House Bill 0567c2

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    Florida House of Representatives - 2000           CS/CS/HB 567

        By the Committees on Governmental Rules & Regulations,
    Health Care Licensing & Regulation and Representatives Boyd,
    Ritchie, Chestnut and Greenstein




  1                      A bill to be entitled

  2         An act relating to nursing; amending part XV of

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

  4         nursing assistants, and transferring that part

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

  6         transfer from the Department of Health to the

  7         Board of Nursing responsibility and rulemaking

  8         authority for regulation of certified nursing

  9         assistants; transferring from the Department of

10         Education to the board responsibility for

11         approval of training programs; revising grounds

12         for which the board may impose certain

13         penalties; creating s. 464.2085, F.S.; creating

14         and providing requirements for a Council on

15         Certified Nursing Assistants; amending ss.

16         20.43, 39.01, 39.304, 110.131, 232.46,

17         240.4075, 246.081, 310.102, 381.0302, 384.30,

18         384.31, 394.455, 395.0191, 400.021, 400.211,

19         400.402, 400.407, 400.4255, 400.426, 400.462,

20         400.464, 400.506, 400.6105, 401.23, 401.252,

21         408.706, 409.908, 415.1085, 455.597, 455.604,

22         455.667, 455.677, 455.694, 455.707, 458.348,

23         464.001, 464.002, 464.003, 464.006, 464.009,

24         464.016, 464.018, 464.019, 464.022, 464.023,

25         464.027, 466.003, 467.003, 467.0125, 467.203,

26         468.505, 483.041, 483.801, 491.0112, 550.24055,

27         627.351, 627.357, 627.9404, 641.31, 766.101,

28         766.110, 766.1115, 877.111, 945.602, 960.28,

29         984.03, 985.03, F.S.; conforming references;

30         revising application procedures for certified

31         nursing assistants; revising registration

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  1         requirements for certified nursing assistants;

  2         amending ss. 400.215, 400.512, F.S.; revising

  3         provisions relating to the granting of

  4         exemptions from disqualification for employment

  5         in nursing homes or home health agencies;

  6         amending s. 455.557, F.S.; including advanced

  7         registered nurse practitioners under the

  8         credentialing program; creating s. 455.56503,

  9         F.S.; requiring advanced registered nurse

10         practitioners to submit information and

11         fingerprints for profiling purposes; amending

12         s. 455.5651, F.S.; authorizing the department

13         to publish certain information in practitioner

14         profiles; amending s. 455.5653, F.S.; deleting

15         obsolete provisions relating to scheduling and

16         development of practitioner profiles for

17         additional health care practitioners; providing

18         access to information on advanced registered

19         nurse practitioners maintained by the Agency

20         for Health Care Administration for

21         corroboration purposes; amending s. 455.5654,

22         F.S.; providing for adoption by rule of a form

23         for submission of profiling information;

24         providing an appropriation; providing an

25         effective date.

26

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

28

29         Section 1.  Sections 468.821 through 468.829, Florida

30  Statutes, are renumbered as sections 464.201 through 464.209,

31

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

  2  Statutes, and amended to read:

  3         464.201 468.821  Definitions.--As used in this part,

  4  the term:

  5         (1)  "Approved training program" means:

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

  7  or private sector educational center licensed by the

  8  Department of Education to implement the basic curriculum for

  9  nursing assistants which is approved by the Department of

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

11  responsibility for approval of training programs under this

12  paragraph.

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

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

15         (3)(2)  "Certified nursing assistant" means a person

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

17  certified by the board department as a certified nursing

18  assistant.

19         (4)(3)  "Department" means the Department of Health.

20         (5)(4)  "Registry" means the listing of certified

21  nursing assistants maintained by the board department.

22         464.202 468.822  Duties and powers of the board

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

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

25  of certified nursing assistants. The registry must consist of

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

27  other identifying information defined by board department

28  rule; certification status; the effective date of

29  certification; other information required by state or federal

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

31  exploitation as provided under chapter 435; and any

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  1  disciplinary action taken against the certified nursing

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

  3  certificateholder, employers, and other state agencies. The

  4  board department shall adopt by rule testing procedures for

  5  use in certifying nursing assistants and shall adopt rules

  6  regulating the practice of certified nursing assistants to

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

  8  approve another entity or organization to provide the

  9  examination services, including the development and

10  administration of examinations. The board shall require that

11  the contract provider provide and accept certified nursing

12  assistant applications via the Internet, and process

13  applications and complete testing within 5 calendar days after

14  the receipt of the application, with test scores provided

15  within 2 calendar days after the test date. The provider shall

16  pay all reasonable costs and expenses incurred by the board

17  department in evaluating the provider's application and

18  performance during the delivery of services, including

19  examination services and procedures for maintaining the

20  certified nursing assistant registry.

21         464.203 468.823  Certified nursing assistants;

22  certification requirement.--

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

24  practice as a certified nursing assistant to any person who

25  demonstrates a minimum competency to read and write and

26  successfully passes the required Level I or Level II screening

27  pursuant to s. 400.215 and meets one of the following

28  requirements:

29         (a)  Has successfully completed an approved training

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

31  the board department, on the nursing assistant competency

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  1  examination, which consists of a written portion and

  2  skills-demonstration portion approved by the board department

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

  4  department.

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

  6  of the board department, on the nursing assistant competency

  7  examination, which consists of a written portion and

  8  skills-demonstration portion, approved by the board department

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

10  department and:

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

12         2.  Is at least 18 years of age.

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

14  on that state's certified nursing assistant registry; and has

15  not been found to have committed abuse, neglect, or

16  exploitation in that state; and has successfully completed a

17  national nursing assistant evaluation in order to receive

18  certification in that state.

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

20  assistant competency examination in three attempts, the

21  applicant is not eligible for reexamination unless the

22  applicant completes an approved training program.

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

24  substitute for the written portion of the examination upon

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

26  and by personnel approved by the department.

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

28  for the initial certification of certified nursing assistants.

29         (5)  A certified nursing assistant shall maintain a

30  current address with the board department in accordance with

31  s. 455.717.

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  1         464.204 468.824  Denial, suspension, or revocation of

  2  certification; disciplinary actions.--

  3         (1)  The following acts constitute grounds for which

  4  the board department may impose disciplinary sanctions as

  5  specified in subsection (2):

  6         (a)  Obtaining or attempting to obtain certification or

  7  an exemption, or possessing or attempting to possess

  8  certification or a letter of exemption, by bribery,

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

10  department.

11         (b)  Intentionally violating any provision of this

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

13  department.

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

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

16  enter an order imposing one or more of the following

17  penalties:

18         (a)  Denial, suspension, or revocation of

19  certification.

20         (b)  Imposition of an administrative fine not to exceed

21  $150 for each count or separate offense.

22         (c)  Imposition of probation or restriction of

23  certification, including conditions such as corrective actions

24  as retraining or compliance with an approved treatment program

25  for impaired practitioners.

26         (3)  The board department may, upon the request of a

27  certificateholder, exempt the certificateholder from

28  disqualification of certification or disqualification of

29  employment in accordance with chapter 435 and issue a letter

30  of exemption. After January 1, 2000, The board department must

31  notify an applicant seeking an exemption from disqualification

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  1  from certification or employment of its decision to approve or

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

  3  department receives all required documentation.

  4         464.205 468.825  Availability of disciplinary records

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

  6  record maintained by the department of Health pursuant to the

  7  discipline of a certified nursing assistant and any proceeding

  8  held by the board department to discipline a certified nursing

  9  assistant shall remain open and available to the public.

10         464.206 468.826  Exemption from liability.--If an

11  employer terminates or denies employment to a certified

12  nursing assistant whose certification is inactive as shown on

13  the certified nursing assistant registry or whose name appears

14  on the central abuse registry and tracking system of the

15  Department of Children and Family Services or on a criminal

16  screening report of the Department of Law Enforcement, the

17  employer is not civilly liable for such termination and a

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

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

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

21  468.824(1). There may not be any monetary liability on the

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

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

24  thereof, medical staff, disciplinary board, agents,

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

26  any action taken in good faith without intentional fraud in

27  carrying out this section.

28         464.207 468.827  Penalties.--It is a misdemeanor of the

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

30  775.083, for any person, knowingly or intentionally, to fail

31  to disclose, by false statement, misrepresentation,

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  1  impersonation, or other fraudulent means, in any application

  2  for voluntary or paid employment or certification licensure

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

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

  5  employee or certificateholder licensee.

  6         464.208 468.828  Background screening information;

  7  rulemaking authority.--

  8         (1)  The Agency for Health Care Administration shall

  9  allow the board department to electronically access its

10  background screening database and records, and the Department

11  of Children and Family Services shall allow the board

12  department to electronically access its central abuse registry

13  and tracking system under chapter 415.

14         (2)  An employer, or an agent thereof, may not use

15  criminal records, juvenile records, or information obtained

16  from the central abuse hotline under chapter 415 relating to

17  vulnerable adults for any purpose other than determining if

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

19  and information obtained by the board department shall remain

20  confidential and exempt from s. 119.07(1).

21         (3)  If the requirements of the Omnibus Budget

22  Reconciliation Act of 1987, as amended, for the certification

23  of nursing assistants are in conflict with this part, the

24  federal requirements shall prevail for those facilities

25  certified to provide care under Title XVIII (Medicare) or

26  Title XIX (Medicaid) of the Social Security Act.

27         (4)  The board department shall adopt rules to

28  administer this part.

29         464.209 468.829  Certified nursing assistant

30  registry.--

31

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

  2  thereafter, each employer of certified nursing assistants

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

  4  names and social security numbers of each person employed by

  5  the employer as a certified nursing assistant in a

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

  7  monetary compensation during the preceding 24 months.

  8  Employers may submit such information electronically through

  9  the department's Internet site.

10         (2)  The board department shall update the certified

11  nursing assistant registry upon receipt of the lists of

12  certified nursing assistants, and shall complete the first of

13  such updates by December 31, 1999.

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

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

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

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

18  such an inactive certification by submitting documentation to

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

20  of 8 hours for monetary compensation as a certified nursing

21  assistant in a nursing-related occupation during the preceding

22  24 months.

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

24         Section 2.  Section 464.2085, Florida Statutes, is

25  created to read:

26         464.2085  Council on Certified Nursing Assistants.--The

27  Council on Certified Nursing Assistants is created within the

28  department, under the Board of Nursing.

29         (1)  The council shall consist of five members

30  appointed as follows:

31

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  1         (a)  The chairperson of the Board of Nursing shall

  2  appoint two members who are registered nurses. One of the

  3  members must currently supervise a certified nursing assistant

  4  in a licensed nursing home.

  5         (b)  The chairperson of the Board of Nursing shall

  6  appoint one member who is a licensed practical nurse who is

  7  currently working in a licensed nursing home.

  8         (c)  The secretary of the department or his or her

  9  designee shall appoint two certified nursing assistants

10  currently certified under this chapter, at least one of whom

11  is currently working in a licensed nursing home.

