CODING: Words stricken are deletions; words underlined are additions.



                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___

                            CHAMBER ACTION
              Senate                               House
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  4  ______________________________________________________________

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10  ______________________________________________________________

11  Senator Silver moved the following amendment to amendment

12  (850612):

13

14         Senate Amendment (with title amendment) 

15         On page 140, between lines 14 and 15,

16

17  insert:

18         Section 82.  Sections 468.821 through 468.829, Florida

19  Statutes, are renumbered as sections 464.201 through 464.209,

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

21  Statutes, and amended to read:

22         464.201 468.821  Definitions.--As used in this part,

23  the term:

24         (1)  "Approved training program" means:

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

26  or private sector educational center licensed by the

27  Department of Education to implement the basic curriculum for

28  nursing assistants which is approved by the Department of

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

30  responsibility for approval of training programs under this

31  paragraph.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

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

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

  5  certified by the board department as a certified nursing

  6  assistant.

  7         (4)(3)  "Department" means the Department of Health.

  8         (5)(4)  "Registry" means the listing of certified

  9  nursing assistants maintained by the board department.

10         464.202 468.822  Duties and powers of the board

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

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

13  of certified nursing assistants. The registry must consist of

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

15  other identifying information defined by board department

16  rule; certification status; the effective date of

17  certification; other information required by state or federal

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

19  exploitation as provided under chapter 435; and any

20  disciplinary action taken against the certified nursing

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

22  certificateholder, employers, and other state agencies. The

23  board department shall adopt by rule testing procedures for

24  use in certifying nursing assistants and shall adopt rules

25  regulating the practice of certified nursing assistants to

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

27  approve another entity or organization to provide the

28  examination services, including the development and

29  administration of examinations. The board shall require that

30  the contract provider offer certified nursing assistant

31  applications via the Internet, and may require the contract

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  provider to accept certified nursing assistant applications

  2  for processing via the Internet.  The board shall require the

  3  contract provider to provide the preliminary results of the

  4  certified nursing examination on the date the test is

  5  administered. The provider shall pay all reasonable costs and

  6  expenses incurred by the board department in evaluating the

  7  provider's application and performance during the delivery of

  8  services, including examination services and procedures for

  9  maintaining the certified nursing assistant registry.

10         464.203 468.823  Certified nursing assistants;

11  certification requirement.--

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

13  practice as a certified nursing assistant to any person who

14  demonstrates a minimum competency to read and write and

15  successfully passes the required Level I or Level II screening

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

17  requirements:

18         (a)  Has successfully completed an approved training

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

20  the board department, on the nursing assistant competency

21  examination, which consists of a written portion and

22  skills-demonstration portion approved by the board department

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

24  department.

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

26  of the board department, on the nursing assistant competency

27  examination, which consists of a written portion and

28  skills-demonstration portion, approved by the board department

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

30  department and:

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         2.  Is at least 18 years of age.

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

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

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

  5  exploitation in that state; and has successfully completed a

  6  national nursing assistant evaluation in order to receive

  7  certification in that state.

  8         (d)  Has completed the curriculum developed under the

  9  Enterprise Florida Jobs and Education Partnership Grant and

10  achieved a minimum score, established by rule of the board, on

11  the nursing assistant competency examination, which consists

12  of a written portion and skills-demonstration portion,

13  approved by the board and administered at a site and by

14  personnel approved by the department.

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

16  assistant competency examination in three attempts, the

17  applicant is not eligible for reexamination unless the

18  applicant completes an approved training program.

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

20  substitute for the written portion of the examination upon

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

22  and by personnel approved by the department.

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

24  for the initial certification of certified nursing assistants.

25         (5)  A certified nursing assistant shall maintain a

26  current address with the board department in accordance with

27  s. 455.717.

28         464.204 468.824  Denial, suspension, or revocation of

29  certification; disciplinary actions.--

30         (1)  The following acts constitute grounds for which

31  the board department may impose disciplinary sanctions as

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  specified in subsection (2):

  2         (a)  Obtaining or attempting to obtain certification or

  3  an exemption, or possessing or attempting to possess

  4  certification or a letter of exemption, by bribery,

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

  6  department.

  7         (b)  Intentionally violating any provision of this

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

  9  department.

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

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

12  enter an order imposing one or more of the following

13  penalties:

14         (a)  Denial, suspension, or revocation of

15  certification.

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

17  $150 for each count or separate offense.

18         (c)  Imposition of probation or restriction of

19  certification, including conditions such as corrective actions

20  as retraining or compliance with an approved treatment program

21  for impaired practitioners.

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

23  certificateholder, exempt the certificateholder from

24  disqualification of certification or disqualification of

25  employment in accordance with chapter 435 and issue a letter

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

27  notify an applicant seeking an exemption from disqualification

28  from certification or employment of its decision to approve or

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

30  department receives all required documentation.

31         464.205 468.825  Availability of disciplinary records

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  record maintained by the department of Health pursuant to the

  3  discipline of a certified nursing assistant and any proceeding

  4  held by the board department to discipline a certified nursing

  5  assistant shall remain open and available to the public.

  6         464.206 468.826  Exemption from liability.--If an

  7  employer terminates or denies employment to a certified

  8  nursing assistant whose certification is inactive as shown on

  9  the certified nursing assistant registry or whose name appears

10  on the central abuse registry and tracking system of the

11  Department of Children and Family Services or on a criminal

12  screening report of the Department of Law Enforcement, the

13  employer is not civilly liable for such termination and a

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

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

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

17  468.824(1). There may not be any monetary liability on the

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

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

20  thereof, medical staff, disciplinary board, agents,

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

22  any action taken in good faith without intentional fraud in

23  carrying out this section.

24         464.207 468.827  Penalties.--It is a misdemeanor of the

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

26  775.083, for any person, knowingly or intentionally, to fail

27  to disclose, by false statement, misrepresentation,

28  impersonation, or other fraudulent means, in any application

29  for voluntary or paid employment or certification licensure

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

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  employee or certificateholder licensee.

  2         464.208 468.828  Background screening information;

  3  rulemaking authority.--

  4         (1)  The Agency for Health Care Administration shall

  5  allow the board department to electronically access its

  6  background screening database and records, and the Department

  7  of Children and Family Services shall allow the board

  8  department to electronically access its central abuse registry

  9  and tracking system under chapter 415.

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

11  criminal records, juvenile records, or information obtained

12  from the central abuse hotline under chapter 415 relating to

13  vulnerable adults for any purpose other than determining if

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

15  and information obtained by the board department shall remain

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

17         (3)  If the requirements of the Omnibus Budget

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

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

20  federal requirements shall prevail for those facilities

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

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

23         (4)  The board department shall adopt rules to

24  administer this part.

25         464.209 468.829  Certified nursing assistant

26  registry.--

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

28  thereafter, each employer of certified nursing assistants

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

30  names and social security numbers of each person employed by

31  the employer as a certified nursing assistant in a

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  monetary compensation during the preceding 24 months.

  3  Employers may submit such information electronically through

  4  the department's Internet site.

  5         (2)  The board department shall update the certified

  6  nursing assistant registry upon receipt of the lists of

  7  certified nursing assistants, and shall complete the first of

  8  such updates by December 31, 1999.

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

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

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

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

13  such an inactive certification by submitting documentation to

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

15  of 8 hours for monetary compensation as a certified nursing

16  assistant in a nursing-related occupation during the preceding

17  24 months.

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

19         Section 83.  Section 464.2085, Florida Statutes, is

20  created to read:

21         464.2085  Council on Certified Nursing Assistants.--The

22  Council on Certified Nursing Assistants is created within the

23  department, under the Board of Nursing.

24         (1)  The council shall consist of five members

25  appointed as follows:

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

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

28  members must currently supervise a certified nursing assistant

29  in a licensed nursing home.

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

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  currently working in a licensed nursing home.

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

  3  designee shall appoint two certified nursing assistants

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

  5  is currently working in a licensed nursing home.

  6         (2)  The council shall:

  7         (a)  Recommend to the department policies and

  8  procedures for the certification of nursing assistants.

  9         (b)  Develop all rules regulating the education,

10  training, and certification process for nursing assistants

11  certified under this chapter. The Board of Nursing shall

12  consider adopting a proposed rule developed by the council at

13  the regularly scheduled meeting immediately following the

14  submission of the proposed rule by the council.

15         (c)  Make recommendations to the board regarding all

16  matters relating to the certification of nursing assistants.

17         (d)  Address concerns and problems of certified nursing

18  assistants in order to improve safety in the practice of

19  certified nursing assistants.

20         Section 84.  Paragraph (g) of subsection (3) of section

21  20.43, Florida Statutes, is amended to read:

22         20.43  Department of Health.--There is created a

23  Department of Health.

24         (3)  The following divisions of the Department of

25  Health are established:

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

27  responsible for the following boards and professions

28  established within the division:

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

30         1.2.  Health care services pools, as provided under s.

31  402.48.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         2.3.  The Board of Acupuncture, created under chapter

  2  457.

  3         3.4.  The Board of Medicine, created under chapter 458.

  4         4.5.  The Board of Osteopathic Medicine, created under

  5  chapter 459.

  6         5.6.  The Board of Chiropractic Medicine, created under

  7  chapter 460.

  8         6.7.  The Board of Podiatric Medicine, created under

  9  chapter 461.

10         7.8.  Naturopathy, as provided under chapter 462.

11         8.9.  The Board of Optometry, created under chapter

12  463.

13         9.10.  The Board of Nursing, created under part I of

14  chapter 464.

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

16  chapter 464.

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

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

19         13.  Midwifery, as provided under chapter 467.

20         14.  The Board of Speech-Language Pathology and

21  Audiology, created under part I of chapter 468.

22         15.  The Board of Nursing Home Administrators, created

23  under part II of chapter 468.

24         16.  The Board of Occupational Therapy, created under

25  part III of chapter 468.

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

27  chapter 468.

28         18.  Dietetics and nutrition practice, as provided

29  under part X of chapter 468.

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

31  XIII of chapter 468.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         20.  The Board of Orthotists and Prosthetists, created

  2  under part XIV of chapter 468.

  3         21.  Electrolysis, as provided under chapter 478.

  4         22.  The Board of Massage Therapy, created under

  5  chapter 480.

  6         23.  The Board of Clinical Laboratory Personnel,

  7  created under part III of chapter 483.

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

  9  chapter 483.

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

11  chapter 484.

12         26.  The Board of Hearing Aid Specialists, created

13  under part II of chapter 484.

14         27.  The Board of Physical Therapy Practice, created

15  under chapter 486.

16         28.  The Board of Psychology, created under chapter

17  490.

18         29.  School psychologists, as provided under chapter

19  490.

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

21  Family Therapy, and Mental Health Counseling, created under

22  chapter 491.

23

24  The department may contract with the Agency for Health Care

25  Administration who shall provide consumer complaint,

26  investigative, and prosecutorial services required by the

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

28  appropriate.

29         Section 85.  Subsection (38) of section 39.01, Florida

30  Statutes, is amended to read:

31         39.01  Definitions.--When used in this chapter, unless

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  the context otherwise requires:

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

  3  physician licensed under chapter 458, an osteopathic physician

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

  5  chapter 464, a physician assistant licensed under chapter 458

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

  7         Section 86.  Paragraph (b) of subsection (1) of section

  8  39.304, Florida Statutes, is amended to read:

  9         39.304  Photographs, medical examinations, X rays, and

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

11         (1)

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

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

14  complains or otherwise exhibits distress as a result of injury

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

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

17  investigate may cause the child to be referred for diagnosis

18  to a licensed physician or an emergency department in a

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

20  custodian. Such examination may be performed by any licensed

21  physician or an advanced registered nurse practitioner

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

23  physician, or advanced registered nurse practitioner licensed

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

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

26  abandonment, or neglect may authorize a radiological

27  examination to be performed on the child without the consent

28  of the child's parent or legal custodian.

29         Section 87.  Paragraph (c) of subsection (6) of section

30  110.131, Florida Statutes, is amended to read:

31         110.131  Other-personal-services temporary

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  employment.--

  2         (6)

  3         (c)  Notwithstanding the provisions of this section,

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

  5  other-personal-services employment of a health care

  6  practitioner licensed pursuant to chapter 458, chapter 459,

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

  8  chapter 466, chapter 468, chapter 483, chapter 486, or chapter

  9  490 beyond 2,080 hours and may employ such practitioner on an

10  hourly or other basis.

