House Bill 2231e2
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HB 2231, Second Engrossed
1 A bill to be entitled
2 An act relating to health care; amending s.
3 455.654, F.S.; providing definitions; providing
4 requirements for accepting outside referrals
5 for diagnostic imaging; providing for
6 disciplinary procedures against a group
7 practice or sole provider that accepts an
8 outside referral for diagnostic imaging
9 services in violation of such requirements;
10 requiring the Agency for Health Care
11 Administration to study issues relating to
12 quality care in providing diagnostic imaging
13 services; requiring the agency to convene a
14 technical advisory panel; providing for
15 registration of all group practices;
16 prescribing registration information; providing
17 for the technical advisory panel to submit
18 recommendations for agency rules; requiring the
19 agency to adopt rules; providing a date for the
20 adoption and publication of rules; authorizing
21 group practices and sole providers to accept a
22 prescribed percentage of their patients from
23 outside referrals; requiring the Agency for
24 Health Care Administration in conjunction with
25 the Medicaid Fraud Unit of the Office of the
26 Attorney General to study certain specified
27 business activities and arrangements of
28 providers of clinical laboratory services for
29 kidney dialysis; requiring a report; amending
30 s. 4, ch. 98-192, Laws of Florida; eliminating
31 requirement that the agency receive written
1
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HB 2231, Second Engrossed
1 confirmation from the federal Health Care
2 Financing Administration that amendments to ss.
3 395.701 and 395.7015, F.S., will not adversely
4 affect assessments or state match for the
5 state's Medicaid program; providing duties for
6 the agency and the Secretary of State;
7 providing for a study and analysis of services
8 for kidney dialysis patients; requiring
9 providers of diagnostic cardiac catheterization
10 services to comply with certain laws and rules
11 adopted by the Agency for Health Care
12 Administration; amending s. 155.40, F.S.;
13 providing construction with respect to a
14 transaction involving the sale or lease of a
15 public hospital; providing construction with
16 respect to specified hospital lessees; amending
17 s. 455.651, F.S.; providing for a cause of
18 action, damages, attorney's fees, and costs;
19 amending s. 409.910, F.S.; clarifying that the
20 state may recover and retain damages in excess
21 of Medicaid payments made under certain
22 circumstances; providing for retroactive
23 application; creating s. 381.100, F.S.;
24 creating the "Florida Community Health
25 Protection Act"; creating s. 381.102, F.S.;
26 providing for Community Health Program pilot
27 projects; establishing pilot projects in
28 designated counties; creating s. 381.103, F.S.;
29 providing duties of the Department of Health;
30 requiring a report; amending s. 627.6472, F.S.;
31 requiring exclusive provider organizations to
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HB 2231, Second Engrossed
1 provide, without prior authorization, female
2 subscribers one annual visit to an
3 obstetrician/gynecologist; requiring
4 coordination of medical care; amending s.
5 641.51, F.S.; requiring a health maintenance
6 organization to provide, without prior
7 authorization, female subscribers one annual
8 visit to an obstetrician/gynecologist;
9 requiring coordination of medical care;
10 providing for application; providing effective
11 dates.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. Section 455.654, Florida Statutes, 1998
16 Supplement, is amended to read:
17 455.654 Financial arrangements between referring
18 health care providers and providers of health care services.--
19 (1) SHORT TITLE.--This section may be cited as the
20 "Patient Self-Referral Act of 1992."
21 (2) LEGISLATIVE INTENT.--It is recognized by the
22 Legislature that the referral of a patient by a health care
23 provider to a provider of health care services in which the
24 referring health care provider has an investment interest
25 represents a potential conflict of interest. The Legislature
26 finds these referral practices may limit or eliminate
27 competitive alternatives in the health care services market,
28 may result in overutilization of health care services, may
29 increase costs to the health care system, and may adversely
30 affect the quality of health care. The Legislature also
31 recognizes, however, that it may be appropriate for providers
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HB 2231, Second Engrossed
1 to own entities providing health care services, and to refer
2 patients to such entities, as long as certain safeguards are
3 present in the arrangement. It is the intent of the
4 Legislature to provide guidance to health care providers
5 regarding prohibited patient referrals between health care
6 providers and entities providing health care services and to
7 protect the people of Florida from unnecessary and costly
8 health care expenditures.
