House Bill 2339er

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  1

  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 exemptions for

  6         combinations or divisions of nursing home

  7         certificates of need and additions of certain

  8         hospital beds and nursing home beds within

  9         specified limitations; providing exemptions for

10         the addition of temporary acute care beds in

11         certain hospitals and for the establishment of

12         certain types of specialty hospitals through

13         transfer of beds and services from certain

14         existing hospitals; requiring a fee for each

15         request for exemption; amending s. 408.037,

16         F.S.; deleting reference to the state health

17         plan; amending ss. 408.038, 408.039, 408.044,

18         and 408.045, F.S.; replacing "department" with

19         "agency"; clarifying the opportunity to

20         challenge an intended award of a certificate of

21         need; amending s. 408.040, F.S.; deleting an

22         obsolete reference; revising the format of

23         conditions related to Medicaid; creating a

24         certificate-of-need workgroup within the Agency

25         for Health Care Administration; providing for

26         expenses; providing membership, duties, and

27         meetings; requiring reports; providing for

28         termination; amending s. 651.118, F.S.;

29         excluding a specified number of beds from a

30         time limit imposed on extension of

31         authorization for continuing care residential


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  1         community providers to use sheltered beds for

  2         nonresidents; requiring a facility to report

  3         such use after the expiration of the extension;

  4         amending s. 395.701, F.S.; reducing the annual

  5         assessment on hospitals to fund public medical

  6         assistance; providing for contingent effect;

  7         amending s. 395.7015, F.S.; reducing the annual

  8         assessment on certain health care entities;

  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 reimbursement of an entity in

13         Pasco or Pinellas County that provides in-home

14         physician services to Medicaid recipients with

15         degenerative neurological diseases; providing

16         for future repeal; providing appropriations;

17         providing for effect of amendments to ss.

18         395.701 and 395.7015, F.S., contingent on a

19         federal waiver; providing for the transfer of

20         certain unexpended Medicaid funds from the

21         Department of Elderly Affairs to the Agency for

22         Health Care Administration; amending ss.

23         641.31, 641.315, and 641.3155, F.S.;

24         prohibiting a health maintenance organization

25         from restricting a provider's ability to

26         provide inpatient hospital services to a

27         subscriber; requiring payment for medically

28         necessary inpatient hospital services;

29         providing applicability; amending s. 641.51,

30         F.S.; relating to quality assurance program

31         requirements for certain managed care


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  1         organizations; allowing the rendering of

  2         adverse determinations by physicians licensed

  3         in any state; requiring the submission of facts

  4         and documentation pertaining to rendered

  5         adverse determinations; providing timeframe for

  6         organizations to submit facts and documentation

  7         to providers and subscribers in writing;

  8         requiring an authorized representative to sign

  9         the notification; creating s. 381.7351, F.S.;

10         creating the "Reducing Racial and Ethnic Health

11         Disparities: Closing the Gap Act"; creating s.

12         381.7352, F.S.; providing legislative findings

13         and intent; creating s. 381.7353, F.S.;

14         providing for the creation of the Reducing

15         Racial and Ethnic Health Disparities: Closing

16         the Gap grant program, to be administered by

17         the Department of Health; providing department

18         duties and responsibilities; authorizing

19         appointment of an advisory committee; creating

20         s. 381.7354, F.S.; providing eligibility for

21         grant awards; creating s. 381.7355, F.S.;

22         providing project requirements, an application

23         process, and review criteria; creating s.

24         381.7356, F.S.; providing for Closing the Gap

25         grant awards; providing for local matching

26         funds; providing factors for determination of

27         the amount of grant awards; providing for award

28         of grants to begin by a specified date, subject

29         to specific appropriation; providing for annual

30         renewal of grants; creating the Florida

31         Commission on Excellence in Health Care;


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  1         providing legislative findings and intent;

  2         providing definitions; providing duties and

  3         responsibilities; providing for membership,

  4         organization, meetings, procedures, and staff;

  5         providing for reimbursement of travel and

  6         related expenses of certain members; providing

  7         certain evidentiary prohibitions; requiring a

  8         report to the Governor, the President of the

  9         Senate, and the Speaker of the House of

10         Representatives; providing for termination of

11         the commission; amending s. 408.7056, F.S.;

12         providing additional definitions for the

13         Statewide Provider and Subscriber Assistance

14         Program; amending s. 627.654, F.S.; providing

15         for insuring small employers under policies

16         issued to small employer health alliances;

17         providing requirements for participation;

18         providing limitations; providing for insuring

19         spouses and dependent children; allowing a

20         single master policy to include alternative

21         health plans; amending s. 627.6571, F.S.;

22         including small employer health alliances

23         within policy nonrenewal or discontinuance,

24         coverage modification, and application

25         provisions; amending s. 627.6699, F.S.;

26         revising restrictions relating to premium rates

27         to authorize small employer carriers to modify

28         rates under certain circumstances and to

29         authorize carriers to issue group health

30         insurance policies to small employer health

31         alliances under certain circumstances;


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  1         requiring carriers issuing a policy to an

  2         alliance to allow appointed agents to sell such

  3         a policy; amending ss. 240.2995, 240.2996,

  4         240.512, 381.0406, 395.3035, and 627.4301,

  5         F.S.; conforming cross references; defining the

  6         term "managed care"; creating s. 641.185, F.S.;

  7         providing health maintenance organization

  8         subscriber protections; specifying the

  9         principles to serve as standards for the

10         Department of Insurance and the Agency for

11         Health Care Administration exercising their

12         duties and responsibilities; requiring that a

13         health maintenance organization observe certain

14         standards in providing health care for

15         subscribers; providing for subscribers to

16         receive quality care from a broad panel of

17         providers, referrals, preventive care,

18         emergency screening services, and second

19         opinions; providing for assurance of

20         independent accreditation by a national review

21         organization and financial security of the

22         organization; providing for continuity of

23         health care; providing for timely, concise

24         information regarding reimbursement to

25         providers and services; providing for

26         flexibility to transfer to another health

27         maintenance organization within the state;

28         providing for eligibility without

29         discrimination based on health status;

30         providing requirements for health maintenance

31         organizations that issue group health contracts


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  1         relating to preexisting conditions, contract

  2         renewability, cancellation, extension,

  3         termination, and conversion; providing for

  4         timely, urgent grievances and appeals within

  5         the organization; providing for timely and

  6         urgent review of grievances and appeals by an

  7         independent state external review agency;

  8         providing for notice of rate changes; providing

  9         for information regarding contract provisions,

10         services, medical conditions, providers, and

11         service delivery; providing that no civil cause

12         of action is created; amending s. 641.511,

13         F.S.; requiring posting of certain consumer

14         assistance notices; providing requirements;

15         amending s. 627.6699, F.S.; revising a

16         definition; requiring small employer carriers

17         to begin to offer and issue all small employer

18         benefit plans on a specified date; deleting a

19         requirement that basic and standard small

20         employer health benefit plans be issued;

21         providing additional requirements for

22         determining premium rates for benefit plans;

23         providing for application to plans provided by

24         certain small employer carriers under certain

25         circumstances; amending s. 409.212, F.S.;

26         providing for periodic increase in the optional

27         state supplementation rate; amending s.

28         409.901, F.S.; amending definitions of terms

29         used in ss. 409.910-409.920, F.S.; amending s.

30         409.902, F.S.; providing that the Department of

31         Children and Family Services is responsible for


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  1         Medicaid eligibility determinations; amending

  2         s. 409.903, F.S.; providing responsibility for

  3         determinations of eligibility for payments for

  4         medical assistance and related services;

  5         amending s. 409.905, F.S.; increasing the

  6         maximum amount that may be paid under Medicaid

  7         for hospital outpatient services; amending s.

  8         409.906, F.S.; allowing the Department of

  9         Children and Family Services to transfer funds

10         to the Agency for Health Care Administration to

11         cover state match requirements as specified;

12         amending s. 409.907, F.S.; specifying bonding

13         requirements for providers; specifying grounds

14         on which provider applications may be denied;

15         amending s. 409.908, F.S.; increasing the

16         maximum amount of reimbursement allowable to

17         Medicaid providers for hospital inpatient care;

18         creating s. 409.9119, F.S.; creating a

19         disproportionate share program for children's

20         hospitals; providing formulas governing

21         payments made to hospitals under the program;

22         providing for withholding payments from a

23         hospital that is not complying with agency

24         rules; amending s. 409.919, F.S.; providing for

25         the adoption and the transfer of certain rules

26         relating to the determination of Medicaid

27         eligibility; authorizing developmental research

28         schools to participate in Medicaid certified

29         school match program; providing for the Agency

30         for Health Care Administration to seek a

31         federal waiver allowing the agency to undertake


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  1         a pilot project that involves contracting with

  2         skilled nursing facilities for the provision of

  3         rehabilitation services to adult ventilator

  4         dependent patients; providing for evaluation of

  5         the pilot program; repealing s. 400.464(3),

  6         F.S., relating to home health agency licenses

  7         provided to certificate-of-need exempt

  8         entities; repealing ss. 408.70(3), 408.701,

  9         408.702, 408.703, 408.704, 408.7041, 408.7042,

10         408.7045, 408.7055, and 408.706, F.S., relating

11         to community health purchasing alliances;

12         repealing s. 409.912(4)(b), F.S., relating to

13         the authorization of the agency to contract

14         with certain prepaid health care services

15         providers; providing appropriations; reducing

16         certain allocation of positions and funds;

17         providing effective dates.

18

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

20

21         Section 1.  This act may be cited as the "Patient

22  Protection Act of 2000."

23         Section 2.  Subsections (2) and (11) of section

24  400.471, Florida Statutes, are amended to read:

25         400.471  Application for license; fee; provisional

26  license; temporary permit.--

27         (2)  The applicant must file with the application

28  satisfactory proof that the home health agency is in

29  compliance with this part and applicable rules, including:

30

31


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  1         (a)  A listing of services to be provided, either

  2  directly by the applicant or through contractual arrangements

  3  with existing providers;

  4         (b)  The number and discipline of professional staff to

  5  be employed; and

  6         (c)  Proof of financial ability to operate.

  7

  8  If the applicant has applied for a certificate of need under

  9  ss. 408.0331-408.045 within the preceding 12 months, the

10  applicant may submit the proof required during the

11  certificate-of-need process along with an attestation that

12  there has been no substantial change in the facts and

13  circumstances underlying the original submission.

14         (11)  The agency may not issue a license designated as

15  certified to a home health agency that fails to receive a

16  certificate of need under ss. 408.031-408.045 or that fails to

17  satisfy the requirements of a Medicare certification survey

18  from the agency.

19         Section 3.  Section 408.032, Florida Statutes, is

20  amended to read:

21         408.032  Definitions.--As used in ss. 408.031-408.045,

22  the term:

23         (1)  "Agency" means the Agency for Health Care

24  Administration.

25         (2)  "Capital expenditure" means an expenditure,

26  including an expenditure for a construction project undertaken

27  by a health care facility as its own contractor, which, under

28  generally accepted accounting principles, is not properly

29  chargeable as an expense of operation and maintenance, which

30  is made to change the bed capacity of the facility, or

31  substantially change the services or service area of the


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  1  health care facility, health service provider, or hospice, and

  2  which includes the cost of the studies, surveys, designs,

  3  plans, working drawings, specifications, initial financing

  4  costs, and other activities essential to acquisition,

  5  improvement, expansion, or replacement of the plant and

  6  equipment.

  7         (3)  "Certificate of need" means a written statement

  8  issued by the agency evidencing community need for a new,

  9  converted, expanded, or otherwise significantly modified

10  health care facility, health service, or hospice.

11         (4)  "Commenced construction" means initiation of and

12  continuous activities beyond site preparation associated with

13  erecting or modifying a health care facility, including

14  procurement of a building permit applying the use of

15  agency-approved construction documents, proof of an executed

16  owner/contractor agreement or an irrevocable or binding forced

17  account, and actual undertaking of foundation forming with

18  steel installation and concrete placing.

19         (5)  "District" means a health service planning

20  district composed of the following counties:

21         District 1.--Escambia, Santa Rosa, Okaloosa, and Walton

22  Counties.

23         District 2.--Holmes, Washington, Bay, Jackson,

24  Franklin, Gulf, Gadsden, Liberty, Calhoun, Leon, Wakulla,

25  Jefferson, Madison, and Taylor Counties.

26         District 3.--Hamilton, Suwannee, Lafayette, Dixie,

27  Columbia, Gilchrist, Levy, Union, Bradford, Putnam, Alachua,

28  Marion, Citrus, Hernando, Sumter, and Lake Counties.

29         District 4.--Baker, Nassau, Duval, Clay, St. Johns,

30  Flagler, and Volusia Counties.

31         District 5.--Pasco and Pinellas Counties.


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  1         District 6.--Hillsborough, Manatee, Polk, Hardee, and

  2  Highlands Counties.

  3         District 7.--Seminole, Orange, Osceola, and Brevard

  4  Counties.

  5         District 8.--Sarasota, DeSoto, Charlotte, Lee, Glades,

  6  Hendry, and Collier Counties.

  7         District 9.--Indian River, Okeechobee, St. Lucie,

  8  Martin, and Palm Beach Counties.

  9         District 10.--Broward County.

10         District 11.--Dade and Monroe Counties.

11         (6)  "Exemption" means the process by which a proposal

12  that would otherwise require a certificate of need may proceed

13  without a certificate of need.

14         (7)(6)  "Expedited review" means the process by which

15  certain types of applications are not subject to the review

16  cycle requirements contained in s. 408.039(1), and the letter

17  of intent requirements contained in s. 408.039(2).

18         (8)(7)  "Health care facility" means a hospital,

19  long-term care hospital, skilled nursing facility, hospice,

20  intermediate care facility, or intermediate care facility for

21  the developmentally disabled. A facility relying solely on

22  spiritual means through prayer for healing is not included as

23  a health care facility.

24         (9)(8)  "Health services" means diagnostic, curative,

25  or rehabilitative services and includes alcohol treatment,

26  drug abuse treatment, and mental health services. Obstetric

27  services are not health services for purposes of ss.

28  408.031-408.045.

29         (9)  "Home health agency" means an organization, as

30  defined in s. 400.462(4), that is certified or seeks

31  certification as a Medicare home health service provider.


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  1         (10)  "Hospice" or "hospice program" means a hospice as

  2  defined in part VI of chapter 400.

  3         (11)  "Hospital" means a health care facility licensed

  4  under chapter 395.

  5         (12)  "Institutional health service" means a health

  6  service which is provided by or through a health care facility

  7  and which entails an annual operating cost of $500,000 or

  8  more.  The agency shall, by rule, adjust the annual operating

  9  cost threshold annually using an appropriate inflation index.

10         (13)  "Intermediate care facility" means an institution

11  which provides, on a regular basis, health-related care and

12  services to individuals who do not require the degree of care

13  and treatment which a hospital or skilled nursing facility is

14  designed to provide, but who, because of their mental or

15  physical condition, require health-related care and services

16  above the level of room and board.

17         (12)(14)  "Intermediate care facility for the

18  developmentally disabled" means a residential facility

19  licensed under chapter 393 and certified by the Federal

20  Government pursuant to the Social Security Act as a provider

21  of Medicaid services to persons who are mentally retarded or

22  who have a related condition.

23         (13)(15)  "Long-term care hospital" means a hospital

24  licensed under chapter 395 which meets the requirements of 42

25  C.F.R. s. 412.23(e) and seeks exclusion from the Medicare

26  prospective payment system for inpatient hospital services.

27         (14)  "Mental health services" means inpatient services

28  provided in a hospital licensed under chapter 395 and listed

29  on the hospital license as psychiatric beds for adults;

30  psychiatric beds for children and adolescents; intensive

31  residential treatment beds for children and adolescents;


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  1  substance abuse beds for adults; or substance abuse beds for

  2  children and adolescents.

  3         (16)  "Multifacility project" means an integrated

  4  residential and health care facility consisting of independent

  5  living units, assisted living facility units, and nursing home

  6  beds certificated on or after January 1, 1987, where:

  7         (a)  The aggregate total number of independent living

  8  units and assisted living facility units exceeds the number of

  9  nursing home beds.

10         (b)  The developer of the project has expended the sum

11  of $500,000 or more on the certificated and noncertificated

12  elements of the project combined, exclusive of land costs, by

13  the conclusion of the 18th month of the life of the

14  certificate of need.

15         (c)  The total aggregate cost of construction of the

16  certificated element of the project, when combined with other,

17  noncertificated elements, is $10 million or more.

18         (d)  All elements of the project are contiguous or

19  immediately adjacent to each other and construction of all

20  elements will be continuous.

21         (15)(17)  "Nursing home geographically underserved

22  area" means:

23         (a)  A county in which there is no existing or approved

24  nursing home;

25         (b)  An area with a radius of at least 20 miles in

26  which there is no existing or approved nursing home; or

27         (c)  An area with a radius of at least 20 miles in

28  which all existing nursing homes have maintained at least a 95

29  percent occupancy rate for the most recent 6 months or a 90

30  percent occupancy rate for the most recent 12 months.

31


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  1         (18)  "Respite care" means short-term care in a

  2  licensed health care facility which is personal or custodial

  3  and is provided for chronic illness, physical infirmity, or

  4  advanced age for the purpose of temporarily relieving family

  5  members of the burden of providing care and attendance.

  6         (16)(19)  "Skilled nursing facility" means an

  7  institution, or a distinct part of an institution, which is

  8  primarily engaged in providing, to inpatients, skilled nursing

  9  care and related services for patients who require medical or

10  nursing care, or rehabilitation services for the

11  rehabilitation of injured, disabled, or sick persons.

12         (17)(20)  "Tertiary health service" means a health

13  service which, due to its high level of intensity, complexity,

14  specialized or limited applicability, and cost, should be

15  limited to, and concentrated in, a limited number of hospitals

16  to ensure the quality, availability, and cost-effectiveness of

17  such service. Examples of such service include, but are not

18  limited to, organ transplantation, specialty burn units,

19  neonatal intensive care units, comprehensive rehabilitation,

20  and medical or surgical services which are experimental or

21  developmental in nature to the extent that the provision of

22  such services is not yet contemplated within the commonly

23  accepted course of diagnosis or treatment for the condition

24  addressed by a given service.  The agency shall establish by

25  rule a list of all tertiary health services.

