First Engrossed



  1  Accreditation in order to qualify.  The applicant must have

  2  completed 60 semester hours that include:

  3         1.  Fundamental information applicable to the normal

  4  development and use of speech, hearing, and language;

  5  information about training in management of speech, hearing,

  6  and language disorders; and information supplementary to these

  7  fields.

  8         2.  Six semester hours in audiology.

  9         3.  Thirty of the required 60 semester hours in courses

10  acceptable toward a graduate degree by the college or

11  university in which these courses were taken, of which 24

12  semester hours must be in speech-language pathology.

13         (3)  The department shall issue a provisional license

14  to practice audiology to each applicant who the board

15  certifies has:

16         (b)  Received a master's degree or doctoral degree with

17  a major emphasis in audiology from an institution of higher

18  learning which at the time the applicant was enrolled and

19  graduated was accredited by an accrediting agency recognized

20  by the Commission on Recognition of Postsecondary

21  Accreditation or from an institution which is publicly

22  recognized as a member in good standing with the Association

23  of Universities and Colleges of Canada.  An applicant who

24  graduated from a program at a university or college outside

25  the United States or Canada must present documentation of the

26  determination of equivalency to standards established by the

27  Commission on Recognition of Postsecondary Accreditation in

28  order to qualify.  The applicant must have completed 60

29  semester hours that include:

30         1.  Fundamental information applicable to the normal

31  development and use of speech, hearing, and language;


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    CS for SB 2220                                 First Engrossed



  1  information about training in management of speech, hearing,

  2  and language disorders; and information supplementary to these

  3  fields.

  4         2.  Six semester hours in speech-language pathology.

  5         3.  Thirty of the required 60 semester hours in courses

  6  acceptable toward a graduate degree by the college or

  7  university in which these courses were taken, of which 24

  8  semester hours must be in audiology.

  9         (4)  An applicant for a provisional license who has

10  received a master's degree or doctoral degree with a major

11  emphasis in speech-language pathology as provided in

12  subsection (2), or audiology as provided in subsection (3),

13  and who seeks licensure in the area in which the applicant is

14  not currently licensed, must have completed 30 semester hours

15  in courses acceptable toward a graduate degree and 200

16  supervised clinical clock hours in the second discipline from

17  an accredited institution.

18         Section 129.  Section 468.1215, Florida Statutes, is

19  amended to read:

20         468.1215  Speech-language pathology assistant and

21  audiology assistant; certification.--

22         (1)  A person desiring to be certified as a

23  speech-language pathology assistant or audiology assistant

24  shall apply to the department.

25         (1)(2)  The department shall issue a certificate as a

26  speech-language pathology assistant or as an audiology

27  assistant to each applicant who the board certifies has:

28         (a)  Completed the application form and remitted the

29  required fees, including a nonrefundable application fee.

30         (b)  Earned a bachelor's degree from a college or

31  university accredited by a regional association of colleges


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    CS for SB 2220                                 First Engrossed



  1  and schools recognized by the Department of Education which

  2  includes at least 24 semester hours of coursework as approved

  3  by the board at an institution accredited by an accrediting

  4  agency recognized by the Commission on Recognition of

  5  Postsecondary Accreditation.

  6         (2)  The department shall issue a certificate as an

  7  audiology assistant to each applicant who the board certifies

  8  has:

  9         (a)  Completed the application form and remitted the

10  required fees, including a nonrefundable application fee.

11         (b)  Completed at least 24 semester hours of coursework

12  as approved by the board at an institution accredited by an

13  accrediting agency recognized by the Commission on Recognition

14  of Postsecondary Accreditation.

15         (3)  The board, by rule, shall establish minimum

16  education and on-the-job training and supervision requirements

17  for certification as a speech-language pathology assistant or

18  audiology assistant.

19         (4)  The provisions of this section shall not apply to

20  any student, intern, or trainee performing speech-language

21  pathology or audiology services while completing the

22  supervised clinical clock hours as required in s. 468.1155.

23         Section 130.  Subsection (1) of section 468.307,

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

25         468.307  Certificate; issuance; possession; display.--

26         (1)  The department shall issue a certificate to each

27  candidate who has met the requirements of ss. 468.304 and

28  468.306 or has qualified under s. 468.3065. The department may

29  by rule establish a subcategory of a certificate issued under

30  this part limiting the certificateholder to a specific

31  procedure or specific type of equipment.


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    CS for SB 2220                                 First Engrossed



  1         Section 131.  Section 468.506, Florida Statutes, 1998

  2  Supplement, is amended to read:

  3         468.506  Dietetics and Nutrition Practice

  4  Council.--There is created the Dietetics and Nutrition

  5  Practice Council under the supervision of the board.  The

  6  council shall consist of four persons licensed under this part

  7  and one consumer who is 60 years of age or older.  Council

  8  members shall be appointed by the board. Licensed members

  9  shall be appointed based on the proportion of licensees within

10  each of the respective disciplines.  Members shall be

11  appointed for 4-year staggered terms.  In order to be eligible

12  for appointment, each licensed member must have been a

13  licensee under this part for at least 3 years prior to his or

14  her appointment.  No council member shall serve more than two

15  successive terms.  The board may delegate such powers and

16  duties to the council as it may deem proper to carry out the

17  operations and procedures necessary to effectuate the

18  provisions of this part.  However, the powers and duties

19  delegated to the council by the board must encompass both

20  dietetics and nutrition practice and nutrition counseling. Any

21  time there is a vacancy on the council, any professional

22  association composed of persons licensed under this part may

23  recommend licensees to fill the vacancy to the board in a

24  number at least twice the number of vacancies to be filled,

25  and the board may appoint from the submitted list, in its

26  discretion, any of those persons so recommended.  Any

27  professional association composed of persons licensed under

28  this part may file an appeal regarding a council appointment

29  with the secretary director of the department agency, whose

30  decision shall be final.  The board shall fix council members'

31


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    CS for SB 2220                                 First Engrossed



  1  compensation and pay their expenses in the same manner as

  2  provided in s. 455.534.

  3         Section 132.  Section 468.701, Florida Statutes, 1998

  4  Supplement, is amended to read:

  5         468.701  Definitions.--As used in this part, the term:

  6         (1)  "Athlete" means a person who participates in an

  7  athletic activity.

  8         (2)  "Athletic activity" means the participation in an

  9  activity, conducted by an educational institution, a

10  professional athletic organization, or an amateur athletic

11  organization, involving exercises, sports, games, or

12  recreation requiring any of the physical attributes of

13  strength, agility, flexibility, range of motion, speed, and

14  stamina.

15         (3)  "Athletic injury" means an injury sustained which

16  affects the athlete's ability to participate or perform in

17  athletic activity.

18         (4)  "Athletic trainer" means a person licensed under

19  this part.

20         (5)  "Athletic training" means the recognition,

21  prevention, and treatment of athletic injuries.

22         (6)  "Board Council" means the Board Council of

23  Athletic Training.

24         (7)  "Department" means the Department of Health.

25         (8)  "Direct supervision" means the physical presence

26  of the supervisor on the premises so that the supervisor is

27  immediately available to the trainee when needed.

28         (9)  "Secretary" means the Secretary of Health.

29         (9)(10)  "Supervision" means the easy availability of

30  the supervisor to the athletic trainer, which includes the

31  ability to communicate by telecommunications.


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    CS for SB 2220                                 First Engrossed



  1         Section 133.  Section 468.703, Florida Statutes, 1998

  2  Supplement, is amended to read:

  3         468.703  Board Council of Athletic Training.--

  4         (1)  The Board Council of Athletic Training is created

  5  within the department and shall consist of nine seven members

  6  to be appointed by the Governor and confirmed by the Senate

  7  secretary.

  8         (2)  Five Four members of the board must council shall

  9  be licensed athletic trainers. One member of the board must

10  council shall be a physician licensed under chapter 458 or

11  chapter 459. One member of the board must council shall be a

12  physician licensed under chapter 460. Two members One member

13  of the board shall be consumer members, each of whom must

14  council shall be a resident of this state who has never worked

15  as an athletic trainer, who has no financial interest in the

16  practice of athletic training, and who has never been a

17  licensed health care practitioner as defined in s. 455.501(4).

18  Members of the council shall serve staggered 4-year terms as

19  determined by rule of the department; however, no member may

20  serve more than two consecutive terms.

21         (3)  For the purpose of staggering terms, the Governor

22  shall appoint the initial members of the board as follows:

23         (a)  Three members for terms of 2 years each.

24         (b)  Three members for terms of 3 years each.

25         (c)  Three members for terms of 4 years each.

26         (4)  As the terms of the members expire, the Governor

27  shall appoint successors for terms of 4 years and such members

28  shall serve until their successors are appointed.

29         (5)  All provisions of part II of chapter 455 relating

30  to activities of the board shall apply.

31


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    CS for SB 2220                                 First Engrossed



  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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    CS for SB 2220                                 First Engrossed



  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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    CS for SB 2220                                 First Engrossed



  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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    CS for SB 2220                                 First Engrossed



  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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  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

31


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  1         Section 140.  Paragraph (g) of subsection (3) of

  2  section 20.43, Florida Statutes, 1998 Supplement, is amended

  3  to read:

  4         20.43  Department of Health.--There is created a

  5  Department of Health.

  6         (3)  The following divisions of the Department of

  7  Health are established:

  8         (g)  Division of Medical Quality Assurance, which is

  9  responsible for the following boards and professions

10  established within the division:

11         1.  Nursing assistants, as provided under s. 400.211.

12         2.  Health care services pools, as provided under s.

13  402.48.

14         3.  The Board of Acupuncture, created under chapter

15  457.

16         4.  The Board of Medicine, created under chapter 458.

17         5.  The Board of Osteopathic Medicine, created under

18  chapter 459.

19         6.  The Board of Chiropractic Medicine, created under

20  chapter 460.

21         7.  The Board of Podiatric Medicine, created under

22  chapter 461.

23         8.  Naturopathy, as provided under chapter 462.

24         9.  The Board of Optometry, created under chapter 463.

25         10.  The Board of Nursing, created under chapter 464.

26         11.  The Board of Pharmacy, created under chapter 465.

27         12.  The Board of Dentistry, created under chapter 466.

28         13.  Midwifery, as provided under chapter 467.

29         14.  The Board of Speech-Language Pathology and

30  Audiology, created under part I of chapter 468.

31


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  1         15.  The Board of Nursing Home Administrators, created

  2  under part II of chapter 468.

  3         16.  The Board of Occupational Therapy, created under

  4  part III of chapter 468.

  5         17.  Respiratory therapy, as provided under part V of

  6  chapter 468.

  7         18.  Dietetics and nutrition practice, as provided

  8  under part X of chapter 468.

  9         19.  The Board of Athletic Training trainers, created

10  as provided under part XIII of chapter 468.

11         20.  The Board of Orthotists and Prosthetists, created

12  under part XIV of chapter 468.

13         21.  Electrolysis, as provided under chapter 478.

14         22.  The Board of Massage Therapy, created under

15  chapter 480.

16         23.  The Board of Clinical Laboratory Personnel,

17  created under part III of chapter 483.

18         24.  Medical physicists, as provided under part IV of

19  chapter 483.

20         25.  The Board of Opticianry, created under part I of

21  chapter 484.

22         26.  The Board of Hearing Aid Specialists, created

23  under part II of chapter 484.

24         27.  The Board of Physical Therapy Practice, created

25  under chapter 486.

26         28.  The Board of Psychology, created under chapter

27  490.

28         29.  School psychologists, as provided under chapter

29  490.

30

31


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  1         30.  The Board of Clinical Social Work, Marriage and

  2  Family Therapy, and Mental Health Counseling, created under

  3  chapter 491.

  4

  5  The department may contract with the Agency for Health Care

  6  Administration who shall provide consumer complaint,

  7  investigative, and prosecutorial services required by the

  8  Division of Medical Quality Assurance, councils, or boards, as

  9  appropriate.

10         Section 141.  The Council of Athletic Training and the

11  terms of all council members are terminated on July 1, 1999.

12  However, such termination in no way precludes the Governor

13  from considering any former council member for appointment to

14  the Board of Athletic Training created by this act.

15         Section 142.  Section 468.805, Florida Statutes, is

16  amended to read:

17         468.805  Grandfathering Licensure without examination;

18  provisional licensure.--

19         (1)  A person who has practiced orthotics, prosthetics,

20  or pedorthics in this state for the required period since July

21  1, 1990, who, before March 1, 1998, applies to the department

22  for a license to practice orthotics, prosthetics, or

23  pedorthics, may be licensed as a prosthetist, orthotist,

24  prosthetist-orthotist, orthotic fitter, orthotic fitter

25  assistant, or pedorthist, as determined from the person's

26  experience, certification, and educational preparation,

27  without meeting the educational requirements set forth in s.

28  468.803, upon receipt of the application fee and licensing fee

29  and after the board has completed an investigation into the

30  applicant's background and experience. The board shall require

31  an application fee not to exceed $500, which shall be


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  1  nonrefundable. The board shall complete its investigation

  2  within 6 months after receipt of the completed application.

  3  The period of experience required for licensure under this

  4  section subsection is 5 years for a prosthetist; 2 years for

  5  an orthotic fitter, an orthotic fitter assistant, or a

  6  pedorthist; and 5 years for an orthotist whose scope of

  7  practice is defined under s. 468.80(7).

  8         (2)(a)  A person who has received certification as an

  9  orthotist, a prosthetist, or a prosthetist-orthotist from a

10  national certifying body and who has practiced orthotics or

11  prosthetics in this state for at least 2 years but less than 5

12  years is eligible for a provisional license.

13         (b)  An applicant for provisional licensure shall

14  submit proof that he or she has been actively practicing as a

15  nationally certified orthotist, prosthetist, or

16  prosthetist-orthotist, an application fee, and a provisional

17  license fee.

18         (c)  A provisional licensee is required to practice

19  under supervision of a fully licensed orthotist, prosthetist,

20  or prosthetist-orthotist for up to 3 years in order to meet

21  the 5-year experience requirement of subsection (1) to be

22  licensed as an orthotist, prosthetist, or

23  prosthetist-orthotist.

24         (d)  After appropriate investigation, the board shall

25  license as an orthotist, prosthetist, or prosthetist-orthotist

26  the provisional licensee who has successfully completed the

27  period of experience required and otherwise meets the

28  requirements of subsection (1).

29         (e)  The board shall require an application fee, not to

30  exceed $500, which is nonrefundable, and a provisional

31  licensure fee, not to exceed $500.


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  1         (3)  An applicant who has received certification as an

  2  orthotist, a prosthetist, a prosthetist-orthotist, or a

  3  pedorthist from a national certifying body which requires the

  4  successful completion of an examination, may be licensed under

  5  this section without taking an additional examination. An

  6  applicant who has not received certification from a national

  7  certifying body which requires the successful completion of an

  8  examination shall be required to take an examination as

  9  determined by the board. This examination shall be designed to

10  determine if the applicant has the minimum qualifications

11  needed to be licensed under this section. The board may charge

12  an examination fee and the actual per applicant cost to the

13  department for purchase or development of the examination.

14         (4)  An applicant who successfully completed prior to

15  March 1, 1998, at least one-half of the examination required

16  for national certification and successfully completed the

17  remaining portion of the examination and became certified

18  prior to July 1, 1998, shall be considered as nationally

19  certified by March 1, 1998, for purposes of this section.

20         (5)(4)  This section is repealed July 1, 2002.

21         Section 143.  Subsection (3) of section 468.806,

22  Florida Statutes, is amended to read:

23         468.806  Biennial renewal of license.--

24         (3)  The board may by rule prescribe continuing

25  education requirements and approve course criteria, not to

26  exceed 30 hours biennially, as a condition for license

27  renewal. The board shall establish a procedure for approving

28  continuing education courses and providers and may set a fee

29  for continuing education course and provider approval.

30         Section 144.  Subsection (5) of section 478.42, Florida

31  Statutes, is amended to read:


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  1         478.42  Definitions.--As used in this chapter, the

  2  term:

  3         (5)  "Electrolysis or electrology" means the permanent

  4  removal of hair by destroying introducing, into and beneath

  5  the skin, ionizing (galvanic current) or nonionizing radiation

  6  (thermolysis or high-frequency current) to destroy the

  7  hair-producing cells of the skin and vascular system, using

  8  equipment and needle-type epilation devices approved by the

  9  board which have been cleared by and that are registered with

10  the United States Food and Drug Administration and that are

11  used pursuant to protocols approved by the council and the

12  board.

13         Section 145.  Section 483.041, Florida Statutes, is

14  amended to read:

15         483.041  Definitions.--As used in this part, the term:

16         (1)  "Agency" means the Agency for Health Care

17  Administration.

18         (2)  "Clinical laboratory" means the physical location

19  in which one or more of the following services a laboratory

20  where examinations are performed on materials or specimens

21  taken from the human body to provide information or materials

22  for use in the diagnosis, prevention, or treatment of a

23  disease or the identification or assessment of a medical or

24  physical condition.

25         (a)  Clinical laboratory services are the examinations

26  of fluids or other materials taken from the human body.

27         (b)  Anatomic laboratory services are the examinations

28  of tissue taken from the human body.

29         (c)  Cytology laboratory services are the examinations

30  of cells from individual tissues or fluid taken from the human

31  body.


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  1         (3)  "Clinical laboratory examination" means a

  2  procedure performed to deliver the services defined in

  3  subsection (2), including the oversight or interpretation

  4  thereof.

  5         (4)(3)  "Clinical laboratory proficiency testing

  6  program" means a program approved by the agency for evaluating

  7  the performance of clinical laboratories.

  8         (5)(4)  "Collection station" or "branch office" means a

  9  facility operated by a clinical laboratory where materials or

10  specimens are withdrawn or collected from patients or

11  assembled after being withdrawn or collected from patients

12  elsewhere, for subsequent delivery to another location for

13  examination.

14         (6)(5)  "Hospital laboratory" means a laboratory

15  located in a hospital licensed under chapter 395 that provides

16  services solely to that hospital and that is owned by the

17  hospital and governed by the hospital medical staff or

18  governing board.

19         (7)(6)  "Licensed practitioner" means a physician

20  licensed under chapter 458, chapter 459, chapter 460, or

21  chapter 461; a dentist licensed under chapter 466; a person

22  licensed under chapter 462; or an advanced registered nurse

23  practitioner licensed under chapter 464 or a duly licensed

24  practitioner from another state licensed under similar

25  statutes who orders examinations on materials or specimens for

26  non residents of the State of Florida, but who reside in the

27  same state as the requesting licensed practitioner.

