CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
CHAMBER ACTION
Senate House
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11 The Committee on Health Regulation offered the following:
12
13 Amendment (with title amendment)
14 Remove everything after the enacting clause
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16 and insert:
17 Section 1. Subsection (4) of section 383.50, Florida
18 Statutes, is amended to read:
19 383.50 Treatment of abandoned newborn infant.--
20 (4) Each hospital of this state subject to s. 395.1041
21 shall, and any other hospital may, admit and provide all
22 necessary emergency services and care, as defined in s.
23 395.002(11)(10), to any newborn infant left with the hospital
24 in accordance with this section. The hospital or any of its
25 licensed health care professionals shall consider these
26 actions as implied consent for treatment, and a hospital
27 accepting physical custody of a newborn infant has implied
28 consent to perform all necessary emergency services and care.
29 The hospital or any of its licensed health care professionals
30 is immune from criminal or civil liability for acting in good
31 faith in accordance with this section. Nothing in this
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 subsection limits liability for negligence.
2 Section 2. Subsection (7) of section 394.4787, Florida
3 Statutes, is amended to read:
4 394.4787 Definitions; ss. 394.4786, 394.4787,
5 394.4788, and 394.4789.--As used in this section and ss.
6 394.4786, 394.4788, and 394.4789:
7 (7) "Specialty psychiatric hospital" means a hospital
8 licensed by the agency pursuant to s. 395.002(31)(29) as a
9 specialty psychiatric hospital.
10 Section 3. Present subsections (9), (10), (26), and
11 (30) of section 395.002, Florida Statutes, are amended,
12 present subsections (10) through (21) and (22) through (33)
13 are renumbered as subsections (11) through (22) and (24)
14 through (35), respectively, and new subsections (10) and (23)
15 are added to said section, to read:
16 395.002 Definitions.--As used in this chapter:
17 (9) "Emergency medical condition" means:
18 (a) A medical condition manifesting itself by acute
19 symptoms of sufficient severity, which may include severe
20 pain, psychiatric disturbances, symptoms of substance abuse,
21 or other acute symptoms, such that the absence of immediate
22 medical attention could reasonably be expected to result in
23 any of the following:
24 1. Serious jeopardy to patient health, including a
25 pregnant woman or fetus.
26 2. Serious impairment to bodily functions.
27 3. Serious dysfunction of any bodily organ or part.
28 (b) With respect to a pregnant woman:
29 1. That there is inadequate time to effect safe
30 transfer to another hospital prior to delivery;
31 2. That a transfer may pose a threat to the health and
2
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 safety of the patient or fetus; or
2 3. That there is evidence of the onset and persistence
3 of uterine contractions or rupture of the membranes.
4 (c) With respect to a person exhibiting acute
5 psychiatric disturbance or substance abuse, or taken into
6 custody and delivered to a hospital under a court ex parte
7 order for examination or placed by an authorized party for
8 involuntary examination in accordance with chapter 394 or
9 chapter 397, that the absence of immediate medical attention
10 could reasonably be expected to result in:
11 1. Serious jeopardy to the health of a patient; or
12 2. Serious jeopardy to the health of others.
13 (10) "Emergency medical services provider" means a
14 provider licensed pursuant to chapter 401.
15 (11)(10) "Emergency services and care" means medical
16 screening, examination, and evaluation by a physician, or, to
17 the extent permitted by applicable law, by other appropriate
18 personnel under the supervision of a physician, to determine
19 if an emergency medical condition exists and, if it does, the
20 care, treatment, or surgery by a physician necessary to
21 stabilize relieve or eliminate the emergency medical
22 condition, within the service capability of the facility.
23 (23) "Medically unnecessary procedure" means a
24 surgical or other invasive procedure that a reasonable
25 physician, in light of the patient's history and available
26 diagnostic information, would not deem to be indicated in
27 order to treat, cure, or palliate the patient's condition or
28 disease.
29 (28)(26) "Service capability" means the physical
30 space, equipment, supplies, and services that the hospital
31 provides and the level of care that the medical staff can
3
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 provide within the training and scope of their professional
2 licenses and hospital privileges all services offered by the
3 facility where identification of services offered is evidenced
4 by the appearance of the service in a patient's medical record
5 or itemized bill.
6 (32)(30) "Stabilized" means, with respect to an
7 emergency medical condition, that no material deterioration of
8 the condition is likely, within reasonable medical
9 probability, to result from the transfer or discharge of the
10 patient from a hospital.
11 Section 4. Subsections (2), (14), and (16) of section
12 395.0197, Florida Statutes, is amended to read:
13 395.0197 Internal risk management program.--
14 (2) The internal risk management program is the
15 responsibility of the governing board of the health care
16 facility. Each licensed facility shall utilize the services of
17 hire a risk manager, licensed under s. 395.10974, who is
18 responsible for implementation and oversight of such
19 facility's internal risk management program as required by
20 this section. A risk manager must not be made responsible for
21 more than four internal risk management programs in separate
22 licensed facilities, unless the facilities are under one
23 corporate ownership or the risk management programs are in
24 rural hospitals.
25 (14) The agency shall have access, as set forth in
26 rules adopted pursuant to s. 395.0161(5), to all licensed
27 facility records necessary to carry out the provisions of this
28 section. The records obtained by the agency under subsection
29 (6), subsection (8), or subsection (10) are not available to
30 the public under s. 119.07(1), nor shall they be discoverable
31 or admissible in any civil or administrative action, except in
4
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 disciplinary proceedings by the agency or the appropriate
2 regulatory board, nor shall records obtained pursuant to s.