26         (18)(21)  "Regional area" means any of those regional

27  health planning areas established by the agency to which local

28  and district health planning funds are directed to local

29  health councils through the General Appropriations Act.

30

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  1         Section 4.  Paragraph (b) of subsection (1) and

  2  paragraph (a) of subsection (3) of section 408.033, Florida

  3  Statutes, are amended to read:

  4         408.033  Local and state health planning.--

  5         (1)  LOCAL HEALTH COUNCILS.--

  6         (b)  Each local health council may:

  7         1.  Develop a district or regional area health plan

  8  that permits is consistent with the objectives and strategies

  9  in the state health plan, but that shall permit each local

10  health council to develop strategies and set priorities for

11  implementation based on its unique local health needs.  The

12  district or regional area health plan must contain preferences

13  for the development of health services and facilities, which

14  may be considered by the agency in its review of

15  certificate-of-need applications.  The district health plan

16  shall be submitted to the agency and updated periodically. The

17  district health plans shall use a uniform format and be

18  submitted to the agency according to a schedule developed by

19  the agency in conjunction with the local health councils. The

20  schedule must provide for coordination between the development

21  of the state health plan and the district health plans and for

22  the development of district health plans by major sections

23  over a multiyear period.  The elements of a district plan

24  which are necessary to the review of certificate-of-need

25  applications for proposed projects within the district may be

26  adopted by the agency as a part of its rules.

27         2.  Advise the agency on health care issues and

28  resource allocations.

29         3.  Promote public awareness of community health needs,

30  emphasizing health promotion and cost-effective health service

31  selection.


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  1         4.  Collect data and conduct analyses and studies

  2  related to health care needs of the district, including the

  3  needs of medically indigent persons, and assist the agency and

  4  other state agencies in carrying out data collection

  5  activities that relate to the functions in this subsection.

  6         5.  Monitor the onsite construction progress, if any,

  7  of certificate-of-need approved projects and report council

  8  findings to the agency on forms provided by the agency.

  9         6.  Advise and assist any regional planning councils

10  within each district that have elected to address health

11  issues in their strategic regional policy plans with the

12  development of the health element of the plans to address the

13  health goals and policies in the State Comprehensive Plan.

14         7.  Advise and assist local governments within each

15  district on the development of an optional health plan element

16  of the comprehensive plan provided in chapter 163, to assure

17  compatibility with the health goals and policies in the State

18  Comprehensive Plan and district health plan.  To facilitate

19  the implementation of this section, the local health council

20  shall annually provide the local governments in its service

21  area, upon request, with:

22         a.  A copy and appropriate updates of the district

23  health plan;

24         b.  A report of hospital and nursing home utilization

25  statistics for facilities within the local government

26  jurisdiction; and

27         c.  Applicable agency rules and calculated need

28  methodologies for health facilities and services regulated

29  under s. 408.034 for the district served by the local health

30  council.

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  1         8.  Monitor and evaluate the adequacy, appropriateness,

  2  and effectiveness, within the district, of local, state,

  3  federal, and private funds distributed to meet the needs of

  4  the medically indigent and other underserved population

  5  groups.

  6         9.  In conjunction with the Agency for Health Care

  7  Administration, plan for services at the local level for

  8  persons infected with the human immunodeficiency virus.

  9         10.  Provide technical assistance to encourage and

10  support activities by providers, purchasers, consumers, and

11  local, regional, and state agencies in meeting the health care

12  goals, objectives, and policies adopted by the local health

13  council.

14         11.  Provide the agency with data required by rule for

15  the review of certificate-of-need applications and the

16  projection of need for health services and facilities in the

17  district.

18         (3)  DUTIES AND RESPONSIBILITIES OF THE AGENCY.--

19         (a)  The agency, in conjunction with the local health

20  councils, is responsible for the coordinated planning of all

21  health care services in the state and for the preparation of

22  the state health plan.

23         Section 5.  Subsection (2) of section 408.034, Florida

24  Statutes, is amended to read:

25         408.034  Duties and responsibilities of agency;

26  rules.--

27         (2)  In the exercise of its authority to issue licenses

28  to health care facilities and health service providers, as

29  provided under chapters 393, 395, and parts II, IV, and VI of

30  chapter 400, the agency may not issue a license to any health

31  care facility, health service provider, hospice, or part of a


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  1  health care facility which fails to receive a certificate of

  2  need or an exemption for the licensed facility or service.

  3         Section 6.  Section 408.035, Florida Statutes, is

  4  amended to read:

  5         408.035  Review criteria.--

  6         (1)  The agency shall determine the reviewability of

  7  applications and shall review applications for

  8  certificate-of-need determinations for health care facilities

  9  and health services in context with the following criteria:

10         (1)(a)  The need for the health care facilities and

11  health services being proposed in relation to the applicable

12  district health plan, except in emergency circumstances that

13  pose a threat to the public health.

14         (2)(b)  The availability, quality of care, efficiency,

15  appropriateness, accessibility, and extent of utilization of,

16  and adequacy of like and existing health care facilities and

17  health services in the service district of the applicant.

18         (3)(c)  The ability of the applicant to provide quality

19  of care and the applicant's record of providing quality of

20  care.

21         (d)  The availability and adequacy of other health care

22  facilities and health services in the service district of the

23  applicant, such as outpatient care and ambulatory or home care

24  services, which may serve as alternatives for the health care

25  facilities and health services to be provided by the

26  applicant.

27         (e)  Probable economies and improvements in service

28  which may be derived from operation of joint, cooperative, or

29  shared health care resources.

30         (4)(f)  The need in the service district of the

31  applicant for special health care equipment and services that


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  1  are not reasonably and economically accessible in adjoining

  2  areas.

  3         (5)(g)  The needs of need for research and educational

  4  facilities, including, but not limited to, facilities with

  5  institutional training programs and community training

  6  programs for health care practitioners and for doctors of

  7  osteopathic medicine and medicine at the student, internship,

  8  and residency training levels.

  9         (6)(h)  The availability of resources, including health

10  personnel, management personnel, and funds for capital and

11  operating expenditures, for project accomplishment and

12  operation.; the effects the project will have on clinical

13  needs of health professional training programs in the service

14  district; the extent to which the services will be accessible

15  to schools for health professions in the service district for

16  training purposes if such services are available in a limited

17  number of facilities; the availability of alternative uses of

18  such resources for the provision of other health services; and

19         (7)  The extent to which the proposed services will

20  enhance access to health care for be accessible to all

21  residents of the service district.

22         (8)(i)  The immediate and long-term financial

23  feasibility of the proposal.

24         (j)  The special needs and circumstances of health

25  maintenance organizations.

26         (k)  The needs and circumstances of those entities that

27  provide a substantial portion of their services or resources,

28  or both, to individuals not residing in the service district

29  in which the entities are located or in adjacent service

30  districts.  Such entities may include medical and other health

31  professions, schools, multidisciplinary clinics, and specialty


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  1  services such as open-heart surgery, radiation therapy, and

  2  renal transplantation.

  3         (9)(l)  The extent to which the proposal will foster

  4  competition that promotes quality and cost-effectiveness. The

  5  probable impact of the proposed project on the costs of

  6  providing health services proposed by the applicant, upon

  7  consideration of factors including, but not limited to, the

  8  effects of competition on the supply of health services being

  9  proposed and the improvements or innovations in the financing

10  and delivery of health services which foster competition and

11  service to promote quality assurance and cost-effectiveness.

12         (10)(m)  The costs and methods of the proposed

13  construction, including the costs and methods of energy

14  provision and the availability of alternative, less costly, or

15  more effective methods of construction.

16         (11)(n)  The applicant's past and proposed provision of

17  health care services to Medicaid patients and the medically

18  indigent.

19         (o)  The applicant's past and proposed provision of

20  services that promote a continuum of care in a multilevel

21  health care system, which may include, but are not limited to,

22  acute care, skilled nursing care, home health care, and

23  assisted living facilities.

24         (12)(p)  The applicant's designation as a Gold Seal

25  Program nursing facility pursuant to s. 400.235, when the

26  applicant is requesting additional nursing home beds at that

27  facility.

28         (2)  In cases of capital expenditure proposals for the

29  provision of new health services to inpatients, the agency

30  shall also reference each of the following in its findings of

31  fact:


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  1         (a)  That less costly, more efficient, or more

  2  appropriate alternatives to such inpatient services are not

  3  available and the development of such alternatives has been

  4  studied and found not practicable.

  5         (b)  That existing inpatient facilities providing

  6  inpatient services similar to those proposed are being used in

  7  an appropriate and efficient manner.

  8         (c)  In the case of new construction or replacement

  9  construction, that alternatives to the construction, for

10  example, modernization or sharing arrangements, have been

11  considered and have been implemented to the maximum extent

12  practicable.

13         (d)  That patients will experience serious problems in

14  obtaining inpatient care of the type proposed, in the absence

15  of the proposed new service.

16         (e)  In the case of a proposal for the addition of beds

17  for the provision of skilled nursing or intermediate care

18  services, that the addition will be consistent with the plans

19  of other agencies of the state responsible for the provision

20  and financing of long-term care, including home health

21  services.

22         Section 7.  Section 408.036, Florida Statutes, is

23  amended to read:

24         408.036  Projects subject to review.--

25         (1)  APPLICABILITY.--Unless exempt under subsection

26  (3), all health-care-related projects, as described in

27  paragraphs (a)-(h)(k), are subject to review and must file an

28  application for a certificate of need with the agency. The

29  agency is exclusively responsible for determining whether a

30  health-care-related project is subject to review under ss.

31  408.031-408.045.


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  1         (a)  The addition of beds by new construction or

  2  alteration.

  3         (b)  The new construction or establishment of

  4  additional health care facilities, including a replacement

  5  health care facility when the proposed project site is not

  6  located on the same site as the existing health care facility.

  7         (c)  The conversion from one type of health care

  8  facility to another, including the conversion from one level

  9  of care to another, in a skilled or intermediate nursing

10  facility, if the conversion effects a change in the level of

11  care of 10 beds or 10 percent of total bed capacity of the

12  skilled or intermediate nursing facility within a 2-year

13  period.  If the nursing facility is certified for both skilled

14  and intermediate nursing care, the provisions of this

15  paragraph do not apply.

16         (d)  An Any increase in the total licensed bed capacity

17  of a health care facility.

18         (e)  Subject to the provisions of paragraph (3)(i), The

19  establishment of a Medicare-certified home health agency, the

20  establishment of a hospice or hospice inpatient facility, or

21  the direct provision of such services by a health care

22  facility or health maintenance organization for those other

23  than the subscribers of the health maintenance organization;

24  except that this paragraph does not apply to the establishment

25  of a Medicare-certified home health agency by a facility

26  described in paragraph (3)(h).

27         (f)  An acquisition by or on behalf of a health care

28  facility or health maintenance organization, by any means,

29  which acquisition would have required review if the

30  acquisition had been by purchase.

31


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  1         (f)(g)  The establishment of inpatient institutional

  2  health services by a health care facility, or a substantial

  3  change in such services.

  4         (h)  The acquisition by any means of an existing health

  5  care facility by any person, unless the person provides the

  6  agency with at least 30 days' written notice of the proposed

  7  acquisition, which notice is to include the services to be

  8  offered and the bed capacity of the facility, and unless the

  9  agency does not determine, within 30 days after receipt of

10  such notice, that the services to be provided and the bed

11  capacity of the facility will be changed.

12         (i)  An increase in the cost of a project for which a

13  certificate of need has been issued when the increase in cost

14  exceeds 20 percent of the originally approved cost of the

15  project, except that a cost overrun review is not necessary

16  when the cost overrun is less than $20,000.

17         (g)(j)  An increase in the number of beds for acute

18  care, specialty burn units, neonatal intensive care units,

19  comprehensive rehabilitation, mental health services, or

20  hospital-based distinct part skilled nursing units, or at a

21  long-term care hospital psychiatric or rehabilitation beds.

22         (h)(k)  The establishment of tertiary health services.

23         (2)  PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless

24  exempt pursuant to subsection (3), projects subject to an

25  expedited review shall include, but not be limited to:

26         (a)  Cost overruns, as defined in paragraph (1)(i).

27         (a)(b)  Research, education, and training programs.

28         (b)(c)  Shared services contracts or projects.

29         (c)(d)  A transfer of a certificate of need.

30         (d)(e)  A 50-percent increase in nursing home beds for

31  a facility incorporated and operating in this state for at


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  1  least 60 years on or before July 1, 1988, which has a licensed

  2  nursing home facility located on a campus providing a variety

  3  of residential settings and supportive services.  The

  4  increased nursing home beds shall be for the exclusive use of

  5  the campus residents.  Any application on behalf of an

  6  applicant meeting this requirement shall be subject to the

  7  base fee of $5,000 provided in s. 408.038.

  8         (f)  Combination within one nursing home facility of

  9  the beds or services authorized by two or more certificates of

10  need issued in the same planning subdistrict.

11         (g)  Division into two or more nursing home facilities

12  of beds or services authorized by one certificate of need

13  issued in the same planning subdistrict.  Such division shall

14  not be approved if it would adversely affect the original

15  certificate's approved cost.

16         (e)(h)  Replacement of a health care facility when the

17  proposed project site is located in the same district and

18  within a 1-mile radius of the replaced health care facility.

19         (f)  The conversion of mental health services beds

20  licensed under chapter 395 or hospital-based distinct part

21  skilled nursing unit beds to general acute care beds; the

22  conversion of mental health services beds between or among the

23  licensed bed categories defined as beds for mental health

24  services; or the conversion of general acute care beds to beds

25  for mental health services.

26         1.  Conversion under this paragraph shall not establish

27  a new licensed bed category at the hospital but shall apply

28  only to categories of beds licensed at that hospital.

29         2.  Beds converted under this paragraph must be

30  licensed and operational for at least 12 months before the

31


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  1  hospital may apply for additional conversion affecting beds of

  2  the same type.

  3

  4  The agency shall develop rules to implement the provisions for

  5  expedited review, including time schedule, application content

  6  which may be reduced from the full requirements of s.

  7  408.037(1), and application processing.

  8         (3)  EXEMPTIONS.--Upon request, the following projects

  9  are subject to supported by such documentation as the agency

10  requires, the agency shall grant an exemption from the

11  provisions of subsection (1):

12         (a)  For the initiation or expansion of obstetric

13  services.

14         (a)(b)  For replacement of any expenditure to replace

15  or renovate any part of a licensed health care facility on the

16  same site, provided that the number of licensed beds in each

17  licensed bed category will not increase and, in the case of a

18  replacement facility, the project site is the same as the

19  facility being replaced.

20         (c)  For providing respite care services. An individual

21  may be admitted to a respite care program in a hospital

22  without regard to inpatient requirements relating to admitting

23  order and attendance of a member of a medical staff.

24         (b)(d)  For hospice services or home health services

25  provided by a rural hospital, as defined in s. 395.602, or for

26  swing beds in such rural hospital in a number that does not

27  exceed one-half of its licensed beds.

28         (c)(e)  For the conversion of licensed acute care

29  hospital beds to Medicare and Medicaid certified skilled

30  nursing beds in a rural hospital as defined in s. 395.602, so

31  long as the conversion of the beds does not involve the


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  1  construction of new facilities. The total number of skilled

  2  nursing beds, including swing beds, may not exceed one-half of

  3  the total number of licensed beds in the rural hospital as of

  4  July 1, 1993. Certified skilled nursing beds designated under

  5  this paragraph, excluding swing beds, shall be included in the

  6  community nursing home bed inventory.  A rural hospital which

  7  subsequently decertifies any acute care beds exempted under

  8  this paragraph shall notify the agency of the decertification,

  9  and the agency shall adjust the community nursing home bed

10  inventory accordingly.

11         (d)(f)  For the addition of nursing home beds at a

12  skilled nursing facility that is part of a retirement

13  community that provides a variety of residential settings and

14  supportive services and that has been incorporated and

15  operated in this state for at least 65 years on or before July

16  1, 1994. All nursing home beds must not be available to the

17  public but must be for the exclusive use of the community

18  residents.

19         (e)(g)  For an increase in the bed capacity of a

20  nursing facility licensed for at least 50 beds as of January

21  1, 1994, under part II of chapter 400 which is not part of a

22  continuing care facility if, after the increase, the total

23  licensed bed capacity of that facility is not more than 60

24  beds and if the facility has been continuously licensed since

25  1950 and has received a superior rating on each of its two

26  most recent licensure surveys.

27         (h)  For the establishment of a Medicare-certified home

28  health agency by a facility certified under chapter 651; a

29  retirement community, as defined in s. 400.404(2)(g); or a

30  residential facility that serves only retired military

31  personnel, their dependents, and the surviving dependents of


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  1  deceased military personnel. Medicare-reimbursed home health

  2  services provided through such agency shall be offered

  3  exclusively to residents of the facility or retirement

  4  community or to residents of facilities or retirement

  5  communities owned, operated, or managed by the same corporate

  6  entity. Each visit made to deliver Medicare-reimbursable home

  7  health services to a home health patient who, at the time of

  8  service, is not a resident of the facility or retirement

  9  community shall be a deceptive and unfair trade practice and

10  constitutes a violation of ss. 501.201-501.213.

11         (i)  For the establishment of a Medicare-certified home

12  health agency. This paragraph shall take effect 90 days after

13  the adjournment sine die of the next regular session of the

14  Legislature occurring after the legislative session in which

15  the Legislature receives a report from the Director of Health

16  Care Administration certifying that the federal Health Care

17  Financing Administration has implemented a per-episode

18  prospective pay system for Medicare-certified home health

19  agencies.

20         (f)(j)  For an inmate health care facility built by or

21  for the exclusive use of the Department of Corrections as

22  provided in chapter 945. This exemption expires when such

23  facility is converted to other uses.

24         (k)  For an expenditure by or on behalf of a health

25  care facility to provide a health service exclusively on an

26  outpatient basis.

27         (g)(l)  For the termination of an inpatient a health

28  care service, upon 30 days' written notice to the agency.

29         (h)(m)  For the delicensure of beds, upon 30 days'

30  written notice to the agency. A request for exemption An

31  application submitted under this paragraph must identify the


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  1  number, the category of beds classification, and the name of

  2  the facility in which the beds to be delicensed are located.

  3         (i)(n)  For the provision of adult inpatient diagnostic

  4  cardiac catheterization services in a hospital.

