Florida Senate - 2008 (Reformatted) SB 156
By Senator Garcia
40-00052-08 2008156__
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A bill to be entitled
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An act relating to insurance fraud; creating s. 324.0221,
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F.S.; prohibiting an owner or operator of a motor vehicle
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from recovering noneconomic damages if the owner or
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operator cannot establish that he or she maintained proof
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of financial responsibility for the vehicle at the time of
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the accident by one of the methods specified by state law;
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providing an exception for a claim against a person who
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intentionally caused the injury or acted with gross
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negligence; amending s. 400.990, F.S.; providing
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additional legislative findings; amending s. 400.9905,
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F.S.; redefining the term "clinic" for purposes of the
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Health Care Clinic Act to include certain additional
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providers; excluding certain facilities owned by publicly
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traded corporations; defining the terms "specialty
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clinic," "infusion therapy," and "fraud"; amending s.
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400.991, F.S.; requiring specialty clinics to be subject
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to licensure requirements; requiring additional persons to
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be subject to background screening; revising certain
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requirements for applying for licensure as a health care
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clinic; creating additional requirements for applying for
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licensure as a specialty clinic; providing additional
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grounds under which an applicant may be denied licensure
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due to a finding of guilt for committing a felony;
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providing grounds for the denial of specialty clinic
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licensure; amending s. 400.9925, F.S.; providing the
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Agency for Health Care Administration with rulemaking
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authority regarding specialty clinics; stating that the
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licensure fee for a specialty clinic is nonrefundable and
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may not exceed $2,000; amending s. 400.993, F.S.;
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including specialty clinics within provisions regarding
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unlicensed clinics; providing penalties for unlicensed
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operation of a specialty clinic; amending s. 400.9935,
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F.S.; including specialty clinics within provisions
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regarding clinic responsibilities; revising the
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responsibilities of the medical director and the clinical
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director; requiring a specialty clinic to file an audited
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report with the agency no less frequently than annually;
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amending s. 400.995, F.S.; authorizing the Agency for
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Health Care Administration to impose administrative
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penalties against a specialty clinic; creating s. 400.996,
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F.S.; creating a process whereby the agency receives,
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documents, and processes complaints about specialty
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clinics; requiring the agency to request that complaints
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regarding billing fraud by a specialty clinic be made by
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sworn affidavit; requiring the agency to refer to the
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Department of Financial Services, Office of Fiscal
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Integrity, any sworn affidavit asserting billing fraud by
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a specialty clinic; requiring the department to report
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findings regarding billing fraud by a specialty clinic to
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the agency; requiring the department to refer an
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investigation to prosecutorial authorities and provide
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investigative assistance under certain circumstances;
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providing that it is a first-degree misdemeanor to submit
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an affidavit asserting billing fraud by a specialty clinic
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which is without any factual basis; allowing the
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department to conduct unannounced reviews, investigations,
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analyses, and audits to investigate complaints of billing
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fraud by a specialty clinic; authorizing the department to
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enter upon the premises of a specialty clinic and
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immediately secure copies of certain documents; requiring
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a specialty clinic to allow full and immediate access to
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the premises and records of the clinic to a department
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officer or employee under s. 400.996, F.S.; providing that
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failure to provide such access is a ground for emergency
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suspension of the license of the specialty clinic;
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permitting the agency to assess a fee against a specialty
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clinic equal to the cost of conducting a review,
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investigation, analysis, or audit performed by the agency
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or the department; providing that all investigators
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designated by the Chief Financial Officer to perform
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duties under part XIII of ch. 400, F.S., and certified
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under s. 943.1395, F.S., are law enforcement officers of
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the state; amending s. 456.072, F.S.; providing that
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intentionally placing false information in an application
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for a certificate of exemption from clinic licensure
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constitutes grounds for which disciplinary action may be
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taken; designating the Florida Center for Nursing as the
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"Florida Barbara B. Lumpkin Center for Nursing"; directing
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the Department of Health to erect suitable markers;
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providing appropriations; authorizing investigative
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enforcement and clerical positions and a salary rate;
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repealing s. 19, ch. 2003-411, Laws of Florida; abrogating
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the repeal of the Florida Motor Vehicle No-Fault Law as
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provided for in that section; repealing ss. 627.730,
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Florida Motor Vehicle No-Fault Law, and providing for
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future review and reenactment; providing an effective
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date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 324.0221, Florida Statutes, is created
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to read:
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324.0221 Proof of financial responsibility required to
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recover noneconomic damages.--In any action to recover damages
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arising out of the operation or use of a motor vehicle, a person
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may not recover noneconomic damages to compensate for pain,
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suffering, inconvenience, or other noneconomic loss or damages if
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the person was the owner or operator of a vehicle involved in the
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accident and cannot establish that he or she maintained proof of
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financial responsibility for that vehicle at the time of the
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accident by one of the methods specified in s. 324.031. However,
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this restriction does not apply to a claim for noneconomic
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damages against a person who intentionally caused, or who acted
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in a grossly negligent manner in causing, the injury giving rise
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to the noneconomic damages.
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Section 2. Section 400.990, Florida Statutes, is amended to
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read:
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400.990 Short title; legislative findings.--
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(1) This part, consisting of ss. 400.990-400.996 ss.
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(2) The Legislature finds that the regulation of health
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care clinics must be strengthened to prevent significant cost and
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harm to consumers.