11         Section 88.  Subsection (1) of section 232.46, Florida

12  Statutes, is amended to read:

13         232.46  Administration of medication by school district

14  personnel.--

15         (1)  Notwithstanding the provisions of the Nurse

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

17  shall be authorized to assist students in the administration

18  of prescription medication when the following conditions have

19  been met:

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

21  approved school health services plan a procedure to provide

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

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

24  a physician assistant licensed pursuant to chapter 458 or

25  chapter 459, to the school personnel designated by the

26  principal to assist students in the administration of

27  prescribed medication.  Such training may be provided in

28  collaboration with other school districts, through contract

29  with an education consortium, or by any other arrangement

30  consistent with the intent of this section.

31         (b)  Each district school board shall adopt policies

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  and procedures governing the administration of prescription

  2  medication by school district personnel.  The policies and

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

  4  provisions:

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

  6  parent or guardian shall provide to the school principal a

  7  written statement which shall grant to the principal or the

  8  principal's designee permission to assist in the

  9  administration of such medication and which shall explain the

10  necessity for such medication to be provided during the school

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

12  school property on official school business. The school

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

14  student in the administration of such medication.

15         2.  Each prescribed medication to be administered by

16  school district personnel shall be received, counted, and

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

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

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

20  the principal.

21         Section 89.  Subsection (6) of section 240.4075,

22  Florida Statutes, is amended to read:

23         240.4075  Nursing Student Loan Forgiveness Program.--

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

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

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

27  or renewal of nursing licensure. Revenues collected from the

28  fee imposed in this subsection shall be deposited in the

29  Nursing Student Loan Forgiveness Trust Fund of the Department

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

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  Up to 50 percent of the revenues appropriated to implement

  2  this subsection may be used for the nursing scholarship

  3  program established pursuant to s. 240.4076.

  4         Section 90.  Paragraph (b) of subsection (1) of section

  5  246.081, Florida Statutes, is amended to read:

  6         246.081  License, certificate of exemption, or

  7  authorization required; exceptions.--

  8         (1)  The following colleges are not under the

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

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

11  an authorization from the board:

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

13  approved for establishment and operation under part I of

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

15  of the Florida Statutes, requiring licensing or approval as

16  defined in ss. 246.011-246.151.

17         Section 91.  Subsection (2) of section 310.102, Florida

18  Statutes, is amended to read:

19         310.102  Treatment programs for impaired pilots and

20  deputy pilots.--

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

22  practitioner consultants as recommended by the committee. A

23  consultant shall be a licensee under the jurisdiction of the

24  Division of Medical Quality Assurance within the Department of

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

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

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

28  department in carrying out the responsibilities of this

29  section. This shall include working with department

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

31  in fact, impaired.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         Section 92.  Subsection (7) of section 381.0302,

  2  Florida Statutes, is amended to read:

  3         381.0302  Florida Health Services Corps.--

  4         (7)  The financial penalty for noncompliance with

  5  participation requirements for persons who have received

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

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

  8  Health Services Corps scholarship program.  In addition,

  9  noncompliance with participation requirements shall also

10  result in ineligibility for professional licensure or renewal

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

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

13  participant who is unable to participate for reasons of

14  disability, the penalty is the actual amount of financial

15  assistance provided to the participant.  Financial penalties

16  shall be deposited in the Florida Health Services Corps Trust

17  Fund and shall be used to provide additional scholarship and

18  financial assistance.

19         Section 93.  Subsection (1) of section 384.30, Florida

20  Statutes, is amended to read:

21         384.30  Minors' consent to treatment.--

22         (1)  The department and its authorized representatives,

23  each physician licensed to practice medicine under the

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

25  professional licensed under the provisions of part I of

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

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

28  health facility may examine and provide treatment for sexually

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

30  care professional, or facility is qualified to provide such

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

                                  16
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  is not a prerequisite for an examination or treatment.

  2         Section 94.  Section 384.31, Florida Statutes, is

  3  amended to read:

  4         384.31  Serological testing of pregnant women; duty of

  5  the attendant.--

  6         (1)  Every person, including every physician licensed

  7  under chapter 458 or chapter 459 or midwife licensed under

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

  9  woman for conditions relating to pregnancy during the period

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

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

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

13  laboratory approved for such purposes under part I of chapter

14  483 for sexually transmissible diseases as required by rule of

15  the department.

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

17  testing for human immunodeficiency virus (HIV) infection shall

18  be offered to each pregnant woman. The prevailing professional

19  standard of care in this state requires each health care

20  provider and midwife who attends a pregnant woman to counsel

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

22  Counseling shall include a discussion of the availability of

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

24  pregnant woman objects to HIV testing, reasonable steps shall

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

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

27  medical record. Every person, including every physician

28  licensed under chapter 458 or chapter 459 or midwife licensed

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

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

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

                                  17
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  the contracting of HIV infection or acquired immune deficiency

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

  3         Section 95.  Subsection (23) of section 394.455,

  4  Florida Statutes, is amended to read:

  5         394.455  Definitions.--As used in this part, unless the

  6  context clearly requires otherwise, the term:

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

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

  9  or a doctorate in psychiatric nursing and 2 years of

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

11  physician.

12         Section 96.  Paragraphs (a) and (b) of subsection (2)

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

14  amended to read:

15         395.0191  Staff membership and clinical privileges.--

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

17  and procedures for consideration of an application for

18  clinical privileges submitted by an advanced registered nurse

19  practitioner licensed and certified under part I of chapter

20  464, in accordance with the provisions of this section.  No

21  licensed facility shall deny such application solely because

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

23  because the applicant is not a participant in the Florida

24  Birth-Related Neurological Injury Compensation Plan.

25         (b)  An advanced registered nurse practitioner who is

26  certified as a registered nurse anesthetist licensed under

27  part I of chapter 464 shall administer anesthesia under the

28  onsite medical direction of a professional licensed under

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

30  with an established protocol approved by the medical staff.

31  The medical direction shall specifically address the needs of

                                  18
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  the individual patient.

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

  3  authority of the medical staff of a licensed facility to

  4  review for approval or disapproval all applications for

  5  appointment and reappointment to all categories of staff and

  6  to make recommendations on each applicant to the governing

  7  board, including the delineation of privileges to be granted

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

  9  delineation of privileges, each applicant shall be considered

10  individually pursuant to criteria for a doctor licensed under

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

12  an advanced registered nurse practitioner licensed and

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

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

15  eligibility for staff membership or clinical privileges shall

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

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

18  adherence to applicable professional ethics; the applicant's

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

20  and by such other elements as determined by the governing

21  board, consistent with this part.

22         Section 97.  Subsection (11) of section 400.021,

23  Florida Statutes, is amended to read:

24         400.021  Definitions.--When used in this part, unless

25  the context otherwise requires, the term:

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

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

28  and which is licensed according to this part.

29         Section 98.  Section 400.211, Florida Statutes, is

30  amended to read:

31         400.211  Persons employed as nursing assistants;

                                  19
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  certification requirement.--

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

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

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

  5  registered nurse or practical nurse licensed in accordance

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

  7  who is permitted to practice nursing in accordance with rules

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

  9  464, to serve as a nursing assistant in any nursing home.

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

11  certified as nursing assistants under this part II of chapter

12  464 may be employed by a nursing facility for a period of 4

13  months:

14         (a)  Persons who are enrolled in, or have completed, a

15  state-approved nursing assistant program; or

16         (b)  Persons who have been positively verified by a

17  state approved test site as actively certified and on the

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

19  have not completed the written examination required under this

20  section.;or

21         (c)  Persons who have preliminarily passed the state's

22  certification exam.

23

24  The certification requirement must be met within 4 months

25  after of initial employment as a nursing assistant in a

26  licensed nursing facility.

27         (3)  Nursing homes shall require persons seeking

28  employment as a certified nursing assistant to submit an

29  employment history to the facility. The facility shall verify

30  the employment history unless, through diligent efforts, such

31  verification is not possible.  There shall be no monetary

                                  20
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

  3  good faith communicates his or her honest opinion about a

  4  former employee's job performance.

  5         Section 99.  Paragraph (b) of subsection (4) of section

  6  400.215, Florida Statutes, is amended to read:

  7         400.215  Personnel screening requirement.--

  8         (4)

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

10  regulatory board within the Department of Health, or that

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

12  exemption from disqualification to an employee or prospective

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

14  professional license or certification from the Department of

15  Health or a regulatory board within that department.

16         Section 100.  Paragraph (c) is added to subsection (3)

17  of section 400.23, Florida Statutes, to read:

18         400.23  Rules; evaluation and deficiencies; licensure

19  status.--

20         (3)

21         (c)  Licensed practical nurses licensed under chapter

22  464 who are providing nursing services in nursing home

23  facilities under this part may supervise the activities of

24  other licensed practical nurses, certified nursing assistants,

25  and other unlicensed personnel providing services in such

26  facilities in accordance with rules adopted by the Board of

27  Nursing.

28         Section 101.  Subsections (12) and (14) of section

29  400.402, Florida Statutes, are amended to read:

30         400.402  Definitions.--When used in this part, the

31  term:

                                  21
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

  3  pursuant to part I of chapter 464 by persons licensed

  4  thereunder while carrying out their professional duties, and

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

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

  7  place in a residential environment despite mental or physical

  8  limitations that might otherwise disqualify them from

  9  residency in a facility licensed under this part.

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

11  performed pursuant to part I of chapter 464 by persons

12  licensed thereunder while carrying out their professional

13  duties but limited to those acts which the department

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

15  allowable limited nursing services shall be for persons who

16  meet the admission criteria established by the department for

17  assisted living facilities and shall not be complex enough to

18  require 24-hour nursing supervision and may include such

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

20  care of casts, braces, and splints.

21         Section 102.  Paragraphs (a) and (b) of subsection (3)

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

23         400.407  License required; fee, display.--

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

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

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

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

28  information deemed necessary by the agency. Licenses shall be

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

30  standard, extended congregate care, limited nursing services,

31  or limited mental health.

                                  22
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

  3  400.402. Such facilities may also employ or contract with a

  4  person licensed under part I of chapter 464 to administer

  5  medications and perform other tasks as specified in s.

  6  400.4255.

  7         (b)  An extended congregate care license shall be

  8  issued to facilities providing, directly or through contract,

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

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

11  licensed thereunder, and supportive services defined by rule

12  to persons who otherwise would be disqualified from continued

13  residence in a facility licensed under this part.

14         1.  In order for extended congregate care services to

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

16  must first determine that all requirements established in law

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

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

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

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

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

22  licensee under this part. Notification of approval or denial

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

24  such request and all necessary documentation. Existing

25  facilities qualifying to provide extended congregate care

26  services must have maintained a standard license and may not

27  have been subject to administrative sanctions during the

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

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

30  following reasons:

31         a.  A class I or class II violation;

                                  23
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         b.  Three or more repeat or recurring class III

  2  violations of identical or similar resident care standards as

  3  specified in rule from which a pattern of noncompliance is

  4  found by the agency;

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

  6  corrected in accordance with the corrective action plan

  7  approved by the agency;

  8         d.  Violation of resident care standards resulting in a

  9  requirement to employ the services of a consultant pharmacist

10  or consultant dietitian;

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

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

13  extended congregate care license has at least 25 percent

14  ownership interest; or

15         f.  Imposition of a moratorium on admissions or

16  initiation of injunctive proceedings.

17         2.  Facilities that are licensed to provide extended

18  congregate care services shall maintain a written progress

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

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

21  services that are rendered and the general status of the

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

23  designee, representing the agency shall visit such facilities

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

25  receiving extended congregate care services and to determine

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

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

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

29  monitoring visits may be provided through contractual

30  arrangements with appropriate community agencies.  A

31  registered nurse shall serve as part of the team that

                                  24
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  the required yearly monitoring visits for a facility that has

  3  been licensed for at least 24 months to provide extended

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

  5  the registered nurse determines that extended congregate care

  6  services are being provided appropriately, and if the facility

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

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

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

10  in which the facility is located to determine if any

11  complaints have been made and substantiated about the quality

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

13  required yearly monitoring visits if complaints have been made

14  and substantiated.

15         3.  Facilities that are licensed to provide extended

16  congregate care services shall:

17         a.  Demonstrate the capability to meet unanticipated

18  resident service needs.

19         b.  Offer a physical environment that promotes a

20  homelike setting, provides for resident privacy, promotes

21  resident independence, and allows sufficient congregate space

22  as defined by rule.

23         c.  Have sufficient staff available, taking into

24  account the physical plant and firesafety features of the

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

26  emergency, as necessary.

27         d.  Adopt and follow policies and procedures that

28  maximize resident independence, dignity, choice, and

29  decisionmaking to permit residents to age in place to the

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

31  status are minimized or avoided.