9 (3) DEFINITIONS.--For the purpose of this section, the
10 word, phrase, or term:
11 (a) "Board" means any of the following boards relating
12 to the respective professions: the Board of Medicine as
13 created in s. 458.307; the Board of Osteopathic Medicine as
14 created in s. 459.004; the Board of Chiropractic Medicine as
15 created in s. 460.404; the Board of Podiatric Medicine as
16 created in s. 461.004; the Board of Optometry as created in s.
17 463.003; the Board of Pharmacy as created in s. 465.004; and
18 the Board of Dentistry as created in s. 466.004.
19 (b) "Comprehensive rehabilitation services" means
20 services that are provided by health care professionals
21 licensed under part I or part III of chapter 468 or chapter
22 486 to provide speech, occupational, or physical therapy
23 services on an outpatient or ambulatory basis.
24 (c) "Designated health services" means, for purposes
25 of this section, clinical laboratory services, physical
26 therapy services, comprehensive rehabilitative services,
27 diagnostic-imaging services, and radiation therapy services.
28 (d) "Diagnostic imaging services" means magnetic
29 resonance imaging, nuclear medicine, angiography,
30 arteriography, computed tomography, positron emission
31 tomography, digital vascular imaging, bronchography,
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HB 2231, Second Engrossed
1 lymphangiography, splenography, ultrasound, EEG, EKG, nerve
2 conduction studies, and evoked potentials.
3 (e) "Direct supervision" means supervision by a
4 physician who is present in the office suite and immediately
5 available to provide assistance and direction throughout the
6 time services are being performed.
7 (f)(d) "Entity" means any individual, partnership,
8 firm, corporation, or other business entity.
9 (g)(e) "Fair market value" means value in arms length
10 transactions, consistent with the general market value, and,
11 with respect to rentals or leases, the value of rental
12 property for general commercial purposes, not taking into
13 account its intended use, and, in the case of a lease of
14 space, not adjusted to reflect the additional value the
15 prospective lessee or lessor would attribute to the proximity
16 or convenience to the lessor where the lessor is a potential
17 source of patient referrals to the lessee.
18 (h)(f) "Group practice" means a group of two or more
19 health care providers legally organized as a partnership,
20 professional corporation, or similar association:
21 1. In which each health care provider who is a member
22 of the group provides substantially the full range of services
23 which the health care provider routinely provides, including
24 medical care, consultation, diagnosis, or treatment, through
25 the joint use of shared office space, facilities, equipment,
26 and personnel;
27 2. For which substantially all of the services of the
28 health care providers who are members of the group are
29 provided through the group and are billed in the name of the
30 group and amounts so received are treated as receipts of the
31 group; and
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HB 2231, Second Engrossed
1 3. In which the overhead expenses of and the income
2 from the practice are distributed in accordance with methods
3 previously determined by members of the group.
4 (i)(g) "Health care provider" means any physician
5 licensed under chapter 458, chapter 459, chapter 460, or
6 chapter 461, or any health care provider licensed under
7 chapter 463 or chapter 466.
8 (j)(h) "Immediate family member" means a health care
9 provider's spouse, child, child's spouse, grandchild,
10 grandchild's spouse, parent, parent-in-law, or sibling.
11 (k)(i) "Investment interest" means an equity or debt
12 security issued by an entity, including, without limitation,
13 shares of stock in a corporation, units or other interests in
14 a partnership, bonds, debentures, notes, or other equity
15 interests or debt instruments. The following investment
16 interests shall be excepted from this definition:
17 1. An investment interest in an entity that is the
18 sole provider of designated health services in a rural area;
19 2. An investment interest in notes, bonds, debentures,
20 or other debt instruments issued by an entity which provides
21 designated health services, as an integral part of a plan by
22 such entity to acquire such investor's equity investment
23 interest in the entity, provided that the interest rate is
24 consistent with fair market value, and that the maturity date
25 of the notes, bonds, debentures, or other debt instruments
26 issued by the entity to the investor is not later than October
27 1, 1996.
28 3. An investment interest in real property resulting
29 in a landlord-tenant relationship between the health care
30 provider and the entity in which the equity interest is held,
31 unless the rent is determined, in whole or in part, by the
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HB 2231, Second Engrossed
1 business volume or profitability of the tenant or exceeds fair
2 market value; or
3 4. An investment interest in an entity which owns or
4 leases and operates a hospital licensed under chapter 395 or a
5 nursing home facility licensed under chapter 400.
