CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for CS for SB 370
Amendment No. ___ Barcode 104940
CHAMBER ACTION
Senate House
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11 Senator Saunders moved the following amendment:
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13 Senate Amendment (with title amendment)
14 Delete everything after the enacting clause
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16 and insert:
17 Section 1. Paragraph (g) of subsection (3) of section
18 20.43, Florida Statutes, is amended to read:
19 20.43 Department of Health.--There is created a
20 Department of Health.
21 (3) The following divisions of the Department of
22 Health are established:
23 (g) Division of Medical Quality Assurance, which is
24 responsible for the following boards and professions
25 established within the division:
26 1. The Board of Acupuncture, created under chapter
27 457.
28 2. The Board of Medicine, created under chapter 458.
29 3. The Board of Osteopathic Medicine, created under
30 chapter 459.
31 4. The Board of Chiropractic Medicine, created under
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1 chapter 460.
2 5. The Board of Podiatric Medicine, created under
3 chapter 461.
4 6. Naturopathy, as provided under chapter 462.
5 7. The Board of Optometry, created under chapter 463.
6 8. The Board of Nursing, created under part I of
7 chapter 464.
8 9. Nursing assistants, as provided under part II of
9 chapter 464.
10 10. The Board of Pharmacy, created under chapter 465.
11 11. The Board of Dentistry, created under chapter 466.
12 12. Midwifery, as provided under chapter 467.
13 13. The Board of Speech-Language Pathology and
14 Audiology, created under part I of chapter 468.
15 14. The Board of Nursing Home Administrators, created
16 under part II of chapter 468.
17 15. The Board of Occupational Therapy, created under
18 part III of chapter 468.
19 16. The Board of Respiratory Care therapy, as created
20 provided under part V of chapter 468.
21 17. Dietetics and nutrition practice, as provided
22 under part X of chapter 468.
23 18. The Board of Athletic Training, created under part
24 XIII of chapter 468.
25 19. The Board of Orthotists and Prosthetists, created
26 under part XIV of chapter 468.
27 20. Electrolysis, as provided under chapter 478.
28 21. The Board of Massage Therapy, created under
29 chapter 480.
30 22. The Board of Clinical Laboratory Personnel,
31 created under part III of chapter 483.
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1 23. Medical physicists, as provided under part IV of
2 chapter 483.
3 24. The Board of Opticianry, created under part I of
4 chapter 484.
5 25. The Board of Hearing Aid Specialists, created
6 under part II of chapter 484.
7 26. The Board of Physical Therapy Practice, created
8 under chapter 486.
9 27. The Board of Psychology, created under chapter
10 490.
11 28. School psychologists, as provided under chapter
12 490.
13 29. The Board of Clinical Social Work, Marriage and
14 Family Therapy, and Mental Health Counseling, created under
15 chapter 491.
16
17 The department may contract with the Agency for Health Care
18 Administration who shall provide consumer complaint,
19 investigative, and prosecutorial services required by the
20 Division of Medical Quality Assurance, councils, or boards, as
21 appropriate.
22 Section 2. Section 456.047, Florida Statutes, is
23 repealed.
24 Section 3. All revenues associated with section
25 456.047, Florida Statutes, and collected by the Department of
26 Health on or before July 1, 2002, shall remain in the Medical
27 Quality Assurance Trust Fund, and no refunds shall be given.
28 Section 4. Paragraph (d) of subsection (4) of section
29 456.039, Florida Statutes, is amended to read:
30 456.039 Designated health care professionals;
31 information required for licensure.--
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1 (4)
2 (d) Any applicant for initial licensure or renewal of
3 licensure as a health care practitioner who submits to the
4 Department of Health a set of fingerprints or information
5 required for the criminal history check required under this
6 section shall not be required to provide a subsequent set of
7 fingerprints or other duplicate information required for a
8 criminal history check to the Agency for Health Care
9 Administration, the Department of Juvenile Justice, or the
10 Department of Children and Family Services for employment or
11 licensure with such agency or department if the applicant has
12 undergone a criminal history check as a condition of initial
13 licensure or licensure renewal as a health care practitioner
14 with the Department of Health or any of its regulatory boards,
15 notwithstanding any other provision of law to the contrary. In
16 lieu of such duplicate submission, the Agency for Health Care
17 Administration, the Department of Juvenile Justice, and the
18 Department of Children and Family Services shall obtain
19 criminal history information for employment or licensure of
20 health care practitioners by such agency and departments from
21 the Department of Health Health's health care practitioner
22 credentialing system.
23 Section 5. Paragraph (d) of subsection (4) of section
24 456.0391, Florida Statutes, is amended to read:
25 456.0391 Advanced registered nurse practitioners;
26 information required for certification.--
27 (4)
28 (d) Any applicant for initial certification or renewal
29 of certification as an advanced registered nurse practitioner
30 who submits to the Department of Health a set of fingerprints
31 and information required for the criminal history check
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1 required under this section shall not be required to provide a
2 subsequent set of fingerprints or other duplicate information
3 required for a criminal history check to the Agency for Health
4 Care Administration, the Department of Juvenile Justice, or
5 the Department of Children and Family Services for employment
6 or licensure with such agency or department, if the applicant
7 has undergone a criminal history check as a condition of
8 initial certification or renewal of certification as an
9 advanced registered nurse practitioner with the Department of
10 Health, notwithstanding any other provision of law to the
11 contrary. In lieu of such duplicate submission, the Agency for
12 Health Care Administration, the Department of Juvenile
13 Justice, and the Department of Children and Family Services
14 shall obtain criminal history information for employment or
15 licensure of persons certified under s. 464.012 by such agency
16 or department from the Department of Health Health's health
17 care practitioner credentialing system.
18 Section 6. Paragraphs (e), (v), (aa), and (bb) of
19 subsection (1) of section 456.072, Florida Statutes, are
20 amended to read:
21 456.072 Grounds for discipline; penalties;
22 enforcement.--
23 (1) The following acts shall constitute grounds for
24 which the disciplinary actions specified in subsection (2) may
25 be taken:
26 (e) Failing to comply with the educational course
27 requirements for conditions caused by nuclear, biological, and
28 chemical terrorism or for human immunodeficiency virus and
29 acquired immune deficiency syndrome. As used in this
30 paragraph, the term "terrorism" has the same meaning as in s.
31 775.30.
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1 (v) Failing to comply with the requirements for
2 profiling and credentialing, including, but not limited to,
3 failing to provide initial information, failing to timely
4 provide updated information, or making misleading, untrue,
5 deceptive, or fraudulent representations on a profile,
6 credentialing, or initial or renewal licensure application.
7 (aa) Performing or attempting to perform health care
8 services on the wrong patient, a wrong-site procedure, a wrong
9 procedure, or an unauthorized procedure or a procedure that is
10 medically unnecessary or otherwise unrelated to the patient's
11 diagnosis or medical condition. For the purposes of this
12 paragraph, performing or attempting to perform health care
13 services includes the preparation of the patient.
14 (bb) Leaving a foreign body in a patient, such as a
15 sponge, clamp, forceps, surgical needle, or other
16 paraphernalia commonly used in surgical, examination, or other
17 diagnostic procedures, unless leaving the foreign body is
18 medically indicated and documented in the patient record. For
19 the purposes of this paragraph, it shall be legally presumed
20 that retention of a foreign body is not in the best interest
21 of the patient and is not within the standard of care of the
22 profession, unless medically indicated and documented in the
23 patient record regardless of the intent of the professional.
24 Section 7. Subsection (2) of section 456.077, Florida
25 Statutes, is amended to read:
26 456.077 Authority to issue citations.--
27 (2) The board, or the department if there is no board,
28 shall adopt rules designating violations for which a citation
29 may be issued. Such rules shall designate as citation
30 violations those violations for which there is no substantial
31 threat to the public health, safety, and welfare. Violations
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1 for which a citation may be issued shall include violations of
2 continuing education requirements; failure to timely pay
3 required fees and fines; failure to comply with the
4 requirements of ss. 381.026 and 381.0261 regarding the
5 dissemination of information regarding patient rights; failure
6 to comply with advertising requirements; failure to timely
7 update practitioner profile and credentialing files; failure
8 to display signs, licenses, and permits; failure to have
9 required reference books available; and all other violations
10 that do not pose a direct and serious threat to the health and
11 safety of the patient.
12 Section 8. Subsection (3) of section 458.309, Florida
13 Statutes, is amended to read:
14 458.309 Authority to make rules.--
15 (3) All physicians who perform level 2 procedures
16 lasting more than 5 minutes and all level 3 surgical
17 procedures in an office setting must register the office with
18 the department unless that office is licensed as a facility
19 pursuant to chapter 395. Each office that is required under
20 this subsection to be registered must be The department shall
21 inspect the physician's office annually unless the office is
22 accredited by a nationally recognized accrediting agency
23 approved by the Board of Medicine by rule or an accrediting
24 organization subsequently approved by the Board of Medicine by
25 rule. Each office registered but not accredited as required
26 by this subsection must achieve full and unconditional
27 accreditation no later than July 1, 2003, and must maintain
28 unconditional accreditation as long as procedures described in
29 this subsection which require the office to be registered and
30 accredited are performed. Accreditation reports shall be
31 submitted to the department. The actual costs for registration
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1 and inspection or accreditation shall be paid by the person
2 seeking to register and operate the office setting in which
3 office surgery is performed. The board may adopt rules
4 pursuant to ss. 120.536(1) and 120.54 to implement this
5 subsection.
6 Section 9. Subsection (2) of section 459.005, Florida
7 Statutes, is amended to read:
8 459.005 Rulemaking authority.--
9 (2) All osteopathic physicians who perform level 2
10 procedures lasting more than 5 minutes and all level 3
11 surgical procedures in an office setting must register the
12 office with the department unless that office is licensed as a
13 facility pursuant to chapter 395. Each office that is
14 required under this subsection to be registered must be The
15 department shall inspect the physician's office annually
16 unless the office is accredited by a nationally recognized
17 accrediting agency approved by the Board of Medicine or the
18 Board of Osteopathic Medicine by rule or an accrediting
19 organization subsequently approved by the Board of Medicine or
20 the Board of Osteopathic Medicine by rule. Each office
21 registered but not accredited as required by this subsection
22 must achieve full and unconditional accreditation no later
23 than July 1, 2003, and must maintain unconditional
24 accreditation as long as procedures described in this
25 subsection which require the office to be registered and
26 accredited are performed. Accreditation reports shall be
27 submitted to the department. The actual costs for registration
28 and inspection or accreditation shall be paid by the person
29 seeking to register and operate the office setting in which
30 office surgery is performed. The Board of Osteopathic
31 Medicine may adopt rules pursuant to ss. 120.536(1) and 120.54
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1 to implement this subsection.
2 Section 10. Subsection (11) is added to section
3 456.004, Florida Statutes, to read:
4 456.004 Department; powers and duties.--The
5 department, for the professions under its jurisdiction, shall:
6 (11) Require objective performance measures for all
7 bureaus, units, boards, contracted entities, and board
8 executive directors which reflect the expected quality and
9 quantity of services.
10 Section 11. Subsection (1) of section 456.009, Florida
11 Statutes, is amended to read:
12 456.009 Legal and investigative services.--
13 (1) The department shall provide board counsel for
14 boards within the department by contracting with the
15 Department of Legal Affairs, by retaining private counsel
16 pursuant to s. 287.059, or by providing department staff
17 counsel. The primary responsibility of board counsel shall be
18 to represent the interests of the citizens of the state. A
19 board shall provide for the periodic review and evaluation of
20 the services provided by its board counsel. Fees and costs of
21 such counsel shall be paid from a trust fund used by the
22 department to implement this chapter, subject to the
23 provisions of s. 456.025. All contracts for independent
24 counsel shall provide for periodic review and evaluation by
25 the board and the department of services provided. All legal
26 and investigative services shall be reviewed by the department
27 annually to determine if such services are meeting the
28 performance measures specified in law and in the contract. All
29 contracts for legal and investigative services must include
30 objective performance measures that reflect the expected
31 quality and quantity of the contracted services.
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1 Section 12. Subsection (6) is added to section
2 456.011, Florida Statutes, to read:
3 456.011 Boards; organization; meetings; compensation
4 and travel expenses.--
5 (6) Meetings of board committees, including probable
6 cause panels, shall be conducted electronically unless held
7 concurrently with, or on the day immediately before or after,
8 a regularly scheduled in-person board meeting. However, if a
9 particular committee meeting is expected to last more than 5
10 hours and cannot be held before or after the in-person board
11 meeting, the chair of the committee may request special
12 permission from the director of the Division of Medical
13 Quality Assurance to hold an in-person committee meeting in
14 Tallahassee.
15 Section 13. Subsection (11) is added to section
16 456.026, Florida Statutes, to read:
17 456.026 Annual report concerning finances,
18 administrative complaints, disciplinary actions, and
19 recommendations.--The department is directed to prepare and
20 submit a report to the President of the Senate and the Speaker
21 of the House of Representatives by November 1 of each year. In
22 addition to finances and any other information the Legislature
23 may require, the report shall include statistics and relevant
24 information, profession by profession, detailing:
25 (11) The performance measures for all bureaus, units,
26 boards, and contracted entities required by the department to
27 reflect the expected quality and quantity of services, and a
28 description of any effort to improve the performance of such
29 services.
30 Section 14. Section 458.3093, Florida Statutes, is
31 created to read:
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1 458.3093 Licensure credentials verification.--All
2 applicants for initial physician licensure pursuant to this
3 chapter must submit their credentials to the Federation of
4 State Medical Boards. Effective January 1, 2003, the board
5 and the department shall only consider applications for
6 initial physician licensure pursuant to this chapter which
7 have been verified by the Federation of State Medical Boards
8 Credentials Verification Service or an equivalent program
9 approved by the board.
10 Section 15. Section 459.0053, Florida Statutes, is
11 created to read:
12 459.0053 Licensure credentials verification.--All
13 applicants for initial osteopathic physician licensure
14 pursuant to this chapter must submit their credentials to the
15 Federation of State Medical Boards. Effective January 1,
16 2003, the board and the department shall only consider
17 applications for initial osteopathic physician licensure
18 pursuant to this chapter which have been verified by the
19 Federation of State Medical Boards Credentials Verification
20 Service, the American Osteopathic Association, or an
21 equivalent program approved by the board.
22 Section 16. Paragraph (t) of subsection (1) and
23 subsection (6) of section 458.331, Florida Statutes, are
24 amended to read:
25 458.331 Grounds for disciplinary action; action by the
26 board and department.--
27 (1) The following acts constitute grounds for denial
28 of a license or disciplinary action, as specified in s.
29 456.072(2):
30 (t) Gross or repeated malpractice or the failure to
31 practice medicine with that level of care, skill, and
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1 treatment which is recognized by a reasonably prudent similar
2 physician as being acceptable under similar conditions and
3 circumstances. The board shall give great weight to the
4 provisions of s. 766.102 when enforcing this paragraph. As
5 used in this paragraph, "repeated malpractice" includes, but
6 is not limited to, three or more claims for medical
7 malpractice within the previous 5-year period resulting in
8 indemnities being paid in excess of $50,000 $25,000 each to
9 the claimant in a judgment or settlement and which incidents
10 involved negligent conduct by the physician. As used in this
11 paragraph, "gross malpractice" or "the failure to practice
12 medicine with that level of care, skill, and treatment which
13 is recognized by a reasonably prudent similar physician as
14 being acceptable under similar conditions and circumstances,"
15 shall not be construed so as to require more than one
16 instance, event, or act. Nothing in this paragraph shall be
17 construed to require that a physician be incompetent to
18 practice medicine in order to be disciplined pursuant to this
19 paragraph.
20 (6) Upon the department's receipt from an insurer or
21 self-insurer of a report of a closed claim against a physician
22 pursuant to s. 627.912 or from a health care practitioner of a
23 report pursuant to s. 456.049, or upon the receipt from a
24 claimant of a presuit notice against a physician pursuant to
25 s. 766.106, the department shall review each report and
26 determine whether it potentially involved conduct by a
27 licensee that is subject to disciplinary action, in which case
28 the provisions of s. 456.073 shall apply. However, if it is
29 reported that a physician has had three or more claims with
30 indemnities exceeding $50,000 $25,000 each within the previous
31 5-year period, the department shall investigate the
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1 occurrences upon which the claims were based and determine
2 whether if action by the department against the physician is
3 warranted.
4 Section 17. Paragraph (x) of subsection (1) and
5 subsection (6) of section 459.015, Florida Statutes, are
6 amended to read:
7 459.015 Grounds for disciplinary action; action by the
8 board and department.--
9 (1) The following acts constitute grounds for denial
10 of a license or disciplinary action, as specified in s.
11 456.072(2):
12 (x) Gross or repeated malpractice or the failure to
13 practice osteopathic medicine with that level of care, skill,
14 and treatment which is recognized by a reasonably prudent
15 similar osteopathic physician as being acceptable under
16 similar conditions and circumstances. The board shall give
17 great weight to the provisions of s. 766.102 when enforcing
18 this paragraph. As used in this paragraph, "repeated
19 malpractice" includes, but is not limited to, three or more
20 claims for medical malpractice within the previous 5-year
21 period resulting in indemnities being paid in excess of
22 $50,000 $25,000 each to the claimant in a judgment or
23 settlement and which incidents involved negligent conduct by
24 the osteopathic physician. As used in this paragraph, "gross
25 malpractice" or "the failure to practice osteopathic medicine
26 with that level of care, skill, and treatment which is
27 recognized by a reasonably prudent similar osteopathic
28 physician as being acceptable under similar conditions and
29 circumstances" shall not be construed so as to require more
30 than one instance, event, or act. Nothing in this paragraph
31 shall be construed to require that an osteopathic physician be
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1 incompetent to practice osteopathic medicine in order to be
2 disciplined pursuant to this paragraph. A recommended order
3 by an administrative law judge or a final order of the board
4 finding a violation under this paragraph shall specify whether
5 the licensee was found to have committed "gross malpractice,"
6 "repeated malpractice," or "failure to practice osteopathic
7 medicine with that level of care, skill, and treatment which
8 is recognized as being acceptable under similar conditions and
9 circumstances," or any combination thereof, and any
10 publication by the board shall so specify.
11 (6) Upon the department's receipt from an insurer or
12 self-insurer of a report of a closed claim against an
13 osteopathic physician pursuant to s. 627.912 or from a health
14 care practitioner of a report pursuant to s. 456.049, or upon
15 the receipt from a claimant of a presuit notice against an
16 osteopathic physician pursuant to s. 766.106, the department
17 shall review each report and determine whether it potentially
18 involved conduct by a licensee that is subject to disciplinary
19 action, in which case the provisions of s. 456.073 shall
20 apply. However, if it is reported that an osteopathic
21 physician has had three or more claims with indemnities
22 exceeding $50,000 $25,000 each within the previous 5-year
23 period, the department shall investigate the occurrences upon
24 which the claims were based and determine whether if action by
25 the department against the osteopathic physician is warranted.