                                  25
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

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

  4  developing service plans, and share responsibility in

  5  decisionmaking.

  6         f.  Implement the concept of managed risk.

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

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

  9  464.

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

11  provide specialized training as defined by rule for facility

12  staff.

13         4.  Facilities licensed to provide extended congregate

14  care services are exempt from the criteria for continued

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

16  Facilities so licensed shall adopt their own requirements

17  within guidelines for continued residency set forth by the

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

19  residents who require 24-hour nursing supervision. Facilities

20  licensed to provide extended congregate care services shall

21  provide each resident with a written copy of facility policies

22  governing admission and retention.

23         5.  The primary purpose of extended congregate care

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

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

26  would otherwise be disqualified for continued residency.  A

27  facility licensed to provide extended congregate care services

28  may also admit an individual who exceeds the admission

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

30  individual is determined appropriate for admission to the

31  extended congregate care facility.

                                  26
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         6.  Before admission of an individual to a facility

  2  licensed to provide extended congregate care services, the

  3  individual must undergo a medical examination as provided in

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

  5  service plan for the individual.

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

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

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

  9  arrangements for relocating the person in accordance with s.

10  400.428(1)(k).

11         8.  Failure to provide extended congregate care

12  services may result in denial of extended congregate care

13  license renewal.

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

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

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

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

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

19  and recommendations related to, extended congregate care

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

21  limited to, the following information:

22         a.  A description of the facilities licensed to provide

23  such services, including total number of beds licensed under

24  this part.

25         b.  The number and characteristics of residents

26  receiving such services.

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

28  provided through a standard license.

29         d.  An analysis of deficiencies cited during biennial

30  inspections.

31         e.  The number of residents who required extended

                                  27
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  congregate care services at admission and the source of

  2  admission.

  3         f.  Recommendations for statutory or regulatory

  4  changes.

  5         g.  The availability of extended congregate care to

  6  state clients residing in facilities licensed under this part

  7  and in need of additional services, and recommendations for

  8  appropriations to subsidize extended congregate care services

  9  for such persons.

10         h.  Such other information as the department considers

11  appropriate.

12         Section 103.  Paragraphs (a) and (c) of subsection (1)

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

14  amended to read:

15         400.4255  Use of personnel; emergency care.--

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

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

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

19  464.022(1), and others as defined by rule, may administer

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

21  individual weekly pill organizers for residents who

22  self-administer medication, give prepackaged enemas ordered by

23  a physician, observe residents, document observations on the

24  appropriate resident's record, report observations to the

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

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

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

28  residents meet the criteria for appropriate placement as

29  defined in s. 400.426.  Nursing assistants certified pursuant

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

31  signs as directed by a licensed nurse or physician.

                                  28
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  carry out their professional duties pursuant to part I of

  3  chapter 464 until emergency medical personnel assume

  4  responsibility for care.

  5         (2)  In facilities licensed to provide extended

  6  congregate care, persons under contract to the facility,

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

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

  9  464.022(1), or those persons certified as nursing assistants

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

11  perform all duties within the scope of their license or

12  certification, as approved by the facility administrator and

13  pursuant to this part.

14         Section 104.  Subsection (3) of section 400.426,

15  Florida Statutes, is amended to read:

16         400.426  Appropriateness of placements; examinations of

17  residents.--

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

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

20  routine basis or at least monthly, perform a nursing

21  assessment of the residents for whom they are providing

22  nursing services ordered by a physician, except administration

23  of medication, and shall document such assessment, including

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

25  necessitate relocation to a nursing home, hospital, or

26  specialized health care facility.  Such records shall be

27  maintained in the facility for inspection by the agency and

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

29  applicable.

30         Section 105.  Subsections (3) and (21) of section

31  400.462, Florida Statutes, are amended to read:

                                  29
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         400.462  Definitions.--As used in this part, the term:

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

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

  4  400.211. The licensed home health agency or licensed nurse

  5  registry shall ensure that the certified nursing assistant

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

  7  licensed nurse registry is adequately trained to perform the

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

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

10  therapeutic services delivered by a health care professional

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

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

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

14  referred by a licensed nurse registry.

15         Section 106.  Paragraph (c) of subsection (6) of

16  section 400.464, Florida Statutes, is amended to read:

17         400.464  Home health agencies to be licensed;

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

19         (6)  The following are exempt from the licensure

20  requirements of this part:

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

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

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

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

25  486; chapter 490; or chapter 491; and who is acting alone

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

27  care to patients in their homes.

28         Section 107.  Paragraph (a) of subsection (10),

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

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

31         400.506  Licensure of nurse registries; requirements;

                                  30
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  penalties.--

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

  3  private residences registered nurses and licensed practical

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

  5  certified nursing assistants certified under part II of

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

  7  documented proof of successful completion of the training

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

  9  for the purposes of providing those services authorized under

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

11  provide current documentation that he or she is free from

12  communicable diseases.

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

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

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

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

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

18  Agency for Health Care Administration or the Department of

19  Business and Professional Regulation. Providing services

20  beyond the scope authorized under this subsection constitutes

21  the unauthorized practice of medicine or a violation of the

22  Nurse Practice Act and is punishable as provided under chapter

23  458, chapter 459, or part I of chapter 464.

24         (15)  All persons referred for contract in private

25  residences by a nurse registry must comply with the following

26  requirements for a plan of treatment:

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

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

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

30  supervision of a physician or when a physician is responsible

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

                                  31
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  treatment must be established for each patient receiving care

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

  3  original medical plan of treatment must be timely signed by

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

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

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

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

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

  9  substantiated by the appropriate nursing notes or

10  documentation made by the nurse in compliance with nursing

11  practices established under part I of chapter 464.

12         Section 108.  Subsection (1) of section 400.512,

13  Florida Statutes, is amended to read:

14         400.512  Screening of home health agency personnel;

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

16  agency shall require employment or contractor screening as

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

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

19  personnel; persons referred for employment by nurse

20  registries; and persons employed by companion or homemaker

21  services registered under s. 400.509.

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

23  upon request, grant exemptions from disqualification from

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

25  435.07, except for health care practitioners licensed by the

26  Department of Health or a regulatory board within that

27  department.

28         (b)  The appropriate regulatory board within the

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

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

31  practitioner, grant exemptions from disqualification from

                                  32
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  435.07.

  3         Section 109.  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 110.  Subsection (20) of section 401.23,

22  Florida 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 111.  Paragraph (c) of subsection (1) of

28  section 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

                                  33
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  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 112.  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 113.  Paragraph (d) of subsection (12) of

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

                                  34
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  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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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  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 114.  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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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  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 115.  Paragraph (a) of subsection (1) of

18  section 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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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  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 116.  Subsection (1) of section 455.604,

  8  Florida 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         Section 117.  Paragraph (a) of subsection (2) of

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  section 455.667, Florida Statutes, is amended to read:

  2         455.667  Ownership and control of patient records;

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

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

  5  owner," "health care practitioner," and "health care

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

  7  persons or entities; furthermore, the following persons or

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

  9  but are authorized under the confidentiality and disclosure

10  requirements of this section to maintain those documents

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

12  or regulated:

13         (a)  Certified nursing assistants regulated under part

14  II of chapter 464 s. 400.211.

15         Section 118.  Section 455.677, Florida Statutes, is

16  amended to read:

17         455.677  Disposition of records of deceased

18  practitioners or practitioners relocating or terminating

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

20  457, chapter 458, chapter 459, chapter 460, chapter 461,

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

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

23  491, and the department under the provisions of chapter 462,

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

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

26  practitioners which are in existence at the time the

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

28  longer available to patients and which records pertain to the

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

30  records be retained for at least 2 years after the

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

  3  the practitioner.

  4         Section 119.  Paragraph (b) of subsection (2) of

  5  section 455.694, Florida Statutes, is amended to read:

  6         455.694  Financial responsibility requirements for

  7  certain health care practitioners.--

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

  9  application by practitioners meeting any of the following

10  criteria:

11         (b)  Any person whose license or certification has

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

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

14  not practicing in this state.  Any person applying for

15  reactivation of a license must show either that such licensee

16  maintained tail insurance coverage which provided liability

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

18  1993, or the initial date of licensure in this state,

19  whichever is later, and incidents that occurred before the

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

21  must submit an affidavit stating that such licensee has no

22  unsatisfied medical malpractice judgments or settlements at

23  the time of application for reactivation.

24         Section 120.  Subsection (2) of section 455.707,

25  Florida Statutes, is amended to read:

26         455.707  Treatment programs for impaired

27  practitioners.--

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

29  practitioner consultants as recommended by the committee.  A

30  consultant shall be a licensee or recovered licensee under the

31  jurisdiction of the Division of Medical Quality Assurance

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  practitioner or recovered practitioner licensed under chapter

  3  458, chapter 459, or part I of chapter 464.  The consultant

  4  shall assist the probable cause panel and department in

  5  carrying out the responsibilities of this section.  This shall

  6  include working with department investigators to determine

  7  whether a practitioner is, in fact, impaired.

  8         Section 121.  Subsection (2) of section 458.348,

  9  Florida Statutes, is amended to read:

10         458.348  Formal supervisory relationships, standing

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

12         (2)  ESTABLISHMENT OF STANDARDS BY JOINT

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

14  shall determine minimum standards for the content of

15  established protocols pursuant to which an advanced registered

16  nurse practitioner may perform medical acts identified and

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

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

19  minimum standards for supervision of such acts by the

20  physician, unless the joint committee determines that any act

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

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

23  standards of medical care and shall take into account the

24  special problems of medically underserved areas. The standards

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

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

27  carrying out their responsibilities pursuant to part I of

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

29  shall have disciplinary powers over the licensees of the other

30  board.

31         Section 122.  Section 464.001, Florida Statutes, is

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  amended to read:

  2         464.001  Short title.--This part may be cited chapter

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

  4         Section 123.  Section 464.002, Florida Statutes, is

  5  amended to read:

  6         464.002  Purpose.--The sole legislative purpose in

  7  enacting this part chapter is to ensure that every nurse

  8  practicing in this state meets minimum requirements for safe

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

10  below minimum competency or who otherwise present a danger to

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

12         Section 124.  Section 464.003, Florida Statutes, is

13  amended to read:

14         464.003  Definitions.--As used in this part chapter:

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

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

17  this chapter.

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

19  performance of those acts requiring substantial specialized

20  knowledge, judgment, and nursing skill based upon applied

21  principles of psychological, biological, physical, and social

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

23         1.  The observation, assessment, nursing diagnosis,

24  planning, intervention, and evaluation of care; health

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

26  the promotion of wellness, maintenance of health, and

27  prevention of illness of others.

28         2.  The administration of medications and treatments as

29  prescribed or authorized by a duly licensed practitioner

30  authorized by the laws of this state to prescribe such

31  medications and treatments.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         3.  The supervision and teaching of other personnel in

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

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

  4  performance of selected acts, including the administration of

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

  6  or infirm and the promotion of wellness, maintenance of

  7  health, and prevention of illness of others under the

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

  9  licensed osteopathic physician, a licensed podiatric

10  physician, or a licensed dentist.

11

12  The professional nurse and the practical nurse shall be

13  responsible and accountable for making decisions that are

14  based upon the individual's educational preparation and

15  experience in nursing.

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

17  in addition to the practice of professional nursing, the

18  performance of advanced-level nursing acts approved by the

19  board which, by virtue of postbasic specialized education,

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

21  advanced registered nurse practitioner.  Within the context of

22  advanced or specialized nursing practice, the advanced

23  registered nurse practitioner may perform acts of nursing

24  diagnosis and nursing treatment of alterations of the health

25  status.  The advanced registered nurse practitioner may also

26  perform acts of medical diagnosis and treatment, prescription,

27  and operation which are identified and approved by a joint

28  committee composed of three members appointed by the Board of

29  Nursing, two of whom shall be advanced registered nurse

30  practitioners; three members appointed by the Board of

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  advanced registered nurse practitioners; and the secretary of

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

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

  4  years unless a shorter term is required to establish or

  5  maintain staggered terms. The Board of Nursing shall adopt

  6  rules authorizing the performance of any such acts approved by

  7  the joint committee. Unless otherwise specified by the joint

  8  committee, such acts shall be performed under the general

  9  supervision of a practitioner licensed under chapter 458,

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

11  protocols which identify the medical acts to be performed and

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

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

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

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

16  evaluation of physical or mental conditions, behaviors, signs

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

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

19  and reactions represent a deviation from normal.

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

21  implementation of a nursing regimen for the care and comfort

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

23  restoration, and maintenance of health.

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

25  this state to practice professional nursing.

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

27  licensed in this state to practice practical nursing.