28         (8)(7)  "Person" means the State of Florida or any

29  individual, firm, partnership, association, corporation,

30  county, municipality, political subdivision, or other entity,

31  whether organized for profit or not.


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  1         (9)(8)  "Validation inspection" means an inspection of

  2  a clinical laboratory by the agency to assess whether a review

  3  by an accrediting organization has adequately evaluated the

  4  clinical laboratory according to state standards.

  5         (10)(9)  "Waived test" means a test that the federal

  6  Health Care Financing Administration has determined qualifies

  7  for a certificate of waiver under the federal Clinical

  8  Laboratory Improvement Amendments of 1988, and the federal

  9  rules adopted thereunder.

10         Section 146.  Subsections (2), (3), and (7) of section

11  483.803, Florida Statutes, are amended to read:

12         483.803  Definitions.--As used in this part, the term:

13         (2)  "Clinical laboratory" means a clinical laboratory

14  as defined in s. 483.041(2).

15         (3)  "Clinical laboratory examination" means a clinical

16  laboratory examination as defined in s. 483.041 an examination

17  performed on materials or specimens of the human body to

18  provide information or materials for use in the diagnosis,

19  prevention, or treatment of a disease or the identification or

20  assessment of a medical or physical condition.

21         (7)  "Licensed practitioner of the healing arts" means

22  a physician licensed under pursuant to chapter 458, chapter

23  459, or chapter 460, or chapter 461; a dentist licensed under

24  pursuant to chapter 466; or a person licensed under pursuant

25  to chapter 461 or chapter 462.

26         Section 147.  Subsection (9) of section 483.807,

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

28         483.807  Fees; establishment; disposition.--

29         (9)  The initial application and renewal fee for

30  approval as a laboratory training program may not exceed $300.

31  The fee for late filing of a renewal application shall be $50.


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  1         Section 148.  Subsections (2) and (3) of section

  2  483.809, Florida Statutes, are amended to read:

  3         483.809  Licensure; examinations; registration of

  4  trainees; approval of curricula.--

  5         (2)  EXAMINATIONS.--The department shall conduct

  6  examinations required by board rules to determine in part the

  7  qualification of clinical laboratory personnel for licensure.

  8  The board by rule may designate a An approved national

  9  certification examination that may be accepted in lieu of

10  state examination for clinical laboratory personnel or public

11  health scientists.

12         (3)  REGISTRATION OF TRAINEES.--The department shall

13  provide for annual registration of clinical laboratory

14  trainees who are enrolled in a training program employed by

15  laboratories approved pursuant to s. 483.811, which

16  registration may not be renewed except upon special

17  authorization of the board.

18         Section 149.  Section 483.812, Florida Statutes, is

19  amended to read:

20         483.812  Public health laboratory scientists;

21  licensure.--

22         (1)  Applicants at the director level in the category

23  of public health shall qualify under s. 483.824.

24         (2)(1)  Applicants at the director and supervisor level

25  in the category of public health who are certified registered

26  by the National Registry in of Clinical Chemistry

27  Certification or the American Society for of Microbiology,

28  licensed as a technologist, and have 5 years of pertinent

29  clinical laboratory experience may qualify under board rules

30  by passing the state-administered appropriate supervision and

31  administration examination.


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  1         (3)(2)(a)  A technologist applicant for licensure in

  2  the category of public health microbiology, with a

  3  baccalaureate degree in one of the biological sciences from an

  4  accredited institution, may use the American Society for of

  5  Microbiology or the National Registry in of Microbiology

  6  Certification in Public Health Microbiology to qualify for a

  7  technologist license in public health microbiology.  Such a

  8  technologist may work in a public health microbiology

  9  laboratory.

10         (b)  A technologist applicant for licensure in the

11  category of public health chemistry, with a baccalaureate

12  degree in one of the chemical, biological, or physical

13  sciences from an accredited institution, may use the National

14  Registry of Clinical Chemistry Certification to qualify for a

15  technologist license in public health chemistry.  Such a

16  technologist may work in a public health chemistry laboratory.

17         (c)  A technician applicant for licensure in the

18  category of public health, with a baccalaureate degree in one

19  of the chemical or biological sciences from an accredited

20  institution, may obtain a 2-year one-time, 3-year, conditional

21  public health technician license, which may be renewed once

22  pending national certification by the American Society of

23  Microbiology or the National Registry of Clinical Chemistry

24  Certification. Such a technician may perform testing only

25  under the direct supervision of a licensed pathologist,

26  director, supervisor, or technologist.

27         (4)(3)  A person licensed by the Board of Clinical

28  Laboratory Personnel may work in a public health laboratory at

29  the appropriate level and specialty.

30         Section 150.  Section 483.813, Florida Statutes, is

31  amended to read:


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  1         483.813  Clinical laboratory personnel license.--A

  2  person may not conduct a clinical laboratory examination or

  3  report the results of such examination unless such person is

  4  licensed under this part to perform such procedures. However,

  5  this provision does not apply to any practitioner of the

  6  healing arts authorized to practice in this state or to

  7  persons engaged in testing performed by laboratories regulated

  8  under s. 483.035(1) or exempt from regulation under s.

  9  483.031(2). The department may grant a temporary license to

10  any candidate it deems properly qualified, for a period not to

11  exceed 1 year, or a conditional license for a period not to

12  exceed 3 years.

13         Section 151.  Subsection (3) is added to section

14  483.821, Florida Statutes, to read:

15         483.821  Periodic demonstration of competency;

16  continuing education or reexamination.--

17         (3)  The board may, by rule, provide for continuing

18  education or retraining requirements for candidates failing an

19  examination two or more times.

20         Section 152.  Section 483.824, Florida Statutes, is

21  amended to read:

22         483.824  Qualifications of clinical laboratory

23  director.--A clinical laboratory director must have 4 years of

24  clinical laboratory experience with 2 years of experience in

25  the speciality to be directed or be nationally board certified

26  in the specialty to be directed, and must meet one of the

27  following requirements:

28         (1)  Be a physician licensed under chapter 458 or

29  chapter 459;

30

31


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  1         (2)  Hold an earned doctoral degree in a chemical,

  2  physical, or biological science from a regionally accredited

  3  institution and be nationally certified; or

  4         (3)  For the subspecialty of oral pathology, be a

  5  physician licensed under chapter 458 or chapter 459 or a

  6  dentist licensed under chapter 466.

  7         Section 153.  Section 483.825, Florida Statutes, is

  8  amended to read:

  9         483.825  Grounds for disciplinary action.--The

10  following acts constitute grounds for which disciplinary

11  actions specified in s. 483.827 may be taken against

12  applicants, registrants, and licensees under this part:

13         (1)  Attempting to obtain, obtaining, or renewing a

14  license or registration under this part by bribery, by

15  fraudulent misrepresentation, or through an error of the

16  department or the board.

17         (2)  Engaging in or attempting to engage in, or

18  representing herself or himself as entitled to perform, any

19  clinical laboratory procedure or category of procedures not

20  authorized pursuant to her or his license.

21         (3)  Demonstrating incompetence or making consistent

22  errors in the performance of clinical laboratory examinations

23  or procedures or erroneous reporting.

24         (4)  Performing a test and rendering a report thereon

25  to a person not authorized by law to receive such services.

26         (5)  Has been convicted or found guilty of, or entered

27  a plea of nolo contendere to, regardless of adjudication, a

28  crime in any jurisdiction which directly relates to the

29  activities of clinical laboratory personnel or involves moral

30  turpitude or fraudulent or dishonest dealing. The record of a

31  conviction certified or authenticated in such form as to be


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  1  admissible in evidence under the laws of the state shall be

  2  admissible as prima facie evidence of such guilt. Having been

  3  convicted of a felony or of any crime involving moral

  4  turpitude under the laws of any state or of the United States.

  5  The record of conviction or a certified copy thereof shall be

  6  conclusive evidence of such conviction.

  7         (6)  Having been adjudged mentally or physically

  8  incompetent.

  9         (7)  Violating or aiding and abetting in the violation

10  of any provision of this part or the rules adopted hereunder.

11         (8)  Reporting a test result when no laboratory test

12  was performed on a clinical specimen.

13         (9)  Knowingly advertising false services or

14  credentials.

15         (10)  Having a license revoked, suspended, or otherwise

16  acted against, including the denial of licensure, by the

17  licensing authority of another jurisdiction. The licensing

18  authority's acceptance of a relinquishment of a license,

19  stipulation, consent order, or other settlement, offered in

20  response to or in anticipation of the filing of administrative

21  charges against the licensee, shall be construed as action

22  against the licensee.

23         (11)  Failing to report to the board, in writing,

24  within 30 days that an if action under subsection (5),

25  subsection (6), or subsection (10) has been taken against the

26  licensee or one's license to practice as clinical laboratory

27  personnel in another state, territory, or country, or other

28  jurisdiction.

29         (12)  Being unable to perform or report clinical

30  laboratory examinations with reasonable skill and safety to

31  patients by reason of illness or use of alcohol, drugs,


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    CS for SB 2220                                 First Engrossed



  1  narcotics, chemicals, or any other type of material or as a

  2  result of any mental or physical condition.  In enforcing this

  3  subsection, the department shall have, upon a finding of the

  4  secretary or his or her designee that probable cause exists to

  5  believe that the licensee is unable to practice because of the

  6  reasons stated in this subsection, the authority to issue an

  7  order to compel a licensee to submit to a mental or physical

  8  examination by physicians designated by the department.  If

  9  the licensee refuses to comply with such order, the

10  department's order directing such examination may be enforced

11  by filing a petition for enforcement in the circuit court

12  where the licensee resides or does business.  The department

13  shall be entitled to the summary procedure provided in s.

14  51.011.  A licensee affected under this subsection shall at

15  reasonable intervals be afforded an opportunity to demonstrate

16  that he or she can resume competent practice with reasonable

17  skill and safety to patients.

18         (13)  Delegating professional responsibilities to a

19  person when the licensee delegating such responsibilities

20  knows, or has reason to know, that such person is not

21  qualified by training, experience, or licensure to perform

22  them.

23         (14)  Violating a previous order of the board entered

24  in a disciplinary proceeding.

25         (15)  Failing to report to the department a person or

26  other licensee who the licensee knows is in violation of this

27  chapter or the rules of the department or board adopted

28  hereunder.

29         (16)  Making or filing a report which the licensee

30  knows to be false, intentionally or negligently failing to

31  file a report or record required by state or federal law,


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  1  willfully impeding or obstructing such filing or inducing

  2  another person to do so, including, but not limited to,

  3  impeding an agent of the state from obtaining a report or

  4  record for investigative purposes. Such reports or records

  5  shall include only those generated in the capacity as a

  6  licensed clinical laboratory personnel.

  7         (17)  Paying or receiving any commission, bonus,

  8  kickback, or rebate, or engaging in any split-fee arrangement

  9  in any form whatsoever with a physician, organization, agency,

10  or person, either directly or indirectly for patients referred

11  to providers of health care goods and services including, but

12  not limited to, hospitals, nursing homes, clinical

13  laboratories, ambulatory surgical centers, or pharmacies. The

14  provisions of this subsection shall not be construed to

15  prevent a clinical laboratory professional from receiving a

16  fee for professional consultation services.

17         (18)  Exercising influence on a patient or client in

18  such a manner as to exploit the patient or client for the

19  financial gain of the licensee or other third party, which

20  shall include, but not be limited to, the promoting, selling,

21  or withholding of services, goods, appliances, referrals, or

22  drugs.

23         (19)  Practicing or offering to practice beyond the

24  scope permitted by law or rule, or accepting or performing

25  professional services or responsibilities which the licensee

26  knows or has reason to know that he or she is not competent to

27  perform.

28         (20)  Misrepresenting or concealing a material fact at

29  any time during any phase of the licensing, investigative, or

30  disciplinary process, procedure, or proceeding.

31


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  1         (21)  Improperly interfering with an investigation or

  2  any disciplinary proceeding.

  3         (22)  Engaging in or attempting to engage in sexual

  4  misconduct, causing undue embarrassment or using disparaging

  5  language or language of a sexual nature towards a patient,

  6  exploiting superior/subordinate, professional/patient,

  7  instructor/student relationships for personal gain, sexual

  8  gratification, or advantage.

  9         Section 154.  Paragraph (g) of subsection (4) and

10  subsections (6) and (8) of section 483.901, Florida Statutes,

11  1998 Supplement, are amended to read:

12         483.901  Medical physicists; definitions; licensure.--

13         (4)  COUNCIL.--The Advisory Council of Medical

14  Physicists is created in the Department of Health to advise

15  the department in regulating the practice of medical physics

16  in this state.

17         (g)  If a vacancy on the council occurs, the secretary

18  director shall appoint a member to serve for a 4-year term.

19         (6)  LICENSE REQUIRED.--An individual may not engage in

20  the practice of medical physics, including the specialties of

21  diagnostic radiological physics, therapeutic radiological

22  physics, medical nuclear radiological physics, or medical

23  health physics, without a license issued by the department for

24  the appropriate specialty.

25         (a)  The department shall adopt rules to administer

26  this section which specify license application and renewal

27  fees, continuing education requirements, and standards for

28  practicing medical physics.  The council shall recommend to

29  the department continuing education requirements that shall be

30  a condition of license renewal.  The department shall require

31  a minimum of 24 hours per biennium of continuing education


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  1  offered by an organization recommended by the council and

  2  approved by the department.  The department, upon

  3  recommendation of the council, may adopt rules to specify

  4  continuing education requirements for persons who hold a

  5  license in more than one specialty.

  6         (b)  In order to apply for a medical physicist license

  7  in one or more specialties, a person must file an individual

  8  application for each specialty with the department.  The

  9  application must be on a form prescribed by the department and

10  must be accompanied by a nonrefundable application fee for

11  each specialty.

12         (c)  The department may issue a license to an eligible

13  applicant if the applicant meets all license requirements.  At

14  any time before the department issues a license, the applicant

15  may request in writing that the application be withdrawn.  To

16  reapply, the applicant must submit a new application and an

17  additional nonrefundable application fee and must meet all

18  current licensure requirements.

19         (d)  The department shall review each completed

20  application for a license which the department receives.

21         (e)  On receipt of an application and fee as specified

22  in this section, the department may issue a license to

23  practice medical physics in this state:

24         1.  Until October 1, 1998, to a person who meets any of

25  the following requirements:

26         a.  Earned from an accredited college or university a

27  doctoral degree in physics, medical physics, biophysics,

28  radiological physics, medical health physics, or nuclear

29  engineering and has at least 2 years' experience in the

30  practice of the medical physics specialty for which

31  application is made.


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  1         b.  Earned from an accredited college or university a

  2  master's degree in physics, medical physics, biophysics,

  3  radiological physics, medical health physics, or nuclear

  4  engineering and has at least 3 years' experience in the

  5  practice of the medical physics specialty for which

  6  application is made.

  7         c.  Earned from an accredited college or university a

  8  bachelor's degree in physics and has at least 5 years'

  9  experience in the practice of the medical physics specialty

10  for which application is made.

11         d.  Has at least 8 years' experience in the practice of

12  the medical physics specialty for which application is made, 2

13  years of which must have been earned within the 4 years

14  immediately preceding application for licensure.

15         e.  Is board certified in the medical physics specialty

16  in which the applicant applies to practice by the American

17  Board of Radiology for diagnostic radiological physics,

18  therapeutic radiological physics, or medical nuclear

19  radiological physics; by the American Board of Medical Physics

20  or the Canadian Board of Medical Physics for diagnostic

21  radiological physics, therapeutic radiological physics, or

22  medical nuclear radiological physics; or by the American Board

23  of Health Physics or an equivalent certifying body approved by

24  the agency.

25         2.  On or after October 1, 1997, to a person who is

26  board certified in the medical physics specialty in which the

27  applicant applies to practice by the American Board of

28  Radiology for diagnostic radiological physics, therapeutic

29  radiological physics, or medical nuclear radiological physics;

30  by the American Board of Medical Physics for diagnostic

31  radiological physics, therapeutic radiological physics, or


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  1  medical nuclear radiological physics; or by the American Board

  2  of Health Physics or an equivalent certifying body approved by

  3  the department.

  4         (f)  A licensee shall:

  5         1.  Display the license in a place accessible to the

  6  public; and

  7         2.  Report immediately any change in the licensee's

  8  address or name to the department.

  9         (g)  The following acts are grounds for which the

10  disciplinary actions in paragraph (h) may be taken:

11         1.  Obtaining or attempting to obtain a license by

12  bribery, fraud, knowing misrepresentation, or concealment of

13  material fact or through an error of the department.

14         2.  Having a license denied, revoked, suspended, or

15  otherwise acted against in another jurisdiction.

16         3.  Being convicted or found guilty of, or entering a

17  plea of nolo contendere to, regardless of adjudication, a

18  crime in any jurisdiction which relates to the practice of, or

19  the ability to practice, the profession of medical physics.

20         4.  Willfully failing to file a report or record

21  required for medical physics or willfully impeding or

22  obstructing the filing of a report or record required by this

23  section or inducing another person to do so.

24         5.  Making misleading, deceptive, or fraudulent

25  representations in or related to the practice of medical

26  physics.

27         6.  Willfully failing to report any known violation of

28  this section or any rule adopted thereunder.

29         7.  Willfully or repeatedly violating a rule adopted

30  under this section or an order of the department.

31


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  1         8.  Failing to perform any statutory or legal

  2  obligation placed upon a licensee.

  3         9.  Aiding, assisting, procuring, employing, or

  4  advising any unlicensed person to practice medical physics

  5  contrary to this section or any rule adopted thereunder.

  6         10.  Delegating or contracting for the performance of

  7  professional responsibilities by a person when the licensee

  8  delegating or contracting such responsibilities knows, or has

  9  reason to know, such person is not qualified by training,

10  experience, and authorization to perform them.

11         11.  Practicing or offering to practice beyond the

12  scope permitted by law or accepting and performing

13  professional responsibilities the licensee knows, or has

14  reason to know, the licensee is not competent to perform.

15         12.  Gross or repeated malpractice or the inability to

16  practice medical physics with reasonable skill and safety.

17         13.  Judicially determined mental incompetency.

18         14.  Being unable to practice medical physics with

19  reasonable skill and safety because of a mental or physical

20  condition or illness or the use of alcohol, controlled

21  substances, or any other substance which impairs one's ability

22  to practice.