6 (l)(j) "Investor" means a person or entity owning a
7 legal or beneficial ownership or investment interest, directly
8 or indirectly, including, without limitation, through an
9 immediate family member, trust, or another entity related to
10 the investor within the meaning of 42 C.F.R... s. 413.17, in
11 an entity.
12 (m) "Outside referral for diagnostic imaging services"
13 means a referral of a patient to a group practice or sole
14 provider for diagnostic imaging services by a physician who is
15 not a member of the group practice or of the sole provider's
16 practice and who does not have an investment interest in the
17 group practice or sole provider's practice, for which the
18 group practice or sole provider billed for both the technical
19 and the professional fee for the patient, and the patient did
20 not become a patient of the group practice or sole provider's
21 practice.
22 (n) "Patient of a group practice" or "patient of a
23 sole provider" means a patient who receives a physical
24 examination, evaluation, diagnosis, and development of a
25 treatment plan if medically necessary by a physician who is a
26 member of the group practice or the sole provider's practice.
27 (o)(k) "Referral" means any referral of a patient by a
28 health care provider for health care services, including,
29 without limitation:
30 1. The forwarding of a patient by a health care
31 provider to another health care provider or to an entity which
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HB 2231, Second Engrossed
1 provides or supplies designated health services or any other
2 health care item or service; or
3 2. The request or establishment of a plan of care by a
4 health care provider, which includes the provision of
5 designated health services or other health care item or
6 service.
7 3. The following orders, recommendations, or plans of
8 care shall not constitute a referral by a health care
9 provider:
10 a. By a radiologist for diagnostic-imaging services.
11 b. By a physician specializing in the provision of
12 radiation therapy services for such services.
13 c. By a medical oncologist for drugs and solutions to
14 be prepared and administered intravenously to such
15 oncologist's patient, as well as for the supplies and
16 equipment used in connection therewith to treat such patient
17 for cancer and the complications thereof.
18 d. By a cardiologist for cardiac catheterization
19 services.
20 e. By a pathologist for diagnostic clinical laboratory
21 tests and pathological examination services, if furnished by
22 or under the supervision of such pathologist pursuant to a
23 consultation requested by another physician.
24 f. By a health care provider who is the sole provider
25 or member of a group practice for designated health services
26 or other health care items or services that are prescribed or
27 provided solely for such referring health care provider's or
28 group practice's own patients, and that are provided or
29 performed by or under the direct supervision of such referring
30 health care provider or group practice; provided, however,
31 that effective July 1, 1999, a physician licensed pursuant to
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1 chapter 458, chapter 459, chapter 460, or chapter 461 may
2 refer a patient to a sole provider or group practice for
3 diagnostic imaging services, excluding radiation therapy
4 services, for which the sole provider or group practice billed
5 both the technical and the professional fee for or on behalf
6 of the patient, if the referring physician has no investment
7 interest in the practice. The diagnostic imaging service
8 referred to a group practice or sole provider must be a
9 diagnostic imaging service normally provided within the scope
10 of practice to the patients of the group practice or sole
11 provider. The group practice or sole provider may accept no
12 more that 15 percent of their patients receiving diagnostic
13 imaging services from outside referrals, excluding radiation
14 therapy services.
15 g. By a health care provider for services provided by
16 an ambulatory surgical center licensed under chapter 395.
17 h. By a health care provider for diagnostic clinical
18 laboratory services where such services are directly related
19 to renal dialysis.
20 i. By a urologist for lithotripsy services.
21 j. By a dentist for dental services performed by an
22 employee of or health care provider who is an independent
23 contractor with the dentist or group practice of which the
24 dentist is a member.
25 k. By a physician for infusion therapy services to a
26 patient of that physician or a member of that physician's
27 group practice.
28 l. By a nephrologist for renal dialysis services and
29 supplies.
30 (p) "Present in the office suite" means that the
31 physician is actually physically present; provided, however,
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1 that the health care provider is considered physically present
2 during brief unexpected absences as well as during routine
3 absences of a short duration if the absences occur during time
4 periods in which the health care provider is otherwise
5 scheduled and ordinarily expected to be present and the
6 absences do not conflict with any other requirement in the
7 Medicare program for a particular level of health care
8 provider supervision.