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

29  person licensed in this state to practice professional nursing

30  and certified in advanced or specialized nursing practice.

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

                                  44
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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

  3  of nurses.

  4         Section 125.  Section 464.006, Florida Statutes, is

  5  amended to read:

  6         464.006  Authority to make rules.--The board of Nursing

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

  8  120.54 to implement the provisions of this part chapter

  9  conferring duties upon it.

10         Section 126.  Subsection (3) of section 464.009,

11  Florida Statutes, is amended to read:

12         464.009  Licensure by endorsement.--

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

14  endorsement to any applicant who is under investigation in

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

16  this part chapter until such time as the investigation is

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

18  apply.

19         Section 127.  Paragraphs (a) and (d) of subsection (1)

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

21  Florida Statutes, are amended to read:

22         464.016  Violations and penalties.--

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

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

25  775.083, or s. 775.084:

26         (a)  Practicing advanced or specialized, professional

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

28  holding an active license or certificate to do so.

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

30  certificate under this part chapter by misleading statements

31  or knowing misrepresentation.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         (2)  Each of the following acts constitutes a

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

  3  775.082 or s. 775.083:

  4         (b)  Knowingly concealing information relating to

  5  violations of this part chapter.

  6         Section 128.  Paragraphs (i), (k), and (l) of

  7  subsection (1) and subsection (4) of section 464.018, Florida

  8  Statutes, are amended to read:

  9         464.018  Disciplinary actions.--

10         (1)  The following acts shall be grounds for

11  disciplinary action set forth in this section:

12         (i)  Engaging or attempting to engage in the

13  possession, sale, or distribution of controlled substances as

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

15  purposes authorized by this part chapter.

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

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

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

19  licensee verifies that such person is actively participating

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

21  mental condition, the licensee is required to report such

22  person only to an impaired professionals consultant.

23         (l)  Knowingly violating any provision of this part

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

25  order of the board or department previously entered in a

26  disciplinary proceeding or failing to comply with a lawfully

27  issued subpoena of the department.

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

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

30  occasions of violations of this part chapter relating to the

31  use of drugs or narcotics, which offenses involved the

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  diversion of drugs or narcotics from patients to personal use

  2  or sale.

  3         Section 129.  Subsections (1), (2), and (3) of section

  4  464.019, Florida Statutes, are amended to read:

  5         464.019  Approval of nursing programs.--

  6         (1)  An institution desiring to conduct an approved

  7  program for the education of professional or practical nurses

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

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

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

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

12  board, not to exceed $1,000.

13         (2)  The board shall adopt rules regarding educational

14  objectives, faculty qualifications, curriculum guidelines,

15  administrative procedures, and clinical training as are

16  necessary to ensure that approved programs graduate nurses

17  capable of competent practice under this part act.

18         (3)  The department shall survey each institution

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

20  If the board is satisfied that the program meets the

21  requirements of this part chapter and rules pursuant thereto,

22  it shall certify the program for approval and the department

23  shall approve the program.

24         Section 130.  Section 464.022, Florida Statutes, is

25  amended to read:

26         464.022  Exceptions.--No provision of this part chapter

27  shall be construed to prohibit:

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

29  family without compensation, the incidental care of the sick

30  by domestic servants, or the incidental care of

31  noninstitutionalized persons by a surrogate family.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

  3  approved schools of nursing.

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

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

  6  licensing examination for which they are eligible following

  7  graduation, provided they practice under direct supervision of

  8  a registered professional nurse.  The board shall by rule

  9  define what constitutes direct supervision.

10         (5)  The rendering of services by nursing assistants

11  acting under the direct supervision of a registered

12  professional nurse.

13         (6)  Any nurse practicing in accordance with the

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

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

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

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

18  Church of Christ Scientist.

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

20  licensed attendant of another state who is employed by the

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

22  thereof, while in the discharge of official duties.

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

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

25  days after furnishing to the employer satisfactory evidence of

26  current licensure in another state and having submitted proper

27  application and fees to the board for licensure prior to

28  employment.  The board may extend this time for administrative

29  purposes when necessary.

30         (9)  The rendering of nursing services on a

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  services directly to a nurse rendering such services by any

  2  government program, commercial insurance company, hospital or

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

  4         (10)  The establishment of an independent practice by

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

  6  nursing services within the scope of the nursing license.

  7         (11)  The furnishing of hemodialysis treatments in a

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

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

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

11  registered nurse who is licensed pursuant to this part chapter

12  and who has dialysis training and experience.

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

14  nurse of another state whose employment requires the nurse to

15  accompany and care for a patient temporarily residing in this

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

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

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

19  standing physician orders and current medical status of the

20  patient available, and prearrangements with the appropriate

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

22  case the patient needs placement in an inpatient setting.

23         (13)  The practice of nursing by individuals enrolled

24  in board-approved remedial courses.

25         Section 131.  Section 464.023, Florida Statutes, is

26  amended to read:

27         464.023  Saving clauses.--

28         (1)  No judicial or administrative proceeding pending

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

30  reenactment of this part chapter.

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

  3  or certificate shall be renewed in accordance with the

  4  provisions of this part act.

  5         Section 132.  Subsection (3) of section 464.027,

  6  Florida Statutes, is amended to read:

  7         464.027  Registered nurse first assistant.--

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

  9  assistant is any person who:

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

11  chapter;

12         (b)  Is certified in perioperative nursing; and

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

14  completed, a recognized program.

15         Section 133.  Subsection (6) of section 466.003,

16  Florida Statutes, is amended to read:

17         466.003  Definitions.--As used in this chapter:

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

19  dental hygienist, who, under the supervision and authorization

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

21  patient. This term shall not include a certified registered

22  nurse anesthetist licensed under part I of chapter 464.

23         Section 134.  Subsection (2) of section 467.003,

24  Florida Statutes, is amended to read:

25         467.003  Definitions.--As used in this chapter, unless

26  the context otherwise requires:

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

28  licensed as an advanced registered nurse practitioner under

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

30  midwifery by the American College of Nurse Midwives.

31         Section 135.  Paragraph (a) of subsection (2) of

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  section 467.0125, Florida Statutes, is amended to read:

  2         467.0125  Licensure by endorsement.--

  3         (2)  The department may issue a temporary certificate

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

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

  6  with the following restrictions:

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

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

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

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

11  certified nurse midwife licensed pursuant to part I of chapter

12  464, or a midwife licensed under this chapter, who has a

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

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

15  areas designated by the United States Department of Health and

16  Human Services.

17         Section 136.  Paragraph (e) of subsection (2) of

18  section 467.203, Florida Statutes, is amended to read:

19         467.203  Disciplinary actions; penalties.--

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

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

22  order imposing one or more of the following penalties:

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

24  period of time and subject to such conditions as the

25  department may specify, including requiring the midwife to

26  submit to treatment; undertake further relevant education or

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

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

29  licensed under part I of chapter 464.

30         Section 137.  Paragraph (a) of subsection (1) of

31  section 468.505, Florida Statutes, is amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         468.505  Exemptions; exceptions.--

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

  3  prohibiting or restricting the practice, services, or

  4  activities of:

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

  6  chapter 458, chapter 459, chapter 460, chapter 461, chapter

  7  462, chapter 463, part I of chapter 464, chapter 465, chapter

  8  466, chapter 480, chapter 490, or chapter 491, when engaging

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

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

11  supervision of the licensee when rendering services within the

12  scope of the profession or occupation of the licensee.

13         Section 138.  Subsection (7) of section 483.041,

14  Florida Statutes, is amended to read:

15         483.041  Definitions.--As used in this part, the term:

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

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

18  dentist licensed under chapter 466; a person licensed under

19  chapter 462; or an advanced registered nurse practitioner

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

21  practitioner from another state licensed under similar

22  statutes who orders examinations on materials or specimens for

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

24  same state as the requesting licensed practitioner.

25         Section 139.  Subsection (5) of section 483.801,

26  Florida Statutes, is amended to read:

27         483.801  Exemptions.--This part applies to all clinical

28  laboratories and clinical laboratory personnel within this

29  state, except:

30         (5)  Advanced registered nurse practitioners licensed

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  setting.

  3         Section 140.  Paragraph (a) of subsection (4) of

  4  section 491.0112, Florida Statutes, is amended to read:

  5         491.0112  Sexual misconduct by a psychotherapist;

  6  penalties.--

  7         (4)  For the purposes of this section:

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

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

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

11  who provides or purports to provide treatment, diagnosis,

12  assessment, evaluation, or counseling of mental or emotional

13  illness, symptom, or condition.

14         Section 141.  Subsection (5) of section 550.24055,

15  Florida Statutes, is amended to read:

16         550.24055  Use of controlled substances or alcohol

17  prohibited; testing of certain occupational licensees;

18  penalty; evidence of test or action taken and admissibility

19  for criminal prosecution limited.--

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

21  use of controlled or chemical substances that are prescribed

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

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

24  of chapter 464, or chapter 466.

25         Section 142.  Paragraph (h) of subsection (4) of

26  section 627.351, Florida Statutes, is amended to read:

27         627.351  Insurance risk apportionment plans.--

28         (4)  MEDICAL MALPRACTICE RISK APPORTIONMENT.--

29         (h)  As used in this subsection:

30         1.  "Health care provider" means hospitals licensed

31  under chapter 395; physicians licensed under chapter 458;

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  osteopathic physicians licensed under chapter 459; podiatric

  2  physicians licensed under chapter 461; dentists licensed under

  3  chapter 466; chiropractic physicians licensed under chapter

  4  460; naturopaths licensed under chapter 462; nurses licensed

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

  6  467; clinical laboratories registered under chapter 483;

  7  physician assistants licensed under chapter 458 or chapter

  8  459; physical therapists and physical therapist assistants

  9  licensed under chapter 486; health maintenance organizations

10  certificated under part I of chapter 641; ambulatory surgical

11  centers licensed under chapter 395; other medical facilities

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

13  industrial clinics, and renal dialysis facilities; or

14  professional associations, partnerships, corporations, joint

15  ventures, or other associations for professional activity by

16  health care providers.

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

18  primary purpose of which is to provide human medical

19  diagnostic services or a facility providing nonsurgical human

20  medical treatment, to which facility the patient is admitted

21  and from which facility the patient is discharged within the

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

23  hospital.  However, a facility existing for the primary

24  purpose of performing terminations of pregnancy or an office

25  maintained by a physician or dentist for the practice of

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

27  facility."

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

29  under chapter 395, health maintenance organization

30  certificated under part I of chapter 641, ambulatory surgical

31  center licensed under chapter 395, or other medical facility

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  as defined in subparagraph 2.

  2         Section 143.  Paragraph (b) of subsection (1) of

  3  section 627.357, Florida Statutes, is amended to read:

  4         627.357  Medical malpractice self-insurance.--

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

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

  7         1.  Hospital licensed under chapter 395.

  8         2.  Physician licensed, or physician assistant

  9  licensed, under chapter 458.

10         3.  Osteopathic physician or physician assistant

11  licensed under chapter 459.

12         4.  Podiatric physician licensed under chapter 461.

13         5.  Health maintenance organization certificated under

14  part I of chapter 641.

15         6.  Ambulatory surgical center licensed under chapter

16  395.

17         7.  Chiropractic physician licensed under chapter 460.

18         8.  Psychologist licensed under chapter 490.

19         9.  Optometrist licensed under chapter 463.

20         10.  Dentist licensed under chapter 466.

21         11.  Pharmacist licensed under chapter 465.

22         12.  Registered nurse, licensed practical nurse, or

23  advanced registered nurse practitioner licensed or registered

24  under part I of chapter 464.

25         13.  Other medical facility.

26         14.  Professional association, partnership,

27  corporation, joint venture, or other association established

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

29  8., 9., 10., 11., and 12. for professional activity.

30         Section 144.  Subsection (6) of section 627.9404,

31  Florida Statutes, is amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         627.9404  Definitions.--For the purposes of this part:

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

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

  4  psychotherapist licensed under chapter 490 or chapter 491, or

  5  any individual who meets any requirements prescribed by rule

  6  by the department.

  7         Section 145.  Subsection (21) of section 641.31,

  8  Florida Statutes, is amended to read:

  9         641.31  Health maintenance contracts.--

10         (21)  Notwithstanding any other provision of law,

11  health maintenance policies or contracts which provide

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

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

14  certified registered nurse anesthetist licensed pursuant to

15  part I of chapter 464.

16         Section 146.  Subsection (8) of section 766.101,

17  Florida Statutes, is amended to read:

18         766.101  Medical review committee, immunity from

19  liability.--

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

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

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

23  466 shall arise against another person licensed pursuant to

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

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

26  information to a duly appointed medical review committee, to

27  an internal risk management program established under s.

