House Bill 2339
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Florida House of Representatives - 2000 HB 2339
By Representatives Feeney, Waters, Peaden, Fasano,
Maygarden and Farkas
1 A bill to be entitled
2 An act relating to comprehensive health care;
3 providing a short title; amending s. 400.471,
4 F.S.; deleting the certificate-of-need
5 requirement for licensure of Medicare-certified
6 home health agencies; amending s. 408.032,
7 F.S.; adding definitions of "exemption" and
8 "mental health services"; deleting the
9 definitions of "home health agency,"
10 "institutional health service," "intermediate
11 care facility," "multifacility project," and
12 "respite care"; revising the definition of
13 "health services"; amending s. 408.033, F.S.;
14 deleting references to the state health plan;
15 amending s. 408.034, F.S.; deleting a reference
16 to licensing of home health agencies by the
17 Agency for Health Care Administration; amending
18 s. 408.035, F.S.; deleting obsolete
19 certificate-of-need review criteria and
20 revising other criteria; amending s. 408.036,
21 F.S.; revising provisions relating to projects
22 subject to review; deleting references to
23 Medicare-certified home health agencies;
24 deleting the review of certain acquisitions;
25 specifying the types of bed increases subject
26 to review; deleting cost overruns from review;
27 deleting review of combinations or division of
28 nursing home certificates of need; providing
29 for expedited review of certain conversions of
30 licensed hospital beds; deleting the
31 requirement for an exemption for initiation or
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1 expansion of obstetric services, provision of
2 respite care services, establishment of a
3 Medicare-certified home health agency, or
4 provision of a health service exclusively on an
5 outpatient basis; providing a sunset date for
6 review of the establishment of a hospice
7 program or hospice inpatient facility;
8 providing exemptions for combinations or
9 divisions of nursing home certificates of need
10 and additions of certain hospital beds and
11 nursing home beds within specified limitations;
12 providing exemptions for the addition of
13 temporary acute care beds in certain hospitals
14 and for the establishment of certain types of
15 specialty hospitals through transfer of beds
16 and services from certain existing hospitals;
17 requiring a fee for each request for exemption;
18 amending s. 408.037, F.S.; deleting reference
19 to the state health plan; amending ss. 408.038,
20 408.039, 408.044, and 408.045, F.S.; replacing
21 "department" with "agency"; clarifying the
22 opportunity to challenge an intended award of a
23 certificate of need; amending s. 408.040, F.S.;
24 deleting an obsolete reference; revising the
25 format of conditions related to Medicaid;
26 creating a certificate-of-need workgroup within
27 the Agency for Health Care Administration;
28 providing for expenses; providing membership,
29 duties, and meetings; requiring reports;
30 providing for termination; amending s. 651.118,
31 F.S.; excluding a specified number of beds from
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1 a time limit imposed on extension of
2 authorization for continuing care residential
3 community providers to use sheltered beds for
4 nonresidents; requiring a facility to report
5 such use after the expiration of the extension;
6 amending s. 395.701, F.S.; reducing the annual
7 assessment on hospitals to fund public medical
8 assistance; providing for contingent effect;
9 amending s. 408.904, F.S.; increasing certain
10 benefits for hospital outpatient services;
11 amending s. 409.912, F.S.; providing for a
12 contract with and reimbursement of an entity in
13 Pasco or Pinellas Counties that provides
14 in-home physician services to Medicaid
15 recipients with degenerative neurological
16 diseases; providing for future repeal;
17 providing appropriations; providing for the
18 transfer of certain unexpended Medicaid funds
19 from the Department of Elderly Affairs to the
20 Agency for Health Care Administration; amending
21 ss. 641.31, 641.315, and 641.3155, F.S.;
22 prohibiting a health maintenance organization
23 from restricting a provider's ability to
24 provide inpatient hospital services to a
25 subscriber; requiring payment for medically
26 necessary inpatient hospital services;
27 providing applicability; amending s. 641.51,
28 F.S.; relating to quality assurance program
29 requirements for certain managed care
30 organizations; allowing the rendering of
31 adverse determinations by physicians licensed
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1 in any state; requiring the submission of facts
2 and documentation pertaining to rendered
3 adverse determinations; providing timeframe for
4 organizations to submit facts and documentation
5 to providers and subscribers in writing;
6 requiring an authorized representative to sign
7 the notification; creating s. 381.7351, F.S.;
8 creating the "Reducing Racial and Ethnic Health
9 Disparities: Closing the Gap Act"; creating s.
10 381.7352, F.S.; providing legislative findings
11 and intent; creating s. 381.7353, F.S.;
12 providing for the creation of the Reducing
13 Racial and Ethnic Health Disparities: Closing
14 the Gap grant program, to be administered by
15 the Department of Health; providing department
16 duties and responsibilities; authorizing
17 appointment of an advisory committee; creating
18 s. 381.7354, F.S.; providing eligibility for
19 grant awards; creating s. 381.7355, F.S.;
20 providing project requirements, an application
21 process, and review criteria; creating s.
22 381.7356, F.S.; providing for Closing the Gap
23 grant awards; providing for local matching
24 funds; providing factors for determination of
25 the amount of grant awards; providing for award
26 of grants to begin by a specified date, subject
27 to specific appropriation; providing for annual
28 renewal of grants; creating the Florida
29 Commission on Excellence in Health Care;
30 providing legislative findings and intent;
31 providing definitions; providing duties and
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1 responsibilities; providing for membership,
2 organization, meetings, procedures, and staff;
3 providing for reimbursement of travel and
4 related expenses of certain members; providing
5 certain evidentiary prohibitions; requiring a
6 report to the Governor, the President of the
7 Senate, and the Speaker of the House of
8 Representatives; providing for termination of
9 the commission; amending s. 408.7056, F.S.;
10 providing additional definitions for the
11 Statewide Provider and Subscriber Assistance
12 Program; amending s. 627.654, F.S.; providing
13 for insuring small employers under policies
14 issued to small employer health alliances;
15 providing requirements for participation;
16 providing limitations; providing for insuring
17 spouses and dependent children; allowing a
18 single master policy to include alternative
19 health plans; amending s. 627.6571, F.S.;
20 including small employer health alliances
21 within policy nonrenewal or discontinuance,
22 coverage modification, and application
23 provisions; amending s. 627.6699, F.S.;
24 revising restrictions relating to premium rates
25 to authorize small employer carriers to modify
26 rates under certain circumstances and to
27 authorize carriers to issue group health
28 insurance policies to small employer health
29 alliances under certain circumstances;
30 requiring carriers issuing a policy to an
31 alliance to allow appointed agents to sell such
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1 a policy; amending ss. 240.2995, 240.2996,
2 240.512, 381.0406, 395.3035, and 627.4301,
3 F.S.; conforming cross references; defining the
4 term "managed care"; creating s. 641.185, F.S.;
5 providing health maintenance organization
6 subscriber protections; specifying the
7 principles to serve as standards for the
8 Department of Insurance and the Agency for
9 Health Care Administration exercising their
10 duties and responsibilities; requiring that a
11 health maintenance organization observe certain
12 standards in providing health care for
13 subscribers; providing for subscribers to
14 receive quality care from a broad panel of
15 providers, referrals, preventive care,
16 emergency screening services, and second
17 opinions; providing for assurance of
18 independent accreditation by a national review
19 organization and financial security of the
20 organization; providing for continuity of
21 health care; providing for timely, concise
22 information regarding reimbursement to
23 providers and services; providing for
24 flexibility to transfer to another health
25 maintenance organization within the state;
26 providing for eligibility without
27 discrimination based on health status;
28 providing requirements for health maintenance
29 organizations that issue group health contracts
30 relating to preexisting conditions, contract
31 renewability, cancellation, extension,
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1 termination, and conversion; providing for
2 timely, urgent grievances and appeals within
3 the organization; providing for timely and
4 urgent review of grievances and appeals by an
5 independent state external review agency;
6 providing for notice of rate changes; providing
7 for information regarding contract provisions,
8 services, medical conditions, providers, and
9 service delivery; providing that no civil cause
10 of action is created; amending s. 641.511,
11 F.S.; requiring posting of certain consumer
12 assistance notices; providing requirements;
13 amending s. 627.6699, F.S.; revising a
14 definition; requiring small employer carriers
15 to begin to offer and issue all small employer
16 benefit plans on a specified date; deleting a
17 requirement that basic and standard small
18 employer health benefit plans be issued;
19 providing additional requirements for
20 determining premium rates for benefit plans;
21 providing for application to plans provided by
22 certain small employer carriers under certain
23 circumstances; amending s. 409.212, F.S.;
24 providing for periodic increase in the optional
25 state supplementation rate; amending s.
26 409.901, F.S.; amending definitions of terms
27 used in ss. 409.910-409.920, F.S.; amending s.
28 409.902, F.S.; providing that the Department of
29 Children and Family Services is responsible for
30 Medicaid eligibility determinations; amending
31 s. 409.903, F.S.; providing responsibility for
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1 determinations of eligibility for payments for
2 medical assistance and related services;
3 amending s. 409.905, F.S.; increasing the
4 maximum amount that may be paid under Medicaid
5 for hospital outpatient services; amending s.
6 409.906, F.S.; allowing the Department of
7 Children and Family Services to transfer funds
8 to the Agency for Health Care Administration to
9 cover state match requirements as specified;
10 amending s. 409.907, F.S.; specifying grounds
11 on which provider applications may be denied;
12 amending s. 409.908, F.S.; increasing the
13 maximum amount of reimbursement allowable to
14 Medicaid providers for hospital inpatient care;
15 creating s. 409.9119, F.S.; creating a
16 disproportionate share program for children's
17 hospitals; providing formulas governing
18 payments made to hospitals under the program;
19 providing for withholding payments from a
20 hospital that is not complying with agency
21 rules; amending s. 409.919, F.S.; providing for
22 the adoption and the transfer of certain rules
23 relating to the determination of Medicaid
24 eligibility; authorizing developmental research
25 schools to participate in Medicaid certified
26 school match program; providing for the Agency
27 for Health Care Administration to seek a
28 federal waiver allowing the agency to undertake
29 a pilot project that involves contracting with
30 skilled nursing facilities for the provision of
31 rehabilitation services to adult ventilator
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1 dependent patients; providing for evaluation of
2 the pilot program; repealing s. 395.7015, F.S.,
3 to eliminate the annual assessment on certain
4 health care entities; repealing s. 400.464(3),
5 F.S., relating to home health agency licenses
6 provided to certificate-of-need exempt
7 entities; repealing ss. 408.70(3), 408.701,
8 408.702, 408.703, 408.704, 408.7041, 408.7042,
9 408.7045, 408.7055, and 408.706, F.S., relating
10 to community health purchasing alliances;
11 repealing s. 409.912(4)(b), F.S., relating to
12 the authorization of the agency to contract
13 with certain prepaid health care services
14 providers; providing appropriations; providing
15 effective dates.
16
17 Be It Enacted by the Legislature of the State of Florida:
18
19 Section 1. This act may be cited as the "Patient
20 Protection Act of 2000."
21 Section 2. Subsections (2) and (11) of section
22 400.471, Florida Statutes, are amended to read:
23 400.471 Application for license; fee; provisional
24 license; temporary permit.--
25 (2) The applicant must file with the application
26 satisfactory proof that the home health agency is in
27 compliance with this part and applicable rules, including:
28 (a) A listing of services to be provided, either
29 directly by the applicant or through contractual arrangements
30 with existing providers;
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1 (b) The number and discipline of professional staff to
2 be employed; and
3 (c) Proof of financial ability to operate.
4
5 If the applicant has applied for a certificate of need under
6 ss. 408.0331-408.045 within the preceding 12 months, the
7 applicant may submit the proof required during the
8 certificate-of-need process along with an attestation that
9 there has been no substantial change in the facts and
10 circumstances underlying the original submission.
11 (11) The agency may not issue a license designated as
12 certified to a home health agency that fails to receive a
13 certificate of need under ss. 408.031-408.045 or that fails to
14 satisfy the requirements of a Medicare certification survey
15 from the agency.
16 Section 3. Section 408.032, Florida Statutes, is
17 amended to read:
18 408.032 Definitions.--As used in ss. 408.031-408.045,
19 the term:
20 (1) "Agency" means the Agency for Health Care
21 Administration.
22 (2) "Capital expenditure" means an expenditure,
23 including an expenditure for a construction project undertaken
24 by a health care facility as its own contractor, which, under
25 generally accepted accounting principles, is not properly
26 chargeable as an expense of operation and maintenance, which
27 is made to change the bed capacity of the facility, or
28 substantially change the services or service area of the
29 health care facility, health service provider, or hospice, and
30 which includes the cost of the studies, surveys, designs,
31 plans, working drawings, specifications, initial financing
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1 costs, and other activities essential to acquisition,
2 improvement, expansion, or replacement of the plant and
3 equipment.
4 (3) "Certificate of need" means a written statement
5 issued by the agency evidencing community need for a new,
6 converted, expanded, or otherwise significantly modified
7 health care facility, health service, or hospice.
8 (4) "Commenced construction" means initiation of and
9 continuous activities beyond site preparation associated with
10 erecting or modifying a health care facility, including
11 procurement of a building permit applying the use of
12 agency-approved construction documents, proof of an executed
13 owner/contractor agreement or an irrevocable or binding forced
14 account, and actual undertaking of foundation forming with
15 steel installation and concrete placing.
16 (5) "District" means a health service planning
17 district composed of the following counties:
18 District 1.--Escambia, Santa Rosa, Okaloosa, and Walton
19 Counties.
20 District 2.--Holmes, Washington, Bay, Jackson,
21 Franklin, Gulf, Gadsden, Liberty, Calhoun, Leon, Wakulla,
22 Jefferson, Madison, and Taylor Counties.
23 District 3.--Hamilton, Suwannee, Lafayette, Dixie,
24 Columbia, Gilchrist, Levy, Union, Bradford, Putnam, Alachua,
25 Marion, Citrus, Hernando, Sumter, and Lake Counties.
26 District 4.--Baker, Nassau, Duval, Clay, St. Johns,
27 Flagler, and Volusia Counties.
28 District 5.--Pasco and Pinellas Counties.
29 District 6.--Hillsborough, Manatee, Polk, Hardee, and
30 Highlands Counties.
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1 District 7.--Seminole, Orange, Osceola, and Brevard
2 Counties.
3 District 8.--Sarasota, DeSoto, Charlotte, Lee, Glades,
4 Hendry, and Collier Counties.
5 District 9.--Indian River, Okeechobee, St. Lucie,
6 Martin, and Palm Beach Counties.
7 District 10.--Broward County.
8 District 11.--Dade and Monroe Counties.
9 (6) "Exemption" means the process by which a proposal
10 that would otherwise require a certificate of need may proceed
11 without a certificate of need.
12 (7)(6) "Expedited review" means the process by which
13 certain types of applications are not subject to the review
14 cycle requirements contained in s. 408.039(1), and the letter
15 of intent requirements contained in s. 408.039(2).
16 (8)(7) "Health care facility" means a hospital,
17 long-term care hospital, skilled nursing facility, hospice,
18 intermediate care facility, or intermediate care facility for
19 the developmentally disabled. A facility relying solely on
20 spiritual means through prayer for healing is not included as
21 a health care facility.
22 (9)(8) "Health services" means diagnostic, curative,
23 or rehabilitative services and includes alcohol treatment,
24 drug abuse treatment, and mental health services. Obstetric
25 services are not health services for purposes of ss.
26 408.031-408.045.
27 (9) "Home health agency" means an organization, as
28 defined in s. 400.462(4), that is certified or seeks
29 certification as a Medicare home health service provider.
30 (10) "Hospice" or "hospice program" means a hospice as
31 defined in part VI of chapter 400.
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1 (11) "Hospital" means a health care facility licensed
2 under chapter 395.
3 (12) "Institutional health service" means a health
4 service which is provided by or through a health care facility
5 and which entails an annual operating cost of $500,000 or
6 more. The agency shall, by rule, adjust the annual operating
7 cost threshold annually using an appropriate inflation index.
8 (13) "Intermediate care facility" means an institution
9 which provides, on a regular basis, health-related care and
10 services to individuals who do not require the degree of care
11 and treatment which a hospital or skilled nursing facility is
12 designed to provide, but who, because of their mental or
13 physical condition, require health-related care and services
14 above the level of room and board.
15 (12)(14) "Intermediate care facility for the
16 developmentally disabled" means a residential facility
17 licensed under chapter 393 and certified by the Federal
18 Government pursuant to the Social Security Act as a provider
19 of Medicaid services to persons who are mentally retarded or
20 who have a related condition.
21 (13)(15) "Long-term care hospital" means a hospital
22 licensed under chapter 395 which meets the requirements of 42
23 C.F.R. s. 412.23(e) and seeks exclusion from the Medicare
24 prospective payment system for inpatient hospital services.
25 (14) "Mental health services" means inpatient services
26 provided in a hospital licensed under chapter 395 and listed
27 on the hospital license as psychiatric beds for adults;
28 psychiatric beds for children and adolescents; intensive
29 residential treatment beds for children and adolescents;
30 substance abuse beds for adults; or substance abuse beds for
31 children and adolescents.
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1 (16) "Multifacility project" means an integrated
2 residential and health care facility consisting of independent
3 living units, assisted living facility units, and nursing home
4 beds certificated on or after January 1, 1987, where:
5 (a) The aggregate total number of independent living
6 units and assisted living facility units exceeds the number of
7 nursing home beds.
