Senate Bill 1932

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    Florida Senate - 2000                                  SB 1932

    By Senator Silver





    38-1289-00                                          See HB 567

  1                      A bill to be entitled

  2         An act relating to nursing; amending part XV of

  3         chapter 468, F.S., relating to certified

  4         nursing assistants, and transferring that part

  5         to chapter 464, F.S., relating to nursing, to

  6         transfer from the Department of Health to the

  7         Board of Nursing responsibility and rulemaking

  8         authority for regulation of certified nursing

  9         assistants; transferring from the Department of

10         Education to the board responsibility for

11         approval of training programs; revising grounds

12         for which the board may impose certain

13         penalties; amending ss. 20.43, 39.01, 39.304,

14         110.131, 232.46, 240.4075, 246.081, 310.102,

15         381.0302, 384.30, 384.31, 394.455, 395.0191,

16         400.021, 400.211, 400.402, 400.407, 400.4255,

17         400.426, 400.462, 400.464, 400.506, 400.6105,

18         401.23, 401.252, 408.07, 408.706, 409.908,

19         415.1085, 455.501, 455.597, 455.604, 455.621,

20         455.664, 455.667, 455.677, 455.687, 455.694,

21         455.707, 458.348, 464.001, 464.002, 464.003,

22         464.006, 464.009, 464.016, 464.018, 464.019,

23         464.022, 464.023, 464.027, 466.003, 467.003,

24         467.0125, 467.203, 468.505, 483.041, 483.801,

25         491.0112, 550.24055, 627.351, 627.357,

26         627.9404, 641.31, 766.101, 766.110, 766.1115,

27         877.111, 945.602, 960.28, 984.03, and 985.03,

28         F.S.; revising references, to conform;

29         requiring hospitals, home health agencies, and

30         other health agencies to submit to the board

31         the names and work titles of certain employees;

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1         amending ss. 455.557, 455.565, and 464.012,

  2         F.S.; including advanced registered nurse

  3         practitioners under the practitioner profiling

  4         and credentialing programs; requiring

  5         applicants for certification or renewal of

  6         certification as an advanced registered nurse

  7         practitioner to submit information,

  8         fingerprints, and fees for such purposes;

  9         providing for citations to, and fines of,

10         applicants failing to comply; providing an

11         effective date.

12

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

14

15         Section 1.  Sections 468.821 through 468.829, Florida

16  Statutes, are renumbered as sections 464.201 through 464.209,

17  respectively, designated as part II of chapter 464, Florida

18  Statutes, and amended to read:

19         464.201 468.821  Definitions.--As used in this part,

20  the term:

21         (1)  "Approved training program" means:

22         (a)  A course of training conducted by a public sector

23  or private sector educational center licensed by the

24  Department of Education to implement the basic curriculum for

25  nursing assistants which is approved by the Department of

26  Education. Beginning October 1, 2000, the board shall assume

27  responsibility for approval of training programs under this

28  paragraph.

29         (b)  A training program operated under s. 400.141.

30         (2)  "Board" means the Board of Nursing.

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1         (3)(2)  "Certified nursing assistant" means a person

  2  who meets the qualifications specified in this part and who is

  3  certified by the board department as a certified nursing

  4  assistant.

  5         (4)(3)  "Department" means the Department of Health.

  6         (5)(4)  "Registry" means the listing of certified

  7  nursing assistants maintained by the board department.

  8         464.202 468.822  Duties and powers of the board

  9  department.--The board department shall maintain, or contract

10  with or approve another entity to maintain, a state registry

11  of certified nursing assistants. The registry must consist of

12  the name of each certified nursing assistant in this state;

13  other identifying information defined by board department

14  rule; certification status; the effective date of

15  certification; other information required by state or federal

16  law; information regarding any crime or any abuse, neglect, or

17  exploitation as provided under chapter 435; and any

18  disciplinary action taken against the certified nursing

19  assistant. The registry shall be accessible to the public, the

20  certificateholder, employers, and other state agencies. The

21  board department shall adopt by rule testing procedures for

22  use in certifying nursing assistants and shall adopt rules

23  regulating the practice of certified nursing assistants to

24  enforce this part. The board department may contract with or

25  approve another entity or organization to provide the

26  examination services, including the development and

27  administration of examinations. The provider shall pay all

28  reasonable costs and expenses incurred by the board department

29  in evaluating the provider's application and performance

30  during the delivery of services, including examination

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  services and procedures for maintaining the certified nursing

  2  assistant registry.

  3         464.203 468.823  Certified nursing assistants;

  4  certification requirement.--

  5         (1)  The board department shall issue a certificate to

  6  practice as a certified nursing assistant to any person who

  7  demonstrates to the board a minimum competency to read and

  8  write and meets one of the following requirements:

  9         (a)  Has successfully completed an approved training

10  program and achieved a minimum score, established by rule of

11  the board department, on the nursing assistant competency

12  examination, which consists of a written portion and

13  skills-demonstration portion approved by the board department

14  and administered at a site and by personnel approved by the

15  department.

16         (b)  Has achieved a minimum score, established by rule

17  of the board department, on the nursing assistant competency

18  examination, which consists of a written portion and

19  skills-demonstration portion, approved by the board department

20  and administered at a site and by personnel approved by the

21  department and:

22         1.  Has a high school diploma, or its equivalent; or

23         2.  Is at least 18 years of age.

24         (c)  Is currently certified in another state; is listed

25  on that state's certified nursing assistant registry; has not

26  been found to have committed abuse, neglect, or exploitation

27  in that state; and has successfully completed a national

28  nursing assistant evaluation in order to receive certification

29  in that state.

30         (2)  If an applicant fails to pass the nursing

31  assistant competency examination in three attempts, the

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  applicant is not eligible for reexamination unless the

  2  applicant completes an approved training program.

  3         (3)  An oral examination shall be administered as a

  4  substitute for the written portion of the examination upon

  5  request. The oral examination shall be administered at a site

  6  and by personnel approved by the department.

  7         (4)  The board department shall adopt rules to provide

  8  for the initial certification of certified nursing assistants.

  9         (5)  A certified nursing assistant shall maintain a

10  current address with the board department in accordance with

11  s. 455.717.

12         464.204 468.824  Denial, suspension, or revocation of

13  certification; disciplinary actions.--

14         (1)  The following acts constitute grounds for which

15  the board department may impose disciplinary sanctions as

16  specified in subsection (2):

17         (a)  Obtaining or attempting to obtain certification or

18  an exemption, or possessing or attempting to possess

19  certification or a letter of exemption, by bribery,

20  misrepresentation, deceit, or through an error of the board

21  department.

22         (b)  Intentionally Violating any provision of this

23  chapter, chapter 455, or the rules adopted by the board

24  department.

25         (2)  When the board department finds any person guilty

26  of any of the grounds set forth in subsection (1), it may

27  enter an order imposing one or more of the following

28  penalties:

29         (a)  Denial, suspension, or revocation of

30  certification.

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  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 board 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. After January 1, 2000, The board department must

12  notify an applicant seeking an exemption from disqualification

13  from certification or employment of its decision to approve or

14  deny the request within 30 days after the date the board

15  department receives all required documentation.

16         464.205 468.825  Availability of disciplinary records

17  and proceedings.--Pursuant to s. 455.621, any complaint or

18  record maintained by the department of Health pursuant to the

19  discipline of a certified nursing assistant and any proceeding

20  held by the board department to discipline a certified nursing

21  assistant shall remain open and available to the public.

22         464.206 468.826  Exemption from liability.--If an

23  employer terminates or denies employment to a certified

24  nursing assistant whose certification is inactive as shown on

25  the certified nursing assistant registry or whose name appears

26  on the central abuse registry and tracking system of the

27  Department of Children and Family Services or on a criminal

28  screening report of the Department of Law Enforcement, the

29  employer is not civilly liable for such termination and a

30  cause of action may not be brought against the employer for

31  damages, regardless of whether the employee has filed for an

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  exemption from the board department under s. 464.204(3)

  2  468.824(1). There may not be any monetary liability on the

  3  part of, and a cause of action for damages may not arise

  4  against, any licensed facility, its governing board or members

  5  thereof, medical staff, disciplinary board, agents,

  6  investigators, witnesses, employees, or any other person for

  7  any action taken in good faith without intentional fraud in

  8  carrying out this section.

  9         464.207 468.827  Penalties.--It is a misdemeanor of the

10  first degree, punishable as provided under s. 775.082 or s.

11  775.083, for any person, knowingly or intentionally, to fail

12  to disclose, by false statement, misrepresentation,

13  impersonation, or other fraudulent means, in any application

14  for voluntary or paid employment or certification licensure

15  regulated under this part, a material fact used in making a

16  determination as to such person's qualifications to be an

17  employee or certificateholder licensee.

18         464.208 468.828  Background screening information;

19  rulemaking authority.--

20         (1)  The Agency for Health Care Administration shall

21  allow the board department to electronically access its

22  background screening database and records, and the Department

23  of Children and Family Services shall allow the board

24  department to electronically access its central abuse registry

25  and tracking system under 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 relating to

29  vulnerable adults for any purpose other than determining if

30  the person meets the requirements of this part. Such records

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  and information obtained by the board department shall remain

  2  confidential and 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 board department shall adopt rules to

10  administer this part.

11         464.209 468.829  Certified nursing assistant

12  registry.--

13         (1)  By October 1, 1999, and by October 1 of every year

14  thereafter, each employer of certified nursing assistants

15  shall submit to the board Department of Health a list of the

16  names and social security numbers of each person employed by

17  the employer as a certified nursing assistant in a

18  nursing-related occupation for a minimum of 8 hours for

19  monetary compensation during the preceding 24 months.

20  Employers may submit such information electronically through

21  the department's Internet site.

22         (2)  The board department shall update the certified

23  nursing assistant registry upon receipt of the lists of

24  certified nursing assistants, and shall complete the first of

25  such updates by December 31, 1999.

26         (3)  Each certified nursing assistant whose name is not

27  reported to the board department under subsection (1) on

28  October 1, 1999, shall be assigned an inactive certification

29  on January 1, 2000. A certified nursing assistant may remove

30  such an inactive certification by submitting documentation to

31  the board department that he or she was employed for a minimum

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  of 8 hours for monetary compensation as a certified nursing

  2  assistant in a nursing-related occupation during the preceding

  3  24 months.

  4         (4)  This section is repealed October 2, 2001.

  5         Section 2.  Paragraph (g) of subsection (3) of section

  6  20.43, Florida Statutes, is amended to read:

  7         20.43  Department of Health.--There is created a

  8  Department of Health.

  9         (3)  The following divisions of the Department of

10  Health are established:

11         (g)  Division of Medical Quality Assurance, which is

12  responsible for the following boards and professions

13  established within the division:

14         1.  Nursing assistants, as provided under s. 400.211.

15         1.2.  Health care services pools, as provided under s.

16  402.48.

17         2.3.  The Board of Acupuncture, created under chapter

18  457.

19         3.4.  The Board of Medicine, created under chapter 458.

20         4.5.  The Board of Osteopathic Medicine, created under

21  chapter 459.

22         5.6.  The Board of Chiropractic Medicine, created under

23  chapter 460.

24         6.7.  The Board of Podiatric Medicine, created under

25  chapter 461.

26         7.8.  Naturopathy, as provided under chapter 462.

27         8.9.  The Board of Optometry, created under chapter

28  463.

29         9.10.  The Board of Nursing, created under part I of

30  chapter 464.

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1         10.  Nursing assistants, as provided under part II of

  2  chapter 464.

  3         11.  The Board of Pharmacy, created under chapter 465.

  4         12.  The Board of Dentistry, created under chapter 466.

  5         13.  Midwifery, as provided under chapter 467.

  6         14.  The Board of Speech-Language Pathology and

  7  Audiology, created under part I of chapter 468.

  8         15.  The Board of Nursing Home Administrators, created

  9  under part II of chapter 468.

10         16.  The Board of Occupational Therapy, created under

11  part III of chapter 468.

12         17.  Respiratory therapy, as provided under part V of

13  chapter 468.

14         18.  Dietetics and nutrition practice, as provided

15  under part X of chapter 468.

16         19.  The Board of Athletic Training, created under part

17  XIII of chapter 468.

18         20.  The Board of Orthotists and Prosthetists, created

19  under part XIV of chapter 468.

20         21.  Electrolysis, as provided under chapter 478.

21         22.  The Board of Massage Therapy, created under

22  chapter 480.

23         23.  The Board of Clinical Laboratory Personnel,

24  created under part III of chapter 483.

25         24.  Medical physicists, as provided under part IV of

26  chapter 483.

27         25.  The Board of Opticianry, created under part I of

28  chapter 484.

29         26.  The Board of Hearing Aid Specialists, created

30  under part II of chapter 484.

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1         27.  The Board of Physical Therapy Practice, created

  2  under chapter 486.

  3         28.  The Board of Psychology, created under chapter

  4  490.

  5         29.  School psychologists, as provided under chapter

  6  490.

  7         30.  The Board of Clinical Social Work, Marriage and

  8  Family Therapy, and Mental Health Counseling, created under

  9  chapter 491.

10

11  The department may contract with the Agency for Health Care

12  Administration who shall provide consumer complaint,

13  investigative, and prosecutorial services required by the

14  Division of Medical Quality Assurance, councils, or boards, as

15  appropriate.

16         Section 3.  Subsection (38) of section 39.01, Florida

17  Statutes, is amended to read:

18         39.01  Definitions.--When used in this chapter, unless

19  the context otherwise requires:

20         (38)  "Licensed health care professional" means a

21  physician licensed under chapter 458, an osteopathic physician

22  licensed under chapter 459, a nurse licensed under part I of

23  chapter 464, a physician assistant licensed under chapter 458

24  or chapter 459, or a dentist licensed under chapter 466.

