Amendment
Bill No. CS/HB 1471

Amendment No. 363017

CHAMBER ACTION
Senate		House
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1	Representative Zapata offered the following:
2
3	Amendment to Senate Amendment (780200) (with title
4	amendment)
5	Remove lines 495-1551 and insert:
6	fiscal years only, the department shall award a contract or
7	grant in the amount of $10 million to the AHEC network for the
8	purpose of developing the components described in paragraph
9	(3)(i). The AHEC network may apply for a competitive contract or
10	grant after the 2008-2009 fiscal year.
11	(a)  In order to ensure that all proposals for funding are
12	appropriate and are evaluated fairly on the basis of merit, the
13	State Surgeon General, in consultation with the council, shall
14	appoint a peer review panel of independent, qualified experts in
15	the field of tobacco control to review the content of each
16	proposal and establish its priority score. The priority scores
17	shall be forwarded to the council and must be considered in
18	determining which proposals will be recommended for funding.
19	(b)  The council and the peer review panel shall establish
20	and follow rigorous guidelines for ethical conduct and adhere to
21	a strict policy with regard to conflicts of interest. Council
22	members are subject to the applicable provisions of chapter 112.
23	A member of the council or panel may not participate in any
24	discussion or decision with respect to a research proposal by
25	any firm, entity, or agency with which the member is associated
26	as a member of the governing body or as an employee or with
27	which the member has entered into a contractual arrangement.
28	Meetings of the council and the peer review panels are subject
29	to chapter 119, s. 286.011, and s. 24, Art. I of the State
30	Constitution.
31	(c)  In each contract or grant agreement, the department
32	shall limit the use of food and promotional items to no more
33	than 2.5 percent of the total amount of the contract or grant
34	and limit overhead or indirect costs to no more than 7.5 percent
35	of the total amount of the contract or grant. The department, in
36	consultation with the Department of Financial Services, shall
37	publish guidelines for appropriate food and promotional items.
38	(d)  In each advertising contract, the department shall
39	limit the total of production fees, buyer commissions, and
40	related costs to no more than 10 percent of the total contract
41	amount.
42	(e)  Notwithstanding the competitive process for contracts
43	prescribed in this subsection, each county health department is
44	eligible for core funding, on a per capita basis, to implement
45	tobacco education and use prevention activities within that
46	county.
47	(7)  ANNUAL REPORT REQUIRED.--By February 28 January 31 of
48	each year, the department shall provide to the Governor, the
49	President of the Senate, and the Speaker of the House of
50	Representatives a report that evaluates the program's
51	effectiveness in reducing and preventing tobacco use and that
52	recommends improvements to enhance the program's effectiveness.
53	The report must contain, at a minimum, an annual survey of youth
54	attitudes and behavior toward tobacco, as well as a description
55	of the progress in reducing the prevalence of tobacco use among
56	youth, adults, and pregnant women; reducing per capita tobacco
57	consumption; and reducing exposure to environmental tobacco
58	smoke.
59	(8)  LIMITATION ON ADMINISTRATIVE EXPENSES.--From the total
60	funds appropriated for the Comprehensive Statewide Tobacco
61	Education and Use Prevention Program in the General
62	Appropriations Act, an amount of up to 5 percent may be used by
63	the department for administrative expenses.
64	(9)  RULEMAKING AUTHORIZED.--By January 1, 2008, the
65	department shall adopt rules pursuant to ss. 120.536(1) and
66	120.54 to administer this section.
67	Section 8.  Section 381.91, Florida Statutes, is
68	transferred and renumbered as section 385.2024, Florida
69	Statutes, to read:
70	385.2024 381.91  Jessie Trice Cancer Prevention Program.--
71	(1)  It is the intent of the Legislature to:
72	(a)  Reduce the rates of illness and death from lung cancer
73	and other cancers and improve the quality of life among low-
74	income African-American and Hispanic populations through
75	increased access to early, effective screening and diagnosis,
76	education, and treatment programs.
77	(b)  Create a community faith-based disease-prevention
78	program in conjunction with the Health Choice Network and other
79	community health centers to build upon the natural referral and
80	education networks in place within minority communities and to
81	increase access to health service delivery in Florida.
82	(c)  Establish a funding source to build upon local private
83	participation to sustain the operation of the program.
84	(2)(a)  There is created the Jessie Trice Cancer Prevention
85	Program, to be located, for administrative purposes, within the
86	Department of Health, and operated from the community health
87	centers within the Health Choice Network in Florida.
88	(b)  Funding may be provided to develop contracts with
89	community health centers and local community faith-based
90	education programs to provide cancer screening, diagnosis,
91	education, and treatment services to low-income populations
92	throughout the state.
93	Section 9.  Section 381.911, Florida Statutes, is
94	transferred, renumbered as section 385.2023, Florida Statutes,
95	and amended to read:
96	385.2023 381.911  Prostate Cancer Awareness Program.--
97	(1)  To the extent that funds are specifically made
98	available for this purpose, the Prostate Cancer Awareness
99	Program is established within the Department of Health. The
100	purpose of this program is to implement the recommendations of
101	January 2000 of the Florida Prostate Cancer Task Force to
102	provide for statewide outreach and health education activities
103	to ensure that men are aware of and appropriately seek medical
104	counseling for prostate cancer as an early-detection health care
105	measure.
106	(2)  For purposes of implementing the program, the
107	Department of Health and the Florida Public Health Foundation,
108	Inc., may:
109	(a)  Conduct activities directly or enter into a contract
110	with a qualified nonprofit community education entity.
111	(b)  Seek any available gifts, grants, or funds from the
112	state, the Federal Government, philanthropic foundations, and
113	industry or business groups.
114	(3)  A prostate cancer advisory committee is created to
115	advise and assist the Department of Health and the Florida
116	Public Health Foundation, Inc., in implementing the program.
117	(a)  The State Surgeon General shall appoint the advisory
118	committee members, who shall consist of:
119	1.  Three persons from prostate cancer survivor groups or
120	cancer-related advocacy groups.
121	2.  Three persons who are scientists or clinicians from
122	public or nonpublic universities or research organizations.
123	3.  Three persons who are engaged in the practice of a
124	cancer-related medical specialty from health organizations
125	committed to cancer research and control.
126	(b)  Members shall serve without compensation but are
127	entitled to reimbursement, pursuant to s. 112.061, for per diem
128	and travel expenses incurred in the performance of their
129	official duties.
