Florida Senate - 2012 COMMITTEE AMENDMENT
Bill No. SB 1316
Barcode 810774
LEGISLATIVE ACTION
Senate . House
Comm: UNFAV .
02/09/2012 .
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The Committee on Health Regulation (Garcia) recommended the
following:
1 Senate Substitute for Amendment (815246) (with title
2 amendment)
3
4 Delete everything after the enacting clause
5 and insert:
6 Section 1. Subsection (1) of section 395.002, Florida
7 Statutes, is amended to read:
8 395.002 Definitions.—As used in this chapter:
9 (1) “Accrediting organizations” means national
10 accreditation organizations that are approved by the Centers for
11 Medicare and Medicaid Services and whose standards incorporate
12 comparable licensure regulations required by the state the Joint
13 Commission on Accreditation of Healthcare Organizations, the
14 American Osteopathic Association, the Commission on
15 Accreditation of Rehabilitation Facilities, and the
16 Accreditation Association for Ambulatory Health Care, Inc.
17 Section 2. Subsection (6) of section 400.474, Florida
18 Statutes, is amended, present subsection (7) of that section is
19 renumbered as subsection (8), and a new subsection (7) is added
20 to that section, to read:
21 400.474 Administrative penalties.—
22 (6) The agency may deny, revoke, or suspend the license of
23 a home health agency and shall impose a fine of $5,000 against a
24 home health agency that:
25 (a) Gives remuneration for staffing services to:
26 1. Another home health agency with which it has formal or
27 informal patient-referral transactions or arrangements; or
28 2. A health services pool with which it has formal or
29 informal patient-referral transactions or arrangements,
30
31 unless the home health agency has activated its
32 comprehensive emergency management plan in accordance with s.
33 400.492. This paragraph does not apply to a Medicare-certified
34 home health agency that provides fair market value remuneration
35 for staffing services to a non-Medicare-certified home health
36 agency that is part of a continuing care facility licensed under
37 chapter 651 for providing services to its own residents if each
38 resident receiving home health services pursuant to this
39 arrangement attests in writing that he or she made a decision
40 without influence from staff of the facility to select, from a
41 list of Medicare-certified home health agencies provided by the
42 facility, that Medicare-certified home health agency to provide
43 the services.
44 (b) Provides services to residents in an assisted living
45 facility for which the home health agency does not receive fair
46 market value remuneration.
47 (c) Provides staffing to an assisted living facility for
48 which the home health agency does not receive fair market value
49 remuneration.
50 (d) Fails to provide the agency, upon request, with copies
51 of all contracts with assisted living facilities which were
52 executed within 5 years before the request.
53 (e) Gives remuneration to a case manager, discharge
54 planner, facility-based staff member, or third-party vendor who
55 is involved in the discharge planning process of a facility
56 licensed under chapter 395, chapter 429, or this chapter from
57 whom the home health agency receives referrals.
58 (f) Fails to submit to the agency, within 15 days after the
59 end of each calendar quarter, a written report that includes the
60 following data based on data as it existed on the last day of
61 the quarter:
62 1. The number of insulin-dependent diabetic patients
63 receiving insulin-injection services from the home health
64 agency;
65 2. The number of patients receiving both home health
66 services from the home health agency and hospice services;
67 3. The number of patients receiving home health services
68 from that home health agency; and
69 4. The names and license numbers of nurses whose primary
70 job responsibility is to provide home health services to
71 patients and who received remuneration from the home health
72 agency in excess of $25,000 during the calendar quarter.
73 (f)(g) Gives cash, or its equivalent, to a Medicare or
74 Medicaid beneficiary.
75 (g)(h) Has more than one medical director contract in
76 effect at one time or more than one medical director contract
77 and one contract with a physician-specialist whose services are
78 mandated for the home health agency in order to qualify to
79 participate in a federal or state health care program at one
80 time.
81 (h)(i) Gives remuneration to a physician without a medical
82 director contract being in effect. The contract must:
83 1. Be in writing and signed by both parties;
84 2. Provide for remuneration that is at fair market value
85 for an hourly rate, which must be supported by invoices
86 submitted by the medical director describing the work performed,
87 the dates on which that work was performed, and the duration of
88 that work; and
89 3. Be for a term of at least 1 year.
90
91 The hourly rate specified in the contract may not be
92 increased during the term of the contract. The home health
93 agency may not execute a subsequent contract with that physician
94 which has an increased hourly rate and covers any portion of the
95 term that was in the original contract.
96 (i)(j) Gives remuneration to:
97 1. A physician, and the home health agency is in violation
98 of paragraph (g) (h) or paragraph (h) (i);
99 2. A member of the physician’s office staff; or
100 3. An immediate family member of the physician,
101
102 if the home health agency has received a patient referral
103 in the preceding 12 months from that physician or physician’s
104 office staff.
105 (j)(k) Fails to provide to the agency, upon request, copies
106 of all contracts with a medical director which were executed
107 within 5 years before the request.
108 (k)(l) Demonstrates a pattern of billing the Medicaid
109 program for services to Medicaid recipients which are medically
110 unnecessary as determined by a final order. A pattern may be
111 demonstrated by a showing of at least two such medically
112 unnecessary services within one Medicaid program integrity audit
113 period.