8 (b) The developer of the project has expended the sum
9 of $500,000 or more on the certificated and noncertificated
10 elements of the project combined, exclusive of land costs, by
11 the conclusion of the 18th month of the life of the
12 certificate of need.
13 (c) The total aggregate cost of construction of the
14 certificated element of the project, when combined with other,
15 noncertificated elements, is $10 million or more.
16 (d) All elements of the project are contiguous or
17 immediately adjacent to each other and construction of all
18 elements will be continuous.
19 (15)(17) "Nursing home geographically underserved
20 area" means:
21 (a) A county in which there is no existing or approved
22 nursing home;
23 (b) An area with a radius of at least 20 miles in
24 which there is no existing or approved nursing home; or
25 (c) An area with a radius of at least 20 miles in
26 which all existing nursing homes have maintained at least a 95
27 percent occupancy rate for the most recent 6 months or a 90
28 percent occupancy rate for the most recent 12 months.
29 (18) "Respite care" means short-term care in a
30 licensed health care facility which is personal or custodial
31 and is provided for chronic illness, physical infirmity, or
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1 advanced age for the purpose of temporarily relieving family
2 members of the burden of providing care and attendance.
3 (16)(19) "Skilled nursing facility" means an
4 institution, or a distinct part of an institution, which is
5 primarily engaged in providing, to inpatients, skilled nursing
6 care and related services for patients who require medical or
7 nursing care, or rehabilitation services for the
8 rehabilitation of injured, disabled, or sick persons.
9 (17)(20) "Tertiary health service" means a health
10 service which, due to its high level of intensity, complexity,
11 specialized or limited applicability, and cost, should be
12 limited to, and concentrated in, a limited number of hospitals
13 to ensure the quality, availability, and cost-effectiveness of
14 such service. Examples of such service include, but are not
15 limited to, organ transplantation, specialty burn units,
16 neonatal intensive care units, comprehensive rehabilitation,
17 and medical or surgical services which are experimental or
18 developmental in nature to the extent that the provision of
19 such services is not yet contemplated within the commonly
20 accepted course of diagnosis or treatment for the condition
21 addressed by a given service. The agency shall establish by
22 rule a list of all tertiary health services.
23 (18)(21) "Regional area" means any of those regional
24 health planning areas established by the agency to which local
25 and district health planning funds are directed to local
26 health councils through the General Appropriations Act.
27 Section 4. Paragraph (b) of subsection (1) and
28 paragraph (a) of subsection (3) of section 408.033, Florida
29 Statutes, are amended to read:
30 408.033 Local and state health planning.--
31 (1) LOCAL HEALTH COUNCILS.--
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1 (b) Each local health council may:
2 1. Develop a district or regional area health plan
3 that permits is consistent with the objectives and strategies
4 in the state health plan, but that shall permit each local
5 health council to develop strategies and set priorities for
6 implementation based on its unique local health needs. The
7 district or regional area health plan must contain preferences
8 for the development of health services and facilities, which
9 may be considered by the agency in its review of
10 certificate-of-need applications. The district health plan
11 shall be submitted to the agency and updated periodically. The
12 district health plans shall use a uniform format and be
13 submitted to the agency according to a schedule developed by
14 the agency in conjunction with the local health councils. The
15 schedule must provide for coordination between the development
16 of the state health plan and the district health plans and for
17 the development of district health plans by major sections
18 over a multiyear period. The elements of a district plan
19 which are necessary to the review of certificate-of-need
20 applications for proposed projects within the district may be
21 adopted by the agency as a part of its rules.
22 2. Advise the agency on health care issues and
23 resource allocations.
24 3. Promote public awareness of community health needs,
25 emphasizing health promotion and cost-effective health service
26 selection.
27 4. Collect data and conduct analyses and studies
28 related to health care needs of the district, including the
29 needs of medically indigent persons, and assist the agency and
30 other state agencies in carrying out data collection
31 activities that relate to the functions in this subsection.
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1 5. Monitor the onsite construction progress, if any,
2 of certificate-of-need approved projects and report council
3 findings to the agency on forms provided by the agency.
4 6. Advise and assist any regional planning councils
5 within each district that have elected to address health
6 issues in their strategic regional policy plans with the
7 development of the health element of the plans to address the
8 health goals and policies in the State Comprehensive Plan.
9 7. Advise and assist local governments within each
10 district on the development of an optional health plan element
11 of the comprehensive plan provided in chapter 163, to assure
12 compatibility with the health goals and policies in the State
13 Comprehensive Plan and district health plan. To facilitate
14 the implementation of this section, the local health council
15 shall annually provide the local governments in its service
16 area, upon request, with:
17 a. A copy and appropriate updates of the district
18 health plan;
19 b. A report of hospital and nursing home utilization
20 statistics for facilities within the local government
21 jurisdiction; and
22 c. Applicable agency rules and calculated need
23 methodologies for health facilities and services regulated
24 under s. 408.034 for the district served by the local health
25 council.
26 8. Monitor and evaluate the adequacy, appropriateness,
27 and effectiveness, within the district, of local, state,
28 federal, and private funds distributed to meet the needs of
29 the medically indigent and other underserved population
30 groups.
31
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1 9. In conjunction with the Agency for Health Care
2 Administration, plan for services at the local level for
3 persons infected with the human immunodeficiency virus.
4 10. Provide technical assistance to encourage and
5 support activities by providers, purchasers, consumers, and
6 local, regional, and state agencies in meeting the health care
7 goals, objectives, and policies adopted by the local health
8 council.
9 11. Provide the agency with data required by rule for
10 the review of certificate-of-need applications and the
11 projection of need for health services and facilities in the
12 district.
13 (3) DUTIES AND RESPONSIBILITIES OF THE AGENCY.--
14 (a) The agency, in conjunction with the local health
15 councils, is responsible for the coordinated planning of all
16 health care services in the state and for the preparation of
17 the state health plan.
18 Section 5. Subsection (2) of section 408.034, Florida
19 Statutes, is amended to read:
20 408.034 Duties and responsibilities of agency;
21 rules.--
22 (2) In the exercise of its authority to issue licenses
23 to health care facilities and health service providers, as
24 provided under chapters 393, 395, and parts II, IV, and VI of
25 chapter 400, the agency may not issue a license to any health
26 care facility, health service provider, hospice, or part of a
27 health care facility which fails to receive a certificate of
28 need or an exemption for the licensed facility or service.
29 Section 6. Section 408.035, Florida Statutes, is
30 amended to read:
31 408.035 Review criteria.--
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1 (1) The agency shall determine the reviewability of
2 applications and shall review applications for
3 certificate-of-need determinations for health care facilities
4 and health services in context with the following criteria:
5 (1)(a) The need for the health care facilities and
6 health services being proposed in relation to the applicable
7 district health plan, except in emergency circumstances that
8 pose a threat to the public health.
9 (2)(b) The availability, quality of care, efficiency,
10 appropriateness, accessibility, and extent of utilization of,
11 and adequacy of like and existing health care facilities and
12 health services in the service district of the applicant.
13 (3)(c) The ability of the applicant to provide quality
14 of care and the applicant's record of providing quality of
15 care.
16 (d) The availability and adequacy of other health care
17 facilities and health services in the service district of the
18 applicant, such as outpatient care and ambulatory or home care
19 services, which may serve as alternatives for the health care
20 facilities and health services to be provided by the
21 applicant.
22 (e) Probable economies and improvements in service
23 which may be derived from operation of joint, cooperative, or
24 shared health care resources.
25 (4)(f) The need in the service district of the
26 applicant for special health care equipment and services that
27 are not reasonably and economically accessible in adjoining
28 areas.
29 (5)(g) The needs of need for research and educational
30 facilities, including, but not limited to, facilities with
31 institutional training programs and community training
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1 programs for health care practitioners and for doctors of
2 osteopathic medicine and medicine at the student, internship,
3 and residency training levels.
4 (6)(h) The availability of resources, including health
5 personnel, management personnel, and funds for capital and
6 operating expenditures, for project accomplishment and
7 operation.; the effects the project will have on clinical
8 needs of health professional training programs in the service
9 district; the extent to which the services will be accessible
10 to schools for health professions in the service district for
11 training purposes if such services are available in a limited
12 number of facilities; the availability of alternative uses of
13 such resources for the provision of other health services; and
14 (7) The extent to which the proposed services will
15 enhance access to health care for be accessible to all
16 residents of the service district.
17 (8)(i) The immediate and long-term financial
18 feasibility of the proposal.
19 (j) The special needs and circumstances of health
20 maintenance organizations.
21 (k) The needs and circumstances of those entities that
22 provide a substantial portion of their services or resources,
23 or both, to individuals not residing in the service district
24 in which the entities are located or in adjacent service
25 districts. Such entities may include medical and other health
26 professions, schools, multidisciplinary clinics, and specialty
27 services such as open-heart surgery, radiation therapy, and
28 renal transplantation.
29 (9)(l) The extent to which the proposal will foster
30 competition that promotes quality and cost-effectiveness. The
31 probable impact of the proposed project on the costs of
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1 providing health services proposed by the applicant, upon
2 consideration of factors including, but not limited to, the
3 effects of competition on the supply of health services being
4 proposed and the improvements or innovations in the financing
5 and delivery of health services which foster competition and
6 service to promote quality assurance and cost-effectiveness.
7 (10)(m) The costs and methods of the proposed
8 construction, including the costs and methods of energy
9 provision and the availability of alternative, less costly, or
10 more effective methods of construction.
11 (11)(n) The applicant's past and proposed provision of
12 health care services to Medicaid patients and the medically
13 indigent.
14 (o) The applicant's past and proposed provision of
15 services that promote a continuum of care in a multilevel
16 health care system, which may include, but are not limited to,
17 acute care, skilled nursing care, home health care, and
18 assisted living facilities.
19 (12)(p) The applicant's designation as a Gold Seal
20 Program nursing facility pursuant to s. 400.235, when the
21 applicant is requesting additional nursing home beds at that
22 facility.
23 (2) In cases of capital expenditure proposals for the
24 provision of new health services to inpatients, the agency
25 shall also reference each of the following in its findings of
26 fact:
27 (a) That less costly, more efficient, or more
28 appropriate alternatives to such inpatient services are not
29 available and the development of such alternatives has been
30 studied and found not practicable.
31
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1 (b) That existing inpatient facilities providing
2 inpatient services similar to those proposed are being used in
3 an appropriate and efficient manner.
4 (c) In the case of new construction or replacement
5 construction, that alternatives to the construction, for
6 example, modernization or sharing arrangements, have been
7 considered and have been implemented to the maximum extent
8 practicable.
9 (d) That patients will experience serious problems in
10 obtaining inpatient care of the type proposed, in the absence
11 of the proposed new service.
12 (e) In the case of a proposal for the addition of beds
13 for the provision of skilled nursing or intermediate care
14 services, that the addition will be consistent with the plans
15 of other agencies of the state responsible for the provision
16 and financing of long-term care, including home health
17 services.
18 Section 7. Section 408.036, Florida Statutes, is
19 amended to read:
20 408.036 Projects subject to review.--
21 (1) APPLICABILITY.--Unless exempt under subsection
22 (3), all health-care-related projects, as described in
23 paragraphs (a)-(h)(k), are subject to review and must file an
24 application for a certificate of need with the agency. The
25 agency is exclusively responsible for determining whether a
26 health-care-related project is subject to review under ss.
27 408.031-408.045.
28 (a) The addition of beds by new construction or
29 alteration.
30 (b) The new construction or establishment of
31 additional health care facilities, including a replacement
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1 health care facility when the proposed project site is not
2 located on the same site as the existing health care facility.
3 (c) The conversion from one type of health care
4 facility to another, including the conversion from one level
5 of care to another, in a skilled or intermediate nursing
6 facility, if the conversion effects a change in the level of
7 care of 10 beds or 10 percent of total bed capacity of the
8 skilled or intermediate nursing facility within a 2-year
9 period. If the nursing facility is certified for both skilled
10 and intermediate nursing care, the provisions of this
11 paragraph do not apply.
12 (d) An Any increase in the total licensed bed capacity
13 of a health care facility.
14 (e) Subject to the provisions of paragraph (3)(i), The
15 establishment of a Medicare-certified home health agency, the
16 establishment of a hospice or hospice inpatient facility, or
17 the direct provision of such services by a health care
18 facility or health maintenance organization for those other
19 than the subscribers of the health maintenance organization;
20 except that this paragraph does not apply to the establishment
21 of a Medicare-certified home health agency by a facility
22 described in paragraph (3)(h).
23 (f) An acquisition by or on behalf of a health care
24 facility or health maintenance organization, by any means,
25 which acquisition would have required review if the
26 acquisition had been by purchase.
27 (f)(g) The establishment of inpatient institutional
28 health services by a health care facility, or a substantial
29 change in such services.
30 (h) The acquisition by any means of an existing health
31 care facility by any person, unless the person provides the
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1 agency with at least 30 days' written notice of the proposed
2 acquisition, which notice is to include the services to be
3 offered and the bed capacity of the facility, and unless the
4 agency does not determine, within 30 days after receipt of
5 such notice, that the services to be provided and the bed
6 capacity of the facility will be changed.
7 (i) An increase in the cost of a project for which a
8 certificate of need has been issued when the increase in cost
9 exceeds 20 percent of the originally approved cost of the
10 project, except that a cost overrun review is not necessary
11 when the cost overrun is less than $20,000.
12 (g)(j) An increase in the number of beds for acute
13 care, specialty burn units, neonatal intensive care units,
14 comprehensive rehabilitation, mental health services, or
15 hospital-based distinct part skilled nursing units, or at a
16 long-term care hospital psychiatric or rehabilitation beds.
17 (h)(k) The establishment of tertiary health services.
18 (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless
19 exempt pursuant to subsection (3), projects subject to an
20 expedited review shall include, but not be limited to:
21 (a) Cost overruns, as defined in paragraph (1)(i).
22 (a)(b) Research, education, and training programs.
23 (b)(c) Shared services contracts or projects.
24 (c)(d) A transfer of a certificate of need.
25 (d)(e) A 50-percent increase in nursing home beds for
26 a facility incorporated and operating in this state for at
27 least 60 years on or before July 1, 1988, which has a licensed
28 nursing home facility located on a campus providing a variety
29 of residential settings and supportive services. The
30 increased nursing home beds shall be for the exclusive use of
31 the campus residents. Any application on behalf of an
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1 applicant meeting this requirement shall be subject to the
2 base fee of $5,000 provided in s. 408.038.
3 (f) Combination within one nursing home facility of
4 the beds or services authorized by two or more certificates of
5 need issued in the same planning subdistrict.
6 (g) Division into two or more nursing home facilities
7 of beds or services authorized by one certificate of need
8 issued in the same planning subdistrict. Such division shall
9 not be approved if it would adversely affect the original
10 certificate's approved cost.
11 (e)(h) Replacement of a health care facility when the
12 proposed project site is located in the same district and
13 within a 1-mile radius of the replaced health care facility.
14 (f) The conversion of mental health services beds
15 licensed under chapter 395 or hospital-based distinct part
16 skilled nursing unit beds to general acute care beds; the
17 conversion of mental health services beds between or among the
18 licensed bed categories defined as beds for mental health
19 services; or the conversion of general acute care beds to beds
20 for mental health services.
21 1. Conversion under this paragraph shall not establish
22 a new licensed bed category at the hospital but shall apply
23 only to categories of beds licensed at that hospital.
24 2. Beds converted under this paragraph must be
25 licensed and operational for at least 12 months before the
26 hospital may apply for additional conversion affecting beds of
27 the same type.
28
29 The agency shall develop rules to implement the provisions for
30 expedited review, including time schedule, application content
31
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1 which may be reduced from the full requirements of s.
2 408.037(1), and application processing.
3 (3) EXEMPTIONS.--Upon request, the following projects
4 are subject to supported by such documentation as the agency
5 requires, the agency shall grant an exemption from the
6 provisions of subsection (1):
7 (a) For the initiation or expansion of obstetric
8 services.
9 (a)(b) For replacement of any expenditure to replace
10 or renovate any part of a licensed health care facility on the
11 same site, provided that the number of licensed beds in each
12 licensed bed category will not increase and, in the case of a
13 replacement facility, the project site is the same as the
14 facility being replaced.
15 (c) For providing respite care services. An individual
16 may be admitted to a respite care program in a hospital
17 without regard to inpatient requirements relating to admitting
18 order and attendance of a member of a medical staff.
19 (b)(d) For hospice services or home health services
20 provided by a rural hospital, as defined in s. 395.602, or for
21 swing beds in such rural hospital in a number that does not
22 exceed one-half of its licensed beds.
23 (c)(e) For the conversion of licensed acute care
24 hospital beds to Medicare and Medicaid certified skilled
25 nursing beds in a rural hospital as defined in s. 395.602, so
26 long as the conversion of the beds does not involve the
27 construction of new facilities. The total number of skilled
28 nursing beds, including swing beds, may not exceed one-half of
29 the total number of licensed beds in the rural hospital as of
30 July 1, 1993. Certified skilled nursing beds designated under
31 this paragraph, excluding swing beds, shall be included in the
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1 community nursing home bed inventory. A rural hospital which
2 subsequently decertifies any acute care beds exempted under
3 this paragraph shall notify the agency of the decertification,
4 and the agency shall adjust the community nursing home bed
5 inventory accordingly.
6 (d)(f) For the addition of nursing home beds at a
7 skilled nursing facility that is part of a retirement
8 community that provides a variety of residential settings and
9 supportive services and that has been incorporated and
10 operated in this state for at least 65 years on or before July
11 1, 1994. All nursing home beds must not be available to the
12 public but must be for the exclusive use of the community
13 residents.