3 456.071 be available to the public as part of the record of
4 investigation for and prosecution in disciplinary proceedings
5 made available to the public by the agency or the appropriate
6 regulatory board. However, the agency or the appropriate
7 regulatory board shall make available, upon written request by
8 a health care professional against whom probable cause has
9 been found, any such records which form the basis of the
10 determination of probable cause, except that, with respect to
11 medical review committee records, s. 766.101 controls.
12 (16) The agency shall review, as part of its licensure
13 inspection process, the internal risk management program at
14 each licensed facility regulated by this section to determine
15 whether the program meets standards established in statutes
16 and rules, whether the program is being conducted in a manner
17 designed to reduce adverse incidents, and whether the program
18 is appropriately reporting incidents under this section. Only
19 a risk manager, licensed under s. 395.10974, and employed by
20 AHCA, shall have authority to conduct inspections to determine
21 whether a program meets the requirements of this section. Such
22 determination shall be based on that level of care, skill, and
23 judgment which, in light of all relevant surrounding
24 circumstances, is recognized as acceptable and appropriate by
25 reasonably prudent similar licensed risk managers.
26 Section 5. Subsection (5) of section 395.0161, Florida
27 Statutes, is created to read:
28 395.0161 Licensure inspection.--
29 (5)(a) The agency shall adopt rules governing the
30 conduct of inspections or investigations it initiates in
31 response to:
5
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 1. Reports filed pursuant to s. 395.0197.
2 2. Complaints alleging violations of state or federal
3 emergency access laws.
4 3. Complaints made by the public alleging violations
5 of law by licensed facilities or personnel.
6 (b) Such rules shall set forth the procedures to be
7 used in such investigations or inspections in order to protect
8 the due process rights of licensed facilities and personnel
9 and to minimize, to the greatest reasonable extent possible,
10 the disruption of facility operations and the cost to
11 facilities resulting from such investigations.
12 Section 6. Subsections (1) and (2) and paragraphs (c)
13 and (d) of subsection (3) of section 395.1041, Florida
14 Statutes, are amended to read:
15 395.1041 Access to emergency services and care.--
16 (1) LEGISLATIVE INTENT.--The Legislature finds and
17 declares it to be of vital importance that emergency services
18 and care be provided by hospitals and physicians to every
19 person in need of such care. The Legislature finds that
20 persons have been denied emergency services and care by
21 hospitals. It is the intent of the Legislature that the
22 agency vigorously enforce the ability of persons to receive
23 all necessary and appropriate emergency services and care and
24 that the agency act in a thorough and timely manner against
25 hospitals and physicians which deny persons emergency services
26 and care. It is further the intent of the Legislature that
27 hospitals, emergency medical services providers, and other
28 health care providers work together in their local communities
29 to enter into agreements or arrangements to ensure access to
30 emergency services and care. The Legislature further
31 recognizes that appropriate emergency services and care often
6
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 require followup consultation and treatment in order to
2 effectively care for emergency medical conditions.
3 (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.--The
4 agency shall establish and maintain an inventory of hospitals
5 with emergency services. The inventory shall list all
6 services within the service capability of the hospital, and
7 such services shall appear on the face of the hospital
8 license. Each hospital having emergency services shall notify
9 the agency of its service capability in the manner and form
10 prescribed by the agency. The agency, in cooperation with the
11 Department of Health shall provide use the inventory to assist
12 emergency medical services providers and shall make the
13 inventory available to others to assist in locating
14 appropriate emergency medical care. The inventory shall also
15 be made available to the general public. On or before August
16 1, 1992, the agency shall request that each hospital identify
17 the services which are within its service capability. On or
18 before November 1, 1992, the agency shall notify each hospital
19 of the service capability to be included in the inventory.
20 The hospital has 15 days from the date of receipt to respond
21 to the notice. By December 1, 1992, the agency shall publish
22 a final inventory. Each hospital shall reaffirm its service
23 capability when its license is renewed and shall notify the
24 agency of the addition of a new service or the termination of
25 a service prior to a change in its service capability.
26 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
27 FACILITY OR HEALTH CARE PERSONNEL.--
28 (c) A patient that has not been stabilized, whether
29 stabilized or not, may be transferred to another hospital
30 which has the requisite service capability or is not at
31 service capacity, if:
7
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 1. The patient, or a person who is legally responsible
2 for the patient and acting on the patient's behalf, after
3 being informed of the hospital's obligation under this section
4 and of the risk of transfer, requests that the transfer be
5 effected;
6 2. A physician has signed a certification that, based
7 upon the reasonable risks and benefits to the patient, and
8 based upon the information available at the time of transfer,
9 the medical benefits reasonably expected from the provision of
10 appropriate medical treatment at another hospital outweigh the
11 increased risks to the individual's medical condition from
12 effecting the transfer; or
13 3. A physician is not physically present in the
14 emergency services area at the time an individual is
15 transferred and a qualified medical person signs a
16 certification that a physician, in consultation with
17 personnel, has determined that the medical benefits reasonably
18 expected from the provision of appropriate medical treatment
19 at another medical facility outweigh the increased risks to
20 the individual's medical condition from effecting the
21 transfer. The consulting physician must countersign the
22 certification;
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24 provided that this paragraph shall not be construed to require
25 acceptance of a transfer that is not medically necessary.
26 (d)1. Every hospital shall ensure the provision of
27 services within the service capability of the hospital, at all
28 times, either directly or indirectly through an arrangement
29 with another hospital, through an arrangement with one or more
30 physicians, or as otherwise made through prior arrangements.
31 A hospital may enter into an agreement with another hospital
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 for purposes of meeting its service capability requirement,
2 and appropriate compensation or other reasonable conditions
3 may be negotiated for these backup services.