130	(4)  The program shall coordinate its efforts with those of
131	the Florida Public Health Foundation, Inc.
132	Section 10.  Section 381.912, Florida Statutes, is
133	repealed.
134	Section 11.  Section 381.92, Florida Statutes, is
135	transferred and renumbered as section 385.2025, Florida
136	Statutes, to read:
137	385.2025 381.92  Florida Cancer Council.--
138	(1)  Effective July 1, 2004, the Florida Cancer Council
139	within the Department of Health is established for the purpose
140	of making the state a center of excellence for cancer research.
141	(2)(a)  The council shall be representative of the state's
142	cancer centers, hospitals, and patient groups and shall be
143	organized and shall operate in accordance with this act.
144	(b)  The Florida Cancer Council may create not-for-profit
145	corporate subsidiaries to fulfill its mission. The council and
146	its subsidiaries are authorized to receive, hold, invest, and
147	administer property and any moneys acquired from private, local,
148	state, and federal sources, as well as technical and
149	professional income generated or derived from the mission-
150	related activities of the council.
151	(c)  The members of the council shall consist of:
152	1.  The chair of the Florida Dialogue on Cancer, who shall
153	serve as the chair of the council;
154	2.  The State Surgeon General or his or her designee;
155	3.  The chief executive officer of the H. Lee Moffitt
156	Cancer Center or his or her designee;
157	4.  The director of the University of Florida Shands Cancer
158	Center or his or her designee;
159	5.  The chief executive officer of the University of Miami
160	Sylvester Comprehensive Cancer Center or his or her designee;
161	6.  The chief executive officer of the Mayo Clinic,
162	Jacksonville, or his or her designee;
163	7.  The chief executive officer of the American Cancer
164	Society, Florida Division, Inc., or his or her designee;
165	8.  The president of the American Cancer Society, Florida
166	Division, Inc., Board of Directors or his or her designee;
167	9.  The president of the Florida Society of Clinical
168	Oncology or his or her designee;
169	10.  The president of the American College of Surgeons,
170	Florida Chapter, or his or her designee;
171	11.  The chief executive officer of Enterprise Florida,
172	Inc., or his or her designee;
173	12.  Five representatives from cancer programs approved by
174	the American College of Surgeons. Three shall be appointed by
175	the Governor, one shall be appointed by the Speaker of the House
176	of Representatives, and one shall be appointed by the President
177	of the Senate;
178	13.  One member of the House of Representatives, to be
179	appointed by the Speaker of the House of Representatives; and
180	14.  One member of the Senate, to be appointed by the
181	President of the Senate.
182	(d)  Appointments made by the Speaker of the House of
183	Representatives and the President of the Senate pursuant to
184	paragraph (c) shall be for 2-year terms, concurrent with the
185	bienniums in which they serve as presiding officers.
186	(e)  Appointments made by the Governor pursuant to
187	paragraph (c) shall be for 2-year terms, although the Governor
188	may reappoint members.
189	(f)  Members of the council or any subsidiaries shall serve
190	without compensation, and each organization represented on the
191	council shall cover the expenses of its representatives.
192	(3)  The council shall issue an annual report to the Center
193	for Universal Research to Eradicate Disease, the Governor, the
194	Speaker of the House of Representatives, and the President of
195	the Senate by December 15 of each year, with policy and funding
196	recommendations regarding cancer research capacity in Florida
197	and related issues.
198	Section 12.  Section 381.921, Florida Statutes, is
199	transferred and renumbered as section 385.20251, Florida
200	Statutes, to read:
201	385.20251 381.921  Florida Cancer Council mission and
202	duties.--The council, which shall work in concert with the
203	Florida Center for Universal Research to Eradicate Disease to
204	ensure that the goals of the center are advanced, shall endeavor
205	to dramatically improve cancer research and treatment in this
206	state through:
207	(1)  Efforts to significantly expand cancer research
208	capacity in the state by:
209	(a)  Identifying ways to attract new research talent and
210	attendant national grant-producing researchers to cancer
211	research facilities in this state;
212	(b)  Implementing a peer-reviewed, competitive process to
213	identify and fund the best proposals to expand cancer research
214	institutes in this state;
215	(c)  Funding through available resources for those
216	proposals that demonstrate the greatest opportunity to attract
217	federal research grants and private financial support;
218	(d)  Encouraging the employment of bioinformatics in order
219	to create a cancer informatics infrastructure that enhances
220	information and resource exchange and integration through
221	researchers working in diverse disciplines, to facilitate the
222	full spectrum of cancer investigations;
223	(e)  Facilitating the technical coordination, business
224	development, and support of intellectual property as it relates
225	to the advancement of cancer research; and
226	(f)  Aiding in other multidisciplinary research-support
227	activities as they inure to the advancement of cancer research.
228	(2)  Efforts to improve both research and treatment through
229	greater participation in clinical trials networks by:
230	(a)  Identifying ways to increase adult enrollment in
231	cancer clinical trials;
232	(b)  Supporting public and private professional education
233	programs designed to increase the awareness and knowledge about
234	cancer clinical trials;
235	(c)  Providing tools to cancer patients and community-based
236	oncologists to aid in the identification of cancer clinical
237	trials available in the state; and
238	(d)  Creating opportunities for the state's academic cancer
239	centers to collaborate with community-based oncologists in
240	cancer clinical trials networks.
241	(3)  Efforts to reduce the impact of cancer on disparate
242	groups by:
243	(a)  Identifying those cancers that disproportionately
244	impact certain demographic groups; and
245	(b)  Building collaborations designed to reduce health
246	disparities as they relate to cancer.
247	Section 13.  Paragraph (a) of subsection (2) and subsection
248	(5) of section 381.922, Florida Statutes, as amended by section
249	2 of chapter 2009-5, Law of Florida, is amended to read:
250	381.922  William G. "Bill" Bankhead, Jr., and David Coley
251	Cancer Research Program.--
252	(2)  The program shall provide grants for cancer research
253	to further the search for cures for cancer.
254	(a)  Emphasis shall be given to the goals enumerated in s.
255	385.20251 s. 381.921, as those goals support the advancement of
256	such cures.