14 (e)(g) For an increase in the bed capacity of a
15 nursing facility licensed for at least 50 beds as of January
16 1, 1994, under part II of chapter 400 which is not part of a
17 continuing care facility if, after the increase, the total
18 licensed bed capacity of that facility is not more than 60
19 beds and if the facility has been continuously licensed since
20 1950 and has received a superior rating on each of its two
21 most recent licensure surveys.
22 (h) For the establishment of a Medicare-certified home
23 health agency by a facility certified under chapter 651; a
24 retirement community, as defined in s. 400.404(2)(g); or a
25 residential facility that serves only retired military
26 personnel, their dependents, and the surviving dependents of
27 deceased military personnel. Medicare-reimbursed home health
28 services provided through such agency shall be offered
29 exclusively to residents of the facility or retirement
30 community or to residents of facilities or retirement
31 communities owned, operated, or managed by the same corporate
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1 entity. Each visit made to deliver Medicare-reimbursable home
2 health services to a home health patient who, at the time of
3 service, is not a resident of the facility or retirement
4 community shall be a deceptive and unfair trade practice and
5 constitutes a violation of ss. 501.201-501.213.
6 (i) For the establishment of a Medicare-certified home
7 health agency. This paragraph shall take effect 90 days after
8 the adjournment sine die of the next regular session of the
9 Legislature occurring after the legislative session in which
10 the Legislature receives a report from the Director of Health
11 Care Administration certifying that the federal Health Care
12 Financing Administration has implemented a per-episode
13 prospective pay system for Medicare-certified home health
14 agencies.
15 (f)(j) For an inmate health care facility built by or
16 for the exclusive use of the Department of Corrections as
17 provided in chapter 945. This exemption expires when such
18 facility is converted to other uses.
19 (k) For an expenditure by or on behalf of a health
20 care facility to provide a health service exclusively on an
21 outpatient basis.
22 (g)(l) For the termination of an inpatient a health
23 care service, upon 30 days' written notice to the agency.
24 (h)(m) For the delicensure of beds, upon 30 days'
25 written notice to the agency. A request for exemption An
26 application submitted under this paragraph must identify the
27 number, the category of beds classification, and the name of
28 the facility in which the beds to be delicensed are located.
29 (i)(n) For the provision of adult inpatient diagnostic
30 cardiac catheterization services in a hospital.
31
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1 1. In addition to any other documentation otherwise
2 required by the agency, a request for an exemption submitted
3 under this paragraph must comply with the following criteria:
4 a. The applicant must certify it will not provide
5 therapeutic cardiac catheterization pursuant to the grant of
6 the exemption.
7 b. The applicant must certify it will meet and
8 continuously maintain the minimum licensure requirements
9 adopted by the agency governing such programs pursuant to
10 subparagraph 2.
11 c. The applicant must certify it will provide a
12 minimum of 2 percent of its services to charity and Medicaid
13 patients.
14 2. The agency shall adopt licensure requirements by
15 rule which govern the operation of adult inpatient diagnostic
16 cardiac catheterization programs established pursuant to the
17 exemption provided in this paragraph. The rules shall ensure
18 that such programs:
19 a. Perform only adult inpatient diagnostic cardiac
20 catheterization services authorized by the exemption and will
21 not provide therapeutic cardiac catheterization or any other
22 services not authorized by the exemption.
23 b. Maintain sufficient appropriate equipment and
24 health personnel to ensure quality and safety.
25 c. Maintain appropriate times of operation and
26 protocols to ensure availability and appropriate referrals in
27 the event of emergencies.
28 d. Maintain appropriate program volumes to ensure
29 quality and safety.
30 e. Provide a minimum of 2 percent of its services to
31 charity and Medicaid patients each year.
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1 3.a. The exemption provided by this paragraph shall
2 not apply unless the agency determines that the program is in
3 compliance with the requirements of subparagraph 1. and that
4 the program will, after beginning operation, continuously
5 comply with the rules adopted pursuant to subparagraph 2. The
6 agency shall monitor such programs to ensure compliance with
7 the requirements of subparagraph 2.
8 b.(I) The exemption for a program shall expire
9 immediately when the program fails to comply with the rules
10 adopted pursuant to sub-subparagraphs 2.a., b., and c.
11 (II) Beginning 18 months after a program first begins
12 treating patients, the exemption for a program shall expire
13 when the program fails to comply with the rules adopted
14 pursuant to sub-subparagraphs 2.d. and e.
15 (III) If the exemption for a program expires pursuant
16 to sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
17 agency shall not grant an exemption pursuant to this paragraph
18 for an adult inpatient diagnostic cardiac catheterization
19 program located at the same hospital until 2 years following
20 the date of the determination by the agency that the program
21 failed to comply with the rules adopted pursuant to
22 subparagraph 2.
23 4. The agency shall not grant any exemption under this
24 paragraph until the adoption of the rules required under this
25 paragraph, or until March 1, 1998, whichever comes first.
26 However, if final rules have not been adopted by March 1,
27 1998, the proposed rules governing the exemptions shall be
28 used by the agency to grant exemptions under the provisions of
29 this paragraph until final rules become effective.
30 (j)(o) For any expenditure to provide mobile surgical
31 facilities and related health care services provided under
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1 contract with the Department of Corrections or a private
2 correctional facility operating pursuant to chapter 957.
3 (k)(p) For state veterans' nursing homes operated by
4 or on behalf of the Florida Department of Veterans' Affairs in
5 accordance with part II of chapter 296 for which at least 50
6 percent of the construction cost is federally funded and for
7 which the Federal Government pays a per diem rate not to
8 exceed one-half of the cost of the veterans' care in such
9 state nursing homes. These beds shall not be included in the
10 nursing home bed inventory.
11 (l) For combination within one nursing home facility
12 of the beds or services authorized by two or more certificates
13 of need issued in the same planning subdistrict. An exemption
14 granted under this paragraph shall extend the validity period
15 of the certificates of need to be consolidated by the length
16 of the period beginning upon submission of the exemption
17 request and ending with issuance of the exemption. The
18 longest validity period among the certificates shall be
19 applicable to each of the combined certificates.
20 (m) For division into two or more nursing home
21 facilities of beds or services authorized by one certificate
22 of need issued in the same planning subdistrict. An exemption
23 granted under this paragraph shall extend the validity period
24 of the certificate of need to be divided by the length of the
25 period beginning upon submission of the exemption request and
26 ending with issuance of the exemption.
27 (n) For the addition of hospital beds licensed under
28 chapter 395 for acute care, mental health services, or a
29 hospital-based distinct part skilled nursing unit in a number
30 that may not exceed 10 total beds or 10 percent of the
31 licensed capacity of the bed category being expanded,
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1 whichever is greater. Beds for specialty burn units, neonatal
2 intensive care units, or comprehensive rehabilitation, or at a
3 long-term care hospital, may not be increased under this
4 paragraph.
5 1. In addition to any other documentation otherwise
6 required by the agency, a request for exemption submitted
7 under this paragraph must:
8 a. Certify that the prior 12-month average occupancy
9 rate for the category of licensed beds being expanded at the
10 facility meets or exceeds 80 percent or, for a hospital-based
11 distinct part skilled nursing unit, the prior 12-month average
12 occupancy rate meets or exceeds 96 percent.
13 b. Certify that any beds of the same type authorized
14 for the facility under this paragraph before the date of the
15 current request for an exemption have been licensed and
16 operational for at least 12 months.
17 2. The timeframes and monitoring process specified in
18 s. 408.040(2)(a)-(c) apply to any exemption issued under this
19 paragraph.
20 3. The agency shall count beds authorized under this
21 paragraph as approved beds in the published inventory of
22 hospital beds until the beds are licensed.
23 (o) For the addition of acute care beds, as authorized
24 by rule consistent with s. 395.003(4), in a number that may
25 not exceed 10 total beds or 10 percent of licensed bed
26 capacity, whichever is greater, for temporary beds in a
27 hospital which has experienced high seasonal occupancy within
28 the prior 12-month period or in a hospital that must respond
29 to emergency or exigent circumstances.
30 (p) For the addition of nursing home beds licensed
31 under chapter 400 in a number not exceeding 10 total beds or
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1 10 percent of the number of beds licensed in the facility
2 being expanded, whichever is greater.
3 1. In addition to any other documentation required by
4 the agency, a request for exemption submitted under this
5 paragraph must:
6 a. Certify that the facility has not had any class I
7 or class II deficiencies within the 30 months preceding the
8 request for addition.
9 b. Certify that the prior 12-month average occupancy
10 rate for the nursing home beds at the facility meets or
11 exceeds 96 percent.
12 c. Certify that any beds authorized for the facility
13 under this paragraph before the date of the current request
14 for an exemption have been licensed and operational for at
15 least 12 months.
16 2. The timeframes and monitoring process specified in
17 s. 408.040(2)(a)-(c) apply to any exemption issued under this
18 paragraph.
19 3. The agency shall count beds authorized under this
20 paragraph as approved beds in the published inventory of
21 nursing home beds until the beds are licensed.
22 (q) For establishment of a specialty hospital offering
23 a range of medical service restricted to a defined age or
24 gender group of the population or a restricted range of
25 services appropriate to the diagnosis, care, and treatment of
26 patients with specific categories of medical illnesses or
27 disorders, through the transfer of beds and services from an
28 existing hospital in the same county.
29 (4) A request for exemption under this subsection (3)
30 may be made at any time and is not subject to the batching
31 requirements of this section. The request shall be supported
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1 by such documentation as the agency requires by rule. The
2 agency shall assess a fee of $250 for each request for
3 exemption submitted under subsection (3).
4 Section 8. Paragraph (a) of subsection (1) of section
5 408.037, Florida Statutes, is amended to read:
6 408.037 Application content.--
7 (1) An application for a certificate of need must
8 contain:
9 (a) A detailed description of the proposed project and
10 statement of its purpose and need in relation to the district
11 local health plan and the state health plan.
12 Section 9. Section 408.038, Florida Statutes, is
13 amended to read:
14 408.038 Fees.--The agency department shall assess fees
15 on certificate-of-need applications. Such fees shall be for
16 the purpose of funding the functions of the local health
17 councils and the activities of the agency department and shall
18 be allocated as provided in s. 408.033. The fee shall be
19 determined as follows:
20 (1) A minimum base fee of $5,000.
21 (2) In addition to the base fee of $5,000, 0.015 of
22 each dollar of proposed expenditure, except that a fee may not
23 exceed $22,000.
24 Section 10. Subsections (3) and (4), paragraph (c) of
25 subsection (5), and paragraphs (a) and (b) of subsection (6)
26 of section 408.039, Florida Statutes, are amended to read:
27 408.039 Review process.--The review process for
28 certificates of need shall be as follows:
29 (3) APPLICATION PROCESSING.--
30 (a) An applicant shall file an application with the
31 agency department, and shall furnish a copy of the application
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1 to the local health council and the agency department. Within
2 15 days after the applicable application filing deadline
3 established by agency department rule, the staff of the agency
4 department shall determine if the application is complete. If
5 the application is incomplete, the staff shall request
6 specific information from the applicant necessary for the
7 application to be complete; however, the staff may make only
8 one such request. If the requested information is not filed
9 with the agency department within 21 days of the receipt of
10 the staff's request, the application shall be deemed
11 incomplete and deemed withdrawn from consideration.
12 (b) Upon the request of any applicant or substantially
13 affected person within 14 days after notice that an
14 application has been filed, a public hearing may be held at
15 the agency's department's discretion if the agency department
16 determines that a proposed project involves issues of great
17 local public interest. The public hearing shall allow
18 applicants and other interested parties reasonable time to
19 present their positions and to present rebuttal information. A
20 recorded verbatim record of the hearing shall be maintained.
21 The public hearing shall be held at the local level within 21
22 days after the application is deemed complete.
23 (4) STAFF RECOMMENDATIONS.--
24 (a) The agency's department's review of and final
25 agency action on applications shall be in accordance with the
26 district health plan, and statutory criteria, and the
27 implementing administrative rules. In the application review
28 process, the agency department shall give a preference, as
29 defined by rule of the agency department, to an applicant
30 which proposes to develop a nursing home in a nursing home
31 geographically underserved area.
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1 (b) Within 60 days after all the applications in a
2 review cycle are determined to be complete, the agency
3 department shall issue its State Agency Action Report and
4 Notice of Intent to grant a certificate of need for the
5 project in its entirety, to grant a certificate of need for
6 identifiable portions of the project, or to deny a certificate
7 of need. The State Agency Action Report shall set forth in
8 writing its findings of fact and determinations upon which its
9 decision is based. If a finding of fact or determination by
10 the agency department is counter to the district health plan
11 of the local health council, the agency department shall
12 provide in writing its reason for its findings, item by item,
13 to the local health council. If the agency department intends
14 to grant a certificate of need, the State Agency Action Report
15 or the Notice of Intent shall also include any conditions
16 which the agency department intends to attach to the
17 certificate of need. The agency department shall designate by
18 rule a senior staff person, other than the person who issues
19 the final order, to issue State Agency Action Reports and
20 Notices of Intent.
21 (c) The agency department shall publish its proposed
22 decision set forth in the Notice of Intent in the Florida
23 Administrative Weekly within 14 days after the Notice of
24 Intent is issued.
25 (d) If no administrative hearing is requested pursuant
26 to subsection (5), the State Agency Action Report and the
27 Notice of Intent shall become the final order of the agency
28 department. The agency department shall provide a copy of the
29 final order to the appropriate local health council.
30 (5) ADMINISTRATIVE HEARINGS.--
31
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1 (c) In administrative proceedings challenging the
2 issuance or denial of a certificate of need, only applicants
3 considered by the agency in the same batching cycle are
4 entitled to a comparative hearing on their applications.
5 Existing health care facilities may initiate or intervene in
6 an administrative hearing upon a showing that an established
7 program will be substantially affected by the issuance of any
8 certificate of need, whether reviewed under s. 408.036(1) or
9 (2), to a competing proposed facility or program within the
10 same district.
11 (6) JUDICIAL REVIEW.--
12 (a) A party to an administrative hearing for an
13 application for a certificate of need has the right, within
14 not more than 30 days after the date of the final order, to
15 seek judicial review in the District Court of Appeal pursuant
16 to s. 120.68. The agency department shall be a party in any
17 such proceeding.
18 (b) In such judicial review, the court shall affirm
19 the final order of the agency department, unless the decision
20 is arbitrary, capricious, or not in compliance with ss.
21 408.031-408.045.
22 Section 11. Subsections (1) and (2) of section
23 408.040, Florida Statutes, are amended to read:
24 408.040 Conditions and monitoring.--
25 (1)(a) The agency may issue a certificate of need
26 predicated upon statements of intent expressed by an applicant
27 in the application for a certificate of need. Any conditions
28 imposed on a certificate of need based on such statements of
29 intent shall be stated on the face of the certificate of need.
30 1. Any certificate of need issued for construction of
31 a new hospital or for the addition of beds to an existing
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1 hospital shall include a statement of the number of beds
2 approved by category of service, including rehabilitation or
3 psychiatric service, for which the agency has adopted by rule
4 a specialty-bed-need methodology. All beds that are approved,
5 but are not covered by any specialty-bed-need methodology,
6 shall be designated as general.
7 (b)2. The agency may consider, in addition to the
8 other criteria specified in s. 408.035, a statement of intent
9 by the applicant that a specified to designate a percentage of
10 the annual patient days at beds of the facility will be
11 utilized for use by patients eligible for care under Title XIX
12 of the Social Security Act. Any certificate of need issued to
13 a nursing home in reliance upon an applicant's statements that
14 to provide a specified percentage number of annual patient
15 days will be utilized beds for use by residents eligible for
16 care under Title XIX of the Social Security Act must include a
17 statement that such certification is a condition of issuance
18 of the certificate of need. The certificate-of-need program
19 shall notify the Medicaid program office and the Department of
20 Elderly Affairs when it imposes conditions as authorized in
21 this paragraph subparagraph in an area in which a community
22 diversion pilot project is implemented.
23 (c)(b) A certificateholder may apply to the agency for
24 a modification of conditions imposed under paragraph (a) or
25 paragraph (b). If the holder of a certificate of need
26 demonstrates good cause why the certificate should be
27 modified, the agency shall reissue the certificate of need
28 with such modifications as may be appropriate. The agency
29 shall by rule define the factors constituting good cause for
30 modification.
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1 (d)(c) If the holder of a certificate of need fails to
2 comply with a condition upon which the issuance of the
3 certificate was predicated, the agency may assess an
4 administrative fine against the certificateholder in an amount
5 not to exceed $1,000 per failure per day. In assessing the
6 penalty, the agency shall take into account as mitigation the
7 relative lack of severity of a particular failure. Proceeds
8 of such penalties shall be deposited in the Public Medical
9 Assistance Trust Fund.
10 (2)(a) Unless the applicant has commenced
11 construction, if the project provides for construction, unless
12 the applicant has incurred an enforceable capital expenditure
13 commitment for a project, if the project does not provide for
14 construction, or unless subject to paragraph (b), a
15 certificate of need shall terminate 18 months after the date
16 of issuance, except in the case of a multifacility project, as
17 defined in s. 408.032, where the certificate of need shall
18 terminate 2 years after the date of issuance. The agency shall
19 monitor the progress of the holder of the certificate of need
20 in meeting the timetable for project development specified in
21 the application with the assistance of the local health
22 council as specified in s. 408.033(1)(b)5., and may revoke the
23 certificate of need, if the holder of the certificate is not
24 meeting such timetable and is not making a good faith effort,
25 as defined by rule, to meet it.