9 (q)(l) "Rural area" means a county with a population
10 density of no greater than 100 persons per square mile, as
11 defined by the United States Census.
12 (r) "Sole provider" means one health care provider
13 licensed under chapter 458, chapter 459, chapter 460, or
14 chapter 461, who maintains a separate medical office and a
15 medical practice separate from any other health care provider
16 and who bills for his or her services separately from the
17 services provided by any other health care provider. A sole
18 provider shall not share overhead expenses or professional
19 income with any other person or group practice.
20 (4) REQUIREMENTS FOR ACCEPTING OUTSIDE REFERRALS FOR
21 DIAGNOSTIC IMAGING.--
22 (a) A group practice or sole provider accepting
23 outside referrals for diagnostic imaging services is required
24 to comply with the following conditions:
25 1. Diagnostic imaging services must be provided
26 exclusively by a group practice physician or by a full-time or
27 part-time employee of the group practice or of the sole
28 provider's practice.
29 2. All equity in the group practice or sole provider's
30 practice accepting outside referrals for diagnostic imaging
31 must be held by the physicians comprising the group practice
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1 or the sole provider's practice, each of which must provide at
2 least 75 percent of his professional services to the group.
3 Alternatively, the group must be incorporated under chapter
4 617, Florida Statutes, and must be exempt under the provisions
5 of the Internal Revenue Code 501(c)(3) and be part of a
6 foundation in existence prior to January 1, 1999 that is
7 created for the purpose of patient care, medical education,
8 and research.
9 3. A group practice or sole provider may not enter
10 into, extend or renew any contract with a practice management
11 company that provides any financial incentives, directly or
12 indirectly, based on an increase in outside referrals for
13 diagnostic imaging services from any group or sole provider
14 managed by the same practice management company.
15 4. The group practice or sole provider accepting
16 outside referrals for diagnostic imaging services must bill
17 for both the professional and technical component of the
18 service on behalf of the patient and no portion of the
19 payment, or any type of consideration, either directly or
20 indirectly, may be shared with the referring physician.
21 5. Group practices or sole providers that have a
22 Medicaid provider agreement with the Agency for Health Care
23 Administration must furnish diagnostic imaging services to
24 their Medicaid patients and may not refer a Medicaid recipient
25 to a hospital for outpatient diagnostic imaging services
26 unless the physician furnishes the hospital with documentation
27 demonstrating the medical necessity for such a referral. If
28 necessary, the Agency for Health Care Administration may apply
29 for a federal waiver to implement this subparagraph.
30 6. All group practices and sole providers accepting
31 outside referrals for diagnostic imaging shall report annually
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1 to the Agency for Health Care Administration providing the
2 number of outside referrals accepted for diagnostic imaging
3 services and the total number of all patients receiving
4 diagnostic imaging services.
5 (b) If a group practice or sole provider accepts an
6 outside referral for diagnostic imaging services in violation
7 of this subsection or if a group practice or sole provider
8 accepts outside referrals for diagnostic imaging services in
9 excess of the percentage limitation established in
10 subparagraph (a)2. of this subsection, the group practice or
11 the sole provider shall be subject to the penalties in
12 subsection (5).
13 (c) Each managing physician member of a group practice
14 and each sole provider who accepts outside referrals for
15 diagnostic imaging services shall submit an annual attestation
16 signed under oath to the Agency for Health Care Administration
17 which shall include the annual report required under s.
18 455.654(4)(a)6. and which shall further confirm that each
19 group practice or sole provider is in compliance with the
20 percentage limitations for accepting outside referrals and the
21 requirements for accepting outside referrals listed in s.
22 455.654(4)(a). The agency may verify the report submitted by
23 group practices and sole providers.
24 (5)(4) PROHIBITED REFERRALS AND CLAIMS FOR
25 PAYMENT.--Except as provided in this section:
26 (a) A health care provider may not refer a patient for
27 the provision of designated health services to an entity in
28 which the health care provider is an investor or has an
29 investment interest.