23         a.  The department may, upon probable cause, compel a

24  licensee to submit to a mental or physical examination by

25  physicians designated by the department.  The cost of an

26  examination shall be borne by the licensee, and the licensee's

27  failure to submit to such an examination constitutes an

28  admission of the allegations against the licensee, consequent

29  upon which a default and a final order may be entered without

30  the taking of testimony or presentation of evidence, unless

31


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  1  the failure was due to circumstances beyond the licensee's

  2  control.

  3         b.  A licensee who is disciplined under this

  4  subparagraph shall, at reasonable intervals, be afforded an

  5  opportunity to demonstrate that the licensee can resume the

  6  practice of medical physics with reasonable skill and safety.

  7         c.  With respect to any proceeding under this

  8  subparagraph, the record of proceedings or the orders entered

  9  by the department may not be used against a licensee in any

10  other proceeding.

11         (h)  When the department finds any person guilty of any

12  of the grounds set forth in paragraph (g), including conduct

13  that would constitute a substantial violation of paragraph (g)

14  which occurred prior to licensure, it may enter an order

15  imposing one or more of the following penalties:

16         1.  Deny the application for licensure.

17         2.  Revoke or suspend the license.

18         3.  Impose an administrative fine for each count or

19  separate offense.

20         4.  Place the licensee on probation for a specified

21  time and subject the licensee to such conditions as the

22  department determines necessary, including requiring

23  treatment, continuing education courses, or working under the

24  monitoring or supervision of another licensee.

25         5.  Restrict a licensee's practice.

26         6.  Issue a reprimand to the licensee.

27         (i)  The department may not issue or reinstate a

28  license to a person it has deemed unqualified until it is

29  satisfied that such person has complied with the terms and

30  conditions of the final order and that the licensee can safely

31  practice medical physics.


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  1         (j)  The department may issue a temporary license to an

  2  applicant pending completion of the application process for

  3  board certification.

  4         (j)(k)  Upon receipt of a complete application and the

  5  fee set forth by rule, the department may issue a

  6  physicist-in-training certificate to a person qualified to

  7  practice medical physics under direct supervision. The

  8  department may establish by rule requirements for initial

  9  certification and renewal of a physicist-in-training

10  certificate.

11         (8)  DISPOSITION OF FEES.--The department shall deposit

12  all funds received into the Medical Quality Assurance Health

13  Care Trust Fund.

14         Section 155.  Paragraph (d) of subsection (1) of

15  section 484.007, Florida Statutes, is amended to read:

16         484.007  Licensure of opticians; permitting of optical

17  establishments.--

18         (1)  Any person desiring to practice opticianry shall

19  apply to the department, upon forms prescribed by it, to take

20  a licensure examination. The department shall examine each

21  applicant who the board certifies:

22         (d)1.  Has received an associate degree, or its

23  equivalent, in opticianry from an educational institution the

24  curriculum of which is accredited by an accrediting agency

25  recognized and approved by the United States Department of

26  Education or the Council on Postsecondary Education or

27  approved by the board;

28         2.  Is an individual licensed to practice the

29  profession of opticianry pursuant to a regulatory licensing

30  law of another state, territory, or jurisdiction of the United

31  States, who has actively practiced in such other state,


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  1  territory, or jurisdiction for more than 3 years immediately

  2  preceding application, and who meets the examination

  3  qualifications as provided in this subsection;

  4         3.  Is an individual who has actively practiced in

  5  another state, territory, or jurisdiction of the United States

  6  for more than 5 years immediately preceding application and

  7  who provides tax or business records, affidavits, or other

  8  satisfactory documentation of such practice and who meets the

  9  examination qualifications as provided in this subsection; or

10         4.  Has registered as an apprentice with the department

11  and paid a registration fee not to exceed $60, as set by rule

12  of the board. The apprentice shall complete 6,240 hours of

13  training under the supervision of an optician licensed in this

14  state for at least 1 year or of, a physician, or an

15  optometrist licensed under the laws of this state. These

16  requirements must be met within 5 years after the date of

17  registration. However, any time spent in a recognized school

18  may be considered as part of the apprenticeship program

19  provided herein. The board may establish administrative

20  processing fees sufficient to cover the cost of administering

21  apprentice rules as promulgated by the board.

22         Section 156.  Subsection (3) is added to section

23  484.0512, Florida Statutes, to read:

24         484.0512  Thirty-day trial period; purchaser's right to

25  cancel; notice; refund; cancellation fee.--

26         (3)  Within 30 days after the return or attempted

27  return of the hearing aid, the seller shall refund all moneys

28  that must be refunded to a purchaser pursuant to this section.

29         Section 157.  Section 484.053, Florida Statutes, is

30  amended to read:

31         484.053  Prohibitions; penalties.--


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  1         (1)  A person may not:

  2         (a)  Practice dispensing hearing aids unless the person

  3  is a licensed hearing aid specialist;

  4         (b)  Use the name or title "hearing aid specialist"

  5  when the person has not been licensed under this part;

  6         (c)  Present as her or his own the license of another;

  7         (d)  Give false, incomplete, or forged evidence to the

  8  board or a member thereof for the purposes of obtaining a

  9  license;

10         (e)  Use or attempt to use a hearing aid specialist

11  license that is delinquent or has been suspended, revoked, or

12  placed on inactive or delinquent status;

13         (f)  Knowingly employ unlicensed persons in the

14  practice of dispensing hearing aids; or

15         (g)  Knowingly conceal information relative to

16  violations of this part.

17         (2)  Any person who violates any of the provisions of

18  this section is guilty of a felony misdemeanor of the third

19  second degree, punishable as provided in s. 775.082 or s.

20  775.083.

21         (3)  If a person licensed under this part allows the

22  sale of a hearing aid by an unlicensed person not registered

23  as a trainee or fails to comply with the requirements of s.

24  484.0445(2) relating to supervision of trainees, the board

25  shall, upon determination of that violation, order the full

26  refund of moneys paid by the purchaser upon return of the

27  hearing aid to the seller's place of business.

28         Section 158.  Paragraph (a) of subsection (1) of

29  section 484.056, Florida Statutes, 1998 Supplement, is amended

30  to read:

31         484.056  Disciplinary proceedings.--


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    CS for SB 2220                                 First Engrossed



  1         (1)  The following acts relating to the practice of

  2  dispensing hearing aids shall be grounds for both disciplinary

  3  action against a hearing aid specialist as set forth in this

  4  section and cease and desist or other related action by the

  5  department as set forth in s. 455.637 against any person

  6  owning or operating a hearing aid establishment who engages

  7  in, aids, or abets any such violation:

  8         (a)  Violation of any provision of s. 455.624(1), s.

  9  484.0512, or s. 484.053.

10         Section 159.  Section 486.041, Florida Statutes, is

11  amended to read:

12         486.041  Physical therapist; application for license;

13  fee; temporary permit.--

14         (1)  A person who desires to be licensed as a physical

15  therapist shall apply to the department in writing on a form

16  furnished by the department.  She or he shall embody in that

17  application evidence under oath, satisfactory to the board, of

18  possession of the qualifications preliminary to examination

19  required by s. 486.031. The applicant shall pay to the

20  department at the time of filing the application a fee not to

21  exceed $100, as fixed by the board.

22         (2)  If a person desires to practice physical therapy

23  before becoming licensed through examination, she or he shall

24  apply for a temporary permit in accordance with rules adopted

25  pursuant to this chapter.

26         (a)  A temporary permit shall only be issued for a

27  limited period of time, not to exceed 1 year, and shall not be

28  renewable. A temporary permit shall automatically expire if an

29  applicant fails the examination.

30

31


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    CS for SB 2220                                 First Engrossed



  1         (b)  An applicant for licensure by examination and

  2  practicing under a temporary permit shall do so only under the

  3  direct supervision of a licensed physical therapist.

  4         Section 160.  Section 486.081, Florida Statutes, is

  5  amended to read:

  6         486.081  Physical therapist; issuance of license

  7  without examination to person passing examination of another

  8  authorized examining board; temporary permit; fee.--

  9         (1)  The board may cause a license to be issued through

10  the department without examination to any applicant who

11  presents evidence satisfactory to the board of having passed

12  the American Registry Examination prior to 1971 or an

13  examination in physical therapy before a similar lawfully

14  authorized examining board of another state, the District of

15  Columbia, a territory, or a foreign country, if the standards

16  for licensure in physical therapy in such other state,

17  district, territory, or foreign country are determined by the

18  board to be as high as those of this state, as established by

19  rules adopted pursuant to this chapter. Any person who holds a

20  license pursuant to this section may use the words "physical

21  therapist" or "physiotherapist," or the letters "P.T.," in

22  connection with her or his name or place of business to denote

23  her or his licensure hereunder.

24         (2)  At the time of making application for licensure

25  without examination pursuant to the terms of this section, the

26  applicant shall pay to the department a fee not to exceed $175

27  as fixed by the board, no part of which will be returned.

28         (3)  If a person desires to practice physical therapy

29  before becoming licensed through endorsement, she or he shall

30  apply to the board for a temporary permit in accordance with

31  rules adopted pursuant to this chapter. A temporary permit


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    CS for SB 2220                                 First Engrossed



  1  shall only be issued for a limited period of time, not to

  2  exceed 1 year, and shall not be renewable.

  3         Section 161.  Section 486.103, Florida Statutes, is

  4  amended to read:

  5         486.103  Physical therapist assistant; application for

  6  license; fee; temporary permit.--

  7         (1)  A person who desires to be licensed as a physical

  8  therapist assistant shall apply to the department in writing

  9  on a form furnished by the department.  She or he shall embody

10  in that application evidence under oath, satisfactory to the

11  board, of possession of the qualifications preliminary to

12  examination required by s. 486.104. The applicant shall pay to

13  the department at the time of filing the application a fee not

14  to exceed $100, as fixed by the board.

15         (2)  If a person desires to work as a physical

16  therapist assistant before being licensed through examination,

17  she or he shall apply for a temporary permit in accordance

18  with rules adopted pursuant to this chapter.

19         (a)  A temporary permit shall only be issued for a

20  limited period of time, not to exceed 1 year, and shall not be

21  renewable. A temporary permit shall automatically expire if an

22  applicant fails the examination.

23         (b)  An applicant for licensure by examination who is

24  practicing under a temporary permit shall do so only under the

25  direct supervision of a licensed physical therapist.

26         Section 162.  Section 486.107, Florida Statutes, is

27  amended to read:

28         486.107  Physical therapist assistant; issuance of

29  license without examination to person licensed in another

30  jurisdiction; temporary permit; fee.--

31


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    CS for SB 2220                                 First Engrossed



  1         (1)  The board may cause a license to be issued through

  2  the department without examination to any applicant who

  3  presents evidence to the board, under oath, of licensure in

  4  another state, the District of Columbia, or a territory, if

  5  the standards for registering as a physical therapist

  6  assistant or licensing of a physical therapist assistant, as

  7  the case may be, in such other state are determined by the

  8  board to be as high as those of this state, as established by

  9  rules adopted pursuant to this chapter. Any person who holds a

10  license pursuant to this section may use the words "physical

11  therapist assistant," or the letters "P.T.A.," in connection

12  with her or his name to denote licensure hereunder.

13         (2)  At the time of making application for licensing

14  without examination pursuant to the terms of this section, the

15  applicant shall pay to the department a fee not to exceed $175

16  as fixed by the board, no part of which will be returned.

17         (3)  If a person desires to work as a physical

18  therapist assistant before being licensed through endorsement,

19  she or he shall apply for a temporary permit in accordance

20  with rules adopted pursuant to this chapter.  A temporary

21  permit shall only be issued for a limited period of time, not

22  to exceed 1 year, and shall not be renewable.

23         Section 163.  Paragraph (b) of subsection (1) of

24  section 490.005, Florida Statutes, 1998 Supplement, is amended

25  to read:

26         490.005  Licensure by examination.--

27         (1)  Any person desiring to be licensed as a

28  psychologist shall apply to the department to take the

29  licensure examination. The department shall license each

30  applicant who the board certifies has:

31


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    CS for SB 2220                                 First Engrossed



  1         (b)  Submitted proof satisfactory to the board that the

  2  applicant has:

  3         1.  Received doctoral-level psychological education, as

  4  defined in s. 490.003(3);

  5         2.  Received the equivalent of a doctoral-level

  6  psychological education, as defined in s. 490.003(3), from a

  7  program at a school or university located outside the United

  8  States of America and Canada, which was officially recognized

  9  by the government of the country in which it is located as an

10  institution or program to train students to practice

11  professional psychology.  The burden of establishing that the

12  requirements of this provision have been met shall be upon the

13  applicant;

14         3.  Received and submitted to the board, prior to July

15  1, 1999, certification of an augmented doctoral-level

16  psychological education from the program director of a

17  doctoral-level psychology program accredited by a programmatic

18  agency recognized and approved by the United States Department

19  of Education; or

20         4.  Received and submitted to the board, prior to

21  August 31, 2001 July 1, 2001, certification of a

22  doctoral-level program that at the time the applicant was

23  enrolled and graduated maintained a standard of education and

24  training comparable to the standard of training of programs

25  accredited by a programmatic agency recognized and approved by

26  the United States Department of Education, as such

27  comparability was determined by the Board of Psychological

28  Examiners immediately prior to the amendment of s. 490.005,

29  Florida Statutes, 1994 Supplement, by s. 5, chapter 95-279,

30  Laws of Florida. Such certification of comparability shall be

31  provided by the program director of a doctoral-level


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    CS for SB 2220                                 First Engrossed



  1  psychology program accredited by a programmatic agency

  2  recognized and approved by the United States Department of

  3  Education.

  4         Section 164.  Subsection (1) of section 490.006,

  5  Florida Statutes, is amended to read:

  6         490.006  Licensure by endorsement.--

  7         (1)  The department shall license a person as a

  8  psychologist or school psychologist who, upon applying to the

  9  department and remitting the appropriate fee, demonstrates to

10  the department or, in the case of psychologists, to the board

11  that the applicant:

12         (a)  Holds a valid license or certificate in another

13  state to practice psychology or school psychology, as

14  applicable, provided that, when the applicant secured such

15  license or certificate, the requirements were substantially

16  equivalent to or more stringent than those set forth in this

17  chapter at that time; and, if no Florida law existed at that

18  time, then the requirements in the other state must have been

19  substantially equivalent to or more stringent than those set

20  forth in this chapter at the present time; or

21         (b)  Is a diplomate in good standing with the American

22  Board of Professional Psychology, Inc.; or

23         (c)  Possesses a doctoral degree in psychology as

24  described in s. 490.003 and has at least 20 years of

25  experience as a licensed psychologist in any jurisdiction or

26  territory of the United States within 25 years preceding the

27  date of application.

28         Section 165.  Subsection (2) of section 490.0085,

29  Florida Statutes, is amended to read:

30         490.0085  Continuing education; approval of providers,

31  programs, and courses; proof of completion.--


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    CS for SB 2220                                 First Engrossed



  1         (2)  The department or, in the case of psychologists,

  2  the board has the authority to set a fee not to exceed $500

  3  for each applicant who applies for or renews provider status.

  4  Such fees shall be deposited into the Medical Quality

  5  Assurance Health Care Trust Fund.

  6         Section 166.  Section 491.0045, Florida Statutes, is

  7  amended to read:

  8         491.0045  Intern registration; requirements.--

  9         (1)  Effective January 1, 1998, an individual who

10  intends to practice in Florida to satisfy the postgraduate or

11  post-master's level experience requirements, as specified in

12  s. 491.005(1)(c), (3)(c), or (4)(c), must register as an

13  intern in the profession for which he or she is seeking

14  licensure prior to commencing the post-master's experience

15  requirement or an individual who intends to satisfy part of

16  the required graduate-level practicum, internship, or field

17  experience, outside the academic arena for any profession,

18  must register as an intern in the profession for which he or

19  she is seeking licensure prior to commencing the practicum,

20  internship, or field experience.

21         (2)  The department shall register as a clinical social

22  worker intern, marriage and family therapist intern, or mental

23  health counselor intern each applicant who the board certifies

24  has:

25         (a)  Completed the application form and remitted a

26  nonrefundable application fee not to exceed $200, as set by

27  board rule;

28         (b)1.  Completed the education requirements as

29  specified in s. 491.005(1)(c), (3)(c), or (4)(c) for the

30  profession for which he or she is applying for licensure, if

31  needed; and


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    CS for SB 2220                                 First Engrossed



  1         2.  Submitted an acceptable supervision plan, as

  2  determined by the board, for meeting the practicum,

  3  internship, or field work required for licensure that was not

  4  satisfied in his or her graduate program.

  5         (c)  Identified a qualified supervisor.

  6         (3)  An individual registered under this section must

  7  remain under supervision until he or she is in receipt of a

  8  license or a letter from the department stating that he or she

  9  is licensed to practice the profession for which he or she

10  applied.

11         (4)  An individual who has applied for intern

12  registration on or before December 31, 2001, and has satisfied

13  the education requirements of s. 491.005 that are in effect

14  through December 31, 2000, will have met the educational

15  requirements for licensure for the profession for which he or

16  she has applied.

17         (5)  Individuals who have commenced the experience

18  requirement as specified in s. 491.005(1)(c), (3)(c), or

19  (4)(c) but failed to register as required by subsection (1)

20  shall register with the department before January 1, 2000.

21  Individuals who fail to comply with this subsection shall not

22  be granted a license, and any time spent by the individual

23  completing the experience requirement prior to registering as

24  an intern shall not count toward completion of such

25  requirement.

26         Section 167.  Subsections (1) and (2) of section

27  491.0046, Florida Statutes, are amended to read:

28         491.0046  Provisional license; requirements.--

29         (1)  An individual applying for licensure by

30  examination who has satisfied the clinical experience

31  requirements of s. 491.005 or an individual applying for


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    CS for SB 2220                                 First Engrossed



  1  licensure by endorsement pursuant to s. 491.006 intending to

  2  provide clinical social work, marriage and family therapy, or

  3  mental health counseling services in Florida while satisfying

  4  coursework or examination requirements for licensure must be

  5  provisionally licensed in the profession for which he or she

  6  is seeking licensure prior to beginning practice.

  7         (2)  The department shall issue a provisional clinical

  8  social worker license, provisional marriage and family

  9  therapist license, or provisional mental health counselor

10  license to each applicant who the board certifies has:

11         (a)  Completed the application form and remitted a

12  nonrefundable application fee not to exceed $100, as set by

13  board rule; and

14         (b)1.  Earned a graduate degree in social work, a

15  graduate degree with a major emphasis in marriage and family

16  therapy or a closely related field, or a graduate degree in a

17  major related to the practice of mental health counseling;

18  and, and satisfied the clinical experience requirements for

19  licensure pursuant to s. 491.005; or

20         2.  Been approved for examination under the provisions

21  for licensure by endorsement pursuant to s. 491.006.