26 Section 18. Subsection (1) of section 627.912, Florida
27 Statutes, is amended to read:
28 627.912 Professional liability claims and actions;
29 reports by insurers.--
30 (1) Each self-insurer authorized under s. 627.357 and
31 each insurer or joint underwriting association providing
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1 professional liability insurance to a practitioner of medicine
2 licensed under chapter 458, to a practitioner of osteopathic
3 medicine licensed under chapter 459, to a podiatric physician
4 licensed under chapter 461, to a dentist licensed under
5 chapter 466, to a hospital licensed under chapter 395, to a
6 crisis stabilization unit licensed under part IV of chapter
7 394, to a health maintenance organization certificated under
8 part I of chapter 641, to clinics included in chapter 390, to
9 an ambulatory surgical center as defined in s. 395.002, or to
10 a member of The Florida Bar shall report in duplicate to the
11 Department of Insurance any claim or action for damages for
12 personal injuries claimed to have been caused by error,
13 omission, or negligence in the performance of such insured's
14 professional services or based on a claimed performance of
15 professional services without consent, if the claim resulted
16 in:
17 (a) A final judgment in any amount.
18 (b) A settlement in any amount.
19
20 Reports shall be filed with the Department of Insurance. and,
21 If the insured party is licensed under chapter 458, chapter
22 459, or chapter 461, or chapter 466, with the Department of
23 Health, and the final judgment or settlement was in an amount
24 exceeding $50,000, the report shall also be filed with the
25 Department of Health. If the insured is licensed under chapter
26 466 and the final judgment or settlement was in an amount
27 exceeding $25,000, the report shall also be filed with the
28 Department of Health. Reports must be filed no later than 30
29 days following the occurrence of any event listed in this
30 subsection paragraph (a) or paragraph (b). The Department of
31 Health shall review each report and determine whether any of
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1 the incidents that resulted in the claim potentially involved
2 conduct by the licensee that is subject to disciplinary
3 action, in which case the provisions of s. 456.073 shall
4 apply. The Department of Health, as part of the annual report
5 required by s. 456.026, shall publish annual statistics,
6 without identifying licensees, on the reports it receives,
7 including final action taken on such reports by the Department
8 of Health or the appropriate regulatory board.
9 Section 19. Subsection (1) of section 456.025, Florida
10 Statutes, is amended to read:
11 456.025 Fees; receipts; disposition.--
12 (1) It is the intent of the Legislature that all costs
13 of regulating health care professions and practitioners shall
14 be borne solely by licensees and licensure applicants. It is
15 also the intent of the Legislature that fees should be
16 reasonable and not serve as a barrier to licensure. Moreover,
17 it is the intent of the Legislature that the department
18 operate as efficiently as possible and regularly report to the
19 Legislature additional methods to streamline operational
20 costs. Therefore, the boards in consultation with the
21 department, or the department if there is no board, shall, by
22 rule, set renewal fees which:
23 (a) Shall be based on revenue projections prepared
24 using generally accepted accounting procedures;
25 (b) Shall be adequate to cover all expenses relating
26 to that board identified in the department's long-range policy
27 plan, as required by s. 456.005;
28 (c) Shall be reasonable, fair, and not serve as a
29 barrier to licensure;
30 (d) Shall be based on potential earnings from working
31 under the scope of the license;
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1 (e) Shall be similar to fees imposed on similar
2 licensure types; and
3 (f) Shall not be more than 10 percent greater than the
4 fee imposed for the previous biennium;
5 (g) Shall not be more than 10 percent greater than the
6 actual cost to regulate that profession for the previous
7 biennium; and
8 (f)(h) Shall be subject to challenge pursuant to
9 chapter 120.
10 Section 20. Section 456.0165, Florida Statutes, is
11 created to read:
12 456.0165 Examination location.--A college, university,
13 or vocational school in this state may serve as the host
14 school for a health care practitioner licensure examination.
15 However, the college, university, or vocational school may not
16 charge the department for rent, space, reusable equipment,
17 utilities, or janitorial services. The college, university,
18 or vocational school may charge the department only the actual
19 cost of nonreusable supplies provided by the school at the
20 request of the department.
21 Section 21. Effective July 1, 2003, paragraph (g) of
22 subsection (3) and paragraph (c) of subsection (6) of section
23 468.302, Florida Statutes, are amended to read:
24 468.302 Use of radiation; identification of certified
25 persons; limitations; exceptions.--
26 (3)
27 (g) A person holding a certificate as a nuclear
28 medicine technologist may only:
29 1. Conduct in vivo and in vitro measurements of
30 radioactivity and administer radiopharmaceuticals to human
31 beings for diagnostic and therapeutic purposes.
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1 2. Administer X radiation from a combination nuclear
2 medicine-computed tomography device if that radiation is
3 administered as an integral part of a nuclear medicine
4 procedure that uses an automated computed tomography protocol
5 and the person has received device-specific training on the
6 combination device.
7
8 However, the authority of a nuclear medicine technologist
9 under this paragraph excludes radioimmunoassay and other
10 clinical laboratory testing regulated pursuant to chapter 483.
11 (6) Requirement for certification does not apply to:
12 (c) A person who is a registered nurse licensed under
13 part I of chapter 464, a respiratory therapist licensed under
14 part V of chapter 468, or a cardiovascular technologist or
15 cardiopulmonary technologist with active certification as a
16 registered cardiovascular invasive specialist from a
17 nationally recognized credentialing organization, or future
18 equivalent should such credentialing be subsequently modified,
19 each of whom is trained and skilled in invasive cardiovascular
20 cardiopulmonary technology, including the radiologic
21 technology duties associated with such procedures, and who
22 provides invasive cardiovascular cardiopulmonary technology
23 services at the direction, and under the direct supervision,
24 of a licensed practitioner. A person requesting this exemption
25 must have successfully completed a didactic and clinical
26 training program in the following areas before performing
27 radiologic technology duties under the direct supervision of a
28 licensed practitioner:
29 1. Principles of X-ray production and equipment
30 operation.
31 2. Biological effects of radiation.
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1 3. Radiation exposure and monitoring.
2 4. Radiation safety and protection.
3 5. Evaluation of radiographic equipment and
4 accessories.
5 6. Radiographic exposure and technique factors.
6 7. Film processing.
7 8. Image quality assurance.
8 9. Patient positioning.
9 10. Administration and complications of contrast
10 media.
11 11. Specific fluoroscopic and digital X-ray imaging
12 procedures related to invasive cardiovascular technology.
13 Section 22. Section 468.352, Florida Statutes, is
14 amended to read:
15 (Substantial rewording of section. See
16 s. 468.352, F.S., for present text.)
17 468.352 Definitions.--As used in this part the term:
18 (1) "Board" means the Board of Respiratory Care.
19 (2) "Certified respiratory therapist" means any person
20 licensed pursuant to this part who is certified by the
21 National Board for Respiratory Care or its successor; who is
22 employed to deliver respiratory care services, under the order
23 of a physician licensed pursuant to chapter 458 or chapter
24 459, in accordance with protocols established by a hospital or
25 other health care provider or the board; and who functions in
26 situations of unsupervised patient contact requiring
27 individual judgment.
28 (3) "Critical care" means care given to a patient in
29 any setting involving a life-threatening emergency.
30 (4) "Department" means the Department of Health.
31 (5) "Direct supervision" means practicing under the
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1 direction of a licensed, registered, or certified respiratory
2 therapist who is physically on the premises and readily
3 available, as defined by the board.
4 (6) "Physician supervision" means supervision and
5 control by a physician licensed under chapter 458 or chapter
6 459 who assumes the legal liability for the services rendered
7 by the personnel employed in his or her office. Except in the
8 case of an emergency, physician supervision requires the easy
9 availability of the physician within the office or the
10 physical presence of the physician for consultation and
11 direction of the actions of the persons who deliver
12 respiratory care services.
13 (7) "Practice of respiratory care" or "respiratory
14 therapy" means the allied health specialty associated with the
15 cardiopulmonary system that is practiced under the orders of a
16 physician licensed under chapter 458 or chapter 459 and in
17 accordance with protocols, policies, and procedures
18 established by a hospital or other health care provider or the
19 board, including the assessment, diagnostic evaluation,
20 treatment, management, control, rehabilitation, education, and
21 care of patients.
22 (8) "Registered respiratory therapist" means any
23 person licensed under this part who is registered by the
24 National Board for Respiratory Care or its successor, and who
25 is employed to deliver respiratory care services under the
26 order of a physician licensed under chapter 458 or chapter
27 459, in accordance with protocols established by a hospital or
28 other health care provider or the board, and who functions in
29 situations of unsupervised patient contact requiring
30 individual judgment.
31 (9) "Respiratory care practitioner" means any person
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1 licensed under this part who is employed to deliver
2 respiratory care services, under direct supervision, pursuant
3 to the order of a physician licensed under chapter 458 or
4 chapter 459.
5 (10) "Respiratory care services" includes:
6 (a) Evaluation and disease management.
7 (b) Diagnostic and therapeutic use of respiratory
8 equipment, devices, or medical gas.
9 (c) Administration of drugs, as duly ordered or
10 prescribed by a physician licensed under chapter 458 or
11 chapter 459 and in accordance with protocols, policies, and
12 procedures established by a hospital or other health care
13 provider or the board.
14 (d) Initiation, management, and maintenance of
15 equipment to assist and support ventilation and respiration.
16 (e) Diagnostic procedures, research, and therapeutic
17 treatment and procedures, including measurement of ventilatory
18 volumes, pressures, and flows; specimen collection and
19 analysis of blood for gas transport and acid/base
20 determinations; pulmonary-function testing; and other related
21 physiological monitoring of cardiopulmonary systems.
22 (f) Cardiopulmonary rehabilitation.
23 (g) Cardiopulmonary resuscitation, advanced cardiac
24 life support, neonatal resuscitation, and pediatric advanced
25 life support, or equivalent functions.
26 (h) Insertion and maintenance of artificial airways
27 and intravascular catheters.
28 (i) Performing sleep-disorder studies.
29 (j) Education of patients, families, the public, or
30 other health care providers, including disease process and
31 management programs and smoking prevention and cessation
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1 programs.
2 (k) Initiation and management of hyperbaric oxygen.
3 Section 23. Section 468.355, Florida Statutes, is
4 amended to read:
5 (Substantial rewording of section. See
6 s. 468.355, F.S., for present text.)
7 468.355 Licensure requirements.--To be eligible for
8 licensure by the board, an applicant must be certified as a
9 "Certified Respiratory Therapist" or be registered as a
10 "Registered Respiratory Therapist" by the National Board for
11 Respiratory Care, or its successor.
12 Section 24. Section 468.368, Florida Statutes, is
13 amended to read:
14 (Substantial rewording of section. See
15 s. 468.368, F.S., for present text.)
16 468.368 Exemptions.--This part may not be construed to
17 prevent or restrict the practice, service, or activities of:
18 (1) Any person licensed in this state by any other law
19 from engaging in the profession or occupation for which he or
20 she is licensed.
21 (2) Any legally qualified person in the state or
22 another state or territory who is employed by the United
23 States Government or any agency thereof while such person is
24 discharging his or her official duties.
25 (3) A friend or family member who is providing
26 respiratory care services to an ill person and who does not
27 represent himself or herself to be a respiratory care
28 practitioner or respiratory therapist.
29 (4) An individual providing respiratory care services
30 in an emergency who does not represent himself or herself as a
31 respiratory care practitioner or respiratory therapist.
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1 (5) Any individual employed to deliver, assemble, set
2 up, or test equipment for use in a home, upon the order of a
3 physician licensed pursuant to chapter 458 or chapter 459.
4 This subsection does not, however, authorize the practice of
5 respiratory care without a license.
6 (6) Any individual credentialed by the Board of
7 Registered Polysomnographic Technologists as a registered
8 polysomnographic technologist, as related to the diagnosis and
9 evaluation of treatment for sleep disorders.
10 (7) Any individual certified or registered as a
11 pulmonary function technologist who is credentialed by the
12 National Board for Respiratory Care for performing
13 cardiopulmonary diagnostic studies.
14 (8) Any student who is enrolled in an accredited
15 respiratory care program approved by the board, while
16 performing respiratory care as an integral part of a required
17 course.
18 (9) The delivery of incidental respiratory care to
19 noninstitutionalized persons by surrogate family members who
20 do not represent themselves as registered or certified
21 respiratory care therapists.
22 (10) Any individual credentialed by the Underseas
23 Hyperbaric Society in hyperbaric medicine or its equivalent as
24 determined by the board, while performing related duties. This
25 subsection does not, however, authorize the practice of
26 respiratory care without a license.
27 Section 25. Sections 468.356 and 468.357, Florida
28 Statutes, are repealed.
29 Section 26. Sections 381.0602, 381.6021, 381.6022,
30 381.6023, 381.6024, and 381.6026, Florida Statutes, are
31 renumbered as sections 765.53, 765.541, 765.542, 765.544,
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1 765.545, and 765.547, Florida Statutes, respectively.
2 Section 27. Section 381.60225, Florida Statutes, is
3 renumbered as section 765.543, Florida Statutes, and is
4 amended to read:
5 765.543 381.60225 Background screening.--
6 (1) Each applicant for certification must comply with
7 the following requirements:
8 (a) Upon receipt of a completed, signed, and dated
9 application, the Agency for Health Care Administration shall
10 require background screening, in accordance with the level 2
11 standards for screening set forth in chapter 435, of the
12 managing employee, or other similarly titled individual
13 responsible for the daily operation of the organization,
14 agency, or entity, and financial officer, or other similarly
15 titled individual who is responsible for the financial
16 operation of the organization, agency, or entity, including
17 billings for services. The applicant must comply with the
18 procedures for level 2 background screening as set forth in
19 chapter 435, as well as the requirements of s. 435.03(3).
20 (b) The Agency for Health Care Administration may
21 require background screening of any other individual who is an
22 applicant if the Agency for Health Care Administration has
23 probable cause to believe that he or she has been convicted of
24 a crime or has committed any other offense prohibited under
25 the level 2 standards for screening set forth in chapter 435.
26 (c) Proof of compliance with the level 2 background
27 screening requirements of chapter 435 which has been submitted
28 within the previous 5 years in compliance with any other
29 health care licensure requirements of this state is acceptable
30 in fulfillment of the requirements of paragraph (a).
31 (d) A provisional certification may be granted to the
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1 organization, agency, or entity when each individual required
2 by this section to undergo background screening has met the
3 standards for the Department of Law Enforcement background
4 check, but the agency has not yet received background
5 screening results from the Federal Bureau of Investigation, or
6 a request for a disqualification exemption has been submitted
7 to the agency as set forth in chapter 435, but a response has
8 not yet been issued. A standard certification may be granted
9 to the organization, agency, or entity upon the agency's
10 receipt of a report of the results of the Federal Bureau of
11 Investigation background screening for each individual
12 required by this section to undergo background screening which
13 confirms that all standards have been met, or upon the
14 granting of a disqualification exemption by the agency as set
15 forth in chapter 435. Any other person who is required to
16 undergo level 2 background screening may serve in his or her
17 capacity pending the agency's receipt of the report from the
18 Federal Bureau of Investigation. However, the person may not
19 continue to serve if the report indicates any violation of
20 background screening standards and a disqualification
21 exemption has not been requested of and granted by the agency
22 as set forth in chapter 435.
23 (e) Each applicant must submit to the agency, with its
24 application, a description and explanation of any exclusions,
25 permanent suspensions, or terminations of the applicant from
26 the Medicare or Medicaid programs. Proof of compliance with
27 the requirements for disclosure of ownership and control
28 interests under the Medicaid or Medicare programs shall be
29 accepted in lieu of this submission.
30 (f) Each applicant must submit to the agency a
31 description and explanation of any conviction of an offense
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1 prohibited under the level 2 standards of chapter 435 by a
2 member of the board of directors of the applicant, its
3 officers, or any individual owning 5 percent or more of the
4 applicant. This requirement does not apply to a director of a
5 not-for-profit corporation or organization if the director
6 serves solely in a voluntary capacity for the corporation or
7 organization, does not regularly take part in the day-to-day
8 operational decisions of the corporation or organization,
9 receives no remuneration for his or her services on the
10 corporation or organization's board of directors, and has no
11 financial interest and has no family members with a financial
12 interest in the corporation or organization, provided that the
13 director and the not-for-profit corporation or organization
14 include in the application a statement affirming that the
15 director's relationship to the corporation satisfies the
16 requirements of this paragraph.
17 (g) The agency may not certify any organization,
18 agency, or entity if any applicant or managing employee has
19 been found guilty of, regardless of adjudication, or has
20 entered a plea of nolo contendere or guilty to, any offense
21 prohibited under the level 2 standards for screening set forth
22 in chapter 435, unless an exemption from disqualification has
23 been granted by the agency as set forth in chapter 435.
24 (h) The agency may deny or revoke certification of any
25 organization, agency, or entity if the applicant:
26 1. Has falsely represented a material fact in the
27 application required by paragraph (e) or paragraph (f), or has
28 omitted any material fact from the application required by
29 paragraph (e) or paragraph (f); or
30 2. Has had prior action taken against the applicant
31 under the Medicaid or Medicare program as set forth in
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1 paragraph (e).
2 (i) An application for renewal of certification must
3 contain the information required under paragraphs (e) and (f).
4 (2) An organ procurement organization, tissue bank, or
5 eye bank certified by the Agency for Health Care
6 Administration in accordance with ss. 381.6021 and 765.542
7 381.6022 is not subject to the requirements of this section if
8 the entity has no direct patient care responsibilities and
9 does not bill patients or insurers directly for services under
10 the Medicare or Medicaid programs, or for privately insured
11 services.
12 Section 28. Section 381.6025, Florida Statutes, is
13 renumbered as section 765.546, Florida Statutes, and amended
14 to read:
15 765.546 381.6025 Physician supervision of cadaveric
16 organ and tissue procurement coordinators.--Organ procurement
17 organizations, tissue banks, and eye banks may employ
18 coordinators, who are registered nurses, physician's
19 assistants, or other medically trained personnel who meet the
20 relevant standards for organ procurement organizations, tissue
21 banks, or eye banks as adopted by the Agency for Health Care
22 Administration under s. 765.541 381.6021, to assist in the
23 medical management of organ donors or in the surgical
24 procurement of cadaveric organs, tissues, or eyes for
25 transplantation or research. A coordinator who assists in the
26 medical management of organ donors or in the surgical
27 procurement of cadaveric organs, tissues, or eyes for
28 transplantation or research must do so under the direction and
29 supervision of a licensed physician medical director pursuant
30 to rules and guidelines to be adopted by the Agency for Health
31 Care Administration. With the exception of organ procurement
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1 surgery, this supervision may be indirect supervision. For
2 purposes of this section, the term "indirect supervision"
3 means that the medical director is responsible for the medical
4 actions of the coordinator, that the coordinator is operating
5 under protocols expressly approved by the medical director,
6 and that the medical director or his or her physician designee
7 is always available, in person or by telephone, to provide
8 medical direction, consultation, and advice in cases of organ,
9 tissue, and eye donation and procurement. Although indirect
10 supervision is authorized under this section, direct physician
11 supervision is to be encouraged when appropriate.