  5         1.  In addition to any other documentation otherwise

  6  required by the agency, a request for an exemption submitted

  7  under this paragraph must comply with the following criteria:

  8         a.  The applicant must certify it will not provide

  9  therapeutic cardiac catheterization pursuant to the grant of

10  the exemption.

11         b.  The applicant must certify it will meet and

12  continuously maintain the minimum licensure requirements

13  adopted by the agency governing such programs pursuant to

14  subparagraph 2.

15         c.  The applicant must certify it will provide a

16  minimum of 2 percent of its services to charity and Medicaid

17  patients.

18         2.  The agency shall adopt licensure requirements by

19  rule which govern the operation of adult inpatient diagnostic

20  cardiac catheterization programs established pursuant to the

21  exemption provided in this paragraph. The rules shall ensure

22  that such programs:

23         a.  Perform only adult inpatient diagnostic cardiac

24  catheterization services authorized by the exemption and will

25  not provide therapeutic cardiac catheterization or any other

26  services not authorized by the exemption.

27         b.  Maintain sufficient appropriate equipment and

28  health personnel to ensure quality and safety.

29         c.  Maintain appropriate times of operation and

30  protocols to ensure availability and appropriate referrals in

31  the event of emergencies.


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  1         d.  Maintain appropriate program volumes to ensure

  2  quality and safety.

  3         e.  Provide a minimum of 2 percent of its services to

  4  charity and Medicaid patients each year.

  5         3.a.  The exemption provided by this paragraph shall

  6  not apply unless the agency determines that the program is in

  7  compliance with the requirements of subparagraph 1. and that

  8  the program will, after beginning operation, continuously

  9  comply with the rules adopted pursuant to subparagraph 2.  The

10  agency shall monitor such programs to ensure compliance with

11  the requirements of subparagraph 2.

12         b.(I)  The exemption for a program shall expire

13  immediately when the program fails to comply with the rules

14  adopted pursuant to sub-subparagraphs 2.a., b., and c.

15         (II)  Beginning 18 months after a program first begins

16  treating patients, the exemption for a program shall expire

17  when the program fails to comply with the rules adopted

18  pursuant to sub-subparagraphs 2.d. and e.

19         (III)  If the exemption for a program expires pursuant

20  to sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the

21  agency shall not grant an exemption pursuant to this paragraph

22  for an adult inpatient diagnostic cardiac catheterization

23  program located at the same hospital until 2 years following

24  the date of the determination by the agency that the program

25  failed to comply with the rules adopted pursuant to

26  subparagraph 2.

27         4.  The agency shall not grant any exemption under this

28  paragraph until the adoption of the rules required under this

29  paragraph, or until March 1, 1998, whichever comes first.

30  However, if final rules have not been adopted by March 1,

31  1998, the proposed rules governing the exemptions shall be


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  1  used by the agency to grant exemptions under the provisions of

  2  this paragraph until final rules become effective.

  3         (j)(o)  For any expenditure to provide mobile surgical

  4  facilities and related health care services provided under

  5  contract with the Department of Corrections or a private

  6  correctional facility operating pursuant to chapter 957.

  7         (k)(p)  For state veterans' nursing homes operated by

  8  or on behalf of the Florida Department of Veterans' Affairs in

  9  accordance with part II of chapter 296 for which at least 50

10  percent of the construction cost is federally funded and for

11  which the Federal Government pays a per diem rate not to

12  exceed one-half of the cost of the veterans' care in such

13  state nursing homes. These beds shall not be included in the

14  nursing home bed inventory.

15         (l)  For combination within one nursing home facility

16  of the beds or services authorized by two or more certificates

17  of need issued in the same planning subdistrict.  An exemption

18  granted under this paragraph shall extend the validity period

19  of the certificates of need to be consolidated by the length

20  of the period beginning upon submission of the exemption

21  request and ending with issuance of the exemption.  The

22  longest validity period among the certificates shall be

23  applicable to each of the combined certificates.

24         (m)  For division into two or more nursing home

25  facilities of beds or services authorized by one certificate

26  of need issued in the same planning subdistrict.  An exemption

27  granted under this paragraph shall extend the validity period

28  of the certificate of need to be divided by the length of the

29  period beginning upon submission of the exemption request and

30  ending with issuance of the exemption.

31


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  1         (n)  For the addition of hospital beds licensed under

  2  chapter 395 for acute care, mental health services, or a

  3  hospital-based distinct part skilled nursing unit in a number

  4  that may not exceed 10 total beds or 10 percent of the

  5  licensed capacity of the bed category being expanded,

  6  whichever is greater. Beds for specialty burn units, neonatal

  7  intensive care units, or comprehensive rehabilitation, or at a

  8  long-term care hospital, may not be increased under this

  9  paragraph.

10         1.  In addition to any other documentation otherwise

11  required by the agency, a request for exemption submitted

12  under this paragraph must:

13         a.  Certify that the prior 12-month average occupancy

14  rate for the category of licensed beds being expanded at the

15  facility meets or exceeds 80 percent or, for a hospital-based

16  distinct part skilled nursing unit, the prior 12-month average

17  occupancy rate meets or exceeds 96 percent.

18         b.  Certify that any beds of the same type authorized

19  for the facility under this paragraph before the date of the

20  current request for an exemption have been licensed and

21  operational for at least 12 months.

22         2.  The timeframes and monitoring process specified in

23  s. 408.040(2)(a)-(c) apply to any exemption issued under this

24  paragraph.

25         3.  The agency shall count beds authorized under this

26  paragraph as approved beds in the published inventory of

27  hospital beds until the beds are licensed.

28         (o)  For the addition of acute care beds, as authorized

29  by rule consistent with s. 395.003(4), in a number that may

30  not exceed 10 total beds or 10 percent of licensed bed

31  capacity, whichever is greater, for temporary beds in a


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  1  hospital which has experienced high seasonal occupancy within

  2  the prior 12-month period or in a hospital that must respond

  3  to emergency circumstances.

  4         (p)  For the addition of nursing home beds licensed

  5  under chapter 400 in a number not exceeding 10 total beds or

  6  10 percent of the number of beds licensed in the facility

  7  being expanded, whichever is greater.

  8         1.  In addition to any other documentation required by

  9  the agency, a request for exemption submitted under this

10  paragraph must:

11         a.  Certify that the facility has not had any class I

12  or class II deficiencies within the 30 months preceding the

13  request for addition.

14         b.  Certify that the prior 12-month average occupancy

15  rate for the nursing home beds at the facility meets or

16  exceeds 96 percent.

17         c.  Certify that any beds authorized for the facility

18  under this paragraph before the date of the current request

19  for an exemption have been licensed and operational for at

20  least 12 months.

21         2.  The timeframes and monitoring process specified in

22  s. 408.040(2)(a)-(c) apply to any exemption issued under this

23  paragraph.

24         3.  The agency shall count beds authorized under this

25  paragraph as approved beds in the published inventory of

26  nursing home beds until the beds are licensed.

27         (q)  For establishment of a specialty hospital offering

28  a range of medical service restricted to a defined age or

29  gender group of the population or a restricted range of

30  services appropriate to the diagnosis, care, and treatment of

31  patients with specific categories of medical illnesses or


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  1  disorders, through the transfer of beds and services from an

  2  existing hospital in the same county.

  3         (4)  A request for exemption under this subsection (3)

  4  may be made at any time and is not subject to the batching

  5  requirements of this section. The request shall be supported

  6  by such documentation as the agency requires by rule. The

  7  agency shall assess a fee of $250 for each request for

  8  exemption submitted under subsection (3).

  9         Section 8.  Paragraph (a) of subsection (1) of section

10  408.037, Florida Statutes, is amended to read:

11         408.037  Application content.--

12         (1)  An application for a certificate of need must

13  contain:

14         (a)  A detailed description of the proposed project and

15  statement of its purpose and need in relation to the district

16  local health plan and the state health plan.

17         Section 9.  Section 408.038, Florida Statutes, is

18  amended to read:

19         408.038  Fees.--The agency department shall assess fees

20  on certificate-of-need applications.  Such fees shall be for

21  the purpose of funding the functions of the local health

22  councils and the activities of the agency department and shall

23  be allocated as provided in s. 408.033. The fee shall be

24  determined as follows:

25         (1)  A minimum base fee of $5,000.

26         (2)  In addition to the base fee of $5,000, 0.015 of

27  each dollar of proposed expenditure, except that a fee may not

28  exceed $22,000.

29         Section 10.  Subsections (3) and (4), paragraph (c) of

30  subsection (5), and paragraphs (a) and (b) of subsection (6)

31  of section 408.039, Florida Statutes, are amended to read:


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  1         408.039  Review process.--The review process for

  2  certificates of need shall be as follows:

  3         (3)  APPLICATION PROCESSING.--

  4         (a)  An applicant shall file an application with the

  5  agency department, and shall furnish a copy of the application

  6  to the local health council and the agency department. Within

  7  15 days after the applicable application filing deadline

  8  established by agency department rule, the staff of the agency

  9  department shall determine if the application is complete.  If

10  the application is incomplete, the staff shall request

11  specific information from the applicant necessary for the

12  application to be complete; however, the staff may make only

13  one such request. If the requested information is not filed

14  with the agency department within 21 days of the receipt of

15  the staff's request, the application shall be deemed

16  incomplete and deemed withdrawn from consideration.

17         (b)  Upon the request of any applicant or substantially

18  affected person within 14 days after notice that an

19  application has been filed, a public hearing may be held at

20  the agency's department's discretion if the agency department

21  determines that a proposed project involves issues of great

22  local public interest. The public hearing shall allow

23  applicants and other interested parties reasonable time to

24  present their positions and to present rebuttal information. A

25  recorded verbatim record of the hearing shall be maintained.

26  The public hearing shall be held at the local level within 21

27  days after the application is deemed complete.

28         (4)  STAFF RECOMMENDATIONS.--

29         (a)  The agency's department's review of and final

30  agency action on applications shall be in accordance with the

31  district health plan, and statutory criteria, and the


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  1  implementing administrative rules.  In the application review

  2  process, the agency department shall give a preference, as

  3  defined by rule of the agency department, to an applicant

  4  which proposes to develop a nursing home in a nursing home

  5  geographically underserved area.

  6         (b)  Within 60 days after all the applications in a

  7  review cycle are determined to be complete, the agency

  8  department shall issue its State Agency Action Report and

  9  Notice of Intent to grant a certificate of need for the

10  project in its entirety, to grant a certificate of need for

11  identifiable portions of the project, or to deny a certificate

12  of need.  The State Agency Action Report shall set forth in

13  writing its findings of fact and determinations upon which its

14  decision is based.  If a finding of fact or determination by

15  the agency department is counter to the district health plan

16  of the local health council, the agency department shall

17  provide in writing its reason for its findings, item by item,

18  to the local health council.  If the agency department intends

19  to grant a certificate of need, the State Agency Action Report

20  or the Notice of Intent shall also include any conditions

21  which the agency department intends to attach to the

22  certificate of need. The agency department shall designate by

23  rule a senior staff person, other than the person who issues

24  the final order, to issue State Agency Action Reports and

25  Notices of Intent.

26         (c)  The agency department shall publish its proposed

27  decision set forth in the Notice of Intent in the Florida

28  Administrative Weekly within 14 days after the Notice of

29  Intent is issued.

30         (d)  If no administrative hearing is requested pursuant

31  to subsection (5), the State Agency Action Report and the


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  1  Notice of Intent shall become the final order of the agency

  2  department.  The agency department shall provide a copy of the

  3  final order to the appropriate local health council.

  4         (5)  ADMINISTRATIVE HEARINGS.--

  5         (c)  In administrative proceedings challenging the

  6  issuance or denial of a certificate of need, only applicants

  7  considered by the agency in the same batching cycle are

  8  entitled to a comparative hearing on their applications.

  9  Existing health care facilities may initiate or intervene in

10  an administrative hearing upon a showing that an established

11  program will be substantially affected by the issuance of any

12  certificate of need, whether reviewed under s. 408.036(1) or

13  (2), to a competing proposed facility or program within the

14  same district.

15         (6)  JUDICIAL REVIEW.--

16         (a)  A party to an administrative hearing for an

17  application for a certificate of need has the right, within

18  not more than 30 days after the date of the final order, to

19  seek judicial review in the District Court of Appeal pursuant

20  to s. 120.68.  The agency department shall be a party in any

21  such proceeding.

22         (b)  In such judicial review, the court shall affirm

23  the final order of the agency department, unless the decision

24  is arbitrary, capricious, or not in compliance with ss.

25  408.031-408.045.

26         Section 11.  Subsections (1) and (2) of section

27  408.040, Florida Statutes, are amended to read:

28         408.040  Conditions and monitoring.--

29         (1)(a)  The agency may issue a certificate of need

30  predicated upon statements of intent expressed by an applicant

31  in the application for a certificate of need. Any conditions


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  1  imposed on a certificate of need based on such statements of

  2  intent shall be stated on the face of the certificate of need.

  3         1.  Any certificate of need issued for construction of

  4  a new hospital or for the addition of beds to an existing

  5  hospital shall include a statement of the number of beds

  6  approved by category of service, including rehabilitation or

  7  psychiatric service, for which the agency has adopted by rule

  8  a specialty-bed-need methodology. All beds that are approved,

  9  but are not covered by any specialty-bed-need methodology,

10  shall be designated as general.

11         (b)2.  The agency may consider, in addition to the

12  other criteria specified in s. 408.035, a statement of intent

13  by the applicant that a specified to designate a percentage of

14  the annual patient days at beds of the facility will be

15  utilized for use by patients eligible for care under Title XIX

16  of the Social Security Act. Any certificate of need issued to

17  a nursing home in reliance upon an applicant's statements that

18  to provide a specified percentage number of annual patient

19  days will be utilized beds for use by residents eligible for

20  care under Title XIX of the Social Security Act must include a

21  statement that such certification is a condition of issuance

22  of the certificate of need. The certificate-of-need program

23  shall notify the Medicaid program office and the Department of

24  Elderly Affairs when it imposes conditions as authorized in

25  this paragraph subparagraph in an area in which a community

26  diversion pilot project is implemented.

27         (c)(b)  A certificateholder may apply to the agency for

28  a modification of conditions imposed under paragraph (a) or

29  paragraph (b). If the holder of a certificate of need

30  demonstrates good cause why the certificate should be

31  modified, the agency shall reissue the certificate of need


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  1  with such modifications as may be appropriate.  The agency

  2  shall by rule define the factors constituting good cause for

  3  modification.

  4         (d)(c)  If the holder of a certificate of need fails to

  5  comply with a condition upon which the issuance of the

  6  certificate was predicated, the agency may assess an

  7  administrative fine against the certificateholder in an amount

  8  not to exceed $1,000 per failure per day.  In assessing the

  9  penalty, the agency shall take into account as mitigation the

10  relative lack of severity of a particular failure.  Proceeds

11  of such penalties shall be deposited in the Public Medical

12  Assistance Trust Fund.

13         (2)(a)  Unless the applicant has commenced

14  construction, if the project provides for construction, unless

15  the applicant has incurred an enforceable capital expenditure

16  commitment for a project, if the project does not provide for

17  construction, or unless subject to paragraph (b), a

18  certificate of need shall terminate 18 months after the date

19  of issuance, except in the case of a multifacility project, as

20  defined in s. 408.032, where the certificate of need shall

21  terminate 2 years after the date of issuance. The agency shall

22  monitor the progress of the holder of the certificate of need

23  in meeting the timetable for project development specified in

24  the application with the assistance of the local health

25  council as specified in s. 408.033(1)(b)5., and may revoke the

26  certificate of need, if the holder of the certificate is not

27  meeting such timetable and is not making a good faith effort,

28  as defined by rule, to meet it.

29         (b)  A certificate of need issued to an applicant

30  holding a provisional certificate of authority under chapter

31  651 shall terminate 1 year after the applicant receives a


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  1  valid certificate of authority from the Department of

  2  Insurance.

  3         (c)  The certificate-of-need validity period for a

  4  project shall be extended by the agency, to the extent that

  5  the applicant demonstrates to the satisfaction of the agency

  6  that good faith commencement of the project is being delayed

  7  by litigation or by governmental action or inaction with

  8  respect to regulations or permitting precluding commencement

  9  of the project.

10         (d)  If an application is filed to consolidate two or

11  more certificates as authorized by s. 408.036(2)(f) or to

12  divide a certificate of need into two or more facilities as

13  authorized by s. 408.036(2)(g), the validity period of the

14  certificate or certificates of need to be consolidated or

15  divided shall be extended for the period beginning upon

16  submission of the application and ending when final agency

17  action and any appeal from such action has been concluded.

18  However, no such suspension shall be effected if the

19  application is withdrawn by the applicant.

20         Section 12.  Section 408.044, Florida Statutes, is

21  amended to read:

22         408.044  Injunction.--Notwithstanding the existence or

23  pursuit of any other remedy, the agency department may

24  maintain an action in the name of the state for injunction or

25  other process against any person to restrain or prevent the

26  pursuit of a project subject to review under ss.

27  408.031-408.045, in the absence of a valid certificate of

28  need.

29         Section 13.  Section 408.045, Florida Statutes, is

30  amended to read:

31


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  1         408.045  Certificate of need; competitive sealed

  2  proposals.--

  3         (1)  The application, review, and issuance procedures

  4  for a certificate of need for an intermediate care facility

  5  for the developmentally disabled may be made by the agency

  6  department by competitive sealed proposals.

  7         (2)  The agency department shall make a decision

  8  regarding the issuance of the certificate of need in

  9  accordance with the provisions of s. 287.057(15), rules

10  adopted by the agency department relating to intermediate care

11  facilities for the developmentally disabled, and the criteria

12  in s. 408.035, as further defined by rule.

13         (3)  Notification of the decision shall be issued to

14  all applicants not later than 28 calendar days after the date

15  responses to a request for proposal are due.

16         (4)  The procedures provided for under this section are

17  exempt from the batching cycle requirements and the public

18  hearing requirement of s. 408.039.

19         (5)  The agency department may use the competitive

20  sealed proposal procedure for determining a certificate of

21  need for other types of health care facilities and services if

22  the agency department identifies an unmet health care need and

23  when funding in whole or in part for such health care

24  facilities or services is authorized by the Legislature.