28  395.0197, to the Department of Business and Professional

29  Regulation, or to the appropriate regulatory board if the

30  information furnished concerns patient care at a facility

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  provide health care services, if the information is not

  2  intentionally fraudulent, and if the information is within the

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

  4  However, if such information is otherwise available from

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

  6  civil action merely because it was presented during a

  7  proceeding of the committee, department, or board.

  8         Section 147.  Subsection (2) of section 766.110,

  9  Florida Statutes, is amended to read:

10         766.110  Liability of health care facilities.--

11         (2)  Every hospital licensed under chapter 395 may

12  carry liability insurance or adequately insure itself in an

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

14  annual aggregate to cover all medical injuries to patients

15  resulting from negligent acts or omissions on the part of

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

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

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

19  hospital's medical staff meets the financial responsibility

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

21  coverage limits are not less than the minimum limits

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

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

24  self-insurance coverage continuously to members of its medical

25  staff for activities both inside and outside of the hospital

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

27  casualty insurance may make available, but shall not be

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

29  an equitable and pro rata basis the following professional

30  health care providers for a portion of the total hospital

31  insurance cost for this coverage:  physicians licensed under

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  chapter 458, osteopathic physicians licensed under chapter

  2  459, podiatric physicians licensed under chapter 461, dentists

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

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

  5  amount to be applied against any individual health care

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

  7  contract.  The legislative intent in providing for the

  8  deductible to be applied to individual health care providers

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

10  individual health care provider the incentive to avoid the

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

12  citizens of this state receive the highest quality health care

13  obtainable.

14         Section 148.  Paragraph (d) of subsection (3) of

15  section 766.1115, Florida Statutes, is amended to read:

16         766.1115  Health care providers; creation of agency

17  relationship with governmental contractors.--

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

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

20         1.  A birth center licensed under chapter 383.

21         2.  An ambulatory surgical center licensed under

22  chapter 395.

23         3.  A hospital licensed under chapter 395.

24         4.  A physician or physician assistant licensed under

25  chapter 458.

26         5.  An osteopathic physician or osteopathic physician

27  assistant licensed under chapter 459.

28         6.  A chiropractic physician licensed under chapter

29  460.

30         7.  A podiatric physician licensed under chapter 461.

31         8.  A registered nurse, nurse midwife, licensed

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  practical nurse, or advanced registered nurse practitioner

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

  3  facility which employs nurses licensed or registered under

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

  5  delivered under this section.

  6         9.  A midwife licensed under chapter 467.

  7         10.  A health maintenance organization certificated

  8  under part I of chapter 641.

  9         11.  A health care professional association and its

10  employees or a corporate medical group and its employees.

11         12.  Any other medical facility the primary purpose of

12  which is to deliver human medical diagnostic services or which

13  delivers nonsurgical human medical treatment, and which

14  includes an office maintained by a provider.

15         13.  A dentist or dental hygienist licensed under

16  chapter 466.

17         14.  Any other health care professional, practitioner,

18  provider, or facility under contract with a governmental

19  contractor.

20

21  The term includes any nonprofit corporation qualified as

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

23  Internal Revenue Code which delivers health care services

24  provided by licensed professionals listed in this paragraph,

25  any federally funded community health center, and any

26  volunteer corporation or volunteer health care provider that

27  delivers health care services.

28         Section 149.  Subsection (1) of section 877.111,

29  Florida Statutes, is amended to read:

30         877.111  Inhalation, ingestion, possession, sale,

31  purchase, or transfer of harmful chemical substances;

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  penalties.--

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

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

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

  5  trichloroethylene, acetone, toluene, ethyl acetate, methyl

  6  ethyl ketone, trichloroethane, isopropanol, methyl isobutyl

  7  ketone, ethylene glycol monomethyl ether acetate,

  8  cyclohexanone, nitrous oxide, diethyl ether, alkyl nitrites

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

10  inducing a condition of intoxication or which distorts or

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

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

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

14  injury by a practitioner licensed under chapter 458, chapter

15  459, part I of chapter 464, or chapter 466 or to beverages

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

17  chapter 563, chapter 564, or chapter 565.

18         Section 150.  Subsection (6) of section 945.602,

19  Florida Statutes, is amended to read:

20         945.602  State of Florida Correctional Medical

21  Authority; creation; members.--

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

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

24  years' experience in the practice of nursing.

25         Section 151.  Subsection (2) of section 960.28, Florida

26  Statutes, is amended to read:

27         960.28  Payment for victims' initial forensic physical

28  examinations.--

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

30  department shall pay for medical expenses connected with an

31  initial forensic physical examination of a victim who reports

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

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

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

  5  Crime Victims' Services Office for the purposes of this

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

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

  8  physical examination unless the law enforcement officer

  9  certifies in writing that the initial forensic physical

10  examination is needed to aid in the investigation of an

11  alleged sexual offense and that the claimant is the alleged

12  victim of the offense. The department shall develop and

13  maintain separate protocols for the initial forensic physical

14  examination of adults and children. Payment under this section

15  is limited to medical expenses connected with the initial

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

17  medical provider using an examiner qualified under part I of

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

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

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

21  initial forensic physical examination associated with the

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

23  directly or indirectly, the cost of an initial forensic

24  physical examination performed in accordance with this

25  section.

26         Section 152.  Subsection (36) of section 984.03,

27  Florida Statutes, is amended to read:

28         984.03  Definitions.--When used in this chapter, the

29  term:

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

31  physician licensed under chapter 458, an osteopathic physician

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  chapter 464, a physician assistant licensed under chapter 458

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

  4         Section 153.  Subsection (37) of section 985.03,

  5  Florida Statutes, is amended to read:

  6         985.03  Definitions.--When used in this chapter, the

  7  term:

  8         (37)  "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 154.  Section 455.557, Florida Statutes, is

14  amended to read:

15         455.557  Standardized credentialing for health care

16  practitioners.--

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

18  efficient and effective health care practitioner credentialing

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

20  recognizes that health care practitioner credentialing

21  activities have increased significantly as a result of health

22  care reform and recent changes in health care delivery and

23  reimbursement systems. Moreover, the resulting duplication of

24  health care practitioner credentialing activities is

25  unnecessarily costly and cumbersome for both the practitioner

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

27  the intent of this section that a credentials collection

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

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

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

31  modifications thereto. Participation under this section shall

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  initially include those individuals licensed under chapter

  2  458, chapter 459, chapter 460, or chapter 461, or s. 464.012.

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

  4  applicable board, include other professions under the

  5  jurisdiction of the Division of Medical Quality Assurance in

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

  7  455.565 or s. 455.56503.

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

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

10  Credentials Advisory Council.

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

12  means approved by a quality assessment program, from the

13  National Committee for Quality Assurance, the Joint Commission

14  on Accreditation of Healthcare Organizations, the American

15  Accreditation HealthCare Commission/URAC, or any such other

16  nationally recognized and accepted organization authorized by

17  the department, used to assess and certify any credentials

18  verification program, entity, or organization that verifies

19  the credentials of any health care practitioner.

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

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

22  professional education, professional training, licensure,

23  current Drug Enforcement Administration certification, social

24  security number, specialty board certification, Educational

25  Commission for Foreign Medical Graduates certification,

26  hospital or other institutional affiliations, evidence of

27  professional liability coverage or evidence of financial

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

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

30  settlements, final disciplinary action reported pursuant to s.

31  455.565(1)(a)8. or s. 455.56503(1)(a)8., and Medicare or

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  Medicaid sanctions.

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

  3  process of assessing and verifying the qualifications of a

  4  licensed health care practitioner or applicant for licensure

  5  as a health care practitioner.

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

  7  any organization certified or accredited as a credentials

  8  verification organization.

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

10  Division of Medical Quality Assurance.

11         (f)(g)  "Designated credentials verification

12  organization" means the credentials verification organization

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

14  health care practitioner chooses to make such a designation.

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

16  means certification issued by the Drug Enforcement

17  Administration for purposes of administration or prescription

18  of controlled substances. Submission of such certification

19  under this section must include evidence that the

20  certification is current and must also include all current

21  addresses to which the certificate is issued.

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

23         1.  Any health care facility or other health care

24  organization licensed or certified to provide approved medical

25  and allied health services in this state;

26         2.  Any entity licensed by the Department of Insurance

27  as a prepaid health care plan or health maintenance

28  organization or as an insurer to provide coverage for health

29  care services through a network of providers; or

30         3.  Any accredited medical school in this state.

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

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

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

  4  licensed or applying for licensure under a chapter

  5  subsequently made subject to this section by the department

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

  7  registered or applying for registration pursuant to s. 458.345

  8  or s. 459.021.

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

10  means each hospital or other institution for which the health

11  care practitioner or applicant has provided medical services.

12  Submission of such information under this section must

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

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

15  the health care practitioner or applicant at that hospital or

16  institution, and the dates of affiliation with that hospital

17  or institution.

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

19  organization that awards accreditation or certification to

20  hospitals, managed care organizations, credentials

21  verification organizations, or other health care

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

23  Commission on Accreditation of Healthcare Organizations, the

24  American Accreditation HealthCare Commission/URAC, and the

25  National Committee for Quality Assurance.

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

27  residency, or fellowship relating to the profession for which

28  the health care practitioner is licensed or seeking licensure.

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

30  certification in a specialty issued by a specialty board

31  recognized by the board in this state that regulates the

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  profession for which the health care practitioner is licensed

  2  or seeking licensure.

  3         (3)  STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.--

  4         (a)  Every health care practitioner shall:

  5         1.  Report all core credentials data to the department

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

  7  designating a credentials verification organization to submit

  8  the data or by submitting the data directly.

  9         2.  Notify the department within 45 days of any

10  corrections, updates, or modifications to the core credentials

11  data either through his or her designated credentials

12  verification organization or by submitting the data directly.

13  Corrections, updates, and modifications to the core

14  credentials data provided the department under this section

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

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

17         (b)  The department shall:

18         1.  Maintain a complete, current file of core

19  credentials data on each health care practitioner, which shall

20  include all updates provided in accordance with subparagraph

21  (a)2.

22         2.  Release the core credentials data that is otherwise

23  confidential or exempt from the provisions of chapter 119 and

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

25  corrections, updates, and modifications thereto, if authorized

26  by the health care practitioner.

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

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

29  and operating costs, pursuant to the requirements of chapter

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

31  advisory council.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  standardized forms to be used by the health care practitioner

  3  or designated credentials verification organization for the

  4  initial reporting of core credentials data, for the health

  5  care practitioner to authorize the release of core credentials

  6  data, and for the subsequent reporting of corrections,

  7  updates, and modifications thereto.

  8         5.  Establish a Credentials Advisory Council,

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

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

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

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

13  required to achieve staggering, such appointments shall be for

14  4-year staggered terms, with one 4-year reappointment, as

15  applicable. Three members shall represent hospitals, and two

16  members shall represent health maintenance organizations. One

17  member shall represent health insurance entities. One member

18  shall represent the credentials verification industry. Two

19  members shall represent physicians licensed under chapter 458.

20  One member shall represent osteopathic physicians licensed

21  under chapter 459. One member shall represent chiropractic

22  physicians licensed under chapter 460. One member shall

23  represent podiatric physicians licensed under chapter 461.

24         (c)  A registered credentials verification organization

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

26  health care practitioner to comply with the requirements of

27  subparagraph (a)2. A designated credentials verification

28  organization shall:

29         1.  Timely comply with the requirements of subparagraph

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

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  without the authorization of the practitioner.

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

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

  5  and to approve or deny an application for hospital staff

  6  membership, clinical privileges, or managed care network

  7  participation.

  8         (4)  DUPLICATION OF DATA PROHIBITED.--

  9         (a)  A health care entity or credentials verification

10  organization is prohibited from collecting or attempting to

11  collect duplicate core credentials data from any health care

12  practitioner if the information is available from the

13  department. This section shall not be construed to restrict

14  the right of any health care entity or credentials

15  verification organization to collect additional information

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

17  core credentials data file. This section shall not be

18  construed to prohibit a health care entity or credentials

19  verification organization from obtaining all necessary

20  attestation and release form signatures and dates.

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

22  state which credentials health care practitioners may not

23  collect or attempt to collect duplicate core credentials data

24  from any individual health care practitioner if the

25  information is already available from the department. This

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

27  such state agency to request additional information not

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

29  necessary for the agency's specific credentialing purposes.