257	(5)  For the 2008-2009 fiscal year and each fiscal year
258	thereafter, the sum of $6.75 million is appropriated annually
259	from recurring funds in the General Revenue Fund to the
260	Biomedical Research Trust Fund within the Department of Health
261	for purposes of the William G. "Bill" Bankhead, Jr., and David
262	Coley Cancer Research Program and shall be distributed pursuant
263	to this section to provide grants to researchers seeking cures
264	for cancer, with emphasis given to the goals enumerated in s.
265	385.20251 s. 381.921. From the total funds appropriated, an
266	amount of up to 10 percent may be used for administrative
267	expenses.
268	Section 14.  Section 381.93, Florida Statutes, is
269	transferred and renumbered as section 385.2021, Florida
270	Statutes, to read:
271	385.2021 381.93  Breast and cervical cancer early detection
272	program.--This section may be cited as the "Mary Brogan Breast
273	and Cervical Cancer Early Detection Program Act."
274	(1)  It is the intent of the Legislature to reduce the
275	rates of death due to breast and cervical cancer through early
276	diagnosis and increased access to early screening, diagnosis,
277	and treatment programs.
278	(2)  The Department of Health, using available federal
279	funds and state funds appropriated for that purpose, is
280	authorized to establish the Mary Brogan Breast and Cervical
281	Cancer Screening and Early Detection Program to provide
282	screening, diagnosis, evaluation, treatment, case management,
283	and followup and referral to the Agency for Health Care
284	Administration for coverage of treatment services.
285	(3)  The Mary Brogan Breast and Cervical Cancer Early
286	Detection Program shall be funded through grants for such
287	screening and early detection purposes from the federal Centers
288	for Disease Control and Prevention under Title XV of the Public
289	Health Service Act, 42 U.S.C. ss. 300k et seq.
290	(4)  The department shall limit enrollment in the program
291	to persons with incomes up to and including 200 percent of the
292	federal poverty level. The department shall establish an
293	eligibility process that includes an income-verification process
294	to ensure that persons served under the program meet income
295	guidelines.
296	(5)  The department may provide other breast and cervical
297	cancer screening and diagnostic services; however, such services
298	shall be funded separately through other sources than this act.
299	Section 15.  Section 381.931, Florida Statutes, is
300	transferred and renumbered as section 385.20211, Florida
301	Statutes, to read:
302	385.20211 381.931  Annual report on Medicaid
303	expenditures.--The Department of Health and the Agency for
304	Health Care Administration shall monitor the total Medicaid
305	expenditures for services made under this act. If Medicaid
306	expenditures are projected to exceed the amount appropriated by
307	the Legislature, the Department of Health shall limit the number
308	of screenings to ensure Medicaid expenditures do not exceed the
309	amount appropriated. The Department of Health, in cooperation
310	with the Agency for Health Care Administration, shall prepare an
311	annual report that must include the number of women screened;
312	the percentage of positive and negative outcomes; the number of
313	referrals to Medicaid and other providers for treatment
314	services; the estimated number of women who are not screened or
315	not served by Medicaid due to funding limitations, if any; the
316	cost of Medicaid treatment services; and the estimated cost of
317	treatment services for women who were not screened or referred
318	for treatment due to funding limitations. The report shall be
319	submitted to the President of the Senate, the Speaker of the
320	House of Representatives, and the Executive Office of the
321	Governor by March 1 of each year.
322	Section 16.  Chapter 385, Florida Statutes, entitled
323	"Chronic Diseases," is renamed the "Healthy and Fit Florida
324	Act."
325	Section 17.  Section 385.101, Florida Statutes, is amended
326	to read:
327	385.101  Short title.--This chapter Sections 385.101-
328	385.103 may be cited as the "Healthy and Fit Florida Chronic
329	Diseases Act."
330	Section 18.  Section 385.102, Florida Statutes, is amended
331	to read:
332	385.102  Legislative intent.--It is the finding of the
333	Legislature that:
334	(1)  Chronic diseases continue to be the leading cause of
335	death and disability in this state and the country exist in high
336	proportions among the people of this state. These Chronic
337	diseases include, but are not limited to, arthritis,
338	cardiovascular disease heart disease, hypertension, diabetes,
339	renal disease, cancer, and chronic obstructive lung disease,
340	including chronic obstructive pulmonary disease. These diseases
341	are often have the same preventable risk factors interrelated,
342	and they directly and indirectly account for a high rate of
343	death, disability, and underlying costs to the state's health
344	care system illness.
345	(2)  Chronic diseases have a significant impact on quality
346	of life, not only for the individuals who experience their
347	painful symptoms and resulting disabilities, but also for family
348	members and caregivers.
349	(3)  Racial and ethnic minorities and other underserved
350	populations are disproportionately affected by chronic diseases.
351	(4)  There are enormous medical costs and lost wages
352	associated with chronic diseases and their complications.
353	(5)(2)  Advances in medical knowledge and technology assist
354	have assisted in the prevention, detection, and management of
355	chronic diseases. Comprehensive approaches that stress the
356	stressing application of current medical treatment, continuing
357	research, professional training, and patient education, and
358	community-level policy and environmental changes should be
359	implemented encouraged.
360	(6)(3)  A comprehensive program dealing with the early
361	detection and prevention of chronic diseases is required to make
362	knowledge and therapy available to all people of this state. The
363	mobilization of scientific, medical, and educational resources,
364	along with the implementation of community-based policy under
365	one comprehensive chronic disease law, act will facilitate the
366	prevention, early intervention, and management treatment of
367	chronic these diseases and their symptoms. This integration of
368	resources and policy will and result in a decline in death and
369	disability illness among the people of this state.
370	(7)  Chronic diseases account for 70 percent of all deaths
371	in the United States. The following chronic diseases are the
372	leading causes of death and disability:
373	(a)  Heart disease and stroke, which have remained the
374	first and third leading causes of death for both men and women
375	in the United States for over seven decades and account for
376	approximately one-third of total deaths each year in this state.
377	(b)  Cancer, which is the second leading cause of death and
378	is responsible for one in four deaths in this state.
379	(c)  Lung disease, which is the third leading cause of
380	death and accounts for one in every six deaths in this state.
381	(d)  Diabetes, which is the sixth leading cause of death in
382	this state.
383	(e)  Arthritis, which is the leading cause of disability in
384	the United States, limiting daily activities for more than 19
385	million citizens. In this state, arthritis limits daily
386	activities for an estimated 1.3 million people.