26 (b) A certificate of need issued to an applicant
27 holding a provisional certificate of authority under chapter
28 651 shall terminate 1 year after the applicant receives a
29 valid certificate of authority from the Department of
30 Insurance.
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1 (c) The certificate-of-need validity period for a
2 project shall be extended by the agency, to the extent that
3 the applicant demonstrates to the satisfaction of the agency
4 that good faith commencement of the project is being delayed
5 by litigation or by governmental action or inaction with
6 respect to regulations or permitting precluding commencement
7 of the project.
8 (d) If an application is filed to consolidate two or
9 more certificates as authorized by s. 408.036(2)(f) or to
10 divide a certificate of need into two or more facilities as
11 authorized by s. 408.036(2)(g), the validity period of the
12 certificate or certificates of need to be consolidated or
13 divided shall be extended for the period beginning upon
14 submission of the application and ending when final agency
15 action and any appeal from such action has been concluded.
16 However, no such suspension shall be effected if the
17 application is withdrawn by the applicant.
18 Section 12. Section 408.044, Florida Statutes, is
19 amended to read:
20 408.044 Injunction.--Notwithstanding the existence or
21 pursuit of any other remedy, the agency department may
22 maintain an action in the name of the state for injunction or
23 other process against any person to restrain or prevent the
24 pursuit of a project subject to review under ss.
25 408.031-408.045, in the absence of a valid certificate of
26 need.
27 Section 13. Section 408.045, Florida Statutes, is
28 amended to read:
29 408.045 Certificate of need; competitive sealed
30 proposals.--
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1 (1) The application, review, and issuance procedures
2 for a certificate of need for an intermediate care facility
3 for the developmentally disabled may be made by the agency
4 department by competitive sealed proposals.
5 (2) The agency department shall make a decision
6 regarding the issuance of the certificate of need in
7 accordance with the provisions of s. 287.057(15), rules
8 adopted by the agency department relating to intermediate care
9 facilities for the developmentally disabled, and the criteria
10 in s. 408.035, as further defined by rule.
11 (3) Notification of the decision shall be issued to
12 all applicants not later than 28 calendar days after the date
13 responses to a request for proposal are due.
14 (4) The procedures provided for under this section are
15 exempt from the batching cycle requirements and the public
16 hearing requirement of s. 408.039.
17 (5) The agency department may use the competitive
18 sealed proposal procedure for determining a certificate of
19 need for other types of health care facilities and services if
20 the agency department identifies an unmet health care need and
21 when funding in whole or in part for such health care
22 facilities or services is authorized by the Legislature.
23 Section 14. (1)(a) There is created a
24 certificate-of-need workgroup staffed by the Agency for Health
25 Care Administration.
26 (b) Workgroup participants shall be responsible for
27 only the expenses that they generate individually through
28 workgroup participation. The agency shall be responsible for
29 expenses incidental to the production of any required data or
30 reports.
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1 (2) The workgroup shall consist of 30 members, 10
2 appointed by the Governor, 10 appointed by the President of
3 the Senate, and 10 appointed by the Speaker of the House of
4 Representatives. The workgroup chair shall be selected by
5 majority vote of a quorum present. Sixteen members shall
6 constitute a quorum. The membership shall include, but not be
7 limited to, representatives from health care provider
8 organizations, health care facilities, individual health care
9 practitioners, local health councils, and consumer
10 organizations, and persons with health care market expertise
11 as private-sector consultants.
12 (3) Appointment to the workgroup shall be as follows:
13 (a) The Governor shall appoint one representative each
14 from the hospital industry, the nursing home industry, the
15 hospice industry, the local health councils, and a consumer
16 organization; three health care market consultants, one of
17 whom is a recognized expert on hospital markets, one of whom
18 is a recognized expert on nursing home or long-term care
19 markets, and one of whom is a recognized expert on hospice
20 markets; one representative from the Medicaid program; and one
21 representative from a health care facility that provides a
22 tertiary service.
23 (b) The President of the Senate shall appoint a
24 representative of a for-profit hospital, a representative of a
25 not-for-profit hospital, a representative of a public
26 hospital, two representatives of the nursing home industry,
27 two representatives of the hospice industry, a representative
28 of a consumer organization, a representative from the
29 Department of Elderly Affairs involved with the implementation
30 of a long-term care community diversion program, and a health
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1 care market consultant with expertise in health care
2 economics.
3 (c) The Speaker of the House of Representatives shall
4 appoint a representative from the Florida Hospital
5 Association, a representative of the Association of Community
6 Hospitals and Health Systems of Florida, a representative of
7 the Florida League of Health Systems, a representative of the
8 Florida Health Care Association, a representative of the
9 Florida Association of Homes for the Aging, three
10 representatives of Florida Hospices and Palliative Care, one
11 representative of local health councils, and one
12 representative of a consumer organization.
13 (4) The workgroup shall study issues pertaining to the
14 certificate-of-need program, including the impact of trends in
15 health care delivery and financing. The workgroup shall study
16 issues relating to implementation of the certificate-of-need
17 program.
18 (5) The workgroup shall meet at least annually, at the
19 request of the chair. The workgroup shall submit an interim
20 report by December 31, 2001, and a final report by December
21 31, 2002. The workgroup is abolished effective July 1, 2003.
22 Section 15. Subsection (7) of section 651.118, Florida
23 Statutes, is amended to read:
24 651.118 Agency for Health Care Administration;
25 certificates of need; sheltered beds; community beds.--
26 (7) Notwithstanding the provisions of subsection (2),
27 at the discretion of the continuing care provider, sheltered
28 nursing home beds may be used for persons who are not
29 residents of the facility and who are not parties to a
30 continuing care contract for a period of up to 5 years after
31 the date of issuance of the initial nursing home license. A
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1 provider whose 5-year period has expired or is expiring may
2 request the Agency for Health Care Administration for an
3 extension, not to exceed 30 percent of the total sheltered
4 nursing home beds, if the utilization by residents of the
5 facility in the sheltered beds will not generate sufficient
6 income to cover facility expenses, as evidenced by one of the
7 following:
8 (a) The facility has a net loss for the most recent
9 fiscal year as determined under generally accepted accounting
10 principles, excluding the effects of extraordinary or unusual
11 items, as demonstrated in the most recently audited financial
12 statement; or
13 (b) The facility would have had a pro forma loss for
14 the most recent fiscal year, excluding the effects of
15 extraordinary or unusual items, if revenues were reduced by
16 the amount of revenues from persons in sheltered beds who were
17 not residents, as reported on by a certified public
18 accountant.
19
20 The agency shall be authorized to grant an extension to the
21 provider based on the evidence required in this subsection.
22 The agency may request a facility to use up to 25 percent of
23 the patient days generated by new admissions of nonresidents
24 during the extension period to serve Medicaid recipients for
25 those beds authorized for extended use if there is a
26 demonstrated need in the respective service area and if funds
27 are available. A provider who obtains an extension is
28 prohibited from applying for additional sheltered beds under
29 the provision of subsection (2), unless additional residential
30 units are built or the provider can demonstrate need by
31 facility residents to the Agency for Health Care
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1 Administration. The 5-year limit does not apply to up to five
2 sheltered beds designated for inpatient hospice care as part
3 of a contractural arrangement with a hospice licensed under
4 part VI of chapter 400. A facility that uses such beds after
5 the 5-year period shall report such use to the Agency for
6 Health Care Administration. For purposes of this subsection,
7 "resident" means a person who, upon admission to the facility,
8 initially resides in a part of the facility not licensed under
9 part II of chapter 400.
10 Section 16. Subsection (2) of section 395.701, Florida
11 Statutes, is amended to read:
12 395.701 Annual assessments on net operating revenues
13 for inpatient services to fund public medical assistance;
14 administrative fines for failure to pay assessments when due;
15 exemption.--
16 (2) There is imposed upon each hospital an assessment
17 in an amount equal to 1.5 percent of the annual net operating
18 revenue for inpatient services for each hospital, such revenue
19 to be determined by the agency, based on the actual experience
20 of the hospital as reported to the agency. Within 6 months
21 after the end of each hospital fiscal year, the agency shall
22 certify the amount of the assessment for each hospital. The
23 assessment shall be payable to and collected by the agency in
24 equal quarterly amounts, on or before the first day of each
25 calendar quarter, beginning with the first full calendar
26 quarter that occurs after the agency certifies the amount of
27 the assessment for each hospital. All moneys collected
28 pursuant to this subsection shall be deposited into the Public
29 Medical Assistance Trust Fund.
30 Section 17. The amendment to s. 395.701, Florida
31 Statutes, by this act shall take effect only upon the Agency
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1 for Health Care Administration receiving written confirmation
2 from the federal Health Care Financing Administration that the
3 changes contained in such amendment will not adversely affect
4 the use of the remaining assessments as state match for the
5 state's Medicaid program.
6 Section 18. Paragraph (c) of subsection (2) of section
7 408.904, Florida Statutes, is amended to read:
8 408.904 Benefits.--
9 (2) Covered health services include:
10 (c) Hospital outpatient services. Those services
11 provided to a member in the outpatient portion of a hospital
12 licensed under part I of chapter 395, up to a limit of $1,500
13 $1,000 per calendar year per member, that are preventive,
14 diagnostic, therapeutic, or palliative.
15 Section 19. Paragraph (e) is added to subsection (3)
16 of section 409.912, Florida Statutes, and subsection (9) of
17 said section is amended, to read:
18 409.912 Cost-effective purchasing of health care.--The
19 agency shall purchase goods and services for Medicaid
20 recipients in the most cost-effective manner consistent with
21 the delivery of quality medical care. The agency shall
22 maximize the use of prepaid per capita and prepaid aggregate
23 fixed-sum basis services when appropriate and other
24 alternative service delivery and reimbursement methodologies,
25 including competitive bidding pursuant to s. 287.057, designed
26 to facilitate the cost-effective purchase of a case-managed
27 continuum of care. The agency shall also require providers to
28 minimize the exposure of recipients to the need for acute
29 inpatient, custodial, and other institutional care and the
30 inappropriate or unnecessary use of high-cost services.
31 (3) The agency may contract with:
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1 (e) An entity in Pasco County or Pinellas County that
2 provides in-home physician services to Medicaid recipients
3 with degenerative neurological diseases in order to test the
4 cost-effectiveness of enhanced home-based medical care. The
5 entity providing the services shall be reimbursed on a
6 fee-for-service basis at a rate not less than comparable
7 Medicare reimbursement rates. The agency may apply for waivers
8 of federal regulations necessary to implement such program.
9 This paragraph shall be repealed on July 1, 2002.
10 (9) The agency, after notifying the Legislature, may
11 apply for waivers of applicable federal laws and regulations
12 as necessary to implement more appropriate systems of health
13 care for Medicaid recipients and reduce the cost of the
14 Medicaid program to the state and federal governments and
15 shall implement such programs, after legislative approval,
16 within a reasonable period of time after federal approval.
17 These programs must be designed primarily to reduce the need
18 for inpatient care, custodial care and other long-term or
19 institutional care, and other high-cost services.
20 (a) Prior to seeking legislative approval of such a
21 waiver as authorized by this subsection, the agency shall
22 provide notice and an opportunity for public comment. Notice
23 shall be provided to all persons who have made requests of the
24 agency for advance notice and shall be published in the
25 Florida Administrative Weekly not less than 28 days prior to
26 the intended action.
27 (b) Notwithstanding s. 216.292, funds that are
28 appropriated to the Department of Elderly Affairs for the
29 Assisted Living for the Elderly Medicaid waiver and are not
30 expended shall be transferred to the agency to fund
31 Medicaid-reimbursed nursing home care.
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1 Section 20. The Legislature shall appropriate each
2 fiscal year from either the General Revenue Fund or the Agency
3 for Health Care Administration Tobacco Settlement Trust Fund
4 an amount sufficient to replace the funds lost due to repeal
5 by this act of the assessment on other health care entities
6 under former s. 395.7015, Florida Statutes, and the reduction
7 by this act in the assessment on hospitals under s. 395.701,
8 Florida Statutes, and to maintain federal approval of the
9 reduced amount of funds deposited into the Public Medical
10 Assistance Trust Fund under s. 395.701, Florida Statutes, as
11 state match for the state's Medicaid program.
12 Section 21. Effective July 1, 2000, and applicable to
13 provider contracts entered into or renewed on or after that
14 date, subsection (39) is added to section 641.31, Florida
15 Statutes, to read:
16 641.31 Health maintenance contracts.--
17 (39) A health maintenance organization contract may
18 not prohibit or restrict a subscriber from receiving inpatient
19 services in a contracted hospital from a contracted primary
20 care or admitting physician if such services are determined by
21 the organization to be medically necessary and covered
22 services under the organization's contract with the contract
23 holder.
24 Section 22. Effective July 1, 2000, and applicable to
25 provider contracts entered into or renewed on or after that
26 date, subsection (11) is added to section 641.315, Florida
27 Statutes, to read:
28 641.315 Provider contracts.--
29 (11) A contract between a health maintenance
30 organization and a contracted primary care or admitting
31 physician may not contain any provision that prohibits such
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1 physician from providing inpatient services in a contracted
2 hospital to a subscriber if such services are determined by
3 the organization to be medically necessary and covered
4 services under the organization's contract with the contract
5 holder.
6 Section 23. Effective July 1, 2000, and applicable to
7 provider contracts entered into or renewed on or after that
8 date, subsection (5) is added to section 641.3155, Florida
9 Statutes, to read:
10 641.3155 Provider contracts; payment of claims.--
11 (5) A health maintenance organization shall pay a
12 contracted primary care or admitting physician, pursuant to
13 such physician's contract, for providing inpatient services in
14 a contracted hospital to a subscriber, if such services are
15 determined by the organization to be medically necessary and
16 covered services under the organization's contract with the
17 contract holder.
18 Section 24. Present subsections (4) through (10) of
19 section 641.51, Florida Statutes, are renumbered as
20 subsections (5) through (11), respectively, and a new
21 subsection (4) is added to said section to read:
22 641.51 Quality assurance program; second medical
23 opinion requirement.--
24 (4) The organization shall ensure that only a
25 physician licensed under chapter 458 or chapter 459, or a
26 medical doctor or doctor of osteopathy with an active,
27 unencumbered license in another state with similar licensing
28 requirements may render an adverse determination regarding a
29 service provided by a physician licensed in this state. The
30 organization shall submit to the treating provider and the
31 subscriber written notification regarding the organization's
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1 adverse determination within 2 working days after the
2 subscriber or provider is notified of the adverse
3 determination. The written notification must include the
4 utilization review criteria or benefits provisions used in the
5 adverse determination, and be signed by an authorized
6 representative of the organization or the physician who
7 renders the adverse determination. The organization must
8 include with the notification of an adverse determination
9 information concerning the appeal process for adverse
10 determinations.
11 Section 25. Section 381.7351, Florida Statutes, is
12 created to read:
13 381.7351 Short title.--Sections 381.7351-381.7356 may
14 be cited as the "Reducing Racial and Ethnic Health
15 Disparities: Closing the Gap Act."
16 Section 26. Section 381.7352, Florida Statutes, is
17 created to read:
18 381.7352 Legislative findings and intent.--
19 (1) The Legislature finds that despite state
20 investments in health care programs, certain racial and ethnic
21 populations in Florida continue to have significantly poorer
22 health outcomes when compared to non-Hispanic whites. The
23 Legislature finds that local solutions to health care problems
24 can have a dramatic and positive effect on the health status
25 of these populations. Local governments and communities are
26 best equipped to identify the health education, health
27 promotion, and disease prevention needs of the racial and
28 ethnic populations in their communities, mobilize the
29 community to address health outcome disparities, enlist and
30 organize local public and private resources, and faith-based
31
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1 organizations to address these disparities, and evaluate the
2 effectiveness of interventions.
3 (2) It is therefore the intent of the Legislature to
4 provide funds within Florida counties and Front Porch Florida
5 Communities, in the form of Reducing Racial and Ethnic Health
6 Disparities: Closing the Gap grants, to stimulate the
7 development of community-based and neighborhood-based projects
8 which will improve the health outcomes of racial and ethnic
9 populations. Further, it is the intent of the Legislature
10 that these programs foster the development of coordinated,
11 collaborative, and broad-based participation by public and
12 private entities, and faith-based organizations. Finally, it
13 is the intent of the Legislature that the grant program
14 function as a partnership between state and local governments,
15 faith-based organizations, and private-sector health care
16 providers, including managed care, voluntary health care
17 resources, social service providers, and nontraditional
18 partners.
19 Section 27. Section 381.7353, Florida Statutes, is
20 created to read:
21 381.7353 Reducing Racial and Ethnic Health
22 Disparities: Closing the Gap grant program; administration;
23 department duties.--
24 (1) The Reducing Racial and Ethnic Health Disparities:
25 Closing the Gap grant program shall be administered by the
26 Department of Health.
27 (2) The department shall:
28 (a) Publicize the availability of funds and establish
29 an application process for submitting a grant proposal.
30
31
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1 (b) Provide technical assistance and training,
2 including a statewide meeting promoting best practice
3 programs, as requested, to grant recipients.
4 (c) Develop uniform data reporting requirements for
5 the purpose of evaluating the performance of the grant
6 recipients and demonstrating improved health outcomes.
7 (d) Develop a monitoring process to evaluate progress
8 toward meeting grant objectives.