12 Section 29. Subsection (2) of section 395.2050,
13 Florida Statutes, is amended to read:
14 395.2050 Routine inquiry for organ and tissue
15 donation; certification for procurement activities.--
16 (2) Every hospital licensed under this chapter that is
17 engaged in the procurement of organs, tissues, or eyes shall
18 comply with the certification requirements of ss.
19 765.541-765.547 381.6021-381.6026.
20 Section 30. Paragraph (e) of subsection (2) of section
21 409.815, Florida Statutes, is amended to read:
22 409.815 Health benefits coverage; limitations.--
23 (2) BENCHMARK BENEFITS.--In order for health benefits
24 coverage to qualify for premium assistance payments for an
25 eligible child under ss. 409.810-409.820, the health benefits
26 coverage, except for coverage under Medicaid and Medikids,
27 must include the following minimum benefits, as medically
28 necessary.
29 (e) Organ transplantation services.--Covered services
30 include pretransplant, transplant, and postdischarge services
31 and treatment of complications after transplantation for
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1 transplants deemed necessary and appropriate within the
2 guidelines set by the Organ Transplant Advisory Council under
3 s. 765.53 381.0602 or the Bone Marrow Transplant Advisory
4 Panel under s. 627.4236.
5 Section 31. Subsection (2) of section 765.5216,
6 Florida Statutes, is amended to read:
7 765.5216 Organ and tissue donor education panel.--
8 (2) There is created within the Agency for Health Care
9 Administration a statewide organ and tissue donor education
10 panel, consisting of 12 members, to represent the interests of
11 the public with regard to increasing the number of organ and
12 tissue donors within the state. The panel and the Organ and
13 Tissue Procurement and Transplantation Advisory Board
14 established in s. 765.544 381.6023 shall jointly develop,
15 subject to the approval of the Agency for Health Care
16 Administration, education initiatives pursuant to s. 732.9215,
17 which the agency shall implement. The membership must be
18 balanced with respect to gender, ethnicity, and other
19 demographic characteristics so that the appointees reflect the
20 diversity of the population of this state. The panel members
21 must include:
22 (a) A representative from the Agency for Health Care
23 Administration, who shall serve as chairperson of the panel.
24 (b) A representative from a Florida licensed organ
25 procurement organization.
26 (c) A representative from a Florida licensed tissue
27 bank.
28 (d) A representative from a Florida licensed eye bank.
29 (e) A representative from a Florida licensed hospital.
30 (f) A representative from the Division of Driver
31 Licenses of the Department of Highway Safety and Motor
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1 Vehicles, who possesses experience and knowledge in dealing
2 with the public.
3 (g) A representative from the family of an organ,
4 tissue, or eye donor.
5 (h) A representative who has been the recipient of a
6 transplanted organ, tissue, or eye, or is a family member of a
7 recipient.
8 (i) A representative who is a minority person as
9 defined in s. 381.81.
10 (j) A representative from a professional association
11 or public relations or advertising organization.
12 (k) A representative from a community service club or
13 organization.
14 (l) A representative from the Department of Education.
15 Section 32. Subsection (5) of section 765.522, Florida
16 Statutes, is amended to read:
17 765.522 Duty of certain hospital administrators;
18 liability of hospital administrators, organ procurement
19 organizations, eye banks, and tissue banks.--
20 (5) There shall be no civil or criminal liability
21 against any organ procurement organization, eye bank, or
22 tissue bank certified under s. 765.542 381.6022, or against
23 any hospital or hospital administrator or designee, when
24 complying with the provisions of this part and the rules of
25 the Agency for Health Care Administration or when, in the
26 exercise of reasonable care, a request for organ donation is
27 inappropriate and the gift is not made according to this part
28 and the rules of the Agency for Health Care Administration.
29 Section 33. Present subsections (11) through (33) of
30 section 395.002, Florida Statutes, are renumbered as
31 subsections (12) through (34), respectively, and a new
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1 subsection (11) is added to that section, to read:
2 395.002 Definitions.--As used in this chapter:
3 (11) "Medically unnecessary procedure" means a
4 surgical or other invasive procedure that no reasonable
5 physician, in light of the patient's history and available
6 diagnostic information, would deem to be indicated in order to
7 treat, cure, or palliate the patient's condition or disease.
8 Section 34. Subsection (5) is added to section
9 395.0161, Florida Statutes, to read:
10 395.0161 Licensure inspection.--
11 (5)(a) The agency shall adopt rules governing the
12 conduct of inspections or investigations it initiates in
13 response to:
14 1. Reports filed pursuant to s. 395.0197.
15 2. Complaints alleging violations of state or federal
16 emergency access laws.
17 3. Complaints made by the public alleging violations
18 of law by licensed facilities or personnel.
19 (b) The rules must set forth the procedures to be used
20 in the investigations or inspections in order to protect the
21 due process rights of licensed facilities and personnel and to
22 minimize, to the greatest reasonable extent possible, the
23 disruption of facility operations and the cost to facilities
24 resulting from those investigations.
25 Section 35. Subsections (2), (14), and (16) of section
26 395.0197, Florida Statutes, are amended to read:
27 395.0197 Internal risk management program.--
28 (2) The internal risk management program is the
29 responsibility of the governing board of the health care
30 facility. Each licensed facility shall use the services of
31 hire a risk manager, licensed under s. 395.10974, who is
31
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1 responsible for implementation and oversight of such
2 facility's internal risk management program as required by
3 this section. A risk manager must not be made responsible for
4 more than four internal risk management programs in separate
5 licensed facilities, unless the facilities are under one
6 corporate ownership or the risk management programs are in
7 rural hospitals.
8 (14) The agency shall have access, as set forth in
9 rules adopted under s. 395.0161(5), to all licensed facility
10 records necessary to carry out the provisions of this section.
11 The records obtained by the agency under subsection (6),
12 subsection (8), or subsection (10) are not available to the
13 public under s. 119.07(1), nor shall they be discoverable or
14 admissible in any civil or administrative action, except in
15 disciplinary proceedings by the agency or the appropriate
16 regulatory board, nor shall records obtained pursuant to s.
17 456.071 be available to the public as part of the record of
18 investigation for and prosecution in disciplinary proceedings
19 made available to the public by the agency or the appropriate
20 regulatory board. However, the agency or the appropriate
21 regulatory board shall make available, upon written request by
22 a health care professional against whom probable cause has
23 been found, any such records which form the basis of the
24 determination of probable cause, except that, with respect to
25 medical review committee records, s. 766.101 controls.
26 (16) The agency shall review, as part of its licensure
27 inspection process, the internal risk management program at
28 each licensed facility regulated by this section to determine
29 whether the program meets standards established in statutes
30 and rules, whether the program is being conducted in a manner
31 designed to reduce adverse incidents, and whether the program
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1 is appropriately reporting incidents under this section. Only
2 a risk manager, licensed under s. 395.10974 and employed by
3 the Agency for Health Care Administration has the authority to
4 conduct inspections necessary to determine whether a program
5 meets the requirements of this section. A determination must
6 be based on the care, skill, and judgment which, in light of
7 all relevant surrounding circumstances, is recognized as
8 acceptable and appropriate by reasonably prudent similar
9 licensed risk managers. By July 1, 2004, the Agency for Health
10 Care Administration shall employ a minimum of three licensed
11 risk managers in each district to conduct inspections as
12 provided in this subsection.
13 Section 36. Paragraph (b) of subsection (1) of section
14 456.0375, Florida Statutes, is amended to read:
15 456.0375 Registration of certain clinics;
16 requirements; discipline; exemptions.--
17 (1)
18 (b) For purposes of this section, the term "clinic"
19 does not include and the registration requirements herein do
20 not apply to:
21 1. Entities licensed or registered by the state
22 pursuant to chapter 390, chapter 394, chapter 395, chapter
23 397, chapter 400, chapter 463, chapter 465, chapter 466,
24 chapter 478, chapter 480, or chapter 484.
25 2. Entities exempt from federal taxation under 26
26 U.S.C. s. 501(c)(3) and community college and university
27 clinics.
28 3. Sole proprietorships, group practices,
29 partnerships, or corporations that provide health care
30 services by licensed health care practitioners pursuant to
31 chapters 457, 458, 459, 460, 461, 462, 463, 466, 467, 484,
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1 486, 490, 491, or part I, part III, part X, part XIII, or part
2 XIV of chapter 468, or s. 464.012, which are wholly owned by
3 licensed health care practitioners or the licensed health care
4 practitioner and the spouse, parent, or child of a licensed
5 health care practitioner, so long as one of the owners who is
6 a licensed health care practitioner is supervising the
7 services performed therein and is legally responsible for the
8 entity's compliance with all federal and state laws. However,
9 no health care practitioner may supervise the delivery of
10 health care services beyond the scope of the practitioner's
11 license. This section does not prohibit a health care
12 practitioner from providing administrative or managerial
13 supervision for personnel purposes.
14 Section 37. Paragraph (b) of subsection (2) of section
15 465.019, Florida Statutes, is amended to read:
16 465.019 Institutional pharmacies; permits.--
17 (2) The following classes of institutional pharmacies
18 are established:
19 (b) "Class II institutional pharmacies" are those
20 institutional pharmacies which employ the services of a
21 registered pharmacist or pharmacists who, in practicing
22 institutional pharmacy, shall provide dispensing and
23 consulting services on the premises to patients of that
24 institution and to patients receiving care in a hospice
25 licensed under part VI of chapter 400 which is located on the
26 premises of that institution, for use on the premises of that
27 institution. However, an institutional pharmacy located in an
28 area or county included in an emergency order or proclamation
29 of a state of emergency declared by the Governor may provide
30 dispensing and consulting services to individuals who are not
31 patients of the institution. However, a single dose of a
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1 medicinal drug may be obtained and administered to a patient
2 on a valid physician's drug order under the supervision of a
3 physician or charge nurse, consistent with good institutional
4 practice procedures. The obtaining and administering of such
5 single dose of a medicinal drug shall be pursuant to
6 drug-handling procedures established by a consultant
7 pharmacist. Medicinal drugs may be dispensed in a Class II
8 institutional pharmacy, but only in accordance with the
9 provisions of this section.
10 Section 38. Subsection (7) is added to section 631.57,
11 Florida Statutes, to read:
12 631.57 Powers and duties of the association.--
13 (7) Notwithstanding any other provision of law, the
14 net direct written premiums of medical malpractice insurance
15 are not subject to assessment under this section to cover
16 claims and administrative costs for the type of insurance
17 defined in s. 624.604.
18 Section 39. Paragraph (a) of subsection (1) of section
19 766.101, Florida Statutes, is amended to read:
20 766.101 Medical review committee, immunity from
21 liability.--
22 (1) As used in this section:
23 (a) The term "medical review committee" or "committee"
24 means:
25 1.a. A committee of a hospital or ambulatory surgical
26 center licensed under chapter 395 or a health maintenance
27 organization certificated under part I of chapter 641,
28 b. A committee of a physician-hospital organization, a
29 provider-sponsored organization, or an integrated delivery
30 system,
31 c. A committee of a state or local professional
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1 society of health care providers,
2 d. A committee of a medical staff of a licensed
3 hospital or nursing home, provided the medical staff operates
4 pursuant to written bylaws that have been approved by the
5 governing board of the hospital or nursing home,
6 e. A committee of the Department of Corrections or the
7 Correctional Medical Authority as created under s. 945.602, or
8 employees, agents, or consultants of either the department or
9 the authority or both,
10 f. A committee of a professional service corporation
11 formed under chapter 621 or a corporation organized under
12 chapter 607 or chapter 617, which is formed and operated for
13 the practice of medicine as defined in s. 458.305(3), and
14 which has at least 25 health care providers who routinely
15 provide health care services directly to patients,
16 g. A committee of a mental health treatment facility
17 licensed under chapter 394 or a community mental health center
18 as defined in s. 394.907, provided the quality assurance
19 program operates pursuant to the guidelines which have been
20 approved by the governing board of the agency,
21 h. A committee of a substance abuse treatment and
22 education prevention program licensed under chapter 397
23 provided the quality assurance program operates pursuant to
24 the guidelines which have been approved by the governing board
25 of the agency,
26 i. A peer review or utilization review committee
27 organized under chapter 440,
28 j. A committee of the Department of Health, a county
29 health department, healthy start coalition, or certified rural
30 health network, when reviewing quality of care, or employees
31 of these entities when reviewing mortality records, or
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1 k. A continuous quality improvement committee of a
2 pharmacy licensed pursuant to chapter 465,
3 l. A committee established by a university board of
4 trustees, or
5 m. A committee comprised of faculty, residents,
6 students, and administrators of an accredited college of
7 medicine, nursing, or other health care discipline,
8
9 which committee is formed to evaluate and improve the quality
10 of health care rendered by providers of health service or to
11 determine that health services rendered were professionally
12 indicated or were performed in compliance with the applicable
13 standard of care or that the cost of health care rendered was
14 considered reasonable by the providers of professional health
15 services in the area; or
16 2. A committee of an insurer, self-insurer, or joint
17 underwriting association of medical malpractice insurance, or
18 other persons conducting review under s. 766.106.
19 Section 40. The Office of Legislative Services shall
20 contract for a business case study of the feasibility of
21 outsourcing the administrative, investigative, legal, and
22 prosecutorial functions and other tasks and services that are
23 necessary to carry out the regulatory responsibilities of the
24 Board of Dentistry employing its own executive director and
25 other staff and obtaining authority over collections and
26 expenditures of funds paid by professions regulated by the
27 board into the Medical Quality Assurance Trust Fund. This
28 feasibility study must include a business plan and an
29 assessment of the direct and indirect costs associated with
30 outsourcing these functions. The sum of $50,000 is
31 appropriated from the Board of Dentistry account within the
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1 Medical Quality Assurance Trust Fund to the Office of
2 Legislative Services for the purpose of contracting for the
3 study. The Office of Legislative Services shall submit the
4 completed study to the Governor, the President of the Senate,
5 and the Speaker of the House of Representatives by January 1,
6 2003.
7 Section 41. Subsection (5) of section 393.064, Florida
8 Statutes, is amended to read:
9 393.064 Prevention.--
10 (5) The Department of Health Children and Family
11 Services shall have the authority, within available resources,
12 to contract for the supervision and management of the Raymond
13 C. Philips Research and Education Unit, and such contract
14 shall include specific program objectives.
15 Section 42. Section 408.7057, Florida Statutes, is
16 amended to read:
17 408.7057 Statewide provider and health plan managed
18 care organization claim dispute resolution program.--
19 (1) As used in this section, the term:
20 (a) "Agency" means the Agency for Health Care
21 Administration.
22 (b)(a) "Health plan Managed care organization" means a
23 health maintenance organization or a prepaid health clinic
24 certified under chapter 641, a prepaid health plan authorized
25 under s. 409.912, or an exclusive provider organization
26 certified under s. 627.6472, or a major medical expense health
27 insurance policy, as defined in s. 627.643(2)(e), offered by a
28 group or an individual health insurer licensed pursuant to
29 chapter 624, including a preferred provider organization under
30 s. 627.6471.
31 (c)(b) "Resolution organization" means a qualified
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1 independent third-party claim-dispute-resolution entity
2 selected by and contracted with the Agency for Health Care
3 Administration.
4 (2)(a) The agency for Health Care Administration shall
5 establish a program by January 1, 2001, to provide assistance
6 to contracted and noncontracted providers and health plans
7 managed care organizations for resolution of claim disputes
8 that are not resolved by the provider and the health plan
9 managed care organization. The agency shall contract with a
10 resolution organization to timely review and consider claim
11 disputes submitted by providers and health plans managed care
12 organizations and recommend to the agency an appropriate
13 resolution of those disputes. The agency shall establish by
14 rule jurisdictional amounts and methods of aggregation for
15 claim disputes that may be considered by the resolution
16 organization.
17 (b) The resolution organization shall review claim
18 disputes filed by contracted and noncontracted providers and
19 health plans managed care organizations unless the disputed
20 claim:
21 1. Is related to interest payment;
22 2. Does not meet the jurisdictional amounts or the
23 methods of aggregation established by agency rule, as provided
24 in paragraph (a);
25 3. Is part of an internal grievance in a Medicare
26 managed care organization or a reconsideration appeal through
27 the Medicare appeals process;
28 4. Is related to a health plan that is not regulated
29 by the state;
30 5. Is part of a Medicaid fair hearing pursued under 42
31 C.F.R. ss. 431.220 et seq.;
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1 6. Is the basis for an action pending in state or
2 federal court; or
3 7. Is subject to a binding claim-dispute-resolution
4 process provided by contract entered into prior to October 1,
5 2000, between the provider and the managed care organization.
6 (c) Contracts entered into or renewed on or after
7 October 1, 2000, may require exhaustion of an internal
8 dispute-resolution process as a prerequisite to the submission
9 of a claim by a provider or a health plan maintenance
10 organization to the resolution organization when the
11 dispute-resolution program becomes effective.
12 (d) A contracted or noncontracted provider or health
13 plan maintenance organization may not file a claim dispute
14 with the resolution organization more than 12 months after a
15 final determination has been made on a claim by a health plan
16 or provider maintenance organization.
17 (e) The resolution organization shall require the
18 health plan or provider submitting the claim dispute to submit
19 any supporting documentation to the resolution organization
20 within 15 days after receipt by the health plan or provider of
21 a request from the resolution organization for documentation
22 in support of the claim dispute. The resolution organization
23 may extend the time if appropriate. Failure to submit the
24 supporting documentation within such time period shall result
25 in the dismissal of the submitted claim dispute.
26 (f) The resolution organization shall require the
27 respondent in the claim dispute to submit all documentation in
28 support of its position within 15 days after receiving a
29 request from the resolution organization for supporting
30 documentation. The resolution organization may extend the time
31 if appropriate. Failure to submit the supporting documentation
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1 within such time period shall result in a default against the
2 health plan or provider. In the event of such a default, the
3 resolution organization shall issue its written recommendation
4 to the agency that a default be entered against the defaulting
5 entity. The written recommendation shall include a
6 recommendation to the agency that the defaulting entity shall
7 pay the entity submitting the claim dispute the full amount of
8 the claim dispute, plus all accrued interest, and shall be
9 considered a nonprevailing party for the purposes of this
10 section.