30 (b) A health care provider may not refer a patient for
31 the provision of any other health care item or service to an
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1 entity in which the health care provider is an investor
2 unless:
3 1. The provider's investment interest is in registered
4 securities purchased on a national exchange or
5 over-the-counter market and issued by a publicly held
6 corporation:
7 a. Whose shares are traded on a national exchange or
8 on the over-the-counter market; and
9 b. Whose total assets at the end of the corporation's
10 most recent fiscal quarter exceeded $50 million; or
11 2. With respect to an entity other than a publicly
12 held corporation described in subparagraph 1., and a referring
13 provider's investment interest in such entity, each of the
14 following requirements are met:
15 a. No more than 50 percent of the value of the
16 investment interests are held by investors who are in a
17 position to make referrals to the entity.
18 b. The terms under which an investment interest is
19 offered to an investor who is in a position to make referrals
20 to the entity are no different from the terms offered to
21 investors who are not in a position to make such referrals.
22 c. The terms under which an investment interest is
23 offered to an investor who is in a position to make referrals
24 to the entity are not related to the previous or expected
25 volume of referrals from that investor to the entity.
26 d. There is no requirement that an investor make
27 referrals or be in a position to make referrals to the entity
28 as a condition for becoming or remaining an investor.
29 3. With respect to either such entity or publicly held
30 corporation:
31
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1 a. The entity or corporation does not loan funds to or
2 guarantee a loan for an investor who is in a position to make
3 referrals to the entity or corporation if the investor uses
4 any part of such loan to obtain the investment interest.
5 b. The amount distributed to an investor representing
6 a return on the investment interest is directly proportional
7 to the amount of the capital investment, including the fair
8 market value of any preoperational services rendered, invested
9 in the entity or corporation by that investor.
10 4. Each board and, in the case of hospitals, the
11 Agency for Health Care Administration, shall encourage the use
12 by licensees of the declaratory statement procedure to
13 determine the applicability of this section or any rule
14 adopted pursuant to this section as it applies solely to the
15 licensee. Boards shall submit to the Agency for Health Care
16 Administration the name of any entity in which a provider
17 investment interest has been approved pursuant to this
18 section, and the Agency for Health Care Administration shall
19 adopt rules providing for periodic quality assurance and
20 utilization review of such entities.
21 (c) No claim for payment may be presented by an entity
22 to any individual, third-party payor, or other entity for a
23 service furnished pursuant to a referral prohibited under this
24 section.
25 (d) If an entity collects any amount that was billed
26 in violation of this section, the entity shall refund such
27 amount on a timely basis to the payor or individual, whichever
28 is applicable.
29 (e) Any person that presents or causes to be presented
30 a bill or a claim for service that such person knows or should
31 know is for a service for which payment may not be made under
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1 paragraph (c), or for which a refund has not been made under
2 paragraph (d), shall be subject to a civil penalty of not more
3 than $15,000 for each such service to be imposed and collected
4 by the appropriate board.
5 (f) Any health care provider or other entity that
6 enters into an arrangement or scheme, such as a cross-referral
7 arrangement, which the physician or entity knows or should
8 know has a principal purpose of assuring referrals by the
9 physician to a particular entity which, if the physician
10 directly made referrals to such entity, would be in violation
11 of this section, shall be subject to a civil penalty of not
12 more than $100,000 for each such circumvention arrangement or
13 scheme to be imposed and collected by the appropriate board.
14 (g) A violation of this section by a health care
15 provider shall constitute grounds for disciplinary action to
16 be taken by the applicable board pursuant to s. 458.331(2), s.
17 459.015(2), s. 460.413(2), s. 461.013(2), s. 463.016(2), or s.
18 466.028(2). Any hospital licensed under chapter 395 found in
19 violation of this section shall be subject to the rules
20 adopted by the Agency for Health Care Administration pursuant
21 to s. 395.0185(2).
22 (h) Any hospital licensed under chapter 395 that
23 discriminates against or otherwise penalizes a health care
24 provider for compliance with this act.
25 (i) The provision of paragraph (a) shall not apply to
26 referrals to the offices of radiation therapy centers managed
27 by an entity or subsidiary or general partner thereof, which
28 performed radiation therapy services at those same offices
29 prior to April 1, 1991, and shall not apply also to referrals
30 for radiation therapy to be performed at no more than one
31 additional office of any entity qualifying for the foregoing
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1 exception which, prior to February 1, 1992, had a binding
2 purchase contract on and a nonrefundable deposit paid for a
3 linear accelerator to be used at the additional office. The
4 physical site of the radiation treatment centers affected by
5 this provision may be relocated as a result of the following
6 factors: acts of God; fire; strike; accident; war; eminent
7 domain actions by any governmental body; or refusal by the
8 lessor to renew a lease. A relocation for the foregoing
9 reasons is limited to relocation of an existing facility to a
10 replacement location within the county of the existing
11 facility upon written notification to the Office of Licensure
12 and Certification.