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(3) The Legislature further finds the additional regulation
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of specialty health care clinics is necessary to prevent
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significant fraudulent practices in the provision of infusion
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therapy services in this state.
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(4) The purpose of this part is to provide for the
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licensure, establishment, and enforcement of basic standards for
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health care clinics and to provide administrative oversight by
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the Agency for Health Care Administration.
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Section 3. Subsection (4) of section 400.9905, Florida
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Statutes, is amended, and subsections (8), (9), and (10) are
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added to that section, to read:
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400.9905 Definitions.--
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(4) "Clinic" means an entity at which health care services
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are provided to individuals and which tenders charges for
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reimbursement for such services, including a mobile clinic and a
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portable equipment provider. For purposes of this part, the term
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does not include and the licensure requirements of this part do
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not apply to:
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(a) Entities licensed or registered by the state under
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chapter 395; or entities licensed or registered by the state and
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providing only health care services within the scope of services
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authorized under their respective licenses granted under ss.
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chapter except part X, chapter 429, chapter 463, chapter 465,
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chapter 466, chapter 478, part I of chapter 483, chapter 484, or
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chapter 651; end-stage renal disease providers authorized under
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42 C.F.R. part 405, subpart U; or providers certified under 42
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C.F.R. part 485, subpart B or subpart H; or any entity that
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provides neonatal or pediatric hospital-based health care
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services or other health care services by licensed practitioners
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solely within a hospital licensed under chapter 395.
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(b) Entities that own, directly or indirectly, entities
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licensed or registered by the state pursuant to chapter 395; or
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entities that own, directly or indirectly, entities licensed or
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registered by the state and providing only health care services
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within the scope of services authorized pursuant to their
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390, chapter 394, chapter 397, this chapter except part X,
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chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
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part I of chapter 483, chapter 484, chapter 651; end-stage renal
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disease providers authorized under 42 C.F.R. part 405, subpart U;
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or providers certified under 42 C.F.R. part 485, subpart B or
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subpart H; or any entity that provides neonatal or pediatric
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hospital-based health care services by licensed practitioners
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solely within a hospital licensed under chapter 395.
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(c) Entities that are owned, directly or indirectly, by an
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entity licensed or registered by the state pursuant to chapter
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395; or entities that are owned, directly or indirectly, by an
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entity licensed or registered by the state and providing only
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health care services within the scope of services authorized
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pursuant to their respective licenses granted under ss. 383.30-
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383.335, chapter 390, chapter 394, chapter 397, this chapter
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except part X, chapter 429, chapter 463, chapter 465, chapter
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466, chapter 478, part I of chapter 483, chapter 484, or chapter
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651; end-stage renal disease providers authorized under 42 C.F.R.
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part 405, subpart U; or providers certified under 42 C.F.R. part
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485, subpart B or subpart H; or any entity that provides neonatal
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or pediatric hospital-based health care services by licensed
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practitioners solely within a hospital under chapter 395.
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(d) Entities that are under common ownership, directly or
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indirectly, with an entity licensed or registered by the state
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pursuant to chapter 395; or entities that are under common
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ownership, directly or indirectly, with an entity licensed or
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registered by the state and providing only health care services
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within the scope of services authorized pursuant to their
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390, chapter 394, chapter 397, this chapter except part X,
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chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
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part I of chapter 483, chapter 484, or chapter 651; end-stage
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renal disease providers authorized under 42 C.F.R. part 405,
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subpart U; or providers certified under 42 C.F.R. part 485,
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subpart B or subpart H; or any entity that provides neonatal or
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pediatric hospital-based health care services by licensed
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practitioners solely within a hospital licensed under chapter
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395.
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(e) An entity that is exempt from federal taxation under 26
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U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
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under 26 U.S.C. s. 409 that has a board of trustees not less than
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two-thirds of which are Florida-licensed health care
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practitioners and provides only physical therapy services under
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physician orders, any community college or university clinic, and
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any entity owned or operated by the federal or state government,
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including agencies, subdivisions, or municipalities thereof.
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(f) A sole proprietorship, group practice, partnership, or
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corporation, or other legal entity that provides health care
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services by physicians and physician assistants licensed under
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chapter 458, chapter 460, chapter 461, or chapter 466 covered by
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s. 627.419, that is directly supervised by one or more of such
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physician assistants or physicians, and that is wholly owned by
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one or more of those physician assistants or physicians or by a
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physician assistant or physician and the spouse, parent, child,
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or sibling of that physician assistant or physician.
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(g) A sole proprietorship, group practice, partnership, or
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corporation, or other legal entity that provides health care
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services by licensed health care practitioners under chapter 457,
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chapter 458, chapter 459, chapter 460, chapter 461, chapter 462,
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chapter 463, chapter 466, chapter 467, chapter 480, chapter 484,
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chapter 486, chapter 490, chapter 491, or part I, part III, part
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X, part XIII, or part XIV of chapter 468, or s. 464.012, which
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entities are wholly owned by one or more licensed health care
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practitioners, or the licensed health care practitioners set
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forth in this paragraph and the spouse, parent, child, or sibling
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of a licensed health care practitioner, so long as one of the
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owners who is a licensed health care practitioner is supervising
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the health care services business activities and is legally
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responsible for the entity's compliance with all federal and
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state laws. However, a health care services provided may not
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exceed the scope of the licensed owner's health care practitioner
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may not supervise services beyond the scope of the practitioner's
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license, except that, for the purposes of this part, a clinic
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owned by a licensee in s. 456.053(3)(b) that provides only
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services authorized pursuant to s. 456.053(3)(b) may be
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supervised by a licensee specified in s. 456.053(3)(b).