25         Section 4.  Paragraph (b) of subsection (1) of section

26  39.304, Florida Statutes, is amended to read:

27         39.304  Photographs, medical examinations, X rays, and

28  medical treatment of abused, abandoned, or neglected child.--

29         (1)

30         (b)  If the areas of trauma visible on a child indicate

31  a need for a medical examination, or if the child verbally

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  complains or otherwise exhibits distress as a result of injury

  2  through suspected child abuse, abandonment, or neglect, or is

  3  alleged to have been sexually abused, the person required to

  4  investigate may cause the child to be referred for diagnosis

  5  to a licensed physician or an emergency department in a

  6  hospital without the consent of the child's parents or legal

  7  custodian. Such examination may be performed by any licensed

  8  physician or an advanced registered nurse practitioner

  9  licensed pursuant to part I of chapter 464. Any licensed

10  physician, or advanced registered nurse practitioner licensed

11  pursuant to part I of chapter 464, who has reasonable cause to

12  suspect that an injury was the result of child abuse,

13  abandonment, or neglect may authorize a radiological

14  examination to be performed on the child without the consent

15  of the child's parent or legal custodian.

16         Section 5.  Paragraph (c) of subsection (6) of section

17  110.131, Florida Statutes, is amended to read:

18         110.131  Other-personal-services temporary

19  employment.--

20         (6)

21         (c)  Notwithstanding the provisions of this section,

22  the agency head or his or her designee may extend the

23  other-personal-services employment of a health care

24  practitioner licensed pursuant to chapter 458, chapter 459,

25  chapter 460, chapter 461, chapter 463, part I of chapter 464,

26  chapter 466, chapter 468, chapter 483, chapter 486, or chapter

27  490 beyond 2,080 hours and may employ such practitioner on an

28  hourly or other basis.

29         Section 6.  Subsection (1) of section 232.46, Florida

30  Statutes, is amended to read:

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1         232.46  Administration of medication by school district

  2  personnel.--

  3         (1)  Notwithstanding the provisions of the Nurse

  4  Practice Act, part I of chapter 464, school district personnel

  5  shall be authorized to assist students in the administration

  6  of prescription medication when the following conditions have

  7  been met:

  8         (a)  Each district school board shall include in its

  9  approved school health services plan a procedure to provide

10  training, by a registered nurse, a licensed practical nurse, a

11  physician licensed pursuant to chapter 458 or chapter 459, or

12  a physician assistant licensed pursuant to chapter 458 or

13  chapter 459, to the school personnel designated by the

14  principal to assist students in the administration of

15  prescribed medication.  Such training may be provided in

16  collaboration with other school districts, through contract

17  with an education consortium, or by any other arrangement

18  consistent with the intent of this section.

19         (b)  Each district school board shall adopt policies

20  and procedures governing the administration of prescription

21  medication by school district personnel.  The policies and

22  procedures shall include, but not be limited to, the following

23  provisions:

24         1.  For each prescribed medication, the student's

25  parent or guardian shall provide to the school principal a

26  written statement which shall grant to the principal or the

27  principal's designee permission to assist in the

28  administration of such medication and which shall explain the

29  necessity for such medication to be provided during the school

30  day, including any occasion when the student is away from

31  school property on official school business. The school

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  principal or the principal's trained designee shall assist the

  2  student in the administration of such medication.

  3         2.  Each prescribed medication to be administered by

  4  school district personnel shall be received, counted, and

  5  stored in its original container. When the medication is not

  6  in use, it shall be stored in its original container in a

  7  secure fashion under lock and key in a location designated by

  8  the principal.

  9         Section 7.  Subsection (6) of section 240.4075, Florida

10  Statutes, is amended to read:

11         240.4075  Nursing Student Loan Forgiveness Program.--

12         (6)  In addition to licensing fees imposed under part I

13  of chapter 464, there is hereby levied and imposed an

14  additional fee of $5, which fee shall be paid upon licensure

15  or renewal of nursing licensure. Revenues collected from the

16  fee imposed in this subsection shall be deposited in the

17  Nursing Student Loan Forgiveness Trust Fund of the Department

18  of Education and will be used solely for the purpose of

19  carrying out the provisions of this section and s. 240.4076.

20  Up to 50 percent of the revenues appropriated to implement

21  this subsection may be used for the nursing scholarship

22  program established pursuant to s. 240.4076.

23         Section 8.  Paragraph (b) of subsection (1) of section

24  246.081, Florida Statutes, is amended to read:

25         246.081  License, certificate of exemption, or

26  authorization required; exceptions.--

27         (1)  The following colleges are not under the

28  jurisdiction of the board and are not required to obtain a

29  license, a certificate of exemption, permission to operate, or

30  an authorization from the board:

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1         (b)  Any college, school, or course licensed or

  2  approved for establishment and operation under part I of

  3  chapter 464, chapter 466, or chapter 475, or any other chapter

  4  of the Florida Statutes, requiring licensing or approval as

  5  defined in ss. 246.011-246.151.

  6         Section 9.  Subsection (2) of section 310.102, Florida

  7  Statutes, is amended to read:

  8         310.102  Treatment programs for impaired pilots and

  9  deputy pilots.--

10         (2)  The department shall retain one or more impaired

11  practitioner consultants as recommended by the committee. A

12  consultant shall be a licensee under the jurisdiction of the

13  Division of Medical Quality Assurance within the Department of

14  Health, and at least one consultant must be a practitioner

15  licensed under chapter 458, chapter 459, or part I of chapter

16  464. The consultant shall assist the probable cause panel and

17  department in carrying out the responsibilities of this

18  section. This shall include working with department

19  investigators to determine whether a pilot or deputy pilot is,

20  in fact, impaired.

21         Section 10.  Subsection (7) of section 381.0302,

22  Florida Statutes, is amended to read:

23         381.0302  Florida Health Services Corps.--

24         (7)  The financial penalty for noncompliance with

25  participation requirements for persons who have received

26  financial payments under subsection (5) or subsection (6)

27  shall be determined in the same manner as in the National

28  Health Services Corps scholarship program.  In addition,

29  noncompliance with participation requirements shall also

30  result in ineligibility for professional licensure or renewal

31  of licensure under chapter 458, chapter 459, chapter 460, part

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  I of chapter 464, chapter 465, or chapter 466.  For a

  2  participant who is unable to participate for reasons of

  3  disability, the penalty is the actual amount of financial

  4  assistance provided to the participant.  Financial penalties

  5  shall be deposited in the Florida Health Services Corps Trust

  6  Fund and shall be used to provide additional scholarship and

  7  financial assistance.

  8         Section 11.  Subsection (1) of section 384.30, Florida

  9  Statutes, is amended to read:

10         384.30  Minors' consent to treatment.--

11         (1)  The department and its authorized representatives,

12  each physician licensed to practice medicine under the

13  provisions of chapter 458 or chapter 459, each health care

14  professional licensed under the provisions of part I of

15  chapter 464 who is acting pursuant to the scope of his or her

16  license, and each public or private hospital, clinic, or other

17  health facility may examine and provide treatment for sexually

18  transmissible diseases to any minor, if the physician, health

19  care professional, or facility is qualified to provide such

20  treatment.  The consent of the parents or guardians of a minor

21  is not a prerequisite for an examination or treatment.

22         Section 12.  Section 384.31, Florida Statutes, is

23  amended to read:

24         384.31  Serological testing of pregnant women; duty of

25  the attendant.--

26         (1)  Every person, including every physician licensed

27  under chapter 458 or chapter 459 or midwife licensed under

28  part I of chapter 464 or chapter 467, attending a pregnant

29  woman for conditions relating to pregnancy during the period

30  of gestation and delivery shall take or cause to be taken a

31  sample of venous blood at a time or times specified by the

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  department.  Each sample of blood shall be tested by a

  2  laboratory approved for such purposes under part I of chapter

  3  483 for sexually transmissible diseases as required by rule of

  4  the department.

  5         (2)  At the time the venous blood sample is taken,

  6  testing for human immunodeficiency virus (HIV) infection shall

  7  be offered to each pregnant woman. The prevailing professional

  8  standard of care in this state requires each health care

  9  provider and midwife who attends a pregnant woman to counsel

10  the woman to be tested for human immunodeficiency virus (HIV).

11  Counseling shall include a discussion of the availability of

12  treatment if the pregnant woman tests HIV positive. If a

13  pregnant woman objects to HIV testing, reasonable steps shall

14  be taken to obtain a written statement of such objection,

15  signed by the patient, which shall be placed in the patient's

16  medical record. Every person, including every physician

17  licensed under chapter 458 or chapter 459 or midwife licensed

18  under part I of chapter 464 or chapter 467, who attends a

19  pregnant woman who has been offered and objects to HIV testing

20  shall be immune from liability arising out of or related to

21  the contracting of HIV infection or acquired immune deficiency

22  syndrome (AIDS) by the child from the mother.

23         Section 13.  Subsection (23) of section 394.455,

24  Florida Statutes, is amended to read:

25         394.455  Definitions.--As used in this part, unless the

26  context clearly requires otherwise, the term:

27         (23)  "Psychiatric nurse" means a registered nurse

28  licensed under part I of chapter 464 who has a master's degree

29  or a doctorate in psychiatric nursing and 2 years of

30  post-master's clinical experience under the supervision of a

31  physician.

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1         Section 14.  Paragraphs (a) and (b) of subsection (2)

  2  and subsection (4) of section 395.0191, Florida Statutes, are

  3  amended to read:

  4         395.0191  Staff membership and clinical privileges.--

  5         (2)(a)  Each licensed facility shall establish rules

  6  and procedures for consideration of an application for

  7  clinical privileges submitted by an advanced registered nurse

  8  practitioner licensed and certified under part I of chapter

  9  464, in accordance with the provisions of this section.  No

10  licensed facility shall deny such application solely because

11  the applicant is licensed under part I of chapter 464 or

12  because the applicant is not a participant in the Florida

13  Birth-Related Neurological Injury Compensation Plan.

14         (b)  An advanced registered nurse practitioner who is

15  certified as a registered nurse anesthetist licensed under

16  part I of chapter 464 shall administer anesthesia under the

17  onsite medical direction of a professional licensed under

18  chapter 458, chapter 459, or chapter 466, and in accordance

19  with an established protocol approved by the medical staff.

20  The medical direction shall specifically address the needs of

21  the individual patient.

22         (4)  Nothing herein shall restrict in any way the

23  authority of the medical staff of a licensed facility to

24  review for approval or disapproval all applications for

25  appointment and reappointment to all categories of staff and

26  to make recommendations on each applicant to the governing

27  board, including the delineation of privileges to be granted

28  in each case.  In making such recommendations and in the

29  delineation of privileges, each applicant shall be considered

30  individually pursuant to criteria for a doctor licensed under

31  chapter 458, chapter 459, chapter 461, or chapter 466, or for

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  an advanced registered nurse practitioner licensed and

  2  certified under part I of chapter 464, or for a psychologist

  3  licensed under chapter 490, as applicable.  The applicant's

  4  eligibility for staff membership or clinical privileges shall

  5  be determined by the applicant's background, experience,

  6  health, training, and demonstrated competency; the applicant's

  7  adherence to applicable professional ethics; the applicant's

  8  reputation; and the applicant's ability to work with others

  9  and by such other elements as determined by the governing

10  board, consistent with this part.

11         Section 15.  Subsection (11) of section 400.021,

12  Florida Statutes, is amended to read:

13         400.021  Definitions.--When used in this part, unless

14  the context otherwise requires, the term:

15         (11)  "Nursing home facility" means any facility which

16  provides nursing services as defined in part I of chapter 464

17  and which is licensed according to this part.

18         Section 16.  Section 400.211, Florida Statutes, is

19  amended to read:

20         400.211  Persons employed as nursing assistants;

21  certification requirement.--

22         (1)  To serve as a nursing assistant in any nursing

23  home, a person must be certified as a nursing assistant under

24  part II XV of chapter 464 468, unless the person is except a

25  registered nurse or practical nurse licensed in accordance

26  with part I of chapter 464 or an applicant for such licensure

27  who is permitted to practice nursing in accordance with rules

28  adopted by the Board of Nursing pursuant to part I of chapter

29  464, to serve as a nursing assistant in any nursing home.

30         (2)  The following categories of persons who are not

31  certified as nursing assistants under this part II of chapter

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  464 may be employed by a nursing facility for a period of 4

  2  months:

  3         (a)  Persons who are enrolled in a state-approved

  4  nursing assistant program; or

  5         (b)  Persons who have been positively verified by the

  6  department a state-approved test site as certified and on the

  7  registry in another state with no findings of abuse, but who

  8  have not completed the written examination required under s.

  9  464.203 this section.

10

11  The certification requirement must be met within 4 months

12  after of initial employment as a nursing assistant in a

13  licensed nursing facility.

14         (3)  Nursing homes shall require persons seeking

15  employment as a certified nursing assistant to submit an

16  employment history to the facility. The facility shall verify

17  the employment history unless, through diligent efforts, such

18  verification is not possible.  There shall be no monetary

19  liability on the part of, and no cause of action for damages

20  shall arise against, a former employer who reasonably and in

21  good faith communicates his or her honest opinion about a

22  former employee's job performance.

23         Section 17.  Subsections (12) and (14) of section

24  400.402, Florida Statutes, are amended to read:

25         400.402  Definitions.--When used in this part, the

26  term:

27         (12)  "Extended congregate care" means acts beyond

28  those authorized in subsection (17) that may be performed

29  pursuant to part I of chapter 464 by persons licensed

30  thereunder while carrying out their professional duties, and

31  other supportive services which may be specified by rule.  The

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    38-1289-00                                          See HB 567




  1  purpose of such services is to enable residents to age in

  2  place in a residential environment despite mental or physical

  3  limitations that might otherwise disqualify them from

  4  residency in a facility licensed under this part.

  5         (14)  "Limited nursing services" means acts that may be

  6  performed pursuant to part I of chapter 464 by persons

  7  licensed thereunder while carrying out their professional

  8  duties but limited to those acts which the department

  9  specifies by rule.  Acts which may be specified by rule as

10  allowable limited nursing services shall be for persons who

11  meet the admission criteria established by the department for

12  assisted living facilities and shall not be complex enough to

13  require 24-hour nursing supervision and may include such

14  services as the application and care of routine dressings, and

15  care of casts, braces, and splints.