114
115 Paragraphs (e) and (i) do not apply to or preclude Nothing
116 in paragraph (e) or paragraph (j) shall be interpreted as
117 applying to or precluding any discount, compensation, waiver of
118 payment, or payment practice permitted by 42 U.S.C. s. 1320a
119 7(b) or regulations adopted thereunder, including 42 C.F.R. s.
120 1001.952 or s. 1395nn or regulations adopted thereunder.
121 (7) The agency shall impose a fine of $50 per day against a
122 home health agency that fails to submit to the agency, within 15
123 days after the end of each calendar quarter, a written report
124 that includes the following data based on data as it existed on
125 the last day of the quarter:
126 (a) The number of patients receiving both home health
127 services from the home health agency and hospice services;
128 (b) The number of patients receiving home health services
129 from the home health agency;
130 (c) The number of insulin-dependent diabetic patients
131 receiving insulin-injection services from the home health
132 agency; and
133 (d) The names and license numbers of nurses whose primary
134 job responsibility is to provide home health services to
135 patients and who received remuneration from the home health
136 agency in excess of $25,000 during the calendar quarter.
137 Section 3. Paragraph (l) of subsection (4) of section
138 400.9905, Florida Statutes, is amended, and paragraph (m) is
139 added to that subsection, to read:
140 400.9905 Definitions.—
141 (4) “Clinic” means an entity at which health care services
142 are provided to individuals and which tenders charges for
143 reimbursement for such services, including a mobile clinic and a
144 portable equipment provider. For purposes of this part, the term
145 does not include and the licensure requirements of this part do
146 not apply to:
147 (l) Orthotic, or prosthetic, pediatric cardiology, or
148 perinatology clinical facilities or anesthesia clinical
149 facilities that are not otherwise exempt under paragraph (a) or
150 paragraph (k) and that are a publicly traded corporation or that
151 are wholly owned, directly or indirectly, by a publicly traded
152 corporation. As used in this paragraph, a publicly traded
153 corporation is a corporation that issues securities traded on an
154 exchange registered with the United States Securities and
155 Exchange Commission as a national securities exchange.
156 (m) Entities that are owned or controlled, directly or
157 indirectly, by a publicly traded entity that has $100 million or
158 more, in the aggregate, in total annual revenues derived from
159 providing health care services by licensed health care
160 practitioners who are employed or contracted by an entity
161 described in this paragraph.
162 Section 4. Paragraph (i) of subsection (4) of section
163 409.221, Florida Statutes, is amended to read:
164 409.221 Consumer-directed care program.—
165 (4) CONSUMER-DIRECTED CARE.—
166 (i) Background screening requirements.—All persons who
167 render care under this section must undergo level 2 background
168 screening pursuant to chapter 435 and s. 408.809. The agency
169 shall, as allowable, reimburse consumer-employed caregivers for
170 the cost of conducting such background screening as required by
171 this section. For purposes of this section, a person who has
172 undergone screening, who is qualified for employment under this
173 section and applicable rule, and who has not been unemployed for
174 more than 90 days following such screening is not required to be
175 rescreened. Such person must attest under penalty of perjury to
176 not having been convicted of a disqualifying offense since
177 completing such screening.
178 Section 5. Paragraph (c) of subsection (3) of section
179 409.907, Florida Statutes, is amended, paragraph (k) is added to
180 that subsection, and subsections (6), (7), and (8) of that
181 section are amended, to read:
182 409.907 Medicaid provider agreements.—The agency may make
183 payments for medical assistance and related services rendered to
184 Medicaid recipients only to an individual or entity who has a
185 provider agreement in effect with the agency, who is performing
186 services or supplying goods in accordance with federal, state,
187 and local law, and who agrees that no person shall, on the
188 grounds of handicap, race, color, or national origin, or for any
189 other reason, be subjected to discrimination under any program
190 or activity for which the provider receives payment from the
191 agency.
192 (3) The provider agreement developed by the agency, in
193 addition to the requirements specified in subsections (1) and
194 (2), shall require the provider to:
195 (c) Retain all medical and Medicaid-related records for 6 a
196 period of 5 years to satisfy all necessary inquiries by the
197 agency.
198 (k) Report a change in any principal of the provider,
199 including any officer, director, agent, managing employee, or
200 affiliated person, or any partner or shareholder who has an
201 ownership interest equal to 5 percent or more in the provider,
202 to the agency in writing no later than 30 days after the change
203 occurs.
204 (6) A Medicaid provider agreement may be revoked, at the
205 option of the agency, due to as the result of a change of
206 ownership of any facility, association, partnership, or other
207 entity named as the provider in the provider agreement.
208 (a) In the event of a change of ownership, the transferor
209 remains liable for all outstanding overpayments, administrative
210 fines, and any other moneys owed to the agency before the
211 effective date of the change of ownership. In addition to the
212 continuing liability of the transferor, The transferee is also
213 liable to the agency for all outstanding overpayments identified
214 by the agency on or before the effective date of the change of
215 ownership. For purposes of this subsection, the term
216 “outstanding overpayment” includes any amount identified in a
217 preliminary audit report issued to the transferor by the agency
218 on or before the effective date of the change of ownership. In
219 the event of a change of ownership for a skilled nursing
220 facility or intermediate care facility, the Medicaid provider
221 agreement shall be assigned to the transferee if the transferee
222 meets all other Medicaid provider qualifications. In the event
223 of a change of ownership involving a skilled nursing facility
224 licensed under part II of chapter 400, liability for all
225 outstanding overpayments, administrative fines, and any moneys
226 owed to the agency before the effective date of the change of
227 ownership shall be determined in accordance with s. 400.179.