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

31  verification organization that does business in this state

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  must be fully accredited or certified as a credentials

  2  verification organization by a national accrediting

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

  4  register with the department. The department may charge a

  5  reasonable registration fee, set in consultation with the

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

  7  its actual expenses in providing and enforcing such

  8  registration. The department shall establish by rule for

  9  biennial renewal of such registration. Failure by a registered

10  credentials verification organization to maintain full

11  accreditation or certification, to provide data as authorized

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

13  changes, updates, and modifications to a health care

14  practitioner's records within the time period specified in

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

16  against collection of duplicate core credentials data from a

17  practitioner may result in denial of an application for

18  renewal of registration or in revocation or suspension of a

19  registration.

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

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

22  against any registered credentials verification organization

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

24  obtained directly from the department.

25         (7)  LIABILITY INSURANCE REQUIREMENTS.--Each

26  credentials verification organization doing business in this

27  state shall maintain liability insurance appropriate to meet

28  the certification or accreditation requirements established in

29  this section.

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

31  advisory council, shall adopt rules necessary to develop and

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  implement the standardized core credentials data collection

  2  program established by this section.

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

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

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

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

  7  out by the department on its own.

  8         Section 155.  Section 455.56503, Florida Statutes, is

  9  created to read:

10         455.56503  Advanced registered nurse practitioners;

11  information required for certification.--

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

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

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

15  applies for certification renewal must, in conjunction with

16  the renewal of such certification and under procedures adopted

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

18  information that may be required from the applicant, furnish

19  the following information to the Department of Health:

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

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

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

23  description of all graduate professional education completed

24  by the applicant, excluding any coursework taken to satisfy

25  continuing education requirements.

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

27  practices.

28         3.  The address at which the applicant will primarily

29  conduct his or her practice.

30         4.  Any certification or designation that the applicant

31  has received from a specialty or certification board that is

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  recognized or approved by the regulatory board or department

  2  to which the applicant is applying.

  3         5.  The year that the applicant received initial

  4  certification and began practicing the profession in any

  5  jurisdiction and the year that the applicant received initial

  6  certification in this state.

  7         6.  Any appointment which the applicant currently holds

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

  9  indication as to whether the applicant has had the

10  responsibility for graduate education within the most recent

11  10 years.

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

13  applicant has been found guilty, regardless of whether

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

15  has pled guilty or nolo contendere. A criminal offense

16  committed in another jurisdiction which would have been a

17  felony or misdemeanor if committed in this state must be

18  reported. If the applicant indicates that a criminal offense

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

20  that criminal offense, the department must state that the

21  criminal offense is under appeal if the criminal offense is

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

23  indicates to the department that a criminal offense is under

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

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

26  the final written order of disposition.

27         8.  A description of any final disciplinary action

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

29  licensing or regulatory body in any jurisdiction, by a

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

31  or by a licensed hospital, health maintenance organization,

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  prepaid health clinic, ambulatory surgical center, or nursing

  2  home. Disciplinary action includes resignation from or

  3  nonrenewal of staff membership or the restriction of

  4  privileges at a licensed hospital, health maintenance

  5  organization, prepaid health clinic, ambulatory surgical

  6  center, or nursing home taken in lieu of or in settlement of a

  7  pending disciplinary case related to competence or character.

  8  If the applicant indicates that the disciplinary action is

  9  under appeal and submits a copy of the document initiating an

10  appeal of the disciplinary action, the department must state

11  that the disciplinary action is under appeal if the

12  disciplinary action is reported in the applicant's profile.

13         (b)  In addition to the information required under

14  paragraph (a), each applicant for initial certification or

15  certification renewal must provide the information required of

16  licensees pursuant to s. 455.697.

17         (2)  The Department of Health shall send a notice to

18  each person certified under s. 464.012 at the

19  certificateholder's last known address of record regarding the

20  requirements for information to be submitted by advanced

21  registered nurse practitioners pursuant to this section in

22  conjunction with the renewal of such certificate.

23         (3)  Each person certified under s. 464.012 who has

24  submitted information pursuant to subsection (1) must update

25  that information in writing by notifying the Department of

26  Health within 45 days after the occurrence of an event or the

27  attainment of a status that is required to be reported by

28  subsection (1). Failure to comply with the requirements of

29  this subsection to update and submit information constitutes a

30  ground for disciplinary action under chapter 464 and s.

31  455.624(1)(k). For failure to comply with the requirements of

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  this subsection to update and submit information, the

  2  department or board, as appropriate, may:

  3         (a)  Refuse to issue a certificate to any person

  4  applying for initial certification who fails to submit and

  5  update the required information.

  6         (b)  Issue a citation to any certificateholder who

  7  fails to submit and update the required information and may

  8  fine the certificateholder up to $50 for each day that the

  9  certificateholder is not in compliance with this subsection.

10  The citation must clearly state that the certificateholder may

11  choose, in lieu of accepting the citation, to follow the

12  procedure under s. 455.621. If the certificateholder disputes

13  the matter in the citation, the procedures set forth in s.

14  455.621 must be followed. However, if the certificateholder

15  does not dispute the matter in the citation with the

16  department within 30 days after the citation is served, the

17  citation becomes a final order and constitutes discipline.

18  Service of a citation may be made by personal service or

19  certified mail, restricted delivery, to the subject at the

20  certificateholder's last known address.

21         (4)(a)  An applicant for initial certification under s.

22  464.012 must submit a set of fingerprints to the Department of

23  Health on a form and under procedures specified by the

24  department, along with payment in an amount equal to the costs

25  incurred by the Department of Health for a national criminal

26  history check of the applicant.

27         (b)  An applicant for renewed certification who has not

28  previously submitted a set of fingerprints to the Department

29  of Health for purposes of certification must submit a set of

30  fingerprints to the department as a condition of the initial

31  renewal of his or her certificate after the effective date of

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  this section. The applicant must submit the fingerprints on a

  2  form and under procedures specified by the department, along

  3  with payment in an amount equal to the costs incurred by the

  4  Department of Health for a national criminal history check.

  5  For subsequent renewals, the applicant for renewed

  6  certification must only submit information necessary to

  7  conduct a statewide criminal history check, along with payment

  8  in an amount equal to the costs incurred by the Department of

  9  Health for a statewide criminal history check.

10         (c)1.  The Department of Health shall submit the

11  fingerprints provided by an applicant for initial

12  certification to the Florida Department of Law Enforcement for

13  a statewide criminal history check, and the Florida Department

14  of Law Enforcement shall forward the fingerprints to the

15  Federal Bureau of Investigation for a national criminal

16  history check of the applicant.

17         2.  The department shall submit the fingerprints

18  provided by an applicant for the initial renewal of

19  certification to the Florida Department of Law Enforcement for

20  a statewide criminal history check, and the Florida Department

21  of Law Enforcement shall forward the fingerprints to the

22  Federal Bureau of Investigation for a national criminal

23  history check for the initial renewal of the applicant's

24  certificate after the effective date of this section.

25         3.  For any subsequent renewal of the applicant's

26  certificate, the department shall submit the required

27  information for a statewide criminal history check of the

28  applicant to the Florida Department of Law Enforcement.

29         (d)  Any applicant for initial certification or renewal

30  of certification as an advanced registered nurse practitioner

31  who submits to the Department of Health a set of fingerprints

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  and information required for the criminal history check

  2  required under this section shall not be required to provide a

  3  subsequent set of fingerprints or other duplicate information

  4  required for a criminal history check to the Agency for Health

  5  Care Administration, the Department of Juvenile Justice, or

  6  the Department of Children and Family Services for employment

  7  or licensure with such agency or department, if the applicant

  8  has undergone a criminal history check as a condition of

  9  initial certification or renewal of certification as an

10  advanced registered nurse practitioner with the Department of

11  Health, notwithstanding any other provision of law to the

12  contrary. In lieu of such duplicate submission, the Agency for

13  Health Care Administration, the Department of Juvenile

14  Justice, and the Department of Children and Family Services

15  shall obtain criminal history information for employment or

16  licensure of persons certified under s. 464.012 by such agency

17  or department from the Department of Health's health care

18  practitioner credentialing system.

19         (5)  Each person who is required to submit information

20  pursuant to this section may submit additional information to

21  the Department of Health. Such information may include, but is

22  not limited to:

23         (a)  Information regarding publications in

24  peer-reviewed professional literature within the previous 10

25  years.

26         (b)  Information regarding professional or community

27  service activities or awards.

28         (c)  Languages, other than English, used by the

29  applicant to communicate with patients or clients and

30  identification of any translating service that may be

31  available at the place where the applicant primarily conducts

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  his or her practice.

  2         (d)  An indication of whether the person participates

  3  in the Medicaid program.

  4         Section 156.  Section 455.5651, Florida Statutes, is

  5  amended to read:

  6         455.5651  Practitioner profile; creation.--

  7         (1)  Beginning July 1, 1999, the Department of Health

  8  shall compile the information submitted pursuant to s. 455.565

  9  into a practitioner profile of the applicant submitting the

10  information, except that the Department of Health may develop

11  a format to compile uniformly any information submitted under

12  s. 455.565(4)(b). Beginning July 1, 2001, the Department of

13  Health may compile the information submitted pursuant to s.

14  455.56503 into a practitioner profile of the applicant

15  submitting the information.

16         (2)  On the profile published required under subsection

17  (1), the department shall indicate if the information provided

18  under s. 455.565(1)(a)7. or s. 455.56503(1)(a)7. is not

19  corroborated by a criminal history check conducted according

20  to this subsection. If the information provided under s.

21  455.565(1)(a)7. or s. 455.56503(1)(a)7. is corroborated by the

22  criminal history check, the fact that the criminal history

23  check was performed need not be indicated on the profile. The

24  department, or the board having regulatory authority over the

25  practitioner acting on behalf of the department, shall

26  investigate any information received by the department or the

27  board when it has reasonable grounds to believe that the

28  practitioner has violated any law that relates to the

29  practitioner's practice.

30         (3)  The Department of Health may include in each

31  practitioner's practitioner profile that criminal information

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  that directly relates to the practitioner's ability to

  2  competently practice his or her profession.  The department

  3  must include in each practitioner's practitioner profile the

  4  following statement:  "The criminal history information, if

  5  any exists, may be incomplete; federal criminal history

  6  information is not available to the public."

  7         (4)  The Department of Health shall include, with

  8  respect to a practitioner licensed under chapter 458 or

  9  chapter 459, a statement of how the practitioner has elected

10  to comply with the financial responsibility requirements of s.

11  458.320 or s. 459.0085. The department shall include, with

12  respect to practitioners subject to s. 455.694, a statement of

13  how the practitioner has elected to comply with the financial

14  responsibility requirements of that section. The department

15  shall include, with respect to practitioners licensed under

16  chapter 458, chapter 459, or chapter 461, information relating

17  to liability actions which has been reported under s. 455.697

18  or s. 627.912 within the previous 10 years for any paid claim

19  that exceeds $5,000. Such claims information shall be reported

20  in the context of comparing an individual practitioner's

21  claims to the experience of other practitioners physicians

22  within the same specialty, or profession if the practitioner

23  is not a specialist, to the extent such information is

24  available to the Department of Health. If information relating

25  to a liability action is included in a practitioner's

26  practitioner profile, the profile must also include the

27  following statement:  "Settlement of a claim may occur for a

28  variety of reasons that do not necessarily reflect negatively

29  on the professional competence or conduct of the practitioner

30  physician.  A payment in settlement of a medical malpractice

31  action or claim should not be construed as creating a

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  presumption that medical malpractice has occurred."

  2         (5)  The Department of Health may not include

  3  disciplinary action taken by a licensed hospital or an

  4  ambulatory surgical center in the practitioner profile.

  5         (6)  The Department of Health may include in the

  6  practitioner's practitioner profile any other information that

  7  is a public record of any governmental entity and that relates

  8  to a practitioner's ability to competently practice his or her

  9  profession.  However, the department must consult with the

10  board having regulatory authority over the practitioner before

11  such information is included in his or her profile.

12         (7)  Upon the completion of a practitioner profile

13  under this section, the Department of Health shall furnish the

14  practitioner who is the subject of the profile a copy of it.

15  The practitioner has a period of 30 days in which to review

16  the profile and to correct any factual inaccuracies in it. The

17  Department of Health shall make the profile available to the

18  public at the end of the 30-day period. The department shall

19  make the profiles available to the public through the World

20  Wide Web and other commonly used means of distribution.

21         (8)  Making a practitioner profile available to the

22  public under this section does not constitute agency action

23  for which a hearing under s. 120.57 may be sought.