12         (2)  The council shall:

13         (a)  Recommend to the department policies and

14  procedures for the certification of nursing assistants.

15         (b)  Develop all rules regulating the education,

16  training, and certification process for nursing assistants

17  certified under this chapter. The Board of Nursing shall

18  consider adopting a proposed rule developed by the council at

19  the regularly scheduled meeting immediately following the

20  submission of the proposed rule by the council.

21         (c)  Make recommendations to the board regarding all

22  matters relating to the certification of nursing assistants.

23         (d)  Address concerns and problems of certified nursing

24  assistants in order to improve safety in the practice of

25  certified nursing assistants.

26         Section 3.  Paragraph (g) of subsection (3) of section

27  20.43, Florida Statutes, is amended to read:

28         20.43  Department of Health.--There is created a

29  Department of Health.

30         (3)  The following divisions of the Department of

31  Health are established:

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

  2  responsible for the following boards and professions

  3  established within the division:

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

  5         1.2.  Health care services pools, as provided under s.

  6  402.48.

  7         2.3.  The Board of Acupuncture, created under chapter

  8  457.

  9         3.4.  The Board of Medicine, created under chapter 458.

10         4.5.  The Board of Osteopathic Medicine, created under

11  chapter 459.

12         5.6.  The Board of Chiropractic Medicine, created under

13  chapter 460.

14         6.7.  The Board of Podiatric Medicine, created under

15  chapter 461.

16         7.8.  Naturopathy, as provided under chapter 462.

17         8.9.  The Board of Optometry, created under chapter

18  463.

19         9.10.  The Board of Nursing, created under part I of

20  chapter 464.

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

22  chapter 464.

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

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

25         13.  Midwifery, as provided under chapter 467.

26         14.  The Board of Speech-Language Pathology and

27  Audiology, created under part I of chapter 468.

28         15.  The Board of Nursing Home Administrators, created

29  under part II of chapter 468.

30         16.  The Board of Occupational Therapy, created under

31  part III of chapter 468.

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

  2  chapter 468.

  3         18.  Dietetics and nutrition practice, as provided

  4  under part X of chapter 468.

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

  6  XIII of chapter 468.

  7         20.  The Board of Orthotists and Prosthetists, created

  8  under part XIV of chapter 468.

  9         21.  Electrolysis, as provided under chapter 478.

10         22.  The Board of Massage Therapy, created under

11  chapter 480.

12         23.  The Board of Clinical Laboratory Personnel,

13  created under part III of chapter 483.

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

15  chapter 483.

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

17  chapter 484.

18         26.  The Board of Hearing Aid Specialists, created

19  under part II of chapter 484.

20         27.  The Board of Physical Therapy Practice, created

21  under chapter 486.

22         28.  The Board of Psychology, created under chapter

23  490.

24         29.  School psychologists, as provided under chapter

25  490.

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

27  Family Therapy, and Mental Health Counseling, created under

28  chapter 491.

29

30  The department may contract with the Agency for Health Care

31  Administration who shall provide consumer complaint,

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  1  investigative, and prosecutorial services required by the

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

  3  appropriate.

  4         Section 4.  Subsection (38) of section 39.01, Florida

  5  Statutes, is amended to read:

  6         39.01  Definitions.--When used in this chapter, unless

  7  the context otherwise requires:

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

  9  physician licensed under chapter 458, an osteopathic physician

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

11  chapter 464, a physician assistant licensed under chapter 458

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

13         Section 5.  Paragraph (b) of subsection (1) of section

14  39.304, Florida Statutes, is amended to read:

15         39.304  Photographs, medical examinations, X rays, and

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

17         (1)

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

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

20  complains or otherwise exhibits distress as a result of injury

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

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

23  investigate may cause the child to be referred for diagnosis

24  to a licensed physician or an emergency department in a

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

26  custodian. Such examination may be performed by any licensed

27  physician or an advanced registered nurse practitioner

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

29  physician, or advanced registered nurse practitioner licensed

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

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

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  1  abandonment, or neglect may authorize a radiological

  2  examination to be performed on the child without the consent

  3  of the child's parent or legal custodian.

  4         Section 6.  Paragraph (c) of subsection (6) of section

  5  110.131, Florida Statutes, is amended to read:

  6         110.131  Other-personal-services temporary

  7  employment.--

  8         (6)

  9         (c)  Notwithstanding the provisions of this section,

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

11  other-personal-services employment of a health care

12  practitioner licensed pursuant to chapter 458, chapter 459,

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

14  chapter 466, chapter 468, chapter 483, chapter 486, or chapter

15  490 beyond 2,080 hours and may employ such practitioner on an

16  hourly or other basis.

17         Section 7.  Subsection (1) of section 232.46, Florida

18  Statutes, is amended to read:

19         232.46  Administration of medication by school district

20  personnel.--

21         (1)  Notwithstanding the provisions of the Nurse

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

23  shall be authorized to assist students in the administration

24  of prescription medication when the following conditions have

25  been met:

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

27  approved school health services plan a procedure to provide

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

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

30  a physician assistant licensed pursuant to chapter 458 or

31  chapter 459, to the school personnel designated by the

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  1  principal to assist students in the administration of

  2  prescribed medication.  Such training may be provided in

  3  collaboration with other school districts, through contract

  4  with an education consortium, or by any other arrangement

  5  consistent with the intent of this section.

  6         (b)  Each district school board shall adopt policies

  7  and procedures governing the administration of prescription

  8  medication by school district personnel.  The policies and

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

10  provisions:

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

12  parent or guardian shall provide to the school principal a

13  written statement which shall grant to the principal or the

14  principal's designee permission to assist in the

15  administration of such medication and which shall explain the

16  necessity for such medication to be provided during the school

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

18  school property on official school business. The school

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

20  student in the administration of such medication.

21         2.  Each prescribed medication to be administered by

22  school district personnel shall be received, counted, and

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

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

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

26  the principal.

27         Section 8.  Subsection (6) of section 240.4075, Florida

28  Statutes, is amended to read:

29         240.4075  Nursing Student Loan Forgiveness Program.--

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

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

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

  2  or renewal of nursing licensure. Revenues collected from the

  3  fee imposed in this subsection shall be deposited in the

  4  Nursing Student Loan Forgiveness Trust Fund of the Department

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

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

  7  Up to 50 percent of the revenues appropriated to implement

  8  this subsection may be used for the nursing scholarship

  9  program established pursuant to s. 240.4076.

10         Section 9.  Paragraph (b) of subsection (1) of section

11  246.081, Florida Statutes, is amended to read:

12         246.081  License, certificate of exemption, or

13  authorization required; exceptions.--

14         (1)  The following colleges are not under the

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

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

17  an authorization from the board:

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

19  approved for establishment and operation under part I of

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

21  of the Florida Statutes, requiring licensing or approval as

22  defined in ss. 246.011-246.151.

23         Section 10.  Subsection (2) of section 310.102, Florida

24  Statutes, is amended to read:

25         310.102  Treatment programs for impaired pilots and

26  deputy pilots.--

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

28  practitioner consultants as recommended by the committee. A

29  consultant shall be a licensee under the jurisdiction of the

30  Division of Medical Quality Assurance within the Department of

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

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

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

  3  department in carrying out the responsibilities of this

  4  section. This shall include working with department

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

  6  in fact, impaired.

  7         Section 11.  Subsection (7) of section 381.0302,

  8  Florida Statutes, is amended to read:

  9         381.0302  Florida Health Services Corps.--

10         (7)  The financial penalty for noncompliance with

11  participation requirements for persons who have received

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

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

14  Health Services Corps scholarship program.  In addition,

15  noncompliance with participation requirements shall also

16  result in ineligibility for professional licensure or renewal

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

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

19  participant who is unable to participate for reasons of

20  disability, the penalty is the actual amount of financial

21  assistance provided to the participant.  Financial penalties

22  shall be deposited in the Florida Health Services Corps Trust

23  Fund and shall be used to provide additional scholarship and

24  financial assistance.

25         Section 12.  Subsection (1) of section 384.30, Florida

26  Statutes, is amended to read:

27         384.30  Minors' consent to treatment.--

28         (1)  The department and its authorized representatives,

29  each physician licensed to practice medicine under the

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

31  professional licensed under the provisions of part I of

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

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

  3  health facility may examine and provide treatment for sexually

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

  5  care professional, or facility is qualified to provide such

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

  7  is not a prerequisite for an examination or treatment.

  8         Section 13.  Section 384.31, Florida Statutes, is

  9  amended to read:

10         384.31  Serological testing of pregnant women; duty of

11  the attendant.--

12         (1)  Every person, including every physician licensed

13  under chapter 458 or chapter 459 or midwife licensed under

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

15  woman for conditions relating to pregnancy during the period

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

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

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

19  laboratory approved for such purposes under part I of chapter

20  483 for sexually transmissible diseases as required by rule of

21  the department.

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

23  testing for human immunodeficiency virus (HIV) infection shall

24  be offered to each pregnant woman. The prevailing professional

25  standard of care in this state requires each health care

26  provider and midwife who attends a pregnant woman to counsel

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

28  Counseling shall include a discussion of the availability of

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

30  pregnant woman objects to HIV testing, reasonable steps shall

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

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

  2  medical record. Every person, including every physician

  3  licensed under chapter 458 or chapter 459 or midwife licensed

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

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

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

  7  the contracting of HIV infection or acquired immune deficiency

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

  9         Section 14.  Subsection (23) of section 394.455,

10  Florida Statutes, is amended to read:

11         394.455  Definitions.--As used in this part, unless the

12  context clearly requires otherwise, the term:

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

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

15  or a doctorate in psychiatric nursing and 2 years of

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

17  physician.

18         Section 15.  Paragraphs (a) and (b) of subsection (2)

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

20  amended to read:

21         395.0191  Staff membership and clinical privileges.--

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

23  and procedures for consideration of an application for

24  clinical privileges submitted by an advanced registered nurse

25  practitioner licensed and certified under part I of chapter

26  464, in accordance with the provisions of this section.  No

27  licensed facility shall deny such application solely because

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

29  because the applicant is not a participant in the Florida

30  Birth-Related Neurological Injury Compensation Plan.

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  1         (b)  An advanced registered nurse practitioner who is

  2  certified as a registered nurse anesthetist licensed under

  3  part I of chapter 464 shall administer anesthesia under the

  4  onsite medical direction of a professional licensed under

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

  6  with an established protocol approved by the medical staff.

  7  The medical direction shall specifically address the needs of

  8  the individual patient.

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

10  authority of the medical staff of a licensed facility to

11  review for approval or disapproval all applications for

12  appointment and reappointment to all categories of staff and

13  to make recommendations on each applicant to the governing

14  board, including the delineation of privileges to be granted

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

16  delineation of privileges, each applicant shall be considered

17  individually pursuant to criteria for a doctor licensed under

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

19  an advanced registered nurse practitioner licensed and

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

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

22  eligibility for staff membership or clinical privileges shall

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

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

25  adherence to applicable professional ethics; the applicant's

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

27  and by such other elements as determined by the governing

28  board, consistent with this part.