13 (j) A health care provider who meets the requirements
14 of paragraphs (b) and (i) must disclose his or her investment
15 interest to his or her patients as provided in s. 455.701.
16 Section 2. The agency shall require registration by
17 all group practices providing diagnostic imaging services,
18 regardless of ownership. Registration information must include
19 the medical specialty of each physician; address and phone
20 number of the group; UPIN numbers for the group and each group
21 member; and Medicare, Medicaid, and commercial billing numbers
22 for the group. The agency shall complete the registration by
23 December 31, 1999.
24 Section 3. Section 4 of chapter 98-192, Laws of
25 Florida, is amended to read:
26 Section 4. This act shall take effect July 1, 1998.
27 However, if the Agency for Health Care Administration between
28 April 15, 1999 and November 15, 1999 receives written
29 certification from the federal Health Care Financing
30 Administration that the amendments enacted herein to s.
31 395.701, F.S. or s. 395.7015, F.S., violate federal
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1 regulations regarding permissible state health care taxes
2 which would cause the state to be denied federal Medicaid
3 funds, then the amendment to the individual section contained
4 herein and so identified by the Health Care Financing
5 Administration as violating federal law hereby stands
6 repealed. Upon receipt of written certification from the
7 Health Care Financing Administration, the Agency for Health
8 Care Administration shall forward such certification to the
9 Secretary of State, the President of the Senate and the
10 Speaker of the House of Representatives with a letter
11 identifying the section or sections which stand repealed
12 consistent with this section. The Secretary of State shall
13 delete the amendment to the section so identified in the
14 official records of the Florida Statutes consistent with this
15 section. The effective date of the repeal of the section
16 contained in the federal certification shall be the date that
17 the notice is received by the Secretary of State., except that
18 the amendment of sections 395.701 and 395.7015, Florida
19 Statutes, by this act shall take effect only upon the Agency
20 for Health Care Administration receiving written confirmation
21 from the federal Health Care Financing Administration that the
22 changes contained in such amendments will not adversely affect
23 the use of the remaining assessments as state match for the
24 state's Medicaid program.
25 Section 4. The Agency for Health Care Administration,
26 in conjunction with other agencies as appropriate shall
27 conduct a detailed study and analysis of clinical laboratory
28 services for kidney dialysis patients in the State of Florida.
29 The study shall include, but not be limited to, an analysis of
30 the past and present utilization rates of clinical laboratory
31 services for dialysis patients; financial arrangements among
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1 kidney dialysis centers, their medical directors, any business
2 relationships and affiliations with clinical laboratories and
3 any self-referral to clinical laboratories; the quality and
4 responsiveness of clinical laboratory services for dialysis
5 patients in Florida; and the average annual revenue for
6 dialysis patients for clinical laboratory services for the
7 past 10 years. The agency shall report its findings to the
8 Legislature by February 1, 2000.
9 Section 5. Each provider of diagnostic cardiac
10 catheterization services shall comply with the requirements of
11 section 408.036(3)(n)2.a.-d., Florida Statutes, and rules of
12 the Agency for Health Care Administration governing the
13 operation of adult inpatient diagnostic cardiac
14 catheterization programs, including the most recent guidelines
15 of the American College of Cardiology and American Heart
16 Association Guidelines for Cardiac Catheterization and Cardiac
17 Catheterization Laboratories.
18 Section 6. Subsections (6) and (7) of section 155.40,
19 Florida Statutes, are added to said section, to read:
20 155.40 Sale or lease of county, district, or municipal
21 hospital.--
22 (6) Unless otherwise expressly stated in the lease
23 documents, the transaction involving the sale or lease of a
24 hospital shall not be construed as:
25 (a) a transfer of a governmental function from the
26 county, district, or municipality to the private purchaser or
27 lessee;
28 (b) constituting a financial interest of the public
29 lessor in the private lessee; or
30 (c) making a private lessee an integral part of the
31 public lessor's decision-making process.