387	(8)  The department shall establish, promote, and maintain
388	state-level and local-level programs for chronic disease
389	prevention and health promotion to the extent that funds are
390	specifically made available for this purpose.
391	Section 19.  Section 385.1021, Florida Statutes, is created
392	to read:
393	385.1021  Definitions.--As used in this chapter, the term:
394	(1)  "CDC" means the United States Centers for Disease
395	Control and Prevention.
396	(2)  "Chronic disease" means an illness that is prolonged,
397	does not resolve spontaneously, and is rarely cured completely.
398	(3)  "Department" means the Department of Health.
399	(4)  "Environmental changes" means changes to the economic,
400	social, or physical natural or built environments which
401	encourage or enable behaviors.
402	(5)  "Policy change" means altering an informal or formal
403	agreement between public or private sectors which sets forth
404	values, behaviors, or resource allocation in order to improve
405	health.
406	(6)  "Primary prevention" means an intervention that is
407	directed toward healthy populations and focuses on avoiding
408	disease before it occurs.
409	(7)  "Risk factor" means a characteristic or condition
410	identified during the course of an epidemiological study of a
411	disease that appears to be statistically associated with a high
412	incidence of that disease.
413	(8)  "Secondary prevention" means an intervention that is
414	designed to promote the early detection and management of
415	diseases and reduce the risks experienced by at-risk
416	populations.
417	(9)  "System changes" means altering standard activities,
418	protocols, policies, processes, and structures carried out in
419	population-based settings, such as schools, worksites, health
420	care facilities, faith-based organizations, and the overall
421	community, which promote and support new behaviors.
422	(10)  "Tertiary prevention" means an intervention that is
423	directed at rehabilitating and minimizing the effects of disease
424	in a chronically ill population.
425	(11)  "Tobacco" means, without limitation, tobacco itself
426	and tobacco products that include tobacco and are intended or
427	expected for human use or consumption, including, but not
428	limited to, cigarettes, cigars, pipe tobacco, and smokeless
429	tobacco.
430	(12)  "Wellness program" means a structured program that is
431	designed or approved by the department to offer intervention
432	activities on or off the worksite which help state employees
433	change certain behaviors or adopt healthy lifestyles.
434	(13)  "Youth" means children and young adults, up through
435	24 years of age, inclusive.
436	Section 20.  Section 385.1022, Florida Statutes, is created
437	to read:
438	385.1022  Chronic disease prevention program.--The
439	department shall support public health programs to reduce the
440	incidence of mortality and morbidity from diseases for which
441	risk factors can be identified. Such risk factors include, but
442	are not limited to, being overweight or obese, physical
443	inactivity, poor nutrition and diet, tobacco use, sun exposure,
444	and other practices that are detrimental to health. The programs
445	shall educate and screen the general public as well as groups at
446	particularly high risk of chronic diseases.
447	Section 21.  Section 385.1023, Florida Statutes, is created
448	to read:
449	385.1023  State-level prevention programs for chronic
450	disease.--
451	(1)  The department shall create state-level programs that
452	address the leading, preventable chronic disease risk factors of
453	poor nutrition and obesity, tobacco use, sun exposure, and
454	physical inactivity in order to decrease the incidence of
455	arthritis, cancer, diabetes, heart disease, lung disease,
456	stroke, and other chronic diseases.
457	(2)  State-level programs shall address, but need not be
458	limited to, the following activities:
459	(a)  Monitoring specific causal and behavioral risk factors
460	that affect the health of residents in the state.
461	(b)  Analyzing data regarding chronic disease mortality and
462	morbidity to track changes over time.
463	(c)  Promoting public awareness and increasing knowledge
464	concerning the causes of chronic diseases, the importance of
465	early detection, diagnosis, and appropriate evidence-based
466	prevention, management, and treatment strategies.
467	(d)  Disseminating educational materials and information
468	concerning evidence-based results, available services, and
469	pertinent new research findings and prevention strategies to
470	patients, health insurers, health professionals, and the public.
471	(e)  Using education and training resources and services
472	developed by organizations having appropriate expertise and
473	knowledge of chronic diseases for technical assistance.
474	(f)  Evaluating the quality and accessibility of existing
475	community-based services for chronic disease.
476	(g)  Increasing awareness among state and local officials
477	involved in health and human services, health professionals and
478	providers, and policymakers about evidence-based chronic-disease
479	prevention, tobacco cessation, and treatment strategies and
480	their benefits for people who have chronic diseases.
481	(h)  Developing a partnership with state and local
482	governments, voluntary health organizations, hospitals, health
483	insurers, universities, medical centers, employer groups,
484	private companies, and health care providers to address the
485	burden of chronic disease in this state.
486	(i)  Implementing and coordinating state-level policies in
487	order to reduce the burden of chronic disease.
488	(j)  Providing lasting improvements in the delivery of
489	health care for individuals who have chronic disease and their
490	families, thus improving their quality of life while also
491	containing health care costs.
492	Section 22.  Section 385.103, Florida Statutes, is amended
493	to read:
494	385.103  Community-level Community intervention programs
495	for chronic disease prevention and health promotion.--
496	(1)  DEFINITIONS.--As used in this section, the term:
497	(a)  "Chronic disease prevention and health promotion
498	control program" means a program that may include, but is not
499	limited to, including a combination of the following elements:
500	1.  Staff who are sufficiently trained and skilled in
501	public health, community health, or school health education to
502	facilitate the operation of the program Health screening;
503	2.  Community input into the planning, implementation, and
504	evaluation processes Risk factor detection;
505	3.  Use of public health data to make decisions and to
506	develop and prioritize community-based interventions focusing on
507	chronic diseases and their risk factors; Appropriate
508	intervention to enable and encourage changes in behaviors that
509	create health risks; and
510	4.  Adherence to a population-based approach by using a
511	socioecological model that addresses the influence on individual
512	behavior, interpersonal behavior, organizational behavior, the
513	community, and public policy; Counseling in nutrition, physical
514	activity, the effects of tobacco use, hypertension, blood
515	pressure control, and diabetes control and the provision of
516	other clinical prevention services.