29         Section 16.  Subsection (11) of section 400.021,

30  Florida Statutes, is amended to read:

31

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  1         400.021  Definitions.--When used in this part, unless

  2  the context otherwise requires, the term:

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

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

  5  and which is licensed according to this part.

  6         Section 17.  Section 400.211, Florida Statutes, is

  7  amended to read:

  8         400.211  Persons employed as nursing assistants;

  9  certification requirement.--

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

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

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

13  registered nurse or practical nurse licensed in accordance

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

15  who is permitted to practice nursing in accordance with rules

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

17  464, to serve as a nursing assistant in any nursing home.

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

19  certified as nursing assistants under this part II of chapter

20  464 may be employed by a nursing facility for a period of 4

21  months:

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

23  nursing assistant program; or

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

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

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

27  have not completed the written examination required under this

28  section.

29

30

31

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  1  The certification requirement must be met within 4 months

  2  after of initial employment as a nursing assistant in a

  3  licensed nursing facility.

  4         (3)  Nursing homes shall require persons seeking

  5  employment as a certified nursing assistant to submit an

  6  employment history to the facility. The facility shall verify

  7  the employment history unless, through diligent efforts, such

  8  verification is not possible.  There shall be no monetary

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

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

11  good faith communicates his or her honest opinion about a

12  former employee's job performance.

13         Section 18.  Paragraph (b) of subsection (4) of section

14  400.215, Florida Statutes, is amended to read:

15         400.215  Personnel screening requirement.--

16         (4)

17         (b)  As provided in s. 435.07, the appropriate

18  regulatory board within the Department of Health, or that

19  department itself when there is no board, may grant an

20  exemption from disqualification to an employee or prospective

21  employee who is subject to this section and who has received a

22  professional license or certification from the Department of

23  Health or a regulatory board within that department.

24         Section 19.  Subsections (12) and (14) of section

25  400.402, Florida Statutes, are amended to read:

26         400.402  Definitions.--When used in this part, the

27  term:

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

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

30  pursuant to part I of chapter 464 by persons licensed

31  thereunder while carrying out their professional duties, and

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

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

  3  place in a residential environment despite mental or physical

  4  limitations that might otherwise disqualify them from

  5  residency in a facility licensed under this part.

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

  7  performed pursuant to part I of chapter 464 by persons

  8  licensed thereunder while carrying out their professional

  9  duties but limited to those acts which the department

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

11  allowable limited nursing services shall be for persons who

12  meet the admission criteria established by the department for

13  assisted living facilities and shall not be complex enough to

14  require 24-hour nursing supervision and may include such

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

16  care of casts, braces, and splints.

17         Section 20.  Paragraphs (a) and (b) of subsection (3)

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

19         400.407  License required; fee, display.--

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

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

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

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

24  information deemed necessary by the agency. Licenses shall be

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

26  standard, extended congregate care, limited nursing services,

27  or limited mental health.

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

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

30  400.402. Such facilities may also employ or contract with a

31  person licensed under part I of chapter 464 to administer

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  1  medications and perform other tasks as specified in s.

  2  400.4255.

  3         (b)  An extended congregate care license shall be

  4  issued to facilities providing, directly or through contract,

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

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

  7  licensed thereunder, and supportive services defined by rule

  8  to persons who otherwise would be disqualified from continued

  9  residence in a facility licensed under this part.

10         1.  In order for extended congregate care services to

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

12  must first determine that all requirements established in law

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

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

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

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

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

18  licensee under this part. Notification of approval or denial

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

20  such request and all necessary documentation. Existing

21  facilities qualifying to provide extended congregate care

22  services must have maintained a standard license and may not

23  have been subject to administrative sanctions during the

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

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

26  following reasons:

27         a.  A class I or class II violation;

28         b.  Three or more repeat or recurring class III

29  violations of identical or similar resident care standards as

30  specified in rule from which a pattern of noncompliance is

31  found by the agency;

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

  2  corrected in accordance with the corrective action plan

  3  approved by the agency;

  4         d.  Violation of resident care standards resulting in a

  5  requirement to employ the services of a consultant pharmacist

  6  or consultant dietitian;

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

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

  9  extended congregate care license has at least 25 percent

10  ownership interest; or

11         f.  Imposition of a moratorium on admissions or

12  initiation of injunctive proceedings.

13         2.  Facilities that are licensed to provide extended

14  congregate care services shall maintain a written progress

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

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

17  services that are rendered and the general status of the

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

19  designee, representing the agency shall visit such facilities

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

21  receiving extended congregate care services and to determine

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

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

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

25  monitoring visits may be provided through contractual

26  arrangements with appropriate community agencies.  A

27  registered nurse shall serve as part of the team that

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

29  the required yearly monitoring visits for a facility that has

30  been licensed for at least 24 months to provide extended

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

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  1  the registered nurse determines that extended congregate care

  2  services are being provided appropriately, and if the facility

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

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

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

  6  in which the facility is located to determine if any

  7  complaints have been made and substantiated about the quality

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

  9  required yearly monitoring visits if complaints have been made

10  and substantiated.

11         3.  Facilities that are licensed to provide extended

12  congregate care services shall:

13         a.  Demonstrate the capability to meet unanticipated

14  resident service needs.

15         b.  Offer a physical environment that promotes a

16  homelike setting, provides for resident privacy, promotes

17  resident independence, and allows sufficient congregate space

18  as defined by rule.

19         c.  Have sufficient staff available, taking into

20  account the physical plant and firesafety features of the

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

22  emergency, as necessary.

23         d.  Adopt and follow policies and procedures that

24  maximize resident independence, dignity, choice, and

25  decisionmaking to permit residents to age in place to the

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

27  status are minimized or avoided.

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

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

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

31

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  1  developing service plans, and share responsibility in

  2  decisionmaking.

  3         f.  Implement the concept of managed risk.

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

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

  6  464.

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

  8  provide specialized training as defined by rule for facility

  9  staff.

10         4.  Facilities licensed to provide extended congregate

11  care services are exempt from the criteria for continued

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

13  Facilities so licensed shall adopt their own requirements

14  within guidelines for continued residency set forth by the

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

16  residents who require 24-hour nursing supervision. Facilities

17  licensed to provide extended congregate care services shall

18  provide each resident with a written copy of facility policies

19  governing admission and retention.

20         5.  The primary purpose of extended congregate care

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

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

23  would otherwise be disqualified for continued residency.  A

24  facility licensed to provide extended congregate care services

25  may also admit an individual who exceeds the admission

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

27  individual is determined appropriate for admission to the

28  extended congregate care facility.

29         6.  Before admission of an individual to a facility

30  licensed to provide extended congregate care services, the

31  individual must undergo a medical examination as provided in

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

  2  service plan for the individual.

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

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

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

  6  arrangements for relocating the person in accordance with s.

  7  400.428(1)(k).

  8         8.  Failure to provide extended congregate care

  9  services may result in denial of extended congregate care

10  license renewal.

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

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

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

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

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

16  and recommendations related to, extended congregate care

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

18  limited to, the following information:

19         a.  A description of the facilities licensed to provide

20  such services, including total number of beds licensed under

21  this part.

22         b.  The number and characteristics of residents

23  receiving such services.

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

25  provided through a standard license.

26         d.  An analysis of deficiencies cited during biennial

27  inspections.

28         e.  The number of residents who required extended

29  congregate care services at admission and the source of

30  admission.

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  1         f.  Recommendations for statutory or regulatory

  2  changes.

  3         g.  The availability of extended congregate care to

  4  state clients residing in facilities licensed under this part

  5  and in need of additional services, and recommendations for

  6  appropriations to subsidize extended congregate care services

  7  for such persons.

  8         h.  Such other information as the department considers

  9  appropriate.

10         Section 21.  Paragraphs (a) and (c) of subsection (1)

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

12  amended to read:

13         400.4255  Use of personnel; emergency care.--

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

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

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

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

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

19  individual weekly pill organizers for residents who

20  self-administer medication, give prepackaged enemas ordered by

21  a physician, observe residents, document observations on the

22  appropriate resident's record, report observations to the

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

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

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

26  residents meet the criteria for appropriate placement as

27  defined in s. 400.426.  Nursing assistants certified pursuant

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

29  signs as directed by a licensed nurse or physician.

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

31  carry out their professional duties pursuant to part I of

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  1  chapter 464 until emergency medical personnel assume

  2  responsibility for care.

  3         (2)  In facilities licensed to provide extended

  4  congregate care, persons under contract to the facility,

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

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

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

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

  9  perform all duties within the scope of their license or

10  certification, as approved by the facility administrator and

11  pursuant to this part.

12         Section 22.  Subsection (3) of section 400.426, Florida

13  Statutes, is amended to read:

14         400.426  Appropriateness of placements; examinations of

15  residents.--

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

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

18  routine basis or at least monthly, perform a nursing

19  assessment of the residents for whom they are providing

20  nursing services ordered by a physician, except administration

21  of medication, and shall document such assessment, including

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

23  necessitate relocation to a nursing home, hospital, or

24  specialized health care facility.  Such records shall be

25  maintained in the facility for inspection by the agency and

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

27  applicable.

28         Section 23.  Subsections (3) and (21) of section

29  400.462, Florida Statutes, are amended to read:

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

31

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

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

  3  400.211. The licensed home health agency or licensed nurse

  4  registry shall ensure that the certified nursing assistant

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

  6  licensed nurse registry is adequately trained to perform the

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

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

  9  therapeutic services delivered by a health care professional

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

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

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

13  referred by a licensed nurse registry.

14         Section 24.  Paragraph (c) of subsection (6) of section

15  400.464, Florida Statutes, is amended to read:

16         400.464  Home health agencies to be licensed;

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

18         (6)  The following are exempt from the licensure

19  requirements of this part:

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

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

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

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

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

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

26  care to patients in their homes.

27         Section 25.  Paragraph (a) of subsection (10),

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

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

30         400.506  Licensure of nurse registries; requirements;

31  penalties.--

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

  2  private residences registered nurses and licensed practical

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

  4  certified nursing assistants certified under part II of

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

  6  documented proof of successful completion of the training

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

  8  for the purposes of providing those services authorized under

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

10  provide current documentation that he or she is free from

11  communicable diseases.

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

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

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

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

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

17  Agency for Health Care Administration or the Department of

18  Business and Professional Regulation. Providing services

19  beyond the scope authorized under this subsection constitutes

20  the unauthorized practice of medicine or a violation of the

21  Nurse Practice Act and is punishable as provided under chapter

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

23         (15)  All persons referred for contract in private

24  residences by a nurse registry must comply with the following

25  requirements for a plan of treatment:

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

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

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

29  supervision of a physician or when a physician is responsible

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

31  treatment must be established for each patient receiving care

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

  2  original medical plan of treatment must be timely signed by

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

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

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

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

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

  8  substantiated by the appropriate nursing notes or

  9  documentation made by the nurse in compliance with nursing

10  practices established under part I of chapter 464.