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(h) Clinical facilities affiliated with an accredited
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medical school at which training is provided for medical
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students, residents, or fellows.
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(i) Entities that provide only oncology or radiation
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therapy services by physicians licensed under chapter 458 or
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chapter 459 or entities that provide oncology or radiation
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therapy services by physicians licensed under chapter 458 or
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chapter 459 which are owned by a corporation whose shares are
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publicly traded on a recognized stock exchange.
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(j) Clinical facilities affiliated with a college of
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chiropractic accredited by the Council on Chiropractic Education
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at which training is provided for chiropractic students.
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(k) Entities that provide licensed practitioners to staff
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emergency departments or to deliver anesthesia services in
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facilities licensed under chapter 395 and that derive at least 90
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percent of their gross annual revenues from the provision of such
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services. Entities claiming an exemption from licensure under
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this paragraph must provide documentation demonstrating
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compliance.
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(l) Orthotic, or prosthetic, or other clinical facilities
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that are a publicly traded corporation or that are wholly owned,
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directly or indirectly, by a publicly traded corporation. As used
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in this paragraph, a publicly traded corporation is a corporation
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that issues securities traded on an exchange registered with the
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United States Securities and Exchange Commission as a national
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securities exchange.
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(5) "Medical director" means a physician who is employed or
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under contract with a clinic and who maintains a full and
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unencumbered physician license in accordance with chapter 458,
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chapter 459, chapter 460, or chapter 461. However, if the clinic
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does not provide services pursuant to the respective physician
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practices acts listed in this subsection, it may appoint a
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Florida-licensed health care practitioner who does not provide
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services pursuant to the respective physician practices acts
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listed in this subsection to serve as a clinic director who is
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responsible for the clinic's activities. A health care
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practitioner may not serve as the clinic director if the services
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provided at the clinic are beyond the scope of that
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practitioner's license, except that a licensee specified in s.
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456.053(3)(b) who provides only services authorized pursuant to
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s. 456.053(3)(b) may serve as clinic director of an entity
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providing services as specified in s. 456.053(3)(b).
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(6) "Mobile clinic" means a movable or detached self-
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contained health care unit within or from which direct health
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care services are provided to individuals and which otherwise
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meets the definition of a clinic in subsection (4).
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(7) "Portable equipment provider" means an entity that
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contracts with or employs persons to provide portable equipment
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to multiple locations performing treatment or diagnostic testing
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of individuals, that bills third-party payors for those services,
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and that otherwise meets the definition of a clinic in subsection
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(4).
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(8) "Specialty clinic" means a clinic not licensed as a
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home health agency which provides infusion therapy services
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either to outpatients who remain less than 24 hours at the
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facility or to patients who receive such services where they
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reside. The term does not include:
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(a) Entities licensed under part II, part III, or part IV;
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or
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(b) Entities licensed under chapter 395.
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(9) "Infusion therapy" includes, but is not limited to, the
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therapeutic infusion of substances into, or injection of
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substances through, the venous peripheral system, consisting of
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activity that includes: observing, initiating, monitoring,
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discontinuing, maintaining, regulating, adjusting, documenting,
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planning, intervening, and evaluating. This definition embraces
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administration of nutrition, antibiotic therapy, and fluid and
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electrolyte repletion.
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(10) "Fraud" means deception or misrepresentation made by a
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person or business entity with the intent that the deception will
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likely result in an unauthorized benefit to herself or himself or
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to another person. The term includes any act that constitutes
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fraud under applicable federal or state law.
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Section 4. Section 400.991, Florida Statutes, is amended to
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read:
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400.991 License requirements; background screenings;
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prohibitions.--
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(1)(a) The requirements of part II of chapter 408 apply to
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the provision of services that require licensure pursuant to this
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part and part II of chapter 408 and to entities licensed by or
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applying for such licensure from the agency pursuant to this
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part. A license issued by the agency is required in order to
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operate a clinic or specialty clinic in this state. Each clinic
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or specialty clinic location shall be licensed separately
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regardless of whether the clinic or specialty clinic is operated
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under the same business name or management as another clinic or
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specialty clinic.
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(b) Each mobile clinic or specialty clinic must obtain a
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separate health care clinic license and must provide to the
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agency, at least quarterly, its projected street location to
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enable the agency to locate and inspect such clinic and specialty
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clinic. A portable equipment provider must obtain a health care
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clinic license for a single administrative office and is not
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required to submit quarterly projected street locations.
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(c) A specialty clinic operating without a specialty clinic
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license on October 1, 2008, shall be given a reasonable time, not
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to exceed 6 months from the effective date of this act, to obtain
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a specialty clinic license.
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(2) The initial clinic license application shall be filed
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with the agency by all clinics, as defined in s. 400.9905, on or
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before July 1, 2004.
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(3) The application shall contain information that
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includes, but need not be limited to, information pertaining to
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the name, residence and business address, phone number, social
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security number, and license number of the medical or clinic
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director and of the licensed medical providers employed or under
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contract with the clinic.