24         Section 157.  Section 455.5653, Florida Statutes, is

25  amended to read:

26         455.5653  Practitioner profiles; data

27  storage.--Effective upon this act becoming a law, the

28  Department of Health must develop or contract for a computer

29  system to accommodate the new data collection and storage

30  requirements under this act pending the development and

31  operation of a computer system by the Department of Health for

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  handling the collection, input, revision, and update of data

  2  submitted by physicians as a part of their initial licensure

  3  or renewal to be compiled into individual practitioner

  4  profiles. The Department of Health must incorporate any data

  5  required by this act into the computer system used in

  6  conjunction with the regulation of health care professions

  7  under its jurisdiction. The department must develop, by the

  8  year 2000, a schedule and procedures for each practitioner

  9  within a health care profession regulated within the Division

10  of Medical Quality Assurance to submit relevant information to

11  be compiled into a profile to be made available to the public.

12  The Department of Health is authorized to contract with and

13  negotiate any interagency agreement necessary to develop and

14  implement the practitioner profiles. The Department of Health

15  shall have access to any information or record maintained by

16  the Agency for Health Care Administration, including any

17  information or record that is otherwise confidential and

18  exempt from the provisions of chapter 119 and s. 24(a), Art. I

19  of the State Constitution, so that the Department of Health

20  may corroborate any information that practitioners physicians

21  are required to report under s. 455.565 or s. 455.56503.

22         Section 158.  Section 455.5654, Florida Statutes, is

23  amended to read:

24         455.5654  Practitioner profiles; rules;

25  workshops.--Effective upon this act becoming a law, the

26  Department of Health shall adopt rules for the form of a

27  practitioner profile that the agency is required to prepare.

28  The Department of Health, pursuant to chapter 120, must hold

29  public workshops for purposes of rule development to implement

30  this section. An agency to which information is to be

31  submitted under this act may adopt by rule a form for the

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  submission of the information required under s. 455.565 or s.

  2  455.56503.

  3         Section 159.  Subsection (20) of section 400.462,

  4  Florida Statutes, is repealed.

  5         Section 160.  Paragraph (d) of subsection (4) of

  6  section 400.471, Florida Statutes, is amended to read:

  7         400.471  Application for license; fee; provisional

  8  license; temporary permit.--

  9         (4)  Each applicant for licensure must comply with the

10  following requirements:

11         (d)  A provisional license may be granted to an

12  applicant when each individual required by this section to

13  undergo background screening has met the standards for the

14  abuse registry background check through the agency and the

15  Department of Law Enforcement background check, but the agency

16  has not yet received background screening results from the

17  Federal Bureau of Investigation. A standard license may be

18  granted to the licensee upon the agency's receipt of a report

19  of the results of the Federal Bureau of Investigation

20  background screening for each individual required by this

21  section to undergo background screening which confirms that

22  all standards have been met, or upon the granting of a

23  disqualification exemption by the agency as set forth in

24  chapter 435. Any other person who is required to undergo level

25  2 background screening may serve in his or her capacity

26  pending the agency's receipt of the report from the Federal

27  Bureau of Investigation. However, the person may not continue

28  to serve if the report indicates any violation of background

29  screening standards and a disqualification exemption has not

30  been requested of and granted by the agency as set forth in

31  chapter 435.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         Section 161.  Subsection (3) is added to section

  2  400.484, Florida Statutes, to read:

  3         400.484  Right of inspection; deficiencies; fines.--

  4         (3)  In addition to any other penalties imposed

  5  pursuant to this section or part, the agency may assess costs

  6  related to an investigation that results in a successful

  7  prosecution, excluding costs associated with an attorney's

  8  time.

  9         Section 162.  Section 400.487, Florida Statutes, is

10  amended to read:

11         400.487  Home health service agreements; physician's

12  treatment orders; patient assessment; establishment and review

13  of plan of care; provision of services; orders not to

14  resuscitate.--

15         (1)  Services provided by a home health agency must be

16  covered by an agreement between the home health agency and the

17  patient or the patient's legal representative specifying the

18  home health services to be provided, the rates or charges for

19  services paid with private funds, and the method of payment. A

20  The home health agency providing skilled care must make an

21  assessment of the patient's needs within 48 hours after the

22  start of services.

23         (2)  When required by the provisions of chapter 464,

24  part I, part III, or part V of chapter 468, or chapter 486,

25  the attending physician for a patient who is to receive

26  skilled care must establish treatment orders. The treatment

27  orders must be signed by the physician within 30 24 days after

28  the start of care and must be reviewed, as at least every 62

29  days or more frequently as if the patient's illness requires,

30  by the physician in consultation with home health agency

31  personnel that provide services to the patient.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         (3)  A home health agency shall arrange for supervisory

  2  visits by a registered nurse to the home of a patient

  3  receiving home health aide services in accordance with the

  4  patient's direction and approval. If a client is accepted for

  5  home health aide services or homemaker or companion services

  6  and such services do not require a physician's order, the home

  7  health agency shall establish a service provision plan and

  8  maintain a record of the services provided.

  9         (4)  Each patient or client has the right to be

10  informed of and to participate in the planning of his or her

11  care. Each patient must be provided, upon request, a copy of

12  the plan of care or service provision plan established and

13  maintained for that patient or client by the home health

14  agency.

15         (5)  When nursing services are ordered, the home health

16  agency to which a patient has been admitted for care must

17  provide the initial admission visit, all service evaluation

18  visits, and the discharge visit by qualified personnel who are

19  on the payroll of, and to whom an IRS payroll form W-2 will be

20  issued by, the home health agency. Services provided by others

21  under contractual arrangements to a home health agency must be

22  monitored and managed by the admitting home health agency. The

23  admitting home health agency is fully responsible for ensuring

24  that all care provided through its employees or contract staff

25  is delivered in accordance with this part and applicable

26  rules.

27         (6)  The skilled care services provided by a home

28  health agency, directly or under contract, must be supervised

29  and coordinated in accordance with the plan of care.

30         (7)  Home health agency personnel may withhold or

31  withdraw cardiopulmonary resuscitation if presented with an

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  order not to resuscitate executed pursuant to s. 401.45. The

  2  agency shall adopt rules providing for the implementation of

  3  such orders. Home health personnel and agencies shall not be

  4  subject to criminal prosecution or civil liability, nor be

  5  considered to have engaged in negligent or unprofessional

  6  conduct, for withholding or withdrawing cardiopulmonary

  7  resuscitation pursuant to such an order and rules adopted by

  8  the agency.

  9         Section 163.  Section 400.497, Florida Statutes, is

10  amended to read:

11         400.497  Rules establishing minimum standards.--The

12  agency shall adopt, publish, and enforce rules to implement

13  this part, including, as applicable, ss. 400.506 and 400.509,

14  which must provide reasonable and fair minimum standards

15  relating to:

16         (1)  The home health aide competency test and home

17  health aide training. The qualifications, minimum training

18  requirements, and supervision requirements of all home health

19  agency personnel. The agency shall create the home health aide

20  competency test and establish the curriculum and instructor

21  qualifications for home health aide training. Licensed home

22  health agencies may provide this training and shall furnish

23  documentation of such training to other licensed home health

24  agencies upon request. Successful passage of the competency

25  test by home health aides may be substituted for the training

26  required under this section and any rule adopted pursuant

27  thereto.

28         (2)  Shared staffing. The agency shall allow shared

29  staffing if the home health agency is part of a retirement

30  community that provides multiple levels of care, is located on

31  one campus, is licensed under this chapter, and otherwise

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  meets the requirements of law and rule.

  2         (2)  Requirements for prospective employees.  A home

  3  health agency must require prospective employees and

  4  contractors to submit an employment or contractual history,

  5  and it must verify the employment or contractual history

  6  unless through diligent efforts such verification is not

  7  possible.  The agency shall prescribe by rule the minimum

  8  requirements for establishing that diligent efforts have been

  9  made. There is no monetary liability on the part of, and no

10  cause of action for damages arising against, a former employer

11  of a prospective employee of or prospective independent

12  contractor with a licensed home health agency who reasonably

13  and in good faith communicates his or her honest opinions

14  about the former employee's job performance. This subsection

15  does not affect the official immunity of an officer or

16  employee of a public corporation.

17         (3)  The criteria for the frequency of onsite licensure

18  surveys.

19         (4)(3)  Licensure application and renewal.

20         (5)(4)  The administration of the home health agency,

21  including requirements for onsite and electronic accessibility

22  of supervisory personnel of home health agencies.

23         (5)  Procedures for administering drugs and

24  biologicals.

25         (6)  Information to be included in Procedures for

26  maintaining patients' records.

27         (7)  Ensuring that home health services are provided in

28  accordance with the treatment orders established for each

29  patient for whom physician orders are required.

30         (7)(8)  Geographic service areas.

31         (9)  Standards for contractual arrangements for the

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  provision of home health services by providers not employed by

  2  the home health agency to whom the patient has been admitted.

  3         Section 164.  Paragraph (d) of subsection (2) and

  4  subsection (13) of section 400.506, Florida Statutes, are

  5  amended, subsection (17) is renumbered as subsection (18), and

  6  a new subsection (17) is added to said section, to read:

  7         400.506  Licensure of nurse registries; requirements;

  8  penalties.--

  9         (2)  Each applicant for licensure must comply with the

10  following requirements:

11         (d)  A provisional license may be granted to an

12  applicant when each individual required by this section to

13  undergo background screening has met the standards for the

14  abuse registry background check through the agency and the

15  Department of Law Enforcement background check, but the agency

16  has not yet received background screening results from the

17  Federal Bureau of Investigation. A standard license may be

18  granted to the applicant upon the agency's receipt of a report

19  of the results of the Federal Bureau of Investigation

20  background screening for each individual required by this

21  section to undergo background screening which confirms that

22  all standards have been met, or upon the granting of a

23  disqualification exemption by the agency as set forth in

24  chapter 435. Any other person who is required to undergo level

25  2 background screening may serve in his or her capacity

26  pending the agency's receipt of the report from the Federal

27  Bureau of Investigation. However, the person may not continue

28  to serve if the report indicates any violation of background

29  screening standards and a disqualification exemption has not

30  been requested of and granted by the agency as set forth in

31  chapter 435.

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         (13)  Each nurse registry must comply with the

  2  procedures set forth in s. 400.512 400.497(3) for maintaining

  3  records of the employment history of all persons referred for

  4  contract and is subject to the standards and conditions set

  5  forth in that section s. 400.512. However, an initial

  6  screening may not be required for persons who have been

  7  continuously registered with the nurse registry since

  8  September 30, 1990.

  9         (17)  In addition to any other penalties imposed

10  pursuant to this section or part, the agency may assess costs

11  related to an investigation that results in a successful

12  prosecution, excluding costs associated with an attorney's

13  time. If the agency imposes such an assessment and the

14  assessment is not paid, and if challenged is not the subject

15  of a pending appeal, prior to the renewal of the license, the

16  license shall not be issued until the assessment is paid or

17  arrangements for payment of the assessment are made.

18         Section 165.  Paragraph (d) of subsection (4) of

19  section 400.509, Florida Statutes, is amended, subsection (14)

20  is renumbered as subsection (15), and a new subsection (14) is

21  added to said section, to read:

22         400.509  Registration of particular service providers

23  exempt from licensure; certificate of registration; regulation

24  of registrants.--

25         (4)  Each applicant for registration must comply with

26  the following requirements:

27         (d)  A provisional registration may be granted to an

28  applicant when each individual required by this section to

29  undergo background screening has met the standards for the

30  abuse-registry background check through the agency and the

31  Department of Law Enforcement background check, but the agency

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  has not yet received background screening results from the

  2  Federal Bureau of Investigation.  A standard registration may

  3  be granted to the applicant upon the agency's receipt of a

  4  report of the results of the Federal Bureau of Investigation

  5  background screening for each individual required by this

  6  section to undergo background screening which confirms that

  7  all standards have been met, or upon the granting of a

  8  disqualification exemption by the agency as set forth in

  9  chapter 435.  Any other person who is required to undergo

10  level 2 background screening may serve in his or her capacity

11  pending the agency's receipt of the report from the Federal

12  Bureau of Investigation.  However, the person may not continue

13  to serve if the report indicates any violation of background

14  screening standards and if a disqualification exemption has

15  not been requested of and granted by the agency as set forth

16  in chapter 435.

17         (14)  In addition to any other penalties imposed

18  pursuant to this section or part, the agency may assess costs

19  related to an investigation that results in a successful

20  prosecution, excluding costs associated with an attorney's

21  time. If the agency imposes such an assessment and the

22  assessment is not paid, and if challenged is not the subject

23  of a pending appeal, prior to the renewal of the registration,

24  the registration shall not be issued until the assessment is

25  paid or arrangements for payment of the assessment are made.

