SENATE AMENDMENT
Bill No. CS for CS for SB 2170
Amendment No. ___ Barcode 212382
CHAMBER ACTION
Senate House
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11 Senator Alexander moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 134, line 22, delete that line
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16 and insert:
17 Section 102. Subsections (3) and (4) of section
18 400.9905, Florida Statutes, are amended, and subsections (5)
19 and (6) are added to that section, to read: (attached)
20 400.9905 Definitions.--
21 (3) "Clinic" means an entity at which health care
22 services are provided to individuals and which tenders charges
23 for reimbursement for such services, including a mobile clinic
24 and a portable equipment provider. For purposes of this part,
25 the term does not include and the licensure requirements of
26 this part do not apply to:
27 (a) Entities licensed or registered by the state under
28 chapter 395; or entities licensed or registered by the state
29 and providing only health care services within the scope of
30 services authorized under their respective licenses granted
31 under ss. 383.30-383.335, chapter 390, chapter 394, chapter
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Amendment No. ___ Barcode 212382
1 395, chapter 397, this chapter except part XIII, chapter 463,
2 chapter 465, chapter 466, chapter 478, part I of chapter 483
3 480, chapter 484, or chapter 651, end-stage renal disease
4 providers authorized under 42 C.F.R. part 405, subpart U, or
5 providers certified under 42 C.F.R. part 485, subpart B or
6 subpart H, or any entity that provides neonatal or pediatric
7 hospital-based healthcare services by licensed practitioners
8 solely within a hospital licensed under chapter 395.
9 (b) Entities that own, directly or indirectly,
10 entities licensed or registered by the state pursuant to
11 chapter 395; or entities that own, directly or indirectly,
12 entities licensed or registered by the state and providing
13 only health care services within the scope of services
14 authorized pursuant to their respective licenses granted under
15 ss. 383.30-383.335, chapter 390, chapter 394, chapter 395,
16 chapter 397, this chapter except part XIII, chapter 463,
17 chapter 465, chapter 466, chapter 478, part I of chapter 483
18 480, chapter 484, or chapter 651, end-stage renal disease
19 providers authorized under 42 C.F.R. part 405, subpart U, or
20 providers certified under 42 C.F.R. part 485, subpart B or
21 subpart H, or any entity that provides neonatal or pediatric
22 hospital-based healthcare services by licensed practitioners
23 solely within a hospital licensed under chapter 395.
24 (c) Entities that are owned, directly or indirectly,
25 by an entity licensed or registered by the state pursuant to
26 chapter 395; or entities that are owned, directly or
27 indirectly, by an entity licensed or registered by the state
28 and providing only health care services within the scope of
29 services authorized pursuant to their respective licenses
30 granted under ss. 383.30-383.335, chapter 390, chapter 394,
31 chapter 395, chapter 397, this chapter except part XIII,
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Bill No. CS for CS for SB 2170
Amendment No. ___ Barcode 212382
1 chapter 463, chapter 465, chapter 466, chapter 478, part I of
2 chapter 483 480, chapter 484, or chapter 651, end-stage renal
3 disease providers authorized under 42 C.F.R. part 405, subpart
4 U, or providers certified under 42 C.F.R. part 485, subpart B
5 or subpart H, or any entity that provides neonatal or
6 pediatric hospital-based healthcare services by licensed
7 practitioners solely within a hospital licensed under chapter
8 395.
9 (d) Entities that are under common ownership, directly
10 or indirectly, with an entity licensed or registered by the
11 state pursuant to chapter 395; or entities that are under
12 common ownership, directly or indirectly, with an entity
13 licensed or registered by the state and providing only health
14 care services within the scope of services authorized pursuant
15 to its respective license granted under ss. 383.30-383.335,
16 chapter 390, chapter 394, chapter 395, chapter 397, this
17 chapter except part XIII, chapter 463, chapter 465, chapter
18 466, chapter 478, part I of chapter 483 480, chapter 484, or
19 chapter 651, end-stage renal disease providers authorized
20 under 42 C.F.R. part 405, subpart U, or providers certified
21 under 42 C.F.R. part 485, subpart B or subpart H, or any
22 entity that provides neonatal or pediatric hospital-based
23 services by licensed practitioners solely within a hospital
24 licensed under chapter 395.