22         (c)  Has met the following minimum coursework

23  requirements:

24         1.  For clinical social work, a minimum of 15 semester

25  hours or 22 quarter hours of the coursework required by s.

26  491.005(1)(b)2.b.

27         2.  For marriage and family therapy, ten of the courses

28  required by s. 491.005(3)(b)1.a.-c., as determined by the

29  board, and at least 6 semester hours or 9 quarter hours of the

30  course credits must have been completed in the area of

31  marriage and family systems, theories, or techniques.


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    CS for SB 2220                                 First Engrossed



  1         3.  For mental health counseling, a minimum of seven of

  2  the courses required under s. 491.005(b)1.a.-c.

  3         Section 168.  Section 491.005, Florida Statutes, is

  4  amended to read:

  5         491.005  Licensure by examination.--

  6         (1)  CLINICAL SOCIAL WORK.--Upon verification of

  7  documentation and payment of a fee not to exceed $200, as set

  8  by board rule, plus the actual per applicant cost to the

  9  department for purchase of the examination from the American

10  Association of State Social Worker's Boards or a similar

11  national organization, the department shall issue a license as

12  a clinical social worker to an applicant who the board

13  certifies:

14         (a)  Has made application therefor and paid the

15  appropriate fee.

16         (b)1.  Has received a doctoral degree in social work

17  from a graduate school of social work which at the time the

18  applicant graduated was accredited by an accrediting agency

19  recognized by the United States Department of Education or has

20  received a master's degree in social work from a graduate

21  school of social work which at the time the applicant

22  graduated:

23         a.  Was accredited by the Council on Social Work

24  Education;

25         b.  Was accredited by the Canadian Association of

26  Schools of Social Work; or

27         c.  Has been determined to have been a program

28  equivalent to programs approved by the Council on Social Work

29  Education by the Foreign Equivalency Determination Service of

30  the Council on Social Work Education.  An applicant who

31  graduated from a program at a university or college outside of


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    CS for SB 2220                                 First Engrossed



  1  the United States or Canada must present documentation of the

  2  equivalency determination from the council in order to

  3  qualify.

  4         2.  The applicant's graduate program must have

  5  emphasized direct clinical patient or client health care

  6  services, including, but not limited to, coursework in

  7  clinical social work, psychiatric social work, medical social

  8  work, social casework, psychotherapy, or group therapy.  The

  9  applicant's graduate program must have included all of the

10  following coursework:

11         a.  A supervised field placement which was part of the

12  applicant's advanced concentration in direct practice, during

13  which the applicant provided clinical services directly to

14  clients.

15         b.  Completion of 24 semester hours or 32 37 quarter

16  hours in theory of human behavior and practice methods as

17  courses in clinically oriented services, including a minimum

18  of one course in psychopathology, and no more than one course

19  in research, taken in a school of social work accredited or

20  approved pursuant to subparagraph 1.

21         3.  If the course title which appears on the

22  applicant's transcript does not clearly identify the content

23  of the coursework, the applicant shall be required to provide

24  additional documentation, including, but not limited to, a

25  syllabus or catalog description published for the course.

26         (c)  Has had not less than 2 years of clinical social

27  work experience, which took place subsequent to completion of

28  a graduate degree in social work at an institution meeting the

29  accreditation requirements of this section, under the

30  supervision of a licensed clinical social worker or the

31  equivalent who is a qualified supervisor as determined by the


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  1  board. An individual who intends to practice in Florida to

  2  satisfy clinical experience requirements must register

  3  pursuant to s. 491.0045 prior to commencing practice.  If the

  4  applicant's graduate program was not a program which

  5  emphasized direct clinical patient or client health care

  6  services as described in subparagraph (b)2. s. 491.003, the

  7  supervised experience requirement must take place after the

  8  applicant has completed a minimum of 15 semester hours or 22

  9  quarter hours of the coursework required.  A doctoral

10  internship may be applied toward the clinical social work

11  experience requirement. The experience requirement may be met

12  by work performed on or off the premises of the supervising

13  clinical social worker or the equivalent, provided the

14  off-premises work is not the independent private practice

15  rendering of clinical social work that does not have a

16  licensed mental health professional, as determined by the

17  board, on the premises at the same time the intern is

18  providing services.

19         (d)  Has passed a theory and practice examination

20  provided by the department for this purpose.

21         (e)  Has demonstrated, in a manner designated by rule

22  of the board, knowledge of the laws and rules governing the

23  practice of clinical social work, marriage and family therapy,

24  and mental health counseling.

25         (2)  CLINICAL SOCIAL WORK.--

26         (a)  Notwithstanding the provisions of paragraph

27  (1)(b), coursework which was taken at a baccalaureate level

28  shall not be considered toward completion of education

29  requirements for licensure unless an official of the graduate

30  program certifies in writing on the graduate school's

31  stationery that a specific course, which students enrolled in


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  1  the same graduate program were ordinarily required to complete

  2  at the graduate level, was waived or exempted based on

  3  completion of a similar course at the baccalaureate level.  If

  4  this condition is met, the board shall apply the baccalaureate

  5  course named toward the education requirements.

  6         (b)  An applicant from a master's or doctoral program

  7  in social work which did not emphasize direct patient or

  8  client services may complete the clinical curriculum content

  9  requirement by returning to a graduate program accredited by

10  the Council on Social Work Education or the Canadian

11  Association of Schools of Social Work, or to a clinical social

12  work graduate program with comparable standards, in order to

13  complete the education requirements for examination.  However,

14  a maximum of 6 semester or 9 quarter hours of the clinical

15  curriculum content requirement may be completed by credit

16  awarded for independent study coursework as defined by board

17  rule.

18         (3)  MARRIAGE AND FAMILY THERAPY.-- Upon verification

19  of documentation and payment of a fee not to exceed $200, as

20  set by board rule, plus the actual cost to the department for

21  the purchase of the examination from the Association of

22  Marital and Family Therapy Regulatory Board, or similar

23  national organization, the department shall issue a license as

24  a marriage and family therapist to an applicant who the board

25  certifies:

26         (a)  Has made application therefor and paid the

27  appropriate fee.

28         (b)1.  Has a minimum of a master's degree with major

29  emphasis in marriage and family therapy, or a closely related

30  field, and has completed all of the following requirements:

31


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  1         a.  Twenty-seven semester hours or 41 quarter hours of

  2  graduate coursework, which must include a minimum of 2

  3  semester hours or 3 quarter hours of graduate-level course

  4  credits in each of the following nine areas: dynamics of

  5  marriage and family systems; marriage therapy and counseling

  6  theory and techniques; family therapy and counseling theory

  7  and techniques; individual human development theories

  8  throughout the life cycle; personality theory;

  9  psychopathology; human sexuality theory and counseling

10  techniques; general counseling theory and techniques; and

11  psychosocial theory. Content may be combined, provided no more

12  than two of the nine content areas are included in any one

13  graduate-level course and the applicant can document that the

14  equivalent of 2 semester hours of coursework was devoted to

15  each content area. Courses in research, evaluation, appraisal,

16  assessment, or testing theories and procedures; thesis or

17  dissertation work; or practicums, internships, or fieldwork

18  may not be applied toward this requirement.

19         b.  A minimum of one graduate-level course of 2

20  semester hours or 3 quarter hours in legal, ethical, and

21  professional standards issues in the practice of marriage and

22  family therapy or a course determined by the board to be

23  equivalent.

24         c.  A minimum of one graduate-level course of 2

25  semester hours or 3 quarter hours in diagnosis, appraisal,

26  assessment, and testing for individual or interpersonal

27  disorder or dysfunction; and a minimum of one 2-semester-hour

28  or 3-quarter-hour graduate-level course in behavioral research

29  which focuses on the interpretation and application of

30  research data as it applies to clinical practice.  Credit for

31


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  1  thesis or dissertation work, practicums, internships, or

  2  fieldwork may not be applied toward this requirement.

  3         d.  A minimum of one supervised clinical practicum,

  4  internship, or field experience in a marriage and family

  5  counseling setting, during which the student provided 180

  6  direct client contact hours of marriage and family therapy

  7  services under the supervision of an individual who met the

  8  requirements for supervision under paragraph (c).  This

  9  requirement may be met by a supervised practice experience

10  which took place outside the academic arena, but which is

11  certified as equivalent to a graduate-level practicum or

12  internship program which required a minimum of 180 direct

13  client contact hours of marriage and family therapy services

14  currently offered within an academic program of a college or

15  university accredited by an accrediting agency approved by the

16  United States Department of Education, or an institution which

17  is publicly recognized as a member in good standing with the

18  Association of Universities and Colleges of Canada or a

19  training institution accredited by the Commission on

20  Accreditation for Marriage and Family Therapy Education

21  recognized by the United States Department of Education.

22  Certification shall be required from an official of such

23  college, university, or training institution.

24         2.  If the course title which appears on the

25  applicant's transcript does not clearly identify the content

26  of the coursework, the applicant shall be required to provide

27  additional documentation, including, but not limited to, a

28  syllabus or catalog description published for the course.

29

30  The required master's degree must have been received in an

31  institution of higher education which at the time the


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  1  applicant graduated was:  fully accredited by a regional

  2  accrediting body recognized by the Commission on Recognition

  3  of Postsecondary Accreditation; publicly recognized as a

  4  member in good standing with the Association of Universities

  5  and Colleges of Canada; or an institution of higher education

  6  located outside the United States and Canada, which at the

  7  time the applicant was enrolled and at the time the applicant

  8  graduated maintained a standard of training substantially

  9  equivalent to the standards of training of those institutions

10  in the United States which are accredited by a regional

11  accrediting body recognized by the Commission on Recognition

12  of Postsecondary Accreditation.  Such foreign education and

13  training must have been received in an institution or program

14  of higher education officially recognized by the government of

15  the country in which it is located as an institution or

16  program to train students to practice as professional marriage

17  and family therapists or psychotherapists.  The burden of

18  establishing that the requirements of this provision have been

19  met shall be upon the applicant, and the board shall require

20  documentation, such as, but not limited to, an evaluation by a

21  foreign equivalency determination service, as evidence that

22  the applicant's graduate degree program and education were

23  equivalent to an accredited program in this country.  An

24  applicant with a master's degree from a program which did not

25  emphasize marriage and family therapy may complete the

26  coursework requirement in a training institution fully

27  accredited by the Commission on Accreditation for Marriage and

28  Family Therapy Education recognized by the United States

29  Department of Education.

30         (c)  Has had not less than 2 years of clinical

31  experience during which 50 percent of the applicant's clients


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    CS for SB 2220                                 First Engrossed



  1  were receiving marriage and family therapy services, which

  2  must be at the post-master's level under the supervision of a

  3  licensed marriage and family therapist with at least 5 years

  4  of experience, or the equivalent, who is a qualified

  5  supervisor as determined by the board.  An individual who

  6  intends to practice in Florida to satisfy the clinical

  7  experience requirements must register pursuant to s. 491.0045

  8  prior to commencing practice.  If a graduate has a master's

  9  degree with a major emphasis in marriage and family therapy or

10  a closely related field that did not include all the

11  coursework required under sub-subparagraphs (b)1.a.-c., credit

12  for the post-master's level clinical experience shall not

13  commence until the applicant has completed a minimum of 10 of

14  the courses required under sub-subparagraphs (b)1.a.-c., as

15  determined by the board, and at least 6 semester hours or 9

16  quarter hours of the course credits must have been completed

17  in the area of marriage and family systems, theories, or

18  techniques. Within the 3 years of required experience, the

19  applicant shall provide direct individual, group, or family

20  therapy and counseling, to include the following categories of

21  cases:  unmarried dyads, married couples, separating and

22  divorcing couples, and family groups including children.  A

23  doctoral internship may be applied toward the clinical

24  experience requirement.  The clinical experience requirement

25  may be met by work performed on or off the premises of the

26  supervising marriage and family therapist or the equivalent,

27  provided the off-premises work is not the independent private

28  practice rendering of marriage and family therapy services

29  that does not have a licensed mental health professional, as

30  determined by the board, on the premises at the same time the

31  intern is providing services.


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  1         (d)  Has passed a theory and practice examination

  2  provided by the department for this purpose.

  3         (e)  Has demonstrated, in a manner designated by rule

  4  of the board, knowledge of the laws and rules governing the

  5  practice of clinical social work, marriage and family therapy,

  6  and mental health counseling.

  7         (f)  For the purposes of dual licensure, the department

  8  shall license as a marriage and family therapist any person

  9  who meets the requirements of s. 491.0057. Fees for dual

10  licensure shall not exceed those stated in this subsection.

11         (4)  MENTAL HEALTH COUNSELING.--Upon verification of

12  documentation and payment of a fee not to exceed $200, as set

13  by board rule, plus the actual per applicant cost to the

14  department for purchase of the examination from the

15  Professional Examination Service for the National Academy of

16  Certified Clinical Mental Health Counselors or a similar

17  national organization, the department shall issue a license as

18  a mental health counselor to an applicant who the board

19  certifies:

20         (a)  Has made application therefor and paid the

21  appropriate fee.

22         (b)1.  Has received a minimum of an earned master's

23  degree with a major related to the practice of mental health

24  counseling, and has completed all of the following

25  requirements:

26         a.  Twenty-one semester hours or 32 quarter hours of

27  graduate coursework, which must include a minimum of 2

28  semester hours or 3 quarter hours of graduate-level coursework

29  in each of the following seven content areas:  counseling

30  theories and practice; human development theories; personality

31  theory; psychopathology or abnormal psychology; human


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  1  sexuality theories; group theories and practice; and

  2  individual evaluation and assessment.  Content may be

  3  combined, provided no more than two of the seven content areas

  4  are included in any one graduate-level course and the

  5  applicant can document that the equivalent of 2 semester hours

  6  of content was devoted to each content area.  Courses in

  7  research, thesis or dissertation work, practicums,

  8  internships, or fieldwork may not be applied toward this

  9  requirement.

10         b.  A minimum of one 2-semester-hour or 3-quarter-hour

11  graduate-level course in research or in career or vocational

12  counseling. Credit for thesis or dissertation work,

13  practicums, internships, or fieldwork may not be applied

14  toward this requirement.

15         c.  A minimum of 2 semester hours or 3 quarter hours of

16  graduate-level coursework in legal, ethical, and professional

17  standards issues in the practice of mental health counseling,

18  which includes goals and objectives of professional counseling

19  organizations, codes of ethics, legal considerations,

20  standards of preparation, certifications and licensing, and

21  the role identity of counselors.  Courses in research, thesis

22  or dissertation work, practicums, internships, or fieldwork

23  may not be applied toward this requirement.

24         d.  A minimum of one supervised practicum, internship,

25  or field experience in a counseling setting.  This requirement

26  may be met by a supervised practice experience which takes

27  place outside the academic arena, but which is certified as

28  equivalent to a graduate-level practicum in a clinical mental

29  health counseling setting currently offered within an academic

30  program of a college or university accredited by an

31  accrediting agency approved by the United States Department of


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  1  Education. Such certification shall be required from an

  2  official of such college or university.

  3         2.  If the course title which appears on the

  4  applicant's transcript does not clearly identify the content

  5  of the coursework, the applicant shall be required to provide

  6  additional documentation, including, but not limited to, a

  7  syllabus or catalog description published for the course.

  8

  9  Except as provided in sub-subparagraph 1.d., education and

10  training in mental health counseling must have been received

11  in an institution of higher education which at the time the

12  applicant graduated was:  fully accredited by a regional

13  accrediting body recognized by the Commission on Recognition

14  of Postsecondary Accreditation; publicly recognized as a

15  member in good standing with the Association of Universities

16  and Colleges of Canada; or an institution of higher education

17  located outside the United States and Canada, which at the

18  time the applicant was enrolled and at the time the applicant

19  graduated maintained a standard of training substantially

20  equivalent to the standards of training of those institutions

21  in the United States which are accredited by a regional

22  accrediting body recognized by the Commission on Recognition

23  of Postsecondary Accreditation. Such foreign education and

24  training must have been received in an institution or program

25  of higher education officially recognized by the government of

26  the country in which it is located as an institution or

27  program to train students to practice as mental health

28  counselors.  The burden of establishing that the requirements

29  of this provision have been met shall be upon the applicant,

30  and the board shall require documentation, such as, but not

31  limited to, an evaluation by a foreign equivalency


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  1  determination service, as evidence that the applicant's

  2  graduate degree program and education were equivalent to an

  3  accredited program in this country.

  4         (c)  Has had not less than 2 years of clinical

  5  experience in mental health counseling, which must be at the

  6  post-master's level under the supervision of a licensed mental

  7  health counselor or the equivalent who is a qualified

  8  supervisor as determined by the board.  An individual who

  9  intends to practice in Florida to satisfy the clinical

10  experience requirements must register pursuant to s. 491.0045

11  prior to commencing practice.  If a graduate has a master's

12  degree with a major related to the practice of mental health

13  counseling which did not include all the coursework required

14  under sub-subparagraphs (b)1.a.-c., credit for the

15  post-master's level clinical experience shall not commence

16  until the applicant has completed a minimum of seven of the

17  courses required under sub-subparagraphs (b)1.a.-c., as

18  determined by the board, one of which must be a course in

19  psychopathology or abnormal psychology. A doctoral internship

20  may be applied toward the clinical experience requirement. The

21  clinical experience requirement may be met by work performed

22  on or off the premises of the supervising mental health

23  counselor or the equivalent, provided the off-premises work is

24  not the independent private practice rendering of services

25  that does not have a licensed mental health professional, as

26  determined by the board, on the premises at the same time the

27  intern is providing services.

28         (d)  Has passed a theory and practice examination

29  provided by the department for this purpose.

30         (e)  Has demonstrated, in a manner designated by rule

31  of the board, knowledge of the laws and rules governing the


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  1  practice of clinical social work, marriage and family therapy,

  2  and mental health counseling.

  3         (5)  INTERNSHIP.--An individual who is registered as an

  4  intern and has satisfied all of the educational requirements

  5  for the profession for which the applicant seeks licensure

  6  shall be certified as having met the educational requirements

  7  for licensure under this section.

  8         (6)  RULES.--The board may adopt rules necessary to

  9  implement any education or experience requirement of this

10  section for licensure as a clinical social worker, marriage

11  and family therapist, or mental health counselor.