4 2. If any arrangement requires the provision of
5 emergency medical transportation, such arrangement must be
6 made in consultation with the applicable emergency medical
7 service provider and may not require the emergency medical
8 service provider to provide transportation that is outside the
9 routine service area of that emergency medical service
10 provider or in a manner that impairs the ability of the
11 emergency medical service provider to timely respond to
12 prehospital emergency calls. Emergency medical transportation
13 provided pursuant to this paragraph shall be considered
14 emergency services and care as provided in s. 395.002.
15 3. A hospital shall not be required to ensure service
16 capability at all times as required in subparagraph 1. if,
17 prior to the receiving of any patient needing such service
18 capability, such hospital has demonstrated to the agency that
19 it lacks the ability to ensure such capability and it has
20 exhausted all reasonable efforts to ensure such capability
21 through backup arrangements. In reviewing a hospital's
22 demonstration of lack of ability to ensure service capability,
23 the agency shall consider factors relevant to the particular
24 case, including the following:
25 a. Number and proximity of hospitals with the same
26 service capability.
27 b. Number, type, credentials, and privileges of
28 specialists.
29 c. Frequency of procedures.
30 d. Size of hospital.
31 4. The agency shall publish proposed rules
9
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 implementing a reasonable exemption procedure by November 1,
2 1992. Subparagraph 1. shall become effective upon the
3 effective date of said rules or January 31, 1993, whichever is
4 earlier. For a period not to exceed 1 year from the effective
5 date of subparagraph 1., a hospital requesting an exemption
6 shall be deemed to be exempt from offering the service until
7 the agency initially acts to deny or grant the original
8 request. The agency has 45 days from the date of receipt of
9 the request for exemption to approve or deny the request.
10 After the first year from the effective date of subparagraph
11 1., If the agency fails to initially act within the time
12 period, the hospital is deemed to be exempt from offering the
13 service until the agency initially acts to deny the request.
14 5. The agency shall convene a workgroup consisting of
15 representatives from the Florida Hospital Association, the
16 Florida Medical Association, Florida Statutory Teaching
17 Hospital Council, and the Florida College of Emergency
18 Physicians to make recommendations to the Legislature for
19 changes to this paragraph regarding:
20 a. Services performed on an infrequent basis that
21 would not be considered to be within the service capability of
22 the hospital.
23 b. Situations in which hospitals would be deemed
24 exempt from providing services at all times that are within
25 their service capability.
26 Section 7. Section 395.1042, Florida Statutes, is
27 created to read:
28 395.1042 Uncompensated Emergency Services and Care
29 Reimbursement Program.--
30 (1) There is established the Uncompensated Emergency
31 Services and Care Reimbursement Program for the purpose of
10
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 reimbursing health care facilities and health care
2 practitioners for the cost of uncompensated emergency services
3 and care provided as required by s. 395.1041. The Agency for
4 Health Care Administration shall reimburse providers for
5 services at the Medicaid rate in an amount equal to the
6 provider's pro rata share of uncompensated emergency services
7 and care provided in the prior fiscal year.
8 (2) Any funds appropriated in the General
9 Appropriations Act for the implementation of s. 395.1041, and
10 any other funds that become available for the implementation
11 of s. 395.1041, shall be used exclusively to compensate
12 providers under the Uncompensated Emergency Services and Care
13 Reimbursement Program.
14 Section 8. Paragraph (c) of subsection (2) of section
15 395.602, Florida Statutes, is amended to read:
16 395.602 Rural hospitals.--
17 (2) DEFINITIONS.--As used in this part:
18 (c) "Inactive rural hospital bed" means a licensed
19 acute care hospital bed, as defined in s. 395.002(15)(14),
20 that is inactive in that it cannot be occupied by acute care
21 inpatients.
22 Section 9. Paragraph (c) of subsection (1) of section
23 395.701, Florida Statutes, is amended to read:
24 395.701 Annual assessments on net operating revenues
25 for inpatient and outpatient services to fund public medical
26 assistance; administrative fines for failure to pay
27 assessments when due; exemption.--
28 (1) For the purposes of this section, the term:
29 (c) "Hospital" means a health care institution as
30 defined in s. 395.002(14)(13), but does not include any
31 hospital operated by the agency or the Department of
11
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 Corrections.
2 Section 10. Paragraph (b) of subsection (1) of section
3 400.051, Florida Statutes, is amended to read:
4 400.051 Homes or institutions exempt from the
5 provisions of this part.--
6 (1) The following shall be exempt from the provisions
7 of this part:
8 (b) Any hospital, as defined in s. 395.002(12)(11),
9 that is licensed under chapter 395.
10 Section 11. Subsections (1), (7), and (11) of section
11 401.23, Florida Statutes, are amended to read:
12 401.23 Definitions.--As used in this part, the term:
13 (1) "Advanced life support" means the use of skills
14 and techniques described in the most recent U.S. DOT National
15 Standard Paramedic Curriculum by a paramedic under the
16 supervision of a licensee's medical director as required by
17 rules of the department. The term "advanced life support" also
18 includes other techniques which have been approved and are
19 performed under conditions specified by rules of the
20 department. The term "advanced life support" also includes
21 provision of care by a paramedic under the supervision of a
22 licensee's medical director to one experiencing an emergency
23 medical condition as defined herein.
24 (1) "Advanced life support" means treatment of
25 life-threatening medical emergencies through the use of
26 techniques such as endotracheal intubation, the administration
27 of drugs or intravenous fluids, telemetry, cardiac monitoring,
28 and cardiac defibrillation by a qualified person, pursuant to
29 rules of the department.