228 (b) At least 60 days before the anticipated date of the
229 change of ownership, the transferor must shall notify the agency
230 of the intended change of ownership and the transferee must
231 shall submit to the agency a Medicaid provider enrollment
232 application. If a change of ownership occurs without compliance
233 with the notice requirements of this subsection, the transferor
234 and transferee are shall be jointly and severally liable for all
235 overpayments, administrative fines, and other moneys due to the
236 agency, regardless of whether the agency identified the
237 overpayments, administrative fines, or other moneys before or
238 after the effective date of the change of ownership. The agency
239 may not approve a transferee’s Medicaid provider enrollment
240 application if the transferee or transferor has not paid or
241 agreed in writing to a payment plan for all outstanding
242 overpayments, administrative fines, and other moneys due to the
243 agency. This subsection does not preclude the agency from
244 seeking any other legal or equitable remedies available to the
245 agency for the recovery of moneys owed to the Medicaid program.
246 In the event of a change of ownership involving a skilled
247 nursing facility licensed under part II of chapter 400,
248 liability for all outstanding overpayments, administrative
249 fines, and any moneys owed to the agency before the effective
250 date of the change of ownership shall be determined in
251 accordance with s. 400.179 if the Medicaid provider enrollment
252 application for change of ownership is submitted before the
253 change of ownership.
254 (c) As used in this subsection, the term:
255 1. “Administrative fines” includes any amount identified in
256 a notice of a monetary penalty or fine which has been issued by
257 the agency or other regulatory or licensing agency that governs
258 the provider.
259 2. “Outstanding overpayment” includes any amount identified
260 in a preliminary audit report issued to the transferor by the
261 agency on or before the effective date of a change of ownership.
262 (7) The agency may require, As a condition of participating
263 in the Medicaid program and before entering into the provider
264 agreement, the agency may require that the provider to submit
265 information, in an initial and any required renewal
266 applications, concerning the professional, business, and
267 personal background of the provider and permit an onsite
268 inspection of the provider’s service location by agency staff or
269 other personnel designated by the agency to perform this
270 function. Before entering into a provider agreement, the agency
271 may shall perform an a random onsite inspection, within 60 days
272 after receipt of a fully complete new provider’s application, of
273 the provider’s service location prior to making its first
274 payment to the provider for Medicaid services to determine the
275 applicant’s ability to provide the services in compliance with
276 the Medicaid program and professional regulations that the
277 applicant is proposing to provide for Medicaid reimbursement.
278 The agency is not required to perform an onsite inspection of a
279 provider or program that is licensed by the agency, that
280 provides services under waiver programs for home and community
281 based services, or that is licensed as a medical foster home by
282 the Department of Children and Family Services. As a continuing
283 condition of participation in the Medicaid program, a provider
284 must shall immediately notify the agency of any current or
285 pending bankruptcy filing. Before entering into the provider
286 agreement, or as a condition of continuing participation in the
287 Medicaid program, the agency may also require that Medicaid
288 providers reimbursed on a fee-for-services basis or fee schedule
289 basis that which is not cost-based, post a surety bond not to
290 exceed $50,000 or the total amount billed by the provider to the
291 program during the current or most recent calendar year,
292 whichever is greater. For new providers, the amount of the
293 surety bond shall be determined by the agency based on the
294 provider’s estimate of its first year’s billing. If the
295 provider’s billing during the first year exceeds the bond
296 amount, the agency may require the provider to acquire an
297 additional bond equal to the actual billing level of the
298 provider. A provider’s bond need shall not exceed $50,000 if a
299 physician or group of physicians licensed under chapter 458,
300 chapter 459, or chapter 460 has a 50 percent or greater
301 ownership interest in the provider or if the provider is an
302 assisted living facility licensed under chapter 429. The bonds
303 permitted by this section are in addition to the bonds
304 referenced in s. 400.179(2)(d). If the provider is a
305 corporation, partnership, association, or other entity, the
306 agency may require the provider to submit information concerning
307 the background of that entity and of any principal of the
308 entity, including any partner or shareholder having an ownership
309 interest in the entity equal to 5 percent or greater, and any
310 treating provider who participates in or intends to participate
311 in Medicaid through the entity. The information must include:
312 (a) Proof of holding a valid license or operating
313 certificate, as applicable, if required by the state or local
314 jurisdiction in which the provider is located or if required by
315 the Federal Government.
316 (b) Information concerning any prior violation, fine,
317 suspension, termination, or other administrative action taken
318 under the Medicaid laws, rules, or regulations of this state or
319 of any other state or the Federal Government; any prior
320 violation of the laws, rules, or regulations relating to the
321 Medicare program; any prior violation of the rules or
322 regulations of any other public or private insurer; and any
323 prior violation of the laws, rules, or regulations of any
324 regulatory body of this or any other state.
325 (c) Full and accurate disclosure of any financial or
326 ownership interest that the provider, or any principal, partner,
327 or major shareholder thereof, may hold in any other Medicaid
328 provider or health care related entity or any other entity that
329 is licensed by the state to provide health or residential care
330 and treatment to persons.