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1 (7) The lessee of a hospital, pursuant to this section
2 or any special act of the legislature, operating under a lease
3 shall not be construed to be "acting on behalf of" the lessor
4 as that term is used in statute, unless the lease document
5 expressly provides to the contrary.
6 Section 7. Subsection (3) is added to section 455.651,
7 Florida Statutes, 1998 Supplement, to read:
8 455.651 Disclosure of confidential information.--
9 (3) Any person injured as a result of a willful
10 violation of this section shall have a civil cause of action
11 for treble damages, reasonable attorney's fees, and costs.
12 Section 8. Subsections (4) and (7) of section 409.910,
13 Florida Statutes, 1998 Supplement, are amended to read:
14 409.910 Responsibility for payments on behalf of
15 Medicaid-eligible persons when other parties are liable.--
16 (4) After the department has provided medical
17 assistance under the Medicaid program, it shall seek recovery
18 of reimbursement from third-party benefits to the limit of
19 legal liability and for the full amount of third-party
20 benefits, but not in excess of the amount of medical
21 assistance paid by Medicaid, as to:
22 (a) Claims for which the department has a waiver
23 pursuant to federal law; or
24 (b) Situations in which the department learns of the
25 existence of a liable third party or in which third-party
26 benefits are discovered or become available after medical
27 assistance has been provided by Medicaid.
28 (7) The department shall recover the full amount of
29 all medical assistance provided by Medicaid on behalf of the
30 recipient to the full extent of third-party benefits.
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HB 2231, Second Engrossed
1 (a) Recovery of such benefits shall be collected
2 directly from:
3 1. Any third party;
4 2. The recipient or legal representative, if he or she
5 has received third-party benefits;
6 3. The provider of a recipient's medical services if
7 third-party benefits have been recovered by the provider;
8 notwithstanding any provision of this section, to the
9 contrary, however, no provider shall be required to refund or
10 pay to the department any amount in excess of the actual
11 third-party benefits received by the provider from a
12 third-party payor for medical services provided to the
13 recipient; or
14 4. Any person who has received the third-party
15 benefits.
16 (b) Upon receipt of any recovery or other collection
17 pursuant to this section, the department shall distribute the
18 amount collected as follows:
19 1. To itself, an amount equal to the state Medicaid
20 expenditures for the recipient plus any incentive payment made
21 in accordance with paragraph (14)(a).
22 2. To the Federal Government, the federal share of the
23 state Medicaid expenditures minus any incentive payment made
24 in accordance with paragraph (14)(a) and federal law, and
25 minus any other amount permitted by federal law to be
26 deducted.
27 3. To the recipient, after deducting any known amounts
28 owed to the department for any related medical assistance or
29 to health care providers, any remaining amount. This amount
30 shall be treated as income or resources in determining
31 eligibility for Medicaid.
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HB 2231, Second Engrossed
1
2 The provisions of this subsection do not apply to any proceeds
3 received by the state, or any agency thereof, pursuant to a
4 final order, judgment, or settlement agreement, in any matter
5 in which the state asserts claims brought on its own behalf,
6 and not as a subrogee of a recipient, or under other theories
7 of liability. The provisions of this subsection do not apply
8 to any proceeds received by the state, or an agency thereof,
9 pursuant to a final order, judgment, or settlement agreement,
10 in any matter in which the state asserted both claims as a
11 subrogee and additional claims, except as to those sums
12 specifically identified in the final order, judgment, or
13 settlement agreement as reimbursements to the recipient as
14 expenditures for the named recipient on the subrogation claim.
15 Section 9. The amendments to section 409.910, Florida
16 Statutes, 1998 Supplement, made by this act are intended to
17 clarify existing law and are remedial in nature. As such,
18 they are specifically made retroactive to October 1, 1990, and
19 shall apply to all causes of action arising on or after
20 October 1, 1990.
21 Section 10. Section 381.100, Florida Statutes, is
22 created to read:
23 381.100 Short title.--Sections 381.100-381.103 may be
24 cited as the "Florida Community Health Protection Act."