16         Section 18.  Paragraphs (a) and (b) of subsection (3)

17  of section 400.407, Florida Statutes, are amended to read:

18         400.407  License required; fee, display.--

19         (3)  Any license granted by the agency must state the

20  maximum resident capacity of the facility, the type of care

21  for which the license is granted, the date the license is

22  issued, the expiration date of the license, and any other

23  information deemed necessary by the agency. Licenses shall be

24  issued for one or more of the following categories of care:

25  standard, extended congregate care, limited nursing services,

26  or limited mental health.

27         (a)  A standard license shall be issued to facilities

28  providing one or more of the services identified in s.

29  400.402. Such facilities may also employ or contract with a

30  person licensed under part I of chapter 464 to administer

31

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    38-1289-00                                          See HB 567




  1  medications and perform other tasks as specified in s.

  2  400.4255.

  3         (b)  An extended congregate care license shall be

  4  issued to facilities providing, directly or through contract,

  5  services beyond those authorized in paragraph (a), including

  6  acts performed pursuant to part I of chapter 464 by persons

  7  licensed thereunder, and supportive services defined by rule

  8  to persons who otherwise would be disqualified from continued

  9  residence in a facility licensed under this part.

10         1.  In order for extended congregate care services to

11  be provided in a facility licensed under this part, the agency

12  must first determine that all requirements established in law

13  and rule are met and must specifically designate, on the

14  facility's license, that such services may be provided and

15  whether the designation applies to all or part of a facility.

16  Such designation may be made at the time of initial licensure

17  or biennial relicensure, or upon request in writing by a

18  licensee under this part. Notification of approval or denial

19  of such request shall be made within 90 days after receipt of

20  such request and all necessary documentation. Existing

21  facilities qualifying to provide extended congregate care

22  services must have maintained a standard license and may not

23  have been subject to administrative sanctions during the

24  previous 2 years, or since initial licensure if the facility

25  has been licensed for less than 2 years, for any of the

26  following reasons:

27         a.  A class I or class II violation;

28         b.  Three or more repeat or recurring class III

29  violations of identical or similar resident care standards as

30  specified in rule from which a pattern of noncompliance is

31  found by the agency;

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  1         c.  Three or more class III violations that were not

  2  corrected in accordance with the corrective action plan

  3  approved by the agency;

  4         d.  Violation of resident care standards resulting in a

  5  requirement to employ the services of a consultant pharmacist

  6  or consultant dietitian;

  7         e.  Denial, suspension, or revocation of a license for

  8  another facility under this part in which the applicant for an

  9  extended congregate care license has at least 25 percent

10  ownership interest; or

11         f.  Imposition of a moratorium on admissions or

12  initiation of injunctive proceedings.

13         2.  Facilities that are licensed to provide extended

14  congregate care services shall maintain a written progress

15  report on each person who receives such services, which report

16  describes the type, amount, duration, scope, and outcome of

17  services that are rendered and the general status of the

18  resident's health.  A registered nurse, or appropriate

19  designee, representing the agency shall visit such facilities

20  at least two times a year to monitor residents who are

21  receiving extended congregate care services and to determine

22  if the facility is in compliance with this part and with rules

23  that relate to extended congregate care. One of these visits

24  may be in conjunction with the regular biennial survey.  The

25  monitoring visits may be provided through contractual

26  arrangements with appropriate community agencies.  A

27  registered nurse shall serve as part of the team that

28  biennially inspects such facility. The agency may waive one of

29  the required yearly monitoring visits for a facility that has

30  been licensed for at least 24 months to provide extended

31  congregate care services, if, during the biennial inspection,

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  1  the registered nurse determines that extended congregate care

  2  services are being provided appropriately, and if the facility

  3  has no class I or class II violations and no uncorrected class

  4  III violations. Before such decision is made, the agency shall

  5  consult with the long-term care ombudsman council for the area

  6  in which the facility is located to determine if any

  7  complaints have been made and substantiated about the quality

  8  of services or care.  The agency may not waive one of the

  9  required yearly monitoring visits if complaints have been made

10  and substantiated.

11         3.  Facilities that are licensed to provide extended

12  congregate care services shall:

13         a.  Demonstrate the capability to meet unanticipated

14  resident service needs.

15         b.  Offer a physical environment that promotes a

16  homelike setting, provides for resident privacy, promotes

17  resident independence, and allows sufficient congregate space

18  as defined by rule.

19         c.  Have sufficient staff available, taking into

20  account the physical plant and firesafety features of the

21  building, to assist with the evacuation of residents in an

22  emergency, as necessary.

23         d.  Adopt and follow policies and procedures that

24  maximize resident independence, dignity, choice, and

25  decisionmaking to permit residents to age in place to the

26  extent possible, so that moves due to changes in functional

27  status are minimized or avoided.

28         e.  Allow residents or, if applicable, a resident's

29  representative, designee, surrogate, guardian, or attorney in

30  fact to make a variety of personal choices, participate in

31

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  1  developing service plans, and share responsibility in

  2  decisionmaking.

  3         f.  Implement the concept of managed risk.

  4         g.  Provide, either directly or through contract, the

  5  services of a person licensed pursuant to part I of chapter

  6  464.

  7         h.  In addition to the training mandated in s. 400.452,

  8  provide specialized training as defined by rule for facility

  9  staff.

10         4.  Facilities licensed to provide extended congregate

11  care services are exempt from the criteria for continued

12  residency as set forth in rules adopted under s. 400.441.

13  Facilities so licensed shall adopt their own requirements

14  within guidelines for continued residency set forth by the

15  department in rule.  However, such facilities may not serve

16  residents who require 24-hour nursing supervision. Facilities

17  licensed to provide extended congregate care services shall

18  provide each resident with a written copy of facility policies

19  governing admission and retention.

20         5.  The primary purpose of extended congregate care

21  services is to allow residents, as they become more impaired,

22  the option of remaining in a familiar setting from which they

23  would otherwise be disqualified for continued residency.  A

24  facility licensed to provide extended congregate care services

25  may also admit an individual who exceeds the admission

26  criteria for a facility with a standard license, if the

27  individual is determined appropriate for admission to the

28  extended congregate care facility.

29         6.  Before admission of an individual to a facility

30  licensed to provide extended congregate care services, the

31  individual must undergo a medical examination as provided in

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  s. 400.426(4) and the facility must develop a preliminary

  2  service plan for the individual.

  3         7.  When a facility can no longer provide or arrange

  4  for services in accordance with the resident's service plan

  5  and needs and the facility's policy, the facility shall make

  6  arrangements for relocating the person in accordance with s.

  7  400.428(1)(k).

  8         8.  Failure to provide extended congregate care

  9  services may result in denial of extended congregate care

10  license renewal.

11         9.  No later than January 1 of each year, the

12  department, in consultation with the agency, shall prepare and

13  submit to the Governor, the President of the Senate, the

14  Speaker of the House of Representatives, and the chairs of

15  appropriate legislative committees, a report on the status of,

16  and recommendations related to, extended congregate care

17  services. The status report must include, but need not be

18  limited to, the following information:

19         a.  A description of the facilities licensed to provide

20  such services, including total number of beds licensed under

21  this part.

22         b.  The number and characteristics of residents

23  receiving such services.

24         c.  The types of services rendered that could not be

25  provided through a standard license.

26         d.  An analysis of deficiencies cited during biennial

27  inspections.

28         e.  The number of residents who required extended

29  congregate care services at admission and the source of

30  admission.

31

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  1         f.  Recommendations for statutory or regulatory

  2  changes.

  3         g.  The availability of extended congregate care to

  4  state clients residing in facilities licensed under this part

  5  and in need of additional services, and recommendations for

  6  appropriations to subsidize extended congregate care services

  7  for such persons.

  8         h.  Such other information as the department considers

  9  appropriate.

10         Section 19.  Paragraphs (a) and (c) of subsection (1)

11  and subsection (2) of section 400.4255, Florida Statutes, are

12  amended to read:

13         400.4255  Use of personnel; emergency care.--

14         (1)(a)  Persons under contract to the facility,

15  facility staff, or volunteers, who are licensed according to

16  part I of chapter 464, or those persons exempt under s.

17  464.022(1), and others as defined by rule, may administer

18  medications to residents, take residents' vital signs, manage

19  individual weekly pill organizers for residents who

20  self-administer medication, give prepackaged enemas ordered by

21  a physician, observe residents, document observations on the

22  appropriate resident's record, report observations to the

23  resident's physician, and contract or allow residents or a

24  resident's representative, designee, surrogate, guardian, or

25  attorney in fact to contract with a third party, provided

26  residents meet the criteria for appropriate placement as

27  defined in s. 400.426.  Nursing assistants certified pursuant

28  to part II of chapter 464 s. 400.211 may take residents' vital

29  signs as directed by a licensed nurse or physician.

30         (c)  In an emergency situation, licensed personnel may

31  carry out their professional duties pursuant to part I of

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  1  chapter 464 until emergency medical personnel assume

  2  responsibility for care.

  3         (2)  In facilities licensed to provide extended

  4  congregate care, persons under contract to the facility,

  5  facility staff, or volunteers, who are licensed according to

  6  part I of chapter 464, or those persons exempt under s.

  7  464.022(1), or those persons certified as nursing assistants

  8  pursuant to part II of chapter 464 s. 400.211, may also

  9  perform all duties within the scope of their license or

10  certification, as approved by the facility administrator and

11  pursuant to this part.

12         Section 20.  Subsection (3) of section 400.426, Florida

13  Statutes, is amended to read:

14         400.426  Appropriateness of placements; examinations of

15  residents.--

16         (3)  Persons licensed under part I of chapter 464 who

17  are employed by or under contract with a facility shall, on a

18  routine basis or at least monthly, perform a nursing

19  assessment of the residents for whom they are providing

20  nursing services ordered by a physician, except administration

21  of medication, and shall document such assessment, including

22  any substantial changes in a resident's status which may

23  necessitate relocation to a nursing home, hospital, or

24  specialized health care facility.  Such records shall be

25  maintained in the facility for inspection by the agency and

26  shall be forwarded to the resident's case manager, if

27  applicable.

28         Section 21.  Subsections (3) and (21) of section

29  400.462, Florida Statutes, are amended to read:

30         400.462  Definitions.--As used in this part, the term:

31

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  1         (3)  "Certified nursing assistant" means any person who

  2  has been issued a certificate under part II of chapter 464 s.

  3  400.211. The licensed home health agency or licensed nurse

  4  registry shall ensure that the certified nursing assistant

  5  employed by or under contract with the home health agency or

  6  licensed nurse registry is adequately trained to perform the

  7  tasks of a home health aide in the home setting.

  8         (21)  "Skilled care" means nursing services or

  9  therapeutic services delivered by a health care professional

10  who is licensed under part I of chapter 464; part I, part III,

11  or part V of chapter 468; or chapter 486 and who is employed

12  by or under contract with a licensed home health agency or is

13  referred by a licensed nurse registry.

14         Section 22.  Paragraph (c) of subsection (6) of section

15  400.464, Florida Statutes, is amended to read:

16         400.464  Home health agencies to be licensed;

17  expiration of license; exemptions; unlawful acts; penalties.--

18         (6)  The following are exempt from the licensure

19  requirements of this part:

20         (c)  A health care professional, whether or not

21  incorporated, who is licensed under chapter 457; chapter 458;

22  chapter 459; part I of chapter 464; chapter 467; part I, part

23  III, part V, or part X of chapter 468; chapter 480; chapter

24  486; chapter 490; or chapter 491; and who is acting alone

25  within the scope of his or her professional license to provide

26  care to patients in their homes.

27         Section 23.  Paragraph (a) of subsection (10),

28  subsection (11), and paragraph (a) of subsection (15) of

29  section 400.506, Florida Statutes, are amended to read:

30         400.506  Licensure of nurse registries; requirements;

31  penalties.--

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    38-1289-00                                          See HB 567




  1         (10)(a)  A nurse registry may refer for contract in

  2  private residences registered nurses and licensed practical

  3  nurses registered and licensed under part I of chapter 464,

  4  certified nursing assistants certified under part II of

  5  chapter 464 s. 400.211, home health aides who present

  6  documented proof of successful completion of the training

  7  required by rule of the agency, and companions or homemakers

  8  for the purposes of providing those services authorized under

  9  s. 400.509(1). Each person referred by a nurse registry must

10  provide current documentation that he or she is free from

11  communicable diseases.

12         (11)  A person who is referred by a nurse registry for

13  contract in private residences and who is not a nurse licensed

14  under part I of chapter 464 may perform only those services or

15  care to clients that the person has been certified to perform

16  or trained to perform as required by law or rules of the

17  Agency for Health Care Administration or the Department of

18  Business and Professional Regulation. Providing services

19  beyond the scope authorized under this subsection constitutes

20  the unauthorized practice of medicine or a violation of the

21  Nurse Practice Act and is punishable as provided under chapter

22  458, chapter 459, or part I of chapter 464.

23         (15)  All persons referred for contract in private

24  residences by a nurse registry must comply with the following

25  requirements for a plan of treatment:

26         (a)  When, in accordance with the privileges and

27  restrictions imposed upon a nurse under part I of chapter 464,

28  the delivery of care to a patient is under the direction or

29  supervision of a physician or when a physician is responsible

30  for the medical care of the patient, a medical plan of

31  treatment must be established for each patient receiving care

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    38-1289-00                                          See HB 567




  1  or treatment provided by a licensed nurse in the home.  The

  2  original medical plan of treatment must be timely signed by

  3  the physician and reviewed by him or her in consultation with

  4  the licensed nurse at least every 2 months.  Any additional

  5  order or change in orders must be obtained from the physician

  6  and reduced to writing and timely signed by the physician.

  7  The delivery of care under a medical plan of treatment must be

  8  substantiated by the appropriate nursing notes or

  9  documentation made by the nurse in compliance with nursing

10  practices established under part I of chapter 464.

11         Section 24.  Subsections (2) and (3) of section

12  400.6105, Florida Statutes, are amended to read:

13         400.6105  Staffing and personnel.--

14         (2)  Each hospice shall employ a full-time registered

15  nurse licensed pursuant to part I of chapter 464 who shall

16  coordinate the implementation of the plan of care for each

17  patient.

