SENATE AMENDMENT
Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
CHAMBER ACTION
Senate House
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04/23/2004 11:52 AM .
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11 Senator Alexander moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 25, line 5, through
15 page 26, line 11, delete those lines
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17 and insert:
18 Section 17. Subsections (3) and (4) of section
19 400.9905, Florida Statutes, are amended, and subsections (5)
20 and (6) are added to that section, to read: (attached)
21 400.9905 Definitions.--
22 (3) "Clinic" means an entity at which health care
23 services are provided to individuals and which tenders charges
24 for reimbursement for such services, including a mobile clinic
25 and a portable equipment provider. For purposes of this part,
26 the term does not include and the licensure requirements of
27 this part do not apply to:
28 (a) Entities licensed or registered by the state under
29 chapter 395; or entities licensed or registered by the state
30 and providing only health care services within the scope of
31 services authorized under their respective licenses granted
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SENATE AMENDMENT
Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 under ss. 383.30-383.335, chapter 390, chapter 394, chapter
2 395, chapter 397, this chapter except part XIII, chapter 463,
3 chapter 465, chapter 466, chapter 478, part I of chapter 483
4 480, chapter 484, or chapter 651, end-stage renal disease
5 providers authorized under 42 C.F.R. part 405, subpart U, or
6 providers certified under 42 C.F.R. part 485, subpart B or
7 subpart H, or any entity that provides neonatal or pediatric
8 hospital-based healthcare services by licensed practitioners
9 solely within a hospital licensed under chapter 395.
10 (b) Entities that own, directly or indirectly,
11 entities licensed or registered by the state pursuant to
12 chapter 395; or entities that own, directly or indirectly,
13 entities licensed or registered by the state and providing
14 only health care services within the scope of services
15 authorized pursuant to their respective licenses granted under
16 ss. 383.30-383.335, chapter 390, chapter 394, chapter 395,
17 chapter 397, this chapter except part XIII, chapter 463,
18 chapter 465, chapter 466, chapter 478, part I of chapter 483
19 480, chapter 484, or chapter 651, end-stage renal disease
20 providers authorized under 42 C.F.R. part 405, subpart U, or
21 providers certified under 42 C.F.R. part 485, subpart B or
22 subpart H, or any entity that provides neonatal or pediatric
23 hospital-based healthcare services by licensed practitioners
24 solely within a hospital licensed under chapter 395.
25 (c) Entities that are owned, directly or indirectly,
26 by an entity licensed or registered by the state pursuant to
27 chapter 395; or entities that are owned, directly or
28 indirectly, by an entity licensed or registered by the state
29 and providing only health care services within the scope of
30 services authorized pursuant to their respective licenses
31 granted under ss. 383.30-383.335, chapter 390, chapter 394,
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SENATE AMENDMENT
Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 chapter 395, chapter 397, this chapter except part XIII,
2 chapter 463, chapter 465, chapter 466, chapter 478, part I of
3 chapter 483 480, chapter 484, or chapter 651, end-stage renal
4 disease providers authorized under 42 C.F.R. part 405, subpart
5 U, or providers certified under 42 C.F.R. part 485, subpart B
6 or subpart H, or any entity that provides neonatal or
7 pediatric hospital-based healthcare services by licensed
8 practitioners solely within a hospital licensed under chapter
9 395.
10 (d) Entities that are under common ownership, directly
11 or indirectly, with an entity licensed or registered by the
12 state pursuant to chapter 395; or entities that are under
13 common ownership, directly or indirectly, with an entity
14 licensed or registered by the state and providing only health
15 care services within the scope of services authorized pursuant
16 to its respective license granted under ss. 383.30-383.335,
17 chapter 390, chapter 394, chapter 395, chapter 397, this
18 chapter except part XIII, chapter 463, chapter 465, chapter
19 466, chapter 478, part I of chapter 483 480, chapter 484, or
20 chapter 651, end-stage renal disease providers authorized
21 under 42 C.F.R. part 405, subpart U, or providers certified
22 under 42 C.F.R. part 485, subpart B or subpart H, or any
23 entity that provides neonatal or pediatric hospital-based
24 services by licensed practitioners solely within a hospital
25 licensed under chapter 395.