11 (g)1. If on an ongoing basis during the preceding 12
12 months, the agency has reason to believe that a pattern of
13 noncompliance with s. 627.6131 and s. 641.3155 exists on the
14 part of a particular health plan or provider, the agency shall
15 evaluate the information contained in these cases to determine
16 whether the information evidences a pattern and report its
17 findings, together with substantiating evidence, to the
18 appropriate licensure or certification entity for the health
19 plan or provider.
20 2. In addition, the agency shall prepare an annual
21 report to the Governor and the Legislature by February 1 of
22 each year, enumerating: claims dismissed; defaults issued;
23 and failures to comply with agency final orders issued under
24 this section.
25 (3) The agency shall adopt rules to establish a
26 process to be used by the resolution organization in
27 considering claim disputes submitted by a provider or health
28 plan managed care organization which must include the issuance
29 by the resolution organization of a written recommendation,
30 supported by findings of fact, to the agency within 60 days
31 after the requested information is received by the resolution
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1 organization within the timeframes specified by the resolution
2 organization. In no event shall the review time exceed 90 days
3 following receipt of the initial claim dispute submission by
4 the resolution organization receipt of the claim dispute
5 submission.
6 (4) Within 30 days after receipt of the recommendation
7 of the resolution organization, the agency shall adopt the
8 recommendation as a final order.
9 (5) The agency shall notify within 7 days the
10 appropriate licensure or certification entity whenever there
11 is a violation of a final order issued by the agency pursuant
12 to this section.
13 (6)(5) The entity that does not prevail in the
14 agency's order must pay a review cost to the review
15 organization, as determined by agency rule. Such rule must
16 provide for an apportionment of the review fee in any case in
17 which both parties prevail in part. If the nonprevailing party
18 fails to pay the ordered review cost within 35 days after the
19 agency's order, the nonpaying party is subject to a penalty of
20 not more than $500 per day until the penalty is paid.
21 (7)(6) The agency for Health Care Administration may
22 adopt rules to administer this section.
23 Section 43. Subsection (1) of section 626.88, Florida
24 Statutes, is amended to read:
25 626.88 Definitions of "administrator" and "insurer".--
26 (1) For the purposes of this part, an "administrator"
27 is any person who directly or indirectly solicits or effects
28 coverage of, collects charges or premiums from, or adjusts or
29 settles claims on residents of this state in connection with
30 authorized commercial self-insurance funds or with insured or
31 self-insured programs which provide life or health insurance
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1 coverage or coverage of any other expenses described in s.
2 624.33(1) or any person who, through a health care risk
3 contract as defined in s. 641.234 with an insurer or health
4 maintenance organization, provides billing and collection
5 services to health insurers and health maintenance
6 organizations on behalf of health care providers, other than
7 any of the following persons:
8 (a) An employer on behalf of such employer's employees
9 or the employees of one or more subsidiary or affiliated
10 corporations of such employer.
11 (b) A union on behalf of its members.
12 (c) An insurance company which is either authorized to
13 transact insurance in this state or is acting as an insurer
14 with respect to a policy lawfully issued and delivered by such
15 company in and pursuant to the laws of a state in which the
16 insurer was authorized to transact an insurance business.
17 (d) A health care services plan, health maintenance
18 organization, professional service plan corporation, or person
19 in the business of providing continuing care, possessing a
20 valid certificate of authority issued by the department, and
21 the sales representatives thereof, if the activities of such
22 entity are limited to the activities permitted under the
23 certificate of authority.
24 (e) An insurance agent licensed in this state whose
25 activities are limited exclusively to the sale of insurance.
26 (f) An adjuster licensed in this state whose
27 activities are limited to the adjustment of claims.
28 (g) A creditor on behalf of such creditor's debtors
29 with respect to insurance covering a debt between the creditor
30 and its debtors.
31 (h) A trust and its trustees, agents, and employees
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1 acting pursuant to such trust established in conformity with
2 29 U.S.C. s. 186.
3 (i) A trust exempt from taxation under s. 501(a) of
4 the Internal Revenue Code, a trust satisfying the requirements
5 of ss. 624.438 and 624.439, or any governmental trust as
6 defined in s. 624.33(3), and the trustees and employees acting
7 pursuant to such trust, or a custodian and its agents and
8 employees, including individuals representing the trustees in
9 overseeing the activities of a service company or
10 administrator, acting pursuant to a custodial account which
11 meets the requirements of s. 401(f) of the Internal Revenue
12 Code.
13 (j) A financial institution which is subject to
14 supervision or examination by federal or state authorities or
15 a mortgage lender licensed under chapter 494 who collects and
16 remits premiums to licensed insurance agents or authorized
17 insurers concurrently or in connection with mortgage loan
18 payments.
19 (k) A credit card issuing company which advances for
20 and collects premiums or charges from its credit card holders
21 who have authorized such collection if such company does not
22 adjust or settle claims.
23 (l) A person who adjusts or settles claims in the
24 normal course of such person's practice or employment as an
25 attorney at law and who does not collect charges or premiums
26 in connection with life or health insurance coverage.
27 (m) A person approved by the Division of Workers'
28 Compensation of the Department of Labor and Employment
29 Security who administers only self-insured workers'
30 compensation plans.
31 (n) A service company or service agent and its
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1 employees, authorized in accordance with ss. 626.895-626.899,
2 serving only a single employer plan, multiple-employer welfare
3 arrangements, or a combination thereof.
4 (o) Any provider or group practice, as defined in s.
5 456.053, providing services under the scope of the license of
6 the provider or the member of the group practice.
7 (p) Any hospital providing billing, claims, and
8 collection services solely on its own and its physicians'
9 behalf and providing services under the scope of its license.
10
11 A person who provides billing and collection services to
12 health insurers and health maintenance organizations on behalf
13 of health care providers shall comply with the provisions of
14 ss. 627.6131, 641.3155, and 641.51(4).
15 Section 44. Section 627.6131, Florida Statutes, is
16 created to read:
17 627.6131 Payment of claims.--
18 (1) The contract shall include the following
19 provision:
20
21 "Time of Payment of Claims: After receiving
22 written proof of loss, the insurer will pay
23 monthly all benefits then due for ...(type of
24 benefit).... Benefits for any other loss
25 covered by this policy will be paid as soon as
26 the insurer receives proper written proof."
27
28 (2) As used in this section, the term "claim" for a
29 noninstitutional provider means a paper or electronic billing
30 instrument submitted to the insurer's designated location that
31 consists of the HCFA 1500 data set, or its successor, that has
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1 all mandatory entries for a physician licensed under chapter
2 458, chapter 459, chapter 460, chapter 461, or chapter 463, or
3 psychologists licensed under chapter 490 or any appropriate
4 billing instrument that has all mandatory entries for any
5 other noninstitutional provider. For institutional providers,
6 "claim" means a paper or electronic billing instrument
7 submitted to the insurer's designated location that consists
8 of the UB-92 data set or its successor with entries stated as
9 mandatory by the National Uniform Billing Committee.
10 (3) All claims for payment, whether electronic or
11 nonelectronic:
12 (a) Are considered received on the date the claim is
13 received by the insurer at its designated claims receipt
14 location.
15 (b) Must be mailed or electronically transferred to an
16 insurer within 6 months after completion of the service and
17 the provider is furnished with the correct name and address of
18 the patient's health insurer. Submission of a provider's claim
19 is considered made on the date it is electronically
20 transferred or mailed.
21 (c) Must not duplicate a claim previously submitted
22 unless it is determined that the original claim was not
23 received or is otherwise lost.
24 (4) For all electronically submitted claims, a health
25 insurer shall:
26 (a) Within 24 hours after the beginning of the next
27 business day after receipt of the claim, provide electronic
28 acknowledgment of the receipt of the claim to the electronic
29 source submitting the claim.
30 (b) Within 20 days after receipt of the claim, pay the
31 claim or notify a provider or designee if a claim is denied or
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1 contested. Notice of the insurer's action on the claim and
2 payment of the claim is considered to be made on the date the
3 notice or payment was mailed or electronically transferred.
4 (c)1. Notification of the health insurer's
5 determination of a contested claim must be accompanied by an
6 itemized list of additional information or documents the
7 insurer can reasonably determine are necessary to process the
8 claim.
9 2. A provider must submit the additional information
10 or documentation, as specified on the itemized list, within 35
11 days after receipt of the notification. Failure of a provider
12 to submit by mail or electronically the additional information
13 or documentation requested within 35 days after receipt of the
14 notification may result in denial of the claim.
15 3. A health insurer may not make more than one request
16 for documents under this paragraph in connection with a claim,
17 unless the provider fails to submit all of the requested
18 documents to process the claim or if documents submitted by
19 the provider raise new additional issues not included in the
20 original written itemization, in which case the health insurer
21 may provide the provider with one additional opportunity to
22 submit the additional documents needed to process the claim.
23 In no case may the health insurer request duplicate documents.
24 (d) For purposes of this subsection, electronic means
25 of transmission of claims, notices, documents, forms, and
26 payments shall be used to the greatest extent possible by the
27 health insurer and the provider.
28 (e) A claim must be paid or denied within 90 days
29 after receipt of the claim. Failure to pay or deny a claim
30 within 120 days after receipt of the claim creates an
31 uncontestable obligation to pay the claim.
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1 (5) For all nonelectronically submitted claims, a
2 health insurer shall:
3 (a) Effective November 1, 2003, provide acknowledgment
4 of receipt of the claim within 15 days after receipt of the
5 claim to the provider or provide a provider within 15 days
6 after receipt with electronic access to the status of a
7 submitted claim.
8 (b) Within 40 days after receipt of the claim, pay the
9 claim or notify a provider or designee if a claim is denied or
10 contested. Notice of the insurer's action on the claim and
11 payment of the claim is considered to be made on the date the
12 notice or payment was mailed or electronically transferred.
13 (c)1. Notification of the health insurer's
14 determination of a contested claim must be accompanied by an
15 itemized list of additional information or documents the
16 insurer can reasonably determine are necessary to process the
17 claim.
18 2. A provider must submit the additional information
19 or documentation, as specified on the itemized list, within 35
20 days after receipt of the notification. Failure of a provider
21 to submit by mail or electronically the additional information
22 or documentation requested within 35 days after receipt of the
23 notification may result in denial of the claim.
24 3. A health insurer may not make more than one request
25 for documents under this paragraph in connection with a claim
26 unless the provider fails to submit all of the requested
27 documents to process the claim or if documents submitted by
28 the provider raise new additional issues not included in the
29 original written itemization, in which case the health insurer
30 may provide the provider with one additional opportunity to
31 submit the additional documents needed to process the claim.
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1 In no case may the health insurer request duplicate documents.
2 (d) For purposes of this subsection, electronic means
3 of transmission of claims, notices, documents, forms, and
4 payments shall be used to the greatest extent possible by the
5 health insurer and the provider.
6 (e) A claim must be paid or denied within 120 days
7 after receipt of the claim. Failure to pay or deny a claim
8 within 140 days after receipt of the claim creates an
9 uncontestable obligation to pay the claim.
10 (6) If a health insurer determines that it has made an
11 overpayment to a provider for services rendered to an insured,
12 the health insurer must make a claim for such overpayment to
13 the provider's designated location. A health insurer that
14 makes a claim for overpayment to a provider under this section
15 shall give the provider a written or electronic statement
16 specifying the basis for the retroactive denial or payment
17 adjustment. The insurer must identify the claim or claims, or
18 overpayment claim portion thereof, for which a claim for
19 overpayment is submitted.
20 (a) If an overpayment determination is the result of
21 retroactive review or audit of coverage decisions or payment
22 levels not related to fraud, a health insurer shall adhere to
23 the following procedures:
24 1. All claims for overpayment must be submitted to a
25 provider within 30 months after the health insurer's payment
26 of the claim. A provider must pay, deny, or contest the health
27 insurer's claim for overpayment within 40 days after the
28 receipt of the claim. All contested claims for overpayment
29 must be paid or denied within 120 days after receipt of the
30 claim. Failure to pay or deny overpayment and claim within 140
31 days after receipt creates an uncontestable obligation to pay
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1 the claim.
2 2. A provider that denies or contests a health
3 insurer's claim for overpayment or any portion of a claim
4 shall notify the health insurer, in writing, within 35 days
5 after the provider receives the claim that the claim for
6 overpayment is contested or denied. The notice that the claim
7 for overpayment is denied or contested must identify the
8 contested portion of the claim and the specific reason for
9 contesting or denying the claim and, if contested, must
10 include a request for additional information. If the health
11 insurer submits additional information, the health insurer
12 must, within 35 days after receipt of the request, mail or
13 electronically transfer the information to the provider. The
14 provider shall pay or deny the claim for overpayment within 45
15 days after receipt of the information. The notice is
16 considered made on the date the notice is mailed or
17 electronically transferred by the provider.
18 3. Failure of a health insurer to respond to a
19 provider's contesting of claim or request for additional
20 information regarding the claim within 35 days after receipt
21 of such notice may result in denial of the claim.
22 4. The health insurer may not reduce payment to the
23 provider for other services unless the provider agrees to the
24 reduction in writing or fails to respond to the health
25 insurer's overpayment claim as required by this paragraph.
26 5. Payment of an overpayment claim is considered made
27 on the date the payment was mailed or electronically
28 transferred. An overdue payment of a claim bears simple
29 interest at the rate of 12 percent per year. Interest on an
30 overdue payment for a claim for an overpayment begins to
31 accrue when the claim should have been paid, denied, or
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1 contested.
2 (b) A claim for overpayment shall not be permitted
3 beyond 30 months after the health insurer's payment of a
4 claim, except that claims for overpayment may be sought beyond
5 that time from providers convicted of fraud pursuant to s.
6 817.234.
7 (7) Payment of a claim is considered made on the date
8 the payment was mailed or electronically transferred. An
9 overdue payment of a claim bears simple interest of 12 percent
10 per year. Interest on an overdue payment for a claim or for
11 any portion of a claim begins to accrue when the claim should
12 have been paid, denied, or contested. The interest is payable
13 with the payment of the claim.
14 (8) For all contracts entered into or renewed on or
15 after October 1, 2002, a health insurer's internal dispute
16 resolution process related to a denied claim not under active
17 review by a mediator, arbitrator, or third-party dispute
18 entity must be finalized within 60 days after the receipt of
19 the provider's request for review or appeal.
20 (9) A provider or any representative of a provider,
21 regardless of whether the provider is under contract with the
22 health insurer, may not collect or attempt to collect money
23 from, maintain any action at law against, or report to a
24 credit agency an insured for payment of covered services for
25 which the health insurer contested or denied the provider's
26 claim. This prohibition applies during the pendency of any
27 claim for payment made by the provider to the health insurer
28 for payment of the services or internal dispute resolution
29 process to determine whether the health insurer is liable for
30 the services. For a claim, this pendency applies from the
31 date the claim or a portion of the claim is denied to the date
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1 of the completion of the health insurer's internal dispute
2 resolution process, not to exceed 60 days.
3 (10) The provisions of this section may not be waived,
4 voided, or nullified by contract.
5 (11) A health insurer may not retroactively deny a
6 claim because of insured ineligibility more than 1 year after
7 the date of payment of the claim.
8 (12) A health insurer shall pay a contracted primary
9 care or admitting physician, pursuant to such physician's
10 contract, for providing inpatient services in a contracted
11 hospital to an insured if such services are determined by the
12 health insurer to be medically necessary and covered services
13 under the health insurer's contract with the contract holder.
14 (13) Upon written notification by an insured, an
15 insurer shall investigate any claim of improper billing by a
16 physician, hospital, or other health care provider. The
17 insurer shall determine if the insured was properly billed for
18 only those procedures and services that the insured actually
19 received. If the insurer determines that the insured has been
20 improperly billed, the insurer shall notify the insured and
21 the provider of its findings and shall reduce the amount of
22 payment to the provider by the amount determined to be
23 improperly billed. If a reduction is made due to such
24 notification by the insured, the insurer shall pay to the
25 insured 20 percent of the amount of the reduction up to $500.
26 (14) A permissible error ratio of 5 percent is
27 established for insurer's claims payment violations of s.
28 627.6131(4)(a), (b), (c), and (e) and (5)(a), (b), (c), and
29 (e). If the error ratio of a particular insurer does not
30 exceed the permissible error ratio of 5 percent for an audit
31 period, no fine shall be assessed for the noted claims
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1 violations for the audit period. The error ratio shall be
2 determined by dividing the number of claims with violations
3 found on a statistically valid sample of claims for the audit
4 period by the total number of claims in the sample. If the
5 error ratio exceeds the permissible error ratio of 5 percent,
6 a fine may be assessed according to s. 624.4211 for those
7 claims payment violations which exceed the error ratio.
8 Notwithstanding the provisions of this section, the department
9 may fine a health insurer for claims payment violations of s.
10 627.6131(4)(e) and (5)(e) which create an uncontestable
11 obligation to pay the claim. The department shall not fine
12 insurers for violations which the department determines were
13 due to circumstances beyond the insurer's control.
14 (15) This section is applicable only to a major
15 medical expense health insurance policy as defined in s.
16 627.643(2)(e) offered by a group or an individual health
17 insurer licensed pursuant to chapter 624, including a
18 preferred provider policy under s. 627.6471 and an exclusive
19 provider organization under s. 627.6472 or a group or
20 individual insurance contract that only provides direct
21 payments to dentists for enumerated dental services.
22 (16) Notwithstanding s. 627.6131(4)(b), where an
23 electronic pharmacy claim is submitted to a pharmacy benefits
24 manager acting on behalf of a health insurer the pharmacy
25 benefits manager shall, within 30 days of receipt of the
26 claim, pay the claim or notify a provider or designee if a
27 claim is denied or contested. Notice of the insurer's action
28 on the claim and payment of the claim is considered to be made
29 on the date the notice or payment was mailed or electronically
30 transferred.
31 (17) Notwithstanding s. 627.6131(5)(a), effective
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1 November 1, 2003, where a nonelectronic pharmacy claim is
2 submitted to a pharmacy benefits manager acting on behalf of a
3 health insurer the pharmacy benefits manager shall provide
4 acknowledgment of receipt of the claim within 30 days after
5 receipt of the claim to the provider or provide a provider
6 within 30 days after receipt with electronic access to the
7 status of a submitted claim.