25         Section 14.  (1)(a)  There is created a

26  certificate-of-need workgroup staffed by the Agency for Health

27  Care Administration.

28         (b)  Workgroup participants shall be responsible for

29  only the expenses that they generate individually through

30  workgroup participation.  The agency shall be responsible for

31


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  1  expenses incidental to the production of any required data or

  2  reports.

  3         (2)  The workgroup shall consist of 30 members, 10

  4  appointed by the Governor, 10 appointed by the President of

  5  the Senate, and 10 appointed by the Speaker of the House of

  6  Representatives. The workgroup chair shall be selected by

  7  majority vote of a quorum present. Sixteen members shall

  8  constitute a quorum. The membership shall include, but not be

  9  limited to, representatives from health care provider

10  organizations, health care facilities, individual health care

11  practitioners, local health councils, and consumer

12  organizations, and persons with health care market expertise

13  as private-sector consultants.

14         (3)  Appointment to the workgroup shall be as follows:

15         (a)  The Governor shall appoint one representative each

16  from the hospital industry, the nursing home industry, the

17  hospice industry, the local health councils, and a consumer

18  organization; three health care market consultants, one of

19  whom is a recognized expert on hospital markets, one of whom

20  is a recognized expert on nursing home or long-term care

21  markets, and one of whom is a recognized expert on hospice

22  markets; one representative from the Medicaid program; and one

23  representative from a health care facility that provides a

24  tertiary service.

25         (b)  The President of the Senate shall appoint a

26  representative of a for-profit hospital, a representative of a

27  not-for-profit hospital, a representative of a public

28  hospital, two representatives of the nursing home industry,

29  two representatives of the hospice industry, a representative

30  of a consumer organization, a representative from the

31  Department of Elderly Affairs involved with the implementation


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  1  of a long-term care community diversion program, and a health

  2  care market consultant with expertise in health care

  3  economics.

  4         (c)  The Speaker of the House of Representatives shall

  5  appoint a representative from the Florida Hospital

  6  Association, a representative of the Association of Community

  7  Hospitals and Health Systems of Florida, a representative of

  8  the Florida League of Health Systems, a representative of the

  9  Florida Health Care Association, a representative of the

10  Florida Association of Homes for the Aging, three

11  representatives of Florida Hospices and Palliative Care, one

12  representative of local health councils, and one

13  representative of a consumer organization.

14         (4)  The workgroup shall study issues pertaining to the

15  certificate-of-need program, including the impact of trends in

16  health care delivery and financing. The workgroup shall study

17  issues relating to implementation of the certificate-of-need

18  program.

19         (5)  The workgroup shall meet at least annually, at the

20  request of the chair. The workgroup shall submit an interim

21  report by December 31, 2001, and a final report by December

22  31, 2002. The workgroup is abolished effective July 1, 2003.

23         Section 15.  Subsection (7) of section 651.118, Florida

24  Statutes, is amended to read:

25         651.118  Agency for Health Care Administration;

26  certificates of need; sheltered beds; community beds.--

27         (7)  Notwithstanding the provisions of subsection (2),

28  at the discretion of the continuing care provider, sheltered

29  nursing home beds may be used for persons who are not

30  residents of the facility and who are not parties to a

31  continuing care contract for a period of up to 5 years after


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  1  the date of issuance of the initial nursing home license.  A

  2  provider whose 5-year period has expired or is expiring may

  3  request the Agency for Health Care Administration for an

  4  extension, not to exceed 30 percent of the total sheltered

  5  nursing home beds, if the utilization by residents of the

  6  facility in the sheltered beds will not generate sufficient

  7  income to cover facility expenses, as evidenced by one of the

  8  following:

  9         (a)  The facility has a net loss for the most recent

10  fiscal year as determined under generally accepted accounting

11  principles, excluding the effects of extraordinary or unusual

12  items, as demonstrated in the most recently audited financial

13  statement; or

14         (b)  The facility would have had a pro forma loss for

15  the most recent fiscal year, excluding the effects of

16  extraordinary or unusual items, if revenues were reduced by

17  the amount of revenues from persons in sheltered beds who were

18  not residents, as reported on by a certified public

19  accountant.

20

21  The agency shall be authorized to grant an extension to the

22  provider based on the evidence required in this subsection.

23  The agency may request a facility to use up to 25 percent of

24  the patient days generated by new admissions of nonresidents

25  during the extension period to serve Medicaid recipients for

26  those beds authorized for extended use if there is a

27  demonstrated need in the respective service area and if funds

28  are available. A provider who obtains an extension is

29  prohibited from applying for additional sheltered beds under

30  the provision of subsection (2), unless additional residential

31  units are built or the provider can demonstrate need by


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  1  facility residents to the Agency for Health Care

  2  Administration. The 5-year limit does not apply to up to five

  3  sheltered beds designated for inpatient hospice care as part

  4  of a contractual arrangement with a hospice licensed under

  5  part VI of chapter 400. A facility that uses such beds after

  6  the 5-year period shall report such use to the Agency for

  7  Health Care Administration.  For purposes of this subsection,

  8  "resident" means a person who, upon admission to the facility,

  9  initially resides in a part of the facility not licensed under

10  part II of chapter 400.

11         Section 16.  Subsection (2) of section 395.701, Florida

12  Statutes, is amended to read:

13         395.701  Annual assessments on net operating revenues

14  for inpatient services to fund public medical assistance;

15  administrative fines for failure to pay assessments when due;

16  exemption.--

17         (2)(a)  There is imposed upon each hospital an

18  assessment in an amount equal to 1.5 percent of the annual net

19  operating revenue for inpatient services for each hospital,

20  such revenue to be determined by the agency, based on the

21  actual experience of the hospital as reported to the agency.

22  Within 6 months after the end of each hospital fiscal year,

23  the agency shall certify the amount of the assessment for each

24  hospital.  The assessment shall be payable to and collected by

25  the agency in equal quarterly amounts, on or before the first

26  day of each calendar quarter, beginning with the first full

27  calendar quarter that occurs after the agency certifies the

28  amount of the assessment for each hospital. All moneys

29  collected pursuant to this subsection shall be deposited into

30  the Public Medical Assistance Trust Fund.

31


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  1         (b)  There is imposed upon each hospital an assessment

  2  in an amount equal to 1 percent of the annual net operating

  3  revenue for outpatient services for each hospital, such

  4  revenue to be determined by the agency, based on the actual

  5  experience of the hospital as reported to the agency. Within 6

  6  months after the end of each hospital fiscal year, the agency

  7  shall certify the amount of the assessment for each hospital.

  8  The assessment shall be payable to and collected by the agency

  9  in equal quarterly amounts, on or before the first day of each

10  calendar quarter, beginning with the first full calendar

11  quarter that occurs after the agency certifies the amount of

12  the assessment for each hospital. All moneys collected

13  pursuant to this subsection shall be deposited into the Public

14  Medical Assistance Trust Fund.

15         Section 17.  Paragraph (a) of subsection (2) of section

16  395.7015, Florida Statutes, is amended to read:

17         395.7015 Annual assessment on health care entities.--

18         (2)  There is imposed an annual assessment against

19  certain health care entities as described in this section:

20         (a)  The assessment shall be equal to 1 1.5 percent of

21  the annual net operating revenues of health care entities. The

22  assessment shall be payable to and collected by the agency.

23  Assessments shall be based on annual net operating revenues

24  for the entity's most recently completed fiscal year as

25  provided in subsection (3).

26         Section 18.  Paragraph (c) of subsection (2) of section

27  408.904, Florida Statutes, is amended to read:

28         408.904  Benefits.--

29         (2)  Covered health services include:

30         (c)  Hospital outpatient services.  Those services

31  provided to a member in the outpatient portion of a hospital


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  1  licensed under part I of chapter 395, up to a limit of $1,500

  2  $1,000 per calendar year per member, that are preventive,

  3  diagnostic, therapeutic, or palliative.

  4         Section 19.  Paragraph (e) is added to subsection (3)

  5  of section 409.912, Florida Statutes, and subsection (9) of

  6  said section is amended to read:

  7         409.912  Cost-effective purchasing of health care.--The

  8  agency shall purchase goods and services for Medicaid

  9  recipients in the most cost-effective manner consistent with

10  the delivery of quality medical care.  The agency shall

11  maximize the use of prepaid per capita and prepaid aggregate

12  fixed-sum basis services when appropriate and other

13  alternative service delivery and reimbursement methodologies,

14  including competitive bidding pursuant to s. 287.057, designed

15  to facilitate the cost-effective purchase of a case-managed

16  continuum of care. The agency shall also require providers to

17  minimize the exposure of recipients to the need for acute

18  inpatient, custodial, and other institutional care and the

19  inappropriate or unnecessary use of high-cost services.

20         (3)  The agency may contract with:

21         (e)  An entity in Pasco County or Pinellas County that

22  provides in-home physician services to Medicaid recipients

23  with degenerative neurological diseases in order to test the

24  cost-effectiveness of enhanced home-based medical care. The

25  entity providing the services shall be reimbursed on a

26  fee-for-service basis at a rate not less than comparable

27  Medicare reimbursement rates. The agency may apply for waivers

28  of federal regulations necessary to implement such program.

29  This paragraph shall be repealed on July 1, 2002.

30         (9)  The agency, after notifying the Legislature, may

31  apply for waivers of applicable federal laws and regulations


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  1  as necessary to implement more appropriate systems of health

  2  care for Medicaid recipients and reduce the cost of the

  3  Medicaid program to the state and federal governments and

  4  shall implement such programs, after legislative approval,

  5  within a reasonable period of time after federal approval.

  6  These programs must be designed primarily to reduce the need

  7  for inpatient care, custodial care and other long-term or

  8  institutional care, and other high-cost services.

  9         (a)  Prior to seeking legislative approval of such a

10  waiver as authorized by this subsection, the agency shall

11  provide notice and an opportunity for public comment.  Notice

12  shall be provided to all persons who have made requests of the

13  agency for advance notice and shall be published in the

14  Florida Administrative Weekly not less than 28 days prior to

15  the intended action.

16         (b)  Notwithstanding s. 216.292, funds that are

17  appropriated to the Department of Elderly Affairs for the

18  Assisted Living for the Elderly Medicaid waiver and are not

19  expended shall be transferred to the agency to fund

20  Medicaid-reimbursed nursing home care.

21         Section 20.  The Legislature shall appropriate each

22  fiscal year from either the General Revenue Fund or the Agency

23  for Health Care Administration Tobacco Settlement Trust Fund

24  an amount sufficient to replace the funds lost due to

25  reduction by this act of the assessment on other health care

26  entities under s. 395.7015, Florida Statutes, and the

27  reduction by this act in the assessment on hospitals under s.

28  395.701, Florida Statutes, and to maintain federal approval of

29  the reduced amount of funds deposited into the Public Medical

30  Assistance Trust Fund under s. 395.701, Florida Statutes, as

31  state match for the state's Medicaid program.


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  1         Section 21.  There is hereby appropriated the sum of

  2  $28.3 million from the General Revenue Fund to the Agency for

  3  Health Care Administration to implement the provisions of this

  4  act relating to the Public Medical Assistance Trust Fund,

  5  provided, however, that no portion of this appropriation shall

  6  be effective that duplicates a similar appropriation for the

  7  same purpose contained in other legislation from the 2000

  8  Legislative Session that becomes law.

  9         Section 22.  The amendments to ss. 395.701 and

10  395.7015, Florida Statutes, by this act shall take effect only

11  upon the Agency for Health Care Administration receiving

12  written confirmation from the federal Health Care Financing

13  Administration that the changes contained in such amendments

14  will not adversely affect the use of the remaining assessments

15  as state match for the state's Medicaid program.

16         Section 23.  Effective July 1, 2000, and applicable to

17  provider contracts entered into or renewed on or after that

18  date, subsection (39) is added to section 641.31, Florida

19  Statutes, to read:

20         641.31  Health maintenance contracts.--

21         (39)  A health maintenance organization contract may

22  not prohibit or restrict a subscriber from receiving inpatient

23  services in a contracted hospital from a contracted primary

24  care or admitting physician if such services are determined by

25  the organization to be medically necessary and covered

26  services under the organization's contract with the contract

27  holder.

28         Section 24.  Effective July 1, 2000, and applicable to

29  provider contracts entered into or renewed on or after that

30  date, subsection (11) is added to section 641.315, Florida

31  Statutes, to read:


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  1         641.315  Provider contracts.--

  2         (11)  A contract between a health maintenance

  3  organization and a contracted primary care or admitting

  4  physician may not contain any provision that prohibits such

  5  physician from providing inpatient services in a contracted

  6  hospital to a subscriber if such services are determined by

  7  the organization to be medically necessary and covered

  8  services under the organization's contract with the contract

  9  holder.

10         Section 25.  Effective July 1, 2000, and applicable to

11  provider contracts entered into or renewed on or after that

12  date, subsection (5) is added to section 641.3155, Florida

13  Statutes, to read:

14         641.3155  Provider contracts; payment of claims.--

15         (5)  A health maintenance organization shall pay a

16  contracted primary care or admitting physician, pursuant to

17  such physician's contract, for providing inpatient services in

18  a contracted hospital to a subscriber, if such services are

19  determined by the organization to be medically necessary and

20  covered services under the organization's contract with the

21  contract holder.

22         Section 26.  Subsections (4) through (10) of section

23  641.51, Florida Statutes, are renumbered as subsections (5)

24  through (11), respectively, and a new subsection (4) is added

25  to said section to read:

26         641.51 Quality assurance program; second medical

27  opinion requirement.--

28         (4)  The organization shall ensure that only a

29  physician licensed under chapter 458 or chapter 459, or an

30  allopathic or osteopathic physician with an active,

31  unencumbered license in another state with similar licensing


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  1  requirements may render an adverse determination regarding a

  2  service provided by a physician licensed in this state. The

  3  organization shall submit to the treating provider and the

  4  subscriber written notification regarding the organization's

  5  adverse determination within 2 working days after the

  6  subscriber or provider is notified of the adverse

  7  determination. The written notification must include the

  8  utilization review criteria or benefits provisions used in the

  9  adverse determination, identify the physician who rendered the

10  adverse determination, and be signed by an authorized

11  representative of the organization or the physician who

12  rendered the adverse determination. The organization must

13  include with the notification of an adverse determination

14  information concerning the appeal process for adverse

15  determinations.

16         Section 27.  Section 381.7351, Florida Statutes, is

17  created to read:

18         381.7351  Short title.--Sections 381.7351-381.7356 may

19  be cited as the "Reducing Racial and Ethnic Health

20  Disparities:  Closing the Gap Act."

21         Section 28.  Section 381.7352, Florida Statutes, is

22  created to read:

23         381.7352  Legislative findings and intent.--

24         (1)  The Legislature finds that despite state

25  investments in health care programs, certain racial and ethnic

26  populations in Florida continue to have significantly poorer

27  health outcomes when compared to non-Hispanic whites.  The

28  Legislature finds that local solutions to health care problems

29  can have a dramatic and positive effect on the health status

30  of these populations.  Local governments and communities are

31  best equipped to identify the health education, health


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  1  promotion, and disease prevention needs of the racial and

  2  ethnic populations in their communities, mobilize the

  3  community to address health outcome disparities, enlist and

  4  organize local public and private resources, and faith-based

  5  organizations to address these disparities, and evaluate the

  6  effectiveness of interventions.

  7         (2)  It is therefore the intent of the Legislature to

  8  provide funds within Florida counties and Front Porch Florida

  9  Communities, in the form of Reducing Racial and Ethnic Health

10  Disparities: Closing the Gap grants, to stimulate the

11  development of community-based and neighborhood-based projects

12  which will improve the health outcomes of racial and ethnic

13  populations.  Further, it is the intent of the Legislature

14  that these programs foster the development of coordinated,

15  collaborative, and broad-based participation by public and

16  private entities, and faith-based organizations.  Finally, it

17  is the intent of the Legislature that the grant program

18  function as a partnership between state and local governments,

19  faith-based organizations, and private-sector health care

20  providers, including managed care, voluntary health care

21  resources, social service providers, and nontraditional

22  partners.

23         Section 29.  Section 381.7353, Florida Statutes, is

24  created to read:

25         381.7353  Reducing Racial and Ethnic Health

26  Disparities:  Closing the Gap grant program; administration;

27  department duties.--

28         (1)  The Reducing Racial and Ethnic Health Disparities:

29  Closing the Gap grant program shall be administered by the

30  Department of Health.

31         (2)  The department shall:


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  1         (a)  Publicize the availability of funds and establish

  2  an application process for submitting a grant proposal.

  3         (b)  Provide technical assistance and training,

  4  including a statewide meeting promoting best practice

  5  programs, as requested, to grant recipients.

  6         (c)  Develop uniform data reporting requirements for

  7  the purpose of evaluating the performance of the grant

  8  recipients and demonstrating improved health outcomes.

  9         (d)  Develop a monitoring process to evaluate progress

10  toward meeting grant objectives.

11         (e)  Coordinate with existing community-based programs,

12  such as chronic disease community intervention programs,

13  cancer prevention and control programs, diabetes control

14  programs, the Healthy Start program, the Florida KidCare

15  Program, the HIV/AIDS program, immunization programs, and

16  other related programs at the state and local levels, to avoid

17  duplication of effort and promote consistency.

18         (3)  Pursuant to s. 20.43(6), the secretary may appoint

19  an ad hoc advisory committee to: examine areas where public

20  awareness, public education, research, and coordination

21  regarding racial and ethnic health outcome disparities are

22  lacking; consider access and transportation issues which

23  contribute to health status disparities; and make

24  recommendations for closing gaps in health outcomes and

25  increasing the public's awareness and understanding of health

26  disparities that exist between racial and ethnic populations.

27         Section 30.  Section 381.7354, Florida Statutes, is

28  created to read:

29         381.7354  Eligibility.--

30         (1)  Any person, entity, or organization within a

31  county may apply for a Closing the Gap grant and may serve as


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  1  the lead agency to administer and coordinate project

  2  activities within the county and develop community

  3  partnerships necessary to implement the grant.

  4         (2)  Persons, entities, or organizations within

  5  adjoining counties with populations of less than 100,000,

  6  based on the annual estimates produced by the Population

  7  Program of the University of Florida Bureau of Economic and

  8  Business Research, may jointly submit a multicounty Closing

  9  the Gap grant proposal.  However, the proposal must clearly

10  identify a single lead agency with respect to program

11  accountability and administration.