9 (e) Coordinate with existing community-based programs,
10 such as chronic disease community intervention programs,
11 cancer prevention and control programs, diabetes control
12 programs, the Healthy Start program, the Florida KidCare
13 Program, the HIV/AIDS program, immunization programs, and
14 other related programs at the state and local levels, to avoid
15 duplication of effort and promote consistency.
16 (3) Pursuant to s. 20.43(6), the secretary may appoint
17 an ad hoc advisory committee to: examine areas where public
18 awareness, public education, research, and coordination
19 regarding racial and ethnic health outcome disparities are
20 lacking; consider access and transportation issues which
21 contribute to health status disparities; and make
22 recommendations for closing gaps in health outcomes and
23 increasing the public's awareness and understanding of health
24 disparities that exist between racial and ethnic populations.
25 Section 28. Section 381.7354, Florida Statutes, is
26 created to read:
27 381.7354 Eligibility.--
28 (1) Any person, entity, or organization within a
29 county may apply for a Closing the Gap grant and may serve as
30 the lead agency to administer and coordinate project
31
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1 activities within the county and develop community
2 partnerships necessary to implement the grant.
3 (2) Persons, entities, or organizations within
4 adjoining counties with populations of less than 100,000,
5 based on the annual estimates produced by the Population
6 Program of the University of Florida Bureau of Economic and
7 Business Research, may jointly submit a multicounty Closing
8 the Gap grant proposal. However, the proposal must clearly
9 identify a single lead agency with respect to program
10 accountability and administration.
11 (3) In addition to the grants awarded under
12 subsections (1) and (2), up to 20 percent of the funding for
13 the Reducing Racial and Ethnic Health Disparities: Closing the
14 Gap grant program shall be dedicated to projects that address
15 improving racial and ethnic health status within specific
16 Front Porch Florida Communities, as designated pursuant to s.
17 14.2015(9)(b).
18 (4) Nothing in ss. 381.7351-381.7356 shall prevent a
19 person, entity, or organization within a county or group of
20 counties from separately contracting for the provision of
21 racial and ethnic health promotion, health awareness, and
22 disease prevention services.
23 Section 29. Section 381.7355, Florida Statutes, is
24 created to read:
25 381.7355 Project requirements; review criteria.--
26 (1) Closing the Gap grant proposals shall be submitted
27 to the Department of Health for review.
28 (2) A proposal must include each of the following
29 elements:
30 (a) The purpose and objectives of the proposal,
31 including identification of the particular racial or ethnic
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1 disparity the project will address. The proposal must address
2 one or more of the following priority areas:
3 1. Decreasing racial and ethnic disparities in
4 maternal and infant mortality rates.
5 2. Decreasing racial and ethnic disparities in
6 morbidity and mortality rates relating to cancer.
7 3. Decreasing racial and ethnic disparities in
8 morbidity and mortality rates relating to HIV/AIDS.
9 4. Decreasing racial and ethnic disparities in
10 morbidity and mortality rates relating to cardiovascular
11 disease.
12 5. Decreasing racial and ethnic disparities in
13 morbidity and mortality rates relating to diabetes.
14 6. Increasing adult and child immunization rates in
15 certain racial and ethnic populations.
16 (b) Identification and relevance of the target
17 population.
18 (c) Methods for obtaining baseline health status data
19 and assessment of community health needs.
20 (d) Mechanisms for mobilizing community resources and
21 gaining local commitment.
22 (e) Development and implementation of health promotion
23 and disease prevention interventions.
24 (f) Mechanisms and strategies for evaluating the
25 project's objectives, procedures, and outcomes.
26 (g) A proposed work plan, including a timeline for
27 implementing the project.
28 (h) Likelihood that project activities will occur and
29 continue in the absence of funding.
30 (3) Priority shall be given to proposals that:
31
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1 (a) Represent areas with the greatest documented
2 racial and ethnic health status disparities.
3 (b) Exceed the minimum local contribution requirements
4 specified in s. 381.7356.
5 (c) Demonstrate broad-based local support and
6 commitment from entities representing racial and ethnic
7 populations, including non-Hispanic whites. Indicators of
8 support and commitment may include agreements to participate
9 in the program, letters of endorsement, letters of commitment,
10 interagency agreements, or other forms of support.
11 (d) Demonstrate a high degree of participation by the
12 health care community in clinical preventive service
13 activities and community-based health promotion and disease
14 prevention interventions.
15 (e) Have been submitted from counties with a high
16 proportion of residents living in poverty and with poor health
17 status indicators.
18 (f) Demonstrate a coordinated community approach to
19 addressing racial and ethnic health issues within existing
20 publicly financed health care programs.
21 (g) Incorporate intervention mechanisms which have a
22 high probability of improving the targeted population's health
23 status.
24 (h) Demonstrate a commitment to quality management in
25 all aspects of project administration and implementation.
26 Section 30. Section 381.7356, Florida Statutes, is
27 created to read:
28 381.7356 Local matching funds; grant awards.--
29 (1) One or more Closing the Gap grants may be awarded
30 in a county, or in a group of adjoining counties from which a
31 multicounty application is submitted. Front Porch Florida
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1 Communities grants may also be awarded in a county or group of
2 adjoining counties that are also receiving a grant award.
3 (2) Closing the Gap grants shall be awarded on a
4 matching basis. One dollar in local matching funds must be
5 provided for each $3 grant payment made by the state, except
6 that:
7 (a) In counties with populations greater than 50,000,
8 up to 50 percent of the local match may be in kind in the form
9 of free services or human resources. Fifty percent of the
10 local match must be in the form of cash.
11 (b) In counties with populations of 50,000 or less,
12 the required local matching funds may be provided entirely
13 through in-kind contributions.
14 (c) Grant awards to Front Porch Florida Communities
15 shall not be required to have a matching requirement.
16 (3) The amount of the grant award shall be based on
17 the county or neighborhood's population, or on the combined
18 population in a group of adjoining counties from which a
19 multicounty application is submitted, and on other factors, as
20 determined by the department.
21 (4) Dissemination of grant awards shall begin no later
22 than January 1, 2001.
23 (5) A Closing the Gap grant shall be funded for 1 year
24 and may be renewed annually upon application to and approval
25 by the department, subject to the achievement of quality
26 standards, objectives, and outcomes and to the availability of
27 funds.
28 (6) Implementation of the Reducing Racial and Ethnic
29 Health Disparities: Closing the Gap grant program shall be
30 subject to a specific appropriation provided in the General
31 Appropriations Act.
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1 Section 31. Florida Commission on Excellence in Health
2 Care.--
3 (1) LEGISLATIVE FINDINGS AND INTENT.--The Legislature
4 finds that the health care delivery industry is one of the
5 largest and most complex industries in Florida. The
6 Legislature finds that the current system of regulating health
7 care practitioners and health care providers is one of blame
8 and punishment and does not encourage voluntary admission of
9 errors and immediate corrective action on a large scale. The
10 Legislature finds that previous attempts to identify and
11 address areas which impact the quality of care provided by the
12 health care industry have suffered from a lack of coordination
13 among the industry's stakeholders and regulators. The
14 Legislature finds that additional focus on strengthening
15 health care delivery systems by eliminating avoidable mistakes
16 in the diagnosis and treatment of Floridians holds tremendous
17 promise to increase the quality of health care services
18 available to Floridians, thereby reducing the costs associated
19 with medical mistakes and malpractice and in turn increasing
20 access to health care in the state. To achieve this enhanced
21 focus, it is the intent of the Legislature to create the
22 Florida Commission on Excellence in Health Care to facilitate
23 the development of a comprehensive statewide strategy for
24 improving health care delivery systems through meaningful
25 reporting standards, data collection and review, and quality
26 measurement.
27 (2) DEFINITIONS.--As used in this act, the term:
28 (a) "Agency" means the Agency for Health Care
29 Administration.
30 (b) "Commission" means the Florida Commission on
31 Excellence in Health Care.
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1 (c) "Department" means the Department of Health.
2 (d) "Error," with respect to health care, means an
3 unintended act, by omission or commission.
4 (e) "Health care practitioner" means any person
5 licensed under chapter 457; chapter 458; chapter 459; chapter
6 460; chapter 461; chapter 462; chapter 463; chapter 464;
7 chapter 465; chapter 466; chapter 467; part I, part II, part
8 III, part V, part X, part XIII, or part XIV of chapter 468;
9 chapter 478; chapter 480; part III or part IV of chapter 483;
10 chapter 484; chapter 486; chapter 490; or chapter 491, Florida
11 Statutes.
12 (f) "Health care provider" means any health care
13 facility or other health care organization licensed or
14 certified to provide approved medical and allied health
15 services in this state, or any entity licensed by the
16 Department of Insurance as a prepaid health care plan or
17 health maintenance organization or as an insurer to provide
18 coverage for health care services through a network of
19 providers.
20 (3) COMMISSION; DUTIES AND RESPONSIBILITIES.--There is
21 hereby created the Florida Commission on Excellence in Health
22 Care. The commission shall:
23 (a) Identify existing data sources that evaluate
24 quality of care in Florida and collect, analyze, and evaluate
25 this data.
26 (b) Establish guidelines for data sharing and
27 coordination.
28 (c) Identify core sets of quality measures for
29 standardized reporting by appropriate components of the health
30 care continuum.
31
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1 (d) Recommend a framework for quality measurement and
2 outcome reporting.
3 (e) Develop quality measures that enhance and improve
4 the ability to evaluate and improve care.
5 (f) Make recommendations regarding research and
6 development needed to advance quality measurement and
7 reporting.
8 (g) Evaluate regulatory issues relating to the
9 pharmacy profession and recommend changes necessary to
10 optimize patient safety.
11 (h) Facilitate open discussion of a process to ensure
12 that comparative information on health care quality is valid,
13 reliable, comprehensive, understandable, and widely available
14 in the public domain.
15 (i) Sponsor public hearings to share information and
16 expertise, identify "best practices," and recommend methods to
17 promote their acceptance.
18 (j) Evaluate current regulatory programs to determine
19 what changes, if any, need to be made to facilitate patient
20 safety.
21 (k) Review public and private health care purchasing
22 systems to determine if there are sufficient mandates and
23 incentives to facilitate continuous improvement in patient
24 safety.
25 (l) Analyze how effective existing regulatory systems
26 are in ensuring continuous competence and knowledge of
27 effective safety practices.
28 (m) Develop a framework for organizations that
29 license, accredit, or credential health care practitioners and
30 health care providers to more quickly and effectively identify
31 unsafe providers and practitioners and to take action
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1 necessary to remove the unsafe provider or practitioner from
2 practice or operation until such time as the practitioner or
3 provider has proven safe to practice or operate.
4 (n) Recommend procedures for development of a
5 curriculum on patient safety and methods of incorporating such
6 curriculum into training, licensure, and certification
7 requirements.
8 (o) Develop a framework for regulatory bodies to
9 disseminate information on patient safety to health care
10 practitioners, health care providers, and consumers through
11 conferences, journal articles and editorials, newsletters,
12 publications, and Internet websites.
13 (p) Recommend procedures to incorporate recognized
14 patient safety considerations into practice guidelines and
15 into standards related to the introduction and diffusion of
16 new technologies, therapies, and drugs.
17 (q) Recommend a framework for development of
18 community-based collaborative initiatives for error reporting
19 and analysis and implementation of patient safety
20 improvements.
21 (r) Evaluate the role of advertising in promoting or
22 adversely affecting patient safety.
23 (s) Evaluate and make recommendations regarding the
24 need for licensure of additional persons who participate in
25 the delivery of health care to Floridians, including, but not
26 limited to, surgical technologists and pharmacy technicians.
27 (t) Evaluate the benefits and problems of the current
28 disciplinary systems and make recommendations regarding
29 alternatives and improvements.
30 (4) MEMBERSHIP, ORGANIZATION, MEETINGS, PROCEDURES,
31 STAFF.--
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1 (a) The commission shall consist of:
2 1. The Secretary of Health and the Executive Director
3 of the Agency for Health Care Administration.
4 2. One representative each from the following agencies
5 or organizations: the Board of Medicine, the Board of
6 Osteopathic Medicine, the Board of Pharmacy, the Board of
7 Nursing, the Board of Dentistry, the Florida Dental
8 Association, the Florida Medical Association, the Florida
9 Osteopathic Medical Association, the Florida Nurses
10 Association, the Florida Organization of Nursing Executives,
11 the Florida Pharmacy Association, the Florida Society of
12 Health System Pharmacists, Inc., the Florida Hospital
13 Association, the Association of Community Hospitals and Health
14 Systems of Florida, Inc., the Florida League of Health Care
15 Systems, the Florida Health Care Risk Management Advisory
16 Council, the Florida Health Care Association, and the Florida
17 Association of Homes for the Aging;
18 3. One licensed clinical laboratory director,
19 appointed by the Secretary of Health;
20 4. Two health lawyers, appointed by the Secretary of
21 Health, one of whom shall be a member of The Florida Bar
22 Health Law Section who defends physicians and one of whom
23 shall be a member of the Florida Academy of Trial Lawyers;
24 5. One representative of the medical malpractice
25 professional liability insurance industry, appointed by the
26 Secretary of Health;
27 6. Two representatives of the health insurance
28 industry, appointed by the Executive Director of the Agency
29 for Health Care Administration, one of whom shall represent
30 indemnity plans and one of whom shall represent managed care;
31
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1 7. Five consumer advocates, consisting of one from the
2 Association for Responsible Medicine, two appointed by the
3 Governor, one appointed by the President of the Senate, and
4 one appointed by the Speaker of the House of Representatives;
5 and
6 8. Two legislators, one appointed by the President of
7 the Senate and one appointed by the Speaker of the House of
8 Representatives.
9
10 Commission membership shall reflect the geographic and
11 demographic diversity of the state.
12 (b) The Secretary of Health and the Executive Director
13 of the Agency for Health Care Administration shall jointly
14 chair the commission. Subcommittees shall be formed by the
15 joint chairs, as needed, to make recommendations to the full
16 commission on the subjects assigned. However, all votes on
17 work products of the commission shall be at the full
18 commission level, and all recommendations to the Governor, the
19 President of the Senate, and the Speaker of the House of
20 Representatives must pass by a two-thirds vote of the full
21 commission. Sponsoring agencies and organizations may
22 designate an alternative member who may attend and vote on
23 behalf of the sponsoring agency or organization in the event
24 the appointed member is unable to attend a meeting of the
25 commission or any subcommittee. The commission shall be
26 staffed by employees of the Department of Health and the
27 Agency for Health Care Administration. Sponsoring agencies or
28 organizations must fund the travel and related expenses of
29 their appointed members on the commission. Travel and related
30 expenses for the consumer members of the commission shall be
31 reimbursed by the state pursuant to s. 112.061, Florida
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1 Statutes. The commission shall hold its first meeting no later
2 than July 15, 2000.
3 (5) EVIDENTIARY PROHIBITIONS.--
4 (a) The findings, recommendations, evaluations,
5 opinions, investigations, proceedings, records, reports,
6 minutes, testimony, correspondence, work product, and actions
7 of the commission shall be available to the public, but may
8 not be introduced into evidence at any civil, criminal,
9 special, or administrative proceeding against a health care
10 practitioner or health care provider arising out of the
11 matters which are the subject of the findings of the
12 commission. Moreover, no member of the commission shall be
13 examined in any civil, criminal, special, or administrative
14 proceeding against a health care practitioner or health care
15 provider as to any evidence or other matters produced or
16 presented during the proceedings of this commission or as to
17 any findings, recommendations, evaluations, opinions,
18 investigations, proceedings, records, reports, minutes,
19 testimony, correspondence, work product, or other actions of
20 the commission or any members thereof. However, nothing in
21 this section shall be construed to mean that information,
22 documents, or records otherwise available and obtained from
23 original sources are immune from discovery or use in any
24 civil, criminal, special, or administrative proceeding merely
25 because they were presented during proceedings of the
26 commission. Nor shall any person who testifies before the
27 commission or who is a member of the commission be prevented
28 from testifying as to matters within his or her knowledge in a
29 subsequent civil, criminal, special, or administrative
30 proceeding merely because such person testified in front of
31 the commission.
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1 (b) The findings, recommendations, evaluations,
2 opinions, investigations, proceedings, records, reports,
3 minutes, testimony, correspondence, work product, and actions
4 of the commission shall be used as a guide and resource and
5 shall not be construed as establishing or advocating the
6 standard of care for health care practitioners or health care
7 providers unless subsequently enacted into law or adopted in
8 rule. Nor shall any findings, recommendations, evaluations,
9 opinions, investigations, proceedings, records, reports,
10 minutes, testimony, correspondence, work product, or actions
11 of the commission be admissible as evidence in any way,
12 directly or indirectly, by introduction of documents or as a
13 basis of an expert opinion as to the standard of care
14 applicable to health care practitioners or health care
15 providers in any civil, criminal, special, or administrative
16 proceeding unless subsequently enacted into law or adopted in
17 rule.
18 (c) No person who testifies before the commission or
19 who is a member of the commission may specifically identify
20 any patient, health care practitioner, or health care provider
21 by name. Moreover, the findings, recommendations, evaluations,
22 opinions, investigations, proceedings, records, reports,
23 minutes, testimony, correspondence, work product, and actions
24 of the commission may not specifically identify any patient,
25 health care practitioner, or health care provider by name.
26 (6) REPORT; TERMINATION.--The commission shall provide
27 a report of its findings and recommendations to the Governor,
28 the President of the Senate, and the Speaker of the House of
29 Representatives no later than February 1, 2001. After
30 submission of the report, the commission shall continue to
31 exist for the purpose of assisting the Department of Health,
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1 the Agency for Health Care Administration, and the regulatory
2 boards in their drafting of proposed legislation and rules to
3 implement its recommendations and for the purpose of providing
4 information to the health care industry on its
5 recommendations. The commission shall be terminated June 1,
6 2001.