12         Section 169.  Effective January 1, 2001, paragraph (b)

13  of subsection (4) of section 491.005, Florida Statutes, as

14  amended by section 13 of chapter 97-198 and section 205 of

15  chapter 97-264, Laws of Florida, and as amended by this act,

16  is amended, and subsection (6) of that section, as created by

17  this act, is reenacted, to read:

18         491.005  Licensure by examination.--

19         (4)  MENTAL HEALTH COUNSELING.--Upon verification of

20  documentation and payment of a fee not to exceed $200, as set

21  by board rule, plus the actual per applicant cost to the

22  department for purchase of the examination from the

23  Professional Examination Service for the National Academy of

24  Certified Clinical Mental Health Counselors or a similar

25  national organization, the department shall issue a license as

26  a mental health counselor to an applicant who the board

27  certifies:

28         (b)1.  Has a minimum of an earned master's degree from

29  a mental health counseling program accredited by the Council

30  for the Accreditation of Counseling and Related Educational

31  Programs that consists of at least 60 semester hours or 80


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  1  quarter hours of clinical and didactic instruction, including

  2  a course in human sexuality and a course in substance abuse.

  3  If the master's degree is earned from a program related to the

  4  practice of mental health counseling that is not accredited by

  5  the Council for the Accreditation of Counseling and Related

  6  Educational Programs, then the coursework and practicum,

  7  internship, or fieldwork must consist of at least 60 semester

  8  hours or 80 quarter hours and meet the following requirements:

  9         a.  Thirty-three Thirty-six semester hours or 44 48

10  quarter hours of graduate coursework, which must include a

11  minimum of 3 semester hours or 4 quarter hours of

12  graduate-level coursework in each of the following 11 12

13  content areas: counseling theories and practice; human growth

14  and development; diagnosis and treatment of psychopathology;

15  human sexuality; group theories and practice; individual

16  evaluation and assessment; career and lifestyle assessment;

17  research and program evaluation; social and cultural

18  foundations; foundations of mental health counseling;

19  counseling in community settings; and substance abuse. Courses

20  in research, thesis or dissertation work, practicums,

21  internships, or fieldwork may not be applied toward this

22  requirement.

23         b.  A minimum of 3 semester hours or 4 quarter hours of

24  graduate-level coursework in legal, ethical, and professional

25  standards issues in the practice of mental health counseling,

26  which includes goals, objectives, and practices of

27  professional counseling organizations, codes of ethics, legal

28  considerations, standards of preparation, certifications and

29  licensing, and the role identity and professional obligations

30  of mental health counselors. Courses in research, thesis or

31


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  1  dissertation work, practicums, internships, or fieldwork may

  2  not be applied toward this requirement.

  3         c.  The equivalent, as determined by the board, of at

  4  least 1,000 hours of university-sponsored supervised clinical

  5  practicum, internship, or field experience as required in the

  6  accrediting standards of the Council for Accreditation of

  7  Counseling and Related Educational Programs for mental health

  8  counseling programs. If the academic practicum, internship, or

  9  field experience was less than 1,000 hours, experience gained

10  outside the academic arena in clinical mental health settings

11  under the supervision of a qualified supervisor as determined

12  by the board may be applied. This experience may not be used

13  to satisfy the post-master's clinical experience requirement.

14         2.  If the course title which appears on the

15  applicant's transcript does not clearly identify the content

16  of the coursework, the applicant shall be required to provide

17  additional documentation, including, but not limited to, a

18  syllabus or catalog description published for the course.

19

20  Education and training in mental health counseling must have

21  been received in an institution of higher education which at

22  the time the applicant graduated was: fully accredited by a

23  regional accrediting body recognized by the Commission on

24  Recognition of Postsecondary Accreditation; publicly

25  recognized as a member in good standing with the Association

26  of Universities and Colleges of Canada; or an institution of

27  higher education located outside the United States and Canada,

28  which at the time the applicant was enrolled and at the time

29  the applicant graduated maintained a standard of training

30  substantially equivalent to the standards of training of those

31  institutions in the United States which are accredited by a


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  1  regional accrediting body recognized by the Commission on

  2  Recognition of Postsecondary Accreditation. Such foreign

  3  education and training must have been received in an

  4  institution or program of higher education officially

  5  recognized by the government of the country in which it is

  6  located as an institution or program to train students to

  7  practice as mental health counselors. The burden of

  8  establishing that the requirements of this provision have been

  9  met shall be upon the applicant, and the board shall require

10  documentation, such as, but not limited to, an evaluation by a

11  foreign equivalency determination service, as evidence that

12  the applicant's graduate degree program and education were

13  equivalent to an accredited program in this country.

14         (6)  RULES.--The board may adopt rules necessary to

15  implement any education or experience requirement of this

16  section for licensure as a clinical social worker, marriage

17  and family therapist, or mental health counselor.

18         Section 170.  Paragraph (b) of subsection (1) of

19  section 491.006, Florida Statutes, is amended to read:

20         491.006  Licensure or certification by endorsement.--

21         (1)  The department shall license or grant a

22  certificate to a person in a profession regulated by this

23  chapter who, upon applying to the department and remitting the

24  appropriate fee, demonstrates to the board that he or she:

25         (b)1.  Holds an active valid license to practice and

26  has actively practiced the profession for which licensure is

27  applied in another state for 3 of the last 5 years immediately

28  preceding licensure.

29         2.  Meets the education requirements of this chapter

30  for the profession for which licensure is applied.

31


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  1         3.  Has passed a substantially equivalent licensing

  2  examination in another state or has passed the licensure

  3  examination in this state in the profession for which the

  4  applicant seeks licensure.

  5         4.  Holds a license in good standing, is not under

  6  investigation for an act which would constitute a violation of

  7  this chapter, and has not been found to have committed any act

  8  which would constitute a violation of this chapter.

  9         Section 171.  Section 491.0085, Florida Statutes, is

10  amended to read:

11         491.0085  Continuing education and laws and rules

12  courses; approval of providers, programs, and courses; proof

13  of completion.--

14         (1)  Continuing education providers, programs, and

15  courses and laws and rules courses and their providers and

16  programs shall be approved by the department or the board.

17         (2)  The department or the board has the authority to

18  set a fee not to exceed $200 for each applicant who applies

19  for or renews provider status.  Such fees shall be deposited

20  into the Medical Quality Assurance Health Care Trust Fund.

21         (3)  Proof of completion of the required number of

22  hours of continuing education and completion of the laws and

23  rules course shall be submitted to the department or the board

24  in the manner and time specified by rule and on forms provided

25  by the department or the board.

26         (4)  The department or the board shall adopt rules and

27  guidelines to administer and enforce the provisions of this

28  section.

29         Section 172.  Paragraph (d) of subsection (4) of

30  section 491.014, Florida Statutes, 1998 Supplement, is amended

31  to read:


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  1         491.014  Exemptions.--

  2         (4)  No person shall be required to be licensed,

  3  provisionally licensed, registered, or certified under this

  4  chapter who:

  5         (d)  Is not a resident of this state but offers

  6  services in this state, provided:

  7         1.  Such services are performed for no more than 5 days

  8  in any month and no more than 15 days in any calendar year;

  9  and

10         2.  Such nonresident is licensed or certified to

11  practice the services provided by a state or territory of the

12  United States or by a foreign country or province.

13         Section 173.  Paragraph (a) of subsection (1) and

14  subsection (5) of section 499.012, Florida Statutes, 1998

15  Supplement, are amended to read:

16         499.012  Wholesale distribution; definitions; permits;

17  general requirements.--

18         (1)  As used in this section, the term:

19         (a)  "Wholesale distribution" means distribution of

20  prescription drugs to persons other than a consumer or

21  patient, but does not include:

22         1.  Any of the following activities, which is not a

23  violation of s. 499.005(21) if such activity is conducted in

24  accordance with s. 499.014:

25         a.  The purchase or other acquisition by a hospital or

26  other health care entity that is a member of a group

27  purchasing organization of a prescription drug for its own use

28  from the group purchasing organization or from other hospitals

29  or health care entities that are members of that organization.

30         b.  The sale, purchase, or trade of a prescription drug

31  or an offer to sell, purchase, or trade a prescription drug by


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  1  a charitable organization described in s. 501(c)(3) of the

  2  Internal Revenue Code of 1986, as amended and revised, to a

  3  nonprofit affiliate of the organization to the extent

  4  otherwise permitted by law.

  5         c.  The sale, purchase, or trade of a prescription drug

  6  or an offer to sell, purchase, or trade a prescription drug

  7  among hospitals or other health care entities that are under

  8  common control. For purposes of this section, "common control"

  9  means the power to direct or cause the direction of the

10  management and policies of a person or an organization,

11  whether by ownership of stock, by voting rights, by contract,

12  or otherwise.

13         d.  The sale, purchase, trade, or other transfer of a

14  prescription drug from or for any federal, state, or local

15  government agency or any entity eligible to purchase

16  prescription drugs at public health services prices pursuant

17  to s. 602 of Pub. L. No. 102-585 to a contract provider or its

18  subcontractor for eligible patients of the agency or entity

19  under the following conditions:

20         (I)  The agency or entity must obtain written

21  authorization for the sale, purchase, trade, or other transfer

22  of a prescription drug under this sub-subparagraph from the

23  Secretary of Health or his or her designee.

24         (II)  The contract provider or subcontractor must be

25  authorized by law to administer or dispense prescription

26  drugs.

27         (III)  In the case of a subcontractor, the agency or

28  entity must be a party to and execute the subcontract.

29         (IV)  A contract provider or subcontractor must

30  maintain separate and apart from other prescription drug

31


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  1  inventory any prescription drugs of the agency or entity in

  2  its possession.

  3         (V)  The contract provider and subcontractor must

  4  maintain and produce immediately for inspection all records of

  5  movement or transfer of all the prescription drugs belonging

  6  to the agency or entity, including, but not limited to, the

  7  records of receipt and disposition of prescription drugs.

  8  Each contractor and subcontractor dispensing or administering

  9  these drugs must maintain and produce records documenting the

10  dispensing or administration.  Records that are required to be

11  maintained include, but are not limited to, a perpetual

12  inventory itemizing drugs received and drugs dispensed by

13  prescription number or administered by patient identifier,

14  which must be submitted to the agency or entity quarterly.

15         (VI)  The contract provider or subcontractor may

16  administer or dispense the prescription drugs only to the

17  eligible patients of the agency or entity or must return the

18  prescription drugs for or to the agency or entity.  The

19  contract provider or subcontractor must require proof from

20  each person seeking to fill a prescription or obtain treatment

21  that the person is an eligible patient of the agency or entity

22  and must, at a minimum, maintain a copy of this proof as part

23  of the records of the contractor or subcontractor required

24  under sub-sub-subparagraph (V).

25         (VII)  The prescription drugs transferred pursuant to

26  this sub-subparagraph may not be billed to Medicaid.

27         (VIII)  In addition to the departmental inspection

28  authority set forth in s. 499.051, the establishment of the

29  contract provider and subcontractor and all records pertaining

30  to prescription drugs subject to this sub-subparagraph shall

31  be subject to inspection by the agency or entity.  All records


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  1  relating to prescription drugs of a manufacturer under this

  2  sub-subparagraph shall be subject to audit by the manufacturer

  3  of those drugs, without identifying individual patient

  4  information.

  5         2.  Any of the following activities, which is not a

  6  violation of s. 499.005(21) if such activity is conducted in

  7  accordance with rules established by the department:

  8         a.  The sale, purchase, or trade of a prescription drug

  9  among federal, state, or local government health care entities

10  that are under common control and are authorized to purchase

11  such prescription drug.

12         b.  The sale, purchase, or trade of a prescription drug

13  or an offer to sell, purchase, or trade a prescription drug

14  for emergency medical reasons.; For purposes of this

15  sub-subparagraph subparagraph, the term "emergency medical

16  reasons" includes transfers of prescription drugs by a retail

17  pharmacy to another retail pharmacy to alleviate a temporary

18  shortage.

19         c.  The transfer purchase or acquisition of a

20  prescription drug acquired by a medical director on behalf of

21  a licensed an emergency medical services provider to that

22  medical director for use by emergency medical services

23  provider and its transport vehicles for use in accordance with

24  the provider's license under providers acting within the scope

25  of their professional practice pursuant to chapter 401.

26         d.  The revocation of a sale or the return of a

27  prescription drug to the person's prescription drug wholesale

28  supplier.

29         e.  The donation of a prescription drug by a health

30  care entity to a charitable organization that has been granted

31  an exemption under s. 501(c)(3) of the Internal Revenue Code


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  1  of 1986, as amended, and that is authorized to possess

  2  prescription drugs.

  3         f.  The transfer of a prescription drug by a person

  4  authorized to purchase or receive prescription drugs to a

  5  person licensed or permitted to handle reverse distributions

  6  or destruction under the laws of the jurisdiction in which the

  7  person handling the reverse distribution or destruction

  8  receives the drug.

  9         3.  The dispensing of a prescription drug pursuant to a

10  prescription;

11         3.4.  The distribution of prescription drug samples by

12  manufacturers' representatives or distributors'

13  representatives conducted in accordance with s. 499.028.; or

14         4.5.  The sale, purchase, or trade of blood and blood

15  components intended for transfusion.  As used in this

16  subparagraph section, the term "blood" means whole blood

17  collected from a single donor and processed either for

18  transfusion or further manufacturing, and the term "blood

19  components" means that part of the blood separated by physical

20  or mechanical means.

21         5.  The lawful dispensing of a prescription drug in

22  accordance with chapter 465.

23         (5)  The department may adopt rules governing the

24  recordkeeping, storage, and handling with respect to each of

25  the distributions of prescription drugs specified in

26  subparagraphs (1)(a)1.-4. (1)(a)1., 2., 4., and 5.

27         Section 174.  Subsection (6) is added to section

28  626.883, Florida Statutes, to read:

29         626.883  Administrator as intermediary; collections

30  held in fiduciary capacity; establishment of account;

31  disbursement; payments on behalf of insurer.--


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  1         (6)  All payments to a health care provider by a fiscal

  2  intermediary for noncapitated providers must include an

  3  explanation of services being reimbursed which includes, at a

  4  minimum, the patient's name, the date of service, the

  5  procedure code, the amount of reimbursement, and the

  6  identification of the plan on whose behalf the payment is

  7  being made. For capitated providers, the statement of services

  8  must include the number of patients covered by the contract,

  9  the rate per patient, the total amount of the payment, and the

10  identification of the plan on whose behalf the payment is

11  being made.

12         Section 175.  Paragraph (a) of subsection (2) of

13  section 641.316, Florida Statutes, 1998 Supplement, is amended

14  to read:

15         641.316  Fiscal intermediary services.--

16         (2)(a)  The term "fiduciary" or "fiscal intermediary

17  services" means reimbursements received or collected on behalf

18  of health care professionals for services rendered, patient

19  and provider accounting, financial reporting and auditing,

20  receipts and collections management, compensation and

21  reimbursement disbursement services, or other related

22  fiduciary services pursuant to health care professional

23  contracts with health maintenance organizations. All payments

24  to a health care provider by a fiscal intermediary for

25  noncapitated providers must include an explanation of services

26  being reimbursed which includes, at a minimum, the patient's

27  name, the date of service, the procedure code, the amount of

28  reimbursement, and the identification of the plan on whose

29  behalf the payment is being made. For capitated providers, the

30  statement of services must include the number of patients

31  covered by the contract, the rate per patient, the total


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  1  amount of the payment, and the identification of the plan on

  2  whose behalf the payment is being made.

  3         Section 176.  Task Force on Telehealth.--

  4         (1)  Because telecommunications technology has made it

  5  possible to provide a wide range of health care services

  6  across state lines between healthcare practitioners and

  7  patients, it is the intent of the Legislature to protect the

  8  health and safety of all patients in this state receiving

  9  services by means of such technology and to ensure the

10  accountability of the healthcare profession with respect to

11  unsafe and incompetent practitioners using such technology to

12  provide health care services to patients in this state.

13         (2)  The Secretary of Health shall appoint a task force

14  consisting of representatives from the affected medical and

15  allied health professions and other affected health care

16  industries.

17         (3)  The task force shall address the following:

18         (a)  Identification of various electronic

19  communications or telecommunications technologies currently

20  used within the state and by other states to provide

21  healthcare information.

22         (b)  Identification of laws, regulations, and

23  reimbursement practices that serve as barriers to

24  implementation of electronic communications related to health

25  care.

26         (c)  Recommendation of the appropriate level of

27  regulation of health care professionals necessary to protect

28  the health and safety of patients in this state, including

29  analysis of existing provisions governing in-state

30  professionals such as licensing, financial responsibility, and

31  medical malpractice insurance requirements.


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  1         (d)  Potential preemption of state regulation by the

  2  Commerce Clause of the United States Constitution.

  3         (e)  The effect of telehealth on access to health care

  4  in rural and underserved areas.

  5         (f)  Potential antitrust concerns.

  6         (g)  The effect of regulations by other states or

  7  jurisdictions on health care professionals in this state who

  8  provide consultative services through telehealth to entities

  9  and patients outside the state.

10         (h)  Research on other public and private data and

11  initiatives related to telehealth.

12         (i)  Any other issue affecting the health, safety, and

13  welfare of patients through telehealth identified by the task

14  force.

15         (4)  The task force shall submit a report of its

16  findings and recommendations by January 1, 2000, to the

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

18  House of Representatives.

19         Section 177.  Subsection (1) of section 468.352,

20  Florida Statutes, is amended to read:

21         468.352  Definitions.--As used in this part, unless the

22  context otherwise requires, the term:

23         (1)  "Board" means the Board of Respiratory Care

24  Medicine.

25         Section 178.  Section 468.353, Florida Statutes, is

26  amended to read:

27         468.353  Board of Respiratory Care Medicine; powers and

28  duties.--

29         (1)  The board, with the assistance of the Advisory

30  Council on Respiratory Care, is authorized to establish

31  minimum standards for the delivery of respiratory care


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    CS for SB 2220                                 First Engrossed



  1  services and to adopt those rules necessary to administer this

  2  part.

  3         (2)  The board may administer oaths, summon witnesses,

  4  and take testimony in all matters relating to its duties under

  5  this part.

  6         (3)  The board may adopt rules to administer this part,

  7  including rules governing the investigation, inspection, and

  8  review of schools and colleges that offer courses in

  9  respiratory care in order to ascertain their compliance with

10  standards established by the board or appropriate accrediting

11  agencies delegate such powers and duties to the council as it

12  may deem proper.