11         Section 26.  Subsection (1) of section 400.512, Florida

12  Statutes, is amended to read:

13         400.512  Screening of home health agency personnel;

14  nurse registry personnel; and companions and homemakers.--The

15  agency shall require employment or contractor screening as

16  provided in chapter 435, using the level 1 standards for

17  screening set forth in that chapter, for home health agency

18  personnel; persons referred for employment by nurse

19  registries; and persons employed by companion or homemaker

20  services registered under s. 400.509.

21         (1)(a)  The Agency for Health Care Administration may,

22  upon request, grant exemptions from disqualification from

23  employment or contracting under this section as provided in s.

24  435.07, except for health care practitioners licensed by the

25  Department of Health or a regulatory board within that

26  department.

27         (b)  The appropriate regulatory board within the

28  Department of Health, or that department itself when there is

29  no board, may, upon request of the licensed health care

30  practitioner, grant exemptions from disqualification from

31

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  1  employment or contracting under this section as provided in s.

  2  435.07.

  3         Section 27.  Subsections (2) and (3) of section

  4  400.6105, Florida Statutes, are amended to read:

  5         400.6105  Staffing and personnel.--

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

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

  8  coordinate the implementation of the plan of care for each

  9  patient.

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

11  teams who shall participate in the establishment and ongoing

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

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

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

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

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

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

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

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

20  met.

21         Section 28.  Subsection (20) of section 401.23, Florida

22  Statutes, is amended to read:

23         401.23  Definitions.--As used in this part, the term:

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

25  licensed to practice professional nursing pursuant to part I

26  of chapter 464.

27         Section 29.  Paragraph (c) of subsection (1) of section

28  401.252, Florida Statutes, is amended to read:

29         401.252  Interfacility transfer.--

30         (1)  A licensed basic or advanced life support

31  ambulance service may conduct interfacility transfers in a

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

  2  emergency medical technician or paramedic, if:

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

  4  part I of chapter 464.

  5         Section 30.  Subsection (11) of section 408.706,

  6  Florida Statutes, is amended to read:

  7         408.706  Community health purchasing alliances;

  8  accountable health partnerships.--

  9         (11)  The ability to recruit and retain alliance

10  district health care providers in its provider network. For

11  provider networks initially formed in an alliance district

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

13  make offers as to provider participation in its provider

14  network to relevant alliance district health care providers

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

16  provider who is made an offer may participate in an

17  accountable health partnership as long as the provider abides

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

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

20  price negotiated by the accountable health partnership, and

21  meets all of the accountable health partnership's

22  qualifications for participation in its provider networks

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

24  purposes of this subsection, "alliance district health care

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

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

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

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

29  accountable health partnership.

30         Section 31.  Paragraph (d) of subsection (12) of

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

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  1         409.908  Reimbursement of Medicaid providers.--Subject

  2  to specific appropriations, the agency shall reimburse

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

  4  according to methodologies set forth in the rules of the

  5  agency and in policy manuals and handbooks incorporated by

  6  reference therein.  These methodologies may include fee

  7  schedules, reimbursement methods based on cost reporting,

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

  9  and other mechanisms the agency considers efficient and

10  effective for purchasing services or goods on behalf of

11  recipients.  Payment for Medicaid compensable services made on

12  behalf of Medicaid eligible persons is subject to the

13  availability of moneys and any limitations or directions

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

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

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

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

18  making any other adjustments necessary to comply with the

19  availability of moneys and any limitations or directions

20  provided for in the General Appropriations Act, provided the

21  adjustment is consistent with legislative intent.

22         (12)

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

24  to physicians for providing total obstetrical services to

25  Medicaid recipients, which include prenatal, delivery, and

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

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

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

29  reimbursement to physicians working in Regional Perinatal

30  Intensive Care Centers designated pursuant to chapter 383, for

31  services to certain pregnant Medicaid recipients with a high

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

  2  neonatal care groupings and rates established by the agency.

  3  Nurse midwives licensed under part I of chapter 464 or

  4  midwives licensed under chapter 467 shall be reimbursed at no

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

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

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

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

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

10  agency shall by rule determine a prorated payment for

11  obstetrical services in cases where only part of the total

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

13  Department of Health shall adopt rules for appropriate

14  insurance coverage for midwives licensed under chapter 467.

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

16  reactivation of an inactive license for midwives licensed

17  under chapter 467, such licensees shall submit proof of

18  coverage with each application.

19         Section 32.  Subsection (1) of section 415.1085,

20  Florida Statutes, is amended to read:

21         415.1085  Photographs, medical examinations, and X rays

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

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

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

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

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

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

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

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

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

31  if the aged person or disabled adult verbally complains or

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  1  otherwise exhibits distress as a result of injury through

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

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

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

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

  6  physician or any emergency department in a hospital or health

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

  8  necessary by the examining physician.  Such examinations may

  9  be performed by an advanced registered nurse practitioner

10  licensed pursuant to part I of chapter 464.  Medical

11  examinations performed and X rays taken pursuant to this

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

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

14  are determined to be financially able to pay; or, if neither

15  is available, the department shall pay the costs within

16  available emergency services funds.

17         Section 33.  Paragraph (a) of subsection (1) of section

18  455.597 Florida Statutes, is amended to read:

19         455.597  Requirement for instruction on domestic

20  violence.--

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

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

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

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

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

26  741.28, as part of biennial relicensure or recertification.

27  The course shall consist of information on the number of

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

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

30  be perpetrators of domestic violence, screening procedures for

31  determining whether a patient has any history of being either

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  1  a victim or a perpetrator of domestic violence, and

  2  instruction on how to provide such patients with information

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

  4  community, such as domestic violence centers and other

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

  6  counseling, batterer counseling, or child protection services.

  7         Section 34.  Subsection (1) of section 455.604, Florida

  8  Statutes, is amended to read:

  9         455.604  Requirement for instruction for certain

10  licensees on human immunodeficiency virus and acquired immune

11  deficiency syndrome.--

12         (1)  The appropriate board shall require each person

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

14  459; chapter 460; chapter 461; chapter 463; part I of chapter

15  464; chapter 465; chapter 466; part II, part III, part V, or

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

17  educational course, approved by the board, on human

18  immunodeficiency virus and acquired immune deficiency syndrome

19  as part of biennial relicensure or recertification. The course

20  shall consist of education on the modes of transmission,

21  infection control procedures, clinical management, and

22  prevention of human immunodeficiency virus and acquired immune

23  deficiency syndrome. Such course shall include information on

24  current Florida law on acquired immune deficiency syndrome and

25  its impact on testing, confidentiality of test results,

26  treatment of patients, and any protocols and procedures

27  applicable to human immunodeficiency virus counseling and

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

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

30  and 384.25.

31

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  1         Section 35.  Paragraph (a) of subsection (2) of section

  2  455.667, Florida Statutes, is amended to read:

  3         455.667  Ownership and control of patient records;

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

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

  6  owner," "health care practitioner," and "health care

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

  8  persons or entities; furthermore, the following persons or

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

10  but are authorized under the confidentiality and disclosure

11  requirements of this section to maintain those documents

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

13  or regulated:

14         (a)  Certified nursing assistants regulated under part

15  II of chapter 464 s. 400.211.

16         Section 36.  Section 455.677, Florida Statutes, is

17  amended to read:

18         455.677  Disposition of records of deceased

19  practitioners or practitioners relocating or terminating

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

21  457, chapter 458, chapter 459, chapter 460, chapter 461,

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

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

24  491, and the department under the provisions of chapter 462,

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

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

27  practitioners which are in existence at the time the

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

29  longer available to patients and which records pertain to the

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

31  records be retained for at least 2 years after the

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

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

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

  4  the practitioner.

  5         Section 37.  Paragraph (b) of subsection (2) of section

  6  455.694, Florida Statutes, is amended to read:

  7         455.694  Financial responsibility requirements for

  8  certain health care practitioners.--

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

10  application by practitioners meeting any of the following

11  criteria:

12         (b)  Any person whose license or certification has

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

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

15  not practicing in this state.  Any person applying for

16  reactivation of a license must show either that such licensee

17  maintained tail insurance coverage which provided liability

18  coverage for incidents that occurred on or after October 1,

19  1993, or the initial date of licensure in this state,

20  whichever is later, and incidents that occurred before the

21  date on which the license became inactive; or such licensee

22  must submit an affidavit stating that such licensee has no

23  unsatisfied medical malpractice judgments or settlements at

24  the time of application for reactivation.

25         Section 38.  Subsection (2) of section 455.707, Florida

26  Statutes, is amended to read:

27         455.707  Treatment programs for impaired

28  practitioners.--

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

30  practitioner consultants as recommended by the committee.  A

31  consultant shall be a licensee or recovered licensee under the

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  1  jurisdiction of the Division of Medical Quality Assurance

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

  3  practitioner or recovered practitioner licensed under chapter

  4  458, chapter 459, or part I of chapter 464.  The consultant

  5  shall assist the probable cause panel and department in

  6  carrying out the responsibilities of this section.  This shall

  7  include working with department investigators to determine

  8  whether a practitioner is, in fact, impaired.

  9         Section 39.  Subsection (2) of section 458.348, Florida

10  Statutes, is amended to read:

11         458.348  Formal supervisory relationships, standing

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

13         (2)  ESTABLISHMENT OF STANDARDS BY JOINT

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

15  shall determine minimum standards for the content of

16  established protocols pursuant to which an advanced registered

17  nurse practitioner may perform medical acts identified and

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

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

20  minimum standards for supervision of such acts by the

21  physician, unless the joint committee determines that any act

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

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

24  standards of medical care and shall take into account the

25  special problems of medically underserved areas. The standards

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

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

28  carrying out their responsibilities pursuant to part I of

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

30  shall have disciplinary powers over the licensees of the other

31  board.

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  1         Section 40.  Section 464.001, Florida Statutes, is

  2  amended to read:

  3         464.001  Short title.--This part may be cited chapter

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

  5         Section 41.  Section 464.002, Florida Statutes, is

  6  amended to read:

  7         464.002  Purpose.--The sole legislative purpose in

  8  enacting this part chapter is to ensure that every nurse

  9  practicing in this state meets minimum requirements for safe

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

11  below minimum competency or who otherwise present a danger to

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

13         Section 42.  Section 464.003, Florida Statutes, is

14  amended to read:

15         464.003  Definitions.--As used in this part chapter:

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

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

18  this chapter.

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

20  performance of those acts requiring substantial specialized

21  knowledge, judgment, and nursing skill based upon applied

22  principles of psychological, biological, physical, and social

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

24         1.  The observation, assessment, nursing diagnosis,

25  planning, intervention, and evaluation of care; health

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

27  the promotion of wellness, maintenance of health, and

28  prevention of illness of others.