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(4) In addition to the requirements of part II of chapter
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408, the applicant must file with the application satisfactory
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proof that the clinic is in compliance with this part and
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applicable rules, including:
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(a) A listing of services to be provided either directly by
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the applicant or through contractual arrangements with existing
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providers;
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(b) The number and discipline of each professional staff
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member to be employed; and
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(c) Proof of financial ability to operate as required under
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s. 408.810(8). As an alternative to submitting proof of financial
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ability to operate as required under s. 408.810(8), the applicant
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may file a surety bond of at least $500,000 which guarantees that
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the clinic will act in full conformity with all legal
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requirements for operating a clinic or specialty clinic, payable
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to the agency. The agency may adopt rules to specify related
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requirements for such surety bond.
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(5) Each applicant for licensure shall comply with the
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following requirements:
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(a) As used in this subsection, the term "applicant" means
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individuals owning or controlling, directly or indirectly, 5
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percent or more of an interest in a clinic; the medical or clinic
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director, or a similarly titled person who is responsible for the
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day-to-day operation of the licensed clinic; the financial
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officer or similarly titled individual who is responsible for the
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financial operation of the clinic; and licensed health care
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practitioners at the clinic.
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(b) Upon receipt of a completed, signed, and dated
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application, the agency shall require background screening of the
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applicant, in accordance with the level 2 standards for screening
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set forth in chapter 435. Proof of compliance with the level 2
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background screening requirements of chapter 435 which has been
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submitted within the previous 5 years in compliance with any
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other health care licensure requirements of this state is
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acceptable in fulfillment of this paragraph. Applicants who own
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less than 10 percent of a health care clinic are not required to
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submit fingerprints under this section.
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(c) Any person or entity that has a pecuniary interest in a
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clinic who may or may not own stock or an equivalent interest in
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the clinic, but nonetheless has control over or the authority to
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approve, directly or indirectly, clinic billing, policy, business
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activities, or personnel decisions, including, but not limited
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to, contracted or employed third-party billing persons or
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entities, managers, and management companies, and persons and
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entities, directly or indirectly, which lend, give, or gift money
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of any denomination or any thing of value exceeding an aggregate
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of $5,000, for clinic use, with or without an expectation of a
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return of the money or thing of value, and regardless of profit
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motive, are subject to background screening requirements under
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this part.
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(d) The agency may adopt rules to administer this
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subsection.
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(e)(c) Each applicant must submit to the agency, with the
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application, a description and explanation of any exclusions,
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permanent suspensions, or terminations of an applicant from the
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Medicare or Medicaid programs. Proof of compliance with the
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requirements for disclosure of ownership and control interest
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under the Medicaid or Medicare programs may be accepted in lieu
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of this submission. The description and explanation may indicate
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whether such exclusions, suspensions, or terminations were
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voluntary or not voluntary on the part of the applicant.
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(f)(d) A license may not be granted to a clinic if the
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applicant has been found guilty of, regardless of adjudication,
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or has entered a plea of nolo contendere or guilty to, any
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offense prohibited under the level 2 standards for screening set
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forth in chapter 435; any felony under chapter 400, chapter 408,
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chapter 409, chapter 440, chapter 624, chapter 626, chapter 627,
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chapter 812, chapter 817, chapter 831, chapter 837, chapter 838,
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chapter 895, or chapter 896; or any substantially comparable
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offense or crime of another state or of the United States, if a
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felony in that jurisdiction, within the past 10 years. Each
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person required to provide background screening shall disclose to
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the agency any arrest for any crime for which any court
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disposition other than dismissal has been made within the past 10
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years. Failure to provide such information shall be considered a
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material omission in the application process, or a violation of
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insurance fraud under s. 817.234, within the past 5 years. If the
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applicant has been convicted of an offense prohibited under the
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level 2 standards or insurance fraud in any jurisdiction, the
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applicant must show that his or her civil rights have been
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restored prior to submitting an application.
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(6) An application for a specialty clinic must contain, in
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addition to the information required in subsection (5):
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(a) The correct business name of each business entity and
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full name of each individual holding any ownership interest of 5
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percent or more, or any pecuniary interest of $5,000 or more, in
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any legal entity that owns or operates any specialty clinic
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seeking licensure, whether such ownership or pecuniary interest
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arose out of a contract, loan, gift, investment, inheritance, or
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any other source. Individual possession of an ownership or
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pecuniary interest in any subject specialty clinic includes, but
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is not limited to, a direct or indirect interest in:
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1. The business operation, equipment, or legend
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pharmaceuticals used in the clinic;
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2. The premises in which the clinic provides its services;
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or
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3. Any legal entity that owns any such interest, directly
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or indirectly, in the business operation of the clinic; the
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equipment used in providing infusion therapy services at the
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clinic; the legend pharmaceuticals used at the clinic; or the
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premises in which the clinic provides its services.
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(b) In the case of an incorporated business entity that
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holds any ownership interest of 5 percent or more, or any
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pecuniary interest of $5,000 or more, in the specialty clinic,
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copies of the articles of incorporation and bylaws, and the names
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and addresses of all officers and directors of the corporation.
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(c) On a form furnished by the agency, a sworn notarized
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statement by each business entity and individual that holds any
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ownership interest of 5 percent or more, or any pecuniary
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interest of $5,000 or more, in the subject specialty clinic which
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discloses the nature and degree of each such ownership or
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pecuniary interest, and that discloses the source of funds which
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gave rise to each such ownership or pecuniary interest.