12         (3)  In addition to the grants awarded under

13  subsections (1) and (2), up to 20 percent of the funding for

14  the Reducing Racial and Ethnic Health Disparities: Closing the

15  Gap grant program shall be dedicated to projects that address

16  improving racial and ethnic health status within specific

17  Front Porch Florida Communities, as designated pursuant to s.

18  14.2015(9)(b).

19         (4)  Nothing in ss. 381.7351-381.7356 shall prevent a

20  person, entity, or organization within a county or group of

21  counties from separately contracting for the provision of

22  racial and ethnic health promotion, health awareness, and

23  disease prevention services.

24         Section 31.  Section 381.7355, Florida Statutes, is

25  created to read:

26         381.7355  Project requirements; review criteria.--

27         (1)  Closing the Gap grant proposals shall be submitted

28  to the Department of Health for review.

29         (2)  A proposal must include each of the following

30  elements:

31


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  1         (a)  The purpose and objectives of the proposal,

  2  including identification of the particular racial or ethnic

  3  disparity the project will address. The proposal must address

  4  one or more of the following priority areas:

  5         1.  Decreasing racial and ethnic disparities in

  6  maternal and infant mortality rates.

  7         2.  Decreasing racial and ethnic disparities in

  8  morbidity and mortality rates relating to cancer.

  9         3.  Decreasing racial and ethnic disparities in

10  morbidity and mortality rates relating to HIV/AIDS.

11         4.  Decreasing racial and ethnic disparities in

12  morbidity and mortality rates relating to cardiovascular

13  disease.

14         5.  Decreasing racial and ethnic disparities in

15  morbidity and mortality rates relating to diabetes.

16         6.  Increasing adult and child immunization rates in

17  certain racial and ethnic populations.

18         (b)  Identification and relevance of the target

19  population.

20         (c)  Methods for obtaining baseline health status data

21  and assessment of community health needs.

22         (d)  Mechanisms for mobilizing community resources and

23  gaining local commitment.

24         (e)  Development and implementation of health promotion

25  and disease prevention interventions.

26         (f)  Mechanisms and strategies for evaluating the

27  project's objectives, procedures, and outcomes.

28         (g)  A proposed work plan, including a timeline for

29  implementing the project.

30         (h)  Likelihood that project activities will occur and

31  continue in the absence of funding.


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  1         (3) Priority shall be given to proposals that:

  2         (a)  Represent areas with the greatest documented

  3  racial and ethnic health status disparities.

  4         (b)  Exceed the minimum local contribution requirements

  5  specified in s. 381.7356.

  6         (c)  Demonstrate broad-based local support and

  7  commitment from entities representing racial and ethnic

  8  populations, including non-Hispanic whites. Indicators of

  9  support and commitment may include agreements to participate

10  in the program, letters of endorsement, letters of commitment,

11  interagency agreements, or other forms of support.

12         (d)  Demonstrate a high degree of participation by the

13  health care community in clinical preventive service

14  activities and community-based health promotion and disease

15  prevention interventions.

16         (e)  Have been submitted from counties with a high

17  proportion of residents living in poverty and with poor health

18  status indicators.

19         (f)  Demonstrate a coordinated community approach to

20  addressing racial and ethnic health issues within existing

21  publicly financed health care programs.

22         (g)  Incorporate intervention mechanisms which have a

23  high probability of improving the targeted population's health

24  status.

25         (h)  Demonstrate a commitment to quality management in

26  all aspects of project administration and implementation.

27         Section 32.  Section 381.7356, Florida Statutes, is

28  created to read:

29         381.7356  Local matching funds; grant awards.--

30         (1)  One or more Closing the Gap grants may be awarded

31  in a county, or in a group of adjoining counties from which a


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  1  multicounty application is submitted. Front Porch Florida

  2  Communities grants may also be awarded in a county or group of

  3  adjoining counties that are also receiving a grant award.

  4         (2)  Closing the Gap grants shall be awarded on a

  5  matching basis.  One dollar in local matching funds must be

  6  provided for each $3 grant payment made by the state, except

  7  that:

  8         (a)  In counties with populations greater than 50,000,

  9  up to 50 percent of the local match may be in kind in the form

10  of free services or human resources. Fifty percent of the

11  local match must be in the form of cash.

12         (b)  In counties with populations of 50,000 or less,

13  the required local matching funds may be provided entirely

14  through in-kind contributions.

15         (c)  Grant awards to Front Porch Florida Communities

16  shall not be required to have a matching requirement.

17         (3)  The amount of the grant award shall be based on

18  the county or neighborhood's population, or on the combined

19  population in a group of adjoining counties from which a

20  multicounty application is submitted, and on other factors, as

21  determined by the department.

22         (4)  Dissemination of grant awards shall begin no later

23  than January 1, 2001.

24         (5)  A Closing the Gap grant shall be funded for 1 year

25  and may be renewed annually upon application to and approval

26  by the department, subject to the achievement of quality

27  standards, objectives, and outcomes and to the availability of

28  funds.

29         (6)  Implementation of the Reducing Racial and Ethnic

30  Health Disparities: Closing the Gap grant program shall be

31


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  1  subject to a specific appropriation provided in the General

  2  Appropriations Act.

  3         Section 33.  Florida Commission on Excellence in Health

  4  Care.--

  5         (1)  LEGISLATIVE FINDINGS AND INTENT.--The Legislature

  6  finds that the health care delivery industry is one of the

  7  largest and most complex industries in Florida. The

  8  Legislature finds that the current system of regulating health

  9  care practitioners and health care providers is one of blame

10  and punishment and does not encourage voluntary admission of

11  errors and immediate corrective action on a large scale. The

12  Legislature finds that previous attempts to identify and

13  address areas which impact the quality of care provided by the

14  health care industry have suffered from a lack of coordination

15  among the industry's stakeholders and regulators. The

16  Legislature finds that additional focus on strengthening

17  health care delivery systems by eliminating avoidable mistakes

18  in the diagnosis and treatment of Floridians holds tremendous

19  promise to increase the quality of health care services

20  available to Floridians, thereby reducing the costs associated

21  with medical mistakes and malpractice and in turn increasing

22  access to health care in the state. To achieve this enhanced

23  focus, it is the intent of the Legislature to create the

24  Florida Commission on Excellence in Health Care to facilitate

25  the development of a comprehensive statewide strategy for

26  improving health care delivery systems through meaningful

27  reporting standards, data collection and review, and quality

28  measurement.

29         (2)  DEFINITIONS.--As used in this act, the term:

30         (a)  "Agency" means the Agency for Health Care

31  Administration.


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  1         (b)  "Commission" means the Florida Commission on

  2  Excellence in Health Care.

  3         (c)  "Department" means the Department of Health.

  4         (d)  "Error," with respect to health care, means an

  5  unintended act, by omission or commission.

  6         (e)  "Health care practitioner" means any person

  7  licensed under chapter 457; chapter 458; chapter 459; chapter

  8  460; chapter 461; chapter 462; chapter 463; chapter 464;

  9  chapter 465; chapter 466; chapter 467; part I, part II, part

10  III, part V, part X, part XIII, or part XIV of chapter 468;

11  chapter 478; chapter 480; part III or part IV of chapter 483;

12  chapter 484; chapter 486; chapter 490; or chapter 491, Florida

13  Statutes.

14         (f)  "Health care provider" means any health care

15  facility or other health care organization licensed or

16  certified to provide approved medical and allied health

17  services in this state.

18         (3)  COMMISSION; DUTIES AND RESPONSIBILITIES.--There is

19  hereby created the Florida Commission on Excellence in Health

20  Care. The commission shall:

21         (a)  Identify existing data sources that evaluate

22  quality of care in Florida and collect, analyze, and evaluate

23  this data.

24         (b)  Establish guidelines for data sharing and

25  coordination.

26         (c)  Identify core sets of quality measures for

27  standardized reporting by appropriate components of the health

28  care continuum.

29         (d)  Recommend a framework for quality measurement and

30  outcome reporting.

31


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  1         (e)  Develop quality measures that enhance and improve

  2  the ability to evaluate and improve care.

  3         (f)  Make recommendations regarding research and

  4  development needed to advance quality measurement and

  5  reporting.

  6         (g)  Evaluate regulatory issues relating to the

  7  pharmacy profession and recommend changes necessary to

  8  optimize patient safety.

  9         (h)  Facilitate open discussion of a process to ensure

10  that comparative information on health care quality is valid,

11  reliable, comprehensive, understandable, and widely available

12  in the public domain.

13         (i)  Sponsor public hearings to share information and

14  expertise, identify "best practices," and recommend methods to

15  promote their acceptance.

16         (j)  Evaluate current regulatory programs to determine

17  what changes, if any, need to be made to facilitate patient

18  safety.

19         (k)  Review public and private health care purchasing

20  systems to determine if there are sufficient mandates and

21  incentives to facilitate continuous improvement in patient

22  safety.

23         (l)  Analyze how effective existing regulatory systems

24  are in ensuring continuous competence and knowledge of

25  effective safety practices.

26         (m)  Develop a framework for organizations that

27  license, accredit, or credential health care practitioners and

28  health care providers to more quickly and effectively identify

29  unsafe providers and practitioners and to take action

30  necessary to remove the unsafe provider or practitioner from

31


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  1  practice or operation until such time as the practitioner or

  2  provider has proven safe to practice or operate.

  3         (n)  Recommend procedures for development of a

  4  curriculum on patient safety and methods of incorporating such

  5  curriculum into training, licensure, and certification

  6  requirements.

  7         (o)  Develop a framework for regulatory bodies to

  8  disseminate information on patient safety to health care

  9  practitioners, health care providers, and consumers through

10  conferences, journal articles and editorials, newsletters,

11  publications, and Internet websites.

12         (p)  Recommend procedures to incorporate recognized

13  patient safety considerations into practice guidelines and

14  into standards related to the introduction and diffusion of

15  new technologies, therapies, and drugs.

16         (q)  Recommend a framework for development of

17  community-based collaborative initiatives for error reporting

18  and analysis and implementation of patient safety

19  improvements.

20         (r)  Evaluate the role of advertising in promoting or

21  adversely affecting patient safety.

22         (s)  Evaluate and make recommendations regarding the

23  need for licensure of additional persons who participate in

24  the delivery of health care to Floridians, including, but not

25  limited to, surgical technologists and pharmacy technicians.

26         (t)  Evaluate the benefits and problems of the current

27  disciplinary systems and make recommendations regarding

28  alternatives and improvements.

29         (4)  MEMBERSHIP, ORGANIZATION, MEETINGS, PROCEDURES,

30  STAFF.--

31         (a)  The commission shall consist of:


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  1         1.  The Secretary of Health and the Executive Director

  2  of the Agency for Health Care Administration.

  3         2.  One representative each from the following agencies

  4  or organizations:  the Board of Medicine, the Board of

  5  Osteopathic Medicine, the Board of Pharmacy, the Board of

  6  Nursing, the Board of Dentistry, the Florida Dental

  7  Association, the Florida Medical Association, the Florida

  8  Osteopathic Medical Association, the Florida Academy of

  9  Physician Assistants, the Florida Chiropractic Society, the

10  Florida Chiropractic Association, the Florida Podiatric

11  Medical Association, the Florida Society of Ambulatory

12  Surgical Centers, the Florida Statutory Teaching Hospital

13  Council, Inc., the Florida Statutory Rural Hospital Council,

14  the Florida Nurses Association, the Florida Organization of

15  Nursing Executives, the Florida Pharmacy Association, the

16  Florida Society of Health System Pharmacists, Inc., the

17  Florida Hospital Association, the Association of Community

18  Hospitals and Health Systems of Florida, Inc., the Florida

19  League of Health Care Systems, the Florida Health Care Risk

20  Management Advisory Council, the Florida Health Care

21  Association, and the Florida Association of Homes for the

22  Aging;

23         3.  One licensed clinical laboratory director,

24  appointed by the Secretary of Health;

25         4.  Two health lawyers, appointed by the Secretary of

26  Health, one of whom shall be a member of The Florida Bar

27  Health Law Section who defends physicians and one of whom

28  shall be a member of the Florida Academy of Trial Lawyers;

29         5.  One representative of the medical malpractice

30  professional liability insurance industry, appointed by the

31  Secretary of Health;


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  1         6.  One representative of a Florida medical school

  2  appointed by the Secretary of Health;

  3         7.  Two representatives of the health insurance

  4  industry, appointed by the Executive Director of the Agency

  5  for Health Care Administration, one of whom shall represent

  6  indemnity plans and one of whom shall represent managed care;

  7         8.  Five consumer advocates, consisting of one from the

  8  Association for Responsible Medicine, two appointed by the

  9  Governor, one appointed by the President of the Senate, and

10  one appointed by the Speaker of the House of Representatives;

11  and

12         9.  Two legislators, one appointed by the President of

13  the Senate and one appointed by the Speaker of the House of

14  Representatives.

15

16  Commission membership shall reflect the geographic and

17  demographic diversity of the state.

18         (b)  The Secretary of Health and the Executive Director

19  of the Agency for Health Care Administration shall jointly

20  chair the commission. Subcommittees shall be formed by the

21  joint chairs, as needed, to make recommendations to the full

22  commission on the subjects assigned. However, all votes on

23  work products of the commission shall be at the full

24  commission level, and all recommendations to the Governor, the

25  President of the Senate, and the Speaker of the House of

26  Representatives must pass by a two-thirds vote of the full

27  commission. Sponsoring agencies and organizations may

28  designate an alternative member who may attend and vote on

29  behalf of the sponsoring agency or organization in the event

30  the appointed member is unable to attend a meeting of the

31  commission or any subcommittee. The commission shall be


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  1  staffed by employees of the Department of Health and the

  2  Agency for Health Care Administration. Sponsoring agencies or

  3  organizations must fund the travel and related expenses of

  4  their appointed members on the commission. Travel and related

  5  expenses for the consumer members of the commission shall be

  6  reimbursed by the state pursuant to s. 112.061, Florida

  7  Statutes. The commission shall hold its first meeting no later

  8  than July 15, 2000.

  9         (5)  EVIDENTIARY PROHIBITIONS.--

10         (a)  The findings, recommendations, evaluations,

11  opinions, investigations, proceedings, records, reports,

12  minutes, testimony, correspondence, work product, and actions

13  of the commission shall be available to the public, but may

14  not be introduced into evidence at any civil, criminal,

15  special, or administrative proceeding against a health care

16  practitioner or health care provider arising out of the

17  matters which are the subject of the findings of the

18  commission. Moreover, no member of the commission shall be

19  examined in any civil, criminal, special, or administrative

20  proceeding against a health care practitioner or health care

21  provider as to any evidence or other matters produced or

22  presented during the proceedings of this commission or as to

23  any findings, recommendations, evaluations, opinions,

24  investigations, proceedings, records, reports, minutes,

25  testimony, correspondence, work product, or other actions of

26  the commission or any members thereof. However, nothing in

27  this section shall be construed to mean that information,

28  documents, or records otherwise available and obtained from

29  original sources are immune from discovery or use in any

30  civil, criminal, special, or administrative proceeding merely

31  because they were presented during proceedings of the


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  1  commission. Nor shall any person who testifies before the

  2  commission or who is a member of the commission be prevented

  3  from testifying as to matters within his or her knowledge in a

  4  subsequent civil, criminal, special, or administrative

  5  proceeding merely because such person testified in front of

  6  the commission.

  7         (b)  The findings, recommendations, evaluations,

  8  opinions, investigations, proceedings, records, reports,

  9  minutes, testimony, correspondence, work product, and actions

10  of the commission shall be used as a guide and resource and

11  shall not be construed as establishing or advocating the

12  standard of care for health care practitioners or health care

13  providers unless subsequently enacted into law or adopted in

14  rule. Nor shall any findings, recommendations, evaluations,

15  opinions, investigations, proceedings, records, reports,

16  minutes, testimony, correspondence, work product, or actions

17  of the commission be admissible as evidence in any way,

18  directly or indirectly, by introduction of documents or as a

19  basis of an expert opinion as to the standard of care

20  applicable to health care practitioners or health care

21  providers in any civil, criminal, special, or administrative

22  proceeding unless subsequently enacted into law or adopted in

23  rule.

24         (c)  No person who testifies before the commission or

25  who is a member of the commission may specifically identify

26  any patient, health care practitioner, or health care provider

27  by name. Moreover, the findings, recommendations, evaluations,

28  opinions, investigations, proceedings, records, reports,

29  minutes, testimony, correspondence, work product, and actions

30  of the commission may not specifically identify any patient,

31  health care practitioner, or health care provider by name.


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  1         (6)  REPORT; TERMINATION.--The commission shall provide

  2  a report of its findings and recommendations to the Governor,

  3  the President of the Senate, and the Speaker of the House of

  4  Representatives no later than February 1, 2001. After

  5  submission of the report, the commission shall continue to

  6  exist for the purpose of assisting the Department of Health,

  7  the Agency for Health Care Administration, and the regulatory

  8  boards in their drafting of proposed legislation and rules to

  9  implement its recommendations and for the purpose of providing

10  information to the health care industry on its

11  recommendations. The commission shall be terminated June 1,

12  2001.

13         Section 34.  Effective October 1, 2000, subsection (1)

14  of section 408.7056, Florida Statutes, is amended to read:

15         408.7056  Statewide Provider and Subscriber Assistance

16  Program.--

17         (1)  As used in this section, the term:

18         (a)  "Agency" means the Agency for Health Care

19  Administration.

20         (b)  "Department" means the Department of Insurance.

21         (c)  "Grievance procedure" means an established set of

22  rules that specify a process for appeal of an organizational

23  decision.

24         (d)  "Health care provider" or "provider" means a

25  state-licensed or state-authorized facility, a facility

26  principally supported by a local government or by funds from a

27  charitable organization that holds a current exemption from

28  federal income tax under s. 501(c)(3) of the Internal Revenue

29  Code, a licensed practitioner, a county health department

30  established under part I of chapter 154, a prescribed

31  pediatric extended care center defined in s. 400.902, a


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  1  federally supported primary care program such as a migrant

  2  health center or a community health center authorized under s.