25 (e) An entity that is exempt from federal taxation
26 under 26 U.S.C. s. 501(c)(3) or s. 501(c)(4), and any
27 community college or university clinic, and any entity owned
28 or operated by federal or state government, including
29 agencies, subdivisions, or municipalities thereof.
30 (f) A sole proprietorship, group practice,
31 partnership, or corporation that provides health care services
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1 by physicians covered by s. 627.419, that is directly
2 supervised by one or more of such physicians, and that is
3 wholly owned by one or more of those physicians or by a
4 physician and the spouse, parent, child, or sibling of that
5 physician.
6 (g)(f) A sole proprietorship, group practice,
7 partnership, or corporation that provides health care services
8 by licensed health care practitioners under chapter 457,
9 chapter 458, chapter 459, chapter 460, chapter 461, chapter
10 462, chapter 463, chapter 466, chapter 467, chapter 480,
11 chapter 484, chapter 486, chapter 490, chapter 491, or part I,
12 part III, part X, part XIII, or part XIV of chapter 468, or s.
13 464.012, which are wholly owned by one or more a licensed
14 health care practitioners practitioner, or the licensed health
15 care practitioners set forth in this paragraph practitioner
16 and the spouse, parent, or child, or sibling of a licensed
17 health care practitioner, so long as one of the owners who is
18 a licensed health care practitioner is supervising the
19 services performed therein and is legally responsible for the
20 entity's compliance with all federal and state laws. However,
21 a health care practitioner may not supervise services beyond
22 the scope of the practitioner's license, except that, for the
23 purposes of this part, a clinic owned by a licensee in s.
24 456.053(3)(b) that provides only services authorized pursuant
25 to s. 456.053(3)(b) may be supervised by a licensee specified
26 in s. 456.053(3)(b).
27 (h)(g) Clinical facilities affiliated with an
28 accredited medical school at which training is provided for
29 medical students, residents, or fellows.
30 (i) Entities that provide only oncology or radiation
31 therapy services by physicians licensed under chapter 458 or
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1 459.
2 (4) "Medical director" means a physician who is
3 employed or under contract with a clinic and who maintains a
4 full and unencumbered physician license in accordance with
5 chapter 458, chapter 459, chapter 460, or chapter 461.
6 However, if the clinic does not provide services pursuant to
7 the respective physician practice acts listed in this
8 subsection, it is limited to providing health care services
9 pursuant to chapter 457, chapter 484, chapter 486, chapter
10 490, or chapter 491 or part I, part III, part X, part XIII, or
11 part XIV of chapter 468, the clinic may appoint a
12 Florida-licensed health care practitioner who does not provide
13 services pursuant to the respective physician practice acts
14 listed in this subsection licensed under that chapter to serve
15 as a clinic director who is responsible for the clinic's
16 activities. A health care practitioner may not serve as the
17 clinic director if the services provided at the clinic are
18 beyond the scope of that practitioner's license, except that a
19 licensee specified in s. 456.053(3)(b) that provides only
20 services authorized pursuant to s. 456.053(3)(b) may serve as
21 clinic director of an entity providing services as specified
22 in s. 456.053(3)(b).
23 (5) "Mobile clinic" means a movable or detached
24 self-contained health care unit within or from which direct
25 health care services are provided to individuals and that
26 otherwise meets the definition of a clinic in subsection (3).
27 (6) "Portable equipment provider" means an entity that
28 contracts with or employs persons to provide portable
29 equipment to multiple locations performing treatment or
30 diagnostic testing of individuals, that bills third-party
31 payors for those services, and that otherwise meets the
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Bill No. CS for CS for SB 2170
Amendment No. ___ Barcode 212382
1 definition of a clinic in subsection (3).
2 Section 103. The creation of paragraph 400.9905(3)(i),
3 Florida Statutes, by this act is intended to clarify the
4 legislative intent of this provision as it existed at the time
5 the provision initially took effect as section 456.0375(1)(b),
6 Florida Statutes, and paragraph 400.9905(3)(i), Florida
7 Statutes, as created by this act, shall operate retroactively
8 to October 1, 2001. Nothing in this section shall be construed
9 as amending, modifying, limiting, or otherwise affecting in
10 any way the legislative intent, scope, terms, prohibition, or
11 requirements of section 456.053, Florida Statutes.