30 (7) "Basic life support" means the use of skills and
31 techniques described in the most recent U.S. DOT National
12
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 Standard EMT-Basic Curriculum by an emergency medical
2 technician or paramedic under the supervision of a licensee's
3 medical director as required by rules of the department. The
4 term "basic life support" also includes other techniques which
5 have been approved and are performed under conditions
6 specified by rules of the department. The term "basic life
7 support" also includes provision of care by a paramedic or
8 emergency medical technician under the supervision of a
9 licensee's medical director to one experiencing an emergency
10 medical condition as defined herein.
11 (7) "Basic life support" means treatment of medical
12 emergencies by a qualified person through the use of
13 techniques such as patient assessment, cardiopulmonary
14 resuscitation (CPR), splinting, obstetrical assistance,
15 bandaging, administration of oxygen, application of medical
16 antishock trousers, administration of a subcutaneous injection
17 using a premeasured autoinjector of epinephrine to a person
18 suffering an anaphylactic reaction, and other techniques
19 described in the Emergency Medical Technician Basic Training
20 Course Curriculum of the United States Department of
21 Transportation. The term "basic life support" also includes
22 other techniques which have been approved and are performed
23 under conditions specified by rules of the department.
24 (11) "Emergency medical condition" means:
25 (a) A medical condition manifesting itself by acute
26 symptoms of sufficient severity, which may include severe
27 pain, psychiatric disturbances, symptoms of substance abuse,
28 such that the absence of immediate medical attention could
29 reasonably be expected to result in any of the following:
30 1. Serious jeopardy to patient health, including a
31 pregnant woman or fetus.
13
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 2. Serious impairment to bodily functions.
2 3. Serious dysfunction of any bodily organ or part.
3 (b) With respect to a pregnant woman:
4 1. That there is inadequate time to effect safe
5 transfer to another hospital prior to delivery;
6 2. That a transfer may pose a threat to the health and
7 safety of the patient or fetus; or
8 3. That there is evidence of the onset and persistence
9 of uterine contractions or rupture of the membranes.
10 (c) With respect to a person exhibiting acute
11 psychiatric disturbance or substance abuse, or taken into
12 custody and delivered to a hospital under a court exparte
13 order for examination or placed by an authorized party for
14 involuntary examination in accordance with chapter 394 or
15 chapter 397, that the absence of immediate medical attention
16 could reasonably be expected to result in:
17 1. Serious jeopardy to the health of a patient; or
18 2. Serious jeopardy to the health of others.
19 (12)(11) "Emergency medical technician" means a person
20 who is certified by the department to perform basic life
21 support pursuant to this part.
22 (13)(12) "Interfacility transfer" means the
23 transportation by ambulance of a patient between two
24 facilities licensed under chapter 393, chapter 395, or chapter
25 400, pursuant to this part.
26 (14)(13) "Licensee" means any basic life support
27 service, advanced life support service, or air ambulance
28 service licensed pursuant to this part.
29 (15)(14) "Medical direction" means direct supervision
30 by a physician through two-way voice communication or, when
31 such voice communication is unavailable, through established
14
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 standing orders, pursuant to rules of the department.
2 (16)(15) "Medical director" means a physician who is
3 employed or contracted by a licensee and who provides medical
4 supervision, including appropriate quality assurance but not
5 including administrative and managerial functions, for daily
6 operations and training pursuant to this part.
7 (17)(16) "Mutual aid agreement" means a written
8 agreement between two or more entities whereby the signing
9 parties agree to lend aid to one another under conditions
10 specified in the agreement and as sanctioned by the governing
11 body of each affected county.
12 (18)(17) "Paramedic" means a person who is certified
13 by the department to perform basic and advanced life support
14 pursuant to this part.
15 (19)(18) "Permit" means any authorization issued
16 pursuant to this part for a vehicle to be operated as a basic
17 life support or advanced life support transport vehicle or an
18 advanced life support nontransport vehicle providing basic or
19 advanced life support.
20 (20)(19) "Physician" means a practitioner who is
21 licensed under the provisions of chapter 458 or chapter 459.
22 For the purpose of providing "medical direction" as defined in
23 subsection (14) for the treatment of patients immediately
24 prior to or during transportation to a United States
25 Department of Veterans Affairs medical facility, "physician"
26 also means a practitioner employed by the United States
27 Department of Veterans Affairs.
28 (21)(20) "Registered nurse" means a practitioner who
29 is licensed to practice professional nursing pursuant to part
30 I of chapter 464.
31 (22)(21) "Secretary" means the Secretary of Health.
15
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 (23)(22) "Service location" means any permanent
2 location in or from which a licensee solicits, accepts, or
3 conducts business under this part.
4 Section 12. Subsections (9) and (10) of section
5 409.901, Florida Statutes, are amended to read:
6 409.901 Definitions; ss. 409.901-409.920.--As used in
7 ss. 409.901-409.920, except as otherwise specifically
8 provided, the term:
9 (9) "Emergency medical condition" means:
10 (a) A medical condition manifesting itself by acute
11 symptoms of sufficient severity, which may include severe
12 pain, psychiatric disturbances, symptoms of substance abuse,
13 or other acute symptoms, such that the absence of immediate
14 medical attention could reasonably be expected to result in
15 any of the following:
16 1. Serious jeopardy to the health of a patient,
17 including a pregnant woman or a fetus.
18 2. Serious impairment to bodily functions.
19 3. Serious dysfunction of any bodily organ or part.
20 (b) With respect to a pregnant woman:
21 1. That there is inadequate time to effect safe
22 transfer to another hospital prior to delivery.
23 2. That a transfer may pose a threat to the health and
24 safety of the patient or fetus.