331 (d) If a group provider, identification of all members of
332 the group and attestation that all members of the group are
333 enrolled in or have applied to enroll in the Medicaid program.
334 (8)(a) Each provider, or each principal of the provider if
335 the provider is a corporation, partnership, association, or
336 other entity, seeking to participate in the Medicaid program
337 must submit a complete set of his or her fingerprints to the
338 agency for the purpose of conducting a criminal history record
339 check. Principals of the provider include any officer, director,
340 billing agent, managing employee, or affiliated person, or any
341 partner or shareholder who has an ownership interest equal to 5
342 percent or more in the provider. However, for a hospital
343 licensed under chapter 395 or a nursing home licensed under
344 chapter 400, principals of the provider are those who meet the
345 definition of a controlling interest under s. 408.803. A
346 director of a not-for-profit corporation or organization is not
347 a principal for purposes of a background investigation as
348 required by this section if the director: serves solely in a
349 voluntary capacity for the corporation or organization, does not
350 regularly take part in the day-to-day operational decisions of
351 the corporation or organization, receives no remuneration from
352 the not-for-profit corporation or organization for his or her
353 service on the board of directors, has no financial interest in
354 the not-for-profit corporation or organization, and has no
355 family members with a financial interest in the not-for-profit
356 corporation or organization; and if the director submits an
357 affidavit, under penalty of perjury, to this effect to the
358 agency and the not-for-profit corporation or organization
359 submits an affidavit, under penalty of perjury, to this effect
360 to the agency as part of the corporation’s or organization’s
361 Medicaid provider agreement application.
362 (a) Notwithstanding the above, the agency may require a
363 background check for any person reasonably suspected by the
364 agency to have been convicted of a crime. This subsection does
365 not apply to:
366 1. A hospital licensed under chapter 395;
367 2. A nursing home licensed under chapter 400;
368 3. A hospice licensed under chapter 400;
369 4. An assisted living facility licensed under chapter 429;
370 1.5. A unit of local government, except that requirements
371 of this subsection apply to nongovernmental providers and
372 entities contracting with the local government to provide
373 Medicaid services. The actual cost of the state and national
374 criminal history record checks must be borne by the
375 nongovernmental provider or entity; or
376 2.6. Any business that derives more than 50 percent of its
377 revenue from the sale of goods to the final consumer, and the
378 business or its controlling parent is required to file a form
379 10-K or other similar statement with the Securities and Exchange
380 Commission or has a net worth of $50 million or more.
381 (b) Background screening shall be conducted in accordance
382 with chapter 435 and s. 408.809. The cost of the state and
383 national criminal record check shall be borne by the provider.
384 (c) Proof of compliance with the requirements of level 2
385 screening under chapter 435 conducted within 12 months before
386 the date the Medicaid provider application is submitted to the
387 agency fulfills the requirements of this subsection.
388 Section 6. Present paragraphs (e) and (f) of subsection (1)
389 of section 409.913, Florida Statutes, are redesignated as
390 paragraphs (f) and (g), respectively, a new paragraph (e) is
391 added to that subsection, and subsections (2), (9), (13), (15),
392 (16), (21), (22), (25), (28), (29), (30), and (31) of that
393 section are amended, to read:
394 409.913 Oversight of the integrity of the Medicaid
395 program.—The agency shall operate a program to oversee the
396 activities of Florida Medicaid recipients, and providers and
397 their representatives, to ensure that fraudulent and abusive
398 behavior and neglect of recipients occur to the minimum extent
399 possible, and to recover overpayments and impose sanctions as
400 appropriate. Beginning January 1, 2003, and each year
401 thereafter, the agency and the Medicaid Fraud Control Unit of
402 the Department of Legal Affairs shall submit a joint report to
403 the Legislature documenting the effectiveness of the state’s
404 efforts to control Medicaid fraud and abuse and to recover
405 Medicaid overpayments during the previous fiscal year. The
406 report must describe the number of cases opened and investigated
407 each year; the sources of the cases opened; the disposition of
408 the cases closed each year; the amount of overpayments alleged
409 in preliminary and final audit letters; the number and amount of
410 fines or penalties imposed; any reductions in overpayment
411 amounts negotiated in settlement agreements or by other means;
412 the amount of final agency determinations of overpayments; the
413 amount deducted from federal claiming as a result of
414 overpayments; the amount of overpayments recovered each year;
415 the amount of cost of investigation recovered each year; the
416 average length of time to collect from the time the case was
417 opened until the overpayment is paid in full; the amount
418 determined as uncollectible and the portion of the uncollectible
419 amount subsequently reclaimed from the Federal Government; the
420 number of providers, by type, that are terminated from
421 participation in the Medicaid program as a result of fraud and
422 abuse; and all costs associated with discovering and prosecuting
423 cases of Medicaid overpayments and making recoveries in such
424 cases. The report must also document actions taken to prevent
425 overpayments and the number of providers prevented from
426 enrolling in or reenrolling in the Medicaid program as a result
427 of documented Medicaid fraud and abuse and must include policy
428 recommendations necessary to prevent or recover overpayments and
429 changes necessary to prevent and detect Medicaid fraud. All
430 policy recommendations in the report must include a detailed
431 fiscal analysis, including, but not limited to, implementation
432 costs, estimated savings to the Medicaid program, and the return
433 on investment. The agency must submit the policy recommendations
434 and fiscal analyses in the report to the appropriate estimating
435 conference, pursuant to s. 216.137, by February 15 of each year.