18         (3)  A hospice shall employ a hospice care team or

19  teams who shall participate in the establishment and ongoing

20  review of the patient's plan of care, and be responsible for

21  and supervise the delivery of hospice care and services to the

22  patient. The team shall, at a minimum, consist of a physician

23  licensed pursuant to chapter 458 or chapter 459, a nurse

24  licensed pursuant to part I of chapter 464, a social worker,

25  and a pastoral or other counselor. The composition of the team

26  may vary for each patient and, over time, for the same patient

27  to ensure that all the patient's needs and preferences are

28  met.

29         Section 25.  Subsection (20) of section 401.23, Florida

30  Statutes, is amended to read:

31         401.23  Definitions.--As used in this part, the term:

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  1         (20)  "Registered nurse" means a practitioner who is

  2  licensed to practice professional nursing pursuant to part I

  3  of chapter 464.

  4         Section 26.  Paragraph (c) of subsection (1) of section

  5  401.252, Florida Statutes, is amended to read:

  6         401.252  Interfacility transfer.--

  7         (1)  A licensed basic or advanced life support

  8  ambulance service may conduct interfacility transfers in a

  9  permitted ambulance, using a registered nurse in place of an

10  emergency medical technician or paramedic, if:

11         (c)  The registered nurse operates within the scope of

12  part I of chapter 464.

13         Section 27.  Subsection (24) of section 408.07, Florida

14  Statutes, is amended to read:

15         408.07  Definitions.--As used in this chapter, with the

16  exception of ss. 408.031-408.045, the term:

17         (24)  "Health care provider" means a health care

18  professional licensed under chapter 458, chapter 459, chapter

19  460, chapter 461, chapter 463, part I of chapter 464, chapter

20  465, chapter 466, part I, part III, part IV, part V, or part X

21  of chapter 468, chapter 483, chapter 484, chapter 486, chapter

22  490, or chapter 491.

23         Section 28.  Subsection (11) of section 408.706,

24  Florida Statutes, is amended to read:

25         408.706  Community health purchasing alliances;

26  accountable health partnerships.--

27         (11)  The ability to recruit and retain alliance

28  district health care providers in its provider network. For

29  provider networks initially formed in an alliance district

30  after July 1, 1993, an accountable health partnership shall

31  make offers as to provider participation in its provider

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    38-1289-00                                          See HB 567




  1  network to relevant alliance district health care providers

  2  for at least 60 percent of the available provider positions. A

  3  provider who is made an offer may participate in an

  4  accountable health partnership as long as the provider abides

  5  by the terms and conditions of the provider network contract,

  6  provides services at a rate or price equal to the rate or

  7  price negotiated by the accountable health partnership, and

  8  meets all of the accountable health partnership's

  9  qualifications for participation in its provider networks

10  including, but not limited to, network adequacy criteria. For

11  purposes of this subsection, "alliance district health care

12  provider" means a health care provider who is licensed under

13  chapter 458, chapter 459, chapter 460, chapter 461, part I of

14  chapter 464, or chapter 465 who has practiced in Florida for

15  more than 1 year within the alliance district served by the

16  accountable health partnership.

17         Section 29.  Paragraph (d) of subsection (12) of

18  section 409.908, Florida Statutes, is amended to read:

19         409.908  Reimbursement of Medicaid providers.--Subject

20  to specific appropriations, the agency shall reimburse

21  Medicaid providers, in accordance with state and federal law,

22  according to methodologies set forth in the rules of the

23  agency and in policy manuals and handbooks incorporated by

24  reference therein.  These methodologies may include fee

25  schedules, reimbursement methods based on cost reporting,

26  negotiated fees, competitive bidding pursuant to s. 287.057,

27  and other mechanisms the agency considers efficient and

28  effective for purchasing services or goods on behalf of

29  recipients.  Payment for Medicaid compensable services made on

30  behalf of Medicaid eligible persons is subject to the

31  availability of moneys and any limitations or directions

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  1  provided for in the General Appropriations Act or chapter 216.

  2  Further, nothing in this section shall be construed to prevent

  3  or limit the agency from adjusting fees, reimbursement rates,

  4  lengths of stay, number of visits, or number of services, or

  5  making any other adjustments necessary to comply with the

  6  availability of moneys and any limitations or directions

  7  provided for in the General Appropriations Act, provided the

  8  adjustment is consistent with legislative intent.

  9         (12)

10         (d)  Notwithstanding paragraph (b), reimbursement fees

11  to physicians for providing total obstetrical services to

12  Medicaid recipients, which include prenatal, delivery, and

13  postpartum care, shall be at least $1,500 per delivery for a

14  pregnant woman with low medical risk and at least $2,000 per

15  delivery for a pregnant woman with high medical risk. However,

16  reimbursement to physicians working in Regional Perinatal

17  Intensive Care Centers designated pursuant to chapter 383, for

18  services to certain pregnant Medicaid recipients with a high

19  medical risk, may be made according to obstetrical care and

20  neonatal care groupings and rates established by the agency.

21  Nurse midwives licensed under part I of chapter 464 or

22  midwives licensed under chapter 467 shall be reimbursed at no

23  less than 80 percent of the low medical risk fee. The agency

24  shall by rule determine, for the purpose of this paragraph,

25  what constitutes a high or low medical risk pregnant woman and

26  shall not pay more based solely on the fact that a caesarean

27  section was performed, rather than a vaginal delivery. The

28  agency shall by rule determine a prorated payment for

29  obstetrical services in cases where only part of the total

30  prenatal, delivery, or postpartum care was performed. The

31  Department of Health shall adopt rules for appropriate

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  insurance coverage for midwives licensed under chapter 467.

  2  Prior to the issuance and renewal of an active license, or

  3  reactivation of an inactive license for midwives licensed

  4  under chapter 467, such licensees shall submit proof of

  5  coverage with each application.

  6         Section 30.  Subsection (1) of section 415.1085,

  7  Florida Statutes, is amended to read:

  8         415.1085  Photographs, medical examinations, and X rays

  9  of abused or neglected aged persons or disabled adults.--

10         (1)  Any person authorized by law to investigate cases

11  of alleged abuse or neglect of an aged person or disabled

12  adult may take or cause to be taken photographs of the areas

13  of trauma visible on the aged person or disabled adult who is

14  the subject of a report, and photographs of the surrounding

15  environment, with the consent of the subject or guardian or

16  guardians.  If the areas of trauma visible on the aged person

17  or disabled adult indicate a need for medical examination, or

18  if the aged person or disabled adult verbally complains or

19  otherwise exhibits distress as a result of injury through

20  suspected adult abuse, neglect, or exploitation, or is alleged

21  to have been sexually abused, the department may, with the

22  consent of the subject or guardian or guardians, cause the

23  aged person or disabled adult to be referred to a licensed

24  physician or any emergency department in a hospital or health

25  care facility for medical examinations and X rays, if deemed

26  necessary by the examining physician.  Such examinations may

27  be performed by an advanced registered nurse practitioner

28  licensed pursuant to part I of chapter 464.  Medical

29  examinations performed and X rays taken pursuant to this

30  section shall be paid for by third-party reimbursement, if

31  available, or by the subject or his or her guardian, if they

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    Florida Senate - 2000                                  SB 1932
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  1  are determined to be financially able to pay; or, if neither

  2  is available, the department shall pay the costs within

  3  available emergency services funds.

  4         Section 31.  Subsection (4) of section 455.501, Florida

  5  Statutes, is amended to read:

  6         455.501  Definitions.--As used in this part, the term:

  7         (4)  "Health care practitioner" means any person

  8  licensed under chapter 457; chapter 458; chapter 459; chapter

  9  460; chapter 461; chapter 462; chapter 463; part I of chapter

10  464; chapter 465; chapter 466; chapter 467; part I, part II,

11  part III, part V, part X, part XIII, or part XIV of chapter

12  468; chapter 478; chapter 480; part III or part IV of chapter

13  483; chapter 484; chapter 486; chapter 490; or chapter 491.

14         Section 32.  Paragraph (a) of subsection (1) of section

15  455.597 Florida Statutes, is amended to read:

16         455.597  Requirement for instruction on domestic

17  violence.--

18         (1)(a)  The appropriate board shall require each person

19  licensed or certified under chapter 458, chapter 459, part I

20  of chapter 464, chapter 466, chapter 467, chapter 490, or

21  chapter 491 to complete a 1-hour continuing education course,

22  approved by the board, on domestic violence, as defined in s.

23  741.28, as part of biennial relicensure or recertification.

24  The course shall consist of information on the number of

25  patients in that professional's practice who are likely to be

26  victims of domestic violence and the number who are likely to

27  be perpetrators of domestic violence, screening procedures for

28  determining whether a patient has any history of being either

29  a victim or a perpetrator of domestic violence, and

30  instruction on how to provide such patients with information

31  on, or how to refer such patients to, resources in the local

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  community, such as domestic violence centers and other

  2  advocacy groups, that provide legal aid, shelter, victim

  3  counseling, batterer counseling, or child protection services.

  4         Section 33.  Subsection (1) of section 455.604, Florida

  5  Statutes, is amended to read:

  6         455.604  Requirement for instruction for certain

  7  licensees on human immunodeficiency virus and acquired immune

  8  deficiency syndrome.--

  9         (1)  The appropriate board shall require each person

10  licensed or certified under chapter 457; chapter 458; chapter

11  459; chapter 460; chapter 461; chapter 463; part I of chapter

12  464; chapter 465; chapter 466; part II, part III, part V, or

13  part X of chapter 468; or chapter 486 to complete a continuing

14  educational course, approved by the board, on human

15  immunodeficiency virus and acquired immune deficiency syndrome

16  as part of biennial relicensure or recertification. The course

17  shall consist of education on the modes of transmission,

18  infection control procedures, clinical management, and

19  prevention of human immunodeficiency virus and acquired immune

20  deficiency syndrome. Such course shall include information on

21  current Florida law on acquired immune deficiency syndrome and

22  its impact on testing, confidentiality of test results,

23  treatment of patients, and any protocols and procedures

24  applicable to human immunodeficiency virus counseling and

25  testing, reporting, the offering of HIV testing to pregnant

26  women, and partner notification issues pursuant to ss. 381.004

27  and 384.25.

28         Section 34.  Paragraph (a) of subsection (12) of

29  section 455.621, Florida Statutes, is amended to read:

30

31

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  1         455.621  Disciplinary proceedings.--Disciplinary

  2  proceedings for each board shall be within the jurisdiction of

  3  the department.

  4         (12)(a)  No person who reports in any capacity, whether

  5  or not required by law, information to the department with

  6  regard to the incompetence, impairment, or unprofessional

  7  conduct of any health care provider licensed under chapter

  8  458, chapter 459, chapter 460, chapter 461, chapter 462,

  9  chapter 463, part I of chapter 464, chapter 465, or chapter

10  466 shall be held liable in any civil action for reporting

11  against such health care provider if such person acts without

12  intentional fraud or malice.

13         Section 35.  Section 455.664, Florida Statutes, is

14  amended to read:

15         455.664  Advertisement by a health care practitioner of

16  free or discounted services; required statement.--In any

17  advertisement for a free, discounted fee, or reduced fee

18  service, examination, or treatment by a health care

19  practitioner licensed under chapter 458, chapter 459, chapter

20  460, chapter 461, chapter 462, chapter 463, part I of chapter

21  464, chapter 465, chapter 466, chapter 467, chapter 478,

22  chapter 483, chapter 484, chapter 486, chapter 490, or chapter

23  491, the following statement shall appear in capital letters

24  clearly distinguishable from the rest of the text:  THE

25  PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A

26  RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR

27  PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT

28  IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING

29  TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED

30  FEE SERVICE, EXAMINATION, OR TREATMENT. However, the required

31  statement shall not be necessary as an accompaniment to an

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    38-1289-00                                          See HB 567




  1  advertisement of a licensed health care practitioner defined

  2  by this section if the advertisement appears in a classified

  3  directory the primary purpose of which is to provide products

  4  and services at free, reduced, or discounted prices to

  5  consumers and in which the statement prominently appears in at

  6  least one place.

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

  8  455.667, Florida Statutes, is amended to read:

  9         455.667  Ownership and control of patient records;

10  report or copies of records to be furnished.--

11         (2)  As used in this section, the terms "records

12  owner," "health care practitioner," and "health care

13  practitioner's employer" do not include any of the following

14  persons or entities; furthermore, the following persons or

15  entities are not authorized to acquire or own medical records,

16  but are authorized under the confidentiality and disclosure

17  requirements of this section to maintain those documents

18  required by the part or chapter under which they are licensed

19  or regulated:

20         (a)  Certified nursing assistants regulated under part

21  II of chapter 464 s. 400.211.

22         Section 37.  Section 455.677, Florida Statutes, is

23  amended to read:

24         455.677  Disposition of records of deceased

25  practitioners or practitioners relocating or terminating

26  practice.--Each board created under the provisions of chapter

27  457, chapter 458, chapter 459, chapter 460, chapter 461,

28  chapter 463, part I of chapter 464, chapter 465, chapter 466,

29  part I of chapter 484, chapter 486, chapter 490, or chapter

30  491, and the department under the provisions of chapter 462,

31  shall provide by rule for the disposition, under that chapter,

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  of the medical records or records of a psychological nature of

  2  practitioners which are in existence at the time the

  3  practitioner dies, terminates practice, or relocates and is no

  4  longer available to patients and which records pertain to the

  5  practitioner's patients.  The rules shall provide that the

  6  records be retained for at least 2 years after the

  7  practitioner's death, termination of practice, or relocation.

  8  In the case of the death of the practitioner, the rules shall

  9  provide for the disposition of such records by the estate of

10  the practitioner.

11         Section 38.  Subsection (1) of section 455.687, Florida

12  Statutes, is amended to read:

13         455.687  Certain health care practitioners; immediate

14  suspension of license.--

15         (1)  The department shall issue an emergency order

16  suspending the license of any person licensed under chapter

17  458, chapter 459, chapter 460, chapter 461, chapter 462,

18  chapter 463, part I of chapter 464, chapter 465, chapter 466,

19  or chapter 484 who pleads guilty to, is convicted or found

20  guilty of, or who enters a plea of nolo contendere to,

21  regardless of adjudication, a felony under chapter 409 or

22  chapter 893 or under 21 U.S.C. ss. 801-970 or under 42 U.S.C.