7 Section 32. Subsection (1) of section 408.7056,
8 Florida Statutes, is amended to read:
9 408.7056 Statewide Provider and Subscriber Assistance
10 Program.--
11 (1) As used in this section, the term:
12 (a) "Agency" means the Agency for Health Care
13 Administration.
14 (b) "Department" means the Department of Insurance.
15 (c) "Grievance procedure" means an established set of
16 rules that specify a process for appeal of an organizational
17 decision.
18 (d) "Health care provider" or "provider" means a
19 state-licensed or state-authorized facility, a facility
20 principally supported by a local government or by funds from a
21 charitable organization that holds a current exemption from
22 federal income tax under s. 501(c)(3) of the Internal Revenue
23 Code, a licensed practitioner, a county health department
24 established under part I of chapter 154, a prescribed
25 pediatric extended care center defined in s. 400.902, a
26 federally supported primary care program such as a migrant
27 health center or a community health center authorized under s.
28 329 or s. 330 of the United States Public Health Services Act
29 that delivers health care services to individuals, or a
30 community facility that receives funds from the state under
31
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1 the Community Alcohol, Drug Abuse, and Mental Health Services
2 Act and provides mental health services to individuals.
3 (e)(a) "Managed care entity" means a health
4 maintenance organization or a prepaid health clinic certified
5 under chapter 641, a prepaid health plan authorized under s.
6 409.912, or an exclusive provider organization certified under
7 s. 627.6472.
8 (f)(b) "Panel" means a statewide provider and
9 subscriber assistance panel selected as provided in subsection
10 (11).
11 Section 33. Section 627.654, Florida Statutes, is
12 amended to read:
13 627.654 Labor union, and association, and small
14 employer health alliance groups.--
15 (1)(a) A group of individuals may be insured under a
16 policy issued to an association, including a labor union,
17 which association has a constitution and bylaws and not less
18 than 25 individual members and which has been organized and
19 has been maintained in good faith for a period of 1 year for
20 purposes other than that of obtaining insurance, or to the
21 trustees of a fund established by such an association, which
22 association or trustees shall be deemed the policyholder,
23 insuring at least 15 individual members of the association for
24 the benefit of persons other than the officers of the
25 association, the association or trustees.
26 (b) A small employer, as defined in s. 627.6699 and
27 including the employer's eligible employees and the spouses
28 and dependents of such employees, may be insured under a
29 policy issued to a small employer health alliance by a carrier
30 as defined in s. 627.6699. A small employer health alliance
31 must be organized as a not-for-profit corporation under
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1 chapter 617. Notwithstanding any other law, if a small
2 employer member of an alliance loses eligibility to purchase
3 health care through the alliance solely because the business
4 of the small employer member expands to more than 50 and fewer
5 than 75 eligible employees, the small employer member may, at
6 its next renewal date, purchase coverage through the alliance
7 for not more than 1 additional year. A small employer health
8 alliance shall establish conditions of participation in the
9 alliance by a small employer, including, but not limited to:
10 1. Assurance that the small employer is not formed for
11 the purpose of securing health benefit coverage.
12 2. Assurance that the employees of a small employer
13 have not been added for the purpose of securing health benefit
14 coverage.
15 (2) No such policy of insurance as defined in
16 subsection (1) may be issued to any such association or
17 alliance, unless all individual members of such association,
18 or all small employer members of an alliance, or all of any
19 class or classes thereof, are declared eligible and acceptable
20 to the insurer at the time of issuance of the policy.
21 (3) Any such policy issued under paragraph (1)(a) may
22 insure the spouse or dependent children with or without the
23 member being insured.
24 (4) A single master policy issued to an association,
25 labor union, or small employer health alliance may include
26 more than one health plan from the same insurer or affiliated
27 insurer group as alternatives for an employer, employee, or
28 member to select.
29 Section 34. Paragraph (f) of subsection (2), paragraph
30 (b) of subsection (4), and subsection (6) of section 627.6571,
31 Florida Statutes, are amended to read:
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1 627.6571 Guaranteed renewability of coverage.--
2 (2) An insurer may nonrenew or discontinue a group
3 health insurance policy based only on one or more of the
4 following conditions:
5 (f) In the case of health insurance coverage that is
6 made available only through one or more bona fide associations
7 as defined in subsection (5) or through one or more small
8 employer health alliances as described in s. 627.654(1)(b),
9 the membership of an employer in the association or in the
10 small employer health alliance, on the basis of which the
11 coverage is provided, ceases, but only if such coverage is
12 terminated under this paragraph uniformly without regard to
13 any health-status-related factor that relates to any covered
14 individuals.
15 (4) At the time of coverage renewal, an insurer may
16 modify the health insurance coverage for a product offered:
17 (b) In the small-group market if, for coverage that is
18 available in such market other than only through one or more
19 bona fide associations as defined in subsection (5) or through
20 one or more small employer health alliances as described in s.
21 627.654(1)(b), such modification is consistent with s.
22 627.6699 and effective on a uniform basis among group health
23 plans with that product.
24 (6) In applying this section in the case of health
25 insurance coverage that is made available by an insurer in the
26 small-group market or large-group market to employers only
27 through one or more associations or through one or more small
28 employer health alliances as described in s. 627.654(1)(b), a
29 reference to "policyholder" is deemed, with respect to
30 coverage provided to an employer member of the association, to
31 include a reference to such employer.
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1 Section 35. Paragraph (h) of subsection (5), paragraph
2 (b) of subsection (6), and paragraph (a) of subsection (12) of
3 section 627.6699, Florida Statutes, are amended to read:
4 627.6699 Employee Health Care Access Act.--
5 (5) AVAILABILITY OF COVERAGE.--
6 (h) All health benefit plans issued under this section
7 must comply with the following conditions:
8 1. For employers who have fewer than two employees, a
9 late enrollee may be excluded from coverage for no longer than
10 24 months if he or she was not covered by creditable coverage
11 continually to a date not more than 63 days before the
12 effective date of his or her new coverage.
13 2. Any requirement used by a small employer carrier in
14 determining whether to provide coverage to a small employer
15 group, including requirements for minimum participation of
16 eligible employees and minimum employer contributions, must be
17 applied uniformly among all small employer groups having the
18 same number of eligible employees applying for coverage or
19 receiving coverage from the small employer carrier, except
20 that a small employer carrier that participates in,
21 administers, or issues health benefits pursuant to s. 381.0406
22 which do not include a preexisting condition exclusion may
23 require as a condition of offering such benefits that the
24 employer has had no health insurance coverage for its
25 employees for a period of at least 6 months. A small employer
26 carrier may vary application of minimum participation
27 requirements and minimum employer contribution requirements
28 only by the size of the small employer group.
29 3. In applying minimum participation requirements with
30 respect to a small employer, a small employer carrier shall
31 not consider as an eligible employee employees or dependents
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1 who have qualifying existing coverage in an employer-based
2 group insurance plan or an ERISA qualified self-insurance plan
3 in determining whether the applicable percentage of
4 participation is met. However, a small employer carrier may
5 count eligible employees and dependents who have coverage
6 under another health plan that is sponsored by that employer
7 except if such plan is offered pursuant to s. 408.706.
8 4. A small employer carrier shall not increase any
9 requirement for minimum employee participation or any
10 requirement for minimum employer contribution applicable to a
11 small employer at any time after the small employer has been
12 accepted for coverage, unless the employer size has changed,
13 in which case the small employer carrier may apply the
14 requirements that are applicable to the new group size.
15 5. If a small employer carrier offers coverage to a
16 small employer, it must offer coverage to all the small
17 employer's eligible employees and their dependents. A small
18 employer carrier may not offer coverage limited to certain
19 persons in a group or to part of a group, except with respect
20 to late enrollees.
21 6. A small employer carrier may not modify any health
22 benefit plan issued to a small employer with respect to a
23 small employer or any eligible employee or dependent through
24 riders, endorsements, or otherwise to restrict or exclude
25 coverage for certain diseases or medical conditions otherwise
26 covered by the health benefit plan.
27 7. An initial enrollment period of at least 30 days
28 must be provided. An annual 30-day open enrollment period
29 must be offered to each small employer's eligible employees
30 and their dependents. A small employer carrier must provide
31 special enrollment periods as required by s. 627.65615.
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1 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
2 (b) For all small employer health benefit plans that
3 are subject to this section and are issued by small employer
4 carriers on or after January 1, 1994, premium rates for health
5 benefit plans subject to this section are subject to the
6 following:
7 1. Small employer carriers must use a modified
8 community rating methodology in which the premium for each
9 small employer must be determined solely on the basis of the
10 eligible employee's and eligible dependent's gender, age,
11 family composition, tobacco use, or geographic area as
12 determined under paragraph (5)(j).
13 2. Rating factors related to age, gender, family
14 composition, tobacco use, or geographic location may be
15 developed by each carrier to reflect the carrier's experience.
16 The factors used by carriers are subject to department review
17 and approval.
18 3. Small employer carriers may not modify the rate for
19 a small employer for 12 months from the initial issue date or
20 renewal date, unless the composition of the group changes or
21 benefits are changed. However, a small employer carrier may
22 modify the rate one time prior to 12 months after the initial
23 issue date for a small employer who enrolls under a previously
24 issued group policy that has a common anniversary date for all
25 employers covered under the policy if:
26 a. The carrier discloses to the employer in a clear
27 and conspicuous manner the date of the first renewal and the
28 fact that the premium may increase on or after that date.
29 b. The insurer demonstrates to the department that
30 efficiencies in administration are achieved and reflected in
31 the rates charged to small employers covered under the policy.
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1 4. A carrier may issue a group health insurance policy
2 to a small employer health alliance or other group association
3 with rates that reflect a premium credit for expense savings
4 attributable to administrative activities being performed by
5 the alliance or group association if such expense savings are
6 specifically documented in the insurer's rate filing and are
7 approved by the department. Any such credit may not be based
8 on different morbidity assumptions or on any other factor
9 related to the health status or claims experience of any
10 person covered under the policy. Nothing in this subparagraph
11 exempts an alliance or group association from licensure for
12 any activities that require licensure under the Insurance
13 Code. A carrier issuing a group health insurance policy to a
14 small employer health alliance or other group association
15 shall allow any properly licensed and appointed agent of that
16 carrier to market and sell the small employer health alliance
17 or other group association policy. Such agent shall be paid
18 the usual and customary commission paid to any agent selling
19 the policy. Carriers participating in the alliance program, in
20 accordance with ss. 408.70-408.706, may apply a different
21 community rate to business written in that program.
22 (12) STANDARD, BASIC, AND LIMITED HEALTH BENEFIT
23 PLANS.--
24 (a)1. By May 15, 1993, the commissioner shall appoint
25 a health benefit plan committee composed of four
26 representatives of carriers which shall include at least two
27 representatives of HMOs, at least one of which is a staff
28 model HMO, two representatives of agents, four representatives
29 of small employers, and one employee of a small employer. The
30 carrier members shall be selected from a list of individuals
31 recommended by the board. The commissioner may require the
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1 board to submit additional recommendations of individuals for
2 appointment. As alliances are established under s. 408.702,
3 each alliance shall also appoint an additional member to the
4 committee.
5 2. The committee shall develop changes to the form and
6 level of coverages for the standard health benefit plan and
7 the basic health benefit plan, and shall submit the forms, and
8 levels of coverages to the department by September 30, 1993.
9 The department must approve such forms and levels of coverages
10 by November 30, 1993, and may return the submissions to the
11 committee for modification on a schedule that allows the
12 department to grant final approval by November 30, 1993.
13 3. The plans shall comply with all of the requirements
14 of this subsection.
15 4. The plans must be filed with and approved by the
16 department prior to issuance or delivery by any small employer
17 carrier.
18 5. After approval of the revised health benefit plans,
19 if the department determines that modifications to a plan
20 might be appropriate, the commissioner shall appoint a new
21 health benefit plan committee in the manner provided in
22 subparagraph 1. to submit recommended modifications to the
23 department for approval.
24 Section 36. Subsection (1) of section 240.2995,
25 Florida Statutes, is amended to read:
26 240.2995 University health services support
27 organizations.--
28 (1) Each state university is authorized to establish
29 university health services support organizations which shall
30 have the ability to enter into, for the benefit of the
31 university academic health sciences center, arrangements with
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1 other entities as providers for accountable health
2 partnerships, as defined in s. 408.701, and providers in other
3 integrated health care systems or similar entities. To the
4 extent required by law or rule, university health services
5 support organizations shall become licensed as insurance
6 companies, pursuant to chapter 624, or be certified as health
7 maintenance organizations, pursuant to chapter 641.
8 University health services support organizations shall have
9 sole responsibility for the acts, debts, liabilities, and
10 obligations of the organization. In no case shall the state
11 or university have any responsibility for such acts, debts,
12 liabilities, and obligations incurred or assumed by university
13 health services support organizations.
14 Section 37. Paragraph (a) of subsection (2) of section
15 240.2996, Florida Statutes, is amended to read:
16 240.2996 University health services support
17 organization; confidentiality of information.--
18 (2) The following university health services support
19 organization's records and information are confidential and
20 exempt from the provisions of s. 119.07(1) and s. 24(a), Art.
21 I of the State Constitution:
22 (a) Contracts for managed care arrangements, as
23 managed care is defined in s. 408.701, under which the
24 university health services support organization provides
25 health care services, including preferred provider
26 organization contracts, health maintenance organization
27 contracts, alliance network arrangements, and exclusive
28 provider organization contracts, and any documents directly
29 relating to the negotiation, performance, and implementation
30 of any such contracts for managed care arrangements or
31 alliance network arrangements. As used in this paragraph, the
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1 term "managed care" means systems or techniques generally used
2 by third-party payors or their agents to affect access to and
3 control payment for health care services. Managed-care
4 techniques most often include one or more of the following:
5 prior, concurrent, and retrospective review of the medical
6 necessity and appropriateness of services or site of services;
7 contracts with selected health care providers; financial
8 incentives or disincentives related to the use of specific
9 providers, services, or service sites; controlled access to
10 and coordination of services by a case manager; and payor
11 efforts to identify treatment alternatives and modify benefit
12 restrictions for high-cost patient care.
13
14 The exemptions in this subsection are subject to the Open
15 Government Sunset Review Act of 1995 in accordance with s.
16 119.15 and shall stand repealed on October 2, 2001, unless
17 reviewed and saved from repeal through reenactment by the
18 Legislature.
19 Section 38. Paragraph (b) of subsection (8) of section
20 240.512, Florida Statutes, is amended to read:
21 240.512 H. Lee Moffitt Cancer Center and Research
22 Institute.--There is established the H. Lee Moffitt Cancer
23 Center and Research Institute at the University of South
24 Florida.
25 (8)
26 (b) Proprietary confidential business information is
27 confidential and exempt from the provisions of s. 119.07(1)
28 and s. 24(a), Art. I of the State Constitution. However, the
29 Auditor General and Board of Regents, pursuant to their
30 oversight and auditing functions, must be given access to all
31 proprietary confidential business information upon request and
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1 without subpoena and must maintain the confidentiality of
2 information so received. As used in this paragraph, the term
3 "proprietary confidential business information" means
4 information, regardless of its form or characteristics, which
5 is owned or controlled by the not-for-profit corporation or
6 its subsidiaries; is intended to be and is treated by the
7 not-for-profit corporation or its subsidiaries as private and
8 the disclosure of which would harm the business operations of
9 the not-for-profit corporation or its subsidiaries; has not
10 been intentionally disclosed by the corporation or its
11 subsidiaries unless pursuant to law, an order of a court or
12 administrative body, a legislative proceeding pursuant to s.
13 5, Art. III of the State Constitution, or a private agreement
14 that provides that the information may be released to the
15 public; and which is information concerning:
16 1. Internal auditing controls and reports of internal
17 auditors;
18 2. Matters reasonably encompassed in privileged
19 attorney-client communications;
20 3. Contracts for managed-care arrangements, as managed
21 care is defined in s. 408.701, including preferred provider
22 organization contracts, health maintenance organization
23 contracts, and exclusive provider organization contracts, and
24 any documents directly relating to the negotiation,
25 performance, and implementation of any such contracts for
26 managed-care arrangements;
27 4. Bids or other contractual data, banking records,
28 and credit agreements the disclosure of which would impair the
29 efforts of the not-for-profit corporation or its subsidiaries
30 to contract for goods or services on favorable terms;
31
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1 5. Information relating to private contractual data,
2 the disclosure of which would impair the competitive interest
3 of the provider of the information;
4 6. Corporate officer and employee personnel
5 information;
6 7. Information relating to the proceedings and records
7 of credentialing panels and committees and of the governing
8 board of the not-for-profit corporation or its subsidiaries
9 relating to credentialing;
10 8. Minutes of meetings of the governing board of the
11 not-for-profit corporation and its subsidiaries, except
12 minutes of meetings open to the public pursuant to subsection
13 (9);
14 9. Information that reveals plans for marketing
15 services that the corporation or its subsidiaries reasonably
16 expect to be provided by competitors;
17 10. Trade secrets as defined in s. 688.002, including
18 reimbursement methodologies or rates; or
19 11. The identity of donors or prospective donors of
20 property who wish to remain anonymous or any information
21 identifying such donors or prospective donors. The anonymity
22 of these donors or prospective donors must be maintained in
23 the auditor's report.