25 3. That there is evidence of the onset and persistence
26 of uterine contractions or rupture of the membranes.
27 (c) With respect to a person exhibiting acute
28 psychiatric disturbance or substance abuse, or taken into
29 custody and delivered to a hospital under a court ex parte
30 order for examination or placed by an authorized party for
31 involuntary examination in accordance with chapter 394 or
16
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 chapter 397, that the absence of immediate medical attention
2 could reasonably be expected to result in:
3 1. Serious jeopardy to the health of a patient; or
4 2. Serious jeopardy to the health of others.
5 (10) "Emergency services and care" means medical
6 screening, examination, and evaluation by a physician, or, to
7 the extent permitted by applicable laws, by other appropriate
8 personnel under the supervision of a physician, to determine
9 whether an emergency medical condition exists and, if it does,
10 the care, treatment, inpatient admission, or surgery for a
11 covered service by a physician which is necessary to stabilize
12 relieve or eliminate the emergency medical condition, within
13 the service capability of a hospital.
14 Section 13. Subsection (8) of section 409.905, Florida
15 Statutes, is amended and subsection (13) is created to read:
16 409.905 Mandatory Medicaid Services.--The agency may
17 make payments for the following services, which are required
18 of the state by Title XIX of the Social Security Act,
19 furnished by Medicaid providers to recipients who are
20 determined to be eligible on the dates on which the services
21 were provided. Any service under this section shall be
22 provided only when medically necessary and in accordance with
23 state and federal law. Mandatory services rendered by
24 providers in mobile units to Medicaid recipients may be
25 restricted by the agency. Nothing in this section shall be
26 construed to prevent or limit the agency from adjusting fees,
27 reimbursement rates, lengths of stay, number of visits, number
28 of services, or any other adjustments necessary to comply with
29 the availability of moneys and any limitations or directions
30 provided for in the General Appropriations Act or chapter 216.
31 (8) NURSING FACILITY SERVICES.--The agency shall pay
17
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 for 24-hour-a-day nursing and rehabilitative services for a
2 recipient in a nursing facility licensed under part II of
3 chapter 400 or in a rural hospital, as defined in s. 395.602,
4 or in a Medicare certified skilled nursing facility operated
5 by a hospital, as defined by s. 395.002(12)(11), that is
6 licensed under part I of chapter 395, and in accordance with
7 provisions set forth in s. 409.908(2)(a), which services are
8 ordered by and provided under the direction of a licensed
9 physician. However, if a nursing facility has been destroyed
10 or otherwise made uninhabitable by natural disaster or other
11 emergency and another nursing facility is not available, the
12 agency must pay for similar services temporarily in a hospital
13 licensed under part I of chapter 395 provided federal funding
14 is approved and available.
15 (13) The agency shall pay for services provided to a
16 recipient by a health facility licensed pursuant to chapter
17 395, and a practitioner licensed pursuant to chapter 458, 459,
18 and 464, F.S., for emergency medical conditions as defined in
19 s. 395.002, F.S.
20 Section 14. Section 409.9128, Florida Statutes, is
21 amended to read:
22 409.9128 Requirements for providing emergency services
23 and care.--
24 (1) Emergency services and care is a covered service.
25 In providing for emergency services and care as a covered
26 service, neither a managed care plan nor the MediPass program
27 may:
28 (a) Require prior authorization for the receipt of
29 prehospital transport or treatment or for the provision of
30 emergency services and care.
31 (b) Indicate that emergencies are covered only if care
18
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 is secured within a certain period of time or from a health
2 care provider that has a contract with the managed care plan
3 or MediPass program.
4 (c) Use terms such as "life threatening" or "bona
5 fide" to qualify the kind of emergency that is covered.
6 (d) Deny payment based on the enrollee's or the
7 hospital's failure to notify the managed care plan or MediPass
8 primary care provider in advance or within a certain period of
9 time after the care is given or failure to obtain care from a
10 health care provider that has a contract with the managed care
11 plan.
12 (2) Prehospital, and hospital-based trauma services,
13 and emergency services and care must be provided as a covered
14 service to an enrollee of a managed care plan or the MediPass
15 program as required under ss. 395.1041, 395.4045, and 401.45.
16 (3)(a) When an enrollee is present at a hospital
17 seeking emergency services and care, the determination as to
18 whether an emergency medical condition, as defined in s.
19 409.901, exists shall be made, for the purposes of treatment,
20 by a physician of the hospital or, to the extent permitted by
21 applicable law, by other appropriate licensed professional
22 hospital personnel under the supervision of the hospital
23 physician. The physician or the appropriate personnel shall
24 indicate in the patient's chart the results of the screening,
25 examination, and evaluation. The managed care plan or the
26 Medicaid program on behalf of MediPass patients shall
27 compensate the provider for the screening, evaluation, and
28 examination that is required by law to determine reasonably
29 calculated to assist the health care provider in arriving at a
30 determination as to whether the patient's condition is an
31 emergency medical condition and shall not deny payment if an
19
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 emergency medical condition is not found to exist. When an
2 emergency medical condition does exist, the managed care plan
3 or the Medicaid program on behalf of MediPass patients shall
4 compensate the provider for all emergency services and care
5 and any medically necessary followup care provided in
6 accordance with this subsection. If a determination is made
7 that an emergency medical condition does not exist, payment
8 for services rendered subsequent to that determination is
9 governed by the managed care plan's contract with the agency.