517	5.  Focus on at least the common preventable risk factors
518	for chronic disease, such as physical inactivity, obesity, poor
519	nutrition, and tobacco use;
520	6.  Focus on developing and implementing interventions and
521	activities through communities, schools, worksites, faith-based
522	organizations, and health-care settings;
523	7.  Use of evidence-based interventions as well as best and
524	promising practices to guide specific activities and effect
525	change, which may include guidelines developed by organizations,
526	volunteer scientists, and health care professionals who write
527	published medical, scientific statements on various chronic
528	disease topics. The statements shall be supported by scientific
529	studies published in recognized journals that have a rigorous
530	review and approval process. Scientific statements generally
531	include a review of data available on a specific subject and an
532	evaluation of its relationship to overall chronic disease
533	science;
534	8.  Use of policy, system, and environmental changes that
535	support healthy behaviors so as to affect large segments of the
536	population and encourage healthy choices;
537	9.  Development of extensive and comprehensive evaluation
538	that is linked to program planning at the state level and the
539	community level in order to determine the program's
540	effectiveness or necessary program modifications; and
541	10.  Reduction of duplication of efforts through
542	coordination among appropriate entities for the efficient use of
543	resources.
544	(b)  "Community Health education program" means a program
545	that follows involving the planned and coordinated use of the
546	educational standards and teaching methods resources available
547	in a community in an effort to provide:
548	1.  Appropriate medical, research-based interventions to
549	enable and encourage changes in behaviors which reduce or
550	eliminate health risks;
551	2.  Counseling in nutrition, weight management, physical
552	inactivity, and tobacco-use prevention and cessation strategies;
553	hypertension, blood pressure, high cholesterol, and diabetes
554	control; and other clinical prevention services;
555	3.1.  Motivation and assistance to individuals or groups in
556	adopting and maintaining Motivate and assist citizens to adopt
557	and maintain healthful practices and lifestyles; and
558	4.2.  Make available Learning opportunities that which will
559	increase the ability of people to make informed decisions
560	affecting their personal, family, and community well-being and
561	that which are designed to facilitate voluntary adoption of
562	behavior that which will improve or maintain health.;
563	3.  Reduce, through coordination among appropriate
564	agencies, duplication of health education efforts; and
565	4.  Facilitate collaboration among appropriate agencies for
566	efficient use of scarce resources.
567	(c)  "Community intervention program" means a program
568	combining the required elements of a chronic disease prevention
569	and health promotion control program and the principles of a
570	community health education program that addresses system,
571	policy, and environmental changes that ensure that communities
572	provide support for healthy lifestyles into a unified program
573	over which a single administrative entity has authority and
574	responsibility.
575	(d)  "Department" means the Department of Health.
576	(e)  "Risk factor" means a factor identified during the
577	course of an epidemiological study of a disease, which factor
578	appears to be statistically associated with a high incidence of
579	that disease.
580	(2)  OPERATION OF COMMUNITY-LEVEL COMMUNITY INTERVENTION
581	PROGRAMS FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION.--
582	(a)  The department shall develop and implement a
583	comprehensive, community-based program for chronic disease
584	prevention and health promotion. The program shall be designed
585	to reduce major behavioral risk factors that are associated with
586	chronic diseases by enhancing the knowledge, skills, motivation,
587	and opportunities for individuals, organizations, health care
588	providers, small businesses, health insurers, and communities to
589	develop and maintain healthy lifestyles. The department shall
590	assist the county health departments in developing and operating
591	community intervention programs throughout the state. At a
592	minimum, the community intervention programs shall address one
593	to three of the following chronic diseases: cancer, diabetes,
594	heart disease, stroke, hypertension, renal disease, and chronic
595	obstructive lung disease.
596	(b)  The program shall include:
597	1.  Countywide assessments of specific, causal, and
598	behavioral risk factors that affect the health of residents;
599	2.  The development of community-based programs for chronic
600	disease prevention and health promotion which incorporate health
601	promotion and preventive care practices that are supported in
602	scientific and medical literature;
603	3.  The development and implementation of statewide age-
604	specific, disease-specific, and community-specific health
605	promotion and preventive care strategies using primary,
606	secondary, and tertiary prevention interventions;
607	4.  The promotion of community, research-based health-
608	promotion model programs that meet specific criteria, address
609	major risk factors, and motivate individuals to permanently
610	adopt healthy behaviors and increase social and personal
611	responsibilities;
612	5.  The development of policies that encourage the use of
613	alternative community delivery sites for health promotion,
614	disease prevention, and preventive care programs and promote the
615	use of neighborhood delivery sites that are close to work, home,
616	and school; and
617	6.  An emphasis on the importance of healthy and physically
618	active lifestyles to build self-esteem and reduce morbidity and
619	mortality associated with chronic disease and being overweight
620	or obese. Existing community resources, when available, shall be
621	used to support the programs. The department shall seek funding
622	for the programs from federal and state financial assistance
623	programs which presently exist or which may be hereafter
624	created. Additional services, as appropriate, may be
625	incorporated into a program to the extent that resources are
626	available. The department may accept gifts and grants in order
627	to carry out a program.
628	(c)  Volunteers shall be used to the maximum extent
629	possible in carrying out the programs. The department shall
630	contract for the necessary insurance coverage to protect
631	volunteers from personal liability while acting within the scope
632	of their volunteer assignments under a program.
633	(d)  The department may contract for the provision of all
634	or any portion of the services required by a program, and shall
635	so contract whenever the services so provided are more cost-
636	efficient than those provided by the department.
637	(e)  If the department determines that it is necessary for
638	clients to help pay for services provided by a program, the
639	department may require clients to make contribution therefor in
640	either money or personal services. The amount of money or value
641	of the personal services shall be fixed according to a fee
642	schedule established by the department or by the entity
643	developing the program. In establishing the fee schedule, the
644	department or the entity developing the program shall take into
645	account the expenses and resources of a client and his or her
646	overall ability to pay for the services.
647	Section 23.  Section 385.105, Florida Statutes, is created
648	to read:
649	385.105  Physical activity, obesity prevention, nutrition,
650	other health-promotion services, and wellness programs.--
651	(1)  PHYSICAL ACTIVITY--.
652	(a)  The department shall develop programs for people at
653	every stage of their lives to increase physical fitness and
654	promote behavior changes.
655	(b)  The department shall work with school health advisory
656	or wellness committees in each school district as established in
657	s. 381.0056.
658	(c)  The department shall develop public and private
659	partnerships that allow the public to easily access recreational
660	facilities and public land areas that are suitable for physical
661	activity.