23  ss. 1395-1396.

24         Section 39.  Paragraph (b) of subsection (2) of section

25  455.694, Florida Statutes, is amended to read:

26         455.694  Financial responsibility requirements for

27  certain health care practitioners.--

28         (2)  The board or department may grant exemptions upon

29  application by practitioners meeting any of the following

30  criteria:

31

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  1         (b)  Any person whose license or certification has

  2  become inactive under chapter 457, chapter 460, chapter 461,

  3  part I of chapter 464, chapter 466, or chapter 467 and who is

  4  not 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         Section 40.  Subsection (2) of section 455.707, Florida

15  Statutes, is amended to read:

16         455.707  Treatment programs for impaired

17  practitioners.--

18         (2)  The department shall retain one or more impaired

19  practitioner consultants as recommended by the committee.  A

20  consultant shall be a licensee or recovered licensee under the

21  jurisdiction of the Division of Medical Quality Assurance

22  within the department, and at least one consultant must be a

23  practitioner or recovered practitioner licensed under chapter

24  458, chapter 459, or part I of chapter 464.  The consultant

25  shall assist the probable cause panel and department in

26  carrying out the responsibilities of this section.  This shall

27  include working with department investigators to determine

28  whether a practitioner is, in fact, impaired.

29         Section 41.  Subsection (2) of section 458.348, Florida

30  Statutes, is amended to read:

31

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  1         458.348  Formal supervisory relationships, standing

  2  orders, and established protocols; notice; standards.--

  3         (2)  ESTABLISHMENT OF STANDARDS BY JOINT

  4  COMMITTEE.--The joint committee created by s. 464.003(3)(c)

  5  shall determine minimum standards for the content of

  6  established protocols pursuant to which an advanced registered

  7  nurse practitioner may perform medical acts identified and

  8  approved by the joint committee pursuant to s. 464.003(3)(c)

  9  or acts set forth in s. 464.012(3) and (4) and shall determine

10  minimum standards for supervision of such acts by the

11  physician, unless the joint committee determines that any act

12  set forth in s. 464.012(3) or (4) is not a medical act.  Such

13  standards shall be based on risk to the patient and acceptable

14  standards of medical care and shall take into account the

15  special problems of medically underserved areas. The standards

16  developed by the joint committee shall be adopted as rules by

17  the Board of Nursing and the Board of Medicine for purposes of

18  carrying out their responsibilities pursuant to part I of

19  chapter 464 and this chapter, respectively, but neither board

20  shall have disciplinary powers over the licensees of the other

21  board.

22         Section 42.  Section 464.001, Florida Statutes, is

23  amended to read:

24         464.001  Short title.--This part may be cited chapter

25  shall be known as the "Nurse Practice Act."

26         Section 43.  Section 464.002, Florida Statutes, is

27  amended to read:

28         464.002  Purpose.--The sole legislative purpose in

29  enacting this part chapter is to ensure that every nurse

30  practicing in this state meets minimum requirements for safe

31  practice.  It is the legislative intent that nurses who fall

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  1  below minimum competency or who otherwise present a danger to

  2  the public shall be prohibited from practicing in this state.

  3         Section 44.  Section 464.003, Florida Statutes, is

  4  amended to read:

  5         464.003  Definitions.--As used in this part chapter:

  6         (1)  "Department" means the Department of Health.

  7         (2)  "Board" means the Board of Nursing as created in

  8  this chapter.

  9         (3)(a)  "Practice of professional nursing" means the

10  performance of those acts requiring substantial specialized

11  knowledge, judgment, and nursing skill based upon applied

12  principles of psychological, biological, physical, and social

13  sciences which shall include, but not be limited to:

14         1.  The observation, assessment, nursing diagnosis,

15  planning, intervention, and evaluation of care; health

16  teaching and counseling of the ill, injured, or infirm; and

17  the promotion of wellness, maintenance of health, and

18  prevention of illness of others.

19         2.  The administration of medications and treatments as

20  prescribed or authorized by a duly licensed practitioner

21  authorized by the laws of this state to prescribe such

22  medications and treatments.

23         3.  The supervision and teaching of other personnel in

24  the theory and performance of any of the above acts.

25         (b)  "Practice of practical nursing" means the

26  performance of selected acts, including the administration of

27  treatments and medications, in the care of the ill, injured,

28  or infirm and the promotion of wellness, maintenance of

29  health, and prevention of illness of others under the

30  direction of a registered nurse, a licensed physician, a

31

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  1  licensed osteopathic physician, a licensed podiatric

  2  physician, or a licensed dentist.

  3

  4  The professional nurse and the practical nurse shall be

  5  responsible and accountable for making decisions that are

  6  based upon the individual's educational preparation and

  7  experience in nursing.

  8         (c)  "Advanced or specialized nursing practice" means,

  9  in addition to the practice of professional nursing, the

10  performance of advanced-level nursing acts approved by the

11  board which, by virtue of postbasic specialized education,

12  training, and experience, are proper to be performed by an

13  advanced registered nurse practitioner.  Within the context of

14  advanced or specialized nursing practice, the advanced

15  registered nurse practitioner may perform acts of nursing

16  diagnosis and nursing treatment of alterations of the health

17  status.  The advanced registered nurse practitioner may also

18  perform acts of medical diagnosis and treatment, prescription,

19  and operation which are identified and approved by a joint

20  committee composed of three members appointed by the Board of

21  Nursing, two of whom shall be advanced registered nurse

22  practitioners; three members appointed by the Board of

23  Medicine, two of whom shall have had work experience with

24  advanced registered nurse practitioners; and the secretary of

25  the department or the secretary's designee. Each committee

26  member appointed by a board shall be appointed to a term of 4

27  years unless a shorter term is required to establish or

28  maintain staggered terms. The Board of Nursing shall adopt

29  rules authorizing the performance of any such acts approved by

30  the joint committee. Unless otherwise specified by the joint

31  committee, such acts shall be performed under the general

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  1  supervision of a practitioner licensed under chapter 458,

  2  chapter 459, or chapter 466 within the framework of standing

  3  protocols which identify the medical acts to be performed and

  4  the conditions for their performance.  The department may, by

  5  rule, require that a copy of the protocol be filed with the

  6  department along with the notice required by s. 458.348.

  7         (d)  "Nursing diagnosis" means the observation and

  8  evaluation of physical or mental conditions, behaviors, signs

  9  and symptoms of illness, and reactions to treatment and the

10  determination as to whether such conditions, signs, symptoms,

11  and reactions represent a deviation from normal.

12         (e)  "Nursing treatment" means the establishment and

13  implementation of a nursing regimen for the care and comfort

14  of individuals, the prevention of illness, and the education,

15  restoration, and maintenance of health.

16         (4)  "Registered nurse" means any person licensed in

17  this state to practice professional nursing.

18         (5)  "Licensed practical nurse" means any person

19  licensed in this state to practice practical nursing.

20         (6)  "Advanced registered nurse practitioner" means any

21  person licensed in this state to practice professional nursing

22  and certified in advanced or specialized nursing practice.

23         (7)  "Approved program" means a nursing program

24  conducted in a school, college, or university which is

25  approved by the board pursuant to s. 464.019 for the education

26  of nurses.

27         Section 45.  Section 464.006, Florida Statutes, is

28  amended to read:

29         464.006  Authority to make rules.--The board of Nursing

30  has authority to adopt rules pursuant to ss. 120.536(1) and

31

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  1  120.54 to implement the provisions of this part chapter

  2  conferring duties upon it.

  3         Section 46.  Subsection (3) of section 464.009, Florida

  4  Statutes, is amended to read:

  5         464.009  Licensure by endorsement.--

  6         (3)  The department shall not issue a license by

  7  endorsement to any applicant who is under investigation in

  8  another state for an act which would constitute a violation of

  9  this part chapter until such time as the investigation is

10  complete, at which time the provisions of s. 464.018 shall

11  apply.

12         Section 47.  Paragraphs (a) and (d) of subsection (1)

13  and paragraph (b) of subsection (2) of section 464.016,

14  Florida Statutes, are amended to read:

15         464.016  Violations and penalties.--

16         (1)  Each of the following acts constitutes a felony of

17  the third degree, punishable as provided in s. 775.082, s.

18  775.083, or s. 775.084:

19         (a)  Practicing advanced or specialized, professional

20  or practical nursing, as defined in this part chapter, unless

21  holding an active license or certificate to do so.

22         (d)  Obtaining or attempting to obtain a license or

23  certificate under this part chapter by misleading statements

24  or knowing misrepresentation.

25         (2)  Each of the following acts constitutes a

26  misdemeanor of the first degree, punishable as provided in s.

27  775.082 or s. 775.083:

28         (b)  Knowingly concealing information relating to

29  violations of this part chapter.

30

31

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  1         Section 48.  Paragraphs (i), (k), and (l) of subsection

  2  (1) and subsection (4) of section 464.018, Florida Statutes,

  3  are amended to read:

  4         464.018  Disciplinary actions.--

  5         (1)  The following acts shall be grounds for

  6  disciplinary action set forth in this section:

  7         (i)  Engaging or attempting to engage in the

  8  possession, sale, or distribution of controlled substances as

  9  set forth in chapter 893, for any other than legitimate

10  purposes authorized by this part chapter.

11         (k)  Failing to report to the department any person who

12  the licensee knows is in violation of this part chapter or of

13  the rules of the department or the board; however, if the

14  licensee verifies that such person is actively participating

15  in a board-approved program for the treatment of a physical or

16  mental condition, the licensee is required to report such

17  person only to an impaired professionals consultant.

18         (l)  Knowingly violating any provision of this part

19  chapter, a rule of the board or the department, or a lawful

20  order of the board or department previously entered in a

21  disciplinary proceeding or failing to comply with a lawfully

22  issued subpoena of the department.

23         (4)  The board shall not reinstate the license of a

24  nurse who has been found guilty by the board on three separate

25  occasions of violations of this part chapter relating to the

26  use of drugs or narcotics, which offenses involved the

27  diversion of drugs or narcotics from patients to personal use

28  or sale.

29         Section 49.  Subsections (1), (2), and (3) of section

30  464.019, Florida Statutes, are amended to read:

31         464.019  Approval of nursing programs.--

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  1         (1)  An institution desiring to conduct an approved

  2  program for the education of professional or practical nurses

  3  shall apply to the department and submit such evidence as may

  4  be required to show that it complies with the provisions of

  5  this part chapter and with the rules of the board. The

  6  application shall include a program review fee, as set by the

  7  board, not to exceed $1,000.

  8         (2)  The board shall adopt rules regarding educational

  9  objectives, faculty qualifications, curriculum guidelines,

10  administrative procedures, and clinical training as are

11  necessary to ensure that approved programs graduate nurses

12  capable of competent practice under this part act.

13         (3)  The department shall survey each institution

14  applying for approval and submit its findings to the board.

15  If the board is satisfied that the program meets the

16  requirements of this part chapter and rules pursuant thereto,

17  it shall certify the program for approval and the department

18  shall approve the program.

19         Section 50.  Section 464.022, Florida Statutes, is

20  amended to read:

21         464.022  Exceptions.--No provision of this part chapter

22  shall be construed to prohibit:

23         (1)  The care of the sick by friends or members of the

24  family without compensation, the incidental care of the sick

25  by domestic servants, or the incidental care of

26  noninstitutionalized persons by a surrogate family.

27         (2)  Assistance by anyone in the case of an emergency.

28         (3)  The practice of nursing by students enrolled in

29  approved schools of nursing.

30         (4)  The practice of nursing by graduates of approved

31  programs or the equivalent, pending the result of the first

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    38-1289-00                                          See HB 567




  1  licensing examination for which they are eligible following

  2  graduation, provided they practice under direct supervision of

  3  a registered professional nurse.  The board shall by rule

  4  define what constitutes direct supervision.

  5         (5)  The rendering of services by nursing assistants

  6  acting under the direct supervision of a registered

  7  professional nurse.

  8         (6)  Any nurse practicing in accordance with the

  9  practices and principles of the body known as the Church of

10  Christ Scientist; nor shall any rule of the board apply to any

11  sanitarium, nursing home, or rest home operated in accordance

12  with the practices and principles of the body known as the

13  Church of Christ Scientist.

14         (7)  The practice of any legally qualified nurse or

15  licensed attendant of another state who is employed by the

16  United States Government, or any bureau, division, or agency

17  thereof, while in the discharge of official duties.

18         (8)  Any nurse currently licensed in another state from

19  performing nursing services in this state for a period of 60

20  days after furnishing to the employer satisfactory evidence of

21  current licensure in another state and having submitted proper

22  application and fees to the board for licensure prior to

23  employment.  The board may extend this time for administrative

24  purposes when necessary.

25         (9)  The rendering of nursing services on a

26  fee-for-service basis, or the reimbursement for nursing

27  services directly to a nurse rendering such services by any

28  government program, commercial insurance company, hospital or

29  medical services plan, or any other third-party payor.

30

31

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    38-1289-00                                          See HB 567




  1         (10)  The establishment of an independent practice by

  2  one or more nurses for the purpose of rendering to patients

  3  nursing services within the scope of the nursing license.

  4         (11)  The furnishing of hemodialysis treatments in a

  5  patient's home, using an assistant chosen by the patient,

  6  provided that the assistant is properly trained, as defined by

  7  the board by rule, and has immediate telephonic access to a

  8  registered nurse who is licensed pursuant to this part chapter

  9  and who has dialysis training and experience.

10         (12)  The practice of nursing by any legally qualified

11  nurse of another state whose employment requires the nurse to

12  accompany and care for a patient temporarily residing in this

13  state for not more than 30 consecutive days, provided the

14  patient is not in an inpatient setting, the board is notified

15  prior to arrival of the patient and nurse, the nurse has the

16  standing physician orders and current medical status of the

17  patient available, and prearrangements with the appropriate

18  licensed health care providers in this state have been made in

19  case the patient needs placement in an inpatient setting.