436 The agency and the Medicaid Fraud Control Unit of the Department
437 of Legal Affairs each must include detailed unit-specific
438 performance standards, benchmarks, and metrics in the report,
439 including projected cost savings to the state Medicaid program
440 during the following fiscal year.
441 (1) For the purposes of this section, the term:
442 (e) “Medicaid provider” or “provider” has the same meaning
443 as provided in s. 409.901 and, for purposes of oversight of the
444 integrity of the Medicaid program, also includes a participant
445 in a Medicaid managed care provider network.
446 (2) The agency shall conduct, or cause to be conducted by
447 contract or otherwise, reviews, investigations, analyses,
448 audits, or any combination thereof, to determine possible fraud,
449 abuse, overpayment, or recipient neglect in the Medicaid program
450 and shall report the findings of any overpayments in audit
451 reports as appropriate. At least 5 percent of all audits must
452 shall be conducted on a random basis. As part of its ongoing
453 fraud detection activities, the agency shall identify and
454 monitor, by contract or otherwise, patterns of overutilization
455 of Medicaid services based on state averages. The agency shall
456 track Medicaid provider prescription and billing patterns and
457 evaluate them against Medicaid medical necessity criteria and
458 coverage and limitation guidelines adopted by rule. Medical
459 necessity determination requires that service be consistent with
460 symptoms or confirmed diagnosis of illness or injury under
461 treatment and not in excess of the patient’s needs. The agency
462 shall conduct reviews of provider exceptions to peer group norms
463 and shall, using statistical methodologies, provider profiling,
464 and analysis of billing patterns, detect and investigate
465 abnormal or unusual increases in billing or payment of claims
466 for Medicaid services and medically unnecessary provision of
467 services. The agency may review and analyze information from
468 sources other than enrolled Medicaid providers in conducting its
469 activities under this subsection.
470 (9) A Medicaid provider shall retain medical, professional,
471 financial, and business records pertaining to services and goods
472 furnished to a Medicaid recipient and billed to Medicaid for 6 a
473 period of 5 years after the date of furnishing such services or
474 goods. The agency may investigate, review, or analyze such
475 records, which must be made available during normal business
476 hours. However, 24-hour notice must be provided if patient
477 treatment would be disrupted. The provider is responsible for
478 furnishing to the agency, and keeping the agency informed of the
479 location of, the provider’s Medicaid-related records. The
480 authority of the agency to obtain Medicaid-related records from
481 a provider is neither curtailed nor limited during a period of
482 litigation between the agency and the provider.
483 (13) The agency shall immediately terminate participation
484 of a Medicaid provider in the Medicaid program and may seek
485 civil remedies or impose other administrative sanctions against
486 a Medicaid provider, if the provider or any principal, officer,
487 director, agent, managing employee, or affiliated person of the
488 provider, or any partner or shareholder having an ownership
489 interest in the provider equal to 5 percent or greater, has been
490 convicted of a criminal offense under federal law or the law of
491 any state relating to the practice of the provider’s profession,
492 or an offense listed under s. 409.907(10), s. 408.809(4), or s.
493 435.04(2) has been:
494 (a) Convicted of a criminal offense related to the delivery
495 of any health care goods or services, including the performance
496 of management or administrative functions relating to the
497 delivery of health care goods or services;
498 (b) Convicted of a criminal offense under federal law or
499 the law of any state relating to the practice of the provider’s
500 profession; or
501 (c) Found by a court of competent jurisdiction to have
502 neglected or physically abused a patient in connection with the
503 delivery of health care goods or services. If the agency
504 determines that the a provider did not participate or acquiesce
505 in the an offense specified in paragraph (a), paragraph (b), or
506 paragraph (c), termination will not be imposed. If the agency
507 effects a termination under this subsection, the agency shall
508 issue an immediate final order pursuant to s. 120.569(2)(n).