662	(d)  The department shall work in collaboration with the
663	Executive Office of the Governor and Volunteer Florida, Inc., to
664	promote school initiatives, such as the Governor's Fitness
665	Challenge.
666	(e)  The department shall collaborate with the Department
667	of Education in recognizing nationally accepted best practices
668	for improving physical education in schools.
669	(2)  OBESITY PREVENTION.--The department shall promote
670	healthy lifestyles to reduce the prevalence of excess weight
671	gain and being overweight or obese through programs that are
672	directed towards all residents of this state by:
673	(a)  Using all appropriate media to promote maximum public
674	awareness of the latest research on healthy lifestyles and
675	chronic diseases and disseminating relevant information through
676	a statewide clearinghouse relating to wellness, physical
677	activity, and nutrition and the effect of these factors on
678	chronic diseases and disabling conditions.
679	(b)  Providing technical assistance, training, and
680	resources on healthy lifestyles and chronic diseases to the
681	public, health care providers, school districts, and other
682	persons or entities, including faith-based organizations that
683	request such assistance to promote physical activity, nutrition,
684	and healthy lifestyle programs.
685	(c)  Developing, implementing, and using all available
686	research methods to collect data, including, but not limited to,
687	population-specific data, and tracking the incidence and effects
688	of weight gain, obesity, and related chronic diseases. The
689	department shall include an evaluation and data-collection
690	component in all programs as appropriate. All research conducted
691	under this paragraph is subject to review and approval as
692	required by the department's institutional review board under s.
693	381.86.
694	(d)  Entering into partnerships with the Department of
695	Education, local communities, school districts, and other
696	entities to encourage schools in this state to promote
697	activities during and after school to help students meet a
698	minimum goal of 30 minutes of physical activity or physical
699	fitness per day.
700	(e)  Entering into partnerships with the Department of
701	Education, school districts, and the Florida Sports Foundation
702	to develop a programs recognizing the schools at which students
703	demonstrate excellent physical fitness or fitness improvement.
704	(f)  Collaborating with other state agencies to develop
705	policies and strategies for preventing and treating obesity,
706	which shall be incorporated into programs administered by each
707	agency and shall include promoting healthy lifestyles of
708	employees of each agency.
709	(g)  Advising, in accordance with s. 456.081, health care
710	practitioners about the morbidity, mortality, and costs
711	associated with being overweight or obese, informing such
712	practitioners of promising clinical practices for preventing and
713	treating obesity, and encouraging practitioners to counsel their
714	patients regarding the adoption of healthy lifestyles.
715	(h)  Maximizing all local, state, and federal funding
716	sources, including grants, public-private partnerships, and
717	other mechanisms to strengthen the department's programs
718	promoting physical activity and nutrition.
719	(3)  NUTRITION.--The department shall promote optimal
720	nutritional status in all stages of people's lives by developing
721	strategies to:
722	(a)  Promote and maintain optimal nutritional status in the
723	population through activities, including, but not limited to:
724	1.  Nutrition screening and assessment and nutrition
725	counseling, including nutrition therapy, followup, case
726	management, and referrals for persons who have medical
727	conditions or nutrition-risk factors and who are provided health
728	services through public health programs or through referrals
729	from private health care providers or facilities;
730	2.  Nutrition education to assist residents of the state in
731	achieving optimal health and preventing chronic disease; and
732	3.  Consultative nutrition services to group facilities
733	which promote the provision of safe and nutritionally adequate
734	diets.
735	(b)  Monitor and conduct surveillance of the nutritional
736	status of this state's population.
737	(c)  Conduct or support research or evaluations related to
738	public health nutrition. All research conducted under this
739	paragraph is subject to review and approval as required by the
740	department's institutional review board under s. 381.86.
741	(d)  Establish policies and standards for public health
742	nutrition practices.
743	(e)  Promote interagency cooperation, professional
744	education, and consultation.
745	(f)  Provide technical assistance and advise state
746	agencies, private institutions, and local organizations
747	regarding public health nutrition standards.
748	(g)  Work with the Department of Agriculture and Consumer
749	Services, the Department of Education, and the Department of
750	Management Services to further the use of fresh produce from
751	this state in schools and encourage the development of community
752	gardens. Nutritional services shall be available to eligible
753	persons in accordance with eligibility criteria adopted by the
754	department. The department shall provide by rule requirements
755	for the service fees, when applicable, which may not exceed the
756	department's actual costs.
757
758	The department may adopt rules to administer this subsection.
759	(4)  OTHER HEALTH-PROMOTION SERVICES.--
760	(a)  The department shall promote personal responsibility
761	by encouraging residents of this state to be informed, follow
762	health recommendations, seek medical consultations and health
763	assessments, take healthy precautions, and comply with medical
764	guidelines, including those that lead to earlier detection of
765	chronic diseases in order to prevent chronic diseases or slow
766	the progression of established chronic diseases.
767	(b)  The department shall promote regular health visits
768	during a person's lifetime, including annual physical
769	examinations that include measuring body mass index and vital
770	signs, blood work, immunizations, screenings, and dental
771	examinations in order to reduce the financial, social, and
772	personal burden of chronic disease.
773	(5)  WELLNESS PROGRAMS.--
774	(a)  Each state agency may conduct employee wellness
775	programs in buildings and lands owned or leased by the state.
776	The department shall serve as a model to develop and implement
777	employee wellness programs that may include physical fitness,
778	healthy nutrition, self-management of disease, education, and
779	behavioral change. The department shall assist other state
780	agencies to develop and implement employee wellness programs.
781	These programs shall use existing resources, facilities, and
782	programs or resources procured through grant funding and
783	donations that are obtained in accordance with state ethics and
784	procurement policies, and shall provide equal access to any such
785	programs, resources, and facilities to all state employees.
786	(b)  The department shall coordinate its efforts with the
787	Department of Management Services and other state agencies.
788	(c)  Each agency may establish an employee wellness work
789	group to design the program. The department shall be available
790	to provide policy guidance and assist in identifying effective
791	wellness program strategies.
792	(d)  The department shall provide by rule requirements for
793	nominal participation fees, when applicable, which may not
794	exceed the department's actual costs; collaborations with
795	businesses; and the procurement of equipment and incentives.