26 (e) An entity that is exempt from federal taxation
27 under 26 U.S.C. s. 501(c)(3) or s. 501(c)(4), and any
28 community college or university clinic, and any entity owned
29 or operated by federal or state government, including
30 agencies, subdivisions, or municipalities thereof.
31 (f) A sole proprietorship, group practice,
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SENATE AMENDMENT
Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 partnership, or corporation that provides health care services
2 by physicians covered by s. 627.419, that is directly
3 supervised by one or more of such physicians, and that is
4 wholly owned by one or more of those physicians or by a
5 physician and the spouse, parent, child, or sibling of that
6 physician.
7 (g)(f) A sole proprietorship, group practice,
8 partnership, or corporation that provides health care services
9 by licensed health care practitioners under chapter 457,
10 chapter 458, chapter 459, chapter 460, chapter 461, chapter
11 462, chapter 463, chapter 466, chapter 467, chapter 480,
12 chapter 484, chapter 486, chapter 490, chapter 491, or part I,
13 part III, part X, part XIII, or part XIV of chapter 468, or s.
14 464.012, which are wholly owned by one or more a licensed
15 health care practitioners practitioner, or the licensed health
16 care practitioners set forth in this paragraph practitioner
17 and the spouse, parent, or child, or sibling of a licensed
18 health care practitioner, so long as one of the owners who is
19 a licensed health care practitioner is supervising the
20 services performed therein and is legally responsible for the
21 entity's compliance with all federal and state laws. However,
22 a health care practitioner may not supervise services beyond
23 the scope of the practitioner's license, except that, for the
24 purposes of this part, a clinic owned by a licensee in s.
25 456.053(3)(b) that provides only services authorized pursuant
26 to s. 456.053(3)(b) may be supervised by a licensee specified
27 in s. 456.053(3)(b).
28 (h)(g) Clinical facilities affiliated with an
29 accredited medical school at which training is provided for
30 medical students, residents, or fellows.
31 (i) Entities that provide oncology or radiation
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SENATE AMENDMENT
Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 therapy services by physicians licensed under chapter 458 or
2 459.
3 (4) "Medical director" means a physician who is
4 employed or under contract with a clinic and who maintains a
5 full and unencumbered physician license in accordance with
6 chapter 458, chapter 459, chapter 460, or chapter 461.
7 However, if the clinic does not provide services pursuant to
8 the respective physician practice acts listed in this
9 subsection, it is limited to providing health care services
10 pursuant to chapter 457, chapter 484, chapter 486, chapter
11 490, or chapter 491 or part I, part III, part X, part XIII, or
12 part XIV of chapter 468, the clinic may appoint a
13 Florida-licensed health care practitioner who does not provide
14 services pursuant to the respective physician practice acts
15 listed in this subsection licensed under that chapter to serve
16 as a clinic director who is responsible for the clinic's
17 activities. A health care practitioner may not serve as the
18 clinic director if the services provided at the clinic are
19 beyond the scope of that practitioner's license, except that a
20 licensee specified in s. 456.053(3)(b) that provides only
21 services authorized pursuant to s. 456.053(3)(b) may serve as
22 clinic director of an entity providing services as specified
23 in s. 456.053(3)(b).
24 (5) "Mobile clinic" means a movable or detached
25 self-contained health care unit within or from which direct
26 health care services are provided to individuals and that
27 otherwise meets the definition of a clinic in subsection (3).
28 (6) "Portable equipment provider" means an entity that
29 contracts with or employs persons to provide portable
30 equipment to multiple locations performing treatment or
31 diagnostic testing of individuals, that bills third-party
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SENATE AMENDMENT
Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 payors for those services, and that otherwise meets the
2 definition of a clinic in subsection (3).
3 Section 18. The creation of paragraph 400.9905(3)(i),
4 Florida Statutes, by this act is intended to clarify the
5 legislative intent of this provision as it existed at the time
6 the provision initially took effect as section 456.0375(1)(b),
7 Florida Statutes, and paragraph 400.9905(3)(i), Florida
8 Statutes, as created by this act, shall operate retroactively
9 to October 1, 2001. Nothing in this section shall be construed
10 as amending, modifying, limiting, or otherwise affecting in
11 any way the legislative intent, scope, terms, prohibition, or
12 requirements of chapter 456, Florida Statutes.