20         (13)  The practice of nursing by individuals enrolled

21  in board-approved remedial courses.

22         Section 51.  Section 464.023, Florida Statutes, is

23  amended to read:

24         464.023  Saving clauses.--

25         (1)  No judicial or administrative proceeding pending

26  on July 1, 1979, shall be abated as a result of the repeal and

27  reenactment of this part chapter.

28         (2)  Each licensee or holder of a certificate who was

29  duly licensed or certified on June 30, 1979, shall be entitled

30  to hold such license or certificate.  Henceforth, such license

31

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  or certificate shall be renewed in accordance with the

  2  provisions of this part act.

  3         Section 52.  Subsection (3) of section 464.027, Florida

  4  Statutes, is amended to read:

  5         464.027  Registered nurse first assistant.--

  6         (3)  QUALIFICATIONS.--A registered nurse first

  7  assistant is any person who:

  8         (a)  Is licensed as a registered nurse under this part

  9  chapter;

10         (b)  Is certified in perioperative nursing; and

11         (c)  Holds a certificate from, and has successfully

12  completed, a recognized program.

13         Section 53.  Subsection (6) of section 466.003, Florida

14  Statutes, is amended to read:

15         466.003  Definitions.--As used in this chapter:

16         (6)  "Dental assistant" means a person, other than a

17  dental hygienist, who, under the supervision and authorization

18  of a dentist, provides dental care services directly to a

19  patient. This term shall not include a certified registered

20  nurse anesthetist licensed under part I of chapter 464.

21         Section 54.  Subsection (2) of section 467.003, Florida

22  Statutes, is amended to read:

23         467.003  Definitions.--As used in this chapter, unless

24  the context otherwise requires:

25         (2)  "Certified nurse midwife" means a person who is

26  licensed as an advanced registered nurse practitioner under

27  part I of chapter 464 and who is certified to practice

28  midwifery by the American College of Nurse Midwives.

29         Section 55.  Paragraph (a) of subsection (2) of section

30  467.0125, Florida Statutes, is amended to read:

31         467.0125  Licensure by endorsement.--

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    38-1289-00                                          See HB 567




  1         (2)  The department may issue a temporary certificate

  2  to practice in areas of critical need to any midwife who is

  3  qualifying for licensure by endorsement under subsection (1),

  4  with the following restrictions:

  5         (a)  The Department of Health shall determine the areas

  6  of critical need, and the midwife so certified shall practice

  7  only in those specific areas, under the auspices of a

  8  physician licensed pursuant to chapter 458 or chapter 459, a

  9  certified nurse midwife licensed pursuant to part I of chapter

10  464, or a midwife licensed under this chapter, who has a

11  minimum of 3 years' professional experience. Such areas shall

12  include, but not be limited to, health professional shortage

13  areas designated by the United States Department of Health and

14  Human Services.

15         Section 56.  Paragraph (e) of subsection (2) of section

16  467.203, Florida Statutes, is amended to read:

17         467.203  Disciplinary actions; penalties.--

18         (2)  When the department finds any person guilty of any

19  of the grounds set forth in subsection (1), it may enter an

20  order imposing one or more of the following penalties:

21         (e)  Placement of the midwife on probation for such

22  period of time and subject to such conditions as the

23  department may specify, including requiring the midwife to

24  submit to treatment; undertake further relevant education or

25  training; take an examination; or work under the supervision

26  of another licensed midwife, a physician, or a nurse midwife

27  licensed under part I of chapter 464.

28         Section 57.  Paragraph (a) of subsection (1) of section

29  468.505, Florida Statutes, is amended to read:

30         468.505  Exemptions; exceptions.--

31

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  1         (1)  Nothing in this part may be construed as

  2  prohibiting or restricting the practice, services, or

  3  activities of:

  4         (a)  A person licensed in this state under chapter 457,

  5  chapter 458, chapter 459, chapter 460, chapter 461, chapter

  6  462, chapter 463, part I of chapter 464, chapter 465, chapter

  7  466, chapter 480, chapter 490, or chapter 491, when engaging

  8  in the profession or occupation for which he or she is

  9  licensed, or of any person employed by and under the

10  supervision of the licensee when rendering services within the

11  scope of the profession or occupation of the licensee.

12         Section 58.  Subsection (7) of section 483.041, Florida

13  Statutes, is amended to read:

14         483.041  Definitions.--As used in this part, the term:

15         (7)  "Licensed practitioner" means a physician licensed

16  under chapter 458, chapter 459, chapter 460, or chapter 461; a

17  dentist licensed under chapter 466; a person licensed under

18  chapter 462; or an advanced registered nurse practitioner

19  licensed under part I of chapter 464; or a duly licensed

20  practitioner from another state licensed under similar

21  statutes who orders examinations on materials or specimens for

22  nonresidents of the State of Florida, but who reside in the

23  same state as the requesting licensed practitioner.

24         Section 59.  Subsection (5) of section 483.801, Florida

25  Statutes, is amended to read:

26         483.801  Exemptions.--This part applies to all clinical

27  laboratories and clinical laboratory personnel within this

28  state, except:

29         (5)  Advanced registered nurse practitioners licensed

30  under part I of chapter 464 who perform provider-performed

31

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  1  microscopy procedures (PPMP) in an exclusive-use laboratory

  2  setting.

  3         Section 60.  Paragraph (a) of subsection (4) of section

  4  491.0112, Florida Statutes, is amended to read:

  5         491.0112  Sexual misconduct by a psychotherapist;

  6  penalties.--

  7         (4)  For the purposes of this section:

  8         (a)  The term "psychotherapist" means any person

  9  licensed pursuant to chapter 458, chapter 459, part I of

10  chapter 464, chapter 490, or chapter 491, or any other person

11  who provides or purports to provide treatment, diagnosis,

12  assessment, evaluation, or counseling of mental or emotional

13  illness, symptom, or condition.

14         Section 61.  Subsection (5) of section 550.24055,

15  Florida Statutes, is amended to read:

16         550.24055  Use of controlled substances or alcohol

17  prohibited; testing of certain occupational licensees;

18  penalty; evidence of test or action taken and admissibility

19  for criminal prosecution limited.--

20         (5)  This section does not apply to the possession and

21  use of controlled or chemical substances that are prescribed

22  as part of the care and treatment of a disease or injury by a

23  practitioner licensed under chapter 458, chapter 459, part I

24  of chapter 464, or chapter 466.

25         Section 62.  Paragraph (h) of subsection (4) of section

26  627.351, Florida Statutes, is amended to read:

27         627.351  Insurance risk apportionment plans.--

28         (4)  MEDICAL MALPRACTICE RISK APPORTIONMENT.--

29         (h)  As used in this subsection:

30         1.  "Health care provider" means hospitals licensed

31  under chapter 395; physicians licensed under chapter 458;

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    38-1289-00                                          See HB 567




  1  osteopathic physicians licensed under chapter 459; podiatric

  2  physicians licensed under chapter 461; dentists licensed under

  3  chapter 466; chiropractic physicians licensed under chapter

  4  460; naturopaths licensed under chapter 462; nurses licensed

  5  under part I of chapter 464; midwives licensed under chapter

  6  467; clinical laboratories registered under chapter 483;

  7  physician assistants licensed under chapter 458 or chapter

  8  459; physical therapists and physical therapist assistants

  9  licensed under chapter 486; health maintenance organizations

10  certificated under part I of chapter 641; ambulatory surgical

11  centers licensed under chapter 395; other medical facilities

12  as defined in subparagraph 2.; blood banks, plasma centers,

13  industrial clinics, and renal dialysis facilities; or

14  professional associations, partnerships, corporations, joint

15  ventures, or other associations for professional activity by

16  health care providers.

17         2.  "Other medical facility" means a facility the

18  primary purpose of which is to provide human medical

19  diagnostic services or a facility providing nonsurgical human

20  medical treatment, to which facility the patient is admitted

21  and from which facility the patient is discharged within the

22  same working day, and which facility is not part of a

23  hospital.  However, a facility existing for the primary

24  purpose of performing terminations of pregnancy or an office

25  maintained by a physician or dentist for the practice of

26  medicine shall not be construed to be an "other medical

27  facility."

28         3.  "Health care facility" means any hospital licensed

29  under chapter 395, health maintenance organization

30  certificated under part I of chapter 641, ambulatory surgical

31

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  1  center licensed under chapter 395, or other medical facility

  2  as defined in subparagraph 2.

  3         Section 63.  Paragraph (b) of subsection (1) of section

  4  627.357, Florida Statutes, is amended to read:

  5         627.357  Medical malpractice self-insurance.--

  6         (1)  DEFINITIONS.--As used in this section, the term:

  7         (b)  "Health care provider" means any:

  8         1.  Hospital licensed under chapter 395.

  9         2.  Physician licensed, or physician assistant

10  licensed, under chapter 458.

11         3.  Osteopathic physician or physician assistant

12  licensed under chapter 459.

13         4.  Podiatric physician licensed under chapter 461.

14         5.  Health maintenance organization certificated under

15  part I of chapter 641.

16         6.  Ambulatory surgical center licensed under chapter

17  395.

18         7.  Chiropractic physician licensed under chapter 460.

19         8.  Psychologist licensed under chapter 490.

20         9.  Optometrist licensed under chapter 463.

21         10.  Dentist licensed under chapter 466.

22         11.  Pharmacist licensed under chapter 465.

23         12.  Registered nurse, licensed practical nurse, or

24  advanced registered nurse practitioner licensed or registered

25  under part I of chapter 464.

26         13.  Other medical facility.

27         14.  Professional association, partnership,

28  corporation, joint venture, or other association established

29  by the individuals set forth in subparagraphs 2., 3., 4., 7.,

30  8., 9., 10., 11., and 12. for professional activity.

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  1         Section 64.  Subsection (6) of section 627.9404,

  2  Florida Statutes, is amended to read:

  3         627.9404  Definitions.--For the purposes of this part:

  4         (6)  "Licensed health care practitioner" means any

  5  physician, nurse licensed under part I of chapter 464, or

  6  psychotherapist licensed under chapter 490 or chapter 491, or

  7  any individual who meets any requirements prescribed by rule

  8  by the department.

  9         Section 65.  Subsection (21) of section 641.31, Florida

10  Statutes, is amended to read:

11         641.31  Health maintenance contracts.--

12         (21)  Notwithstanding any other provision of law,

13  health maintenance policies or contracts which provide

14  anesthesia coverage, benefits, or services shall offer to the

15  subscriber, if requested and available, the services of a

16  certified registered nurse anesthetist licensed pursuant to

17  part I of chapter 464.

18         Section 66.  Subsection (8) of section 766.101, Florida

19  Statutes, is amended to read:

20         766.101  Medical review committee, immunity from

21  liability.--

22         (8)  No cause of action of any nature by a person

23  licensed pursuant to chapter 458, chapter 459, chapter 461,

24  chapter 463, part I of chapter 464, chapter 465, or chapter

25  466 shall arise against another person licensed pursuant to

26  chapter 458, chapter 459, chapter 461, chapter 463, part I of

27  chapter 464, chapter 465, or chapter 466 for furnishing

28  information to a duly appointed medical review committee, to

29  an internal risk management program established under s.

30  395.0197, to the Department of Business and Professional

31  Regulation, or to the appropriate regulatory board if the

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    38-1289-00                                          See HB 567




  1  information furnished concerns patient care at a facility

  2  licensed pursuant to part I of chapter 395 where both persons

  3  provide health care services, if the information is not

  4  intentionally fraudulent, and if the information is within the

  5  scope of the functions of the committee, department, or board.

  6  However, if such information is otherwise available from

  7  original sources, it is not immune from discovery or use in a

  8  civil action merely because it was presented during a

  9  proceeding of the committee, department, or board.

10         Section 67.  Subsection (2) of section 766.110, Florida

11  Statutes, is amended to read:

12         766.110  Liability of health care facilities.--

13         (2)  Every hospital licensed under chapter 395 may

14  carry liability insurance or adequately insure itself in an

15  amount of not less than $1.5 million per claim, $5 million

16  annual aggregate to cover all medical injuries to patients

17  resulting from negligent acts or omissions on the part of

18  those members of its medical staff who are covered thereby in

19  furtherance of the requirements of ss. 458.320 and 459.0085.

20  Self-insurance coverage extended hereunder to a member of a

21  hospital's medical staff meets the financial responsibility

22  requirements of ss. 458.320 and 459.0085 if the physician's

23  coverage limits are not less than the minimum limits

24  established in ss. 458.320 and 459.0085 and the hospital is a

25  verified trauma center as of July 1, 1990, that has extended

26  self-insurance coverage continuously to members of its medical

27  staff for activities both inside and outside of the hospital

28  since January 1, 1987.  Any insurer authorized to write

29  casualty insurance may make available, but shall not be

30  required to write, such coverage.  The hospital may assess on

31  an equitable and pro rata basis the following professional

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  1  health care providers for a portion of the total hospital

  2  insurance cost for this coverage:  physicians licensed under

  3  chapter 458, osteopathic physicians licensed under chapter

  4  459, podiatric physicians licensed under chapter 461, dentists

  5  licensed under chapter 466, and nurses licensed under part I

  6  of chapter 464. The hospital may provide for a deductible

  7  amount to be applied against any individual health care

  8  provider found liable in a law suit in tort or for breach of

  9  contract.  The legislative intent in providing for the

10  deductible to be applied to individual health care providers

11  found negligent or in breach of contract is to instill in each

12  individual health care provider the incentive to avoid the

13  risk of injury to the fullest extent and ensure that the

14  citizens of this state receive the highest quality health care

15  obtainable.

16         Section 68.  Paragraph (d) of subsection (3) of section

17  766.1115, Florida Statutes, is amended to read:

18         766.1115  Health care providers; creation of agency

19  relationship with governmental contractors.--

20         (3)  DEFINITIONS.--As used in this section, the term:

21         (d)  "Health care provider" or "provider" means:

22         1.  A birth center licensed under chapter 383.