29         2.  The administration of medications and treatments as

30  prescribed or authorized by a duly licensed practitioner

31

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  1  authorized by the laws of this state to prescribe such

  2  medications and treatments.

  3         3.  The supervision and teaching of other personnel in

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

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

  6  performance of selected acts, including the administration of

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

  8  or infirm and the promotion of wellness, maintenance of

  9  health, and prevention of illness of others under the

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

11  licensed osteopathic physician, a licensed podiatric

12  physician, or a licensed dentist.

13

14  The professional nurse and the practical nurse shall be

15  responsible and accountable for making decisions that are

16  based upon the individual's educational preparation and

17  experience in nursing.

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

19  in addition to the practice of professional nursing, the

20  performance of advanced-level nursing acts approved by the

21  board which, by virtue of postbasic specialized education,

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

23  advanced registered nurse practitioner.  Within the context of

24  advanced or specialized nursing practice, the advanced

25  registered nurse practitioner may perform acts of nursing

26  diagnosis and nursing treatment of alterations of the health

27  status.  The advanced registered nurse practitioner may also

28  perform acts of medical diagnosis and treatment, prescription,

29  and operation which are identified and approved by a joint

30  committee composed of three members appointed by the Board of

31  Nursing, two of whom shall be advanced registered nurse

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  1  practitioners; three members appointed by the Board of

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

  3  advanced registered nurse practitioners; and the secretary of

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

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

  6  years unless a shorter term is required to establish or

  7  maintain staggered terms. The Board of Nursing shall adopt

  8  rules authorizing the performance of any such acts approved by

  9  the joint committee. Unless otherwise specified by the joint

10  committee, such acts shall be performed under the general

11  supervision of a practitioner licensed under chapter 458,

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

13  protocols which identify the medical acts to be performed and

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

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

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

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

18  evaluation of physical or mental conditions, behaviors, signs

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

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

21  and reactions represent a deviation from normal.

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

23  implementation of a nursing regimen for the care and comfort

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

25  restoration, and maintenance of health.

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

27  this state to practice professional nursing.

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

29  licensed in this state to practice practical nursing.

30

31

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

  2  person licensed in this state to practice professional nursing

  3  and certified in advanced or specialized nursing practice.

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

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

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

  7  of nurses.

  8         Section 43.  Section 464.006, Florida Statutes, is

  9  amended to read:

10         464.006  Authority to make rules.--The board of Nursing

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

12  120.54 to implement the provisions of this part chapter

13  conferring duties upon it.

14         Section 44.  Subsection (3) of section 464.009, Florida

15  Statutes, is amended to read:

16         464.009  Licensure by endorsement.--

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

18  endorsement to any applicant who is under investigation in

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

20  this part chapter until such time as the investigation is

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

22  apply.

23         Section 45.  Paragraphs (a) and (d) of subsection (1)

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

25  Florida Statutes, are amended to read:

26         464.016  Violations and penalties.--

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

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

29  775.083, or s. 775.084:

30

31

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  1         (a)  Practicing advanced or specialized, professional

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

  3  holding an active license or certificate to do so.

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

  5  certificate under this part chapter by misleading statements

  6  or knowing misrepresentation.

  7         (2)  Each of the following acts constitutes a

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

  9  775.082 or s. 775.083:

10         (b)  Knowingly concealing information relating to

11  violations of this part chapter.

12         Section 46.  Paragraphs (i), (k), and (l) of subsection

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

14  are amended to read:

15         464.018  Disciplinary actions.--

16         (1)  The following acts shall be grounds for

17  disciplinary action set forth in this section:

18         (i)  Engaging or attempting to engage in the

19  possession, sale, or distribution of controlled substances as

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

21  purposes authorized by this part chapter.

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

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

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

25  licensee verifies that such person is actively participating

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

27  mental condition, the licensee is required to report such

28  person only to an impaired professionals consultant.

29         (l)  Knowingly violating any provision of this part

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

31  order of the board or department previously entered in a

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  1  disciplinary proceeding or failing to comply with a lawfully

  2  issued subpoena of the department.

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

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

  5  occasions of violations of this part chapter relating to the

  6  use of drugs or narcotics, which offenses involved the

  7  diversion of drugs or narcotics from patients to personal use

  8  or sale.

  9         Section 47.  Subsections (1), (2), and (3) of section

10  464.019, Florida Statutes, are amended to read:

11         464.019  Approval of nursing programs.--

12         (1)  An institution desiring to conduct an approved

13  program for the education of professional or practical nurses

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

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

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

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

18  board, not to exceed $1,000.

19         (2)  The board shall adopt rules regarding educational

20  objectives, faculty qualifications, curriculum guidelines,

21  administrative procedures, and clinical training as are

22  necessary to ensure that approved programs graduate nurses

23  capable of competent practice under this part act.

24         (3)  The department shall survey each institution

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

26  If the board is satisfied that the program meets the

27  requirements of this part chapter and rules pursuant thereto,

28  it shall certify the program for approval and the department

29  shall approve the program.

30         Section 48.  Section 464.022, Florida Statutes, is

31  amended to read:

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  1         464.022  Exceptions.--No provision of this part chapter

  2  shall be construed to prohibit:

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

  4  family without compensation, the incidental care of the sick

  5  by domestic servants, or the incidental care of

  6  noninstitutionalized persons by a surrogate family.

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

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

  9  approved schools of nursing.

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

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

12  licensing examination for which they are eligible following

13  graduation, provided they practice under direct supervision of

14  a registered professional nurse.  The board shall by rule

15  define what constitutes direct supervision.

16         (5)  The rendering of services by nursing assistants

17  acting under the direct supervision of a registered

18  professional nurse.

19         (6)  Any nurse practicing in accordance with the

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

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

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

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

24  Church of Christ Scientist.

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

26  licensed attendant of another state who is employed by the

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

28  thereof, while in the discharge of official duties.

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

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

31  days after furnishing to the employer satisfactory evidence of

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  1  current licensure in another state and having submitted proper

  2  application and fees to the board for licensure prior to

  3  employment.  The board may extend this time for administrative

  4  purposes when necessary.

  5         (9)  The rendering of nursing services on a

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

  7  services directly to a nurse rendering such services by any

  8  government program, commercial insurance company, hospital or

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

10         (10)  The establishment of an independent practice by

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

12  nursing services within the scope of the nursing license.

13         (11)  The furnishing of hemodialysis treatments in a

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

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

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

17  registered nurse who is licensed pursuant to this part chapter

18  and who has dialysis training and experience.

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

20  nurse of another state whose employment requires the nurse to

21  accompany and care for a patient temporarily residing in this

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

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

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

25  standing physician orders and current medical status of the

26  patient available, and prearrangements with the appropriate

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

28  case the patient needs placement in an inpatient setting.

29         (13)  The practice of nursing by individuals enrolled

30  in board-approved remedial courses.

31

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  1         Section 49.  Section 464.023, Florida Statutes, is

  2  amended to read:

  3         464.023  Saving clauses.--

  4         (1)  No judicial or administrative proceeding pending

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

  6  reenactment of this part chapter.

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

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

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

10  or certificate shall be renewed in accordance with the

11  provisions of this part act.

12         Section 50.  Subsection (3) of section 464.027, Florida

13  Statutes, is amended to read:

14         464.027  Registered nurse first assistant.--

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

16  assistant is any person who:

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

18  chapter;

19         (b)  Is certified in perioperative nursing; and

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

21  completed, a recognized program.

22         Section 51.  Subsection (6) of section 466.003, Florida

23  Statutes, is amended to read:

24         466.003  Definitions.--As used in this chapter:

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

26  dental hygienist, who, under the supervision and authorization

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

28  patient. This term shall not include a certified registered

29  nurse anesthetist licensed under part I of chapter 464.

30         Section 52.  Subsection (2) of section 467.003, Florida

31  Statutes, is amended to read:

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  1         467.003  Definitions.--As used in this chapter, unless

  2  the context otherwise requires:

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

  4  licensed as an advanced registered nurse practitioner under

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

  6  midwifery by the American College of Nurse Midwives.

  7         Section 53.  Paragraph (a) of subsection (2) of section

  8  467.0125, Florida Statutes, is amended to read:

  9         467.0125  Licensure by endorsement.--

10         (2)  The department may issue a temporary certificate

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

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

13  with the following restrictions:

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

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

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

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

18  certified nurse midwife licensed pursuant to part I of chapter

19  464, or a midwife licensed under this chapter, who has a

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

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

22  areas designated by the United States Department of Health and

23  Human Services.

24         Section 54.  Paragraph (e) of subsection (2) of section

25  467.203, Florida Statutes, is amended to read:

26         467.203  Disciplinary actions; penalties.--

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

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

29  order imposing one or more of the following penalties:

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

31  period of time and subject to such conditions as the

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  1  department may specify, including requiring the midwife to

  2  submit to treatment; undertake further relevant education or

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

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

  5  licensed under part I of chapter 464.

  6         Section 55.  Paragraph (a) of subsection (1) of section

  7  468.505, Florida Statutes, is amended to read:

  8         468.505  Exemptions; exceptions.--

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

10  prohibiting or restricting the practice, services, or

11  activities of:

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

13  chapter 458, chapter 459, chapter 460, chapter 461, chapter

14  462, chapter 463, part I of chapter 464, chapter 465, chapter

15  466, chapter 480, chapter 490, or chapter 491, when engaging

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

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

18  supervision of the licensee when rendering services within the

19  scope of the profession or occupation of the licensee.

20         Section 56.  Subsection (7) of section 483.041, Florida

21  Statutes, is amended to read:

22         483.041  Definitions.--As used in this part, the term:

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

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

25  dentist licensed under chapter 466; a person licensed under

26  chapter 462; or an advanced registered nurse practitioner

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

28  practitioner from another state licensed under similar

29  statutes who orders examinations on materials or specimens for

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

31  same state as the requesting licensed practitioner.

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  1         Section 57.  Subsection (5) of section 483.801, Florida

  2  Statutes, is amended to read:

  3         483.801  Exemptions.--This part applies to all clinical

  4  laboratories and clinical laboratory personnel within this

  5  state, except:

  6         (5)  Advanced registered nurse practitioners licensed

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

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

  9  setting.

10         Section 58.  Paragraph (a) of subsection (4) of section

11  491.0112, Florida Statutes, is amended to read:

12         491.0112  Sexual misconduct by a psychotherapist;

13  penalties.--

14         (4)  For the purposes of this section:

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

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

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

18  who provides or purports to provide treatment, diagnosis,

19  assessment, evaluation, or counseling of mental or emotional

20  illness, symptom, or condition.

21         Section 59.  Subsection (5) of section 550.24055,

22  Florida Statutes, is amended to read:

23         550.24055  Use of controlled substances or alcohol

24  prohibited; testing of certain occupational licensees;

25  penalty; evidence of test or action taken and admissibility

26  for criminal prosecution limited.--

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

28  use of controlled or chemical substances that are prescribed

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

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

31  of chapter 464, or chapter 466.