  3  329 or s. 330 of the United States Public Health Services Act

  4  that delivers health care services to individuals, or a

  5  community facility that receives funds from the state under

  6  the Community Alcohol, Drug Abuse, and Mental Health Services

  7  Act and provides mental health services to individuals.

  8         (e)(a)  "Managed care entity" means a health

  9  maintenance organization or a prepaid health clinic certified

10  under chapter 641, a prepaid health plan authorized under s.

11  409.912, or an exclusive provider organization certified under

12  s. 627.6472.

13         (f)(b)  "Panel" means a statewide provider and

14  subscriber assistance panel selected as provided in subsection

15  (11).

16         Section 35.  Effective October 1, 2000, section

17  627.654, Florida Statutes, is amended to read:

18         627.654  Labor union, and association, and small

19  employer health alliance groups.--

20         (1)(a)  A group of individuals may be insured under a

21  policy issued to an association, including a labor union,

22  which association has a constitution and bylaws and not less

23  than 25 individual members and which has been organized and

24  has been maintained in good faith for a period of 1 year for

25  purposes other than that of obtaining insurance, or to the

26  trustees of a fund established by such an association, which

27  association or trustees shall be deemed the policyholder,

28  insuring at least 15 individual members of the association for

29  the benefit of persons other than the officers of the

30  association, the association or trustees.

31


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  1         (b)  A small employer, as defined in s. 627.6699 and

  2  including the employer's eligible employees and the spouses

  3  and dependents of such employees, may be insured under a

  4  policy issued to a small employer health alliance by a carrier

  5  as defined in s. 627.6699.  A small employer health alliance

  6  must be organized as a not-for-profit corporation under

  7  chapter 617. Notwithstanding any other law, if a small

  8  employer member of an alliance loses eligibility to purchase

  9  health care through the alliance solely because the business

10  of the small employer member expands to more than 50 and fewer

11  than 75 eligible employees, the small employer member may, at

12  its next renewal date, purchase coverage through the alliance

13  for not more than 1 additional year.  A small employer health

14  alliance shall establish conditions of participation in the

15  alliance by a small employer, including, but not limited to:

16         1.  Assurance that the small employer is not formed for

17  the purpose of securing health benefit coverage.

18         2.  Assurance that the employees of a small employer

19  have not been added for the purpose of securing health benefit

20  coverage.

21         (2)  No such policy of insurance as defined in

22  subsection (1) may be issued to any such association or

23  alliance, unless all individual members of such association,

24  or all small employer members of an alliance, or all of any

25  class or classes thereof, are declared eligible and acceptable

26  to the insurer at the time of issuance of the policy.

27         (3)  Any such policy issued under paragraph (1)(a) may

28  insure the spouse or dependent children with or without the

29  member being insured.

30         (4)  A single master policy issued to an association,

31  labor union, or small employer health alliance may include


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  1  more than one health plan from the same insurer or affiliated

  2  insurer group as alternatives for an employer, employee, or

  3  member to select.

  4         Section 36.  Effective October 1, 2000, paragraph (f)

  5  of subsection (2), paragraph (b) of subsection (4), and

  6  subsection (6) of section 627.6571, Florida Statutes, are

  7  amended to read:

  8         627.6571  Guaranteed renewability of coverage.--

  9         (2)  An insurer may nonrenew or discontinue a group

10  health insurance policy based only on one or more of the

11  following conditions:

12         (f)  In the case of health insurance coverage that is

13  made available only through one or more bona fide associations

14  as defined in subsection (5) or through one or more small

15  employer health alliances as described in s. 627.654(1)(b),

16  the membership of an employer in the association or in the

17  small employer health alliance, on the basis of which the

18  coverage is provided, ceases, but only if such coverage is

19  terminated under this paragraph uniformly without regard to

20  any health-status-related factor that relates to any covered

21  individuals.

22         (4)  At the time of coverage renewal, an insurer may

23  modify the health insurance coverage for a product offered:

24         (b)  In the small-group market if, for coverage that is

25  available in such market other than only through one or more

26  bona fide associations as defined in subsection (5) or through

27  one or more small employer health alliances as described in s.

28  627.654(1)(b), such modification is consistent with s.

29  627.6699 and effective on a uniform basis among group health

30  plans with that product.

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  1         (6)  In applying this section in the case of health

  2  insurance coverage that is made available by an insurer in the

  3  small-group market or large-group market to employers only

  4  through one or more associations or through one or more small

  5  employer health alliances as described in s. 627.654(1)(b), a

  6  reference to "policyholder" is deemed, with respect to

  7  coverage provided to an employer member of the association, to

  8  include a reference to such employer.

  9         Section 37.  Effective October 1, 2000, paragraph (h)

10  of subsection (5), paragraph (b) of subsection (6), and

11  paragraph (a) of subsection (12) of section 627.6699, Florida

12  Statutes, are amended to read:

13         627.6699  Employee Health Care Access Act.--

14         (5)  AVAILABILITY OF COVERAGE.--

15         (h)  All health benefit plans issued under this section

16  must comply with the following conditions:

17         1.  For employers who have fewer than two employees, a

18  late enrollee may be excluded from coverage for no longer than

19  24 months if he or she was not covered by creditable coverage

20  continually to a date not more than 63 days before the

21  effective date of his or her new coverage.

22         2.  Any requirement used by a small employer carrier in

23  determining whether to provide coverage to a small employer

24  group, including requirements for minimum participation of

25  eligible employees and minimum employer contributions, must be

26  applied uniformly among all small employer groups having the

27  same number of eligible employees applying for coverage or

28  receiving coverage from the small employer carrier, except

29  that a small employer carrier that participates in,

30  administers, or issues health benefits pursuant to s. 381.0406

31  which do not include a preexisting condition exclusion may


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  1  require as a condition of offering such benefits that the

  2  employer has had no health insurance coverage for its

  3  employees for a period of at least 6 months.  A small employer

  4  carrier may vary application of minimum participation

  5  requirements and minimum employer contribution requirements

  6  only by the size of the small employer group.

  7         3.  In applying minimum participation requirements with

  8  respect to a small employer, a small employer carrier shall

  9  not consider as an eligible employee employees or dependents

10  who have qualifying existing coverage in an employer-based

11  group insurance plan or an ERISA qualified self-insurance plan

12  in determining whether the applicable percentage of

13  participation is met. However, a small employer carrier may

14  count eligible employees and dependents who have coverage

15  under another health plan that is sponsored by that employer

16  except if such plan is offered pursuant to s. 408.706.

17         4.  A small employer carrier shall not increase any

18  requirement for minimum employee participation or any

19  requirement for minimum employer contribution applicable to a

20  small employer at any time after the small employer has been

21  accepted for coverage, unless the employer size has changed,

22  in which case the small employer carrier may apply the

23  requirements that are applicable to the new group size.

24         5.  If a small employer carrier offers coverage to a

25  small employer, it must offer coverage to all the small

26  employer's eligible employees and their dependents.  A small

27  employer carrier may not offer coverage limited to certain

28  persons in a group or to part of a group, except with respect

29  to late enrollees.

30         6.  A small employer carrier may not modify any health

31  benefit plan issued to a small employer with respect to a


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  1  small employer or any eligible employee or dependent through

  2  riders, endorsements, or otherwise to restrict or exclude

  3  coverage for certain diseases or medical conditions otherwise

  4  covered by the health benefit plan.

  5         7.  An initial enrollment period of at least 30 days

  6  must be provided.  An annual 30-day open enrollment period

  7  must be offered to each small employer's eligible employees

  8  and their dependents. A small employer carrier must provide

  9  special enrollment periods as required by s. 627.65615.

10         (6)  RESTRICTIONS RELATING TO PREMIUM RATES.--

11         (b)  For all small employer health benefit plans that

12  are subject to this section and are issued by small employer

13  carriers on or after January 1, 1994, premium rates for health

14  benefit plans subject to this section are subject to the

15  following:

16         1.  Small employer carriers must use a modified

17  community rating methodology in which the premium for each

18  small employer must be determined solely on the basis of the

19  eligible employee's and eligible dependent's gender, age,

20  family composition, tobacco use, or geographic area as

21  determined under paragraph (5)(j).

22         2.  Rating factors related to age, gender, family

23  composition, tobacco use, or geographic location may be

24  developed by each carrier to reflect the carrier's experience.

25  The factors used by carriers are subject to department review

26  and approval.

27         3.  Small employer carriers may not modify the rate for

28  a small employer for 12 months from the initial issue date or

29  renewal date, unless the composition of the group changes or

30  benefits are changed. However, a small employer carrier may

31  modify the rate one time prior to 12 months after the initial


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  1  issue date for a small employer who enrolls under a previously

  2  issued group policy that has a common anniversary date for all

  3  employers covered under the policy if:

  4         a.  The carrier discloses to the employer in a clear

  5  and conspicuous manner the date of the first renewal and the

  6  fact that the premium may increase on or after that date.

  7         b.  The insurer demonstrates to the department that

  8  efficiencies in administration are achieved and reflected in

  9  the rates charged to small employers covered under the policy.

10         4.  A carrier may issue a group health insurance policy

11  to a small employer health alliance or other group association

12  with rates that reflect a premium credit for expense savings

13  attributable to administrative activities being performed by

14  the alliance or group association if such expense savings are

15  specifically documented in the insurer's rate filing and are

16  approved by the department. Any such credit may not be based

17  on different morbidity assumptions or on any other factor

18  related to the health status or claims experience of any

19  person covered under the policy. Nothing in this subparagraph

20  exempts an alliance or group association from licensure for

21  any activities that require licensure under the Insurance

22  Code. A carrier issuing a group health insurance policy to a

23  small employer health alliance or other group association

24  shall allow any properly licensed and appointed agent of that

25  carrier to market and sell the small employer health alliance

26  or other group association policy. Such agent shall be paid

27  the usual and customary commission paid to any agent selling

28  the policy. Carriers participating in the alliance program, in

29  accordance with ss. 408.70-408.706, may apply a different

30  community rate to business written in that program.

31


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  1         (12)  STANDARD, BASIC, AND LIMITED HEALTH BENEFIT

  2  PLANS.--

  3         (a)1.  By May 15, 1993, the commissioner shall appoint

  4  a health benefit plan committee composed of four

  5  representatives of carriers which shall include at least two

  6  representatives of HMOs, at least one of which is a staff

  7  model HMO, two representatives of agents, four representatives

  8  of small employers, and one employee of a small employer.  The

  9  carrier members shall be selected from a list of individuals

10  recommended by the board.  The commissioner may require the

11  board to submit additional recommendations of individuals for

12  appointment.  As alliances are established under s. 408.702,

13  each alliance shall also appoint an additional member to the

14  committee.

15         2.  The committee shall develop changes to the form and

16  level of coverages for the standard health benefit plan and

17  the basic health benefit plan, and shall submit the forms, and

18  levels of coverages to the department by September 30, 1993.

19  The department must approve such forms and levels of coverages

20  by November 30, 1993, and may return the submissions to the

21  committee for modification on a schedule that allows the

22  department to grant final approval by November 30, 1993.

23         3.  The plans shall comply with all of the requirements

24  of this subsection.

25         4.  The plans must be filed with and approved by the

26  department prior to issuance or delivery by any small employer

27  carrier.

28         5.  After approval of the revised health benefit plans,

29  if the department determines that modifications to a plan

30  might be appropriate, the commissioner shall appoint a new

31  health benefit plan committee in the manner provided in


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  1  subparagraph 1. to submit recommended modifications to the

  2  department for approval.

  3         Section 38.  Effective October 1, 2000, subsection (1)

  4  of section 240.2995, Florida Statutes, is amended to read:

  5         240.2995  University health services support

  6  organizations.--

  7         (1)  Each state university is authorized to establish

  8  university health services support organizations which shall

  9  have the ability to enter into, for the benefit of the

10  university academic health sciences center, arrangements with

11  other entities as providers for accountable health

12  partnerships, as defined in s. 408.701, and providers in other

13  integrated health care systems or similar entities.  To the

14  extent required by law or rule, university health services

15  support organizations shall become licensed as insurance

16  companies, pursuant to chapter 624, or be certified as health

17  maintenance organizations, pursuant to chapter 641.

18  University health services support organizations shall have

19  sole responsibility for the acts, debts, liabilities, and

20  obligations of the organization.  In no case shall the state

21  or university have any responsibility for such acts, debts,

22  liabilities, and obligations incurred or assumed by university

23  health services support organizations.

24         Section 39.  Effective October 1, 2000, paragraph (a)

25  of subsection (2) of section 240.2996, Florida Statutes, is

26  amended to read:

27         240.2996  University health services support

28  organization; confidentiality of information.--

29         (2)  The following university health services support

30  organization's records and information are confidential and

31


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  1  exempt from the provisions of s. 119.07(1) and s. 24(a), Art.

  2  I of the State Constitution:

  3         (a)  Contracts for managed care arrangements, as

  4  managed care is defined in s. 408.701, under which the

  5  university health services support organization provides

  6  health care services, including preferred provider

  7  organization contracts, health maintenance organization

  8  contracts, alliance network arrangements, and exclusive

  9  provider organization contracts, and any documents directly

10  relating to the negotiation, performance, and implementation

11  of any such contracts for managed care arrangements or

12  alliance network arrangements. As used in this paragraph, the

13  term "managed care" means systems or techniques generally used

14  by third-party payors or their agents to affect access to and

15  control payment for health care services. Managed-care

16  techniques most often include one or more of the following:

17  prior, concurrent, and retrospective review of the medical

18  necessity and appropriateness of services or site of services;

19  contracts with selected health care providers; financial

20  incentives or disincentives related to the use of specific

21  providers, services, or service sites; controlled access to

22  and coordination of services by a case manager; and payor

23  efforts to identify treatment alternatives and modify benefit

24  restrictions for high-cost patient care.

25

26  The exemptions in this subsection are subject to the Open

27  Government Sunset Review Act of 1995 in accordance with s.

28  119.15 and shall stand repealed on October 2, 2001, unless

29  reviewed and saved from repeal through reenactment by the

30  Legislature.

31


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  1         Section 40.  Effective October 1, 2000, paragraph (b)

  2  of subsection (8) of section 240.512, Florida Statutes, is

  3  amended to read:

  4         240.512  H. Lee Moffitt Cancer Center and Research

  5  Institute.--There is established the H. Lee Moffitt Cancer

  6  Center and Research Institute at the University of South

  7  Florida.

  8         (8)

  9         (b)  Proprietary confidential business information is

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

11  and s. 24(a), Art. I of the State Constitution.  However, the

12  Auditor General and Board of Regents, pursuant to their

13  oversight and auditing functions, must be given access to all

14  proprietary confidential business information upon request and

15  without subpoena and must maintain the confidentiality of

16  information so received. As used in this paragraph, the term

17  "proprietary confidential business information" means

18  information, regardless of its form or characteristics, which

19  is owned or controlled by the not-for-profit corporation or

20  its subsidiaries; is intended to be and is treated by the

21  not-for-profit corporation or its subsidiaries as private and

22  the disclosure of which would harm the business operations of

23  the not-for-profit corporation or its subsidiaries; has not

24  been intentionally disclosed by the corporation or its

25  subsidiaries unless pursuant to law, an order of a court or

26  administrative body, a legislative proceeding pursuant to s.

27  5, Art. III of the State Constitution, or a private agreement

28  that provides that the information may be released to the

29  public; and which is information concerning:

30         1.  Internal auditing controls and reports of internal

31  auditors;


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  1         2.  Matters reasonably encompassed in privileged

  2  attorney-client communications;

  3         3.  Contracts for managed-care arrangements, as managed

  4  care is defined in s. 408.701, including preferred provider

  5  organization contracts, health maintenance organization

  6  contracts, and exclusive provider organization contracts, and

  7  any documents directly relating to the negotiation,

  8  performance, and implementation of any such contracts for

  9  managed-care arrangements;

10         4.  Bids or other contractual data, banking records,

11  and credit agreements the disclosure of which would impair the

12  efforts of the not-for-profit corporation or its subsidiaries

13  to contract for goods or services on favorable terms;

14         5.  Information relating to private contractual data,

15  the disclosure of which would impair the competitive interest

16  of the provider of the information;

17         6.  Corporate officer and employee personnel

18  information;

19         7.  Information relating to the proceedings and records

20  of credentialing panels and committees and of the governing

21  board of the not-for-profit corporation or its subsidiaries

22  relating to credentialing;

23         8.  Minutes of meetings of the governing board of the

24  not-for-profit corporation and its subsidiaries, except

25  minutes of meetings open to the public pursuant to subsection

26  (9);

27         9.  Information that reveals plans for marketing

28  services that the corporation or its subsidiaries reasonably

29  expect to be provided by competitors;

30         10.  Trade secrets as defined in s. 688.002, including

31  reimbursement methodologies or rates; or


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  1         11.  The identity of donors or prospective donors of

  2  property who wish to remain anonymous or any information

  3  identifying such donors or prospective donors.  The anonymity

  4  of these donors or prospective donors must be maintained in

  5  the auditor's report.

  6

  7  As used in this paragraph, the term "managed care" means

  8  systems or techniques generally used by third-party payors or

  9  their agents to affect access to and control payment for

10  health care services. Managed-care techniques most often

11  include one or more of the following:  prior, concurrent, and

12  retrospective review of the medical necessity and

13  appropriateness of services or site of services; contracts

14  with selected health care providers; financial incentives or

15  disincentives related to the use of specific providers,

16  services, or service sites; controlled access to and

17  coordination of services by a case manager; and payor efforts

18  to identify treatment alternatives and modify benefit

19  restrictions for high-cost patient care.

20         Section 41.  Effective October 1, 2000, subsection (14)

21  of section 381.0406, Florida Statutes, is amended to read:

22         381.0406  Rural health networks.--

23         (14)  NETWORK FINANCING.--Networks may use all sources

24  of public and private funds to support network activities.

25  Nothing in this section prohibits networks from becoming

26  managed care providers, or accountable health partnerships,

27  provided they meet the requirements for an accountable health

28  partnership as specified in s. 408.706.