509 (15) The agency shall seek a remedy provided by law,
510 including, but not limited to, any remedy provided in
511 subsections (13) and (16) and s. 812.035, if:
512 (a) The provider’s license has not been renewed, or has
513 been revoked, suspended, or terminated, for cause, by the
514 licensing agency of any state;
515 (b) The provider has failed to make available or has
516 refused access to Medicaid-related records to an auditor,
517 investigator, or other authorized employee or agent of the
518 agency, the Attorney General, a state attorney, or the Federal
519 Government;
520 (c) The provider has not furnished or has failed to make
521 available such Medicaid-related records as the agency has found
522 necessary to determine whether Medicaid payments are or were due
523 and the amounts thereof;
524 (d) The provider has failed to maintain medical records
525 made at the time of service, or prior to service if prior
526 authorization is required, demonstrating the necessity and
527 appropriateness of the goods or services rendered;
528 (e) The provider is not in compliance with provisions of
529 Medicaid provider publications that have been adopted by
530 reference as rules in the Florida Administrative Code; with
531 provisions of state or federal laws, rules, or regulations; with
532 provisions of the provider agreement between the agency and the
533 provider; or with certifications found on claim forms or on
534 transmittal forms for electronically submitted claims that are
535 submitted by the provider or authorized representative, as such
536 provisions apply to the Medicaid program;
537 (f) The provider or person who ordered, authorized, or
538 prescribed the care, services, or supplies has furnished, or
539 ordered, or authorized the furnishing of, goods or services to a
540 recipient which are inappropriate, unnecessary, excessive, or
541 harmful to the recipient or are of inferior quality;
542 (g) The provider has demonstrated a pattern of failure to
543 provide goods or services that are medically necessary;
544 (h) The provider or an authorized representative of the
545 provider, or a person who ordered, authorized, or prescribed the
546 goods or services, has submitted or caused to be submitted false
547 or a pattern of erroneous Medicaid claims;
548 (i) The provider or an authorized representative of the
549 provider, or a person who has ordered, authorized, or prescribed
550 the goods or services, has submitted or caused to be submitted a
551 Medicaid provider enrollment application, a request for prior
552 authorization for Medicaid services, a drug exception request,
553 or a Medicaid cost report that contains materially false or
554 incorrect information;
555 (j) The provider or an authorized representative of the
556 provider has collected from or billed a recipient or a
557 recipient’s responsible party improperly for amounts that should
558 not have been so collected or billed by reason of the provider’s
559 billing the Medicaid program for the same service;
560 (k) The provider or an authorized representative of the
561 provider has included in a cost report costs that are not
562 allowable under a Florida Title XIX reimbursement plan, after
563 the provider or authorized representative had been advised in an
564 audit exit conference or audit report that the costs were not
565 allowable;
566 (l) The provider is charged by information or indictment
567 with fraudulent billing practices or any offense referenced in
568 subsection (13). The sanction applied for this reason is limited
569 to suspension of the provider’s participation in the Medicaid
570 program for the duration of the indictment unless the provider
571 is found guilty pursuant to the information or indictment;
572 (m) The provider or a person who has ordered, authorized,
573 or prescribed the goods or services is found liable for
574 negligent practice resulting in death or injury to the
575 provider’s patient;
576 (n) The provider fails to demonstrate that it had available
577 during a specific audit or review period sufficient quantities
578 of goods, or sufficient time in the case of services, to support
579 the provider’s billings to the Medicaid program;
580 (o) The provider has failed to comply with the notice and
581 reporting requirements of s. 409.907;
582 (p) The agency has received reliable information of patient
583 abuse or neglect or of any act prohibited by s. 409.920; or
584 (q) The provider has failed to comply with an agreed-upon
585 repayment schedule.
586
587 A provider is subject to sanctions for violations of this
588 subsection as the result of actions or inactions of the
589 provider, or actions or inactions of any principal, officer,
590 director, agent, managing employee, or affiliated person of the
591 provider, or any partner or shareholder having an ownership
592 interest in the provider equal to 5 percent or greater, in which
593 the provider participated or acquiesced.
594 (16) The agency shall impose any of the following sanctions
595 or disincentives on a provider or a person for any of the acts
596 described in subsection (15):
597 (a) Suspension for a specific period of time of not more
598 than 1 year. Suspension precludes shall preclude participation
599 in the Medicaid program, which includes any action that results
600 in a claim for payment to the Medicaid program as a result of
601 furnishing, supervising a person who is furnishing, or causing a
602 person to furnish goods or services.
603 (b) Termination for a specific period of time of from more
604 than 1 year to 20 years. Termination precludes shall preclude
605 participation in the Medicaid program, which includes any action
606 that results in a claim for payment to the Medicaid program as a
607 result of furnishing, supervising a person who is furnishing, or
608 causing a person to furnish goods or services.
609 (c) Imposition of a fine of up to $5,000 for each
610 violation. Each day that an ongoing violation continues, such as
611 refusing to furnish Medicaid-related records or refusing access
612 to records, is considered, for the purposes of this section, to
613 be a separate violation. Each instance of improper billing of a
614 Medicaid recipient; each instance of including an unallowable
615 cost on a hospital or nursing home Medicaid cost report after
616 the provider or authorized representative has been advised in an
617 audit exit conference or previous audit report of the cost
618 unallowability; each instance of furnishing a Medicaid recipient
619 goods or professional services that are inappropriate or of
620 inferior quality as determined by competent peer judgment; each
621 instance of knowingly submitting a materially false or erroneous
622 Medicaid provider enrollment application, request for prior
623 authorization for Medicaid services, drug exception request, or
624 cost report; each instance of inappropriate prescribing of drugs
625 for a Medicaid recipient as determined by competent peer
626 judgment; and each false or erroneous Medicaid claim leading to
627 an overpayment to a provider is considered, for the purposes of
628 this section, to be a separate violation.
629 (d) Immediate suspension, if the agency has received
630 information of patient abuse or neglect or of any act prohibited
631 by s. 409.920. Upon suspension, the agency must issue an
632 immediate final order under s. 120.569(2)(n).
633 (e) A fine, not to exceed $10,000, for a violation of
634 paragraph (15)(i).
635 (f) Imposition of liens against provider assets, including,
636 but not limited to, financial assets and real property, not to
637 exceed the amount of fines or recoveries sought, upon entry of
638 an order determining that such moneys are due or recoverable.
639 (g) Prepayment reviews of claims for a specified period of
640 time.
641 (h) Comprehensive followup reviews of providers every 6
642 months to ensure that they are billing Medicaid correctly.