12 Section 104. Subsections (1), (2), and (3) and
13 paragraphs (a) and (b) of subsection (7) of section 400.991,
14 Florida Statutes, are amended to read:
15 400.991 License requirements; background screenings;
16 prohibitions.--
17 (1)(a) Each clinic, as defined in s. 400.9905, must be
18 licensed and shall at all times maintain a valid license with
19 the agency. Each clinic location shall be licensed separately
20 regardless of whether the clinic is operated under the same
21 business name or management as another clinic.
22 (b) Each mobile clinic must obtain a separate health
23 care clinic license and clinics must provide to the agency, at
24 least quarterly, its their projected street location locations
25 to enable the agency to locate and inspect such clinic
26 clinics. A portable equipment provider must obtain a health
27 care clinic license for a single administrative office and is
28 not required to submit quarterly projected street locations.
29 (2) The initial clinic license application shall be
30 filed with the agency by all clinics, as defined in s.
31 400.9905, on or before July March 1, 2004. A clinic license
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Amendment No. ___ Barcode 212382
1 must be renewed biennially.
2 (3) Applicants that submit an application on or before
3 July March 1, 2004, which meets all requirements for initial
4 licensure as specified in this section shall receive a
5 temporary license until the completion of an initial
6 inspection verifying that the applicant meets all requirements
7 in rules authorized by s. 400.9925. However, a clinic engaged
8 in magnetic resonance imaging services may not receive a
9 temporary license unless it presents evidence satisfactory to
10 the agency that such clinic is making a good faith effort and
11 substantial progress in seeking accreditation required under
12 s. 400.9935.
13 (7) Each applicant for licensure shall comply with the
14 following requirements:
15 (a) As used in this subsection, the term "applicant"
16 means individuals owning or controlling, directly or
17 indirectly, 5 percent or more of an interest in a clinic; the
18 medical or clinic director, or a similarly titled person who
19 is responsible for the day-to-day operation of the licensed
20 clinic; the financial officer or similarly titled individual
21 who is responsible for the financial operation of the clinic;
22 and licensed health care practitioners medical providers at
23 the clinic.
24 (b) Upon receipt of a completed, signed, and dated
25 application, the agency shall require background screening of
26 the applicant, in accordance with the level 2 standards for
27 screening set forth in chapter 435. Proof of compliance with
28 the level 2 background screening requirements of chapter 435
29 which has been submitted within the previous 5 years in
30 compliance with any other health care licensure requirements
31 of this state is acceptable in fulfillment of this paragraph.
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Amendment No. ___ Barcode 212382
1 Applicants who own less than 10 percent of a health care
2 clinic are not required to submit fingerprints under this
3 section.
4 Section 105. Subsections (9) and (11) of section
5 400.9935, Florida Statutes, are amended to read:
6 400.9935 Clinic responsibilities.--
7 (9) Any person or entity providing health care
8 services which is not a clinic, as defined under s. 400.9905,
9 may voluntarily apply for a certificate of exemption from
10 licensure under its exempt status with the agency on a form
11 that sets forth its name or names and addresses, a statement
12 of the reasons why it cannot be defined as a clinic, and other
13 information deemed necessary by the agency. An exemption is
14 not transferable. The agency may charge an applicant for a
15 certificate of exemption $100 or the actual cost, whichever is
16 less, for processing the certificate.
17 (11)(a) Each clinic engaged in magnetic resonance
18 imaging services must be accredited by the Joint Commission on
19 Accreditation of Healthcare Organizations, the American
20 College of Radiology, or the Accreditation Association for
21 Ambulatory Health Care, within 1 year after licensure.
22 However, a clinic may request a single, 6-month extension if
23 it provides evidence to the agency establishing that, for good
24 cause shown, such clinic can not be accredited within 1 year
25 after licensure, and that such accreditation will be completed
26 within the 6-month extension. After obtaining accreditation as
27 required by this subsection, each such clinic must maintain
28 accreditation as a condition of renewal of its license.
29 (b) The agency may deny disallow the application or
30 revoke the license of any entity formed for the purpose of
31 avoiding compliance with the accreditation provisions of this
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1 subsection and whose principals were previously principals of
2 an entity that was unable to meet the accreditation
3 requirements within the specified timeframes. The agency may
4 adopt rules as to the accreditation of magnetic resonance
5 imaging clinics.