8 Section 45. Paragraph (a) of subsection (2) of section
9 627.6425, Florida Statutes, is amended to read:
10 627.6425 Renewability of individual coverage.--
11 (2) An insurer may nonrenew or discontinue health
12 insurance coverage of an individual in the individual market
13 based only on one or more of the following:
14 (a) The individual has failed to pay premiums, or
15 contributions, or a required copayment payable to the insurer
16 in accordance with the terms of the health insurance coverage
17 or the insurer has not received timely premium payments. When
18 the copayment is payable to the insurer and exceeds $300 the
19 insurer shall allow the insured up to ninety days from the
20 date of the procedure to pay the required copayment. The
21 insurer shall print in 10 point type on the Declaration of
22 Benefits page notification that the insured could be
23 terminated for failure to make any required copayment to the
24 insurer.
25 Section 46. Subsection (4) of section 627.651, Florida
26 Statutes, is amended to read:
27 627.651 Group contracts and plans of self-insurance
28 must meet group requirements.--
29 (4) This section does not apply to any plan which is
30 established or maintained by an individual employer in
31 accordance with the Employee Retirement Income Security Act of
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1 1974, Pub. L. No. 93-406, or to a multiple-employer welfare
2 arrangement as defined in s. 624.437(1), except that a
3 multiple-employer welfare arrangement shall comply with ss.
4 627.419, 627.657, 627.6575, 627.6578, 627.6579, 627.6612,
5 627.66121, 627.66122, 627.6615, 627.6616, and 627.662(8)(6).
6 This subsection does not allow an authorized insurer to issue
7 a group health insurance policy or certificate which does not
8 comply with this part.
9 Section 47. Section 627.662, Florida Statutes, is
10 amended to read:
11 627.662 Other provisions applicable.--The following
12 provisions apply to group health insurance, blanket health
13 insurance, and franchise health insurance:
14 (1) Section 627.569, relating to use of dividends,
15 refunds, rate reductions, commissions, and service fees.
16 (2) Section 627.602(1)(f) and (2), relating to
17 identification numbers and statement of deductible provisions.
18 (3) Section 627.635, relating to excess insurance.
19 (4) Section 627.638, relating to direct payment for
20 hospital or medical services.
21 (5) Section 627.640, relating to filing and
22 classification of rates.
23 (6) Section 627.613, relating to timely payment of
24 claims, or s. 627.6131, relating to payment of claims.
25 (7)(6) Section 627.645(1), relating to denial of
26 claims.
27 (8)(7) Section 627.613, relating to time of payment of
28 claims.
29 (9)(8) Section 627.6471, relating to preferred
30 provider organizations.
31 (10)(9) Section 627.6472, relating to exclusive
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1 provider organizations.
2 (11)(10) Section 627.6473, relating to combined
3 preferred provider and exclusive provider policies.
4 (12)(11) Section 627.6474, relating to provider
5 contracts.
6 Section 48. Subsection (2) of section 627.638, Florida
7 Statutes, is amended to read:
8 627.638 Direct payment for hospital, medical
9 services.--
10 (2) Whenever, in any health insurance claim form, an
11 insured specifically authorizes payment of benefits directly
12 to any recognized hospital or physician, the insurer shall
13 make such payment to the designated provider of such services,
14 unless otherwise provided in the insurance contract. However,
15 if:
16 (a) The benefit is determined to be covered under the
17 terms of the policy;
18 (b) The claim is limited to treatment of mental health
19 or substance abuse, including drug and alcohol abuse; and
20 (c) The insured authorizes the insurer, in writing, as
21 part of the claim to make direct payment of benefits to a
22 recognized hospital, physician, or other licensed provider,
23
24 payments shall be made directly to the recognized hospital,
25 physician, or other licensed provider, notwithstanding any
26 contrary provisions in the insurance contract.
27 Section 49. Paragraph (e) of subsection (1) of section
28 641.185, Florida Statutes, is amended to read:
29 641.185 Health maintenance organization subscriber
30 protections.--
31 (1) With respect to the provisions of this part and
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1 part III, the principles expressed in the following statements
2 shall serve as standards to be followed by the Department of
3 Insurance and the Agency for Health Care Administration in
4 exercising their powers and duties, in exercising
5 administrative discretion, in administrative interpretations
6 of the law, in enforcing its provisions, and in adopting
7 rules:
8 (e) A health maintenance organization subscriber
9 should receive timely, concise information regarding the
10 health maintenance organization's reimbursement to providers
11 and services pursuant to ss. 641.31 and 641.31015 and should
12 receive prompt payment from the organization pursuant to s.
13 641.3155.
14 Section 50. Subsection (4) is added to section
15 641.234, Florida Statutes, to read:
16 641.234 Administrative, provider, and management
17 contracts.--
18 (4)(a) If a health maintenance organization, through a
19 health care risk contract, transfers to any entity the
20 obligations to pay any provider for any claims arising from
21 services provided to or for the benefit of any subscriber of
22 the organization, the health maintenance organization shall
23 remain responsible for any violations of ss. 641,3155,
24 641.3156, and 641.51(4). The provisions of ss.
25 624.418-624.4211 and 641.52 shall apply to any such
26 violations.
27 (b) As used in this subsection:
28 1. The term "health care risk contract" means a
29 contract under which an entity receives compensation in
30 exchange for providing to the health maintenance organization
31 a provider network or other services, which may include
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1 administrative services.
2 2. The term "entity" means a person licensed as an
3 administrator under s. 626.88 and does not include any
4 provider or group practice, as defined in s. 456.053,
5 providing services under the scope of the license of the
6 provider or the members of the group practice. The term does
7 not include a hospital providing billing, claims, and
8 collection services solely on its own and its physicians'
9 behalf and providing services under the scope of its license.
10 Section 51. Subsection (1) of section 641.30, Florida
11 Statutes, is amended to read:
12 641.30 Construction and relationship to other laws.--
13 (1) Every health maintenance organization shall accept
14 the standard health claim form prescribed pursuant to s.
15 641.3155 627.647.
16 Section 52. Subsection (4) of section 641.3154,
17 Florida Statutes, is amended to read:
18 641.3154 Organization liability; provider billing
19 prohibited.--
20 (4) A provider or any representative of a provider,
21 regardless of whether the provider is under contract with the
22 health maintenance organization, may not collect or attempt to
23 collect money from, maintain any action at law against, or
24 report to a credit agency a subscriber of an organization for
25 payment of services for which the organization is liable, if
26 the provider in good faith knows or should know that the
27 organization is liable. This prohibition applies during the
28 pendency of any claim for payment made by the provider to the
29 organization for payment of the services and any legal
30 proceedings or dispute resolution process to determine whether
31 the organization is liable for the services if the provider is
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1 informed that such proceedings are taking place. It is
2 presumed that a provider does not know and should not know
3 that an organization is liable unless:
4 (a) The provider is informed by the organization that
5 it accepts liability;
6 (b) A court of competent jurisdiction determines that
7 the organization is liable; or
8 (c) The department or agency makes a final
9 determination that the organization is required to pay for
10 such services subsequent to a recommendation made by the
11 Statewide Provider and Subscriber Assistance Panel pursuant to
12 s. 408.7056; or
13 (d) The agency issues a final order that the
14 organization is required to pay for such services subsequent
15 to a recommendation made by a resolution organization pursuant
16 to s. 408.7057.
17 Section 53. Section 641.3155, Florida Statutes, is
18 amended to read:
19 (Substantial rewording of section. See
20 s. 641.3155, F.S., for present text.)
21 641.3155 Prompt payment of claims.--
22 (1) As used in this section, the term "claim" for a
23 noninstitutional provider means a paper or electronic billing
24 instrument submitted to the health maintenance organization's
25 designated location that consists of the HCFA 1500 data set,
26 or its successor, that has all mandatory entries for a
27 physician licensed under chapter 458, chapter 459, chapter
28 460, chapter 461, or chapter 463, or psychologists licensed
29 under chapter 490 or any appropriate billing instrument that
30 has all mandatory entries for any other noninstitutional
31 provider. For institutional providers, "claim" means a paper
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1 or electronic billing instrument submitted to the health
2 maintenance organization's designated location that consists
3 of the UB-92 data set or its successor with entries stated as
4 mandatory by the National Uniform Billing Committee.
5 (2) All claims for payment, whether electronic or
6 nonelectronic:
7 (a) Are considered received on the date the claim is
8 received by the organization at its designated claims receipt
9 location.
10 (b) Must be mailed or electronically transferred to an
11 organization within 6 months after completion of the service
12 and the provider is furnished with the correct name and
13 address of the patient's health insurer. Submission of a
14 provider's claim is considered made on the date it is
15 electronically transferred or mailed.
16 (c) Must not duplicate a claim previously submitted
17 unless it is determined that the original claim was not
18 received or is otherwise lost.
19 (3) For all electronically submitted claims, a health
20 maintenance organization shall:
21 (a) Within 24 hours after the beginning of the next
22 business day after receipt of the claim, provide electronic
23 acknowledgment of the receipt of the claim to the electronic
24 source submitting the claim.
25 (b) Within 20 days after receipt of the claim, pay the
26 claim or notify a provider or designee if a claim is denied or
27 contested. Notice of the organization's action on the claim
28 and payment of the claim is considered to be made on the date
29 the notice or payment was mailed or electronically
30 transferred.
31 (c)1. Notification of the health maintenance
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1 organization's determination of a contested claim must be
2 accompanied by an itemized list of additional information or
3 documents the insurer can reasonably determine are necessary
4 to process the claim.
5 2. A provider must submit the additional information
6 or documentation, as specified on the itemized list, within 35
7 days after receipt of the notification. Failure of a provider
8 to submit by mail or electronically the additional information
9 or documentation requested within 35 days after receipt of the
10 notification may result in denial of the claim.
11 3. A health maintenance organization may not make more
12 than one request for documents under this paragraph in
13 connection with a claim, unless the provider fails to submit
14 all of the requested documents to process the claim or if
15 documents submitted by the provider raise new additional
16 issues not included in the original written itemization, in
17 which case the health maintenance organization may provide the
18 provider with one additional opportunity to submit the
19 additional documents needed to process the claim. In no case
20 may the health maintenance organization request duplicate
21 documents.
22 (d) For purposes of this subsection, electronic means
23 of transmission of claims, notices, documents, forms, and
24 payment shall be used to the greatest extent possible by the
25 health maintenance organization and the provider.
26 (e) A claim must be paid or denied within 90 days
27 after receipt of the claim. Failure to pay or deny a claim
28 within 120 days after receipt of the claim creates an
29 uncontestable obligation to pay the claim.
30 (4) For all nonelectronically submitted claims, a
31 health maintenance organization shall:
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1 (a) Effective November 1, 2003, provide
2 acknowledgement of receipt of the claim within 15 days after
3 receipt of the claim to the provider or designee or provide a
4 provider or designee within 15 days after receipt with
5 electronic access to the status of a submitted claim.
6 (b) Within 40 days after receipt of the claim, pay the
7 claim or notify a provider or designee if a claim is denied or
8 contested. Notice of the health maintenance organization's
9 action on the claim and payment of the claim is considered to
10 be made on the date the notice or payment was mailed or
11 electronically transferred.
12 (c)1. Notification of the health maintenance
13 organization's determination of a contested claim must be
14 accompanied by an itemized list of additional information or
15 documents the organization can reasonably determine are
16 necessary to process the claim.
17 2. A provider must submit the additional information
18 or documentation, as specified on the itemized list, within 35
19 days after receipt of the notification. Failure of a provider
20 to submit by mail or electronically the additional information
21 or documentation requested within 35 days after receipt of the
22 notification may result in denial of the claim.
23 3. A health maintenance organization may not make more
24 than one request for documents under this paragraph in
25 connection with a claim unless the provider fails to submit
26 all of the requested documents to process the claim or if
27 documents submitted by the provider raise new additional
28 issues not included in the original written itemization, in
29 which case the health maintenance organization may provide the
30 provider with one additional opportunity to submit the
31 additional documents needed to process the claim. In no case
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1 may the health maintenance organization request duplicate
2 documents.
3 (d) For purposes of this subsection, electronic means
4 of transmission of claims, notices, documents, forms, and
5 payments shall be used to the greatest extent possible by the
6 health maintenance organization and the provider.
7 (e) A claim must be paid or denied within 120 days
8 after receipt of the claim. Failure to pay or deny a claim
9 within 140 days after receipt of the claim creates an
10 uncontestable obligation to pay the claim.
11 (5) If a health maintenance organization determines
12 that it has made an overpayment to a provider for services
13 rendered to a subscriber, the health maintenance organization
14 must make a claim for such overpayment to the provider's
15 designated location. A health maintenance organization that
16 makes a claim for overpayment to a provider under this section
17 shall give the provider a written or electronic statement
18 specifying the basis for the retroactive denial or payment
19 adjustment. The health maintenance organization must identify
20 the claim or claims, or overpayment claim portion thereof, for
21 which a claim for overpayment is submitted.
22 (a) If an overpayment determination is the result of
23 retroactive review or audit of coverage decisions or payment
24 levels not related to fraud, a health maintenance organization
25 shall adhere to the following procedures:
26 1. All claims for overpayment must be submitted to a
27 provider within 30 months after the health maintenance
28 organization's payment of the claim. A provider must pay,
29 deny, or contest the health maintenance organization's claim
30 for overpayment within 40 days after the receipt of the claim.
31 All contested claims for overpayment must be paid or denied
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1 within 120 days after receipt of the claim. Failure to pay or
2 deny overpayment and claim within 140 days after receipt
3 creates an uncontestable obligation to pay the claim.
4 2. A provider that denies or contests a health
5 maintenance organization's claim for overpayment or any
6 portion of a claim shall notify the organization, in writing,
7 within 35 days after the provider receives the claim that the
8 claim for overpayment is contested or denied. The notice that
9 the claim for overpayment is denied or contested must identify
10 the contested portion of the claim and the specific reason for
11 contesting or denying the claim and, if contested, must
12 include a request for additional information. If the
13 organization submits additional information, the organization
14 must, within 35 days after receipt of the request, mail or
15 electronically transfer the information to the provider. The
16 provider shall pay or deny the claim for overpayment within 45
17 days after receipt of the information. The notice is
18 considered made on the date the notice is mailed or
19 electronically transferred by the provider.
20 3. Failure of a health maintenance organization to
21 respond to a provider's contestment of claim or request for
22 additional information regarding the claim within 35 days
23 after receipt of such notice may result in denial of the
24 claim.
25 4. The health maintenance organization may not reduce
26 payment to the provider for other services unless the provider
27 agrees to the reduction in writing or fails to respond to the
28 health maintenance organization's overpayment claim as
29 required by this paragraph.
30 5. Payment of an overpayment claim is considered made
31 on the date the payment was mailed or electronically
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1 transferred. An overdue payment of a claim bears simple
2 interest at the rate of 12 percent per year. Interest on an
3 overdue payment for a claim for an overpayment payment begins
4 to accrue when the claim should have been paid, denied, or
5 contested.
6 (b) A claim for overpayment shall not be permitted
7 beyond 30 months after the health maintenance organization's
8 payment of a claim, except that claims for overpayment may be
9 sought beyond that time from providers convicted of fraud
10 pursuant to s. 817.234.
11 (6) Payment of a claim is considered made on the date
12 the payment was mailed or electronically transferred. An
13 overdue payment of a claim bears simple interest of 12 percent
14 per year. Interest on an overdue payment for a claim or for
15 any portion of a claim begins to accrue when the claim should
16 have been paid, denied, or contested. The interest is payable
17 with the payment of the claim.
18 (7)(a) For all contracts entered into or renewed on or
19 after October 1, 2002, a health maintenance organization's
20 internal dispute resolution process related to a denied claim
21 not under active review by a mediator, arbitrator, or
22 third-party dispute entity must be finalized within 60 days
23 after the receipt of the provider's request for review or
24 appeal.
25 (b) All claims to a health maintenance organization
26 begun after October 1, 2000, not under active review by a
27 mediator, arbitrator, or third-party dispute entity, shall
28 result in a final decision on the claim by the health
29 maintenance organization by January 2, 2003, for the purpose
30 of the statewide provider and managed care organization claim
31 dispute resolution program pursuant to s. 408.7057.
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1 (8) A provider or any representative of a provider,
2 regardless of whether the provider is under contract with the
3 health maintenance organization, may not collect or attempt to
4 collect money from, maintain any action at law against, or
5 report to a credit agency a subscriber for payment of covered
6 services for which the health maintenance organization
7 contested or denied the provider's claim. This prohibition
8 applies during the pendency of any claim for payment made by
9 the provider to the health maintenance organization for
10 payment of the services or internal dispute resolution process
11 to determine whether the health maintenance organization is
12 liable for the services. For a claim, this pendency applies
13 from the date the claim or a portion of the claim is denied to
14 the date of the completion of the health maintenance
15 organization's internal dispute resolution process, not to
16 exceed 60 days.
17 (9) The provisions of this section may not be waived,
18 voided, or nullified by contract.
19 (10) A health maintenance organization may not
20 retroactively deny a claim because of subscriber ineligibility
21 more than 1 year after the date of payment of the claim.
22 (11) A health maintenance organization shall pay a
23 contracted primary care or admitting physician, pursuant to
24 such physician's contract, for providing inpatient services in
25 a contracted hospital to a subscriber if such services are
26 determined by the health maintenance organization to be
27 medically necessary and covered services under the health
28 maintenance organization's contract with the contract holder.
29 (12) Upon written notification by a subscriber, a
30 health maintenance organization shall investigate any claim of
31 improper billing by a physician, hospital, or other health
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1 care provider. The organization shall determine if the
2 subscriber was properly billed for only those procedures and
3 services that the subscriber actually received. If the
4 organization determines that the subscriber has been
5 improperly billed, the organization shall notify the
6 subscriber and the provider of its findings and shall reduce
7 the amount of payment to the provider by the amount determined
8 to be improperly billed. If a reduction is made due to such
9 notification by the insured, the insurer shall pay to the
10 insured 20 percent of the amount of the reduction up to $500.
11 (13) A permissible error ratio of 5 percent is
12 established for health maintenance organizations' claims
13 payment violations of s. 641.3155(3)(a), (b), (c), and (e) and
14 (4)(a), (b), (c), and (e). If the error ratio of a particular
15 insurer does not exceed the permissible error ratio of 5
16 percent for an audit period, no fine shall be assessed for the
17 noted claims violations for the audit period. The error ratio
18 shall be determined by dividing the number of claims with
19 violations found on a statistically valid sample of claims for
20 the audit period by the total number of claims in the sample.
21 If the error ratio exceeds the permissible error ratio of 5
22 percent, a fine may be assessed according to s. 624.4211 for
23 those claims payment violations which exceed the error ratio.
24 Notwithstanding the provisions of this section, the department
25 may fine a health maintenance organization for claims payment
26 violations of s. 641.3155(3)(e) and (4)(e) which create an
27 uncontestable obligation to pay the claim. The department
28 shall not fine organizations for violations which the
29 department determines were due to circumstances beyond the
30 organization's control.