25 Section 11. Section 381.102, Florida Statutes, is
26 created to read:
27 381.102 Community Health pilot projects.--
28 (1) The Legislature has determined that:
29 (a) The state is committed to the economic,
30 environmental, and public health revitalization of its
31 communities;
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HB 2231, Second Engrossed
1 (b) Measures to address the public health needs of
2 low-income communities in urban and rural areas must be
3 implemented in order to ensure the sustainability of these
4 communities;
5 (c) The implementation of these measures will enhance
6 cooperative efforts among the private sector, government, and
7 nonprofit organizations in this state to ensure the
8 sustainability of Florida; and
9 (d) It would be beneficial to provide resources in
10 this state to undertake a series of pilot projects that
11 demonstrate techniques and approaches to ensure health care
12 for disease prevention and health promotion for low-income
13 persons who are living in urban and rural communities.
14 (2) Community Health pilot projects are hereby
15 established to promote disease prevention and health promotion
16 among low-income persons living in urban and rural
17 communities.
18 (3) The pilot projects may form partnerships with
19 existing health care providers and units, contribute to a
20 health care needs assessment, provide research capacity to
21 improve health status, and serve as the basis for health care
22 capacity in urban and rural communities.
23 (4) The following pilot projects are created:
24 (a) In Pinellas County, for the Greenwood Community
25 Health Center in Clearwater.
26 (b) In Escambia County, for the low-income communities
27 within the Palafox Redevelopment Area.
28 (c) In Hillsborough, Pasco, Pinellas, and Manatee
29 counties for the Urban League of Pinellas County, to operate
30 its mobile health screening unit to provide public health care
31 to persons living in low-income urban and rural communities.
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HB 2231, Second Engrossed
1 (d) In Palm Beach County, for the low-income
2 communities within the City of Riviera Beach.
3 (e) In the City of St. Petersburg, for the low-income
4 communities within the Challenge 2001 Area.
5 (f) In Broward County, the communities immediately
6 surrounding the Miles Health Center in Ft. Lauderdale.
7 Section 12. Section 381.103, Florida Statutes, is
8 created to read:
9 381.103 Community Health Pilot Projects; duties of
10 department.--To the extent feasible, the department may:
11 (1) Assist the pilot projects in development and
12 implementation of their community programs by acting as the
13 granting agency and contracting with the pilot projects.
14 (2) Facilitate the integration of the pilot projects
15 with ongoing departmental programs, so that duplication of
16 services is avoided and synergy between the programs enhanced.
17 (3) Develop educational and outreach programs for
18 health care providers and communities that increase awareness
19 of health care needs for low-income persons living in urban
20 and rural communities.
21 (4) Assist the pilot projects in obtaining low-cost
22 health care services designed to prevent disease and promote
23 health in low-income communities.
24 (5) Prepare a report to be submitted to the President
25 of the Senate, the Speaker of the House of Representatives,
26 and the Governor on the findings, accomplishments, and
27 recommendations of the Community Health pilot projects by or
28 on January 1, 2001.
29 (6) Facilitate cooperation between affected
30 communities, appropriate agencies, and ongoing initiatives,
31 such as Front Porch Florida.
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HB 2231, Second Engrossed
1 Section 13. Subsection (18) is added to section
2 627.6472, Florida Statutes, 1998 Supplement, to read:
3 627.6472 Exclusive provider organizations.--
4 (18) Each organization shall allow, without prior
5 authorization, a female subscriber to visit a contracted
6 obstetrician/gynecologist for one annual visit and medically
7 necessary follow-up care detected at that visit. Nothing in
8 this subsection shall prevent an organization from requiring
9 that an obstetrician/gynecologist treating a covered patient
10 coordinate the medical care through the patient's primary care
11 physician, if applicable.
12 Section 14. Subsection (11) is added to section
13 641.51, Florida Statutes, to read:
14 641.51 Quality assurance program; second medical
15 opinion requirement.--
16 (11) Each organization shall allow, without prior
17 authorization, a female subscriber, to visit a contracted
18 obstetrician/gynecologist for one annual visit and for
19 medically necessary follow-up care detected at that visit.
20 Nothing in this subsection shall prevent an organization from
21 requiring that an obstetrician/gynecologist treating a covered
22 patient coordinate the medical care through the patient's
23 primary care physician, if applicable.
24 Section 15. This act shall take effect July 1, 1999,
25 except that sections 10 and 11 of this act shall take effect
26 October 1, 1999, and shall apply to contracts issued or
27 renewed on or after that date.
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