24
25 As used in this paragraph, the term "managed care" means
26 systems or techniques generally used by third-party payors or
27 their agents to affect access to and control payment for
28 health care services. Managed-care techniques most often
29 include one or more of the following: prior, concurrent, and
30 retrospective review of the medical necessity and
31 appropriateness of services or site of services; contracts
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1 with selected health care providers; financial incentives or
2 disincentives related to the use of specific providers,
3 services, or service sites; controlled access to and
4 coordination of services by a case manager; and payor efforts
5 to identify treatment alternatives and modify benefit
6 restrictions for high-cost patient care.
7 Section 39. Subsection (14) of section 381.0406,
8 Florida Statutes, is amended to read:
9 381.0406 Rural health networks.--
10 (14) NETWORK FINANCING.--Networks may use all sources
11 of public and private funds to support network activities.
12 Nothing in this section prohibits networks from becoming
13 managed care providers, or accountable health partnerships,
14 provided they meet the requirements for an accountable health
15 partnership as specified in s. 408.706.
16 Section 40. Paragraph (a) of subsection (2) of section
17 395.3035, Florida Statutes, is amended to read:
18 395.3035 Confidentiality of hospital records and
19 meetings.--
20 (2) The following records and information of any
21 hospital that is subject to chapter 119 and s. 24(a), Art. I
22 of the State Constitution are confidential and exempt from the
23 provisions of s. 119.07(1) and s. 24(a), Art. I of the State
24 Constitution:
25 (a) Contracts for managed care arrangements, as
26 managed care is defined in s. 408.701, under which the public
27 hospital provides health care services, including preferred
28 provider organization contracts, health maintenance
29 organization contracts, exclusive provider organization
30 contracts, and alliance network arrangements, and any
31 documents directly relating to the negotiation, performance,
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1 and implementation of any such contracts for managed care or
2 alliance network arrangements. As used in this paragraph, the
3 term "managed care" means systems or techniques generally used
4 by third-party payors or their agents to affect access to and
5 control payment for health care services. Managed-care
6 techniques most often include one or more of the following:
7 prior, concurrent, and retrospective review of the medical
8 necessity and appropriateness of services or site of services;
9 contracts with selected health care providers; financial
10 incentives or disincentives related to the use of specific
11 providers, services, or service sites; controlled access to
12 and coordination of services by a case manager; and payor
13 efforts to identify treatment alternatives and modify benefit
14 restrictions for high-cost patient care.
15 Section 41. Paragraph (b) of subsection (1) of section
16 627.4301, Florida Statutes, is amended to read:
17 627.4301 Genetic information for insurance purposes.--
18 (1) DEFINITIONS.--As used in this section, the term:
19 (b) "Health insurer" means an authorized insurer
20 offering health insurance as defined in s. 624.603, a
21 self-insured plan as defined in s. 624.031, a
22 multiple-employer welfare arrangement as defined in s.
23 624.437, a prepaid limited health service organization as
24 defined in s. 636.003, a health maintenance organization as
25 defined in s. 641.19, a prepaid health clinic as defined in s.
26 641.402, a fraternal benefit society as defined in s. 632.601,
27 an accountable health partnership as defined in s. 408.701, or
28 any health care arrangement whereby risk is assumed.
29 Section 42. Section 641.185, Florida Statutes, is
30 created to read:
31
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1 641.185 Health maintenance organization subscriber
2 protections.--
3 (1) With respect to the provisions of this part and
4 part III, the principles expressed in the following statements
5 shall serve as standards to be followed by the Department of
6 Insurance and the Agency for Health Care Administration in
7 exercising their powers and duties, in exercising
8 administrative discretion, in administrative interpretations
9 of the law, in enforcing its provisions, and in adopting
10 rules:
11 (a) A health maintenance organization shall ensure
12 that the health care services provided to its subscribers
13 shall be rendered under reasonable standards of quality of
14 care which are at a minimum consistent with the prevailing
15 standards of medical practice in the community pursuant to ss.
16 641.495(1) and 641.51.
17 (b) A health maintenance organization subscriber
18 should receive quality health care from a broad panel of
19 providers, including referrals, preventive care pursuant to s.
20 641.402(1), emergency screening and services pursuant to ss.
21 641.31(12) and 641.513, and second opinions pursuant to s.
22 641.51.
23 (c) A health maintenance organization subscriber
24 should receive assurance that the health maintenance
25 organization has been independently accredited by a national
26 review organization pursuant to s. 641.512, and is financially
27 secure as determined by the state pursuant to ss. 641.221,
28 641.225, and 641.228.
29 (d) A health maintenance organization subscriber
30 should receive continuity of health care, even after the
31
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1 provider is no longer with the health maintenance organization
2 pursuant to s. 641.51(7).
3 (e) A health maintenance organization subscriber
4 should receive timely, concise information regarding the
5 health maintenance organization's reimbursement to providers
6 and services pursuant to ss. 641.31 and 641.31015.
7 (f) A health maintenance organization subscriber
8 should receive the flexibility to transfer to another Florida
9 health maintenance organization, regardless of health status,
10 pursuant to ss. 641.3104, 641.3107, 641.3111, 641.3921,
11 641.3922, and 641.228.
12 (g) A health maintenance organization subscriber
13 should be eligible for coverage without discrimination against
14 individual participants and beneficiaries of group plans based
15 on health status pursuant to s. 641.31073.
16 (h) A health maintenance organization that issues a
17 group health contract must: provide coverage for preexisting
18 conditions pursuant to s. 641.31071; guarantee renewability of
19 coverage pursuant to s. 641.31074; provide notice of
20 cancellation pursuant to s. 641.3108; provide extension of
21 benefits pursuant to s. 641.3111; provide for conversion on
22 termination of eligibility pursuant to s. 641.3921; and
23 provide for conversion contracts and conditions pursuant to s.
24 641.3922.
25 (i) A health maintenance organization subscriber
26 should receive timely, and, if necessary, urgent grievances
27 and appeals within the health maintenance organization
28 pursuant to ss. 641.228, 641.31(5), 641.47, and 641.511.
29 (j) A health maintenance organization should receive
30 timely and, if necessary, urgent review by an independent
31
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1 state external review organization for unresolved grievances
2 and appeals pursuant to s. 408.7056.
3 (k) A health maintenance organization subscriber shall
4 be given written notice at least 30 days in advance of a rate
5 change pursuant to s. 641.31(3)(b). In the case of a group
6 member, there may be a contractual agreement with the health
7 maintenance organization to have the employer provide the
8 required notice to the individual members of the group
9 pursuant to s. 641.31(3)(b).
10 (l) A health maintenance organization subscriber shall
11 be given a copy of the applicable health maintenance contract,
12 certificate, or member handbook specifying: all the
13 provisions, disclosure, and limitations required pursuant to
14 s. 641.31(1) and (4); the covered services, including those
15 services, medical conditions, and provider types specified in
16 ss. 641.31, 641.31094, 641.31095, 641.31096, 641.51(10), and
17 641.513; and where and in what manner services may be obtained
18 pursuant to s. 641.31(4).
19 (2) This section shall not be construed as creating a
20 civil cause of action by any subscriber or provider against
21 any health maintenance organization.
22 Section 43. Subsection (11) of section 641.511,
23 Florida Statutes, is renumbered as subsection (12) and a new
24 subsection (11) is added to said section to read:
25 641.511 Subscriber grievance reporting and resolution
26 requirements.--
27 (11) Each organization, as part of its contract with
28 any provider, must require the provider to post a consumer
29 assistance notice prominently displayed in the reception area
30 of the provider and clearly noticeable by all patients. The
31 consumer assistance notice must state the addresses and
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1 toll-free telephone numbers of the organization's grievance
2 department, the agency, the Statewide Provider and Subscriber
3 Assistance Program, and the Department of Insurance. The
4 agency is authorized to develop rules to implement this
5 subsection. aaa
6 Section 44. Paragraph (n) of subsection (3), paragraph
7 (c) of subsection (5), and paragraphs (b) and (d) of
8 subsection (6) of section 627.6699, Florida Statutes, are
9 amended to read:
10 627.6699 Employee Health Care Access Act.--
11 (3) DEFINITIONS.--As used in this section, the term:
12 (n) "Modified community rating" means a method used to
13 develop carrier premiums which spreads financial risk across a
14 large population, and allows the use of separate rating
15 factors adjustments for age, gender, family composition,
16 tobacco usage, and geographic area as determined under
17 paragraph (5)(j); and allows adjustments for claims
18 experience, health status, or duration of coverage as provided
19 in subparagraph (6)(b)5.; and administrative and acquisition
20 expenses as provided in subparagraph (6)(b)6.
21 (5) AVAILABILITY OF COVERAGE.--
22 (c) Every small employer carrier must, as a condition
23 of transacting business in this state:
24 1. Beginning July 1, 2000 January 1, 1994, offer and
25 issue all small employer health benefit plans on a
26 guaranteed-issue basis to every eligible small employer, with
27 two 3 to 50 eligible employees, that elects to be covered
28 under such plan, agrees to make the required premium payments,
29 and satisfies the other provisions of the plan. A rider for
30 additional or increased benefits may be medically underwritten
31 and may only be added to the standard health benefit plan.
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1 The increased rate charged for the additional or increased
2 benefit must be rated in accordance with this section.
3 2. Beginning August 1, 2000 April 15, 1994, offer and
4 issue basic and standard small employer health benefit plans
5 on a guaranteed-issue basis, during an open enrollment period
6 of August 1 through August 31 of each year, to every eligible
7 small employer, with less than one or two eligible employees,
8 which is not formed primarily for purposes of buying health
9 insurance and which elects to be covered under such plan,
10 agrees to make the required premium payments, and satisfies
11 the other provisions of the plan. Coverage provided pursuant
12 to this subparagraph shall begin on October 1 of the same year
13 as the date of enrollment, unless the small employer carrier
14 and the small employer agree to a different date. A rider for
15 additional or increased benefits may be medically underwritten
16 and may only be added to the standard health benefit plan.
17 The increased rate charged for the additional or increased
18 benefit must be rated in accordance with this section. For
19 purposes of this subparagraph, a person, his or her spouse,
20 and his or her dependent children shall constitute a single
21 eligible employee if such person and spouse are employed by
22 the same small employer and either one has a normal work week
23 of less than 25 hours.
24
25 3. Offer to eligible small employers the standard and basic
26 health benefit plans. This paragraph subparagraph does not
27 limit a carrier's ability to offer other health benefit plans
28 to small employers if the standard and basic health benefit
29 plans are offered and rejected.
30 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
31
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1 (b) For all small employer health benefit plans that
2 are subject to this section and are issued by small employer
3 carriers on or after January 1, 1994, premium rates for health
4 benefit plans subject to this section are subject to the
5 following:
6 1. Small employer carriers must use a modified
7 community rating methodology in which the premium for each
8 small employer must be determined solely on the basis of the
9 eligible employee's and eligible dependent's gender, age,
10 family composition, tobacco use, or geographic area as
11 determined under paragraph (5)(j) and may be adjusted as
12 permitted by subparagraphs 5. and 6.
13 2. Rating factors related to age, gender, family
14 composition, tobacco use, or geographic location may be
15 developed by each carrier to reflect the carrier's experience.
16 The factors used by carriers are subject to department review
17 and approval.
18 3. Small employer carriers may not modify the rate for
19 a small employer for 12 months from the initial issue date or
20 renewal date, unless the composition of the group changes or
21 benefits are changed.
22 4. Carriers participating in the alliance program, in
23 accordance with ss. 408.70-408.706, may apply a different
24 community rate to business written in that program.
25 5. Any adjustments in rates for claims experience,
26 health status, or duration of coverage may not be charged to
27 individual employees or dependents. For a small employer's
28 policy, such adjustments may not result in a rate for the
29 small employer which deviates more than 15 percent from the
30 carrier's approved rate. Any such adjustment must be applied
31 uniformly to the rates charged for all employees and
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1 dependents of the small employer. A small employer carrier may
2 make an adjustment to a small employer's renewal premium, not
3 to exceed 10 percent annually, due to the claims experience,
4 health status, or duration of coverage of the employees or
5 dependents of the small employer. Semiannually, small group
6 carriers shall report information on forms adopted by rule by
7 the department, to enable the department to monitor the
8 relationship of aggregate adjusted premiums actually charged
9 policyholders by each carrier to the premiums that would have
10 been charged by application of the carrier's approved modified
11 community rates. If the aggregate resulting from the
12 application of such adjustment exceeds the premium that would
13 have been charged by application of the approved modified
14 community rate by 5 percent for the current reporting period,
15 the carrier shall limit the application of such adjustments to
16 only minus adjustments beginning not more than 60 days after
17 the report is sent to the department. For any subsequent
18 reporting period, if the total aggregate adjusted premium
19 actually charged does not exceed the premium that would have
20 been charged by application of the approved modified community
21 rate by 5 percent, the carrier may apply both plus and minus
22 adjustments.
23 6. A small employer carrier may provide a credit to a
24 small employer's premium based on administrative and
25 acquisition expense differences resulting from the size of the
26 group. Group size administrative and acquisition expense
27 factors may be developed by each carrier to reflect the
28 carrier's experience and are subject to department review and
29 approval.
30 7. A small employer carrier rating methodology may
31 include separate rating categories for one dependent child,
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1 for two dependent children, and for three or more dependent
2 children for family coverage of employees having a spouse and
3 dependent children or employees having dependent children
4 only. A small employer carrier may have fewer, but not
5 greater, numbers of categories for dependent children than
6 those specified in this subparagraph.
7 8. Small employer carriers may not use a composite
8 rating methodology to rate a small employer with fewer than 10
9 employees. For the purposes of this subparagraph a "composite
10 rating methodology" means a rating methodology that averages
11 the impact of the rating factors for age and gender in the
12 premiums charged to all of the employees of a small employer.
13 (d) Notwithstanding s. 627.401(2), this section and
14 ss. 627.410 and 627.411 apply to any health benefit plan
15 provided by a small employer carrier that is an insurer, and
16 this section and s. 641.31 apply to any health benefit
17 provided by a small employer carrier that is a health
18 maintenance organization, that provides coverage to one or
19 more employees of a small employer regardless of where the
20 policy, certificate, or contract is issued or delivered, if
21 the health benefit plan covers employees or their covered
22 dependents who are residents of this state.
23 Section 45. Subsection (6) of section 409.212, Florida
24 Statutes, is renumbered as subsection (7), and new subsection
25 (6) is added to said section to read:
26 409.212 Optional supplementation.--
27 (6) The optional state supplementation rate shall be
28 increased by the cost-of-living adjustment to the federal
29 benefits rate provided the average state optional
30 supplementation contribution does not increase as a result.
31
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1 Section 46. Subsections (3), (15), and (18) of section
2 409.901, Florida Statutes, are amended to read:
3 409.901 Definitions.--As used in ss. 409.901-409.920,
4 except as otherwise specifically provided, the term:
5 (3) "Applicant" means an individual whose written
6 application for medical assistance provided by Medicaid under
7 ss. 409.903-409.906 has been submitted to the Department of
8 Children and Family Services agency, or to the Social Security
9 Administration if the application is for Supplemental Security
10 Income, but has not received final action. This term includes
11 an individual, who need not be alive at the time of
12 application, whose application is submitted through a
13 representative or a person acting for the individual.
14 (15) "Medicaid program" means the program authorized
15 under Title XIX of the federal Social Security Act which
16 provides for payments for medical items or services, or both,
17 on behalf of any person who is determined by the Department of
18 Children and Family Services, or, for Supplemental Security
19 Income, by the Social Security Administration, to be eligible
20 on the date of service for Medicaid assistance.
21 (18) "Medicaid recipient" or "recipient" means an
22 individual whom the Department of Children and Family
23 Services, or, for Supplemental Security Income, by the Social
24 Security Administration, determines is eligible, pursuant to
25 federal and state law, to receive medical assistance and
26 related services for which the agency may make payments under
27 the Medicaid program. For the purposes of determining
28 third-party liability, the term includes an individual
29 formerly determined to be eligible for Medicaid, an individual
30 who has received medical assistance under the Medicaid
31
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1 program, or an individual on whose behalf Medicaid has become
2 obligated.
3 Section 47. Section 409.902, Florida Statutes, is
4 amended to read:
5 409.902 Designated single state agency; payment
6 requirements; program title.--The Agency for Health Care
7 Administration is designated as the single state agency
8 authorized to make payments for medical assistance and related
9 services under Title XIX of the Social Security Act. These
10 payments shall be made, subject to any limitations or
11 directions provided for in the General Appropriations Act,
12 only for services included in the program, shall be made only
13 on behalf of eligible individuals, and shall be made only to
14 qualified providers in accordance with federal requirements
15 for Title XIX of the Social Security Act and the provisions of
16 state law. This program of medical assistance is designated
17 the "Medicaid program." The Department of Children and Family
18 Services is responsible for Medicaid eligibility
19 determinations, including, but not limited to, policy, rules,
20 and the agreement with the Social Security Administration for
21 Medicaid eligibility determinations for Supplemental Security
22 Income recipients, as well as the actual determination of
23 eligibility.
24 Section 48. Section 409.903, Florida Statutes, is
25 amended to read:
26 409.903 Mandatory payments for eligible persons.--The
27 agency shall make payments for medical assistance and related
28 services on behalf of the following persons who the
29 department, or the Social Security Administration by contract
30 with the Department of Children and Family Services, agency
31 determines to be eligible, subject to the income, assets, and
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1 categorical eligibility tests set forth in federal and state
2 law. Payment on behalf of these Medicaid eligible persons is
3 subject to the availability of moneys and any limitations
4 established by the General Appropriations Act or chapter 216.