31 (14) This section shall apply to all claims or any
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1 portion of a claim submitted by a health maintenance
2 organization subscriber under a health maintenance
3 organization subscriber contract to the organization for
4 payment.
5 (15) Notwithstanding s. 641.3155(3)(b), where an
6 electronic pharmacy claim is submitted to a pharmacy benefits
7 manager acting on behalf of a health maintenance organization
8 the pharmacy benefits manager shall, within 30 days of receipt
9 of the claim, pay the claim or notify a provider or designee
10 if a claim is denied or contested. Notice of the
11 organization's action on the claim and payment of the claim is
12 considered to be made on the date the notice or payment was
13 mailed or electronically transferred.
14 (16) Notwithstanding s. 641.3155(4)(a), effective
15 November 1, 2003, where a nonelectronic pharmacy claim is
16 submitted to a pharmacy benefits manager acting on behalf of a
17 health maintenance organization the pharmacy benefits manager
18 shall provide acknowledgment of receipt of the claim within 30
19 days after receipt of the claim to the provider or provide a
20 provider within 30 days after receipt with electronic access
21 to the status of a submitted claim.
22 Section 54. Subsection (12) of section 641.51, Florida
23 Statutes, is amended to read:
24 641.51 Quality assurance program; second medical
25 opinion requirement.--
26 (12) If a contracted primary care physician, licensed
27 under chapter 458 or chapter 459, determines and the
28 organization determine that a subscriber requires examination
29 by a licensed ophthalmologist for medically necessary,
30 contractually covered services, then the organization shall
31 authorize the contracted primary care physician to send the
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1 subscriber to a contracted licensed ophthalmologist.
2 Section 55. Subsection (3) is added to section
3 381.003, Florida Statutes, to read:
4 381.003 Communicable disease and AIDS prevention and
5 control.--
6 (3) The department shall by rule adopt the
7 blood-borne-pathogen standard set forth in subpart Z of 29
8 C.F.R. part 1910, as amended by Pub. L. No. 106-430, which
9 shall apply to all public-sector employers. The department
10 shall compile and maintain a list of existing needleless
11 systems and sharps with engineered sharps-injury protection
12 which shall be available to assist employers, including the
13 department and the Department of Corrections, in complying
14 with the applicable requirements of the blood-borne-pathogen
15 standard. The list may be developed from existing sources of
16 information, including, without limitation, the United States
17 Food and Drug Administration, the Centers for Disease Control
18 and Prevention, the Occupational Safety and Health
19 Administration, and the United States Department of Veterans
20 Affairs.
21 Section 56. The Agency for Health Care Administration
22 shall conduct a study of health care services provided to the
23 medically fragile or medical-technology-dependent children in
24 the state and conduct a pilot program in Dade County to
25 provide subacute pediatric transitional care to a maximum of
26 30 children at any one time. The purposes of the study and the
27 pilot program are to determine ways to permit medically
28 fragile or medical-technology-dependent children to
29 successfully make a transition from acute care in a health
30 care institution to live with their families when possible,
31 and to provide cost-effective, subacute transitional care
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1 services.
2 Section 57. The Agency for Health Care Administration,
3 in cooperation with the Children's Medical Services Program in
4 the Department of Health, shall conduct a study to identify
5 the total number of medically fragile or
6 medical-technology-dependent children, from birth through age
7 21, in the state. By January 1, 2003, the agency must report
8 to the Legislature regarding the children's ages, the
9 locations where the children are served, the types of services
10 received, itemized costs of the services, and the sources of
11 funding that pay for the services, including the proportional
12 share when more than one funding source pays for a service.
13 The study must include information regarding medically fragile
14 or medical-technology-dependent children residing in
15 hospitals, nursing homes, and medical foster care, and those
16 who live with their parents. The study must describe children
17 served in prescribed pediatric extended-care centers,
18 including their ages and the services they receive. The report
19 must identify the total services provided for each child and
20 the method for paying for those services. The report must also
21 identify the number of such children who could, if appropriate
22 transitional services were available, return home or move to a
23 less-institutional setting.
24 Section 58. (1) Within 30 days after the effective
25 date of this act, the agency shall establish minimum staffing
26 standards and quality requirements for a subacute pediatric
27 transitional care center to be operated as a 2-year pilot
28 program in Dade County. The pilot program must operate under
29 the license of a hospital licensed under chapter 395, Florida
30 Statutes, or a nursing home licensed under chapter 400,
31 Florida Statutes, and shall use existing beds in the hospital
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1 or nursing home. A child's placement in the subacute pediatric
2 transitional care center may not exceed 90 days. The center
3 shall arrange for an alternative placement at the end of a
4 child's stay and a transitional plan for children expected to
5 remain in the facility for the maximum allowed stay.
6 (2) Within 60 days after the effective date of this
7 act, the agency must amend the state Medicaid plan and request
8 any federal waivers necessary to implement and fund the pilot
9 program.
10 (3) The subacute pediatric transitional care center
11 must require level I background screening as provided in
12 chapter 435, Florida Statutes, for all employees or
13 prospective employees of the center who are expected to, or
14 whose responsibilities may require them to, provide personal
15 care or services to children, have access to children's living
16 areas, or have access to children's funds or personal
17 property.
18 Section 59. (1) The subacute pediatric transitional
19 care center must have an advisory board. Membership on the
20 advisory board must include, but need not be limited to:
21 (a) A physician and an advanced registered nurse
22 practitioner who is familiar with services for medically
23 fragile or medical-technology-dependent children;
24 (b) A registered nurse who has experience in the care
25 of medically fragile or medical-technology-dependent children;
26 (c) A child development specialist who has experience
27 in the care of medically fragile or
28 medical-technology-dependent children and their families;
29 (d) A social worker who has experience in the care of
30 medically fragile or medical-technology-dependent children and
31 their families; and
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1 (e) A consumer representative who is a parent or
2 guardian of a child placed in the center.
3 (2) The advisory board shall:
4 (a) Review the policy and procedure components of the
5 center to assure conformance with applicable standards
6 developed by the Agency for Health Care Administration; and
7 (b) Provide consultation with respect to the
8 operational and programmatic components of the center.
9 Section 60. (1) The subacute pediatric transitional
10 care center must have written policies and procedures
11 governing the admission, transfer, and discharge of children.
12 (2) The admission of each child to the center must be
13 under the supervision of the center nursing administrator or
14 his or her designee, and must be in accordance with the
15 center's policies and procedures. Each Medicaid admission must
16 be approved as appropriate for placement in the facility by
17 the Children's Medical Services Multidisciplinary Assessment
18 Team of the Department of Health, in conjunction with the
19 Agency for Health Care Administration.
20 (3) Each child admitted to the center shall be
21 admitted upon prescription of the medical director of the
22 center, licensed pursuant to chapter 458 or chapter 459, and
23 the child shall remain under the care of the medical director
24 and the advanced registered nurse practitioner for the
25 duration of his or her stay in the center.
26 (4) Each child admitted to the center must meet at
27 least the following criteria:
28 (a) The child must be medically fragile or
29 medical-technology-dependent.
30 (b) The child may not, prior to admission, present
31 significant risk of infection to other children or personnel.
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1 The medical and nursing directors shall review, on a
2 case-by-case basis, the condition of any child who is
3 suspected of having an infectious disease to determine whether
4 admission is appropriate.
5 (c) The child must be medically stabilized and require
6 skilled nursing care or other interventions.
7 (5) If the child meets the criteria specified in
8 paragraphs (4)(a), (b), and (c), the medical director or
9 nursing director of the center shall implement a preadmission
10 plan that delineates services to be provided and appropriate
11 sources for such services.
12 (a) If the child is hospitalized at the time of
13 referral, preadmission planning must include the participation
14 of the child's parent or guardian and relevant medical,
15 nursing, social services, and developmental staff to assure
16 that the hospital's discharge plans will be implemented
17 following the child's placement in the center.
18 (b) A consent form, outlining the purpose of the
19 center, family responsibilities, authorized treatment,
20 appropriate release of liability, and emergency disposition
21 plans, must be signed by the parent or guardian and witnessed
22 before the child is admitted to the center. The parent or
23 guardian shall be provided a copy of the consent form.
24 Section 61. By January 1, 2003, the Agency for Health
25 Care Administration shall report to the Legislature concerning
26 the progress of the pilot program. By January 1, 2004, the
27 agency shall submit to the Legislature a report on the success
28 of the pilot program.
29 Section 62. Section 765.510, Florida Statutes, is
30 amended to read:
31 765.510 Legislative declaration.--Because of the rapid
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1 medical progress in the fields of tissue and organ
2 preservation, transplantation of tissue, and tissue culture,
3 and because it is in the public interest to aid the medical
4 developments in the these fields of organ and tissue recovery
5 and transplantation, and in order to promote the general
6 welfare, save lives, and reduce sickness, pain, suffering,
7 disabilities, and medical costs of persons with organ and
8 tissue impairment, and to help alleviate the shortage of
9 organs and tissues available for transplantation and research,
10 the Legislature in enacting this part intends to encourage and
11 aid the development of reconstructive medicine and surgery and
12 the development of medical research by facilitating premortem
13 and postmortem authorizations for donations of tissue and
14 organs. It is the purpose of this part to regulate the gift
15 of a body or parts of a body, the gift to be made after the
16 death of a donor.
17 Section 63. Subsections (1), (2), and (6) of section
18 765.512, Florida Statutes, are amended to read:
19 765.512 Persons who may make an anatomical gift.--
20 (1) Any person who may make a will may give all or
21 part of his or her body for any purpose specified in s.
22 765.510, the gift to take effect upon death. An anatomical
23 gift made by an adult donor and not revoked by the donor as
24 provided in s. 765.516 is irrevocable and does not require the
25 consent or concurrence of any person after the donor's death.
26 A family member, guardian, representative ad litem, or health
27 care surrogate of a decedent who has made an anatomical gift
28 may not modify the decedent's wishes or deny or prevent the
29 anatomical gift from being made.
30 (2) If the decedent has executed an agreement
31 concerning an anatomical gift, by including signing an organ
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1 and tissue donor card, by expressing his or her wish to donate
2 in a living will or advance directive, or by signifying his or
3 her intent to donate on his or her driver's license or in some
4 other written form has indicated his or her wish to make an
5 anatomical gift, and in the absence of actual notice of
6 contrary indications by the decedent, the document is evidence
7 of legally sufficient informed consent to donate an anatomical
8 gift and is legally binding. Any surrogate designated by the
9 decedent pursuant to part II of this chapter may give all or
10 any part of the decedent's body for any purpose specified in
11 s. 765.510.
12 (6) A gift of all or part of a body authorizes:
13 (a) Any examination necessary to assure medical
14 acceptability of the gift for the purposes intended; and.
15 (b) The decedent's medical provider, family, or a
16 third party to furnish medical records requested concerning
17 the decedent's medical and social history.
18 Section 64. Section 765.516, Florida Statutes, is
19 amended to read:
20 765.516 Amendment of the terms of or the revocation of
21 the gift.--
22 (1) A donor may amend the terms of or revoke an
23 anatomical gift by:
24 (a) The execution and delivery to the donee of a
25 signed statement.
26 (b) An oral statement that is:
27 1. Made to the donor's spouse; or
28 2. made in the presence of two persons, other than the
29 donor's spouse, and communicated to the donor's family or
30 attorney or to the donee.
31 (c) A statement during a terminal illness or injury
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1 addressed to an attending physician, who must communicate the
2 revocation of the gift to the procurement organization that is
3 certified by the state.
4 (d) A signed document found on or about the donor's
5 person or in the donor's effects.
6 (2) The terms of any gift made by a will may also be
7 amended or the gift may be revoked in the manner provided for
8 the amendment or revocation of wills or as provided in
9 subsection (1).
10 Section 65. Subsections (1) and (5) of section
11 765.517, Florida Statutes, are amended to read:
12 765.517 Rights and duties at death.--
13 (1) The donee, as specified under the provisions of s.
14 765.515(2), may accept or reject the gift. If the donee
15 accepts a gift of the entire body or a part of the body to be
16 used for scientific purposes other than a transplant, the
17 donee may authorize embalming and the use of the body in
18 funeral services, subject to the terms of the gift. If the
19 gift is of a part of the body, the donee shall cause the part
20 to be removed without unnecessary mutilation upon the death of
21 the donor and before or after embalming. After removal of the
22 part, custody of the remainder of the body shall be made
23 available to vests in the surviving spouse, next of kin, or
24 other persons under obligation to dispose of the body.
25 (5) A person or entity that who acts or attempts to
26 act in good faith and without negligence in accordance accord
27 with the terms of this part or under the anatomical gift laws
28 of another state or a foreign country is not liable for
29 damages in any civil action or subject to prosecution for his
30 or her acts in any criminal proceeding. Neither an individual
31 who makes an anatomical gift nor the individual's estate is
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1 liable for any injury or damage that results from the making
2 or the use of the anatomical gift.
3 Section 66. Section 381.0034, Florida Statutes, is
4 amended to read:
5 381.0034 Requirement for instruction on conditions
6 caused by nuclear, biological, and chemical terrorism and on
7 human immunodeficiency virus and acquired immune deficiency
8 syndrome.--
9 (1) As of July 1, 1991, The Department of Health shall
10 require each person licensed or certified under chapter 401,
11 chapter 467, part IV of chapter 468, or chapter 483, as a
12 condition of biennial relicensure, to complete an educational
13 course approved by the department on conditions caused by
14 nuclear, biological, and chemical terrorism. The course shall
15 consist of education on diagnosis and treatment, the modes of
16 transmission, infection control procedures, and clinical
17 management. Such course shall also include information on
18 reporting suspected cases of conditions caused by nuclear,
19 biological, or chemical terrorism to the appropriate health
20 and law enforcement authorities, and prevention of human
21 immunodeficiency virus and acquired immune deficiency
22 syndrome. Such course shall include information on current
23 Florida law on acquired immune deficiency syndrome and its
24 impact on testing, confidentiality of test results, and
25 treatment of patients. Each such licensee or certificateholder
26 shall submit confirmation of having completed said course, on
27 a form provided by the department, when submitting fees or
28 application for each biennial renewal.
29 (2) Failure to complete the requirements of this
30 section shall be grounds for disciplinary action contained in
31 the chapters specified in subsection (1). In addition to
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1 discipline by the department, the licensee or
2 certificateholder shall be required to complete the required
3 said course or courses.
4 (3) The department shall require, as a condition of
5 granting a license under the chapters specified in subsection
6 (1), that an applicant making initial application for
7 licensure complete respective an educational courses course
8 acceptable to the department on conditions caused by nuclear,
9 biological, and chemical terrorism and on human
10 immunodeficiency virus and acquired immune deficiency
11 syndrome. An applicant who has not taken such courses a
12 course at the time of licensure shall, upon an affidavit
13 showing good cause, be allowed 6 months to complete this
14 requirement.
15 (4) The department shall have the authority to adopt
16 rules to carry out the provisions of this section.
17 (5) Any professional holding two or more licenses or
18 certificates subject to the provisions of this section shall
19 be permitted to show proof of having taken one
20 department-approved course on conditions caused by nuclear,
21 biological, and chemical terrorism human immunodeficiency
22 virus and acquired immune deficiency syndrome, for purposes of
23 relicensure or recertification for the additional licenses.
24 (6) As used in this section, the term "terrorism" has
25 the same meaning as in s. 775.30.
26 Section 67. Section 381.0035, Florida Statutes, is
27 amended to read:
28 381.0035 Educational courses course on human
29 immunodeficiency virus and acquired immune deficiency syndrome
30 and on conditions caused by nuclear, biological, and chemical
31 terrorism; employees and clients of certain health care
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1 facilities.--
2 (1)(a) The Department of Health shall require all
3 employees and clients of facilities licensed under chapters
4 393, 394, and 397 and employees of facilities licensed under
5 chapter 395 and parts II, III, IV, and VI of chapter 400 to
6 complete, biennially, a continuing educational course on the
7 modes of transmission, infection control procedures, clinical
8 management, and prevention of human immunodeficiency virus and
9 acquired immune deficiency syndrome with an emphasis on
10 appropriate behavior and attitude change. Such instruction
11 shall include information on current Florida law and its
12 impact on testing, confidentiality of test results, and
13 treatment of patients and any protocols and procedures
14 applicable to human immunodeficiency counseling and testing,
15 reporting, the offering of HIV testing to pregnant women, and
16 partner notification issues pursuant to ss. 381.004 and
17 384.25.
18 (b) The department shall require all employees of
19 facilities licensed under chapters 393, 394, 395, and 397 and
20 parts II, III, IV, and VI of chapter 400 to complete,
21 biennially, a continuing educational course on conditions
22 caused by nuclear, biological, and chemical terrorism. The
23 course shall consist of education on diagnosis and treatment,
24 modes of transmission, infection control procedures, and
25 clinical management. Such course shall also include
26 information on reporting suspected cases of conditions caused
27 by nuclear, biological, or chemical terrorism to the
28 appropriate health and law enforcement authorities.
29 (2) New employees of facilities licensed under
30 chapters 393, 394, 395, and 397 and parts II, III, IV, and VI
31 of chapter 400 shall be required to complete a course on human
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1 immunodeficiency virus and acquired immune deficiency
2 syndrome, with instruction to include information on current
3 Florida law and its impact on testing, confidentiality of test
4 results, and treatment of patients. New employees of such
5 facilities shall also be required to complete a course on
6 conditions caused by nuclear, biological, and chemical
7 terrorism, with instruction to include information on
8 reporting suspected cases to the appropriate health and law
9 enforcement authorities.
10 (3) Facilities licensed under chapters 393, 394, 395,
11 and 397, and parts II, III, IV, and VI of chapter 400 shall
12 maintain a record of employees and dates of attendance at
13 human immunodeficiency virus and acquired immune deficiency
14 syndrome educational courses on human immunodeficiency virus
15 and acquired immune deficiency syndrome and on conditions
16 caused by nuclear, biological, and chemical terrorism.
17 (4) The department shall have the authority to review
18 the records of each facility to determine compliance with the
19 requirements of this section. The department may adopt rules
20 to carry out the provisions of this section.
21 (5) As used in this section, the term "terrorism" has
22 the same meaning as in s. 775.30.
23 Section 68. Section 401.23, Florida Statutes, is
24 amended to read:
25 401.23 Definitions.--As used in this part, the term:
26 (1) "Advanced life support" means the use of skills
27 and techniques described in the most recent U.S. DOT National
28 Standard Paramedic Curriculum by a paramedic under the
29 supervision of a licensee's medical director as required by
30 rules of the department. The term "advanced life support" also
31 includes other techniques which have been approved and are
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1 performed under conditions specified by rules of the
2 department. The term "advanced life support" also includes
3 provision of care by a paramedic under the supervision of a
4 licensee's medical director to one experiencing an emergency
5 medical condition as defined herein. "Advanced life support"
6 means treatment of life-threatening medical emergencies
7 through the use of techniques such as endotracheal intubation,
8 the administration of drugs or intravenous fluids, telemetry,
9 cardiac monitoring, and cardiac defibrillation by a qualified
10 person, pursuant to rules of the department.