29         Section 42.  Effective October 1, 2000, paragraph (a)

30  of subsection (2) of section 395.3035, Florida Statutes, is

31  amended to read:


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  1         395.3035  Confidentiality of hospital records and

  2  meetings.--

  3         (2)  The following records and information of any

  4  hospital that is subject to chapter 119 and s. 24(a), Art. I

  5  of the State Constitution are confidential and exempt from the

  6  provisions of s. 119.07(1) and s. 24(a), Art. I of the State

  7  Constitution:

  8         (a)  Contracts for managed care arrangements, as

  9  managed care is defined in s. 408.701, under which the public

10  hospital provides health care services, including preferred

11  provider organization contracts, health maintenance

12  organization contracts, exclusive provider organization

13  contracts, and alliance network arrangements, and any

14  documents directly relating to the negotiation, performance,

15  and implementation of any such contracts for managed care or

16  alliance network arrangements. As used in this paragraph, the

17  term "managed care" means systems or techniques generally used

18  by third-party payors or their agents to affect access to and

19  control payment for health care services. Managed-care

20  techniques most often include one or more of the following:

21  prior, concurrent, and retrospective review of the medical

22  necessity and appropriateness of services or site of services;

23  contracts with selected health care providers; financial

24  incentives or disincentives related to the use of specific

25  providers, services, or service sites; controlled access to

26  and coordination of services by a case manager; and payor

27  efforts to identify treatment alternatives and modify benefit

28  restrictions for high-cost patient care.

29         Section 43.  Effective October 1, 2000, paragraph (b)

30  of subsection (1) of section 627.4301, Florida Statutes, is

31  amended to read:


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  1         627.4301  Genetic information for insurance purposes.--

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

  3         (b)  "Health insurer" means an authorized insurer

  4  offering health insurance as defined in s. 624.603, a

  5  self-insured plan as defined in s. 624.031, a

  6  multiple-employer welfare arrangement as defined in s.

  7  624.437, a prepaid limited health service organization as

  8  defined in s. 636.003, a health maintenance organization as

  9  defined in s. 641.19, a prepaid health clinic as defined in s.

10  641.402, a fraternal benefit society as defined in s. 632.601,

11  an accountable health partnership as defined in s. 408.701, or

12  any health care arrangement whereby risk is assumed.

13         Section 44.  Section 641.185, Florida Statutes, is

14  created to read:

15         641.185  Health maintenance organization subscriber

16  protections.--

17         (1)  With respect to the provisions of this part and

18  part III, the principles expressed in the following statements

19  shall serve as standards to be followed by the Department of

20  Insurance and the Agency for Health Care Administration in

21  exercising their powers and duties, in exercising

22  administrative discretion, in administrative interpretations

23  of the law, in enforcing its provisions, and in adopting

24  rules:

25         (a)  A health maintenance organization shall ensure

26  that the health care services provided to its subscribers

27  shall be rendered under reasonable standards of quality of

28  care which are at a minimum consistent with the prevailing

29  standards of medical practice in the community pursuant to ss.

30  641.495(1) and 641.51.

31


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  1         (b)  A health maintenance organization subscriber

  2  should receive quality health care from a broad panel of

  3  providers, including referrals, preventive care pursuant to s.

  4  641.402(1), emergency screening and services pursuant to ss.

  5  641.31(12) and 641.513, and second opinions pursuant to s.

  6  641.51.

  7         (c)  A health maintenance organization subscriber

  8  should receive assurance that the health maintenance

  9  organization has been independently accredited by a national

10  review organization pursuant to s. 641.512, and is financially

11  secure as determined by the state pursuant to ss. 641.221,

12  641.225, and 641.228.

13         (d)  A health maintenance organization subscriber

14  should receive continuity of health care, even after the

15  provider is no longer with the health maintenance organization

16  pursuant to s. 641.51(7).

17         (e)  A health maintenance organization subscriber

18  should receive timely, concise information regarding the

19  health maintenance organization's reimbursement to providers

20  and services pursuant to ss. 641.31 and 641.31015.

21         (f)  A health maintenance organization subscriber

22  should receive the flexibility to transfer to another Florida

23  health maintenance organization, regardless of health status,

24  pursuant to ss. 641.3104, 641.3107, 641.3111, 641.3921,

25  641.3922, and 641.228.

26         (g)  A health maintenance organization subscriber

27  should be eligible for coverage without discrimination against

28  individual participants and beneficiaries of group plans based

29  on health status pursuant to s. 641.31073.

30         (h)  A health maintenance organization that issues a

31  group health contract must: provide coverage for preexisting


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  1  conditions pursuant to s. 641.31071; guarantee renewability of

  2  coverage pursuant to s. 641.31074; provide notice of

  3  cancellation pursuant to s. 641.3108; provide extension of

  4  benefits pursuant to s. 641.3111; provide for conversion on

  5  termination of eligibility pursuant to s. 641.3921; and

  6  provide for conversion contracts and conditions pursuant to s.

  7  641.3922.

  8         (i)  A health maintenance organization subscriber

  9  should receive timely, and, if necessary, urgent grievances

10  and appeals within the health maintenance organization

11  pursuant to ss. 641.228, 641.31(5), 641.47, and 641.511.

12         (j)  A health maintenance organization should receive

13  timely and, if necessary, urgent review by an independent

14  state external review organization for unresolved grievances

15  and appeals pursuant to s. 408.7056.

16         (k)  A health maintenance organization subscriber shall

17  be given written notice at least 30 days in advance of a rate

18  change pursuant to s. 641.31(3)(b). In the case of a group

19  member, there may be a contractual agreement with the health

20  maintenance organization to have the employer provide the

21  required notice to the individual members of the group

22  pursuant to s. 641.31(3)(b).

23         (l)  A health maintenance organization subscriber shall

24  be given a copy of the applicable health maintenance contract,

25  certificate, or member handbook specifying: all the

26  provisions, disclosure, and limitations required pursuant to

27  s. 641.31(1) and (4); the covered services, including those

28  services, medical conditions, and provider types specified in

29  ss. 641.31, 641.31094, 641.31095, 641.31096, 641.51(10), and

30  641.513; and where and in what manner services may be obtained

31  pursuant to s. 641.31(4).


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  1         (2)  This section shall not be construed as creating a

  2  civil cause of action by any subscriber or provider against

  3  any health maintenance organization.

  4         Section 45.  Subsection (11) of section 641.511,

  5  Florida Statutes, is renumbered as subsection (12) and a new

  6  subsection (11) is added to said section to read:

  7         641.511  Subscriber grievance reporting and resolution

  8  requirements.--

  9         (11)  Each organization, as part of its contract with

10  any provider, must require the provider to post a consumer

11  assistance notice prominently displayed in the reception area

12  of the provider and clearly noticeable by all patients. The

13  consumer assistance notice must state the addresses and

14  toll-free telephone numbers of the Agency for Health Care

15  Administration, the Statewide Provider and Subscriber

16  Assistance Program, and the Department of Insurance. The

17  consumer assistance notice must also clearly state that the

18  address and toll-free telephone number of the organization's

19  grievance department shall be provided upon request. The

20  agency is authorized to promulgate rules to implement this

21  section.

22         Section 46.  Paragraph (n) of subsection (3), paragraph

23  (c) of subsection (5), and paragraphs (b) and (d) of

24  subsection (6) of section 627.6699, Florida Statutes, are

25  amended to read:

26         627.6699  Employee Health Care Access Act.--

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

28         (n)  "Modified community rating" means a method used to

29  develop carrier premiums which spreads financial risk across a

30  large population, and allows the use of separate rating

31  factors adjustments for age, gender, family composition,


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  1  tobacco usage, and geographic area as determined under

  2  paragraph (5)(j); and allows adjustments for claims

  3  experience, health status, or duration of coverage as provided

  4  in subparagraph (6)(b)5.; and administrative and acquisition

  5  expenses as provided in subparagraph (6)(b)6.

  6         (5)  AVAILABILITY OF COVERAGE.--

  7         (c)  Every small employer carrier must, as a condition

  8  of transacting business in this state:

  9         1.  Beginning July 1, 2000 January 1, 1994, offer and

10  issue all small employer health benefit plans on a

11  guaranteed-issue basis to every eligible small employer, with

12  two 3 to 50 eligible employees, that elects to be covered

13  under such plan, agrees to make the required premium payments,

14  and satisfies the other provisions of the plan. 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.

19         2.  Beginning August 1, 2000 April 15, 1994, offer and

20  issue basic and standard small employer health benefit plans

21  on a guaranteed-issue basis, during an open enrollment period

22  of August 1 through August 31 of each year, to every eligible

23  small employer, with less than one or two eligible employees,

24  which is not formed primarily for purposes of buying health

25  insurance and which elects to be covered under such plan,

26  agrees to make the required premium payments, and satisfies

27  the other provisions of the plan.  Coverage provided pursuant

28  to this subparagraph shall begin on October 1 of the same year

29  as the date of enrollment, unless the small employer carrier

30  and the small employer agree to a different date.  A rider for

31  additional or increased benefits may be medically underwritten


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  1  and may only be added to the standard health benefit plan.

  2  The increased rate charged for the additional or increased

  3  benefit must be rated in accordance with this section. For

  4  purposes of this subparagraph, a person, his or her spouse,

  5  and his or her dependent children shall constitute a single

  6  eligible employee if such person and spouse are employed by

  7  the same small employer and either one has a normal work week

  8  of less than 25 hours.

  9

10  3.  Offer to eligible small employers the standard and basic

11  health benefit plans.  This paragraph subparagraph does not

12  limit a carrier's ability to offer other health benefit plans

13  to small employers if the standard and basic health benefit

14  plans are offered and rejected.

15         (6)  RESTRICTIONS RELATING TO PREMIUM RATES.--

16         (b)  For all small employer health benefit plans that

17  are subject to this section and are issued by small employer

18  carriers on or after January 1, 1994, premium rates for health

19  benefit plans subject to this section are subject to the

20  following:

21         1.  Small employer carriers must use a modified

22  community rating methodology in which the premium for each

23  small employer must be determined solely on the basis of the

24  eligible employee's and eligible dependent's gender, age,

25  family composition, tobacco use, or geographic area as

26  determined under paragraph (5)(j) and may be adjusted as

27  permitted by subparagraphs 5. and 6.

28         2.  Rating factors related to age, gender, family

29  composition, tobacco use, or geographic location may be

30  developed by each carrier to reflect the carrier's experience.

31


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  1  The factors used by carriers are subject to department review

  2  and approval.

  3         3.  Small employer carriers may not modify the rate for

  4  a small employer for 12 months from the initial issue date or

  5  renewal date, unless the composition of the group changes or

  6  benefits are changed.

  7         4.  Carriers participating in the alliance program, in

  8  accordance with ss. 408.70-408.706, may apply a different

  9  community rate to business written in that program.

10         5.  Any adjustments in rates for claims experience,

11  health status, or duration of coverage may not be charged to

12  individual employees or dependents. For a small employer's

13  policy, such adjustments may not result in a rate for the

14  small employer which deviates more than 15 percent from the

15  carrier's approved rate. Any such adjustment must be applied

16  uniformly to the rates charged for all employees and

17  dependents of the small employer. A small employer carrier may

18  make an adjustment to a small employer's renewal premium, not

19  to exceed 10 percent annually, due to the claims experience,

20  health status, or duration of coverage of the employees or

21  dependents of the small employer. Semiannually, small group

22  carriers shall report information on forms adopted by rule by

23  the department, to enable the department to monitor the

24  relationship of aggregate adjusted premiums actually charged

25  policyholders by each carrier to the premiums that would have

26  been charged by application of the carrier's approved modified

27  community rates. If the aggregate resulting from the

28  application of such adjustment exceeds the premium that would

29  have been charged by application of the approved modified

30  community rate by 5 percent for the current reporting period,

31  the carrier shall limit the application of such adjustments to


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  1  only minus adjustments beginning not more than 60 days after

  2  the report is sent to the department. For any subsequent

  3  reporting period, if the total aggregate adjusted premium

  4  actually charged does not exceed the premium that would have

  5  been charged by application of the approved modified community

  6  rate by 5 percent, the carrier may apply both plus and minus

  7  adjustments.

  8         6.  A small employer carrier may provide a credit to a

  9  small employer's premium based on administrative and

10  acquisition expense differences resulting from the size of the

11  group. Group size administrative and acquisition expense

12  factors may be developed by each carrier to reflect the

13  carrier's experience and are subject to department review and

14  approval.

15         7.  A small employer carrier rating methodology may

16  include separate rating categories for one dependent child,

17  for two dependent children, and for three or more dependent

18  children for family coverage of employees having a spouse and

19  dependent children or employees having dependent children

20  only. A small employer carrier may have fewer, but not

21  greater, numbers of categories for dependent children than

22  those specified in this subparagraph.

23         8.  Small employer carriers may not use a composite

24  rating methodology to rate a small employer with fewer than 10

25  employees. For the purposes of this subparagraph a "composite

26  rating methodology" means a rating methodology that averages

27  the impact of the rating factors for age and gender in the

28  premiums charged to all of the employees of a small employer.

29         (d)  Notwithstanding s. 627.401(2), this section and

30  ss. 627.410 and 627.411 apply to any health benefit plan

31  provided by a small employer carrier that is an insurer, and


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  1  this section and s. 641.31 apply to any health benefit

  2  provided by a small employer carrier that is a health

  3  maintenance organization, that provides coverage to one or

  4  more employees of a small employer regardless of where the

  5  policy, certificate, or contract is issued or delivered, if

  6  the health benefit plan covers employees or their covered

  7  dependents who are residents of this state.

  8         Section 47.  Subsection (6) of section 409.212, Florida

  9  Statutes, is renumbered as subsection (7), and new subsection

10  (6) is added to said section to read:

11         409.212  Optional supplementation.--

12         (6)  The optional state supplementation rate shall be

13  increased by the cost-of-living adjustment to the federal

14  benefits rate provided the average state optional

15  supplementation contribution does not increase as a result.

16         Section 48.  Subsections (3), (15), and (18) of section

17  409.901, Florida Statutes, are amended to read:

18         409.901  Definitions.--As used in ss. 409.901-409.920,

19  except as otherwise specifically provided, the term:

20         (3)  "Applicant" means an individual whose written

21  application for medical assistance provided by Medicaid under

22  ss. 409.903-409.906 has been submitted to the Department of

23  Children and Family Services agency, or to the Social Security

24  Administration if the application is for Supplemental Security

25  Income, but has not received final action.  This term includes

26  an individual, who need not be alive at the time of

27  application, whose application is submitted through a

28  representative or a person acting for the individual.

29         (15)  "Medicaid program" means the program authorized

30  under Title XIX of the federal Social Security Act which

31  provides for payments for medical items or services, or both,


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  1  on behalf of any person who is determined by the Department of

  2  Children and Family Services, or, for Supplemental Security

  3  Income, by the Social Security Administration, to be eligible

  4  on the date of service for Medicaid assistance.

  5         (18)  "Medicaid recipient" or "recipient" means an

  6  individual whom the Department of Children and Family

  7  Services, or, for Supplemental Security Income, by the Social

  8  Security Administration, determines is eligible, pursuant to

  9  federal and state law, to receive medical assistance and

10  related services for which the agency may make payments under

11  the Medicaid program. For the purposes of determining

12  third-party liability, the term includes an individual

13  formerly determined to be eligible for Medicaid, an individual

14  who has received medical assistance under the Medicaid

15  program, or an individual on whose behalf Medicaid has become

16  obligated.

17         Section 49.  Section 409.902, Florida Statutes, is

18  amended to read:

19         409.902  Designated single state agency; payment

20  requirements; program title.--The Agency for Health Care

21  Administration is designated as the single state agency

22  authorized to make payments for medical assistance and related

23  services under Title XIX of the Social Security Act.  These

24  payments shall be made, subject to any limitations or

25  directions provided for in the General Appropriations Act,

26  only for services included in the program, shall be made only

27  on behalf of eligible individuals, and shall be made only to

28  qualified providers in accordance with federal requirements

29  for Title XIX of the Social Security Act and the provisions of

30  state law.  This program of medical assistance is designated

31  the "Medicaid program." The Department of Children and Family


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  1  Services is responsible for Medicaid eligibility

  2  determinations, including, but not limited to, policy, rules,

  3  and the agreement with the Social Security Administration for

  4  Medicaid eligibility determinations for Supplemental Security

  5  Income recipients, as well as the actual determination of

  6  eligibility.

  7         Section 50.  Section 409.903, Florida Statutes, is

  8  amended to read:

  9         409.903  Mandatory payments for eligible persons.--The

10  agency shall make payments for medical assistance and related

11  services on behalf of the following persons who the

12  department, or the Social Security Administration by contract

13  with the Department of Children and Family Services, agency

14  determines to be eligible, subject to the income, assets, and

15  categorical eligibility tests set forth in federal and state

16  law.  Payment on behalf of these Medicaid eligible persons is

17  subject to the availability of moneys and any limitations

18  established by the General Appropriations Act or chapter 216.

19         (1)  Low-income families with children are eligible for

20  Medicaid provided they meet the following requirements:

21         (a)  The family includes a dependent child who is

22  living with a caretaker relative.

23         (b)  The family's income does not exceed the gross

24  income test limit.

25         (c)  The family's countable income and resources do not

26  exceed the applicable Aid to Families with Dependent Children

27  (AFDC) income and resource standards under the AFDC state plan

28  in effect in July 1996, except as amended in the Medicaid

29  state plan to conform as closely as possible to the

30  requirements of the WAGES Program as created in s. 414.015, to

31  the extent permitted by federal law.


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  1         (2)  A person who receives payments from, who is

  2  determined eligible for, or who was eligible for but lost cash

  3  benefits from the federal program known as the Supplemental

  4  Security Income program (SSI).  This category includes a

  5  low-income person age 65 or over and a low-income person under

  6  age 65 considered to be permanently and totally disabled.

  7         (3)  A child under age 21 living in a low-income,

  8  two-parent family, and a child under age 7 living with a

  9  nonrelative, if the income and assets of the family or child,

10  as applicable, do not exceed the resource limits under the

11  WAGES Program.

12         (4)  A child who is eligible under Title IV-E of the

13  Social Security Act for subsidized board payments, foster

14  care, or adoption subsidies, and a child for whom the state

15  has assumed temporary or permanent responsibility and who does

16  not qualify for Title IV-E assistance but is in foster care,

17  shelter or emergency shelter care, or subsidized adoption.