10 (b) If a determination has been made that an emergency
11 medical condition exists and the enrollee has notified the
12 hospital, or the hospital emergency personnel otherwise has
13 knowledge that the patient is an enrollee of the managed care
14 plan or the MediPass program, the hospital must make a
15 reasonable attempt to notify the enrollee's primary care
16 physician, if known, or the managed care plan, if the managed
17 care plan had previously requested in writing that the
18 notification be made directly to the managed care plan, of the
19 existence of the emergency medical condition. If the primary
20 care physician is not known, or has not been contacted, the
21 hospital must:
22 1. Notify the managed care plan or the MediPass
23 provider as soon as possible prior to discharge of the
24 enrollee from the emergency care area; or
25 2. Notify the managed care plan or the MediPass
26 provider within 24 hours or on the next business day after
27 admission of the enrollee as an inpatient to the hospital.
28
29 If notification required by this paragraph is not
30 accomplished, the hospital must document its attempts to
31 notify the managed care plan or the MediPass provider or the
20
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 circumstances that precluded attempts to notify the managed
2 care plan or the MediPass provider. Neither a managed care
3 plan nor the Medicaid program on behalf of MediPass patients
4 may deny payment for emergency services and care based on a
5 hospital's failure to comply with the notification
6 requirements of this paragraph.
7 (c) The physician who provides the medical screening,
8 evaluation, care, treatment, or surgery necessary to stabilize
9 the emergency medical condition may, at his or her sole
10 discretion, continue to care for the patient for the duration
11 of the patient's hospital stay and for any medically necessary
12 followup or may transfer care of the patient, in accordance
13 with state and federal laws, to a provider that has a contract
14 with the managed care plan or MediPass provider. If the
15 enrollee's primary care physician responds to the
16 notification, the hospital physician and the primary care
17 physician may discuss the appropriate care and treatment of
18 the enrollee. The managed care plan may have a member of the
19 hospital staff with whom it has a contract participate in the
20 treatment of the enrollee within the scope of the physician's
21 hospital staff privileges. The enrollee may be transferred,
22 in accordance with state and federal law, to a hospital that
23 has a contract with the managed care plan and has the service
24 capability to treat the enrollee's emergency medical
25 condition. Notwithstanding any other state law, a hospital
26 may request and collect insurance or financial information
27 from a patient in accordance with federal law, which is
28 necessary to determine if the patient is an enrollee of a
29 managed care plan or the MediPass program, if emergency
30 services and care are not delayed.
31 (4) Nothing in this section is intended to prohibit or
21
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 limit application of a nominal copayment as provided in s.
2 409.9081 for the use of an emergency room for services other
3 than emergency services and care.
4 (5) Reimbursement amounts for services provided to an
5 enrollee of a managed care plan under this section shall be
6 governed by the terms of the contract with the provider if
7 such contract exists. Reimbursement amounts for services under
8 this section by a provider that who does not have a contract
9 with the managed care plan shall be the lesser of:
10 (a) The provider's charges;
11 (b) For non-hospital providers, the usual and
12 customary provider charges for similar services in the
13 community where the services were provided;
14 (c) The charge mutually agreed to by the entity and
15 the provider within 35 60 days after submittal of the claim;
16 or
17 (d) The Medicaid rate.
18 (6) The provisions of this section may not be waived,
19 voided, or nullified by contract.
20 Section 15. Paragraph (3) of section 456.056, Florida
21 Statutes, is amended to read:
22 456.056 Treatment of Medicare beneficiaries; refusal,
23 emergencies, consulting physicians.--
24 (3) If treatment is provided to a beneficiary for an
25 emergency medical condition as defined in s. 395.002(9)
26 395.0142(2)(c), the physician must accept Medicare assignment
27 provided that the requirement to accept Medicare assignment
28 for an emergency medical condition shall not apply to
29 treatment rendered after the patient is stabilized, or the
30 treatment is unrelated to the original emergency medical
31 condition. For the purpose of this subsection "stabilized" is
22
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 defined to mean with respect to an emergency medical
2 condition, that no material deterioration of the condition is
3 likely within reasonable medical probability.
4 Section 16. Paragraph (l) of subsection (1) of section
5 468.505, Florida Statutes, is amended to read:
6 468.505 Exemptions; exceptions.--
7 (1) Nothing in this part may be construed as
8 prohibiting or restricting the practice, services, or
9 activities of:
10 (l) A person employed by a nursing facility exempt
11 from licensing under s. 395.002(14)(13), or a person exempt
12 from licensing under s. 464.022.
13 Section 17. Subsection (7) of section 641.19, Florida
14 Statutes, is amended to read:
15 641.19 Definitions.--As used in this part, the term:
16 (7) "Emergency medical condition" means:
17 (a) A medical condition manifesting itself by acute
18 symptoms of sufficient severity, which may include severe
19 pain, psychiatric disturbances, symptoms of substance abuse,
20 or other acute symptoms, such that the absence of immediate
21 medical attention could reasonably be expected to result in
22 any of the following:
23 1. Serious jeopardy to the health of a patient,
24 including a pregnant woman or a fetus.
25 2. Serious impairment to bodily functions.
26 3. Serious dysfunction of any bodily organ or part.
27 (b) With respect to a pregnant woman:
28 1. That there is inadequate time to effect safe
29 transfer to another hospital prior to delivery;
30 2. That a transfer may pose a threat to the health and
31 safety of the patient or fetus; or
23
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 3. That there is evidence of the onset and persistence
2 of uterine contractions or rupture of the membranes.
3 (c) With respect to a person exhibiting acute
4 psychiatric disturbance or substance abuse, or taken into
5 custody and delivered to a hospital under a court ex parte
6 order for examination or placed by an authorized party for
7 involuntary examination in accordance with chapter 394 or
8 chapter 397, that the absence of immediate medical attention
9 could reasonably be expected to result in:
10 1. Serious jeopardy to the health of a patient; or
11 2. Serious jeopardy to the health of others.