11 (2) "Advanced life support service" means any
12 emergency medical transport or nontransport service which uses
13 advanced life support techniques.
14 (3) "Air ambulance" means any fixed-wing or
15 rotary-wing aircraft used for, or intended to be used for, air
16 transportation of sick or injured persons requiring or likely
17 to require medical attention during transport.
18 (4) "Air ambulance service" means any publicly or
19 privately owned service, licensed in accordance with the
20 provisions of this part, which operates air ambulances to
21 transport persons requiring or likely to require medical
22 attention during transport.
23 (5) "Ambulance" or "emergency medical services
24 vehicle" means any privately or publicly owned land or water
25 vehicle that is designed, constructed, reconstructed,
26 maintained, equipped, or operated for, and is used for, or
27 intended to be used for, land or water transportation of sick
28 or injured persons requiring or likely to require medical
29 attention during transport.
30 (6) "Ambulance driver" means any person who meets the
31 requirements of s. 401.281.
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1 (7) "Basic life support" means the use of skills and
2 techniques described in the most recent U.S. DOT National
3 Standard EMT-Basic Curriculum by an emergency medical
4 technician or paramedic under the supervision of a licensee's
5 medical director as required by rules of the department. The
6 term "basic life support" also includes other techniques which
7 have been approved and are performed under conditions
8 specified by rules of the department. The term "basic life
9 support" also includes provision of care by a paramedic or
10 emergency medical technician under the supervision of a
11 licensee's medical director to one experiencing an emergency
12 medical condition as defined herein. "Basic life support"
13 means treatment of medical emergencies by a qualified person
14 through the use of techniques such as patient assessment,
15 cardiopulmonary resuscitation (CPR), splinting, obstetrical
16 assistance, bandaging, administration of oxygen, application
17 of medical antishock trousers, administration of a
18 subcutaneous injection using a premeasured autoinjector of
19 epinephrine to a person suffering an anaphylactic reaction,
20 and other techniques described in the Emergency Medical
21 Technician Basic Training Course Curriculum of the United
22 States Department of Transportation. The term "basic life
23 support" also includes other techniques which have been
24 approved and are performed under conditions specified by rules
25 of the department.
26 (8) "Basic life support service" means any emergency
27 medical service which uses only basic life support techniques.
28 (9) "Certification" means any authorization issued
29 pursuant to this part to a person to act as an emergency
30 medical technician or a paramedic.
31 (10) "Department" means the Department of Health.
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1 (11) "Emergency medical condition" means:
2 (a) A medical condition manifesting itself by acute
3 symptoms of sufficient severity, which may include severe
4 pain, psychiatric disturbances, symptoms of substance abuse,
5 or other acute symptoms, such that the absence of immediate
6 medical attention could reasonably be expected to result in
7 any of the following:
8 1. Serious jeopardy to patient health, including a
9 pregnant woman or fetus.
10 2. Serious impairment to bodily functions.
11 3. Serious dysfunction of any bodily organ or part.
12 (b) With respect to a pregnant woman, that there is
13 evidence of the onset and persistence of uterine contractions
14 or rupture of the membranes.
15 (c) With respect to a person exhibiting acute
16 psychiatric disturbance or substance abuse, that the absence
17 of immediate medical attention could reasonably be expected to
18 result in:
19 1. Serious jeopardy to the health of a patient; or
20 2. Serious jeopardy to the health of others.
21 (12)(11) "Emergency medical technician" means a person
22 who is certified by the department to perform basic life
23 support pursuant to this part.
24 (13)(12) "Interfacility transfer" means the
25 transportation by ambulance of a patient between two
26 facilities licensed under chapter 393, chapter 395, or chapter
27 400, pursuant to this part.
28 (14)(13) "Licensee" means any basic life support
29 service, advanced life support service, or air ambulance
30 service licensed pursuant to this part.
31 (15)(14) "Medical direction" means direct supervision
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1 by a physician through two-way voice communication or, when
2 such voice communication is unavailable, through established
3 standing orders, pursuant to rules of the department.
4 (16)(15) "Medical director" means a physician who is
5 employed or contracted by a licensee and who provides medical
6 supervision, including appropriate quality assurance but not
7 including administrative and managerial functions, for daily
8 operations and training pursuant to this part.
9 (17)(16) "Mutual aid agreement" means a written
10 agreement between two or more entities whereby the signing
11 parties agree to lend aid to one another under conditions
12 specified in the agreement and as sanctioned by the governing
13 body of each affected county.
14 (18)(17) "Paramedic" means a person who is certified
15 by the department to perform basic and advanced life support
16 pursuant to this part.
17 (19)(18) "Permit" means any authorization issued
18 pursuant to this part for a vehicle to be operated as a basic
19 life support or advanced life support transport vehicle or an
20 advanced life support nontransport vehicle providing basic or
21 advanced life support.
22 (20)(19) "Physician" means a practitioner who is
23 licensed under the provisions of chapter 458 or chapter 459.
24 For the purpose of providing "medical direction" as defined in
25 subsection (14) for the treatment of patients immediately
26 prior to or during transportation to a United States
27 Department of Veterans Affairs medical facility, "physician"
28 also means a practitioner employed by the United States
29 Department of Veterans Affairs.
30 (21)(20) "Registered nurse" means a practitioner who
31 is licensed to practice professional nursing pursuant to part
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1 I of chapter 464.
2 (22)(21) "Secretary" means the Secretary of Health.
3 (23)(22) "Service location" means any permanent
4 location in or from which a licensee solicits, accepts, or
5 conducts business under this part.
6 Section 69. Subsection (6) of section 401.27, Florida
7 Statutes, is amended to read:
8 401.27 Personnel; standards and certification.--
9 (6)(a) The department shall establish by rule a
10 procedure for biennial renewal certification of emergency
11 medical technicians. Such rules must require a United States
12 Department of Transportation refresher training program of at
13 least 30 hours as approved by the department every 2 years.
14 Completion of the course required by s. 381.0034(1) shall
15 count toward the 30 hours. The refresher program may be
16 offered in multiple presentations spread over the 2-year
17 period. The rules must also provide that the refresher course
18 requirement may be satisfied by passing a challenge
19 examination.
20 (b) The department shall establish by rule a procedure
21 for biennial renewal certification of paramedics. Such rules
22 must require candidates for renewal to have taken at least 30
23 hours of continuing education units during the 2-year period.
24 Completion of the course required by s. 381.0034(1) shall
25 count toward the 30 hours. The rules must provide that the
26 continuing education requirement may be satisfied by passing a
27 challenge examination.
28 Section 70. Section 456.033, Florida Statutes, is
29 amended to read:
30 456.033 Requirement for instruction for certain
31 licensees on conditions caused by nuclear, biological, and
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1 chemical terrorism and on HIV and AIDS.--
2 (1) The appropriate board shall require each person
3 licensed or certified under chapter 457; chapter 458; chapter
4 459; chapter 460; chapter 461; chapter 463; part I of chapter
5 464; chapter 465; chapter 466; part II, part III, part V, or
6 part X of chapter 468; or chapter 486 to complete a continuing
7 educational course, approved by the board, on conditions
8 caused by nuclear, biological, and chemical terrorism human
9 immunodeficiency virus and acquired immune deficiency syndrome
10 as part of biennial relicensure or recertification. The course
11 shall consist of education on diagnosis and treatment, the
12 modes of transmission, infection control procedures, and
13 clinical management. Such course shall also include
14 information on reporting suspected cases of conditions caused
15 by nuclear, biological, or chemical terrorism to the
16 appropriate health and law enforcement authorities, and
17 prevention of human immunodeficiency virus and acquired immune
18 deficiency syndrome. Such course shall include information on
19 current Florida law on acquired immune deficiency syndrome and
20 its impact on testing, confidentiality of test results,
21 treatment of patients, and any protocols and procedures
22 applicable to human immunodeficiency virus counseling and
23 testing, reporting, the offering of HIV testing to pregnant
24 women, and partner notification issues pursuant to ss. 381.004
25 and 384.25.
26 (2) Each such licensee or certificateholder shall
27 submit confirmation of having completed said course, on a form
28 as provided by the board, when submitting fees for each
29 biennial renewal.
30 (3) The board shall have the authority to approve
31 additional equivalent courses that may be used to satisfy the
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1 requirements in subsection (1). Each licensing board that
2 requires a licensee to complete an educational course pursuant
3 to this section may count the hours required for completion of
4 the course included in the total continuing educational
5 requirements as required by law.
6 (4) Any person holding two or more licenses subject to
7 the provisions of this section shall be permitted to show
8 proof of having taken one board-approved course on conditions
9 caused by nuclear, biological, and chemical terrorism human
10 immunodeficiency virus and acquired immune deficiency
11 syndrome, for purposes of relicensure or recertification for
12 additional licenses.
13 (5) Failure to comply with the above requirements of
14 this section shall constitute grounds for disciplinary action
15 under each respective licensing chapter and s. 456.072(1)(e).
16 In addition to discipline by the board, the licensee shall be
17 required to complete the required course or courses.
18 (6) The board shall require as a condition of granting
19 a license under the chapters and parts specified in subsection
20 (1) that an applicant making initial application for licensure
21 complete respective an educational courses course acceptable
22 to the board on conditions caused by nuclear, biological, and
23 chemical terrorism and on human immunodeficiency virus and
24 acquired immune deficiency syndrome. An applicant who has not
25 taken such courses a course at the time of licensure shall,
26 upon an affidavit showing good cause, be allowed 6 months to
27 complete this requirement.
28 (7) The board shall have the authority to adopt rules
29 to carry out the provisions of this section.
30 (8) The board shall report to the Legislature by March
31 1 of each year as to the implementation and compliance with
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1 the requirements of this section.
2 (9)(a) In lieu of completing a course as required in
3 subsection (1), the licensee may complete a course on in
4 end-of-life care and palliative health care or a course on
5 HIV/AIDS, so long as the licensee completed an approved
6 AIDS/HIV course on conditions caused by nuclear, biological,
7 and chemical terrorism in the immediately preceding biennium.
8 (b) In lieu of completing a course as required by
9 subsection (1), a person licensed under chapter 466 who has
10 completed an approved AIDS/HIV course in the immediately
11 preceding 2 years may complete a course approved by the Board
12 of Dentistry.
13 (10) As used in this section, the term "terrorism" has
14 the same meaning as in s. 775.30.
15 Section 71. Section 456.0345, Florida Statutes, is
16 created to read:
17 456.0345 Life support training.--Health care
18 practitioners who obtain training in advanced cardiac life
19 support, cardiopulmonary resuscitation, or emergency first aid
20 shall receive an equivalent number of continuing education
21 course credits which may be applied toward licensure renewal
22 requirements.
23 Section 72. Subsection (4) of section 458.319, Florida
24 Statutes, is amended to read:
25 458.319 Renewal of license.--
26 (4) Notwithstanding the provisions of s. 456.033, a
27 physician may complete continuing education on end-of-life
28 care and palliative care in lieu of continuing education in
29 conditions caused by nuclear, biological, and chemical
30 terrorism AIDS/HIV, if that physician has completed the
31 AIDS/HIV continuing education in conditions caused by nuclear,
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1 biological, and chemical terrorism in the immediately
2 preceding biennium. As used in this subsection, the term
3 "terrorism" has the same meaning as in s. 775.30.
4 Section 73. Subsection (5) of section 459.008, Florida
5 Statutes, is amended to read:
6 459.008 Renewal of licenses and certificates.--
7 (5) Notwithstanding the provisions of s. 456.033, an
8 osteopathic physician may complete continuing education on
9 end-of-life and palliative care in lieu of continuing
10 education in conditions caused by nuclear, biological, and
11 chemical terrorism AIDS/HIV, if that physician has completed
12 the AIDS/HIV continuing education in conditions caused by
13 nuclear, biological, and chemical terrorism in the immediately
14 preceding biennium. As used in this subsection, the term
15 "terrorism" has the same meaning as in s. 775.30.
16 Section 74. Subsection (6) of section 381.0011,
17 Florida Statutes, is amended to read:
18 381.0011 Duties and powers of the Department of
19 Health.--It is the duty of the Department of Health to:
20 (6) Declare, enforce, modify, and abolish quarantine
21 of persons, animals, and premises as the circumstances
22 indicate for controlling communicable diseases or providing
23 protection from unsafe conditions that pose a threat to public
24 health, except as provided in ss. 384.28 and 392.545-392.60.
25 (a) The department shall adopt rules to specify the
26 conditions and procedures for imposing and releasing a
27 quarantine. The rules must include provisions related to:
28 1. The closure of premises.
29 2. The movement of persons or animals exposed to or
30 infected with a communicable disease.
31 3. The tests or prophylactic treatment, including
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Amendment No. ___ Barcode 104940
1 vaccination, for communicable disease required prior to
2 employment or admission to the premises or to comply with a
3 quarantine.
4 4. Testing or destruction of animals with or suspected
5 of having a disease transmissible to humans.
6 5. Access by the department to quarantined premises.
7 6. The disinfection of quarantined animals, persons,
8 or premises.
9 7. Methods of quarantine.
10 (b) Any health regulation that restricts travel or
11 trade within the state may not be adopted or enforced in this
12 state except by authority of the department.
13 Section 75. Section 381.00315, Florida Statutes, is
14 amended to read:
15 381.00315 Public health advisories; public health
16 emergencies.--The State Health Officer is responsible for
17 declaring public health emergencies and issuing public health
18 advisories.
19 (1) As used in this section, the term:
20 (a) "Public health advisory" means any warning or
21 report giving information to the public about a potential
22 public health threat. Prior to issuing any public health
23 advisory, the State Health Officer must consult with any state
24 or local agency regarding areas of responsibility which may be
25 affected by such advisory. Upon determining that issuing a
26 public health advisory is necessary to protect the public
27 health and safety, and prior to issuing the advisory, the
28 State Health Officer must notify each county health department
29 within the area which is affected by the advisory of the State
30 Health Officer's intent to issue the advisory. The State
31 Health Officer is authorized to take any action appropriate to
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Amendment No. ___ Barcode 104940
1 enforce any public health advisory.
2 (b) "Public health emergency" means any occurrence, or
3 threat thereof, whether natural or man made, which results or
4 may result in substantial injury or harm to the public health
5 from infectious disease, chemical agents, nuclear agents,
6 biological toxins, or situations involving mass casualties or
7 natural disasters. Prior to declaring a public health
8 emergency, the State Health Officer shall, to the extent
9 possible, consult with the Governor and shall notify the Chief
10 of Domestic Security Initiatives as created in s. 943.03. The
11 declaration of a public health emergency shall continue until
12 the State Health Officer finds that the threat or danger has
13 been dealt with to the extent that the emergency conditions no
14 longer exist and he or she terminates the declaration.
15 However, a declaration of a public health emergency may not
16 continue for longer than 60 days unless the Governor concurs
17 in the renewal of the declaration. The State Health Officer,
18 upon declaration of a public health emergency, may take
19 actions that are necessary to protect the public health. Such
20 actions include, but are not limited to:
21 1. Directing manufacturers of prescription drugs or
22 over-the-counter drugs who are permitted under chapter 499 and
23 wholesalers of prescription drugs located in this state who
24 are permitted under chapter 499 to give priority to the
25 shipping of specified drugs to pharmacies and health care
26 providers within geographic areas that have been identified by
27 the State Health Officer. The State Health Officer must
28 identify the drugs to be shipped. Manufacturers and
29 wholesalers located in the state must respond to the State
30 Health Officer's priority shipping directive before shipping
31 the specified drugs.
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Amendment No. ___ Barcode 104940
1 2. Notwithstanding chapters 465 and 499 and rules
2 adopted thereunder, directing pharmacists employed by the
3 department to compound bulk prescription drugs and provide
4 these bulk prescription drugs to physicians and nurses of
5 county health departments or any qualified person authorized
6 by the State Health Officer for administration to persons as
7 part of a prophylactic or treatment regimen.
8 3. Notwithstanding s. 456.036, temporarily
9 reactivating the inactive license of the following health care
10 practitioners, when such practitioners are needed to respond
11 to the public health emergency: physicians licensed under
12 chapter 458 or chapter 459; physician assistants licensed
13 under chapter 458 or chapter 459; licensed practical nurses,
14 registered nurses, and advanced registered nurse practitioners
15 licensed under part I of chapter 464; respiratory therapists
16 licensed under part V of chapter 468; and emergency medical
17 technicians and paramedics certified under part III of chapter
18 401. Only those health care practitioners specified in this
19 paragraph who possess an unencumbered inactive license and who
20 request that such license be reactivated are eligible for
21 reactivation. An inactive license that is reactivated under
22 this paragraph shall return to inactive status when the public
23 health emergency ends or prior to the end of the public health
24 emergency if the State Health Officer determines that the
25 health care practitioner is no longer needed to provide
26 services during the public health emergency. Such licenses may
27 only be reactivated for a period not to exceed 90 days without
28 meeting the requirements of s. 456.036 or chapter 401, as
29 applicable.
30 4. Ordering an individual to be examined, tested,
31 vaccinated, treated, or quarantined for communicable diseases
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Amendment No. ___ Barcode 104940
1 that have significant morbidity or mortality and present a
2 severe danger to public health. Individuals who are unable or
3 unwilling to be examined, tested, vaccinated or treated for
4 reasons of health, religion or conscience may be subjected to
5 quarantine.
6 a. Examination, testing, vaccination, or treatment may
7 be performed by any qualified person authorized by the State
8 Health Officer.
9 b. If the individual poses a danger to the public
10 health, the State Health Officer may subject the individual to
11 quarantine. If there is no practical method to quarantine the
12 individual, the State Health Officer may use any means
13 necessary to vaccinate or treat the individual.
14
15 Any order of the State Health Officer given to effectuate this
16 paragraph shall be immediately enforceable by a law
17 enforcement officer under s. 381.0012.
18 (2) Individuals who assist the State Health Officer at
19 his or her request on a volunteer basis during a public health
20 emergency are entitled to the benefits specified in s. 110.504
21 (2), (3), (4), and (5).