643 (i) Corrective-action plans that would remain in effect for
644 providers for up to 3 years and that are would be monitored by
645 the agency every 6 months while in effect.
646 (j) Other remedies as permitted by law to effect the
647 recovery of a fine or overpayment.
648
649 If a provider voluntarily relinquishes its Medicaid provider
650 number after receiving written notice that the agency is
651 conducting, or has conducted, an audit or investigation and the
652 sanction of suspension or termination will be imposed for
653 noncompliance discovered as a result of the audit or
654 investigation, the agency shall impose the sanction of
655 termination for cause against the provider. The Secretary of
656 Health Care Administration may make a determination that
657 imposition of a sanction or disincentive is not in the best
658 interest of the Medicaid program, in which case a sanction or
659 disincentive may shall not be imposed.
660 (21) When making a determination that an overpayment has
661 occurred, the agency shall prepare and issue an audit report to
662 the provider showing the calculation of overpayments. The
663 agency’s determination shall be based solely upon information
664 available to it before issuance of the audit report and, in the
665 case of documentation obtained to substantiate claims for
666 Medicaid reimbursement, based solely upon contemporaneous
667 records.
668 (22) The audit report, supported by agency work papers,
669 showing an overpayment to a provider constitutes evidence of the
670 overpayment. A provider may not present or elicit testimony,
671 either on direct examination or cross-examination in any court
672 or administrative proceeding, regarding the purchase or
673 acquisition by any means of drugs, goods, or supplies; sales or
674 divestment by any means of drugs, goods, or supplies; or
675 inventory of drugs, goods, or supplies, unless such acquisition,
676 sales, divestment, or inventory is documented by written
677 invoices, written inventory records, or other competent written
678 documentary evidence maintained in the normal course of the
679 provider’s business. Testimony or evidence that is not based
680 upon contemporaneous records or that was not furnished to the
681 agency within 21 days after the issuance of the audit report is
682 inadmissible in an administrative hearing on a Medicaid
683 overpayment or an administrative sanction. Notwithstanding the
684 applicable rules of discovery, all documentation to that will be
685 offered as evidence at an administrative hearing on a Medicaid
686 overpayment or an administrative sanction must be exchanged by
687 all parties at least 14 days before the administrative hearing
688 or must be excluded from consideration.
689 (25)(a) The agency shall withhold Medicaid payments, in
690 whole or in part, to a provider upon receipt of reliable
691 evidence that the circumstances giving rise to the need for a
692 withholding of payments involve fraud, willful
693 misrepresentation, or abuse under the Medicaid program, or a
694 crime committed while rendering goods or services to Medicaid
695 recipients. If it is determined that fraud, willful
696 misrepresentation, abuse, or a crime did not occur, the payments
697 withheld must be paid to the provider within 14 days after such
698 determination with interest at the rate of 10 percent a year.
699 Any money withheld in accordance with this paragraph shall be
700 placed in a suspended account, readily accessible to the agency,
701 so that any payment ultimately due the provider shall be made
702 within 14 days.
703 (b) The agency shall deny payment, or require repayment, if
704 the goods or services were furnished, supervised, or caused to
705 be furnished by a person who has been suspended or terminated
706 from the Medicaid program or Medicare program by the Federal
707 Government or any state.
708 (c) Overpayments owed to the agency bear interest at the
709 rate of 10 percent per year from the date of determination of
710 the overpayment by the agency, and payment arrangements
711 regarding overpayments and fines must be made within 30 days
712 after the date of the final order and are not subject to further
713 appeal at the conclusion of legal proceedings. A provider who
714 does not enter into or adhere to an agreed-upon repayment
715 schedule may be terminated by the agency for nonpayment or
716 partial payment.
717 (d) The agency, upon entry of a final agency order, a
718 judgment or order of a court of competent jurisdiction, or a
719 stipulation or settlement, may collect the moneys owed by all
720 means allowable by law, including, but not limited to, notifying
721 any fiscal intermediary of Medicare benefits that the state has
722 a superior right of payment. Upon receipt of such written
723 notification, the Medicare fiscal intermediary shall remit to
724 the state the sum claimed.
725 (e) The agency may institute amnesty programs to allow
726 Medicaid providers the opportunity to voluntarily repay
727 overpayments. The agency may adopt rules to administer such
728 programs.
729 (28) Venue for all Medicaid program integrity overpayment
730 cases lies shall lie in Leon County, at the discretion of the
731 agency.
732 (29) Notwithstanding other provisions of law, the agency
733 and the Medicaid Fraud Control Unit of the Department of Legal
734 Affairs may review a person’s or provider’s Medicaid-related and
735 non-Medicaid-related records in order to determine the total
736 output of a provider’s practice to reconcile quantities of goods
737 or services billed to Medicaid with quantities of goods or
738 services used in the provider’s total practice.
739 (30) The agency shall terminate a provider’s participation
740 in the Medicaid program if the provider fails to reimburse an
741 overpayment or pay a fine that has been determined by final
742 order, not subject to further appeal, within 30 35 days after
743 the date of the final order, unless the provider and the agency
744 have entered into a repayment agreement.