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(d) On a form furnished by the agency, a sworn notarized
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statement by each individual and business entity that holds any
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ownership interest of 5 percent or more, or any pecuniary
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interest of $5,000 or more, in the subject specialty clinic which
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discloses whether he or she has been an owner or part owner,
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individually or through any business entity, of any business
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entity whose health care license has been revoked or suspended in
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any jurisdiction.
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(e) On a form furnished by the agency, an estimate of the
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costs for establishing the specialty clinic and the source of
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funds for payment of those costs and for sustaining the operation
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of the clinic until its operation produces a positive cash flow.
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For purposes of this subsection, the term "ownership or pecuniary
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interest" does not include any individual whose interest in a
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specialty clinic arises only out of his or her interest in a
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lending company, insurance company, or banking institution
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licensed by this state or any other state of the United States; a
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company regularly trading on a national stock exchange of the
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United States; or a governmental entity in the United States.
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(7) The agency shall deny or revoke a specialty clinic
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license if an applicant has been found guilty of, regardless of
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adjudication, or entered a plea of nolo contendere or guilty to,
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any felony involving dishonesty or making a false statement in
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any jurisdiction within the preceding 10 years.
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(8) The agency shall deny a specialty clinic license
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application when any business entity or individual possessing an
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ownership or pecuniary interest in the specialty clinic also
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possessed an ownership or pecuniary interest, individually or
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through any business entity, in any health care facility whose
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license was revoked in any jurisdiction during the pendency of
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that interest.
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(9) The agency may not issue a specialty clinic license to
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any applicant to whom the agency has sent notice that there is a
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pending question as to whether one or more of the individuals
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with an ownership of 5 percent or more or with a pecuniary
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interest of $5,000 or more in the clinic has a disqualifying
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criminal record. The agency notice shall request the applicant to
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submit any additional information necessary to resolve the
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pending criminal background question within 21 days after receipt
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of the notice. The agency shall deny a specialty clinic license
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application when the applicant has failed to resolve a criminal
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background screening issue pertaining to an individual who is
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required to meet criminal background screening requirements of
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this part and the agency raised such background screening issue
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by notice as set forth in this part.
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Section 5. Section 400.9925, Florida Statutes, is amended
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to read:
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400.9925 Rulemaking authority; license fees.--
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(1) The agency shall adopt rules necessary to administer
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the clinic and specialty clinic administration, regulation, and
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licensure program, including rules pursuant to this part and part
502
II of chapter 408, establishing the specific licensure
503
requirements, procedures, forms, and fees. It shall adopt rules
504
establishing a procedure for the biennial renewal of licenses.
505
The agency may issue initial licenses for less than the full 2-
506
year period by charging a prorated licensure fee and specifying a
507
different renewal date than would otherwise be required for
508
biennial licensure. The rules shall specify the expiration dates
509
of licenses, the process of tracking compliance with financial
510
responsibility requirements, and any other conditions of renewal
511
required by law or rule.
512
(2) The agency shall adopt rules specifying limitations on
513
the number of licensed clinics and specialty clinic and licensees
514
for which a medical director or a clinic director may assume
515
responsibility for purposes of this part. In determining the
516
quality of supervision a medical director or a clinic director
517
can provide, the agency shall consider the number of clinic or
518
specialty clinic employees, the clinic or specialty clinic
519
location, and the health care services provided by the clinic or
520
specialty clinic.
521
(3) In accordance with s. 408.805, an applicant or a
522
licensee shall pay a fee for each license application submitted
523
under this part, part II of chapter 408, and applicable rules.
524
The amount of the fee shall be established by rule and may not
525
exceed $2,000.
526
Section 6. Subsection (3) of section 400.993, Florida
527
Statutes, is amended to read:
528
400.993 Unlicensed clinics; reporting.--
529
(3) In addition to the requirements of part II of chapter
530
408, any health care provider who is aware of the operation of an
531
unlicensed clinic or specialty clinic shall report that facility
532
to the agency. Failure to report a clinic or specialty clinic
533
that the provider knows or has reasonable cause to suspect is
534
unlicensed shall be reported to the provider's licensing board.
535
Section 7. Section 400.9935, Florida Statutes, is amended
536
to read:
537
400.9935 Clinic responsibilities.--
538
(1) Each clinic and specialty clinic shall appoint a
539
medical director or clinic director who shall agree in writing to
540
accept legal responsibility for the following activities on
541
behalf of the clinic. The medical director or the clinic director
542
shall:
543
(a) Have signs identifying the medical director or clinic
544
director posted in a conspicuous location within the clinic
545
readily visible to all patients.
546
(b) Ensure that all practitioners providing health care
547
services or supplies to patients maintain a current active and
548
unencumbered Florida license.
549
(c) Review any patient referral contracts or agreements
550
executed by the clinic.
551
(d) Ensure that all health care practitioners at the clinic
552
have active appropriate certification or licensure for the level
553
of care being provided.
554
(e) Ensure that all health care practitioners at the clinic
555
provide health care services in accordance with the requirements
556
of subsection (6).
557
(f)(e) Serve as the clinic records owner as defined in s.
558
559
(g)(f) Ensure compliance with the recordkeeping, office
560
surgery, and adverse incident reporting requirements of chapter
561
456, the respective practice acts, and rules adopted under this
562
part and part II of chapter 408.