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  1         Section 60.  Paragraph (h) of subsection (4) of section

  2  627.351, Florida Statutes, is amended to read:

  3         627.351  Insurance risk apportionment plans.--

  4         (4)  MEDICAL MALPRACTICE RISK APPORTIONMENT.--

  5         (h)  As used in this subsection:

  6         1.  "Health care provider" means hospitals licensed

  7  under chapter 395; physicians licensed under chapter 458;

  8  osteopathic physicians licensed under chapter 459; podiatric

  9  physicians licensed under chapter 461; dentists licensed under

10  chapter 466; chiropractic physicians licensed under chapter

11  460; naturopaths licensed under chapter 462; nurses licensed

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

13  467; clinical laboratories registered under chapter 483;

14  physician assistants licensed under chapter 458 or chapter

15  459; physical therapists and physical therapist assistants

16  licensed under chapter 486; health maintenance organizations

17  certificated under part I of chapter 641; ambulatory surgical

18  centers licensed under chapter 395; other medical facilities

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

20  industrial clinics, and renal dialysis facilities; or

21  professional associations, partnerships, corporations, joint

22  ventures, or other associations for professional activity by

23  health care providers.

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

25  primary purpose of which is to provide human medical

26  diagnostic services or a facility providing nonsurgical human

27  medical treatment, to which facility the patient is admitted

28  and from which facility the patient is discharged within the

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

30  hospital.  However, a facility existing for the primary

31  purpose of performing terminations of pregnancy or an office

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  1  maintained by a physician or dentist for the practice of

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

  3  facility."

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

  5  under chapter 395, health maintenance organization

  6  certificated under part I of chapter 641, ambulatory surgical

  7  center licensed under chapter 395, or other medical facility

  8  as defined in subparagraph 2.

  9         Section 61.  Paragraph (b) of subsection (1) of section

10  627.357, Florida Statutes, is amended to read:

11         627.357  Medical malpractice self-insurance.--

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

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

14         1.  Hospital licensed under chapter 395.

15         2.  Physician licensed, or physician assistant

16  licensed, under chapter 458.

17         3.  Osteopathic physician or physician assistant

18  licensed under chapter 459.

19         4.  Podiatric physician licensed under chapter 461.

20         5.  Health maintenance organization certificated under

21  part I of chapter 641.

22         6.  Ambulatory surgical center licensed under chapter

23  395.

24         7.  Chiropractic physician licensed under chapter 460.

25         8.  Psychologist licensed under chapter 490.

26         9.  Optometrist licensed under chapter 463.

27         10.  Dentist licensed under chapter 466.

28         11.  Pharmacist licensed under chapter 465.

29         12.  Registered nurse, licensed practical nurse, or

30  advanced registered nurse practitioner licensed or registered

31  under part I of chapter 464.

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  1         13.  Other medical facility.

  2         14.  Professional association, partnership,

  3  corporation, joint venture, or other association established

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

  5  8., 9., 10., 11., and 12. for professional activity.

  6         Section 62.  Subsection (6) of section 627.9404,

  7  Florida Statutes, is amended to read:

  8         627.9404  Definitions.--For the purposes of this part:

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

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

11  psychotherapist licensed under chapter 490 or chapter 491, or

12  any individual who meets any requirements prescribed by rule

13  by the department.

14         Section 63.  Subsection (21) of section 641.31, Florida

15  Statutes, is amended to read:

16         641.31  Health maintenance contracts.--

17         (21)  Notwithstanding any other provision of law,

18  health maintenance policies or contracts which provide

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

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

21  certified registered nurse anesthetist licensed pursuant to

22  part I of chapter 464.

23         Section 64.  Subsection (8) of section 766.101, Florida

24  Statutes, is amended to read:

25         766.101  Medical review committee, immunity from

26  liability.--

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

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

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

30  466 shall arise against another person licensed pursuant to

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

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

  2  information to a duly appointed medical review committee, to

  3  an internal risk management program established under s.

  4  395.0197, to the Department of Business and Professional

  5  Regulation, or to the appropriate regulatory board if the

  6  information furnished concerns patient care at a facility

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

  8  provide health care services, if the information is not

  9  intentionally fraudulent, and if the information is within the

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

11  However, if such information is otherwise available from

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

13  civil action merely because it was presented during a

14  proceeding of the committee, department, or board.

15         Section 65.  Subsection (2) of section 766.110, Florida

16  Statutes, is amended to read:

17         766.110  Liability of health care facilities.--

18         (2)  Every hospital licensed under chapter 395 may

19  carry liability insurance or adequately insure itself in an

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

21  annual aggregate to cover all medical injuries to patients

22  resulting from negligent acts or omissions on the part of

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

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

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

26  hospital's medical staff meets the financial responsibility

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

28  coverage limits are not less than the minimum limits

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

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

31  self-insurance coverage continuously to members of its medical

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  1  staff for activities both inside and outside of the hospital

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

  3  casualty insurance may make available, but shall not be

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

  5  an equitable and pro rata basis the following professional

  6  health care providers for a portion of the total hospital

  7  insurance cost for this coverage:  physicians licensed under

  8  chapter 458, osteopathic physicians licensed under chapter

  9  459, podiatric physicians licensed under chapter 461, dentists

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

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

12  amount to be applied against any individual health care

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

14  contract.  The legislative intent in providing for the

15  deductible to be applied to individual health care providers

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

17  individual health care provider the incentive to avoid the

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

19  citizens of this state receive the highest quality health care

20  obtainable.

21         Section 66.  Paragraph (d) of subsection (3) of section

22  766.1115, Florida Statutes, is amended to read:

23         766.1115  Health care providers; creation of agency

24  relationship with governmental contractors.--

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

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

27         1.  A birth center licensed under chapter 383.

28         2.  An ambulatory surgical center licensed under

29  chapter 395.

30         3.  A hospital licensed under chapter 395.

31

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  1         4.  A physician or physician assistant licensed under

  2  chapter 458.

  3         5.  An osteopathic physician or osteopathic physician

  4  assistant licensed under chapter 459.

  5         6.  A chiropractic physician licensed under chapter

  6  460.

  7         7.  A podiatric physician licensed under chapter 461.

  8         8.  A registered nurse, nurse midwife, licensed

  9  practical nurse, or advanced registered nurse practitioner

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

11  facility which employs nurses licensed or registered under

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

13  delivered under this section.

14         9.  A midwife licensed under chapter 467.

15         10.  A health maintenance organization certificated

16  under part I of chapter 641.

17         11.  A health care professional association and its

18  employees or a corporate medical group and its employees.

19         12.  Any other medical facility the primary purpose of

20  which is to deliver human medical diagnostic services or which

21  delivers nonsurgical human medical treatment, and which

22  includes an office maintained by a provider.

23         13.  A dentist or dental hygienist licensed under

24  chapter 466.

25         14.  Any other health care professional, practitioner,

26  provider, or facility under contract with a governmental

27  contractor.

28

29  The term includes any nonprofit corporation qualified as

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

31  Internal Revenue Code which delivers health care services

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  1  provided by licensed professionals listed in this paragraph,

  2  any federally funded community health center, and any

  3  volunteer corporation or volunteer health care provider that

  4  delivers health care services.

  5         Section 67.  Subsection (1) of section 877.111, Florida

  6  Statutes, is amended to read:

  7         877.111  Inhalation, ingestion, possession, sale,

  8  purchase, or transfer of harmful chemical substances;

  9  penalties.--

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

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

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

13  trichloroethylene, acetone, toluene, ethyl acetate, methyl

14  ethyl ketone, trichloroethane, isopropanol, methyl isobutyl

15  ketone, ethylene glycol monomethyl ether acetate,

16  cyclohexanone, nitrous oxide, diethyl ether, alkyl nitrites

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

18  inducing a condition of intoxication or which distorts or

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

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

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

22  injury by a practitioner licensed under chapter 458, chapter

23  459, part I of chapter 464, or chapter 466 or to beverages

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

25  chapter 563, chapter 564, or chapter 565.

26         Section 68.  Subsection (6) of section 945.602, Florida

27  Statutes, is amended to read:

28         945.602  State of Florida Correctional Medical

29  Authority; creation; members.--

30

31

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

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

  3  years' experience in the practice of nursing.

  4         Section 69.  Subsection (2) of section 960.28, Florida

  5  Statutes, is amended to read:

  6         960.28  Payment for victims' initial forensic physical

  7  examinations.--

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

  9  department shall pay for medical expenses connected with an

10  initial forensic physical examination of a victim who reports

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

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

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

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

15  Crime Victims' Services Office for the purposes of this

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

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

18  physical examination unless the law enforcement officer

19  certifies in writing that the initial forensic physical

20  examination is needed to aid in the investigation of an

21  alleged sexual offense and that the claimant is the alleged

22  victim of the offense. The department shall develop and

23  maintain separate protocols for the initial forensic physical

24  examination of adults and children. Payment under this section

25  is limited to medical expenses connected with the initial

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

27  medical provider using an examiner qualified under part I of

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

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

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

31  initial forensic physical examination associated with the

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

  2  directly or indirectly, the cost of an initial forensic

  3  physical examination performed in accordance with this

  4  section.

  5         Section 70.  Subsection (36) of section 984.03, Florida

  6  Statutes, is amended to read:

  7         984.03  Definitions.--When used in this chapter, the

  8  term:

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

10  physician licensed under chapter 458, an osteopathic physician

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

12  chapter 464, a physician assistant licensed under chapter 458

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

14         Section 71.  Subsection (37) of section 985.03, Florida

15  Statutes, is amended to read:

16         985.03  Definitions.--When used in this chapter, the

17  term:

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

19  physician licensed under chapter 458, an osteopathic physician

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

21  chapter 464, a physician assistant licensed under chapter 458

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

23         Section 72.  Section 455.557, Florida Statutes, is

24  amended to read:

25         455.557  Standardized credentialing for health care

26  practitioners.--

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

28  efficient and effective health care practitioner credentialing

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

30  recognizes that health care practitioner credentialing

31  activities have increased significantly as a result of health

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  1  care reform and recent changes in health care delivery and

  2  reimbursement systems. Moreover, the resulting duplication of

  3  health care practitioner credentialing activities is

  4  unnecessarily costly and cumbersome for both the practitioner

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

  6  the intent of this section that a credentials collection

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

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

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

10  modifications thereto. Participation under this section shall

11  initially include those individuals licensed under chapter

12  458, chapter 459, chapter 460, or chapter 461, or s. 464.012.

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

14  applicable board, include other professions under the

15  jurisdiction of the Division of Medical Quality Assurance in

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

17  455.565 or s. 455.56503.

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

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

20  Credentials Advisory Council.

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

22  means approved by a quality assessment program, from the

23  National Committee for Quality Assurance, the Joint Commission

24  on Accreditation of Healthcare Organizations, the American

25  Accreditation HealthCare Commission/URAC, or any such other

26  nationally recognized and accepted organization authorized by

27  the department, used to assess and certify any credentials

28  verification program, entity, or organization that verifies

29  the credentials of any health care practitioner.