13 Section 19. Subsections (1), (2), and (3) and
14 paragraph (a) of subsection (7) of section 400.991, Florida
15 Statutes, are amended to read:
16 400.991 License requirements; background screenings;
17 prohibitions.--
18 (1)(a) Each clinic, as defined in s. 400.9905, must be
19 licensed and shall at all times maintain a valid license with
20 the agency. Each clinic location shall be licensed separately
21 regardless of whether the clinic is operated under the same
22 business name or management as another clinic.
23 (b) Each mobile clinic must obtain a separate health
24 care clinic license and clinics must provide to the agency, at
25 least quarterly, its their projected street location locations
26 to enable the agency to locate and inspect such clinic
27 clinics. A portable equipment provider must obtain a health
28 care clinic license for a single administrative office and is
29 not required to submit quarterly projected street locations.
30 (2) The initial clinic license application shall be
31 filed with the agency by all clinics, as defined in s.
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SENATE AMENDMENT
Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 400.9905, on or before July March 1, 2004. A clinic license
2 must be renewed biennially.
3 (3) Applicants that submit an application on or before
4 July March 1, 2004, which meets all requirements for initial
5 licensure as specified in this section shall receive a
6 temporary license until the completion of an initial
7 inspection verifying that the applicant meets all requirements
8 in rules authorized by s. 400.9925. However, a clinic engaged
9 in magnetic resonance imaging services may not receive a
10 temporary license unless it presents evidence satisfactory to
11 the agency that such clinic is making a good faith effort and
12 substantial progress in seeking accreditation required under
13 s. 400.9935.
14 (7) Each applicant for licensure shall comply with the
15 following requirements:
16 (a) As used in this subsection, the term "applicant"
17 means individuals owning or controlling, directly or
18 indirectly, 5 percent or more of an interest in a clinic; the
19 medical or clinic director, or a similarly titled person who
20 is responsible for the day-to-day operation of the licensed
21 clinic; the financial officer or similarly titled individual
22 who is responsible for the financial operation of the clinic;
23 and licensed health care practitioners medical providers at
24 the clinic.
25 Section 20. Subsections (9) and (11) of section
26 400.9935, Florida Statutes, are amended to read:
27 400.9935 Clinic responsibilities.--
28 (9) Any person or entity providing health care
29 services which is not a clinic, as defined under s. 400.9905,
30 may voluntarily apply for a certificate of exemption from
31 licensure under its exempt status with the agency on a form
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SENATE AMENDMENT
Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 that sets forth its name or names and addresses, a statement
2 of the reasons why it cannot be defined as a clinic, and other
3 information deemed necessary by the agency. An exemption is
4 not transferable. The agency may charge an applicant for a
5 certificate of exemption $100 or the actual cost, whichever is
6 less, for processing the certificate.
7 (11)(a) Each clinic engaged in magnetic resonance
8 imaging services must be accredited by the Joint Commission on
9 Accreditation of Healthcare Organizations, the American
10 College of Radiology, or the Accreditation Association for
11 Ambulatory Health Care, within 1 year after licensure.
12 However, a clinic may request a single, 6-month extension if
13 it provides evidence to the agency establishing that, for good
14 cause shown, such clinic can not be accredited within 1 year
15 after licensure, and that such accreditation will be completed
16 within the 6-month extension. After obtaining accreditation as
17 required by this subsection, each such clinic must maintain
18 accreditation as a condition of renewal of its license.
19 (b) The agency may deny disallow the application or
20 revoke the license of any entity formed for the purpose of
21 avoiding compliance with the accreditation provisions of this
22 subsection and whose principals were previously principals of
23 an entity that was unable to meet the accreditation
24 requirements within the specified timeframes. The agency may
25 adopt rules as to the accreditation of magnetic resonance
26 imaging clinics.