563
(h)(g) Conduct systematic reviews of clinic billings to
564
ensure that the billings are not fraudulent or unlawful. Upon
565
discovery of an unlawful charge, the medical director or clinic
566
director shall take immediate corrective action. If the clinic
567
performs only the technical component of magnetic resonance
568
imaging, static radiographs, computed tomography, or positron
569
emission tomography, and provides the professional interpretation
570
of such services, in a fixed facility that is accredited by the
571
Joint Commission on Accreditation of Healthcare Organizations or
572
the Accreditation Association for Ambulatory Health Care, and the
573
American College of Radiology; and if, in the preceding quarter,
574
the percentage of scans performed by that clinic which was billed
575
to all personal injury protection insurance carriers was less
576
than 15 percent, the chief financial officer of the clinic may,
577
in a written acknowledgment provided to the agency, assume the
578
responsibility for the conduct of the systematic reviews of
579
clinic billings to ensure that the billings are not fraudulent or
580
unlawful.
581
(i) Serve in that capacity for no more than a maximum of
582
five health care clinics that have a cumulative total of no more
583
than 200 employees and persons under contract with the health
584
care clinic at a given time. A medical or clinic director may not
585
supervise a health care clinic more than 200 miles away from any
586
other health care clinic supervised by the same medical or clinic
587
director. The agency may allow for waivers to the limitations of
588
this paragraph upon a showing of good cause and a determination
589
by the agency that the medical director will be able to
590
adequately perform the requirements of this subsection.
591
(j)(h) Not refer a patient to the clinic if the clinic
592
performs magnetic resonance imaging, static radiographs, computed
593
tomography, or positron emission tomography. The term "refer a
594
patient" means the referral of one or more patients of the
595
medical or clinical director or a member of the medical or
596
clinical director's group practice to the clinic for magnetic
597
resonance imaging, static radiographs, computed tomography, or
598
positron emission tomography. A medical director who is found to
599
violate this paragraph commits a felony of the third degree,
601
(2) Any contract to serve as a medical director or a clinic
602
director entered into or renewed by a physician or a licensed
603
health care practitioner in violation of this part is void as
604
contrary to public policy. This subsection shall apply to
605
contracts entered into or renewed on or after March 1, 2004.
606
(3) All charges or reimbursement claims made by or on
607
behalf of a clinic or specialty clinic that is required to be
608
licensed under this part, but that is not so licensed, or that is
609
otherwise operating in violation of this part, are unlawful
610
charges, and therefore are noncompensable and unenforceable.
611
(4) In addition to the requirements of s. 408.812, any
612
person establishing, operating, or managing an unlicensed clinic
613
or specialty clinic otherwise required to be licensed under this
614
part or part II of chapter 408, or any person who knowingly files
615
a false or misleading license application or license renewal
616
application, or false or misleading information related to such
617
application or department rule, commits a felony of the third
619
620
(5) Any licensed health care provider who violates this
621
part is subject to discipline in accordance with this chapter and
622
his or her respective practice act.
623
(6) Any person or entity providing health care services
624
which is not a clinic or specialty clinic, as defined under s.
625
400.9905, may voluntarily apply for a certificate of exemption
626
from licensure under its exempt status with the agency on a form
627
that sets forth its name or names and addresses, a statement of
628
the reasons why it cannot be defined as a clinic, and other
629
information deemed necessary by the agency. An exemption is not
630
transferable. The agency may charge an applicant for a
631
certificate of exemption in an amount equal to $100 or the actual
632
cost of processing the certificate, whichever is less.
633
(7)(a) Each clinic or specialty clinic engaged in magnetic
634
resonance imaging services must be accredited by the Joint
635
Commission on Accreditation of Healthcare Organizations, the
636
American College of Radiology, or the Accreditation Association
637
for Ambulatory Health Care, within 1 year after licensure.
638
However, a clinic may request a single, 6-month extension if it
639
provides evidence to the agency establishing that, for good cause
640
shown, such clinic can not be accredited within 1 year after
641
licensure, and that such accreditation will be completed within
642
the 6-month extension. After obtaining accreditation as required
643
by this subsection, each such clinic must maintain accreditation
644
as a condition of renewal of its license.
645
(b) The agency may deny the application or revoke the
646
license of any entity formed for the purpose of avoiding
647
compliance with the accreditation provisions of this subsection
648
and whose principals were previously principals of an entity that
649
was unable to meet the accreditation requirements within the
650
specified timeframes. The agency may adopt rules as to the
651
accreditation of magnetic resonance imaging clinics.
652
(8) The agency shall give full faith and credit pertaining
653
to any past variance and waiver granted to a magnetic resonance
654
imaging clinic from rule 64-2002, Florida Administrative Code, by
655
the Department of Health, until September 2004. After that date,
656
such clinic must request a variance and waiver from the agency
657
under s. 120.542.
658
(9) In addition to the requirements of part II of chapter
659
408, the clinic shall display a sign in a conspicuous location
660
within the clinic readily visible to all patients indicating
661
that, pursuant to s. 626.9892, the Department of Financial
662
Services may pay rewards of up to $25,000 to persons providing
663
information leading to the arrest and conviction of persons
664
committing crimes investigated by the Division of Insurance Fraud
667
Insurance Fraud may make unannounced inspections of a clinic
668
licensed under this part as necessary to determine whether the
669
clinic is in compliance with this subsection. A licensed clinic
670
shall allow full and complete access to the premises to such
671
authorized employee of the division who makes an inspection to
672
determine compliance with this subsection.