26         Section 166.  Section 400.512, Florida Statutes, is

27  amended to read:

28         400.512  Screening of home health agency personnel;

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

30  agency shall require employment or contractor screening as

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

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





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

  2  personnel; persons referred for employment by nurse

  3  registries; and persons employed by companion or homemaker

  4  services registered under s. 400.509.

  5         (1)  The agency may grant exemptions from

  6  disqualification from employment or contracting under this

  7  section as provided in s. 435.07.

  8         (2)  The administrator of each home health agency, the

  9  managing employee of each nurse registry, and the managing

10  employee of each companion or homemaker service registered

11  under s. 400.509 must sign an affidavit annually, under

12  penalty of perjury, stating that all personnel hired,

13  contracted with, or registered on or after October 1, 1994,

14  who enter the home of a patient or client in their service

15  capacity have been screened and that its remaining personnel

16  have worked for the home health agency or registrant

17  continuously since before October 1, 1994.

18         (3)  As a prerequisite to operating as a home health

19  agency, nurse registry, or companion or homemaker service

20  under s. 400.509, the administrator or managing employee,

21  respectively, must submit to the agency his or her name and

22  any other information necessary to conduct a complete

23  screening according to this section.  The agency shall submit

24  the information to the Department of Law Enforcement and shall

25  conduct a search for any report of confirmed abuse the

26  department's abuse hotline for state processing.  The agency

27  shall review the record of the administrator or manager with

28  respect to the offenses specified in this section and shall

29  notify the owner of its findings.  If disposition information

30  is missing on a criminal record, the administrator or manager,

31  upon request of the agency, must obtain and supply within 30

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  days the missing disposition information to the agency.

  2  Failure to supply missing information within 30 days or to

  3  show reasonable efforts to obtain such information will result

  4  in automatic disqualification.

  5         (4)  Proof of compliance with the screening

  6  requirements of chapter 435 shall be accepted in lieu of the

  7  requirements of this section if the person has been

  8  continuously employed or registered without a breach in

  9  service that exceeds 180 days, the proof of compliance is not

10  more than 2 years old, and the person has been screened

11  through the agency for any reports of confirmed abuse central

12  abuse registry and tracking system of the department and for

13  any criminal record from by the Department of Law Enforcement.

14  A home health agency, nurse registry, or companion or

15  homemaker service registered under s. 400.509 shall directly

16  provide proof of compliance to another home health agency,

17  nurse registry, or companion or homemaker service registered

18  under s. 400.509. The recipient home health agency, nurse

19  registry, or companion or homemaker service registered under

20  s. 400.509 may not accept any proof of compliance directly

21  from the person who requires screening. Proof of compliance

22  with the screening requirements of this section shall be

23  provided upon request to the person screened by the home

24  health agencies; nurse registries; or companion or homemaker

25  services registered under s. 400.509.

26         (5)(a)  There is no monetary liability on the part of,

27  and no cause of action for damages arises against, a licensed

28  home health agency, licensed nurse registry, or companion or

29  homemaker service registered under s. 400.509, that, upon

30  notice of a confirmed report of adult abuse, neglect, or

31  exploitation through the agency, terminates the employee or

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  contractor against whom the report was issued, whether or not

  2  the employee or contractor has filed for an exemption with the

  3  agency in accordance with chapter 435 and whether or not the

  4  time for filing has expired.

  5         (b)  If a home health agency is asked about a person

  6  who was employed by or contracted with that agency, there is

  7  no monetary liability on the part of, and no cause of action

  8  for damages arising against, a former employer of the person

  9  for that agency, who reasonably and in good faith communicates

10  his or her honest opinions about the former caregiver's job

11  performance. This paragraph does not affect the official

12  immunity of an officer or employee of a public corporation.

13         (6)  The costs of processing the statewide

14  correspondence criminal records checks and the search of the

15  department's central abuse hotline must be borne by the home

16  health agency; the nurse registry; or the companion or

17  homemaker service registered under s. 400.509, or by the

18  person being screened, at the discretion of the home health

19  agency, nurse registry, or s. 400.509 registrant.

20         (7)(a)  It is a misdemeanor of the first degree,

21  punishable under s. 775.082 or s. 775.083, for any person

22  willfully, knowingly, or intentionally to:

23         1.  Fail, by false statement, misrepresentation,

24  impersonation, or other fraudulent means, to disclose in any

25  application for voluntary or paid employment a material fact

26  used in making a determination as to such person's

27  qualifications to be an employee under this section;

28         2.  Operate or attempt to operate an entity licensed or

29  registered under this part with persons who do not meet the

30  minimum standards for good moral character as contained in

31  this section; or

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         3.  Use information from the criminal records or the

  2  agency's reports of confirmed abuse central abuse hotline

  3  obtained under this section for any purpose other than

  4  screening that person for employment as specified in this

  5  section or release such information to any other person for

  6  any purpose other than screening for employment under this

  7  section.

  8         (b)  It is a felony of the third degree, punishable

  9  under s. 775.082, s. 775.083, or s. 775.084, for any person

10  willfully, knowingly, or intentionally to use information from

11  the juvenile records of a person obtained under this section

12  for any purpose other than screening for employment under this

13  section.

14         Section 167.  Subsection (5) of section 455.587,

15  Florida Statutes, is amended to read:

16         455.587  Fees; receipts; disposition.--

17         (5)  All moneys collected by the department from fees

18  or fines or from costs awarded to the agency by a court shall

19  be paid into a trust fund used by the department to implement

20  this part. The Legislature shall appropriate funds from this

21  trust fund sufficient to carry out this part and the

22  provisions of law with respect to professions regulated by the

23  Division of Medical Quality Assurance within the department

24  and the boards.  The department may contract with public and

25  private entities to receive and deposit revenue pursuant to

26  this section.  The department shall maintain separate accounts

27  in the trust fund used by the department to implement this

28  part for every profession within the department.  To the

29  maximum extent possible, the department shall directly charge

30  all expenses to the account of each regulated profession.  For

31  the purpose of this subsection, direct charge expenses

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  include, but are not limited to, costs for investigations,

  2  examinations, and legal services.  For expenses that cannot be

  3  charged directly, the department shall provide for the

  4  proportionate allocation among the accounts of expenses

  5  incurred by the department in the performance of its duties

  6  with respect to each regulated profession. The regulation by

  7  the department of professions, as defined in this part, shall

  8  be financed solely from revenue collected by it from fees and

  9  other charges and deposited in the Medical Quality Assurance

10  Trust Fund, and all such revenue is hereby appropriated to the

11  department. However, it is legislative intent that each

12  profession shall operate within its anticipated fees. The

13  department may not expend funds from the account of a

14  profession to pay for the expenses incurred on behalf of

15  another profession, except that the Board of Nursing must pay

16  for any costs incurred in the regulation of certified nursing

17  assistants. The department shall maintain adequate records to

18  support its allocation of agency expenses.  The department

19  shall provide any board with reasonable access to these

20  records upon request.  The department shall provide each board

21  an annual report of revenue and direct and allocated expenses

22  related to the operation of that profession. The board shall

23  use these reports and the department's adopted long-range plan

24  to determine the amount of license fees.  A condensed version

25  of this information, with the department's recommendations,

26  shall be included in the annual report to the Legislature

27  prepared under s. 455.644.

28         Section 168.  There is appropriated from the Medical

29  Quality Assurance Trust Fund to the Department of Health the

30  sum of $280,000 to implement the provisions of this act.

31

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1  (Redesignate subsequent sections.)

  2

  3

  4  ================ T I T L E   A M E N D M E N T ===============

  5  And the title is amended as follows:

  6         On page 150, line 31, after the semicolon,

  7

  8  insert:

  9         amending part XV of chapter 468, F.S., relating

10         to certified nursing assistants, and

11         transferring that part to chapter 464, F.S.,

12         relating to nursing, to transfer from the

13         Department of Health to the Board of Nursing

14         responsibility and rulemaking authority for

15         regulation of certified nursing assistants;

16         changing requirements for nursing assistants;

17         transferring from the Department of Education

18         to the board responsibility for approval of

19         training programs; revising grounds for which

20         the board may impose certain penalties;

21         creating s. 464.2085, F.S.; creating and

22         providing requirements for a Council on

23         Certified Nursing Assistants; amending ss.

24         20.43, 39.01, 39.304, 110.131, 232.46,

25         240.4075, 246.081, 310.102, 381.0302, 384.30,

26         384.31, 394.455, 395.0191, 400.021, 400.211,

27         400.402, 400.407, 400.4255, 400.426, 400.462,

28         400.464, 400.506, 400.6105, 401.23, 401.252,

29         408.706, 409.908, 415.1085, 455.597, 455.604,

30         455.667, 455.677, 455.694, 455.707, 458.348,

31         464.001, 464.002, 464.003, 464.006, 464.009,

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         464.016, 464.018, 464.019, 464.022, 464.023,

  2         464.027, 466.003, 467.003, 467.0125, 467.203,

  3         468.505, 483.041, 483.801, 491.0112, 550.24055,

  4         627.351, 627.357, 627.9404, 641.31, 766.101,

  5         766.110, 766.1115, 877.111, 945.602, 960.28,

  6         984.03, 985.03, F.S.; conforming references;

  7         revising application procedures for certified

  8         nursing assistants; revising registration

  9         requirements for certified nursing assistants;

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

11         provisions relating to the granting of

12         exemptions from disqualification for employment

13         in nursing homes or home health agencies;

14         amending s. 400.23, F.S.; authorizing licensed

15         practical nurses in nursing home facilities to

16         supervise the activities of other licensed

17         practical nurses, certified nursing assistants,

18         and other unlicensed personnel working in such

19         facilities in accordance with rules adopted by

20         the Board of Nursing; amending s. 455.557,

21         F.S.; including advanced registered nurse

22         practitioners under the credentialing program;

23         creating s. 455.56503, F.S.; requiring advanced

24         registered nurse practitioners to submit

25         information and fingerprints for profiling

26         purposes; amending s. 455.5651, F.S.;

27         authorizing the department to publish certain

28         information in practitioner profiles; amending

29         s. 455.5653, F.S.; deleting obsolete provisions

30         relating to scheduling and development of

31         practitioner profiles for additional health

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         care practitioners; providing access to

  2         information on advanced registered nurse

  3         practitioners maintained by the Agency for

  4         Health Care Administration for corroboration

  5         purposes; amending s. 455.5654, F.S.; providing

  6         for adoption by rule of a form for submission

  7         of profiling information; repealing s.

  8         400.462(20), F.S., to delete the definition of

  9         "screening" under the Home Health Services Act;

10         amending s. 400.471, F.S.; providing for an

11         abuse registry background check through the

12         Agency for Health Care Administration; amending

13         s. 400.484, F.S.; providing for assessment of

14         certain costs of an investigation that results

15         in a successful prosecution; amending s.

16         400.487, F.S.; requiring home health service

17         agreements; revising requirements for

18         physician's treatment orders; providing for

19         supervisory visits by a registered nurse under

20         certain circumstances; deleting provisions

21         relating to service provision plans; amending

22         s. 400.497, F.S.; providing for a home health

23         aide competency test, criteria for the

24         frequency of onsite licensure surveys, and

25         information to be included in patients'

26         records; amending s. 400.506, F.S.; providing

27         for an abuse registry background check through

28         the Agency for Health Care Administration;

29         authorizing assessment of certain costs of an

30         investigation that results in a successful

31         prosecution; revising a cross reference; making

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                                                  SENATE AMENDMENT

    Bill No. CS/CS/HB 591, 2nd Eng.

    Amendment No. ___





  1         renewal of license contingent on payment or

  2         arrangement for payment of any unpaid

  3         assessment; amending s. 400.509, F.S.;

  4         providing for an abuse registry background

  5         check through the Agency for Health Care

  6         Administration; authorizing assessment of

  7         certain costs of an investigation that results

  8         in a successful prosecution; making renewal of

  9         registration contingent on payment or

10         arrangement for payment of any unpaid

11         assessment; amending s. 400.512, F.S.; revising

12         provisions relating to the screening of home

13         health agency, nurse registry, and companion

14         and homemaker service personnel; requiring the

15         Agency for Health Care Administration to

16         conduct the search for reports of confirmed

17         abuse; providing an exemption from liability

18         under certain conditions for providing opinions

19         on the job performance of former employees and

20         contract workers; providing conforming changes;

21         amending s. 455.587, F.S.; providing

22         requirements for funding regulation of

23         professions by the Department of Health;

24         providing an appropriation;

25

26

27

28

29

30

31

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