13         Section 179.  Section 468.354, Florida Statutes, is

14  amended to read:

15         468.354  Board of Advisory Council on Respiratory Care;

16  organization; function.--

17         (1)  There is created within the department, the Board

18  of Advisory Council on Respiratory Care, composed of seven

19  members appointed by the Governor and confirmed by the Senate

20  under the supervision of the board.

21         (2)  The board council shall consist of five members

22  appointed by the board and shall include:

23         (a)  A registered respiratory therapist.

24         (b)  A certified respiratory therapist care

25  practitioner.

26         (c)  A respiratory care professional from each of the

27  following areas:

28         1.  Respiratory care education.

29         2.  Respiratory care management and supervision.

30         3.  Homecare/subacute Cardiopulmonary diagnostics.

31


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    CS for SB 2220                                 First Engrossed



  1         (d)  Two consumer members, who are residents of this

  2  state and have never been licensed as health care

  3  practitioners.

  4

  5  Each member of the council shall be a respiratory care

  6  professional on the board must have who has been actively

  7  engaged in the delivery of respiratory care services in this

  8  state for at least 4 consecutive years prior to appointment.

  9         (3)(a)  Except as provided in paragraph (b), the term

10  of office for each board council member shall be 4 years.  No

11  member shall serve for more than two consecutive terms.  Any

12  time there is a vacancy to be filled on the council, all

13  professional organizations dealing with respiratory therapy

14  incorporated within the state as not for profit which register

15  their interest with the board shall recommend at least twice

16  as many persons to fill the vacancy to the council as the

17  number of vacancies to be filled, and the Governor board may

18  appoint from the submitted list, in his its discretion, any of

19  those persons so recommended.  The Governor board shall,

20  insofar as possible, appoint persons from different

21  geographical areas.

22         (b)  In order To achieve staggering of terms, within

23  120 days after July 1, 1999, October 1, 1984, the Governor

24  board shall appoint the board members of the council as

25  follows:

26         1.  Two members One member shall be appointed for terms

27  a term of 2 years.

28         2.  Two members shall be appointed for terms of 3

29  years.

30         3.  Three Two members shall be appointed for terms of 4

31  years.


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  1         (c)  All provisions of part II of chapter 455, relating

  2  to boards apply to this part.

  3         (4)(a)  The board council shall annually elect from

  4  among its members a chair and vice chair.

  5         (b)  The board council shall meet at least twice a year

  6  and shall hold such additional meetings as are deemed

  7  necessary by the board.  Four Three members of the council

  8  constitute a quorum.

  9         (c)  Unless otherwise provided by law, a board council

10  member shall be compensated $50 for each day he or she attends

11  an official board meeting of the council and for each day he

12  or she participates in any other board business involving the

13  council.  A board council member shall also be entitled to

14  reimbursement for expenses pursuant to s. 112.061. Travel out

15  of the state shall require the prior approval of the secretary

16  of the department.

17         (5)(a)  The board may council shall recommend to the

18  department a code of ethics for those persons licensed

19  pursuant to this part.

20         (b)  The council shall make recommendations to the

21  department for the approval of continuing education courses.

22         Section 180.  Section 468.355, Florida Statutes, is

23  amended to read:

24         468.355  Eligibility for licensure; temporary

25  licensure.--

26         (1)  To be eligible for licensure by the board as a

27  respiratory care practitioner, an applicant must:

28         (a)  Be at least 18 years old.

29         (b)  Possess a high school diploma or a graduate

30  equivalency diploma.

31         (c)  Meet at least one of the following criteria:


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  1         1.  The applicant has successfully completed a training

  2  program for respiratory therapy technicians or respiratory

  3  therapists approved by the Commission on Accreditation of

  4  Allied Health Education Programs, or the equivalent thereof,

  5  as accepted by the board.

  6         2.  The applicant is currently a "Certified Respiratory

  7  Therapy Technician" certified by the National Board for

  8  Respiratory Care, or the equivalent thereof, as accepted by

  9  the board.

10         3.  The applicant is currently a "Registered

11  Respiratory Therapist" registered by the National Board for

12  Respiratory Care, or the equivalent thereof, as accepted by

13  the board.

14         4.  The applicant is currently employed in this state

15  as a respiratory care practitioner or respiratory therapist on

16  October 1, 1984.

17

18  The criteria set forth in subparagraphs 2. and 3.

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         (2)  To be eligible for licensure by the board as a

24  respiratory therapist, an applicant must:

25         (a)  Be at least 18 years old.

26         (b)  Possess a high school diploma or a graduate

27  equivalency diploma.

28         (c)  Meet at least one of the following criteria:

29         1.  The applicant has successfully completed a training

30  program for respiratory therapists approved by the Commission

31


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  1  on Accreditation of Allied Health Education Programs, or the

  2  equivalent thereof, as accepted by the board.

  3         2.  The applicant is currently a "Registered

  4  Respiratory Therapist" registered by the National Board for

  5  Respiratory Care, or the equivalent thereof, as accepted by

  6  the board.

  7

  8  The criteria set forth in subparagraphs 1. and 2.

  9  notwithstanding, the board shall periodically annually review

10  the examinations and standards of the National Board for

11  Respiratory Care and may reject those examinations and

12  standards if they are deemed inappropriate.

13         (3)  With respect to the delivery of respiratory care

14  services, the board shall establish procedures for temporary

15  licensure of eligible individuals entering the state and

16  temporary licensure of those persons who have graduated from a

17  program approved by the board.  Such temporary licensure shall

18  be for a period not to exceed 1 year.

19         Section 181.  Section 468.357, Florida Statutes, is

20  amended to read:

21         468.357  Licensure by examination.--

22         (1)  A person who desires to be licensed as a

23  respiratory care practitioner may submit an application to the

24  department to take the examination, in accordance with board

25  rule to be administered by the department.

26         (a)  The department shall examine Each applicant may

27  take the examination who is determined by the board to have:

28         1.  Completed the application form and remitted the

29  applicable fee set by the board;

30         2.  Submitted required documentation as required in s.

31  468.355; and


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  1         3.  Remitted an examination fee set by the examination

  2  provider board.

  3         (b)  The department shall conduct Examinations for

  4  licensure of respiratory care practitioners must be conducted

  5  no less than two times a year in such geographical locations

  6  or by such methods as are deemed advantageous to the majority

  7  of the applicants.

  8         (c)  The examination given for respiratory care

  9  practitioners shall be the same as that given by the National

10  Board for Respiratory Care for entry-level certification of

11  respiratory therapy technicians.  However, an equivalent

12  examination may be accepted by the board in lieu of that

13  examination.

14         (2)  Each applicant who passes the examination shall be

15  entitled to licensure as a respiratory care practitioner, and

16  the department shall issue a license pursuant to this part to

17  any applicant who successfully completes the examination in

18  accordance with this section.  However, the department shall

19  not issue a license to any applicant who is under

20  investigation in another jurisdiction for an offense which

21  would constitute a violation of this part.  Upon completion of

22  such an investigation, if the applicant is found guilty of

23  such an offense, the applicable provisions of s. 468.365 will

24  apply.

25         (3)  Any person who was employed in this state on or

26  before September 30, 1983, as a respiratory therapy technician

27  or respiratory therapist, and who has performed services in

28  such professional capacity for 4 years or more by October 1,

29  1987, under the supervision of a licensed physician or in a

30  hospital or licensed health care facility, shall be issued a

31  license without examination, if such person provides


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    CS for SB 2220                                 First Engrossed



  1  acceptable documentation of performance of such services to

  2  the board.  Such documentation shall include certification by

  3  a physician licensed pursuant to chapter 458 or chapter 459

  4  who has direct knowledge of the practice of, or who has

  5  supervised, the person.  If such person is not determined to

  6  have performed critical care respiratory services for at least

  7  4 years, the board may limit the license of such person to the

  8  performance of noncritical care respiratory services.

  9         Section 182.  Section 468.364, Florida Statutes, 1998

10  Supplement, is amended to read:

11         468.364  Fees; establishment; disposition.--

12         (1)  The board shall establish by rule fees for the

13  following purposes:

14         (a)  Application, a fee not to exceed $50.

15         (b)  Examination, a fee not to exceed $125 plus the

16  actual per applicant cost to the department for purchase of

17  the examination from the National Board for Respiratory Care

18  or a similar national organization.

19         (b)(c)  Initial licensure, a fee not to exceed $200.

20         (c)(d)  Renewal of licensure, a fee not to exceed $200

21  biennially.

22         (d)(e)  Renewal of inactive licensure, a fee not to

23  exceed $50.

24         (e)(f)  Reactivation, a fee not to exceed $50.

25         (2)  The fees established pursuant to subsection (1)

26  shall be based upon the actual costs incurred by the

27  department in carrying out its responsibilities under this

28  part.

29         (3)  All moneys collected by the department under this

30  part shall be deposited as required by s. 455.587.

31


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    CS for SB 2220                                 First Engrossed



  1         Section 183.  Paragraph (f) of subsection (1) of

  2  section 468.365, Florida Statutes, 1998 Supplement, is amended

  3  to read:

  4         468.365  Disciplinary grounds and actions.--

  5         (1)  The following acts constitute grounds for which

  6  the disciplinary actions in subsection (2) may be taken:

  7         (f)  Unprofessional conduct, which includes, but is not

  8  limited to, any departure from, or failure to conform to,

  9  acceptable standards related to the delivery of respiratory

10  care services, as set forth by the board and the Advisory

11  Council on Respiratory Care in rules adopted pursuant to this

12  part.

13         Section 184.  Paragraph (a) of subsection (2) of

14  section 464.016, Florida Statutes, is amended to read:

15         464.016  Violations and penalties.--

16         (2)  Each of the following acts constitutes a

17  misdemeanor of the first degree, punishable as provided in s.

18  775.082 or s. 775.083:

19         (a)  Using the name or title "Nurse," "Registered

20  Nurse," "Licensed Practical Nurse," "Advanced Registered Nurse

21  Practitioner," or any other name or title which implies that a

22  person was licensed or certified as same, unless such person

23  is duly licensed or certified.

24         Section 185.  Paragraphs (b) and (c) of subsection (1)

25  of section 458.3115, Florida Statutes, 1998 Supplement, are

26  amended to read:

27         458.3115  Restricted license; certain foreign-licensed

28  physicians; United States Medical Licensing Examination

29  (USMLE) or agency-developed examination; restrictions on

30  practice; full licensure.--

31         (1)


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    CS for SB 2220                                 First Engrossed



  1         (b)  A person who is eligible to take and elects to

  2  take the USMLE who has previously passed part 1 or part 2 of

  3  the previously administered FLEX shall not be required to

  4  retake or pass the equivalent parts of the USMLE up to the

  5  year 2002 2000.

  6         (c)  A person shall be eligible to take such

  7  examination for restricted licensure if the person:

  8         1.  Has taken, upon approval by the board, and

  9  completed, in November 1990 or November 1992, one of the

10  special preparatory medical update courses authorized by the

11  board and the University of Miami Medical School and

12  subsequently passed the final course examination; upon

13  approval by the board to take the course completed in 1990 or

14  in 1992, has a certificate of successful completion of that

15  course from the University of Miami or the Stanley H. Kaplan

16  course; or can document to the department that he or she was

17  one of the persons who took and successfully completed the

18  Stanley H. Kaplan course that was approved by the Board of

19  Medicine and supervised by the University of Miami. At a

20  minimum, the documentation must include class attendance

21  records and the test score on the final course examination;

22         2.  Applies to the agency and submits an application

23  fee that is nonrefundable and equivalent to the fee required

24  for full licensure;

25         3.  Documents no less than 2 years of the active

26  practice of medicine in any another jurisdiction;

27         4.  Submits an examination fee that is nonrefundable

28  and equivalent to the fee required for full licensure plus the

29  actual per-applicant cost to the agency to provide either

30  examination described in this section;

31


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    CS for SB 2220                                 First Engrossed



  1         5.  Has not committed any act or offense in this or any

  2  other jurisdiction that would constitute a substantial basis

  3  for disciplining a physician under this chapter or part II of

  4  chapter 455; and

  5         6.  Is not under discipline, investigation, or

  6  prosecution in this or any other jurisdiction for an act that

  7  would constitute a violation of this chapter or part II of

  8  chapter 455 and that substantially threatened or threatens the

  9  public health, safety, or welfare.

10         Section 186.  Subsection (2) of section 458.3124,

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

12         458.3124  Restricted license; certain experienced

13  foreign-trained physicians.--

14         (2)  A person applying for licensure under this section

15  must submit to the Department of Health on or before December

16  31, 2000 1998:

17         (a)  A completed application and documentation required

18  by the Board of Medicine to prove compliance with subsection

19  (1); and

20         (b)  A nonrefundable application fee not to exceed $500

21  and a nonrefundable examination fee not to exceed $300 plus

22  the actual cost to purchase and administer the examination.

23         Section 187.  Effective upon this act becoming a law,

24  section 301 of chapter 98-166, Laws of Florida, is amended to

25  read:

26         Section 301.  The sum of $1.2 million from the

27  unallocated balance in the Medical Quality Assurance Trust

28  Fund is appropriated to the Department of Health to allow the

29  department to develop the examination required for foreign

30  licensed physicians in section 458.3115(1)(a), Florida

31  Statutes, through a contract with the University of South


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  1  Florida. The department shall charge examinees a fee not to

  2  exceed 25 percent of the cost of the actual costs of the first

  3  examination administered pursuant to section 458.3115, Florida

  4  Statutes, 1998 Supplement, and a fee not to exceed 75 percent

  5  of the actual costs for any subsequent examination

  6  administered pursuant to that section.

  7         Section 188.  The Agency for Health Care Administration

  8  shall conduct a detailed study and analysis of clinical

  9  laboratory services for kidney dialysis patients in the State

10  of Florida. The study shall include, but not be limited to, an

11  analysis of the past and present utilization rates of clinical

12  laboratory services for dialysis patients, financial

13  arrangements among kidney dialysis centers, their medical

14  directors, and any business relationships and affiliations

15  with clinical laboratories, any self referral to clinical

16  laboratories, the quality and responsiveness of clinical

17  laboratory services for dialysis patients in Florida, and the

18  average annual revenue for dialysis patients for clinical

19  laboratory services for the past ten years. The agency shall

20  report back to the President of the Senate, Speaker of the

21  House of Representatives, and chairs of the appropriate

22  substantive committees of the Legislature on its findings no

23  later than February 1, 2000.

24         Section 189.  Subsection (3) is added to section

25  455.651, Florida Statutes, 1998 Supplement, to read:

26         455.651  Disclosure of confidential information.--

27         (1)  No officer, employee, or person under contract

28  with the department, or any board therein, or any subject of

29  an investigation shall convey knowledge or information to any

30  person who is not lawfully entitled to such knowledge or

31  information about any public meeting or public record, which


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  1  at the time such knowledge or information is conveyed is

  2  exempt from the provisions of s. 119.01, s. 119.07(1), or s.

  3  286.011.

  4         (2)  Any person who willfully violates any provision of

  5  this section is guilty of a misdemeanor of the first degree,

  6  punishable as provided in s. 775.082 or s. 775.083, and may be

  7  subject to discipline pursuant to s. 455.624, and, if

  8  applicable, shall be removed from office, employment, or the

  9  contractual relationship.

10         (3)  Any person injured as a result of a violation of

11  this section shall have a civil cause of action for treble

12  damages, reasonable attorney fees, and costs.

13         Section 190.  Section 641.261, Florida Statutes, is

14  amended to read:

15         641.261  Other reporting requirements.--

16         (1)  Each authorized health maintenance organization

17  shall provide records and information to the Agency for Health

18  Care Administration Department of Health and Rehabilitative

19  Services pursuant to s. 409.910(20) and (21) (22) for the sole

20  purpose of identifying potential coverage for claims filed

21  with the agency Department of Health and Rehabilitative

22  Services and its fiscal agents for payment of medical services

23  under the Medicaid program.

24         (2)  Any information provided by a health maintenance

25  organization under this section to the agency Department of

26  Health and Rehabilitative Services shall not be considered a

27  violation of any right of confidentiality or contract that the

28  health maintenance organization may have with covered persons.

29  The health maintenance organization is immune from any

30  liability that it may otherwise incur through its release of

31


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    CS for SB 2220                                 First Engrossed



  1  information to the agency Department of Health and

  2  Rehabilitative Services under this section.

  3         Section 191.  Section 641.411, Florida Statutes, is

  4  amended to read:

  5         641.411  Other reporting requirements.--

  6         (1)  Each prepaid health clinic shall provide records

  7  and information to the Agency for Health Care Administration

  8  Department of Health and Rehabilitative Services pursuant to

  9  s. 409.910(20) and (21) (22) for the sole purpose of

10  identifying potential coverage for claims filed with the

11  agency Department of Health and Rehabilitative Services and

12  its fiscal agents for payment of medical services under the

13  Medicaid program.

14         (2)  Any information provided by a prepaid health

15  clinic under this section to the agency Department of Health

16  and Rehabilitative Services shall not be considered a

17  violation of any right of confidentiality or contract that the

18  prepaid health clinic may have with covered persons.  The

19  prepaid health clinic is immune from any liability that it may

20  otherwise incur through its release of information to the

21  agency Department of Health and Rehabilitative Services under

22  this section.

23         Section 192.  Paragraph (a) of subsection (4) of

24  section 733.212, Florida Statutes, is amended to read:

25         733.212  Notice of administration; filing of objections

26  and claims.--

27         (4)(a)  The personal representative shall promptly make

28  a diligent search to determine the names and addresses of

29  creditors of the decedent who are reasonably ascertainable and

30  shall serve on those creditors a copy of the notice within 3

31  months after the first publication of the notice. Under s.


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    CS for SB 2220                                 First Engrossed



  1  409.9101, the Agency for Health Care Administration is

  2  considered a reasonably ascertainable creditor in instances

  3  where the decedent had received Medicaid assistance for

  4  medical care after reaching 55 years of age. Impracticable and

  5  extended searches are not required.  Service is not required

  6  on any creditor who has filed a claim as provided in this

  7  part; a creditor whose claim has been paid in full; or a

  8  creditor whose claim is listed in a personal representative's

  9  timely proof of claim if the personal representative notified

10  the creditor of that listing.