796	Section 24.  Section 385.202, Florida Statutes, is amended
797	to read:
798	385.202  Statewide cancer registry.--
799	(1)  Each facility, laboratory, or practitioner licensed
800	under chapter 395, chapter 458, chapter 459, chapter 464,
801	chapter 483, and each freestanding radiation therapy center as
802	defined in s. 408.07, shall report to the department of Health
803	such information, specified by the department, by rule. The
804	department may adopt rules regarding reporting requirements for
805	the cancer registry, which shall include the data required, the
806	timeframe for reporting, and those professionals who are
807	responsible for ensuring compliance with reporting requirements,
808	which indicates diagnosis, stage of disease, medical history,
809	laboratory data, tissue diagnosis, and radiation, surgical, or
810	other methods of diagnosis or treatment for each cancer
811	diagnosed or treated by the facility or center. Failure to
812	comply with this requirement may be cause for registration or
813	licensure suspension or revocation.
814	(2)  The department shall establish, or cause to have
815	established, by contract with a recognized medical organization
816	in this state and its affiliated institutions, a statewide
817	cancer registry program to ensure that cancer reports required
818	under this section shall be maintained and available for use in
819	the course of public health surveillance and any study for the
820	purpose of reducing morbidity or mortality; and no liability of
821	any kind or character for damages or other relief shall arise or
822	be enforced against any facility or practitioner hospital by
823	reason of having provided such information or material to the
824	department.
825	(3)  The department may adopt rules regarding the
826	establishment and operation of a statewide cancer registry
827	program.
828	(4)(3)  The department or a contractual designee operating
829	the statewide cancer registry program required by this section
830	shall use or publish said material only for the purpose of
831	public health surveillance and advancing medical research or
832	medical education in the interest of reducing morbidity or
833	mortality, except that a summary of such studies may be released
834	for general publication. Information which discloses or could
835	lead to the disclosure of the identity of any person whose
836	condition or treatment has been reported and studied shall be
837	confidential and exempt from the provisions of s. 119.07(1),
838	except that:
839	(a)  Release may be made with the written consent of all
840	persons to whom the information applies;
841	(b)  The department or a contractual designee may contact
842	individuals for the purpose of epidemiologic investigation and
843	monitoring, provided information that is confidential under this
844	section is not further disclosed; or
845	(c)  The department may exchange personal data with any
846	other governmental agency or a contractual designee for the
847	purpose of public health surveillance and medical or scientific
848	research, if provided such governmental agency or contractual
849	designee does shall not further disclose information that is
850	confidential under this section.
851	(5)(4)  Funds appropriated for this section shall be used
852	for establishing, administering, compiling, processing, and
853	providing biometric and statistical analyses to the reporting
854	facilities and practitioners. Funds may also be used to ensure
855	the quality and accuracy of the information reported and to
856	provide management information to the reporting facilities and
857	practitioners.
858	(6)(5)  The department may adopt rules regarding the
859	classifications of, by rule, classify facilities that are
860	responsible for making reports to the cancer registry, the
861	content and frequency of the reports, and the penalty for
862	failure to comply with these requirements for purposes of
863	reports made to the cancer registry and specify the content and
864	frequency of the reports. In classifying facilities, the
865	department shall exempt certain facilities from reporting cancer
866	information that was previously reported to the department or
867	retrieved from existing state reports made to the department or
868	the Agency for Health Care Administration. The provisions of
869	This section does shall not apply to any facility whose primary
870	function is to provide psychiatric care to its patients.
871	(7)  Notwithstanding subsection (1), each facility and
872	practitioner that reports cancer cases to the department shall
873	make their records available for onsite review by the department
874	or its authorized representative.
875	Section 25.  Subsection (3) of section 385.203, Florida
876	Statutes, is amended to read:
877	385.203  Diabetes Advisory Council; creation; function;
878	membership.--
879	(3)  The council shall be composed of 26 25 citizens of the
880	state who have knowledge of, or work in, the area of diabetes
881	mellitus as follows:
882	(a)  Five interested citizens, three of whom are affected
883	by diabetes.
884	(b)  Twenty-one Twenty members, who must include one
885	representative from each of the following areas: nursing with
886	diabetes-educator certification; dietary with diabetes educator
887	certification; podiatry; ophthalmology or optometry; psychology;
888	pharmacy; adult endocrinology; pediatric endocrinology; the
889	American Diabetes Association (ADA); the Juvenile Diabetes
890	Foundation (JDF); the Florida Academy of Family Physicians; a
891	community health center; a county health department; an American
892	Diabetes Association recognized community education program;
893	each medical school in the state; an osteopathic medical school;
894	the insurance industry; a Children's Medical Services diabetes
895	regional program; and an employer.
896	(c)  One or more representatives from the Department of
897	Health, who shall serve on the council as ex officio members.
898	Section 26.  Section 385.206, Florida Statutes, is amended
899	to read:
900	385.206  Pediatric Hematology-Oncology care Center
901	Program.--
902	(1)  DEFINITIONS.--As used in this section, the term:
903	(a)  "Department" means the Department of Health.
904	(b)  "Hematology" means the study, diagnosis, and treatment
905	of blood and blood-forming tissues.
906	(c)  "Oncology" means the study, diagnosis, and treatment
907	of malignant neoplasms or cancer.
908	(d)  "Hemophilia" or "other hemostatic disorder" means a
909	bleeding disorder resulting from a genetic abnormality of
910	mechanisms related to the control of bleeding.
911	(e)  "Sickle-cell anemia or other hemoglobinopathy" means
912	an hereditary, chronic disease caused by an abnormal type of
913	hemoglobin.
914	(f)  "Patient" means a person under the age of 21 who is in
915	need of hematologic-oncologic services and who is enrolled in
916	the Children's Medical Services Network declared medically and
917	financially eligible by the department; or a person who received
918	such services prior to age 21 and who requires long-term
919	monitoring and evaluation to ascertain the sequelae and the
920	effectiveness of treatment.
921	(g)  "Center" means a facility designated by the department
922	as having a program specifically designed to provide a full
923	range of medical and specialty services to patients with
924	hematologic and oncologic disorders.
925	(2)  PEDIATRIC HEMATOLOGY-ONCOLOGY CARE CENTER PROGRAM;
926	AUTHORITY.--The department may designate is authorized to make
927	grants and reimbursements to designated centers and provide
928	funding to establish and maintain programs for the care of
929	patients with hematologic and oncologic disorders. Program
930	administration costs shall be paid by the department from funds
931	appropriated for this purpose.