12 (8) "Emergency services and care" means medical
13 screening, examination, and evaluation by a physician, or, to
14 the extent permitted by applicable law, by other appropriate
15 personnel under the supervision of a physician, to determine
16 if an emergency medical condition exists and, if it does, the
17 care, treatment, or surgery for a covered service by a
18 physician necessary to stabilize relieve or eliminate the
19 emergency medical condition, within the service capability of
20 a hospital.
21 Section 18. Subsection (7) of section 641.47, Florida
22 Statutes, is amended to read:
23 641.47 Definitions.--As used in this part, the term:
24 (7) "Emergency medical condition" means:
25 (a) A medical condition manifesting itself by acute
26 symptoms of sufficient severity, which may include severe
27 pain, psychiatric disturbances, symptoms of substance abuse,
28 or other acute symptoms, such that the absence of immediate
29 medical attention could reasonably be expected to result in
30 any of the following:
31 1. Serious jeopardy to the health of a patient,
24
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 including a pregnant woman or a fetus.
2 2. Serious impairment to bodily functions.
3 3. Serious dysfunction of any bodily organ or part.
4 (b) With respect to a pregnant woman:
5 1. That there is inadequate time to effect safe
6 transfer to another hospital prior to delivery;
7 2. That a transfer may pose a threat to the health and
8 safety of the patient or fetus; or
9 3. That there is evidence of the onset and persistence
10 of uterine contractions or rupture of the membranes.
11 (c) With respect to a person exhibiting acute
12 psychiatric disturbance or substance abuse, or taken into
13 custody and delivered to a hospital under a court ex parte
14 order for examination or placed by authorized party for
15 involuntary examination in accordance with chapter 394 or
16 chapter 397, that the absence of immediate medical attention
17 could reasonably be expected to result in:
18 1. Serious jeopardy to the health of a patient; or
19 2. Serious jeopardy to the health of others.
20 Section 19. Section 641.513, Florida Statutes, is
21 amended to read:
22 641.513 Requirements for providing emergency services
23 and care.--
24 (1) Emergency services and care is a covered service.
25 In providing for emergency services and care as a covered
26 service, a health maintenance organization may not:
27 (a) Require prior authorization for the receipt of
28 prehospital transport or treatment or for the provision of
29 emergency services and care.
30 (b) Indicate that emergencies are covered only if care
31 is secured within a certain period of time or only if care is
25
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 provided from a health care provider that has a contract with
2 the health maintenance organization.
3 (c) Use terms such as "life threatening" or "bona
4 fide" to qualify the kind of emergency that is covered.
5 (d) Deny payment based on the subscriber's failure to
6 notify the health maintenance organization in advance of
7 seeking treatment or within a certain period of time after the
8 care is given or to obtain care from a health care provider
9 that does not have a contract with the health maintenance
10 organization.
11 (2) Prehospital and hospital-based trauma services and
12 emergency services and care must be provided as a covered
13 service to a subscriber of a health maintenance organization
14 as required under ss. 395.1041, 395.4045, and 401.45.
15 (3)(a) When a subscriber is present at a hospital
16 seeking emergency services and care, the determination as to
17 whether an emergency medical condition, as defined in s.
18 641.47, exists shall be made, for the purposes of treatment,
19 by a physician of the hospital or, to the extent permitted by
20 applicable law, by other appropriate licensed professional
21 hospital personnel under the supervision of the hospital
22 physician. The physician or the appropriate personnel shall
23 indicate in the patient's chart the results of the screening,
24 examination, and evaluation. The health maintenance
25 organization shall compensate the provider for the screening,
26 evaluation, and examination that is required by law to
27 determine reasonably calculated to assist the health care
28 provider in arriving at a determination as to whether the
29 patient's condition is an emergency medical condition and
30 shall not deny payment if an emergency medical condition is
31 not found to exist. When an emergency medical condition does
26
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 exist, the health maintenance organization shall compensate
2 the provider for all emergency services and care and any
3 medically necessary followup care provided in accordance with
4 this subsection. If a determination is made that an emergency
5 medical condition does not exist, payment for services
6 rendered subsequent to that determination is governed by the
7 contract under which the subscriber is covered.
8 (b) If a determination has been made that an emergency
9 medical condition exists and the subscriber has notified the
10 hospital, or the hospital emergency personnel otherwise have
11 knowledge that the patient is a subscriber of the health
12 maintenance organization, the hospital must make a reasonable
13 attempt to notify the subscriber's primary care physician, if
14 known, or the health maintenance organization, if the health
15 maintenance organization had previously requested in writing
16 that the notification be made directly to the health
17 maintenance organization, of the existence of the emergency
18 medical condition. If the primary care physician is not
19 known, or has not been contacted, the hospital must:
20 1. Notify the health maintenance organization as soon
21 as possible prior to discharge of the subscriber from the
22 emergency care area; or
23 2. Notify the health maintenance organization within
24 24 hours or on the next business day after admission of the
25 subscriber as an inpatient to the hospital.
26
27 If notification required by this paragraph is not
28 accomplished, the hospital must document its attempts to
29 notify the health maintenance organization of the
30 circumstances that precluded attempts to notify the health
31 maintenance organization. A health maintenance organization
27
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 may not deny payment for emergency services and care based on
2 a hospital's failure to comply with the notification
3 requirements of this paragraph. Nothing in this paragraph
4 shall alter any contractual responsibility of a subscriber to
5 make contact with the health maintenance organization,
6 subsequent to receiving treatment for the emergency medical
7 condition.