673
(10) Every licensed specialty clinic shall file with the
674
agency no less frequently than annually, including concurrently
675
with the filing of any change of ownership application, upon
676
forms to be furnished by the agency, an audited report showing
677
the following information:
678
(a) The number of patients served by the specialty clinic
679
during the previous 12-month period, which report may exclude any
680
partial month for the month when the report was prepared;
681
(b) Total specialty clinic operating expenses;
682
(c) Gross patient charges by payor category, including
683
Medicare, Medicaid, county indigent programs, any other
684
governmental programs, private insurance, self-paying patients,
685
nonpaying patients and other payees;
686
(d) The cost of operation of the specialty clinic during
687
the previous 12-month period, excluding any partial month during
688
which time the report was prepared;
689
(e) Unless the specialty clinic can demonstrate that the
690
clinic already has furnished the required information regarding a
691
particular subject individual, the full name of any individual
692
who became an owner or became possessed of any pecuniary interest
693
in the subject clinic since the last report to the agency, along
694
with the disclosure of the information required by s. 400.9961(2)
695
as to such individual; and
696
(f) A current statement of the source of funds for payment
697
of the costs of establishing the specialty clinic and for
698
sustaining the operation of the specialty clinic until its
699
operation produces a positive cash flow.
700
(11) Every licensee of a specialty clinic has a continuing
701
obligation to comply with this part and to report to the agency
702
any change of circumstance related to the clinic's continuing
703
compliance with this part. Such change of circumstance includes,
704
but is not limited to, any change in the ownership of the
705
specialty clinic, the addition of any individual or business
706
entity possessing a pecuniary interest in the specialty clinic,
707
the employment of any individual as a member of the specialty
708
clinic's staff who would be required to undergo a criminal
709
background screening if such individual had been an employee at
710
the time of the initial licensure, and any change in the medical
711
or clinic director. The clinic shall furnish the information
712
required about and of such individuals under this part and s.
713
400.991 within 30 days after the occurrence of such change of
714
circumstance.
715
Section 8. Section 400.995, Florida Statutes, is amended to
716
read:
717
400.995 Agency administrative penalties.--
718
(1) In addition to the requirements of part II of chapter
719
408, the agency may deny the application for a license renewal,
720
revoke and suspend the license, and impose administrative fines
721
of up to $5,000 per violation for violations of the requirements
722
of this part or rules of the agency. In determining if a penalty
723
is to be imposed and in fixing the amount of the fine, the agency
724
shall consider the following factors:
725
(a) The gravity of the violation, including the probability
726
that death or serious physical or emotional harm to a patient
727
will result or has resulted, the severity of the action or
728
potential harm, and the extent to which the provisions of the
729
applicable laws or rules were violated.
730
(b) Actions taken by the owner, medical director, or clinic
731
director to correct violations.
732
(c) Any previous violations.
733
(d) The financial benefit to the clinic or specialty clinic
734
of committing or continuing the violation.
735
(2) Each day of continuing violation after the date fixed
736
for termination of the violation, as ordered by the agency,
737
constitutes an additional, separate, and distinct violation.
738
(3) Any action taken to correct a violation shall be
739
documented in writing by the owner, medical director, or clinic
740
director of the clinic or specialty clinic and verified through
741
followup visits by agency personnel. The agency may impose a fine
742
and, in the case of an owner-operated clinic or specialty clinic,
743
revoke or deny a clinic's license when a clinic medical director
744
or clinic director knowingly misrepresents actions taken to
745
correct a violation.
746
(4) Any licensed clinic or specialty clinic whose owner,
747
medical director, or clinic director concurrently operates an
748
unlicensed clinic shall be subject to an administrative fine of
749
$5,000 per day.
750
(5) Any clinic or specialty clinic whose owner fails to
751
apply for a change-of-ownership license in accordance with s.
752
400.992 and operates the clinic under the new ownership is
753
subject to a fine of $5,000.
754
(6) The agency, as an alternative to or in conjunction with
755
an administrative action against a clinic or specialty clinic for
756
violations of this part and adopted rules, shall make a
757
reasonable attempt to discuss each violation and recommended
758
corrective action with the owner, medical director, or clinic
759
director of the clinic or specialty clinic, prior to written
760
notification. The agency, instead of fixing a period within which
761
the clinic or specialty clinic shall enter into compliance with
762
standards, may request a plan of corrective action from the
763
clinic or specialty clinic which demonstrates a good faith effort
764
to remedy each violation by a specific date, subject to the
765
approval of the agency.
766
Section 9. Section 400.996, Florida Statutes, is created to
767
read:
768
400.996 Specialty clinics; complaints; audits; referrals.--
769
(1) The agency shall receive, document, and process
770
complaints about specialty clinics. Upon receipt of any complaint
771
that asserts the existence of facts evidencing possible billing
772
fraud by a specialty clinic or by any employee of a specialty
773
clinic, the agency shall request the complainant to make such
774
assertions by sworn affidavit.
775
(2) Upon receipt of any sworn affidavit that asserts the
776
existence of facts evidencing possible billing fraud by a
777
specialty clinic or any of its employees, the agency shall refer
778
the complaint to the Office of Fiscal Integrity within the
779
Department of Financial Services.