18         (5)  A pregnant woman for the duration of her pregnancy

19  and for the post partum period as defined in federal law and

20  rule, or a child under age 1, if either is living in a family

21  that has an income which is at or below 150 percent of the

22  most current federal poverty level, or, effective January 1,

23  1992, that has an income which is at or below 185 percent of

24  the most current federal poverty level.  Such a person is not

25  subject to an assets test. Further, a pregnant woman who

26  applies for eligibility for the Medicaid program through a

27  qualified Medicaid provider must be offered the opportunity,

28  subject to federal rules, to be made presumptively eligible

29  for the Medicaid program.

30         (6)  A child born after September 30, 1983, living in a

31  family that has an income which is at or below 100 percent of


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  1  the current federal poverty level, who has attained the age of

  2  6, but has not attained the age of 19.  In determining the

  3  eligibility of such a child, an assets test is not required.

  4         (7)  A child living in a family that has an income

  5  which is at or below 133 percent of the current federal

  6  poverty level, who has attained the age of 1, but has not

  7  attained the age of 6.  In determining the eligibility of such

  8  a child, an assets test is not required.

  9         (8)  A person who is age 65 or over or is determined by

10  the agency to be disabled, whose income is at or below 100

11  percent of the most current federal poverty level and whose

12  assets do not exceed limitations established by the agency.

13  However, the agency may only pay for premiums, coinsurance,

14  and deductibles, as required by federal law, unless additional

15  coverage is provided for any or all members of this group by

16  s. 409.904(1).

17         Section 51.  Subsection (6) of section 409.905, Florida

18  Statutes, is amended to read:

19         409.905  Mandatory Medicaid services.--The agency may

20  make payments for the following services, which are required

21  of the state by Title XIX of the Social Security Act,

22  furnished by Medicaid providers to recipients who are

23  determined to be eligible on the dates on which the services

24  were provided.  Any service under this section shall be

25  provided only when medically necessary and in accordance with

26  state and federal law. Nothing in this section shall be

27  construed to prevent or limit the agency from adjusting fees,

28  reimbursement rates, lengths of stay, number of visits, number

29  of services, or any other adjustments necessary to comply with

30  the availability of moneys and any limitations or directions

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


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  1         (6)  HOSPITAL OUTPATIENT SERVICES.--The agency shall

  2  pay for preventive, diagnostic, therapeutic, or palliative

  3  care and other services provided to a recipient in the

  4  outpatient portion of a hospital licensed under part I of

  5  chapter 395, and provided under the direction of a licensed

  6  physician or licensed dentist, except that payment for such

  7  care and services is limited to $1,500 $1,000 per state fiscal

  8  year per recipient, unless an exception has been made by the

  9  agency, and with the exception of a Medicaid recipient under

10  age 21, in which case the only limitation is medical

11  necessity.

12         Section 52.  Subsection (5) of section 409.906, Florida

13  Statutes, is amended to read:

14         409.906  Optional Medicaid services.--Subject to

15  specific appropriations, the agency may make payments for

16  services which are optional to the state under Title XIX of

17  the Social Security Act and are furnished by Medicaid

18  providers to recipients who are determined to be eligible on

19  the dates on which the services were provided.  Any optional

20  service that is provided shall be provided only when medically

21  necessary and in accordance with state and federal law.

22  Nothing in this section shall be construed to prevent or limit

23  the agency from adjusting fees, reimbursement rates, lengths

24  of stay, number of visits, or number of services, or making

25  any other adjustments necessary to comply with the

26  availability of moneys and any limitations or directions

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

28  If necessary to safeguard the state's systems of providing

29  services to elderly and disabled persons and subject to the

30  notice and review provisions of s. 216.177, the Governor may

31  direct the Agency for Health Care Administration to amend the


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  1  Medicaid state plan to delete the optional Medicaid service

  2  known as "Intermediate Care Facilities for the Developmentally

  3  Disabled."  Optional services may include:

  4         (5)  CASE MANAGEMENT SERVICES.--The agency may pay for

  5  primary care case management services rendered to a recipient

  6  pursuant to a federally approved waiver, and targeted case

  7  management services for specific groups of targeted

  8  recipients, for which funding has been provided and which are

  9  rendered pursuant to federal guidelines. The agency is

10  authorized to limit reimbursement for targeted case management

11  services in order to comply with any limitations or directions

12  provided for in the General Appropriations Act.

13  Notwithstanding s. 216.292, the Department of Children and

14  Family Services may transfer general funds to the Agency for

15  Health Care Administration to fund state match requirements

16  exceeding the amount specified in the General Appropriations

17  Act for targeted case management services.

18         Section 53.  Subsection (7), (9), and (10) of section

19  409.907, Florida Statutes, are amended to read:

20         409.907 Medicaid provider agreements.--The agency may

21  make payments for medical assistance and related services

22  rendered to Medicaid recipients only to an individual or

23  entity who has a provider agreement in effect with the agency,

24  who is performing services or supplying goods in accordance

25  with federal, state, and local law, and who agrees that no

26  person shall, on the grounds of handicap, race, color, or

27  national origin, or for any other reason, be subjected to

28  discrimination under any program or activity for which the

29  provider receives payment from the agency.

30         (7)  The agency may require, as a condition of

31  participating in the Medicaid program and before entering into


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  1  the provider agreement, that the provider  submit information

  2  concerning the professional, business, and personal background

  3  of the provider and permit an onsite inspection of the

  4  provider's service location by agency staff or other personnel

  5  designated by the agency to perform assist in this function.

  6  Before entering into the provider agreement, or as a condition

  7  of continuing in the Medicaid program, the agency and may also

  8  require that Medicaid providers reimbursed on a

  9  fee-for-services basis or fee schedule basis which is not

10  cost-based, post a surety bond from the provider not to exceed

11  $50,000 or the total amount billed by the provider to the

12  program during the currant or most recent calendar year,

13  whichever is greater. For new providers, the amount of the

14  surety bond shall be determined by the agency based on the

15  provider's estimate of its first year's billing. If the

16  provider's billing during the first year exceeds the bond

17  amount, the agency may require the provider to acquire an

18  additional bond equal to the actual billing level of the

19  provider. A provider's bond shall not exceed $50,000 if a

20  physician or group of physicians licensed under chapter 458,

21  chapter 459, or chapter 460 has a 50 percent or greater

22  ownership interest in the provider or if the provider is an

23  assisted living facility licensed under part III of chapter

24  400. The bonds permitted by this section are in addition to

25  the bonds referenced in s. 400.179(4)(d). If the provider is a

26  corporation, partnership, association, or other entity, the

27  agency may require the provider to submit information

28  concerning the background of that entity and of any principal

29  of the entity, including any partner or shareholder having an

30  ownership interest in the entity equal to 5 percent or

31  greater, and any treating provider who participates in or


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  1  intends to participate in Medicaid through the entity. The

  2  information must include:

  3         (a)  Proof of holding a valid license or operating

  4  certificate, as applicable, if required by the state or local

  5  jurisdiction in which the provider is located or if required

  6  by the Federal Government.

  7         (b)  Information concerning any prior violation, fine,

  8  suspension, termination, or other administrative action taken

  9  under the Medicaid laws, rules, or regulations of this state

10  or of any other state or the Federal Government; any prior

11  violation of the laws, rules, or regulations relating to the

12  Medicare program; any prior violation of the rules or

13  regulations of any other public or private insurer; and any

14  prior violation of the laws, rules, or regulations of any

15  regulatory body of this or any other state.

16         (c)  Full and accurate disclosure of any financial or

17  ownership interest that the provider, or any principal,

18  partner, or major shareholder thereof, may hold in any other

19  Medicaid provider or health care related entity or any other

20  entity that is licensed by the state to provide health or

21  residential care and treatment to persons.

22         (d)  If a group provider, identification of all members

23  of the group and attestation that all members of the group are

24  enrolled in or have applied to enroll in the Medicaid program.

25         (9)  Upon receipt of a completed, signed, and dated

26  application, and completion of any necessary background

27  investigation and criminal history record check, the agency

28  must either:

29         (a)  Enroll the applicant as a Medicaid provider; or

30         (b)  Deny the application if the agency finds that,

31  based on the grounds listed in subsection (10), it is in the


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  1  best interest of the Medicaid program to do so, specifying the

  2  reasons for denial. The agency may consider the factors listed

  3  in subsection (10), as well as any other factor that could

  4  affect the effective and efficient administration of the

  5  program, including, but not limited to, the current

  6  availability of medical care, services, or supplies to

  7  recipients, taking into account geographic location and

  8  reasonable travel time.

  9         (10)  The agency may consider whether deny enrollment

10  in the Medicaid program to a provider if the provider, or any

11  officer, director, agent, managing employee, or affiliated

12  person, or any partner or shareholder having an ownership

13  interest equal to 5 percent or greater in the provider if the

14  provider is a corporation, partnership, or other business

15  entity, has:

16         (a)  Made a false representation or omission of any

17  material fact in making the application, including the

18  submission of an application that conceals the controlling or

19  ownership interest of any officer, director, agent, managing

20  employee, affiliated person, or partner or shareholder who may

21  not be eligible to participate;

22         (b)  Been or is currently excluded, suspended,

23  terminated from, or has involuntarily withdrawn from

24  participation in, Florida's Medicaid program or any other

25  state's Medicaid program, or from participation in any other

26  governmental or private health care or health insurance

27  program;

28         (c)  Been convicted of a criminal offense relating to

29  the delivery of any goods or services under Medicaid or

30  Medicare or any other public or private health care or health

31  insurance program including the performance of management or


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  1  administrative services relating to the delivery of goods or

  2  services under any such program;

  3         (d)  Been convicted under federal or state law of a

  4  criminal offense related to the neglect or abuse of a patient

  5  in connection with the delivery of any health care goods or

  6  services;

  7         (e)  Been convicted under federal or state law of a

  8  criminal offense relating to the unlawful manufacture,

  9  distribution, prescription, or dispensing of a controlled

10  substance;

11         (f)  Been convicted of any criminal offense relating to

12  fraud, theft, embezzlement, breach of fiduciary

13  responsibility, or other financial misconduct;

14         (g)  Been convicted under federal or state law of a

15  crime punishable by imprisonment of a year or more which

16  involves moral turpitude;

17         (h)  Been convicted in connection with the interference

18  or obstruction of any investigation into any criminal offense

19  listed in this subsection;

20         (i)  Been found to have violated federal or state laws,

21  rules, or regulations governing Florida's Medicaid program or

22  any other state's Medicaid program, the Medicare program, or

23  any other publicly funded federal or state health care or

24  health insurance program, and been sanctioned accordingly;

25         (j)  Been previously found by a licensing, certifying,

26  or professional standards board or agency to have violated the

27  standards or conditions relating to licensure or certification

28  or the quality of services provided; or

29         (k)  Failed to pay any fine or overpayment properly

30  assessed under the Medicaid program in which no appeal is

31  pending or after resolution of the proceeding by stipulation


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  1  or agreement, unless the agency has issued a specific letter

  2  of forgiveness or has approved a repayment schedule to which

  3  the provider agrees to adhere.

  4         Section 54.  Paragraph (a) of subsection (1) of section

  5  409.908, Florida Statutes, is amended to read:

  6         409.908  Reimbursement of Medicaid providers.--Subject

  7  to specific appropriations, the agency shall reimburse

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

  9  according to methodologies set forth in the rules of the

10  agency and in policy manuals and handbooks incorporated by

11  reference therein.  These methodologies may include fee

12  schedules, reimbursement methods based on cost reporting,

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

14  and other mechanisms the agency considers efficient and

15  effective for purchasing services or goods on behalf of

16  recipients.  Payment for Medicaid compensable services made on

17  behalf of Medicaid eligible persons is subject to the

18  availability of moneys and any limitations or directions

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

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

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

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

23  making any other adjustments necessary to comply with the

24  availability of moneys and any limitations or directions

25  provided for in the General Appropriations Act, provided the

26  adjustment is consistent with legislative intent.

27         (1)  Reimbursement to hospitals licensed under part I

28  of chapter 395 must be made prospectively or on the basis of

29  negotiation.

30         (a)  Reimbursement for inpatient care is limited as

31  provided for in s. 409.905(5). Reimbursement for hospital


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  1  outpatient care is limited to $1,500 $1,000 per state fiscal

  2  year per recipient, except for:

  3         1.  Such care provided to a Medicaid recipient under

  4  age 21, in which case the only limitation is medical

  5  necessity;

  6         2.  Renal dialysis services; and

  7         3.  Other exceptions made by the agency.

  8         Section 55.  Section 409.9119, Florida Statutes, is

  9  created to read:

10         409.9119  Disproportionate share program for children's

11  hospitals.--In addition to the payments made under s. 409.911,

12  the Agency for Health Care Administration shall develop and

13  implement a system under which disproportionate share payments

14  are made to those hospitals that are licensed by the state as

15  a children's hospital. This system of payments must conform to

16  federal requirements and must distribute funds in each fiscal

17  year for which an appropriation is made by making quarterly

18  Medicaid payments. Notwithstanding s. 409.915, counties are

19  exempt from contributing toward the cost of this special

20  reimbursement for hospitals that serve a disproportionate

21  share of low-income patients.

22         (1)  The agency shall use the following formula to

23  calculate the total amount earned for hospitals that

24  participate in the children's hospital disproportionate share

25  program:

26                      TAE = DSR x BMPD x MD

27  Where:

28         TAE = total amount earned by a children's hospital.

29         DSR = disproportionate share rate.

30         BMPD = base Medicaid per diem.

31         MD = Medicaid days.


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  1         (2)  The agency shall calculate the total additional

  2  payment for hospitals that participate in the children's

  3  hospital disproportionate share program as follows:

  4

  5                         TAP = (TAE x TA)

  6                                         

  7                               STAE

  8  Where:

  9         TAP = total additional payment for a children's

10  hospital.

11         TAE = total amount earned by a children's hospital.

12         STAE = sum of total amount earned by each hospital that

13  participates in the children's hospital disproportionate share

14  program.

15         TA = total appropriation for the children's hospital

16  disproportionate share program.

17

18         (3)  A hospital may not receive any payments under this

19  section until it achieves full compliance with the applicable

20  rules of the agency. A hospital that is not in compliance for

21  two or more consecutive quarters may not receive its share of

22  the funds. Any forfeited funds must be distributed to the

23  remaining participating children's hospitals that are in

24  compliance.

25         Section 56.  Section 409.919, Florida Statutes, is

26  amended to read:

27         409.919  Rules.--The agency shall adopt any rules

28  necessary to comply with or administer ss. 409.901-409.920 and

29  all rules necessary to comply with federal requirements. In

30  addition, the Department of Children and Family Services shall

31  adopt and accept transfer of any rules necessary to carry out


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  1  its responsibilities for receiving and processing Medicaid

  2  applications and determining Medicaid eligibility, and for

  3  assuring compliance with and administering ss. 409.901-409.906

  4  and any other provisions related to responsibility for the

  5  determination of Medicaid eligibility.

  6         Section 57.  Notwithstanding the provisions of ss.

  7  236.0812, 409.9071, and 409.908(21), Florida Statutes,

  8  developmental research schools, as authorized under s.

  9  228.053, Florida Statutes, shall be authorized to participate

10  in the Medicaid certified school match program subject to the

11  provisions of ss. 236.0812, 409.9071, and 409.908(21), Florida

12  Statutes.

13         Section 58.  (1)  The Agency for Health Care

14  Administration is directed to submit to the Health Care

15  Financing Administration a request for a waiver that will

16  allow the agency to undertake a pilot project that would

17  implement a coordinated system of care for adult ventilator

18  dependent patients. Under this pilot program, the agency shall

19  identify a network of skilled nursing facilities that have

20  respiratory departments geared towards intensive treatment and

21  rehabilitation of adult ventilator patients and will contract

22  with such a network for respiratory services under a

23  capitation arrangement. The pilot project must allow the

24  agency to evaluate a coordinated and focused system of care

25  for adult ventilator dependent patients to determine the

26  overall cost-effectiveness and improved outcomes for

27  participants.

28         (2)  The agency shall submit the waiver by September 1,

29  2000.  The agency shall forward a preliminary report of the

30  pilot project's findings to the Governor, the Speaker of the

31  House of Representatives, and the President of the Senate 6


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  1  months after project implementation.  The agency shall submit

  2  a final report of the pilot project's findings to the

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

  4  President of the Senate no later than February 15, 2002.

  5         Section 59.  Subsection (3) of section 400.464 and

  6  paragraph (b) of subsection (4) of section 409.912, Florida

  7  Statutes, are repealed.

  8         Section 60.  Effective October 1, 2000, subsection (3)

  9  of section 408.70 and sections 408.701, 408.702, 408.703,

10  408.704, 408.7041, 408.7042, 408.7045, 408.7055, and 408.706,

11  Florida Statutes, are repealed.

12         Section 61.  The sum of $91,000 in nonrecurring general

13  revenue is hereby appropriated from the General Revenue Fund

14  to the Department of Health to cover costs of the Florida

15  Commission on Excellence in Health Care relating to the travel

16  and related expenses of staff, consumer members, and members

17  appointed by the department or agency; the hiring of

18  consultants, if necessary; and the reproduction and

19  dissemination of documents; however, no portion of this

20  appropriation shall be effective that duplicates a similar

21  appropriation for the same purpose contained in other

22  legislation from the 2000 legislative session that becomes

23  law.

24         Section 62.  The sum of $200,000 is appropriated from

25  the Insurance Commissioner's Regulatory Trust Fund to the

26  Office of Legislative Services for the purpose of implementing

27  the legislative intent expressed in s. 624.215(1), Florida

28  Statutes, for a systematic review of current mandated health

29  coverages. The review must be conducted by certified actuaries

30  and other appropriate professionals and shall consist of an

31  assessment of the impact, including, but not limited to, the


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  1  costs and benefits, of current mandated health coverages using

  2  the guidelines provided in s. 624.215(2), Florida Statutes.

  3  This assessment shall establish the aggregate cost of mandated

  4  health coverages.

  5         Section 63.  The General Appropriations Act for Fiscal

  6  Year 2000-2001 shall be reduced by four full-time-equivalent

  7  positions and $260,719 from the Health Care Trust Fund in the

  8  Agency for Health Care Administration for purposes of

  9  implementing the provisions of this act; however, the

10  reductions shall not be effective if duplicative of similar

11  reductions for the same purpose contained in other legislation

12  from the 2000 legislative session that becomes law.

13         Section 64.  Except as otherwise provided herein, this

14  act shall take effect July 1, 2000.

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