23         2.  An ambulatory surgical center licensed under

24  chapter 395.

25         3.  A hospital licensed under chapter 395.

26         4.  A physician or physician assistant licensed under

27  chapter 458.

28         5.  An osteopathic physician or osteopathic physician

29  assistant licensed under chapter 459.

30         6.  A chiropractic physician licensed under chapter

31  460.

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  1         7.  A podiatric physician licensed under chapter 461.

  2         8.  A registered nurse, nurse midwife, licensed

  3  practical nurse, or advanced registered nurse practitioner

  4  licensed or registered under part I of chapter 464 or any

  5  facility which employs nurses licensed or registered under

  6  part I of chapter 464 to supply all or part of the care

  7  delivered under this section.

  8         9.  A midwife licensed under chapter 467.

  9         10.  A health maintenance organization certificated

10  under part I of chapter 641.

11         11.  A health care professional association and its

12  employees or a corporate medical group and its employees.

13         12.  Any other medical facility the primary purpose of

14  which is to deliver human medical diagnostic services or which

15  delivers nonsurgical human medical treatment, and which

16  includes an office maintained by a provider.

17         13.  A dentist or dental hygienist licensed under

18  chapter 466.

19         14.  Any other health care professional, practitioner,

20  provider, or facility under contract with a governmental

21  contractor.

22

23  The term includes any nonprofit corporation qualified as

24  exempt from federal income taxation under s. 501(c) of the

25  Internal Revenue Code which delivers health care services

26  provided by licensed professionals listed in this paragraph,

27  any federally funded community health center, and any

28  volunteer corporation or volunteer health care provider that

29  delivers health care services.

30         Section 69.  Subsection (1) of section 877.111, Florida

31  Statutes, is amended to read:

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  1         877.111  Inhalation, ingestion, possession, sale,

  2  purchase, or transfer of harmful chemical substances;

  3  penalties.--

  4         (1)  It is unlawful for any person to inhale or ingest,

  5  or to possess with intent to breathe, inhale, or drink, any

  6  compound, liquid, or chemical containing toluol, hexane,

  7  trichloroethylene, acetone, toluene, ethyl acetate, methyl

  8  ethyl ketone, trichloroethane, isopropanol, methyl isobutyl

  9  ketone, ethylene glycol monomethyl ether acetate,

10  cyclohexanone, nitrous oxide, diethyl ether, alkyl nitrites

11  (butyl nitrite), or any similar substance for the purpose of

12  inducing a condition of intoxication or which distorts or

13  disturbs the auditory, visual, or mental processes.  This

14  section does not apply to the possession and use of these

15  substances as part of the care or treatment of a disease or

16  injury by a practitioner licensed under chapter 458, chapter

17  459, part I of chapter 464, or chapter 466 or to beverages

18  controlled by the provisions of chapter 561, chapter 562,

19  chapter 563, chapter 564, or chapter 565.

20         Section 70.  Subsection (6) of section 945.602, Florida

21  Statutes, is amended to read:

22         945.602  State of Florida Correctional Medical

23  Authority; creation; members.--

24         (6)  At least one member of the authority must be a

25  nurse licensed under part I of chapter 464 and have at least 5

26  years' experience in the practice of nursing.

27         Section 71.  Subsection (2) of section 960.28, Florida

28  Statutes, is amended to read:

29         960.28  Payment for victims' initial forensic physical

30  examinations.--

31

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  1         (2)  The Crime Victims' Services Office of the

  2  department shall pay for medical expenses connected with an

  3  initial forensic physical examination of a victim who reports

  4  a violation of chapter 794 or chapter 800 to a law enforcement

  5  officer.  Such payment shall be made regardless of whether or

  6  not the victim is covered by health or disability insurance.

  7  The payment shall be made only out of moneys allocated to the

  8  Crime Victims' Services Office for the purposes of this

  9  section, and the payment may not exceed $250 with respect to

10  any violation. Payment may not be made for an initial forensic

11  physical examination unless the law enforcement officer

12  certifies in writing that the initial forensic physical

13  examination is needed to aid in the investigation of an

14  alleged sexual offense and that the claimant is the alleged

15  victim of the offense. The department shall develop and

16  maintain separate protocols for the initial forensic physical

17  examination of adults and children. Payment under this section

18  is limited to medical expenses connected with the initial

19  forensic physical examination, and payment may be made to a

20  medical provider using an examiner qualified under part I of

21  chapter 464, excluding s. 464.003(5); chapter 458; or chapter

22  459. Payment made to the medical provider by the department

23  shall be considered by the provider as payment in full for the

24  initial forensic physical examination associated with the

25  collection of evidence. The victim may not be required to pay,

26  directly or indirectly, the cost of an initial forensic

27  physical examination performed in accordance with this

28  section.

29         Section 72.  Subsection (36) of section 984.03, Florida

30  Statutes, is amended to read:

31

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  1         984.03  Definitions.--When used in this chapter, the

  2  term:

  3         (36)  "Licensed health care professional" means a

  4  physician licensed under chapter 458, an osteopathic physician

  5  licensed under chapter 459, a nurse licensed under part I of

  6  chapter 464, a physician assistant licensed under chapter 458

  7  or chapter 459, or a dentist licensed under chapter 466.

  8         Section 73.  Subsection (37) of section 985.03, Florida

  9  Statutes, is amended to read:

10         985.03  Definitions.--When used in this chapter, the

11  term:

12         (37)  "Licensed health care professional" means a

13  physician licensed under chapter 458, an osteopathic physician

14  licensed under chapter 459, a nurse licensed under part I of

15  chapter 464, a physician assistant licensed under chapter 458

16  or chapter 459, or a dentist licensed under chapter 466.

17         Section 74.  In January of 2001, all hospitals, home

18  health agencies, and other health agencies in this state that

19  employ unlicensed persons to perform health care services

20  under the supervision of licensed nurses must submit the names

21  and work titles of those employees to the Board of Nursing.

22  This information may be submitted electronically to the

23  Internet site of the Department of Health.

24         Section 75.  Section 455.557, Florida Statutes, is

25  amended to read:

26         455.557  Standardized credentialing for health care

27  practitioners.--

28         (1)  INTENT.--The Legislature recognizes that an

29  efficient and effective health care practitioner credentialing

30  program helps to ensure access to quality health care and also

31  recognizes that health care practitioner credentialing

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  1  activities have increased significantly as a result of health

  2  care reform and recent changes in health care delivery and

  3  reimbursement systems. Moreover, the resulting duplication of

  4  health care practitioner credentialing activities is

  5  unnecessarily costly and cumbersome for both the practitioner

  6  and the entity granting practice privileges. Therefore, it is

  7  the intent of this section that a credentials collection

  8  program be established which provides that, once a health care

  9  practitioner's core credentials data are collected, they need

10  not be collected again, except for corrections, updates, and

11  modifications thereto. Participation under this section shall

12  initially include those individuals licensed under chapter

13  458, chapter 459, chapter 460, or chapter 461, or s. 464.012.

14  However, the department shall, with the approval of the

15  applicable board, include other professions under the

16  jurisdiction of the Division of Medical Quality Assurance in

17  this program, provided they meet the requirements of s.

18  455.565.

19         (2)  DEFINITIONS.--As used in this section, the term:

20         (a)  "Advisory council" or "council" means the

21  Credentials Advisory Council.

22         (a)(b)  "Certified" or "accredited," as applicable,

23  means approved by a quality assessment program, from the

24  National Committee for Quality Assurance, the Joint Commission

25  on Accreditation of Healthcare Organizations, the American

26  Accreditation HealthCare Commission/URAC, or any such other

27  nationally recognized and accepted organization authorized by

28  the department, used to assess and certify any credentials

29  verification program, entity, or organization that verifies

30  the credentials of any health care practitioner.

31

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    38-1289-00                                          See HB 567




  1         (b)(c)  "Core credentials data" means the following

  2  data: current name, any former name, and any alias, any

  3  professional education, professional training, licensure,

  4  current Drug Enforcement Administration certification, social

  5  security number, specialty board certification, Educational

  6  Commission for Foreign Medical Graduates certification,

  7  hospital or other institutional affiliations, evidence of

  8  professional liability coverage or evidence of financial

  9  responsibility as required by s. 458.320, or s. 459.0085, or

10  s. 455.694, history of claims, suits, judgments, or

11  settlements, final disciplinary action reported pursuant to s.

12  455.565(1)(a)8., and Medicare or Medicaid sanctions.

13         (c)(d)  "Credential" or "credentialing" means the

14  process of assessing and verifying the qualifications of a

15  licensed health care practitioner or applicant for licensure

16  as a health care practitioner.

17         (d)(e)  "Credentials verification organization" means

18  any organization certified or accredited as a credentials

19  verification organization.

20         (e)(f)  "Department" means the Department of Health,

21  Division of Medical Quality Assurance.

22         (f)(g)  "Designated credentials verification

23  organization" means the credentials verification organization

24  which is selected by the health care practitioner, if the

25  health care practitioner chooses to make such a designation.

26         (g)(h)  "Drug Enforcement Administration certification"

27  means certification issued by the Drug Enforcement

28  Administration for purposes of administration or prescription

29  of controlled substances. Submission of such certification

30  under this section must include evidence that the

31

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  certification is current and must also include all current

  2  addresses to which the certificate is issued.

  3         (h)(i)  "Health care entity" means:

  4         1.  Any health care facility or other health care

  5  organization licensed or certified to provide approved medical

  6  and allied health services in this state;

  7         2.  Any entity licensed by the Department of Insurance

  8  as a prepaid health care plan or health maintenance

  9  organization or as an insurer to provide coverage for health

10  care services through a network of providers; or

11         3.  Any accredited medical school in this state.

12         (i)(j)  "Health care practitioner" means any person

13  licensed, or, for credentialing purposes only, any person

14  applying for licensure, under chapter 458, chapter 459,

15  chapter 460, or chapter 461, or s. 464.012 or any person

16  licensed or applying for licensure under a chapter

17  subsequently made subject to this section by the department

18  with the approval of the applicable board, except a person

19  registered or applying for registration pursuant to s. 458.345

20  or s. 459.021.

21         (j)(k)  "Hospital or other institutional affiliations"

22  means each hospital or other institution for which the health

23  care practitioner or applicant has provided medical services.

24  Submission of such information under this section must

25  include, for each hospital or other institution, the name and

26  address of the hospital or institution, the staff status of

27  the health care practitioner or applicant at that hospital or

28  institution, and the dates of affiliation with that hospital

29  or institution.

30         (k)(l)  "National accrediting organization" means an

31  organization that awards accreditation or certification to

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  1  hospitals, managed care organizations, credentials

  2  verification organizations, or other health care

  3  organizations, including, but not limited to, the Joint

  4  Commission on Accreditation of Healthcare Organizations, the

  5  American Accreditation HealthCare Commission/URAC, and the

  6  National Committee for Quality Assurance.

  7         (l)(m)  "Professional training" means any internship,

  8  residency, or fellowship relating to the profession for which

  9  the health care practitioner is licensed or seeking licensure.

10         (m)(n)  "Specialty board certification" means

11  certification in a specialty issued by a specialty board

12  recognized by the board in this state that regulates the

13  profession for which the health care practitioner is licensed

14  or seeking licensure.

15         (3)  STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.--

16         (a)  Every health care practitioner shall:

17         1.  Report all core credentials data to the department

18  which is not already on file with the department, either by

19  designating a credentials verification organization to submit

20  the data or by submitting the data directly.

21         2.  Notify the department within 45 days of any

22  corrections, updates, or modifications to the core credentials

23  data either through his or her designated credentials

24  verification organization or by submitting the data directly.

25  Corrections, updates, and modifications to the core

26  credentials data provided the department under this section

27  shall comply with the updating requirements of s. 455.565(3)

28  related to profiling.

29         (b)  The department shall:

30         1.  Maintain a complete, current file of core

31  credentials data on each health care practitioner, which shall

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  1  include all updates provided in accordance with subparagraph

  2  (a)2.

  3         2.  Release the core credentials data that is otherwise

  4  confidential or exempt from the provisions of chapter 119 and

  5  s. 24(a), Art. I of the State Constitution and any

  6  corrections, updates, and modifications thereto, if authorized

  7  by the health care practitioner.

  8         3.  Charge a fee to access the core credentials data,

  9  which may not exceed the actual cost, including prorated setup

10  and operating costs, pursuant to the requirements of chapter

11  119. The actual cost shall be set in consultation with the

12  advisory council.

13         4.  Develop, in consultation with the advisory council,

14  standardized forms to be used by the health care practitioner

15  or designated credentials verification organization for the

16  initial reporting of core credentials data, for the health

17  care practitioner to authorize the release of core credentials

18  data, and for the subsequent reporting of corrections,

19  updates, and modifications thereto.

20         5.  Establish a Credentials Advisory Council,

21  consisting of 13 members, to assist the department as provided

22  in this section. The secretary, or his or her designee, shall

23  serve as one member and chair of the council and shall appoint

24  the remaining 12 members. Except for any initial lesser term

25  required to achieve staggering, such appointments shall be for

26  4-year staggered terms, with one 4-year reappointment, as

27  applicable. Three members shall represent hospitals, and two

28  members shall represent health maintenance organizations. One

29  member shall represent health insurance entities. One member

30  shall represent the credentials verification industry. Two

31  members shall represent physicians licensed under chapter 458.

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  1  One member shall represent osteopathic physicians licensed

  2  under chapter 459. One member shall represent chiropractic

  3  physicians licensed under chapter 460. One member shall

  4  represent podiatric physicians licensed under chapter 461.

  5         (c)  A registered credentials verification organization

  6  may be designated by a health care practitioner to assist the

  7  health care practitioner to comply with the requirements of

  8  subparagraph (a)2. A designated credentials verification

  9  organization shall:

10         1.  Timely comply with the requirements of subparagraph

11  (a)2., pursuant to rules adopted by the department.

12         2.  Not provide the health care practitioner's core

13  data, including all corrections, updates, and modifications,

14  without the authorization of the practitioner.