932	(3)  GRANT FUNDING CONTRACTS GRANT AGREEMENTS;
933	CONDITIONS.--
934	(a)  Funding provided A grant made under this section shall
935	be pursuant to a contract contractual agreement made between a
936	center and the department. Each contract agreement shall provide
937	that patients will receive services specified types of treatment
938	and care from the center without additional charge to the
939	patients or their parents or guardians. Grants shall be
940	disbursed in accordance with conditions set forth in the
941	disbursement guidelines.
942	(4)  GRANT DISBURSEMENTS AND SPECIAL DISBURSEMENTS FOR
943	LOCAL PROGRAMS.--
944	(b)(a)  Funding may be provided Grant disbursements may be
945	made to centers that which meet the following criteria:
946	1.  The personnel shall include at least one board-
947	certified pediatric hematologist-oncologist, at least one board-
948	certified pediatric surgeon, at least one board-certified
949	radiotherapist, and at least one board-certified pathologist.
950	2.  As approved by the department, The center shall
951	actively participate in a national children's cancer study
952	group, maintain a pediatric tumor registry, have a
953	multidisciplinary pediatric tumor board, and meet other
954	guidelines for development, including, but not limited to,
955	guidelines from such organizations as the American Academy of
956	Pediatrics and the American Pediatric Surgical Association.
957	(b)  Programs shall also be established to provide care to
958	hematology-oncology patients within each district of the
959	department. The guidelines for local programs shall be
960	formulated by the department. Special disbursements may be made
961	by the program office to centers for educational programs
962	designed for the districts of the department. These programs may
963	include teaching total supportive care of the dying patient and
964	his or her family, home therapy to hemophiliacs and patients
965	with other hemostatic disorders, and screening and counseling
966	for patients with sickle-cell anemia or other
967	hemoglobinopathies.
968	(4)(5)  PROGRAM AND PEER REVIEW.--The department shall
969	evaluate at least annually during the grant period the services
970	rendered by the centers and the districts of the department.
971	Data from the centers and other sources relating to pediatric
972	cancer shall be reviewed annually by the Florida Association of
973	Pediatric Tumor Programs, Inc.; and a written report with
974	recommendations shall be made to the department. This database
975	will be available to the department for program planning and
976	quality assurance initiatives formulation of its annual program
977	and financial evaluation report. A portion of the funds
978	appropriated for this section may be used to provide statewide
979	consultation, supervision, and evaluation of the programs of the
980	centers, as well as central program office support personnel.
981	Section 27.  Paragraph (g) of subsection (2) and subsection
982	(7) of section 385.207, Florida Statutes, are amended to read:
983	385.207  Care and assistance of persons with epilepsy;
984	establishment of programs in epilepsy control.--
985	(2)  The Department of Health shall:
986	(g)  Continue current programs and develop cooperative
987	programs and services designed to enhance the vocational
988	rehabilitation of epilepsy clients, including the current jobs
989	programs. The department shall, as part of its contract with a
990	provider of epilepsy services, collect information regarding the
991	number of clients served, the outcomes reached, the expenses
992	incurred, and the fees collected by such providers for the
993	provision of services keep and make this information available
994	to the Governor and the Legislature upon request information
995	regarding the number of clients served, the outcome reached, and
996	the expense incurred by such programs and services.
997	(7)  The department shall limit total administrative
998	expenditures from the Epilepsy Services Trust Fund to 5 percent
999	of annual receipts.
1000	Section 28.  Paragraphs (b), (d), and (g) of subsection (2)
1001	and paragraph (b) of subsection (5) of section 385.210, Florida
1002	Statutes, are amended to read:
1003	385.210  Arthritis prevention and education.--
1004	(2)  LEGISLATIVE FINDINGS.--The Legislature finds the
1005	following:
1006	(b)  Arthritis is the leading cause of disability in the
1007	United States, limiting daily activities for more than 19 7
1008	million citizens.
1009	(d)  There are enormous economic and social costs
1010	associated with treating arthritis and its complications; the
1011	economic costs are estimated at over $128 billion (2003) $116
1012	billion (1997) annually in the United States.
1013	(g)  The National Arthritis Foundation, the CDC Centers for
1014	Disease Control and Prevention, and the Association of State and
1015	Territorial Health Officials have led the development of a
1016	public health strategy, the National Arthritis Action Plan, to
1017	respond to this challenge.
1018	(5)  FUNDING.--
1019	(b)  The State Surgeon General may shall seek any federal
1020	waiver or waivers that may be necessary to maximize funds from
1021	the Federal Government to implement this program.
1022	Section 29.  Section 385.301, Florida Statutes, is created
1023	to read:
1024	385.301  Rulemaking authority.--The department may adopt
1025	rules pursuant to chapter 120 to administer this chapter.
1026	Section 30.  Paragraph (l) of subsection (4) of section
1027	400.9905, Florida Statutes, is amended to read:
1028	400.9905  Definitions.--
1029	(4)  "Clinic" means an entity at which health care services
1030	are provided to individuals and which tenders charges for
1031	reimbursement for such services, including a mobile clinic and a
1032	portable equipment provider. For purposes of this part, the term
1033	does not include and the licensure requirements of this part do
1034	not apply to:
1035	(l)  Orthotic, or prosthetic, pediatric cardiological, or
1036	perinatological clinical facilities that are a publicly traded
1037	corporation or that are wholly owned, directly or indirectly, by
1038	a publicly traded corporation. As used in this paragraph, a
1039	publicly traded corporation is a corporation that issues
1040	securities traded on an exchange registered with the United
1041	States Securities and Exchange Commission as a national
1042	securities exchange.
1043	Section 31.  Subsection (9) of section 409.904, Florida
1044	Statutes, is amended to read:
1045	409.904  Optional payments for eligible persons.--The
1046	agency may make payments for medical assistance and related
1047	services on behalf of the following persons who are determined
1048	to be eligible subject to the income, assets, and categorical
1049	eligibility tests set forth in federal and state law. Payment on
1050	behalf of these Medicaid eligible persons is subject to the
1051	availability of moneys and any limitations established by the
1052	General Appropriations Act or chapter 216.
1053	(9)  Eligible women with incomes at or below 200 percent of
1054	the federal poverty level and under age 65, for cancer treatment
1055	pursuant to the federal Breast and Cervical Cancer Prevention
1056	and Treatment Act of 2000, screened through the Mary Brogan
1057	Breast and Cervical Cancer Early Detection Program established
1058	under s. 385.2021 s. 381.93.
1059
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