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


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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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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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                                         HB 2231, Second Engrossed



  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.

31


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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.

28

29

30

31


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