780
(3) The Department of Financial Services shall report
781
findings to the agency for any appropriate licensure action. Such
782
report shall include a statement of facts as determined by the
783
Department of Financial Services to exist, specifically with
784
regard to the possible violations of licensure requirements. If
785
during an investigation the department has reason to believe that
786
any criminal law of this state has or may have been violated, the
787
department shall refer such investigation to appropriate
788
prosecutorial agencies and shall provide investigative assistance
789
to those agencies as required.
790
(4) The investigating authority and the agency shall
791
cooperate with each other with respect to preparing a record and
792
sharing information from which the agency may determine if any
793
action for sanctions under this part by the agency is warranted.
794
(5) Any person submitting a sworn complaint that initiates
795
a complaint investigation pursuant to this section, which sworn
796
complaint is determined to be totally without any factual basis
797
to support the assertions made in the complaint that facts
798
existed evidencing possible fraudulent practices by a specialty
799
clinic or any of its employees, shall be guilty of a misdemeanor
800
of the first degree, punishable as provided in s. 775.082 or s.
801
802
(6) The Office of Fiscal Integrity within the Department of
803
Financial Services shall conduct unannounced reviews,
804
investigations, analyses, and audits to investigate complaints
805
and, as necessary, to determine whether specialty clinic billings
806
are fraudulent or unlawful. The Department of Financial Services
807
is expressly authorized to enter upon the premises of the clinic
808
during regular business hours and demand and immediately secure
809
copies of billing and other records of the clinic that will
810
enable the Department of Financial Services to investigate
811
complaints or determine whether specialty clinic billings are
812
fraudulent or unlawful.
813
(7) A licensed specialty clinic shall allow full, complete,
814
and immediate access to the premises and to billing records or
815
information to any such officer or employee who conducts a
816
review, investigation, analysis, or audit to determine compliance
817
with this part and with applicable rules. Failure to allow full,
818
complete, and immediate access to the premises and to billing
819
records or information to any representative of the agency or
820
Department of Financial Services who attempts to conduct a
821
review, investigation, analysis, or audit to determine compliance
822
with this part constitutes a ground for emergency suspension of
823
the license by the agency pursuant to s. 120.60(6).
824
(8) In addition to any administrative fines imposed, the
825
agency may assess a fee equal to the cost of conducting any
826
review, investigation, analysis, or audit performed by the agency
827
or the department.
828
(9) All investigators designated by the Chief Financial
829
Officer to perform duties under this part and who are certified
830
under s. 943.1395 are law enforcement officers of the state. Such
831
investigators have the authority to conduct criminal
832
investigations, bear arms, make arrests, and apply for, serve,
833
and execute search warrants, arrest warrants, capias, and other
834
process throughout the state pertaining to fraud investigations
835
under this section.
836
Section 10. Paragraph (ii) is added to subsection (1) of
837
section 456.072, Florida Statutes, to read:
838
456.072 Grounds for discipline; penalties; enforcement.--
839
(1) The following acts shall constitute grounds for which
840
the disciplinary actions specified in subsection (2) may be
841
taken:
842
(ii) Intentionally providing false information on an
843
application for a certificate of exemption from clinic licensure
844
under part XIII of chapter 400.
845
Section 11. Florida Barbara B. Lumpkin Center for Nursing
846
designated; Department of Health to erect suitable markers.--
847
(1) The Florida Center for Nursing, created by s. 464.0195,
848
Florida Statutes, and located in Orlando is designated as the
849
"Florida Barbara B. Lumpkin Center for Nursing."
850
(2) The Department of Health is directed to erect suitable
851
markers designating the Florida Barbara B. Lumpkin Center for
852
Nursing as described in subsection (1).
853
Section 12. The sums of $212,528 in recurring funds from
854
the Health Care Trust Fund, and $25,347 in nonrecurring funds
855
from the Health Care Trust Fund are appropriated to the Agency
856
for Health Care Administration and four full time equivalent
857
positions and associated salary rate of 134,455 are authorized,
858
for the 2008-2009 fiscal year for the purpose of implementing the
859
provisions of this act.
860
Section 13. For the 2008-2009 fiscal year, the sums of
861
$510,276 in recurring funds and $111,455 in nonrecurring funds
862
are appropriated from the Insurance Regulatory Trust Fund of the
863
Department of Financial Services to the Division of Insurance
864
Fraud within the department for the purpose of providing a new
865
fraud unit within the division consisting of six sworn law
866
enforcement officers, one non-sworn investigator, one crime
867
analyst, and one clerical position. A total of nine full-time
868
equivalent positions and associated salary rate of 381,500 are
869
authorized. This appropriation is for the purposes provided in s.
870
626.989, Florida Statutes.
871
Section 14. For the 2008-2009 fiscal year, the sums of
872
$415,291 in recurring funds and $52,430 in nonrecurring funds are
873
appropriated from the Insurance Regulatory Trust Fund of the
874
Department of Financial Services to the Division of Insurance
875
Fraud within the department and 10 full-time equivalent positions
876
and associated salary rate of 342,500 are authorized. This
877
appropriation is for the purposes provided in s. 626.989, Florida
878
Statutes.
879
Section 15. Effective January 1, 2009, section 627.730,
882
the Florida Motor Vehicle No-Fault Law, are repealed, unless
883
reviewed and reenacted by the Legislature before that date.
884
Section 16. Section 19 of chapter 2003-411, Laws of
885
Florida, is repealed.
886
Section 17. This act shall take effect October 1, 2008.
CODING: Words stricken are deletions; words underlined are additions.