8 (c) The physician who provides the care, treatment, or
9 surgery necessary to stabilize the emergency medical condition
10 may, at his or her sole discretion, continue to provide care
11 to the patient for the duration of the patient's hospital stay
12 and for any medically necessary followup, or may transfer care
13 of the patient, in accordance with state and federal law, to a
14 provider that has a contract with the health maintenance
15 organization. If the subscriber's primary care physician
16 responds to the notification, the hospital physician and the
17 primary care physician may discuss the appropriate care and
18 treatment of the subscriber. The health maintenance
19 organization may have a member of the hospital staff with whom
20 it has a contract participate in the treatment of the
21 subscriber within the scope of the physician's hospital staff
22 privileges. The subscriber may be transferred, in accordance
23 with state and federal law, to a hospital that has a contract
24 with the health maintenance organization and has the service
25 capability to treat the subscriber's emergency medical
26 condition. Notwithstanding any other state law, a hospital may
27 request and collect insurance or financial information from a
28 patient in accordance with federal law, which is necessary to
29 determine if the patient is a subscriber of a health
30 maintenance organization, if emergency services and care are
31 not delayed.
28
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 (4) A subscriber may be charged a reasonable
2 copayment, as provided in s. 641.31(12), for the use of an
3 emergency room.
4 (5) Reimbursement amounts for services pursuant to
5 this section shall be governed by the terms of the contract
6 with the provider if such contract exists. Reimbursement
7 amounts for services pursuant to this section by a provider
8 that who does not have a contract with the health maintenance
9 organization shall be the lesser of:
10 (a) The provider's charges;
11 (b) For non-hospital providers, the usual and
12 customary provider charges for similar services in the
13 community where the services were provided; or
14 (c) The charge mutually agreed to by the health
15 maintenance organization and the provider within 35 60 days
16 after of the submittal of the claim.
17
18 Such reimbursement shall be net of any applicable copayment
19 authorized pursuant to subsection (4).
20 (6) Reimbursement amounts for services under this
21 section provided to subscribers who are Medicaid recipients
22 shall be governed by the terms of the contract with the
23 provider. Reimbursement amounts for services under this
24 section by a provider when for whom no contract exists between
25 the provider and the health maintenance organization shall be
26 the lesser of:
27 (a) The provider's charges;
28 (b) For non-hospital providers, the usual and
29 customary provider charges for similar services in the
30 community where the services were provided;
31 (c) The charge mutually agreed to by the entity and
29
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 the provider within 35 60 days after submittal of the claim;
2 or
3 (d) The Medicaid rate.
4 (7) The provisions of this section may not be waived,
5 voided, or nullified by contract.
6 Section 20. Paragraph (b) of subsection (2) of section
7 812.014, Florida Statutes, is amended to read:
8 812.014 Theft.--
9 (2)
10 (b)1. If the property stolen is valued at $20,000 or
11 more, but less than $100,000;
12 2. The property stolen is cargo valued at less than
13 $50,000 that has entered the stream of interstate or
14 intrastate commerce from the shipper's loading platform to the
15 consignee's receiving dock; or
16 3. The property stolen is emergency medical equipment,
17 valued at $300 or more, that is taken from a facility licensed
18 under chapter 395 or from an aircraft or vehicle permitted
19 under chapter 401,
20
21 the offender commits grand theft in the second degree,
22 punishable as a felony of the second degree, as provided in s.
23 775.082, s. 775.083, or s. 775.084. Emergency medical
24 equipment means mechanical or electronic apparatus used to
25 provide emergency services and care as defined in s.
26 395.002(11)(10) or to treat medical emergencies.
27 Section 21. This act shall take effect July 1, 2002.
28
29
30 ================ T I T L E A M E N D M E N T ===============
31 And the title is amended as follows:
30
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 remove: Everything before the enacting clause
2
3 and insert:
4 An act relating to health care; amending s.
5 395.002, F.S.; revising definitions relating to
6 emergency services and care provided by
7 hospitals and related facilities; amending s.
8 395.0197, F.S., revising provisions relating to
9 Risk Management; amending s. 395.0161, F.S.,
10 authorize department to adopt rule regarding
11 risk managements; amending s. 395.1041, F.S.;
12 revising provisions relating to hospital
13 service capability and access to emergency
14 services and care; directing the Agency for
15 Health Care Administration to convene a
16 workgroup to report to the Legislature
17 regarding hospital service capability
18 requirements; creating s. 395.1042, F.S.;
19 establishing a program under the agency to
20 reimburse health care facilities and
21 practitioners for the cost of uncompensated
22 emergency services and care; amending ss.
23 383.50, 394.4787, 395.602, 395.701, 400.051,
24 409.905, 456.056, 468.505, and 812.014, F.S.;
25 correcting cross references; amending s.
26 401.23, F.S.; revising definitions relating to
27 emergency medical transportation services;
28 amending s. 409.901, F.S.; revising definition
29 s relating to emergency services and care for
30 purposes of Medicaid coverage; amending s.
31 409.950, F.S., revising requirements for
31
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HOUSE AMENDMENT
Bill No. HB 589
Amendment No. 1 (for drafter's use only)
1 mandatory services; amending s. 409.9128, F.S.;
2 revising requirements for providing emergency
3 services and care under Medicaid managed care
4 plans and MediPass; creating s. 627.6053, F.S.;
5 providing requirements for health insurance
6 policy coverage of hospital emergency services
7 and care; amending ss. 641.19, 641.47, and
8 641.513, F.S.; revising definitions and
9 requirements relating to the provision of
10 emergency services and care by health
11 maintenance organizations and prepaid health
12 clinics; providing an appropriation; providing
13 an effective date.
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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