15         (d)  This section shall not be construed to restrict in

16  any way the authority of the health care entity to credential

17  and to approve or deny an application for hospital staff

18  membership, clinical privileges, or managed care network

19  participation.

20         (4)  DUPLICATION OF DATA PROHIBITED.--

21         (a)  A health care entity or credentials verification

22  organization is prohibited from collecting or attempting to

23  collect duplicate core credentials data from any health care

24  practitioner if the information is available from the

25  department. This section shall not be construed to restrict

26  the right of any health care entity or credentials

27  verification organization to collect additional information

28  from the health care practitioner which is not included in the

29  core credentials data file. This section shall not be

30  construed to prohibit a health care entity or credentials

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    38-1289-00                                          See HB 567




  1  verification organization from obtaining all necessary

  2  attestation and release form signatures and dates.

  3         (b)  Effective July 1, 2002, a state agency in this

  4  state which credentials health care practitioners may not

  5  collect or attempt to collect duplicate core credentials data

  6  from any individual health care practitioner if the

  7  information is already available from the department. This

  8  section shall not be construed to restrict the right of any

  9  such state agency to request additional information not

10  included in the core credential data file, but which is deemed

11  necessary for the agency's specific credentialing purposes.

12         (5)  STANDARDS AND REGISTRATION.--Any credentials

13  verification organization that does business in this state

14  must be fully accredited or certified as a credentials

15  verification organization by a national accrediting

16  organization as specified in paragraph (2)(a)(b) and must

17  register with the department. The department may charge a

18  reasonable registration fee, set in consultation with the

19  advisory council, not to exceed an amount sufficient to cover

20  its actual expenses in providing and enforcing such

21  registration. The department shall establish by rule for

22  biennial renewal of such registration. Failure by a registered

23  credentials verification organization to maintain full

24  accreditation or certification, to provide data as authorized

25  by the health care practitioner, to report to the department

26  changes, updates, and modifications to a health care

27  practitioner's records within the time period specified in

28  subparagraph (3)(a)2., or to comply with the prohibition

29  against collection of duplicate core credentials data from a

30  practitioner may result in denial of an application for

31

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    38-1289-00                                          See HB 567




  1  renewal of registration or in revocation or suspension of a

  2  registration.

  3         (6)  LIABILITY.--No civil, criminal, or administrative

  4  action may be instituted, and there shall be no liability,

  5  against any registered credentials verification organization

  6  or health care entity on account of its reliance on any data

  7  obtained directly from the department.

  8         (7)  LIABILITY INSURANCE REQUIREMENTS.--Each

  9  credentials verification organization doing business in this

10  state shall maintain liability insurance appropriate to meet

11  the certification or accreditation requirements established in

12  this section.

13         (8)  RULES.--The department, in consultation with the

14  advisory council, shall adopt rules necessary to develop and

15  implement the standardized core credentials data collection

16  program established by this section.

17         (9)  COUNCIL ABOLISHED; DEPARTMENT AUTHORITY.--The

18  council shall be abolished October 1, 1999. After the council

19  is abolished, all duties of the department required under this

20  section to be in consultation with the council may be carried

21  out by the department on its own.

22         Section 76.  Section 455.565, Florida Statutes, is

23  amended to read:

24         455.565  Designated health care professionals;

25  information required for licensure.--

26         (1)  Each person who applies for initial licensure as a

27  physician or as an advanced registered nurse practitioner

28  under chapter 458, chapter 459, chapter 460, or chapter 461,

29  or s. 464.012, except a person applying for registration

30  pursuant to ss. 458.345 and 459.021, must, at the time of

31  application, and each physician or advanced registered nurse

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    38-1289-00                                          See HB 567




  1  practitioner who applies for license renewal under chapter

  2  458, chapter 459, chapter 460, or chapter 461, or s. 464.012,

  3  except a person registered pursuant to ss. 458.345 and

  4  459.021, must, in conjunction with the renewal of such license

  5  and under procedures adopted by the Department of Health, and

  6  in addition to any other information that may be required from

  7  the applicant, furnish the following information to the

  8  Department of Health:

  9         (a)1.  The name of each medical or nursing school that

10  the applicant has attended, with the dates of attendance and

11  the date of graduation, and a description of all graduate

12  medical or nursing education completed by the applicant,

13  excluding any coursework taken to satisfy medical or nursing

14  licensure continuing education requirements.

15         2.  The name of each hospital at which the applicant

16  has privileges.

17         3.  The address at which the applicant will primarily

18  conduct his or her practice.

19         4.  Any certification that the applicant has received

20  from a specialty board that is recognized by the board to

21  which the applicant is applying.

22         5.  The year that the applicant began practicing

23  medicine or advanced or specialized nursing.

24         6.  Any appointment to the faculty of a medical or

25  nursing school which the applicant currently holds and an

26  indication as to whether the applicant has had the

27  responsibility for graduate medical or nursing education

28  within the most recent 10 years.

29         7.  A description of any criminal offense of which the

30  applicant has been found guilty, regardless of whether

31  adjudication of guilt was withheld, or to which the applicant

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    38-1289-00                                          See HB 567




  1  has pled guilty or nolo contendere.  A criminal offense

  2  committed in another jurisdiction which would have been a

  3  felony or misdemeanor if committed in this state must be

  4  reported. If the applicant indicates that a criminal offense

  5  is under appeal and submits a copy of the notice for appeal of

  6  that criminal offense, the department must state that the

  7  criminal offense is under appeal if the criminal offense is

  8  reported in the applicant's profile. If the applicant

  9  indicates to the department that a criminal offense is under

10  appeal, the applicant must, upon disposition of the appeal,

11  submit to the department a copy of the final written order of

12  disposition.

13         8.  A description of any final disciplinary action

14  taken within the previous 10 years against the applicant by

15  the agency regulating the profession that the applicant is or

16  has been licensed to practice, whether in this state or in any

17  other jurisdiction, by a specialty board that is recognized by

18  the American Board of Medical Specialities, the American

19  Osteopathic Association, or a similar national organization,

20  or by a licensed hospital, health maintenance organization,

21  prepaid health clinic, ambulatory surgical center, or nursing

22  home.  Disciplinary action includes resignation from or

23  nonrenewal of medical staff membership or the restriction of

24  privileges at a licensed hospital, health maintenance

25  organization, prepaid health clinic, ambulatory surgical

26  center, or nursing home taken in lieu of or in settlement of a

27  pending disciplinary case related to competence or character.

28  If the applicant indicates that the disciplinary action is

29  under appeal and submits a copy of the document initiating an

30  appeal of the disciplinary action, the department must state

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  that the disciplinary action is under appeal if the

  2  disciplinary action is reported in the applicant's profile.

  3         (b)  In addition to the information required under

  4  paragraph (a), each applicant who seeks licensure under

  5  chapter 458, chapter 459, or chapter 461, and who has

  6  practiced previously in this state or in another jurisdiction

  7  or a foreign country must provide the information required of

  8  licensees under those chapters pursuant to s. 455.697.  An

  9  applicant for licensure under chapter 460 or s. 464.012 who

10  has practiced previously in this state or in another

11  jurisdiction or a foreign country must provide the same

12  information as is required of licensees under chapter 458,

13  pursuant to s. 455.697.

14         (2)  Before the issuance of the licensure renewal

15  notice required by s. 455.714, the Department of Health shall

16  send a notice to each person licensed under chapter 458,

17  chapter 459, chapter 460, or chapter 461, or s. 464.012, at

18  the licensee's last known address of record with the

19  department, regarding the requirements for information to be

20  submitted by those practitioners pursuant to this section in

21  conjunction with the renewal of such license and under

22  procedures adopted by the department.

23         (3)  Each person who has submitted information pursuant

24  to subsection (1) must update that information in writing by

25  notifying the Department of Health within 45 days after the

26  occurrence of an event or the attainment of a status that is

27  required to be reported by subsection (1). Failure to comply

28  with the requirements of this subsection to update and submit

29  information constitutes a ground for disciplinary action under

30  each respective licensing chapter and s. 455.624(1)(k). For

31  failure to comply with the requirements of this subsection to

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    38-1289-00                                          See HB 567




  1  update and submit information, the department or board, as

  2  appropriate, may:

  3         (a)  Refuse to issue a license to any person applying

  4  for initial licensure who fails to submit and update the

  5  required information.

  6         (b)  Issue a citation to any licensee who fails to

  7  submit and update the required information and may fine the

  8  licensee up to $50 for each day that the licensee is not in

  9  compliance with this subsection. The citation must clearly

10  state that the licensee may choose, in lieu of accepting the

11  citation, to follow the procedure under s. 455.621. If the

12  licensee disputes the matter in the citation, the procedures

13  set forth in s. 455.621 must be followed. However, if the

14  licensee does not dispute the matter in the citation with the

15  department within 30 days after the citation is served, the

16  citation becomes a final order and constitutes discipline.

17  Service of a citation may be made by personal service or

18  certified mail, restricted delivery, to the subject at the

19  licensee's last known address.

20         (4)(a)  An applicant for initial licensure must submit

21  a set of fingerprints to the Department of Health in

22  accordance with s. 458.311, s. 458.3115, s. 458.3124, s.

23  458.313, s. 459.0055, s. 460.406, or s. 461.006, or s.

24  464.012.

25         (b)  An applicant for renewed licensure must submit a

26  set of fingerprints for the initial renewal of his or her

27  license after January 1, 2000, to the agency regulating that

28  profession in accordance with procedures established under s.

29  458.319, s. 459.008, s. 460.407, or s. 461.007, or s. 464.012.

30         (c)  The Department of Health shall submit the

31  fingerprints provided by an applicant for initial licensure to

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    Florida Senate - 2000                                  SB 1932
    38-1289-00                                          See HB 567




  1  the Florida Department of Law Enforcement for a statewide

  2  criminal history check, and the Florida Department of Law

  3  Enforcement shall forward the fingerprints to the Federal

  4  Bureau of Investigation for a national criminal history check

  5  of the applicant. The department shall submit the fingerprints

  6  provided by an applicant for a renewed license to the Florida

  7  Department of Law Enforcement for a statewide criminal history

  8  check, and the Florida Department of Law Enforcement shall

  9  forward the fingerprints to the Federal Bureau of

10  Investigation for a national criminal history check for the

11  initial renewal of the applicant's license after January 1,

12  2000; for any subsequent renewal of the applicant's license,

13  the department shall submit the required information for a

14  statewide criminal history check of the applicant.

15         (5)  Each person who is required to submit information

16  pursuant to this section may submit additional information.

17  Such information may include, but is not limited to:

18         (a)  Information regarding publications in

19  peer-reviewed medical literature within the previous 10 years.

20         (b)  Information regarding professional or community

21  service activities or awards.

22         (c)  Languages, other than English, used by the

23  applicant to communicate with patients and identification of

24  any translating service that may be available at the place

25  where the applicant primarily conducts his or her practice.

26         (d)  An indication of whether the person participates

27  in the Medicaid program.

28         Section 77.  Present subsection (5) of section 464.012,

29  Florida Statutes, is renumbered as subsection (6) and a new

30  subsection (5) is added to that section to read:

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  1         464.012  Certification of advanced registered nurse

  2  practitioners; fees.--

  3         (5)(a)  An applicant for certification under this

  4  section must also submit to the department a set of

  5  fingerprints on a form and under procedures specified by the

  6  department, along with payment in an amount equal to the costs

  7  incurred by the department for the criminal background check

  8  of the applicant.

  9         (b)  An applicant for renewal of certification under

10  this section must also submit the information required under

11  s. 455.565 to the department on a form and under procedures

12  specified by the department, along with payment in an amount

13  equal to the costs incurred by the department for the

14  statewide criminal background check of the applicant. The

15  applicant must submit a set of fingerprints to the department

16  on a form and under procedures specified by the department,

17  along with payment in an amount equal to the costs incurred by

18  the department for a national criminal background check of the

19  applicant for the initial renewal of his or her license after

20  January 1, 2002. If the applicant fails to submit either the

21  information required under s. 455.565 or a set of fingerprints

22  to the department as required by this paragraph, the

23  department shall issue a notice of noncompliance, and the

24  applicant will be given 30 additional days to comply. If the

25  applicant fails to comply within 30 days after the notice of

26  noncompliance is issued, the department or board, as

27  appropriate, may issue a citation to the applicant and may

28  fine the applicant up to $50 for each day that the applicant

29  is not in compliance with the requirements of s. 455.565. The

30  citation must clearly state that the applicant may choose, in

31  lieu of accepting the citation, to follow the procedure under

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  1  s. 455.621. If the applicant disputes the matter in the

  2  citation, the procedures set forth in s. 455.621 must be

  3  followed. However, if the applicant does not dispute the

  4  matter in the citation with the department within 30 days

  5  after the citation is served, the citation becomes a final

  6  order and constitutes discipline. Service of a citation may be

  7  made by personal service or certified mail, restricted

  8  delivery, to the subject at the applicant's last known

  9  address. If an applicant has submitted fingerprints to the

10  department for a national criminal history check upon initial

11  licensure and is renewing his or her license for the first

12  time, then the applicant need only submit the information and

13  fee required for a statewide criminal history check.

14         Section 78.  This act shall take effect July 1, 2000.

15

16            *****************************************

17                       LEGISLATIVE SUMMARY

18
      Transfers pt. XV, ch. 468, F.S., relating to certified
19    nursing assistants, to ch. 464, F.S., relating to
      nursing, to transfer from the Department of Health to the
20    Board of Nursing responsibility and rulemaking authority
      for regulation of certified nursing assistants. Transfers
21    from the Department of Education to the board
      responsibility for approval of training programs. Revises
22    grounds for which the board may impose certain penalties.
      Requires hospitals, home health agencies, and other
23    health agencies to submit to the board in January of 2001
      the names and work titles of all unlicensed persons
24    employed by them to perform health care services under
      the supervision of licensed nurses.
25

26    Includes advanced registered nurse practitioners under
      the practitioner profiling and credentialing programs.
27    Requires applicants for certification or renewal of
      certification as an advanced registered nurse
28    practitioner to submit information, fingerprints, and
      fees for such purposes. Provides for citations to, and
29    fines of, applicants failing to comply.

30

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