27 Section 21. Subsections (1) and (3) of section
28 400.995, Florida Statutes, are amended, and subsection (10) is
29 added to said section, to read:
30 400.995 Agency administrative penalties.--
31 (1) The agency may deny the application for a license
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Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 renewal, revoke or suspend the license, and impose
2 administrative fines penalties against clinics of up to $5,000
3 per violation for violations of the requirements of this part
4 or rules of the agency. In determining if a penalty is to be
5 imposed and in fixing the amount of the fine, the agency shall
6 consider the following factors:
7 (a) The gravity of the violation, including the
8 probability that death or serious physical or emotional harm
9 to a patient will result or has resulted, the severity of the
10 action or potential harm, and the extent to which the
11 provisions of the applicable laws or rules were violated.
12 (b) Actions taken by the owner, medical director, or
13 clinic director to correct violations.
14 (c) Any previous violations.
15 (d) The financial benefit to the clinic of committing
16 or continuing the violation.
17 (3) Any action taken to correct a violation shall be
18 documented in writing by the owner, medical director, or
19 clinic director of the clinic and verified through followup
20 visits by agency personnel. The agency may impose a fine and,
21 in the case of an owner-operated clinic, revoke or deny a
22 clinic's license when a clinic medical director or clinic
23 director knowingly fraudulently misrepresents actions taken to
24 correct a violation.
25 (10) If the agency issues a notice of intent to deny a
26 license application after a temporary license has been issued
27 pursuant to s. 400.991(3), the temporary license shall expire
28 on the date of the notice and may not be extended during any
29 proceeding for administrative or judicial review pursuant to
30 chapter 120.
31 Section 22. The agency shall refund 90 percent of the
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SENATE AMENDMENT
Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 license application fee to applicants that submitted their
2 health care clinic licensure fees and applications but were
3 subsequently exempted from licensure by this act.
4 Section 23. Any person or entity defined as a clinic
5 under s. 400.9905, Florida Statutes, shall not be in violation
6 of part XIII of chapter 400, Florida Statutes, due to failure
7 to apply for a clinic license by March 1, 2004, as previously
8 required by s. 400.991, Florida Statutes. Payment to any such
9 person or entity by an insurer or other person liable for
10 payment to such person or entity may not be denied on the
11 grounds that the person or entity failed to apply for or
12 obtain a clinic license before March 1, 2004.
13 Section 24. This act shall take effect upon becoming a
14 law, and section 19 shall apply retroactively to March 1,
15 2004.
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17
18 ================ T I T L E A M E N D M E N T ===============
19 And the title is amended as follows:
20 On page 3, lines 15-23, delete those lines
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22 and insert:
23 amending s. 400.9905, F.S.; revising the
24 definitions of "clinic" and "medical director"
25 and defining "mobile clinic" and "portable
26 equipment provider" for purposes of the Health
27 Care Clinic Act; providing that certain
28 entities providing oncology or radiation
29 therapy services are exempt from the licensure
30 requirements of part XIII of ch. 400, F.S.;
31 providing legislative intent with respect to
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Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 such exemption; providing for retroactive
2 application; amending s. 400.991, F.S.;
3 requiring each mobile clinic to obtain a health
4 care clinic license; requiring a portable
5 equipment provider to obtain a health care
6 clinic license for a single office and
7 exempting such a provider from submitting
8 certain information to the Agency for Health
9 Care Administration; revising the date by which
10 an initial application for a health care clinic
11 license must be filed with the agency; revising
12 the definition of "applicant"; amending s.
13 400.9935, F.S.; providing that an exemption
14 from licensure is not transferable; providing
15 that the agency may charge a fee of applicants
16 for certificates of exemption; providing that
17 the agency may deny an application or revoke a
18 license under certain circumstances; amending
19 s. 400.995, F.S.; providing that the agency may
20 deny, revoke, or suspend specified licenses and
21 impose fines for certain violations; providing
22 that a temporary license expires after a notice
23 of intent to deny an application is issued by
24 the agency; providing that persons or entities
25 made exempt under the act and which have paid
26 the clinic licensure fee to the agency are
27 entitled to a partial refund from the agency;
28 providing that certain persons or entities are
29 not in violation of part XIII of ch. 400, F.S.,
30 due to failure to apply for a clinic license by
31 a specified date; providing that certain
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Bill No. CS for SB 1062, 1st Eng.
Amendment No. ___ Barcode 454186
1 payments may not be denied to such persons or
2 entities for failure to apply for or obtain a
3 clinic license before a specified date;
4 providing an effective date.
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