11         Section 193.  (1)  There is established a seven-member

12  task force to review sources of funds deposited into the

13  Public Medical Assistance Trust Fund as created by section

14  409.918, Florida Statutes. The task force shall consist of:

15         (a)  Two members appointed by the President of the

16  Senate, one of whom must be a member of the Senate and one of

17  whom must represent a hospital subject to the assessment

18  imposed under section 395.701, Florida Statutes, 1998

19  Supplement, or section 394.4786, Florida Statutes;

20         (b)  Two members appointed by the Speaker of the House

21  of Representatives, one of whom must be a member of the House

22  and one of whom must represent a health care entity subject to

23  the assessment imposed under section 395.7015, Florida

24  Statutes, 1998 Supplement;

25         (c)  Three members appointed by the Governor, one of

26  whom must be the Director of the Agency for Health Care

27  Administration, or his or her designee; one of whom must be a

28  medical doctor licensed to practice in the state; and one of

29  whom must be a consumer who has no employment or investment

30  interest in any health care entity subject to the assessment

31


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    CS for SB 2220                                 First Engrossed



  1  imposed for deposit into the Public Medical Assistance Trust

  2  Fund and who is a representative of Florida TaxWatch.

  3         (2)  The Governor shall designate the task force chair

  4  from among the members.

  5         (3)  The task force shall consider and make specific

  6  recommendations concerning, but not limited to:

  7         (a)  Whether any provisions of sections 395.701,

  8  395.7015, and 409.918, Florida Statutes, need to be revised;

  9         (b)  Whether the annual assessments imposed by these

10  statutes on the various health care entities are imposed

11  equitably;

12         (c)  Whether additional exemptions from, or inclusions

13  within, the assessments are justified; and

14         (d)  The extent to which modifications to other

15  statutory provisions that require deposit of specified revenue

16  into the Public Medical Assistance Trust Fund, including, but

17  not limited to, sections 210.20, 395.1041, 408.040, and

18  408.08, Florida Statutes, could result in increased revenue

19  for the trust fund.

20

21  The task force shall provide an analysis of the budgetary

22  impact of any recommended exemptions from, inclusions within,

23  or modifications to existing assessments.

24         (4)  The Agency for Health Care Administration shall

25  provide necessary staff support and technical assistance to

26  the task force.

27         (5)  The task force shall convene by August 1, 1999,

28  for its first meeting, and shall submit its findings and

29  recommendations, including any proposed legislation, to the

30  President of the Senate, the Speaker of the House of

31  Representatives, and the Governor by December 1, 1999.


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  1         Section 194.  Section 395.40, Florida Statutes, is

  2  created to read:

  3         395.40  Legislative findings and intent.--

  4         (1)  The Legislature finds that there has been a lack

  5  of timely access to trauma care due to the state's fragmented

  6  trauma system. This finding is based on the 1999 Trauma System

  7  Report on Timely Access to Trauma Care submitted by the

  8  department in response to the request of the Legislature.

  9         (2)  The Legislature finds that it is necessary to plan

10  for and to establish an inclusive trauma system to meet the

11  needs of trauma victims. An "inclusive trauma system" means a

12  system designed to meet the needs of all injured trauma

13  victims who require care in an acute-care setting and into

14  which every health care provider or facility with resources to

15  care for the injured trauma victim is incorporated. The

16  Legislature deems the benefits of trauma care provided within

17  an inclusive trauma system to be of vital significance to the

18  outcome of a trauma victim.

19         (3)  It is the intent of the Legislature to place

20  primary responsibility for the planning and establishment of a

21  statewide inclusive trauma system with the department. The

22  department shall undertake the implementation of a statewide

23  inclusive trauma system as funding is available.

24         (4)  The Legislature finds that significant benefits

25  are to be obtained by directing the coordination of activities

26  by several state agencies, relative to access to trauma care

27  and the provision of trauma care to all trauma victims. It is

28  the intent of the Legislature that the department, the Agency

29  for Health Care Administration, the Board of Medicine, and the

30  Board of Nursing establish interagency teams and agreements

31  for the development of guidelines, standards, and rules for


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    CS for SB 2220                                 First Engrossed



  1  those portions of the inclusive state trauma system within the

  2  statutory authority of each agency. This coordinated approach

  3  will provide the necessary continuum of care for the trauma

  4  victim from injury to final hospital discharge. The department

  5  has the leadership responsibility for this activity.

  6         (5)  In addition, the agencies listed in subsection (4)

  7  should undertake to:

  8         (a)  Establish a coordinated methodology for

  9  monitoring, evaluating, and enforcing the requirements of the

10  state's inclusive trauma system which recognizes the interests

11  of each agency.

12         (b)  Develop appropriate roles for trauma agencies, to

13  assist in furthering the operation of trauma systems at the

14  regional level. This should include issues of system

15  evaluation as well as managed care.

16         (c)  Develop and submit appropriate requests for

17  waivers of federal requirements which will facilitate the

18  delivery of trauma care.

19         (d)  Develop criteria that will become the future basis

20  for mandatory consultation on the care of trauma victims and

21  mandatory transfer of appropriate trauma victims to trauma

22  centers.

23         (e)  Develop a coordinated approach to the care of the

24  trauma victim. This shall include the movement of the trauma

25  victim through the system of care and the identification of

26  medical responsibility for each phase of care for

27  out-of-hospital and in-hospital trauma care.

28         (f)  Require the medical director of an emergency

29  medical services provider to have medical accountability for a

30  trauma victim during interfacility transfer.

31


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    CS for SB 2220                                 First Engrossed



  1         (6)  Furthermore, the Legislature encourages the

  2  department to actively foster the provision of trauma care and

  3  serve as a catalyst for improvements in the process and

  4  outcome of the provision of trauma care in an inclusive trauma

  5  system. Among other considerations, the department is

  6  encouraged to:

  7         (a)  Promote the development of at least one trauma

  8  center in every trauma service area.

  9         (b)  Promote the development of a trauma agency for

10  each trauma region.

11         (c)  Update the state trauma system plan by December

12  2000 and at least every 5th year thereafter.

13         Section 195.  Subsection (1) and paragraphs (c) and (n)

14  of subsection (2) of section 395.401, Florida Statutes, 1998

15  Supplement, are amended to read:

16         395.401  Trauma services system plans; verification of

17  trauma centers and pediatric trauma referral centers;

18  procedures; renewal.--

19         (1)  As used in this part, the term:

20         (a)  "Agency" means the Agency for Health Care

21  Administration.

22         (b)  "Charity care" or "uncompensated charity care"

23  means that portion of hospital charges reported to the agency

24  for which there is no compensation for care provided to a

25  patient whose family income for the 12 months preceding the

26  determination is less than or equal to 150 percent of the

27  federal poverty level, unless the amount of hospital charges

28  due from the patient exceeds 25 percent of the annual family

29  income. However, in no case shall the hospital charges for a

30  patient whose family income exceeds four times the federal

31  poverty level for a family of four be considered charity.


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    CS for SB 2220                                 First Engrossed



  1         (c)  "Department" means the Department of Health.

  2         (d)  "Level I trauma center" means a hospital that is

  3  determined by the department to be in substantial compliance

  4  with trauma center and pediatric trauma referral center

  5  verification standards as established by rule of the

  6  department, and which:

  7         1.  Has formal research and education programs for the

  8  enhancement of trauma care.

  9         2.  Serves as a resource facility to Level II trauma

10  centers, pediatric trauma referral centers, and community

11  hospitals.

12         3.  Ensures an organized system of trauma care.

13         (e)  "Level II trauma center" means a hospital that is

14  determined by the department to be in substantial compliance

15  with trauma center verification standards as established by

16  rule of the department, and which:

17         1.  Serves as a resource facility to community

18  hospitals.

19         2.  Ensures an organized system of trauma care.

20         (f)  "Local trauma agency" means an agency established

21  and operated by a county or an entity with which the county

22  contracts for the purpose of administrative trauma services.

23         (f)(g)  "Pediatric trauma referral center" means a

24  hospital that is determined to be in substantial compliance

25  with pediatric trauma referral center standards as established

26  by rule of the department.

27         (h)  "Regional trauma agency" means an agency created

28  and operated by two or more counties, or an entity with which

29  two or more counties contract, for the purpose of

30  administering trauma services.

31


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  1         (g)(i)  "State-approved trauma center" means a hospital

  2  that has successfully completed the state-approved selection

  3  process pursuant to s. 395.4025 and has been approved by the

  4  department to operate as a trauma center in the state.

  5         (h)(j)  "State-sponsored trauma center" means a

  6  state-approved trauma center that receives state funding for

  7  trauma care services.

  8         (i)  "Trauma agency" means an agency established and

  9  operated by one or more counties, or an entity with which one

10  or more counties contract, for the purpose of administering an

11  inclusive regional trauma system.

12         (j)  "Trauma alert victim" means a person who has

13  incurred a single or multisystem injury due to blunt or

14  penetrating means or burns; who requires immediate medical

15  intervention or treatment; and who meets one or more of the

16  adult or pediatric scorecard criteria established by the

17  department by rule.

18         (k)  "Trauma center" means any hospital that has been

19  determined by the department to be in substantial compliance

20  with trauma center verification standards.

21         (l)  "Trauma scorecard" means a statewide methodology

22  adopted by the department by rule under which a person who has

23  incurred a traumatic injury is graded as to the severity of

24  his or her injuries or illness and which methodology is used

25  as the basis for making destination decisions.

26         (m)  "Trauma victim" means any person who has incurred

27  a single or multisystem life-threatening injury due to blunt

28  or penetrating means or burns and who requires immediate

29  medical intervention or treatment.

30         (2)

31


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    CS for SB 2220                                 First Engrossed



  1         (c)  The department shall receive plans for the

  2  implementation of inclusive trauma care systems from local and

  3  regional trauma agencies.  The department may approve or not

  4  approve the local or regional trauma agency plans based on the

  5  conformance of the plan local or regional plans with this

  6  section and ss. 395.4015, 395.404, and 395.4045 and the rules

  7  adopted by the department pursuant to those sections.  The

  8  department shall approve or disapprove the plans within 120

  9  days after the date the plans are submitted to the department.

10         (n)  After the submission of the initial local or

11  regional trauma care system plan, each local or regional

12  trauma agency shall, every 5th year, annually submit to the

13  department  for approval an updated plan that which identifies

14  the changes, if any, to be made in the regional trauma care

15  system. The department shall approve or disapprove the updated

16  plan within 120 days after the date the plan is submitted to

17  the department.  At least 60 days before the local or regional

18  trauma agency submits a plan for a trauma care system to the

19  department, the local or regional trauma agency shall hold a

20  public hearing and give adequate notice of the public hearing

21  to all hospitals and other interested parties in the area. A

22  local or regional trauma agency shall submit to the department

23  written notice of its intent to cease operation of the local

24  or regional trauma agency at least 90 days before the date on

25  which the local or regional trauma agency will cease

26  operation.

27         Section 196.  Subsections (1) and (3) of section

28  395.402, Florida Statutes, are amended to read:

29         395.402  Trauma service areas; number and location of

30  trauma centers.--

31


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    CS for SB 2220                                 First Engrossed



  1         (1)  The Legislature finds that it is appropriate to

  2  recognize as a trauma patient someone with an injury severity

  3  score (ISS) of 9 or greater.  The Legislature also recognizes

  4  that Level I and Level II trauma centers should each be

  5  capable of annually treating a minimum of 1,000 and 500

  6  patients, respectively, with an injury severity score (ISS) of

  7  9 or greater. Further, the Legislature finds that, based on

  8  the numbers and locations of trauma victims with these injury

  9  severity scores, there should be 19 trauma service areas in

10  the state, and, at a minimum, there should be at least one

11  trauma center in each service area.

12         (3)  Trauma service areas are to be used. The

13  department shall periodically review the assignment of the 67

14  counties to trauma service areas. These assignments are made

15  for the purpose of developing a system of trauma centers.

16  Revisions made by the department should take into

17  consideration the recommendations made as part of the regional

18  trauma system plans approved by the department, as well as the

19  recommendations made as part of the state trauma system plan.

20  These areas must, at a minimum, be reviewed in the year 2000

21  and every 5 years thereafter. Until the department completes

22  its initial review, the assignment of counties shall remain as

23  established pursuant to chapter 90-284, Laws of Florida. The

24  following trauma service areas are to be utilized in

25  developing a system of state-sponsored trauma centers. These

26  areas are subject to periodic revision by the Legislature

27  based on recommendations made as part of local or regional

28  trauma plans approved by the department pursuant to s.

29  395.401(2).  These areas shall, at a minimum, be reviewed by

30  the Legislature prior to the next 7-year verification cycle of

31  state-sponsored trauma centers.


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    CS for SB 2220                                 First Engrossed



  1         (a)  The following trauma service areas are hereby

  2  established:

  3         1.  Trauma service area 1 shall consist of Escambia,

  4  Okaloosa, Santa Rosa, and Walton Counties.

  5         2.  Trauma service area 2 shall consist of Bay, Gulf,

  6  Holmes, and Washington Counties.

  7         3.  Trauma service area 3 shall consist of Calhoun,

  8  Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,

  9  Taylor, and Wakulla Counties.

10         4.  Trauma service area 4 shall consist of Alachua,

11  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette,

12  Levy, Putnam, Suwannee, and Union Counties.

13         5.  Trauma service area 5 shall consist of Baker, Clay,

14  Duval, Nassau, and St. Johns Counties.

15         6.  Trauma service area 6 shall consist of Citrus,

16  Hernando, and Marion Counties.

17         7.  Trauma service area 7 shall consist of Flagler and

18  Volusia Counties.

19         8.  Trauma service area 8 shall consist of Lake,

20  Orange, Osceola, Seminole, and Sumter Counties.

21         9.  Trauma service area 9 shall consist of Pasco and

22  Pinellas Counties.

23         10.  Trauma service area 10 shall consist of

24  Hillsborough County.

25         11.  Trauma service area 11 shall consist of Hardee,

26  Highlands, and Polk Counties.

27         12.  Trauma service area 12 shall consist of Brevard

28  and Indian River Counties.

29         13.  Trauma service area 13 shall consist of DeSoto,

30  Manatee, and Sarasota Counties.

31


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    CS for SB 2220                                 First Engrossed



  1         14.  Trauma service area 14 shall consist of Martin,

  2  Okeechobee, and St. Lucie Counties.

  3         15.  Trauma service area 15 shall consist of Charlotte,

  4  Glades, Hendry, and Lee Counties.

  5         16.  Trauma service area 16 shall consist of Palm Beach

  6  County.

  7         17.  Trauma service area 17 shall consist of Collier

  8  County.

  9         18.  Trauma service area 18 shall consist of Broward

10  County.

11         19.  Trauma service area 19 shall consist of Dade and

12  Monroe Counties.

13         (b)  Each trauma service area should have at least one

14  Level I or Level II trauma center.

15         (c)  There shall be no more than a total of 44

16  state-sponsored trauma centers in the state.

17         Section 197.  Subsection (1) of section 395.4045,

18  Florida Statutes, is amended to read:

19         395.4045  Emergency medical service providers;

20  transport of trauma victims to trauma centers.--

21         (1)  Each emergency medical services provider licensed

22  under chapter 401 shall transport trauma alert victims to

23  hospitals approved as trauma centers, except as may be

24  provided for either in department-approved local or regional

25  trauma transport protocol or, if no local or regional trauma

26  transport protocol is in effect, as provided for in a

27  department-approved provider's trauma transport protocol.

28  Development of regional trauma protocols shall be through

29  consultation with interested parties, including, but not

30  limited to, each approved trauma center; physicians

31  specializing in trauma care, emergency care, and surgery in


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    CS for SB 2220                                 First Engrossed



  1  the region; each trauma system administrator in the region;

  2  and each emergency medical service provider in the region

  3  licensed under chapter 401. Trauma alert victims shall be

  4  identified through the use of a trauma scoring system.  The

  5  department shall specify by rule the subjects to be included

  6  in an emergency medical service provider's trauma transport

  7  protocol and shall approve or disapprove each such protocol.

  8         Section 198.  Section 458.351, Florida Statutes, is

  9  created to read:

10         458.351  Reports of adverse incidents in office

11  practice settings.--

12         (1)  Any adverse incident that occurs on or after

13  January 1, 2000, in any office maintained by a physician for

14  the practice of medicine which is not licensed under chapter

15  395 must be reported to the department in accordance with the

16  provisions of this section.

17         (2)  Any physician or other licensee under this chapter

18  practicing in this state must notify the department if the

19  physician or licensee was involved in an adverse incident that

20  occurred on or after January 1, 2000, in any office maintained

21  by a physician for the practice of medicine which is not

22  licensed under chapter 395.

23         (3)  The required notification to the department must

24  be submitted in writing by certified mail and postmarked

25  within 15 days after the occurrence of the adverse incident.

26         (4)  For purposes of notification to the department

27  pursuant to this section, the term "adverse incident" means an

28  event over which the physician or licensee could exercise

29  control and which is associated in whole or in part with a

30  medical intervention, rather than the condition for which such

31


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    CS for SB 2220                                 First Engrossed



  1  intervention occurred, and which results in the following

  2  patient injuries:

  3         (a)  The death of a patient.

  4         (b)  Brain or spinal damage to a patient.

  5         (c)  The performance of a surgical procedure on the

  6  wrong patient.

  7         (d)1.  The performance of a wrong-site surgical

  8  procedure;

  9         2.  The performance of a wrong surgical procedure; or

10         3.  The surgical repair of damage to a patient

11  resulting from a planned surgical procedure where the damage

12  is not a recognized specific risk as disclosed to the patient

13  and documented through the informed-consent process

14

15  if it results in: death; brain or spinal damage; permanent

16  disfigurement not to include the incision scar; fracture or

17  dislocation of bones or joints; a limitation of neurological,

18  physical or sensory function; or any condition that required

19  the transfer of the patient.

20         (e)  A procedure to remove unplanned foreign objects

21  remaining from a surgical procedure.

22         (f)  Any condition that required the transfer of a

23  patient to a hospital licensed under chapter 395 from an

24  ambulatory surgical center licensed under chapter 395 or any

25  facility or any office maintained by a physician for the

26  practice of medicine which is not licensed under chapter 395.

27         (5)  The department shall review each incident and

28  determine whether it potentially involved conduct by a health

29  care professional who is subject to disciplinary action, in

30  which case s. 455.621 applies. Disciplinary action, if any,

31


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  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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  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.


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  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


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  1  location where it can readily be seen by any person purchasing

  2  compressed air.

  3         (4)  The Department of Health shall maintain a record

  4  of all quarterly test results provided under this section.