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

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

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  1  professional education, professional training, licensure,

  2  current Drug Enforcement Administration certification, social

  3  security number, specialty board certification, Educational

  4  Commission for Foreign Medical Graduates certification,

  5  hospital or other institutional affiliations, evidence of

  6  professional liability coverage or evidence of financial

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

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

  9  settlements, final disciplinary action reported pursuant to s.

10  455.565(1)(a)8. or s. 455.56503(1)(a)8., and Medicare or

11  Medicaid sanctions.

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

13  process of assessing and verifying the qualifications of a

14  licensed health care practitioner or applicant for licensure

15  as a health care practitioner.

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

17  any organization certified or accredited as a credentials

18  verification organization.

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

20  Division of Medical Quality Assurance.

21         (f)(g)  "Designated credentials verification

22  organization" means the credentials verification organization

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

24  health care practitioner chooses to make such a designation.

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

26  means certification issued by the Drug Enforcement

27  Administration for purposes of administration or prescription

28  of controlled substances. Submission of such certification

29  under this section must include evidence that the

30  certification is current and must also include all current

31  addresses to which the certificate is issued.

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

  2         1.  Any health care facility or other health care

  3  organization licensed or certified to provide approved medical

  4  and allied health services in this state;

  5         2.  Any entity licensed by the Department of Insurance

  6  as a prepaid health care plan or health maintenance

  7  organization or as an insurer to provide coverage for health

  8  care services through a network of providers; or

  9         3.  Any accredited medical school in this state.

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

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

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

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

14  licensed or applying for licensure under a chapter

15  subsequently made subject to this section by the department

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

17  registered or applying for registration pursuant to s. 458.345

18  or s. 459.021.

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

20  means each hospital or other institution for which the health

21  care practitioner or applicant has provided medical services.

22  Submission of such information under this section must

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

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

25  the health care practitioner or applicant at that hospital or

26  institution, and the dates of affiliation with that hospital

27  or institution.

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

29  organization that awards accreditation or certification to

30  hospitals, managed care organizations, credentials

31  verification organizations, or other health care

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

  2  Commission on Accreditation of Healthcare Organizations, the

  3  American Accreditation HealthCare Commission/URAC, and the

  4  National Committee for Quality Assurance.

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

  6  residency, or fellowship relating to the profession for which

  7  the health care practitioner is licensed or seeking licensure.

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

  9  certification in a specialty issued by a specialty board

10  recognized by the board in this state that regulates the

11  profession for which the health care practitioner is licensed

12  or seeking licensure.

13         (3)  STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.--

14         (a)  Every health care practitioner shall:

15         1.  Report all core credentials data to the department

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

17  designating a credentials verification organization to submit

18  the data or by submitting the data directly.

19         2.  Notify the department within 45 days of any

20  corrections, updates, or modifications to the core credentials

21  data either through his or her designated credentials

22  verification organization or by submitting the data directly.

23  Corrections, updates, and modifications to the core

24  credentials data provided the department under this section

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

26  or s. 455.56503(3) related to profiling.

27         (b)  The department shall:

28         1.  Maintain a complete, current file of core

29  credentials data on each health care practitioner, which shall

30  include all updates provided in accordance with subparagraph

31  (a)2.

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  1         2.  Release the core credentials data that is otherwise

  2  confidential or exempt from the provisions of chapter 119 and

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

  4  corrections, updates, and modifications thereto, if authorized

  5  by the health care practitioner.

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

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

  8  and operating costs, pursuant to the requirements of chapter

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

10  advisory council.

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

12  standardized forms to be used by the health care practitioner

13  or designated credentials verification organization for the

14  initial reporting of core credentials data, for the health

15  care practitioner to authorize the release of core credentials

16  data, and for the subsequent reporting of corrections,

17  updates, and modifications thereto.

18         5.  Establish a Credentials Advisory Council,

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

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

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

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

23  required to achieve staggering, such appointments shall be for

24  4-year staggered terms, with one 4-year reappointment, as

25  applicable. Three members shall represent hospitals, and two

26  members shall represent health maintenance organizations. One

27  member shall represent health insurance entities. One member

28  shall represent the credentials verification industry. Two

29  members shall represent physicians licensed under chapter 458.

30  One member shall represent osteopathic physicians licensed

31  under chapter 459. One member shall represent chiropractic

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  1  physicians licensed under chapter 460. One member shall

  2  represent podiatric physicians licensed under chapter 461.

  3         (c)  A registered credentials verification organization

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

  5  health care practitioner to comply with the requirements of

  6  subparagraph (a)2. A designated credentials verification

  7  organization shall:

  8         1.  Timely comply with the requirements of subparagraph

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

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

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

12  without the authorization of the practitioner.

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

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

15  and to approve or deny an application for hospital staff

16  membership, clinical privileges, or managed care network

17  participation.

18         (4)  DUPLICATION OF DATA PROHIBITED.--

19         (a)  A health care entity or credentials verification

20  organization is prohibited from collecting or attempting to

21  collect duplicate core credentials data from any health care

22  practitioner if the information is available from the

23  department. This section shall not be construed to restrict

24  the right of any health care entity or credentials

25  verification organization to collect additional information

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

27  core credentials data file. This section shall not be

28  construed to prohibit a health care entity or credentials

29  verification organization from obtaining all necessary

30  attestation and release form signatures and dates.

31

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

  2  state which credentials health care practitioners may not

  3  collect or attempt to collect duplicate core credentials data

  4  from any individual health care practitioner if the

  5  information is already available from the department. This

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

  7  such state agency to request additional information not

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

  9  necessary for the agency's specific credentialing purposes.

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

11  verification organization that does business in this state

12  must be fully accredited or certified as a credentials

13  verification organization by a national accrediting

14  organization as specified in paragraph (2)(a)(b) and must

15  register with the department. The department may charge a

16  reasonable registration fee, set in consultation with the

17  advisory council, not to exceed an amount sufficient to cover

18  its actual expenses in providing and enforcing such

19  registration. The department shall establish by rule for

20  biennial renewal of such registration. Failure by a registered

21  credentials verification organization to maintain full

22  accreditation or certification, to provide data as authorized

23  by the health care practitioner, to report to the department

24  changes, updates, and modifications to a health care

25  practitioner's records within the time period specified in

26  subparagraph (3)(a)2., or to comply with the prohibition

27  against collection of duplicate core credentials data from a

28  practitioner may result in denial of an application for

29  renewal of registration or in revocation or suspension of a

30  registration.

31

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  1         (6)  LIABILITY.--No civil, criminal, or administrative

  2  action may be instituted, and there shall be no liability,

  3  against any registered credentials verification organization

  4  or health care entity on account of its reliance on any data

  5  obtained directly from the department.

  6         (7)  LIABILITY INSURANCE REQUIREMENTS.--Each

  7  credentials verification organization doing business in this

  8  state shall maintain liability insurance appropriate to meet

  9  the certification or accreditation requirements established in

10  this section.

11         (8)  RULES.--The department, in consultation with the

12  advisory council, shall adopt rules necessary to develop and

13  implement the standardized core credentials data collection

14  program established by this section.

15         (9)  COUNCIL ABOLISHED; DEPARTMENT AUTHORITY.--The

16  council shall be abolished October 1, 1999. After the council

17  is abolished, all duties of the department required under this

18  section to be in consultation with the council may be carried

19  out by the department on its own.

20         Section 73.  Section 455.56503, Florida Statutes, is

21  created to read:

22         455.56503  Advanced registered nurse practitioners;

23  information required for certification.--

24         (1)(a)  Each person who applies for initial

25  certification under s. 464.012 must, at the time of

26  application, and each person certified under s. 464.012 who

27  applies for certification renewal must, in conjunction with

28  the renewal of such certification and under procedures adopted

29  by the Department of Health, and in addition to any other

30  information that may be required from the applicant, furnish

31  the following information to the Department of Health:

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  1         1.  The name of each school or training program that

  2  the applicant has attended, with the months and years of

  3  attendance and the month and year of graduation, and a

  4  description of all graduate professional education completed

  5  by the applicant, excluding any coursework taken to satisfy

  6  continuing education requirements.

  7         2.  The name of each location at which the applicant

  8  practices.

  9         3.  The address at which the applicant will primarily

10  conduct his or her practice.

11         4.  Any certification or designation that the applicant

12  has received from a specialty or certification board that is

13  recognized or approved by the regulatory board or department

14  to which the applicant is applying.

15         5.  The year that the applicant received initial

16  certification and began practicing the profession in any

17  jurisdiction and the year that the applicant received initial

18  certification in this state.

19         6.  Any appointment which the applicant currently holds

20  to the faculty of a school related to the profession and an

21  indication as to whether the applicant has had the

22  responsibility for graduate education within the most recent

23  10 years.

24         7.  A description of any criminal offense of which the

25  applicant has been found guilty, regardless of whether

26  adjudication of guilt was withheld, or to which the applicant

27  has pled guilty or nolo contendere. A criminal offense

28  committed in another jurisdiction which would have been a

29  felony or misdemeanor if committed in this state must be

30  reported. If the applicant indicates that a criminal offense

31  is under appeal and submits a copy of the notice for appeal of

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  1  that criminal offense, the department must state that the

  2  criminal offense is under appeal if the criminal offense is

  3  reported in the applicant's profile. If the applicant

  4  indicates to the department that a criminal offense is under

  5  appeal, the applicant must, within 15 days after the

  6  disposition of the appeal, submit to the department a copy of

  7  the final written order of disposition.

  8         8.  A description of any final disciplinary action

  9  taken within the previous 10 years against the applicant by a

10  licensing or regulatory body in any jurisdiction, by a

11  specialty board that is recognized by the board or department,

12  or by a licensed hospital, health maintenance organization,

13  prepaid health clinic, ambulatory surgical center, or nursing

14  home. Disciplinary action includes resignation from or

15  nonrenewal of staff membership or the restriction of

16  privileges at a licensed hospital, health maintenance

17  organization, prepaid health clinic, ambulatory surgical

18  center, or nursing home taken in lieu of or in settlement of a

19  pending disciplinary case related to competence or character.

20  If the applicant indicates that the disciplinary action is

21  under appeal and submits a copy of the document initiating an

22  appeal of the disciplinary action, the department must state

23  that the disciplinary action is under appeal if the

24  disciplinary action is reported in the applicant's profile.

25         (b)  In addition to the information required under

26  paragraph (a), each applicant for initial certification or

27  certification renewal must provide the information required of

28  licensees pursuant to s. 455.697.

29         (2)  The Department of Health shall send a notice to

30  each person certified under s. 464.012 at the

31  certificateholder's last known address of record regarding the

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  1  requirements for information to be submitted by advanced

  2  registered nurse practitioners pursuant to this section in

  3  conjunction with the renewal of such certificate.