5 (1) Low-income families with children are eligible for
6 Medicaid provided they meet the following requirements:
7 (a) The family includes a dependent child who is
8 living with a caretaker relative.
9 (b) The family's income does not exceed the gross
10 income test limit.
11 (c) The family's countable income and resources do not
12 exceed the applicable Aid to Families with Dependent Children
13 (AFDC) income and resource standards under the AFDC state plan
14 in effect in July 1996, except as amended in the Medicaid
15 state plan to conform as closely as possible to the
16 requirements of the WAGES Program as created in s. 414.015, to
17 the extent permitted by federal law.
18 (2) A person who receives payments from, who is
19 determined eligible for, or who was eligible for but lost cash
20 benefits from the federal program known as the Supplemental
21 Security Income program (SSI). This category includes a
22 low-income person age 65 or over and a low-income person under
23 age 65 considered to be permanently and totally disabled.
24 (3) A child under age 21 living in a low-income,
25 two-parent family, and a child under age 7 living with a
26 nonrelative, if the income and assets of the family or child,
27 as applicable, do not exceed the resource limits under the
28 WAGES Program.
29 (4) A child who is eligible under Title IV-E of the
30 Social Security Act for subsidized board payments, foster
31 care, or adoption subsidies, and a child for whom the state
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1 has assumed temporary or permanent responsibility and who does
2 not qualify for Title IV-E assistance but is in foster care,
3 shelter or emergency shelter care, or subsidized adoption.
4 (5) A pregnant woman for the duration of her pregnancy
5 and for the post partum period as defined in federal law and
6 rule, or a child under age 1, if either is living in a family
7 that has an income which is at or below 150 percent of the
8 most current federal poverty level, or, effective January 1,
9 1992, that has an income which is at or below 185 percent of
10 the most current federal poverty level. Such a person is not
11 subject to an assets test. Further, a pregnant woman who
12 applies for eligibility for the Medicaid program through a
13 qualified Medicaid provider must be offered the opportunity,
14 subject to federal rules, to be made presumptively eligible
15 for the Medicaid program.
16 (6) A child born after September 30, 1983, living in a
17 family that has an income which is at or below 100 percent of
18 the current federal poverty level, who has attained the age of
19 6, but has not attained the age of 19. In determining the
20 eligibility of such a child, an assets test is not required.
21 (7) A child living in a family that has an income
22 which is at or below 133 percent of the current federal
23 poverty level, who has attained the age of 1, but has not
24 attained the age of 6. In determining the eligibility of such
25 a child, an assets test is not required.
26 (8) A person who is age 65 or over or is determined by
27 the agency to be disabled, whose income is at or below 100
28 percent of the most current federal poverty level and whose
29 assets do not exceed limitations established by the agency.
30 However, the agency may only pay for premiums, coinsurance,
31 and deductibles, as required by federal law, unless additional
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1 coverage is provided for any or all members of this group by
2 s. 409.904(1).
3 Section 49. Subsection (6) of section 409.905, Florida
4 Statutes, is amended to read:
5 409.905 Mandatory Medicaid services.--The agency may
6 make payments for the following services, which are required
7 of the state by Title XIX of the Social Security Act,
8 furnished by Medicaid providers to recipients who are
9 determined to be eligible on the dates on which the services
10 were provided. Any service under this section shall be
11 provided only when medically necessary and in accordance with
12 state and federal law. Nothing in this section shall be
13 construed to prevent or limit the agency from adjusting fees,
14 reimbursement rates, lengths of stay, number of visits, number
15 of services, or any other adjustments necessary to comply with
16 the availability of moneys and any limitations or directions
17 provided for in the General Appropriations Act or chapter 216.
18 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
19 pay for preventive, diagnostic, therapeutic, or palliative
20 care and other services provided to a recipient in the
21 outpatient portion of a hospital licensed under part I of
22 chapter 395, and provided under the direction of a licensed
23 physician or licensed dentist, except that payment for such
24 care and services is limited to $1,500 $1,000 per state fiscal
25 year per recipient, unless an exception has been made by the
26 agency, and with the exception of a Medicaid recipient under
27 age 21, in which case the only limitation is medical
28 necessity.
29 Section 50. Subsection (5) of section 409.906, Florida
30 Statutes, is amended to read:
31
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1 409.906 Optional Medicaid services.--Subject to
2 specific appropriations, the agency may make payments for
3 services which are optional to the state under Title XIX of
4 the Social Security Act and are furnished by Medicaid
5 providers to recipients who are determined to be eligible on
6 the dates on which the services were provided. Any optional
7 service that is provided shall be provided only when medically
8 necessary and in accordance with state and federal law.
9 Nothing in this section shall be construed to prevent or limit
10 the agency from adjusting fees, reimbursement rates, lengths
11 of stay, number of visits, or number of services, or making
12 any other adjustments necessary to comply with the
13 availability of moneys and any limitations or directions
14 provided for in the General Appropriations Act or chapter 216.
15 If necessary to safeguard the state's systems of providing
16 services to elderly and disabled persons and subject to the
17 notice and review provisions of s. 216.177, the Governor may
18 direct the Agency for Health Care Administration to amend the
19 Medicaid state plan to delete the optional Medicaid service
20 known as "Intermediate Care Facilities for the Developmentally
21 Disabled." Optional services may include:
22 (5) CASE MANAGEMENT SERVICES.--The agency may pay for
23 primary care case management services rendered to a recipient
24 pursuant to a federally approved waiver, and targeted case
25 management services for specific groups of targeted
26 recipients, for which funding has been provided and which are
27 rendered pursuant to federal guidelines. The agency is
28 authorized to limit reimbursement for targeted case management
29 services in order to comply with any limitations or directions
30 provided for in the General Appropriations Act.
31 Notwithstanding s. 216.292, the Department of Children and
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1 Family Services may transfer general funds to the Agency for
2 Health Care Administration to fund state match requirements
3 exceeding the amount specified in the General Appropriations
4 Act for targeted case management services.
5 Section 51. Subsections (9) and (10) of section
6 409.907, Florida Statutes, are amended to read:
7 409.907 Medicaid provider agreements.--The agency may
8 make payments for medical assistance and related services
9 rendered to Medicaid recipients only to an individual or
10 entity who has a provider agreement in effect with the agency,
11 who is performing services or supplying goods in accordance
12 with federal, state, and local law, and who agrees that no
13 person shall, on the grounds of handicap, race, color, or
14 national origin, or for any other reason, be subjected to
15 discrimination under any program or activity for which the
16 provider receives payment from the agency.
17 (9) Upon receipt of a completed, signed, and dated
18 application, and completion of any necessary background
19 investigation and criminal history record check, the agency
20 must either:
21 (a) Enroll the applicant as a Medicaid provider; or
22 (b) Deny the application if the agency finds that,
23 based on the grounds listed in subsection (10), it is in the
24 best interest of the Medicaid program to do so, specifying the
25 reasons for denial. The agency may consider the factors listed
26 in subsection (10), as well as any other factor that could
27 affect the effective and efficient administration of the
28 program, including, but not limited to, the current
29 availability of medical care, services, or supplies to
30 recipients, taking into account geographic location and
31 reasonable travel time.
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1 (10) The agency may consider whether deny enrollment
2 in the Medicaid program to a provider if the provider, or any
3 officer, director, agent, managing employee, or affiliated
4 person, or any partner or shareholder having an ownership
5 interest equal to 5 percent or greater in the provider if the
6 provider is a corporation, partnership, or other business
7 entity, has:
8 (a) Made a false representation or omission of any
9 material fact in making the application, including the
10 submission of an application that conceals the controlling or
11 ownership interest of any officer, director, agent, managing
12 employee, affiliated person, or partner or shareholder who may
13 not be eligible to participate;
14 (b) Been or is currently excluded, suspended,
15 terminated from, or has involuntarily withdrawn from
16 participation in, Florida's Medicaid program or any other
17 state's Medicaid program, or from participation in any other
18 governmental or private health care or health insurance
19 program;
20 (c) Been convicted of a criminal offense relating to
21 the delivery of any goods or services under Medicaid or
22 Medicare or any other public or private health care or health
23 insurance program including the performance of management or
24 administrative services relating to the delivery of goods or
25 services under any such program;
26 (d) Been convicted under federal or state law of a
27 criminal offense related to the neglect or abuse of a patient
28 in connection with the delivery of any health care goods or
29 services;
30 (e) Been convicted under federal or state law of a
31 criminal offense relating to the unlawful manufacture,
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1 distribution, prescription, or dispensing of a controlled
2 substance;
3 (f) Been convicted of any criminal offense relating to
4 fraud, theft, embezzlement, breach of fiduciary
5 responsibility, or other financial misconduct;
6 (g) Been convicted under federal or state law of a
7 crime punishable by imprisonment of a year or more which
8 involves moral turpitude;
9 (h) Been convicted in connection with the interference
10 or obstruction of any investigation into any criminal offense
11 listed in this subsection;
12 (i) Been found to have violated federal or state laws,
13 rules, or regulations governing Florida's Medicaid program or
14 any other state's Medicaid program, the Medicare program, or
15 any other publicly funded federal or state health care or
16 health insurance program, and been sanctioned accordingly;
17 (j) Been previously found by a licensing, certifying,
18 or professional standards board or agency to have violated the
19 standards or conditions relating to licensure or certification
20 or the quality of services provided; or
21 (k) Failed to pay any fine or overpayment properly
22 assessed under the Medicaid program in which no appeal is
23 pending or after resolution of the proceeding by stipulation
24 or agreement, unless the agency has issued a specific letter
25 of forgiveness or has approved a repayment schedule to which
26 the provider agrees to adhere.
27 Section 52. Paragraph (a) of subsection (1) of section
28 409.908, Florida Statutes, is amended to read:
29 409.908 Reimbursement of Medicaid providers.--Subject
30 to specific appropriations, the agency shall reimburse
31 Medicaid providers, in accordance with state and federal law,
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1 according to methodologies set forth in the rules of the
2 agency and in policy manuals and handbooks incorporated by
3 reference therein. These methodologies may include fee
4 schedules, reimbursement methods based on cost reporting,
5 negotiated fees, competitive bidding pursuant to s. 287.057,
6 and other mechanisms the agency considers efficient and
7 effective for purchasing services or goods on behalf of
8 recipients. Payment for Medicaid compensable services made on
9 behalf of Medicaid eligible persons is subject to the
10 availability of moneys and any limitations or directions
11 provided for in the General Appropriations Act or chapter 216.
12 Further, nothing in this section shall be construed to prevent
13 or limit the agency from adjusting fees, reimbursement rates,
14 lengths of stay, number of visits, or number of services, or
15 making any other adjustments necessary to comply with the
16 availability of moneys and any limitations or directions
17 provided for in the General Appropriations Act, provided the
18 adjustment is consistent with legislative intent.
19 (1) Reimbursement to hospitals licensed under part I
20 of chapter 395 must be made prospectively or on the basis of
21 negotiation.
22 (a) Reimbursement for inpatient care is limited as
23 provided for in s. 409.905(5). Reimbursement for hospital
24 outpatient care is limited to $1,500 $1,000 per state fiscal
25 year per recipient, except for:
26 1. Such care provided to a Medicaid recipient under
27 age 21, in which case the only limitation is medical
28 necessity;
29 2. Renal dialysis services; and
30 3. Other exceptions made by the agency.
31
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1 Section 53. Section 409.9119, Florida Statutes, is
2 created to read:
3 409.9119 Disproportionate share program for children's
4 hospitals.--In addition to the payments made under s. 409.911,
5 the Agency for Health Care Administration shall develop and
6 implement a system under which disproportionate share payments
7 are made to those hospitals that are licensed by the state as
8 a children's hospital. This system of payments must conform to
9 federal requirements and must distribute funds in each fiscal
10 year for which an appropriation is made by making quarterly
11 Medicaid payments. Notwithstanding s. 409.915, counties are
12 exempt from contributing toward the cost of this special
13 reimbursement for hospitals that serve a disproportionate
14 share of low-income patients.
15 (1) The agency shall use the following formula to
16 calculate the total amount earned for hospitals that
17 participate in the children's hospital disproportionate share
18 program:
19 TAE = DSR x BMPD x MD
20 Where:
21 TAE = total amount earned by a children's hospital.
22 DSR = disproportionate share rate.
23 BMPD = base Medicaid per diem.
24 MD = Medicaid days.
25 (2) The agency shall calculate the total additional
26 payment for hospitals that participate in the children's
27 hospital disproportionate share program as follows:
28
29 TAP = (TAE x TA)
30
31 STAE
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1 Where:
2 TAP = total additional payment for a children's
3 hospital.
4 TAE = total amount earned by a children's hospital.
5 STAE = sum of total amount earned by each hospital that
6 participates in the children's hospital disproportionate share
7 program.
8 TA = total appropriation for the children's hospital
9 disproportionate share program.
10
11 (3) A hospital may not receive any payments under this
12 section until it achieves full compliance with the applicable
13 rules of the agency. A hospital that is not in compliance for
14 two or more consecutive quarters may not receive its share of
15 the funds. Any forfeited funds must be distributed to the
16 remaining participating children's hospitals that are in
17 compliance.
18 Section 54. Section 409.919, Florida Statutes, is
19 amended to read:
20 409.919 Rules.--The agency shall adopt any rules
21 necessary to comply with or administer ss. 409.901-409.920 and
22 all rules necessary to comply with federal requirements. In
23 addition, the Department of Children and Family Services shall
24 adopt and accept transfer of any rules necessary to carry out
25 its responsibilities for receiving and processing Medicaid
26 applications and determining Medicaid eligibility, and for
27 assuring compliance with and administering ss. 409.901-409.906
28 and any other provisions related to responsibility for the
29 determination of Medicaid eligibility.
30 Section 55. Notwithstanding the provisions of ss.
31 236.0812, 409.9071, and 409.908(21), Florida Statutes,
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1 developmental research schools, as authorized under s.
2 228.053, Florida Statutes, shall be authorized to participate
3 in the Medicaid certified school match program subject to the
4 provisions of ss. 236.0812, 409.9071, and 409.908(21), Florida
5 Statutes.
6 Section 56. (1) The Agency for Health Care
7 Administration is directed to submit to the Health Care
8 Financing Administration a request for a waiver that will
9 allow the agency to undertake a pilot project that would
10 implement a coordinated system of care for adult ventilator
11 dependent patients. Under this pilot program, the agency shall
12 identify a network of skilled nursing facilities that have
13 respiratory departments geared towards intensive treatment and
14 rehabilitation of adult ventilator patients and will contract
15 with such a network for respiratory services under a
16 capitation arrangement. The pilot project must allow the
17 agency to evaluate a coordinated and focused system of care
18 for adult ventilator dependent patients to determine the
19 overall cost-effectiveness and improved outcomes for
20 participants.
21 (2) The agency shall submit the waiver by September 1,
22 2000. The agency shall forward a preliminary report of the
23 pilot project's findings to the Governor, the Speaker of the
24 House of Representatives, and the President of the Senate 6
25 months after project implementation. The agency shall submit
26 a final report of the pilot project's findings to the
27 Governor, the Speaker of the House of Representatives, and the
28 President of the Senate no later than February 15, 2002.
29 Section 57. Section 395.7015, subsection (3) of
30 section 400.464, subsection (3) of section 408.70, sections
31 408.701, 408.702, 408.703, 408.704, 408.7041, 408.7042,
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1 408.7045, 408.7055, and 408.706, and paragraph (b) of
2 subsection (4) of section 409.912, Florida Statutes, are
3 repealed.
4 Section 58. There is hereby appropriated each fiscal
5 year from either the General Revenue Fund or the Agency for
6 Health Care Administration Tobacco Settlement Trust Fund an
7 amount sufficient to provide for the increased reimbursement
8 to hospitals for hospital outpatient care provided to adults
9 eligible under the MedAccess program or Medicaid required by
10 the amendment of ss. 408.904, 409.905, and 409.908, Florida
11 Statutes, by this act.
12 Section 59. There is appropriated from the General
13 Revenue Fund to the Department of Health the sum of $10
14 million to be used to establish and implement the Reducing
15 Racial and Ethnic Health Disparities: Closing the Gap grant
16 program, including funding for one full-time-equivalent
17 position.
18 Section 60. The sum of $91,000 in nonrecurring general
19 revenue is hereby appropriated from the General Revenue Fund
20 to the Department of Health to cover costs of the Florida
21 Commission on Excellence in Health Care relating to the travel
22 and related expenses of staff, consumer members, and members
23 appointed by the department or agency; the hiring of
24 consultants, if necessary; and the reproduction and
25 dissemination of documents.
26 Section 61. The sum of $200,000 is appropriated from
27 the Insurance Commissioner's Regulatory Trust Fund to the
28 Office of Legislative Services for the purpose of implementing
29 the legislative intent expressed in s. 624.215(1), Florida
30 Statutes, for a systematic review of current mandated health
31 coverages. The review must be conducted by certified actuaries
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1 and other appropriate professionals and shall consist of an
2 assessment of the impact, including, but not limited to, the
3 costs and benefits, of current mandated health coverages using
4 the guidelines provided in s. 624.215(2), Florida Statutes.
5 Section 62. Except as otherwise provided herein, this
6 act shall take effect July 1, 2000.
7
8 *****************************************
9 HOUSE SUMMARY
10
Creates the Patient Protection Act of 2000. Provides a
11 comprehensive revision of various provisions relating to
health care. See bill for details.
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