  5         (5)  It is a misdemeanor of the second degree for any

  6  person or entity to provide, for compensation, compressed air

  7  for recreational sport diving in this state, including

  8  compressed air provided as part of a dive package of equipment

  9  rental, dive boat rental, or dive boat charter, without:

10         (a)  Having received a valid certificate issued by a

11  laboratory accredited by the American Industrial Hygiene

12  Association or the American Association for Laboratory

13  Accreditation which certifies that the compressed air meets

14  the standards for contaminant levels established by the

15  Department of Health.

16         (b)  Posting the certificate issued by a laboratory

17  accredited by the American Industrial Hygiene Association or

18  the American Association for Laboratory Accreditation in a

19  conspicuous location where it can readily be seen by persons

20  purchasing compressed air.

21         (6)  The department shall adopt rules necessary to

22  carry out the provisions of this section, which must include:

23         (a)  Maximum allowable levels of contaminants in

24  compressed air used for sport diving.

25         (b)  Procedures for the submission of test results to

26  the department.

27         (7)  This section shall take effect January 1, 2000.

28         Section 201.  The Minority HIV and AIDS Task Force.--

29         (1)  There is created within the Department of Health

30  the Minority HIV and AIDS Task Force to develop and provide

31  specific recommendations to the Governor, the Legislature, and


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  1  the Department of Health on ways to strengthen HIV and AIDS

  2  prevention programs and early intervention and treatment

  3  efforts in the state's black, Hispanic, and other minority

  4  communities, as well as ways to address the many needs of the

  5  state's minorities infected with AIDS and their families.

  6         (2)  The Secretary of Health shall appoint at least 15

  7  members to the task force. The members must include, but need

  8  not be limited to, representatives from:

  9         (a)  Persons infected with the human immunodeficiency

10  virus (HIV) or acquired immune deficiency syndrome (AIDS).

11         (b)  Minority community-based support organizations.

12         (c)  Minority treatment providers.

13         (d)  The religious community within groups of persons

14  infected with HIV or AIDS.

15         (e)  The Department of Health.

16         (3)  The task force shall meet as often as necessary to

17  carry out its duties and responsibilities. Within existing

18  resources, the Department of Health shall provide support

19  services to the task force.

20         (4)  The members of the task force shall serve without

21  compensation.

22         (5)  The task force shall prepare and submit a report

23  of its findings and recommendations to the Governor, the

24  President of the Senate, and the Speaker of the House of

25  Representatives by February 1, 2001. The report must include:

26         (a)  Specific strategies for reducing the risk of HIV

27  and AIDS in the state's minority communities.

28         (b)  A plan for establishing mentor programs and

29  exchanging information and ideas among minority

30  community-based organizations that provide HIV and AIDS

31  prevention services.


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  1         (c)  The needs of prevention and treatment programs

  2  within communities and the resources that are available within

  3  minority communities.

  4         (d)  Specific strategies for ensuring that minority

  5  persons who are at risk of HIV and AIDS infection seek

  6  testing.

  7         (e)  Specific strategies for ensuring that persons who

  8  test positive for HIV or AIDS are provided with access to

  9  treatment and secondary prevention services.

10         (f)  Specific strategies to help reduce or eliminate

11  high-risk behaviors in persons who test negative but continue

12  to practice high-risk behaviors.

13         (g)  A plan to evaluate the implementation of the

14  recommendations of the task force.

15         (6)  The task force is abolished on July 1, 2001.

16         Section 202.  Statewide HIV and AIDS prevention

17  campaign.--

18         (1)  The Department of Health shall develop and

19  implement a statewide HIV and AIDS prevention campaign that is

20  directed towards minorities who are at risk of HIV infection.

21  The campaign shall include television, radio, and outdoor

22  advertising; public service announcements; and peer-to-peer

23  outreach. Each campaign message and concept shall be evaluated

24  with members of the target group to ensure its effectiveness.

25  The campaign shall provide information on the risk of HIV and

26  AIDS infection and strategies to follow for prevention, early

27  detection, and treatment. The campaign shall use culturally

28  sensitive literature and educational materials and promote the

29  development of individual skills for behavior modification.

30         (2)  The Department of Health shall establish four

31  positions within the department for HIV and AIDS regional


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    CS for SB 2220                                 First Engrossed



  1  minority coordinators and one position for a statewide HIV and

  2  AIDS minority coordinator. The coordinators shall facilitate

  3  statewide efforts to implement and coordinate HIV and AIDS

  4  prevention and treatment programs. The statewide coordinator

  5  shall report directly to the chief of the Bureau of HIV and

  6  AIDS within the Department of Health.

  7         (3)  The Department of Health shall, with assistance

  8  from the Minority HIV and AIDS Task Force and the statewide

  9  coordinator, plan and conduct a statewide Black Leadership

10  Conference on HIV and AIDS by January 2000. The conference

11  shall provide workshops for minority organizations in building

12  skills and improving an organization's capacity to conduct HIV

13  and AIDS prevention and treatment programs.

14         Section 203.  The sum of $250,000 is appropriated from

15  the General Revenue Fund to the Department of Health for the

16  purpose of carrying out the provisions of sections 201 and 202

17  of this act during the 1999-2000 fiscal year.

18         Section 204.  Subsection (9) is added to section 20.41,

19  Florida Statutes, to read:

20         20.41  Department of Elderly Affairs.--There is created

21  a Department of Elderly Affairs.

22         (9)  Area agencies on aging are subject to chapter 119,

23  relating to public records, and, when considering any

24  contracts requiring the expenditure of funds, are subject to

25  ss. 286.011-286.012, relating to public meetings.

26         Section 205.  Effective October 1, 1999, part XV of

27  chapter 468, Florida Statutes, consisting of sections 468.821,

28  468.822, 468.823, 468.824, 468.825, 468.826, 468.827, and

29  468.828, Florida Statutes, is created to read:

30         468.821  Definitions.--As used in this part, the term:

31         (1)  "Approved training program" means:


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  1         (a)  A course of training conducted by a public sector

  2  or private sector educational center licensed by the

  3  Department of Education to implement the basic curriculum for

  4  nursing assistants which is approved by the Department of

  5  Education.

  6         (b)  A training program operated under s. 400.141.

  7         (2)  "Certified nursing assistant" means a person who

  8  meets the qualifications specified in this part and who is

  9  certified by the department as a certified nursing assistant.

10         (3)  "Department" means the Department of Health.

11         (4)  "Registry" means the listing of certified nursing

12  assistants maintained by the department.

13         468.822  Duties and powers of the department.--The

14  department shall maintain, or contract with or approve another

15  entity to maintain, a state registry of certified nursing

16  assistants. The registry must consist of the name of each

17  certified nursing assistant in this state; other identifying

18  information defined by department rule; certification status;

19  the effective date of certification; other information

20  required by state or federal law; information regarding any

21  crime or any abuse, neglect, or exploitation as provided under

22  chapter 435; and any disciplinary action taken against the

23  certified nursing assistant. The registry shall be accessible

24  to the public, the certificateholder, employers, and other

25  state agencies. The department shall adopt by rule testing

26  procedures for use in certifying nursing assistants and shall

27  adopt rules regulating the practice of certified nursing

28  assistants to enforce this part. The department may contract

29  with or approve another entity or organization to provide the

30  examination services, including the development and

31  administration of examinations. The provider shall pay all


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  1  reasonable costs and expenses incurred by the department in

  2  evaluating the provider's application and performance during

  3  the delivery of services, including examination services and

  4  procedures for maintaining the certified nursing assistant

  5  registry.

  6         468.823  Certified nursing assistants; certification

  7  requirement.--

  8         (1)  The department shall issue a certificate to

  9  practice as a certified nursing assistant to any person who

10  demonstrates a minimum competency to read and write and meets

11  one of the following requirements:

12         (a)  Has successfully completed an approved training

13  program and achieved a minimum score, established by rule of

14  the department, on the nursing assistant competency

15  examination, which consists of a written portion and

16  skills-demonstration portion approved by the department and

17  administered at a site and by personnel approved by the

18  department.

19         (b)  Has achieved a minimum score, established by rule

20  of the department, on the nursing assistant competency

21  examination, which consists of a written portion and

22  skills-demonstration portion, approved by the department and

23  administered at a site and by personnel approved by the

24  department and:

25         1.  Has a high school diploma, or its equivalent; or

26         2.  Is at least 18 years of age.

27         (c)  Is currently certified in another state; is listed

28  on that state's certified nursing assistant registry; has not

29  been found to have committed abuse, neglect, or exploitation

30  in that state; and has successfully completed a national

31


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  1  nursing assistant evaluation in order to receive certification

  2  in that state.

  3         (2)  If an applicant fails to pass the nursing

  4  assistant competency examination in three attempts, the

  5  applicant is not eligible for reexamination unless the

  6  applicant completes an approved training program.

  7         (3)  An oral examination shall be administered as a

  8  substitute for the written portion of the examination upon

  9  request. The oral examination shall be administered at a site

10  and by personnel approved by the department.

11         (4)  The department shall adopt rules to provide for

12  the initial certification of certified nursing assistants.

13         (5)  A certified nursing assistant shall maintain a

14  current address with the department in accordance with s.

15  455.717.

16         468.824  Denial, suspension, or revocation of

17  certification; disciplinary actions.--

18         (1)  The following acts constitute grounds for which

19  the department may impose disciplinary sanctions as specified

20  in subsection (2):

21         (a)  Obtaining or attempting to obtain an exemption, or

22  possessing or attempting to possess a letter of exemption, by

23  bribery, misrepresentation, deceit, or through an error of the

24  department.

25         (b)  Intentionally violating any provision of this

26  chapter, chapter 455, or the rules adopted by the department.

27         (2)  When the department finds any person guilty of any

28  of the grounds set forth in subsection (1), it may enter an

29  order imposing one or more of the following penalties:

30         (a)  Denial, suspension, or revocation of

31  certification.


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  1         (b)  Imposition of an administrative fine not to exceed

  2  $150 for each count or separate offense.

  3         (c)  Imposition of probation or restriction of

  4  certification, including conditions such as corrective actions

  5  as retraining or compliance with an approved treatment program

  6  for impaired practitioners.

  7         (3)  The department may, upon the request of a

  8  certificateholder, exempt the certificateholder from

  9  disqualification of certification or disqualification of

10  employment in accordance with chapter 435 and issue a letter

11  of exemption.

12

13  After January 1, 2000, the department must notify an applicant

14  seeking an exemption from disqualification from certification

15  or employment of its decision to approve or deny the request

16  within 30 days after the date the department receives all

17  required documentation.

18         468.825  Availability of disciplinary records and

19  proceedings.--Pursuant to s. 455.621, any complaint or record

20  maintained by the Department of Health pursuant to the

21  discipline of a certified nursing assistant and any proceeding

22  held by the department to discipline a certified nursing

23  assistant shall remain open and available to the public.

24         468.826  Exemption from liability.--If an employer

25  terminates or denies employment to a certified nursing

26  assistant whose certification is inactive as shown on the

27  certified nursing assistant registry or whose name appears on

28  the central abuse registry and tracking system of the

29  Department of Children and Family Services or on a criminal

30  screening report of the Department of Law Enforcement, the

31  employer is not civilly liable for such termination and a


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    CS for SB 2220                                 First Engrossed



  1  cause of action may not be brought against the employer for

  2  damages, regardless of whether the employee has filed for an

  3  exemption from the department under s. 468.824(1). There may

  4  not be any monetary liability on the part of, and a cause of

  5  action for damages may not arise against, any licensed

  6  facility, its governing board or members thereof, medical

  7  staff, disciplinary board, agents, investigators, witnesses,

  8  employees, or any other person for any action taken in good

  9  faith without intentional fraud in carrying out this section.

10         468.827  Penalties.--It is a misdemeanor of the first

11  degree, punishable as provided under s. 775.082 or s. 775.083,

12  for any person, knowingly or intentionally, to fail to

13  disclose, by false statement, misrepresentation,

14  impersonation, or other fraudulent means, in any application

15  for voluntary or paid employment or licensure regulated under

16  this part, a material fact used in making a determination as

17  to such person's qualifications to be an employee or licensee.

18         468.828  Background screening information; rulemaking

19  authority.--

20         (1)  The Agency for Health Care Administration shall

21  allow the department to electronically access its background

22  screening database and records and the Department of Children

23  and Families shall allow the department to electronically

24  access its central abuse registry and tracking system under

25  chapter 415.

26         (2)  An employer, or an agent thereof, may not use

27  criminal records, juvenile records, or information obtained

28  from the central abuse hotline under chapter 415 for any

29  purpose other than determining if the person meets the

30  requirements of this part. Such records and information

31


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    CS for SB 2220                                 First Engrossed



  1  obtained by the department shall remain confidential and

  2  exempt from s. 119.07(1).

  3         (3)  If the requirements of the Omnibus Budget

  4  Reconciliation Act of 1987, as amended, for the certification

  5  of nursing assistants are in conflict with this part, the

  6  federal requirements shall prevail for those facilities

  7  certified to provide care under Title XVIII (Medicare) or

  8  Title XIX (Medicaid) of the Social Security Act.

  9         (4)  The department shall adopt rules to administer

10  this part.

11         Section 206.  Certified nursing assistant registry.--

12         (1)  By October 1, 1999, and by October 1 of every year

13  thereafter, each employer of certified nursing assistants

14  shall submit to the Department of Health a list of the names

15  and social security numbers of each person employed by the

16  employer as a certified nursing assistant in a nursing-related

17  occupation for a minimum of 8 hours for monetary compensation

18  during the preceding 24 months. Employers may submit such

19  information electronically through the department's Internet

20  site.

21         (2)  The department shall update the certified nursing

22  assistant registry upon receipt of the lists of certified

23  nursing assistants, and shall complete the first of such

24  updates by December 31, 1999.

25         (3)  Each certified nursing assistant whose name is not

26  reported to the department under subsection (1) on October 1,

27  1999, shall be assigned an inactive certification on January

28  1, 2000. A certified nursing assistant may remove such an

29  inactive certification by submitting documentation to the

30  department that he or she was employed for a minimum of 8

31  hours for monetary compensation as a certified nursing


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  1  assistant in a nursing-related occupation during the preceding

  2  24 months.

  3         (4)  This section is repealed October 2, 2001.

  4         Section 207.  Effective October 1, 1999, section

  5  400.211, Florida Statutes, 1998 Supplement, is amended to

  6  read:

  7         400.211  Persons employed as nursing assistants;

  8  certification requirement.--

  9         (1)  A person must be certified under part XV of

10  chapter 468 pursuant to this section, except a registered

11  nurse or practical nurse licensed in accordance with the

12  provisions of chapter 464 or an applicant for such licensure

13  who is permitted to practice nursing in accordance with rules

14  adopted promulgated by the Board of Nursing pursuant to

15  chapter 464, to serve as a nursing assistant in any nursing

16  home. The Department of Health shall issue a certificate to

17  any person who:

18         (a)  Has successfully completed a nursing assistant

19  program in a state-approved school and has achieved a minimum

20  score of 75 percent on the written portion of the Florida

21  Nursing Assistant Certification Test approved by the

22  Department of Health and administered by state-approved test

23  site personnel;

24         (b)  Has achieved a minimum score of 75 percent on the

25  written and performance portions of the Florida Nursing

26  Assistant Certification Test approved by the Department of

27  Health and administered by state-approved test site personnel;

28  or

29         (c)  Is currently certified in another state, is on

30  that state's registry, has no findings of abuse, and has

31  achieved a minimum score of 75 percent on the written portion


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    CS for SB 2220                                 First Engrossed



  1  of the Florida Nursing Assistant Certification Test approved

  2  by the Department of Health and administered by state-approved

  3  test site personnel.

  4

  5  An oral examination shall be administered upon request.

  6         (2)  The agency may deny, suspend, or revoke the

  7  certification of any person to serve as a nursing assistant,

  8  based upon written notification from a court of competent

  9  jurisdiction, law enforcement agency, or administrative agency

10  of any finding of guilt of, regardless of adjudication, or a

11  plea of nolo contendere or guilty to, any offense set forth in

12  the level 1 screening standards of chapter 435 or any

13  confirmed report of abuse of a vulnerable adult.

14         (2)(3)  The following categories of persons who are not

15  certified as nursing assistants under this part may be

16  employed by a nursing facility for a period of 4 months:

17         (a)  Persons who are enrolled in a state-approved

18  nursing assistant program; or

19         (b)  Persons who have been positively verified by a

20  state-approved test site as certified and on the registry in

21  another state with no findings of abuse, but who have not

22  completed the written examination required under this section.

23

24  The certification requirement must be met within 4 months of

25  initial employment as a nursing assistant in a licensed

26  nursing facility.

27         (4)  A person certified under this section on or after

28  September 30, 1990, who has not worked for pay as a nursing

29  assistant in a nursing-related occupation for a period of time

30  during a consecutive 24-month period must be recertified under

31  this section to be eligible to work in a nursing facility.


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  1         (3)(5)  Nursing homes shall require persons seeking

  2  employment as a certified nursing assistant to submit an

  3  employment history to the facility. The facility shall verify

  4  the employment history unless, through diligent efforts, such

  5  verification is not possible.  There shall be no monetary

  6  liability on the part of, and no cause of action for damages

  7  shall arise against, a former employer who reasonably and in

  8  good faith communicates his or her honest opinion about a

  9  former employee's job performance.

10         (6)  If the requirements pursuant to the Omnibus Budget

11  Reconciliation Act of 1987, as amended, for the certification

12  of nursing assistants are in conflict with this section, the

13  federal requirements shall prevail for those facilities

14  certified to provide care under Title XVIII (Medicare) or

15  Title XIX (Medicaid) of the Social Security Act.

16         (7)  The Department of Health may adopt such rules as

17  are necessary to carry out this section.

18         Section 208.  Subsection (36) is added to section

19  409.912, Florida Statutes, 1998 Supplement, to read:

20         409.912  Cost-effective purchasing of health care.--The

21  agency shall purchase goods and services for Medicaid

22  recipients in the most cost-effective manner consistent with

23  the delivery of quality medical care.  The agency shall

24  maximize the use of prepaid per capita and prepaid aggregate

25  fixed-sum basis services when appropriate and other

26  alternative service delivery and reimbursement methodologies,

27  including competitive bidding pursuant to s. 287.057, designed

28  to facilitate the cost-effective purchase of a case-managed

29  continuum of care. The agency shall also require providers to

30  minimize the exposure of recipients to the need for acute

31


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  1  inpatient, custodial, and other institutional care and the

  2  inappropriate or unnecessary use of high-cost services.

  3         (36)  The agency shall enter into agreements with

  4  not-for-profit organizations based in this state for the

  5  purpose of providing vision screening.

  6         Section 209.  Except as otherwise expressly provided in

  7  this act, this act shall take effect July 1, 1999.

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