6 Section 106. Subsections (1) and (3) of section
7 400.995, Florida Statutes, are amended, and subsection (10) is
8 added to said section, to read:
9 400.995 Agency administrative penalties.--
10 (1) The agency may deny the application for a license
11 renewal, revoke or suspend the license, and impose
12 administrative fines penalties against clinics of up to $5,000
13 per violation for violations of the requirements of this part
14 or rules of the agency. In determining if a penalty is to be
15 imposed and in fixing the amount of the fine, the agency shall
16 consider the following factors:
17 (a) The gravity of the violation, including the
18 probability that death or serious physical or emotional harm
19 to a patient will result or has resulted, the severity of the
20 action or potential harm, and the extent to which the
21 provisions of the applicable laws or rules were violated.
22 (b) Actions taken by the owner, medical director, or
23 clinic director to correct violations.
24 (c) Any previous violations.
25 (d) The financial benefit to the clinic of committing
26 or continuing the violation.
27 (3) Any action taken to correct a violation shall be
28 documented in writing by the owner, medical director, or
29 clinic director of the clinic and verified through followup
30 visits by agency personnel. The agency may impose a fine and,
31 in the case of an owner-operated clinic, revoke or deny a
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1 clinic's license when a clinic medical director or clinic
2 director knowingly fraudulently misrepresents actions taken to
3 correct a violation.
4 (10) If the agency issues a notice of intent to deny a
5 license application after a temporary license has been issued
6 pursuant to s. 400.991(3), the temporary license shall expire
7 on the date of the notice and may not be extended during any
8 proceeding for administrative or judicial review pursuant to
9 chapter 120.
10 Section 107. The agency shall refund 90 percent of the
11 license application fee to applicants that submitted their
12 health care clinic licensure fees and applications but were
13 subsequently exempted from licensure by this act.
14 Section 108. Any person or entity defined as a clinic
15 under s. 400.9905, Florida Statutes, shall not be in violation
16 of part XIII of chapter 400, Florida Statutes, due to failure
17 to apply for a clinic license by March 1, 2004, as previously
18 required by s. 400.991, Florida Statutes. Payment to any such
19 person or entity by an insurer or other person liable for
20 payment to such person or entity may not be denied on the
21 grounds that the person or entity failed to apply for or
22 obtain a clinic license before March 1, 2004.
23 Section 109. Except for this section and sections
24 102-108, which shall take effect upon becoming a law, and
25 except that section 103 shall apply retroactively to march 1,
26 2004, this act shall take effect July 1, 2004.
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29 ================ T I T L E A M E N D M E N T ===============
30 And the title is amended as follows:
31 On page 10, line 28, delete that line
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1 and insert:
2 examination fees; amending s. 400.9905, F.S.;
3 revising the definitions of "clinic" and
4 "medical director" and defining "mobile clinic"
5 and "portable equipment provider" for purposes
6 of the Health Care Clinic Act; providing that
7 certain entities providing oncology or
8 radiation therapy services are exempt from the
9 licensure requirements of part XIII of ch. 400,
10 F.S.; providing legislative intent with respect
11 to such exemption; providing for retroactive
12 application; amending s. 400.991, F.S.;
13 requiring each mobile clinic to obtain a health
14 care clinic license; requiring a portable
15 equipment provider to obtain a health care
16 clinic license for a single office and
17 exempting such a provider from submitting
18 certain information to the Agency for Health
19 Care Administration; revising the date by which
20 an initial application for a health care clinic
21 license must be filed with the agency; revising
22 the definition of "applicant"; amending s.
23 400.9935, F.S.; providing that an exemption
24 from licensure is not transferable; providing
25 that the agency may charge a fee of applicants
26 for certificates of exemption; providing that
27 the agency may deny an application or revoke a
28 license under certain circumstances; amending
29 s. 400.995, F.S.; providing that the agency may
30 deny, revoke, or suspend specified licenses and
31 impose fines for certain violations; providing
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1 that a temporary license expires after a notice
2 of intent to deny an application is issued by
3 the agency; providing that persons or entities
4 made exempt under the act and which have paid
5 the clinic licensure fee to the agency are
6 entitled to a partial refund from the agency;
7 providing that certain persons or entities are
8 not in violation of part XIII of ch. 400, F.S.,
9 due to failure to apply for a clinic license by
10 a specified date; providing that certain
11 payments may not be denied to such persons or
12 entities for failure to apply for or obtain a
13 clinic license before a specified date;
14 providing effective dates.
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