22 Section 76. Paragraphs (a) and (b) of subsection (2)
23 of section 768.13, Florida Statutes, are amended to read:
24 768.13 Good Samaritan Act; immunity from civil
25 liability.--
26 (2)(a) Any person, including those licensed to
27 practice medicine, who gratuitously and in good faith renders
28 emergency care or treatment either in direct response to
29 emergency situations related to and arising out of a public
30 health emergency declared pursuant to s. 381.00315, a state of
31 emergency which has been declared pursuant to s. 252.36 or at
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Amendment No. ___ Barcode 104940
1 the scene of an emergency outside of a hospital, doctor's
2 office, or other place having proper medical equipment,
3 without objection of the injured victim or victims thereof,
4 shall not be held liable for any civil damages as a result of
5 such care or treatment or as a result of any act or failure to
6 act in providing or arranging further medical treatment where
7 the person acts as an ordinary reasonably prudent person would
8 have acted under the same or similar circumstances.
9 (b)1. Any hospital licensed under chapter 395, any
10 employee of such hospital working in a clinical area within
11 the facility and providing patient care, and any person
12 licensed to practice medicine who in good faith renders
13 medical care or treatment necessitated by a sudden, unexpected
14 situation or occurrence resulting in a serious medical
15 condition demanding immediate medical attention, for which the
16 patient enters the hospital through its emergency room or
17 trauma center, or necessitated by a public health emergency
18 declared pursuant to s. 381.00315 shall not be held liable for
19 any civil damages as a result of such medical care or
20 treatment unless such damages result from providing, or
21 failing to provide, medical care or treatment under
22 circumstances demonstrating a reckless disregard for the
23 consequences so as to affect the life or health of another.
24 2. The immunity provided by this paragraph does not
25 apply to damages as a result of any act or omission of
26 providing medical care or treatment:
27 a. Which occurs after the patient is stabilized and is
28 capable of receiving medical treatment as a nonemergency
29 patient, unless surgery is required as a result of the
30 emergency within a reasonable time after the patient is
31 stabilized, in which case the immunity provided by this
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Amendment No. ___ Barcode 104940
1 paragraph applies to any act or omission of providing medical
2 care or treatment which occurs prior to the stabilization of
3 the patient following the surgery; or
4 b. Unrelated to the original medical emergency.
5 3. For purposes of this paragraph, "reckless
6 disregard" as it applies to a given health care provider
7 rendering emergency medical services shall be such conduct
8 which a health care provider knew or should have known, at the
9 time such services were rendered, would be likely to result in
10 injury so as to affect the life or health of another, taking
11 into account the following to the extent they may be present;
12 a. The extent or serious nature of the circumstances
13 prevailing.
14 b. The lack of time or ability to obtain appropriate
15 consultation.
16 c. The lack of a prior patient-physician relationship.
17 d. The inability to obtain an appropriate medical
18 history of the patient.
19 e. The time constraints imposed by coexisting
20 emergencies.
21 4. Every emergency care facility granted immunity
22 under this paragraph shall accept and treat all emergency care
23 patients within the operational capacity of such facility
24 without regard to ability to pay, including patients
25 transferred from another emergency care facility or other
26 health care provider pursuant to Pub. L. No. 99-272, s. 9121.
27 The failure of an emergency care facility to comply with this
28 subparagraph constitutes grounds for the department to
29 initiate disciplinary action against the facility pursuant to
30 chapter 395.
31 Section 77. Subsection (4) is added to section
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Amendment No. ___ Barcode 104940
1 401.2715, Florida Statutes, to read:
2 401.2715 Recertification training of emergency medical
3 technicians and paramedics.--
4 (4) Any certified emergency medical technician or
5 paramedic may, as a condition of recertification, complete up
6 to 8 hours of training to respond to terrorism, as defined in
7 s. 775.30, and such hours completed may be substituted on a
8 hour-for-hour basis for any other areas of training required
9 for recertification. The department may adopt rules necessary
10 to administer this subsection.
11 Section 78. Subsection (1) of section 633.35, Florida
12 Statutes, is amended to read:
13 633.35 Firefighter training and certification.--
14 (1) The division shall establish a firefighter
15 training program of not less than 360 hours, administered by
16 such agencies and institutions as it approves for the purpose
17 of providing basic employment training for firefighters. Any
18 firefighter may, as a condition of certification, complete up
19 to 8 hours of training to respond to terrorism, as defined in
20 s. 775.30, and such hours completed may be substituted on a
21 hour-for-hour basis for any other areas of training required
22 for certification. The division may adopt rules necessary to
23 administer this subsection. Nothing herein shall require a
24 public employer to pay the cost of such training.
25 Section 79. Subsection (1) of section 943.135, Florida
26 Statutes, is amended to read:
27 943.135 Requirements for continued employment.--
28 (1) The commission shall, by rule, adopt a program
29 that requires all officers, as a condition of continued
30 employment or appointment as officers, to receive periodic
31 commission-approved continuing training or education. Such
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Amendment No. ___ Barcode 104940
1 continuing training or education shall be required at the rate
2 of 40 hours every 4 years, and up to 8 hours which may consist
3 of training to respond to terrorism as defined in s. 775.30.
4 No officer shall be denied a reasonable opportunity by the
5 employing agency to comply with this section. The employing
6 agency must document that the continuing training or education
7 is job-related and consistent with the needs of the employing
8 agency. The employing agency must maintain and submit, or
9 electronically transmit, the documentation to the commission,
10 in a format approved by the commission. The rule shall also
11 provide:
12 (a) Assistance to an employing agency in identifying
13 each affected officer, the date of his or her employment or
14 appointment, and his or her most recent date for successful
15 completion of continuing training or education;
16 (b) A procedure for reactivation of the certification
17 of an officer who is not in compliance with this section; and
18 (c) A remediation program supervised by the training
19 center director within the geographic area for any officer who
20 is attempting to comply with the provisions of this subsection
21 and in whom learning disabilities are identified. The officer
22 shall be assigned nonofficer duties, without loss of employee
23 benefits, and the program shall not exceed 90 days.
24 Section 80. Except as otherwise provided in this act,
25 this act shall take effect July 1, 2002.
26
27
28 ================ T I T L E A M E N D M E N T ===============
29 And the title is amended as follows:
30 Delete everything before the enacting clause
31
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Amendment No. ___ Barcode 104940
1 and insert:
2 A bill to be entitled
3 An act relating to health regulation; amending
4 s. 20.43, F.S.; updating a reference to provide
5 the name of a regulatory board under the
6 Division of Medical Quality Assurance;
7 repealing s. 456.047, F.S.; terminating the
8 standardized credentialing program for health
9 care practitioners; prohibiting the refund of
10 moneys collected through the credentialing
11 program; amending ss. 456.039, 456.0391,
12 456.077, F.S.; removing references, to conform;
13 amending s. 456.072, F.S.; revising provisions
14 governing grounds for discipline; amending s.
15 458.309, F.S.; requiring accreditation of
16 physician offices in which surgery is
17 performed; amending s. 459.005, F.S.; requiring
18 accreditation of osteopathic physician offices
19 in which surgery is performed; amending s.
20 456.004, F.S., relating to powers and duties of
21 the department; requiring performance measures
22 for certain entities; amending s. 456.009,
23 F.S.; requiring performance measures for
24 certain legal and investigative services and
25 annual review of such services to determine
26 whether such performance measures are being
27 met; amending s. 456.011, F.S.; requiring
28 regulatory board committee meetings, including
29 probable cause panels, to be held
30 electronically unless certain conditions are
31 met; amending s. 456.026, F.S.; requiring
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Amendment No. ___ Barcode 104940
1 inclusion of performance measures for certain
2 entities in the department's annual report to
3 the Legislature; creating s. 458.3093, F.S.;
4 requiring submission of credentials for initial
5 physician licensure to a national licensure
6 verification service; requiring verification of
7 such credentials by that service or an
8 equivalent program; creating s. 459.0053, F.S.;
9 requiring submission of credentials for initial
10 osteopathic physician licensure to a national
11 licensure verification service; requiring
12 verification of such credentials by that
13 service, a specified association, or an
14 equivalent program; amending ss. 458.331,
15 459.015, F.S.; revising the definition of the
16 term "repeated malpractice" for purposes of
17 disciplinary action against physicians and
18 osteopaths; increasing the monetary limits of
19 claims against certain health care providers
20 which result in investigation; amending s.
21 627.912, F.S.; raising the malpractice closed
22 claims reporting requirement amount; amending
23 s. 456.025, F.S.; eliminating certain
24 restrictions on the setting of licensure
25 renewal fees for health care practitioners;
26 creating s. 456.0165, F.S.; restricting the
27 costs that may be charged by educational
28 institutions hosting health care practitioner
29 licensure examinations; amending s. 468.302,
30 F.S.; authorizing certified nuclear medicine
31 technologists to administer X radiation from
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Bill No. CS for CS for SB 370
Amendment No. ___ Barcode 104940
1 certain devices under certain circumstances;
2 exempting certain persons from radiologic
3 technologist certification and providing
4 certain training requirements for such
5 exemption; amending s. 468.352, F.S.; revising
6 and providing definitions applicable to the
7 regulation of respiratory therapy; amending s.
8 468.355, F.S.; revising provisions relating to
9 respiratory therapy licensure and testing
10 requirements; amending s. 468.368, F.S.;
11 revising exemptions from respiratory therapy
12 licensure requirements; repealing s. 468.356,
13 F.S., relating to the approval of educational
14 programs; repealing s. 468.357, F.S., relating
15 to licensure by examination; renumbering ss.
16 381.0602, 381.6021, 381.6022, 381.6023,
17 381.6024, 381.6026, F.S., and renumbering and
18 amending ss. 381.60225, 381.6025, F.S., to move
19 provisions relating to organ and tissue
20 procurement, donation, and transplantation to
21 part V, ch. 765, F.S., relating to anatomical
22 gifts; conforming cross-references; amending
23 ss. 395.2050, 409.815, 765.5216, 765.522, F.S.;
24 conforming cross-references; amending s.
25 395.002, F.S.; defining the term "medically
26 unnecessary procedure"; amending s. 395.0161,
27 F.S.; requiring the Agency for Health Care
28 Administration to adopt rules governing the
29 conduct of inspections or investigations;
30 amending s. 395.0197, F.S.; revising provisions
31 governing the internal risk management program;
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Amendment No. ___ Barcode 104940
1 amending s. 456.0375, F.S.; redefining the term
2 "clinic"; amending s. 465.019, F.S.; revising
3 definitions; amending s. 631.57, F.S.;
4 exempting medical professional liability
5 insurance premiums from an assessment; amending
6 s. 766.101, F.S.; redefining the term "medical
7 review committee"; providing an appropriation
8 for a feasibility study; amending s. 393.064,
9 F.S.; transferring to the Department of Health
10 the responsibility for managing the Raymond C.
11 Philips Research and Education Unit; amending
12 s. 408.7057, F.S.; redesignating a program
13 title; revising definitions; including
14 preferred provider organizations and health
15 insurers in the claim dispute resolution
16 program; specifying timeframes for submission
17 of supporting documentation necessary for
18 dispute resolution; providing consequences for
19 failure to comply; providing additional
20 responsibilities for the agency relating to
21 patterns of claim disputes; providing
22 timeframes for review by the resolution
23 organization; directing the agency to notify
24 appropriate licensure and certification
25 entities as part of violation of final orders;
26 amending s. 626.88, F.S.; redefining the term
27 "administrator," with respect to regulation of
28 insurance administrators; creating s. 627.6131,
29 F.S.; specifying payment of claims provisions
30 applicable to certain health insurers;
31 providing a definition; providing requirements
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Amendment No. ___ Barcode 104940
1 and procedures for paying, denying, or
2 contesting claims; providing criteria and
3 limitations; requiring payment within specified
4 periods; specifying rate of interest charged on
5 overdue payments; providing for electronic and
6 nonelectronic transmission of claims; providing
7 procedures for overpayment recovery; specifying
8 timeframes for adjudication of claims,
9 internally and externally; prohibiting action
10 to collect payment from an insured under
11 certain circumstances; providing applicability;
12 prohibiting contractual modification of
13 provisions of law; specifying circumstances for
14 retroactive claim denial; specifying claim
15 payment requirements; providing for billing
16 review procedures; specifying claim content
17 requirements; establishing a permissible error
18 ratio, specifying its applicability, and
19 providing for fines; providing specified
20 exceptions from notice and acknowledgment
21 requirements for pharmacy benefit manager
22 claims; amending s. 627.6425, F.S., relating to
23 renewability of individual coverage; providing
24 for circumstances relating to nonrenewal or
25 discontinuance of coverage; amending s.
26 627.651, F.S.; correcting a cross reference, to
27 conform; amending s. 627.662, F.S.; specifying
28 application of certain additional provisions to
29 group, blanket, and franchise health insurance;
30 amending s. 627.638, F.S.; revising
31 requirements relating to direct payment of
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Amendment No. ___ Barcode 104940
1 benefits to specified providers under certain
2 circumstances; amending s. 641.185, F.S.;
3 specifying that health maintenance organization
4 subscribers should receive prompt payment from
5 the organization; amending s. 641.234, F.S.;
6 specifying responsibility of a health
7 maintenance organization for certain violations
8 under certain circumstances; amending s.
9 641.30, F.S.; conforming a cross reference;
10 amending s. 641.3154, F.S.; modifying the
11 circumstances under which a provider knows that
12 an organization is liable for service
13 reimbursement; amending s. 641.3155, F.S.;
14 revising payment of claims provisions
15 applicable to certain health maintenance
16 organizations; providing a definition;
17 providing requirements and procedures for
18 paying, denying, or contesting claims;
19 providing criteria and limitations; requiring
20 payment within specified periods; revising rate
21 of interest charged on overdue payments;
22 providing for electronic and nonelectronic
23 transmission of claims; providing procedures
24 for overpayment recovery; specifying timeframes
25 for adjudication of claims, internally and
26 externally; prohibiting action to collect
27 payment from a subscriber under certain
28 circumstances; prohibiting contractual
29 modification of provisions of law; specifying
30 circumstances for retroactive claim denial;
31 specifying claim payment requirements;
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Amendment No. ___ Barcode 104940
1 providing for billing review procedures;
2 specifying claim content requirements;
3 establishing a permissible error ratio,
4 specifying its applicability, and providing for
5 fines; providing specified exceptions from
6 notice and acknowledgment requirements for
7 pharmacy benefit manager claims; amending s.
8 641.51, F.S.; revising provisions governing
9 examinations by ophthalmologists; amending s.
10 381.003, F.S.; requiring the Department of
11 Health to adopt certain standards applicable to
12 all public-sector employers; requiring the
13 compilation and maintenance of certain
14 information by the department for use by
15 employers; requiring the Agency for Health Care
16 Administration to conduct a study of health
17 care services provided to medically fragile or
18 medical-technology-dependent children;
19 requiring the Agency for Health Care
20 Administration to conduct a pilot program for a
21 subacute pediatric transitional care center;
22 requiring background screening of center
23 personnel; requiring the agency to amend the
24 Medicaid state plan and seek federal waivers as
25 necessary; requiring the center to have an
26 advisory board; providing for membership on the
27 advisory board; providing requirements for the
28 admission, transfer, and discharge of a child
29 to the center; requiring the agency to submit
30 certain reports to the Legislature; amending
31 ss. 765.510, 765.512, 765.516, 765.517, F.S.;
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Amendment No. ___ Barcode 104940
1 amending the declaration of legislative intent;
2 prohibiting modification of a donor's intent;
3 providing that a donor document is legally
4 binding; authorizing specified persons to
5 furnish donors' medical records upon request;
6 revising procedures by which the terms of an
7 anatomical gift may be amended or the gift may
8 be revoked; revising rights and duties with
9 respect to the disposition of a body at death;
10 proscribing legal liability; amending s.
11 381.0034, F.S.; providing a requirement for
12 instruction of certain health care licensees on
13 conditions caused by nuclear, biological, and
14 chemical terrorism, as a condition of initial
15 licensure, and, in lieu of the requirement for
16 instruction on HIV and AIDS, as a condition of
17 relicensure; amending s. 381.0035, F.S.;
18 providing a requirement for instruction of
19 employees at certain health care facilities on
20 conditions caused by nuclear, biological, and
21 chemical terrorism, upon initial employment,
22 and, in lieu of the requirement of instruction
23 on HIV and AIDS, as biennial continuing
24 education; amending s. 401.23, F.S.; redefining
25 the terms "advanced life support" and "basic
26 life support"; defining the term "emergency
27 medical conditions"; amending s. 401.27, F.S.;
28 providing that the course on conditions caused
29 by nuclear, biological, and chemical terrorism
30 shall count toward the total required hours for
31 biennial recertification of emergency medical
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Bill No. CS for CS for SB 370
Amendment No. ___ Barcode 104940
1 technicians and paramedics; amending s.
2 456.033, F.S.; providing a requirement for
3 instruction of certain health care
4 practitioners on conditions caused by nuclear,
5 biological, and chemical terrorism, as a
6 condition of initial licensure, and, in lieu of
7 the requirement for instruction on HIV and
8 AIDS, as part of biennial relicensure; creating
9 s. 456.0345, F.S.; providing continuing
10 education credits to health care practitioners
11 for certain life support training; amending ss.
12 458.319 and 459.008, F.S.; conforming
13 provisions relating to exceptions to continuing
14 education requirements for physicians and
15 osteopathic physicians; amending s. 381.0011,
16 F.S.; revising the rulemaking authority of the
17 Department of Health with respect to its power
18 to impose quarantine, including requiring
19 vaccination; amending s. 381.00315, F.S.;
20 defining the terms "public health advisory" and
21 "public health emergency"; specifying the terms
22 under which a public health emergency is
23 declared; providing for consultation for,
24 notice, and duration of a declaration of a
25 public health emergency; authorizing the State
26 Health Officer to take specified actions upon
27 the declaration of a public health emergency
28 relating to shipping of specified drugs,
29 directing the compounding of bulk prescription
30 drugs, and specifying the use of such drugs;
31 authorizing the State Health Officer to
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Bill No. CS for CS for SB 370
Amendment No. ___ Barcode 104940
1 reactivate the inactive licenses of certain
2 practitioners who request such reactivation;
3 authorizing the State Health Officer to order
4 that an individual be examined, tested,
5 vaccinated, treated, or quarantined for certain
6 communicable diseases under specified
7 circumstances; specifying benefits to be made
8 available to volunteers acting under a public
9 health emergency; amending s. 768.13, F.S.;
10 providing immunity from civil damages under the
11 Good Samaritan Act for actions taken in
12 response to situations during a declared public
13 health emergency; revising the circumstances
14 under which immunity from civil damages is
15 extended to actions taken by persons licensed
16 to practice medicine; amending ss. 401.2715,
17 633.35, 943.135, F.S.; authorizing the
18 substitution of a specified number of hours of
19 qualifying terrorism response training for a
20 like number of hours of training required for
21 certification; providing effective dates.
22
23
24
25
26
27
28
29
30
31
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