  4         (3)  Each person certified under s. 464.012 who has

  5  submitted information pursuant to subsection (1) must update

  6  that information in writing by notifying the Department of

  7  Health within 45 days after the occurrence of an event or the

  8  attainment of a status that is required to be reported by

  9  subsection (1). Failure to comply with the requirements of

10  this subsection to update and submit information constitutes a

11  ground for disciplinary action under chapter 464 and s.

12  455.624(1)(k). For failure to comply with the requirements of

13  this subsection to update and submit information, the

14  department or board, as appropriate, may:

15         (a)  Refuse to issue a certificate to any person

16  applying for initial certification who fails to submit and

17  update the required information.

18         (b)  Issue a citation to any certificateholder who

19  fails to submit and update the required information and may

20  fine the certificateholder up to $50 for each day that the

21  certificateholder is not in compliance with this subsection.

22  The citation must clearly state that the certificateholder may

23  choose, in lieu of accepting the citation, to follow the

24  procedure under s. 455.621. If the certificateholder disputes

25  the matter in the citation, the procedures set forth in s.

26  455.621 must be followed. However, if the certificateholder

27  does not dispute the matter in the citation with the

28  department within 30 days after the citation is served, the

29  citation becomes a final order and constitutes discipline.

30  Service of a citation may be made by personal service or

31

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  1  certified mail, restricted delivery, to the subject at the

  2  certificateholder's last known address.

  3         (4)(a)  An applicant for initial certification under s.

  4  464.012 must submit a set of fingerprints to the Department of

  5  Health on a form and under procedures specified by the

  6  department, along with payment in an amount equal to the costs

  7  incurred by the Department of Health for a national criminal

  8  history check of the applicant.

  9         (b)  An applicant for renewed certification who has not

10  previously submitted a set of fingerprints to the Department

11  of Health for purposes of certification must submit a set of

12  fingerprints to the department as a condition of the initial

13  renewal of his or her certificate after the effective date of

14  this section. The applicant must submit the fingerprints on a

15  form and under procedures specified by the department, along

16  with payment in an amount equal to the costs incurred by the

17  Department of Health for a national criminal history check.

18  For subsequent renewals, the applicant for renewed

19  certification must only submit information necessary to

20  conduct a statewide criminal history check, along with payment

21  in an amount equal to the costs incurred by the Department of

22  Health for a statewide criminal history check.

23         (c)1.  The Department of Health shall submit the

24  fingerprints provided by an applicant for initial

25  certification to the Florida Department of Law Enforcement for

26  a statewide criminal history check, and the Florida Department

27  of Law Enforcement shall forward the fingerprints to the

28  Federal Bureau of Investigation for a national criminal

29  history check of the applicant.

30         2.  The department shall submit the fingerprints

31  provided by an applicant for the initial renewal of

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  1  certification to the Florida Department of Law Enforcement for

  2  a statewide criminal history check, and the Florida Department

  3  of Law Enforcement shall forward the fingerprints to the

  4  Federal Bureau of Investigation for a national criminal

  5  history check for the initial renewal of the applicant's

  6  certificate after the effective date of this section.

  7         3.  For any subsequent renewal of the applicant's

  8  certificate, the department shall submit the required

  9  information for a statewide criminal history check of the

10  applicant to the Florida Department of Law Enforcement.

11         (d)  Any applicant for initial certification or renewal

12  of certification as an advanced registered nurse practitioner

13  who submits to the Department of Health a set of fingerprints

14  and information required for the criminal history check

15  required under this section shall not be required to provide a

16  subsequent set of fingerprints or other duplicate information

17  required for a criminal history check to the Agency for Health

18  Care Administration, the Department of Juvenile Justice, or

19  the Department of Children and Family Services for employment

20  or licensure with such agency or department, if the applicant

21  has undergone a criminal history check as a condition of

22  initial certification or renewal of certification as an

23  advanced registered nurse practitioner with the Department of

24  Health, notwithstanding any other provision of law to the

25  contrary. In lieu of such duplicate submission, the Agency for

26  Health Care Administration, the Department of Juvenile

27  Justice, and the Department of Children and Family Services

28  shall obtain criminal history information for employment or

29  licensure of persons certified under s. 464.012 by such agency

30  or department from the Department of Health's health care

31  practitioner credentialing system.

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  1         (5)  Each person who is required to submit information

  2  pursuant to this section may submit additional information to

  3  the Department of Health. Such information may include, but is

  4  not limited to:

  5         (a)  Information regarding publications in

  6  peer-reviewed professional literature within the previous 10

  7  years.

  8         (b)  Information regarding professional or community

  9  service activities or awards.

10         (c)  Languages, other than English, used by the

11  applicant to communicate with patients or clients and

12  identification of any translating service that may be

13  available at the place where the applicant primarily conducts

14  his or her practice.

15         (d)  An indication of whether the person participates

16  in the Medicaid program.

17         Section 74.  Section 455.5651, Florida Statutes, is

18  amended to read:

19         455.5651  Practitioner profile; creation.--

20         (1)  Beginning July 1, 1999, the Department of Health

21  shall compile the information submitted pursuant to s. 455.565

22  into a practitioner profile of the applicant submitting the

23  information, except that the Department of Health may develop

24  a format to compile uniformly any information submitted under

25  s. 455.565(4)(b). Beginning July 1, 2001, the Department of

26  Health may compile the information submitted pursuant to s.

27  455.56503 into a practitioner profile of the applicant

28  submitting the information.

29         (2)  On the profile published required under subsection

30  (1), the department shall indicate if the information provided

31  under s. 455.565(1)(a)7. or s. 455.56503(1)(a)7. is not

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  1  corroborated by a criminal history check conducted according

  2  to this subsection. If the information provided under s.

  3  455.565(1)(a)7. or s. 455.56503(1)(a)7. is corroborated by the

  4  criminal history check, the fact that the criminal history

  5  check was performed need not be indicated on the profile. The

  6  department, or the board having regulatory authority over the

  7  practitioner acting on behalf of the department, shall

  8  investigate any information received by the department or the

  9  board when it has reasonable grounds to believe that the

10  practitioner has violated any law that relates to the

11  practitioner's practice.

12         (3)  The Department of Health may include in each

13  practitioner's practitioner profile that criminal information

14  that directly relates to the practitioner's ability to

15  competently practice his or her profession.  The department

16  must include in each practitioner's practitioner profile the

17  following statement:  "The criminal history information, if

18  any exists, may be incomplete; federal criminal history

19  information is not available to the public."

20         (4)  The Department of Health shall include, with

21  respect to a practitioner licensed under chapter 458 or

22  chapter 459, a statement of how the practitioner has elected

23  to comply with the financial responsibility requirements of s.

24  458.320 or s. 459.0085. The department shall include, with

25  respect to practitioners subject to s. 455.694, a statement of

26  how the practitioner has elected to comply with the financial

27  responsibility requirements of that section. The department

28  shall include, with respect to practitioners licensed under

29  chapter 458, chapter 459, or chapter 461, information relating

30  to liability actions which has been reported under s. 455.697

31  or s. 627.912 within the previous 10 years for any paid claim

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  1  that exceeds $5,000. Such claims information shall be reported

  2  in the context of comparing an individual practitioner's

  3  claims to the experience of other practitioners physicians

  4  within the same specialty, or profession if the practitioner

  5  is not a specialist, to the extent such information is

  6  available to the Department of Health. If information relating

  7  to a liability action is included in a practitioner's

  8  practitioner profile, the profile must also include the

  9  following statement:  "Settlement of a claim may occur for a

10  variety of reasons that do not necessarily reflect negatively

11  on the professional competence or conduct of the practitioner

12  physician.  A payment in settlement of a medical malpractice

13  action or claim should not be construed as creating a

14  presumption that medical malpractice has occurred."

15         (5)  The Department of Health may not include

16  disciplinary action taken by a licensed hospital or an

17  ambulatory surgical center in the practitioner profile.

18         (6)  The Department of Health may include in the

19  practitioner's practitioner profile any other information that

20  is a public record of any governmental entity and that relates

21  to a practitioner's ability to competently practice his or her

22  profession.  However, the department must consult with the

23  board having regulatory authority over the practitioner before

24  such information is included in his or her profile.

25         (7)  Upon the completion of a practitioner profile

26  under this section, the Department of Health shall furnish the

27  practitioner who is the subject of the profile a copy of it.

28  The practitioner has a period of 30 days in which to review

29  the profile and to correct any factual inaccuracies in it. The

30  Department of Health shall make the profile available to the

31  public at the end of the 30-day period. The department shall

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  1  make the profiles available to the public through the World

  2  Wide Web and other commonly used means of distribution.

  3         (8)  Making a practitioner profile available to the

  4  public under this section does not constitute agency action

  5  for which a hearing under s. 120.57 may be sought.

  6         Section 75.  Section 455.5653, Florida Statutes, is

  7  amended to read:

  8         455.5653  Practitioner profiles; data

  9  storage.--Effective upon this act becoming a law, the

10  Department of Health must develop or contract for a computer

11  system to accommodate the new data collection and storage

12  requirements under this act pending the development and

13  operation of a computer system by the Department of Health for

14  handling the collection, input, revision, and update of data

15  submitted by physicians as a part of their initial licensure

16  or renewal to be compiled into individual practitioner

17  profiles. The Department of Health must incorporate any data

18  required by this act into the computer system used in

19  conjunction with the regulation of health care professions

20  under its jurisdiction. The department must develop, by the

21  year 2000, a schedule and procedures for each practitioner

22  within a health care profession regulated within the Division

23  of Medical Quality Assurance to submit relevant information to

24  be compiled into a profile to be made available to the public.

25  The Department of Health is authorized to contract with and

26  negotiate any interagency agreement necessary to develop and

27  implement the practitioner profiles. The Department of Health

28  shall have access to any information or record maintained by

29  the Agency for Health Care Administration, including any

30  information or record that is otherwise confidential and

31  exempt from the provisions of chapter 119 and s. 24(a), Art. I

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  1  of the State Constitution, so that the Department of Health

  2  may corroborate any information that practitioners physicians

  3  are required to report under s. 455.565 or s. 455.56503.

  4         Section 76.  Section 455.5654, Florida Statutes, is

  5  amended to read:

  6         455.5654  Practitioner profiles; rules;

  7  workshops.--Effective upon this act becoming a law, the

  8  Department of Health shall adopt rules for the form of a

  9  practitioner profile that the agency is required to prepare.

10  The Department of Health, pursuant to chapter 120, must hold

11  public workshops for purposes of rule development to implement

12  this section. An agency to which information is to be

13  submitted under this act may adopt by rule a form for the

14  submission of the information required under s. 455.565 or s.

15  455.56503.

16         Section 77.  There is appropriated from the Medical

17  Quality Assurance Trust Fund to the Department of Health the

18  sum of $280,000 to implement the provisions of this act.

19         Section 78.  This act shall take effect July 1, 2000.

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