745 (31) If a provider requests an administrative hearing
746 pursuant to chapter 120, such hearing must be conducted within
747 90 days following assignment of an administrative law judge,
748 absent exceptionally good cause shown as determined by the
749 administrative law judge or hearing officer. Upon issuance of a
750 final order, the outstanding balance of the amount determined to
751 constitute the overpayment and fines is shall become due. If a
752 provider fails to make payments in full, fails to enter into a
753 satisfactory repayment plan, or fails to comply with the terms
754 of a repayment plan or settlement agreement, the agency shall
755 withhold medical assistance reimbursement payments for Medicaid
756 services until the amount due is paid in full.
757 Section 7. Subsection (8) of section 409.920, Florida
758 Statutes, is amended to read:
759 409.920 Medicaid provider fraud.—
760 (8) A person who provides the state, any state agency, any
761 of the state’s political subdivisions, or any agency of the
762 state’s political subdivisions with information about fraud or
763 suspected fraudulent acts fraud by a Medicaid provider,
764 including a managed care organization, is immune from civil
765 liability for libel, slander, or any other relevant tort for
766 providing any the information about fraud or suspected
767 fraudulent acts, unless the person acted with knowledge that the
768 information was false or with reckless disregard for the truth
769 or falsity of the information. For purposes of this subsection,
770 the term “fraudulent acts” includes actual or suspected fraud,
771 abuse, or overpayment, including any fraud-related matters that
772 a provider or health plan is required to report to the agency or
773 a law enforcement agency. The immunity from civil liability
774 extends to reports of fraudulent acts conveyed to the agency in
775 any manner, including any forum and with any audience as
776 directed by the agency, and includes all discussions subsequent
777 to the report and subsequent inquiries from the agency, unless
778 the person acted with knowledge that the information was false
779 or with reckless disregard for the truth or falsity of the
780 information.
781 Section 8. Paragraph (c) of subsection (2) of section
782 409.967, Florida Statutes, is amended to read:
783 409.967 Managed care plan accountability.—
784 (2) The agency shall establish such contract requirements
785 as are necessary for the operation of the statewide managed care
786 program. In addition to any other provisions the agency may deem
787 necessary, the contract must require:
788 (c) Access.—
789 1. Providers.—The agency shall establish specific standards
790 for the number, type, and regional distribution of providers in
791 managed care plan networks to ensure access to care for both
792 adults and children. Each plan must maintain a regionwide
793 network of providers in sufficient numbers to meet the access
794 standards for specific medical services for all recipients
795 enrolled in the plan. The exclusive use of mail-order pharmacies
796 is may not be sufficient to meet network access standards.
797 Consistent with the standards established by the agency,
798 provider networks may include providers located outside the
799 region. A plan may contract with a new hospital facility before
800 the date the hospital becomes operational if the hospital has
801 commenced construction, will be licensed and operational by
802 January 1, 2013, and a final order has issued in any civil or
803 administrative challenge. Each plan shall establish and maintain
804 an accurate and complete electronic database of contracted
805 providers, including information about licensure or
806 registration, locations and hours of operation, specialty
807 credentials and other certifications, specific performance
808 indicators, and such other information as the agency deems
809 necessary. The database must be available online to both the
810 agency and the public and have the capability to compare the
811 availability of providers to network adequacy standards and to
812 accept and display feedback from each provider’s patients. Each
813 plan shall submit quarterly reports to the agency identifying
814 the number of enrollees assigned to each primary care provider.
815 2. Prescribed drugs.—
816 a. If establishing a prescribed drug formulary or preferred
817 drug list, a managed care plan must:
818 (I) Provide a broad range of therapeutic options for the
819 treatment of disease states consistent with the general needs of
820 an outpatient population. Whenever feasible, the formulary or
821 preferred drug list should include at least two products in a
822 therapeutic class;
823 (II) Include coverage via prior authorization for each drug
824 newly approved by the federal Food and Drug Administration until
825 the plan’s Pharmaceutical and Therapeutics Committee reviews
826 such drug for inclusion on the formulary. The timing of the
827 formulary review must comply with s. 409.91195; and
828 (III) Provide a response within 24 hours after receipt of
829 all necessary information from the medical provider for a
830 request for prior authorization and provide a procedure for
831 escalating a delayed prior authorization request to the pharmacy
832 management team for resolution or to override other medical
833 management tools.
834 b. Each managed care plan shall must publish any prescribed
835 drug formulary or preferred drug list on the plan’s website in a
836 manner that is accessible to and searchable by enrollees and
837 providers. The plan must update the list within 24 hours after
838 making a change. Each plan must ensure that the prior
839 authorization process for prescribed drugs is readily accessible
840 to health care providers, including posting appropriate contact
841 information on its website and providing timely responses to
842 providers.
843 c. The managed care plan must continue to permit an
844 enrollee who was receiving a prescription drug that was on the
845 plan’s formulary and subsequently removed or changed to continue
846 to receive that drug if the provider submits a written request
847 that demonstrates that the drug is medically necessary, and the
848 enrollee meets clinical criteria to receive the drug.
849 d. A managed care plan that imposes a step-therapy or a
850 fail-first protocol must do so in accordance with the following:
851 (I) If prescribed drugs for the treatment of a medical
852 condition are restricted for use by the plan through a step
853 therapy or fail-first protocol, the plan must provide the
854 prescriber with access to a clear and convenient process to
855 expeditiously request a prior authorization that includes a
856 procedure for escalation to the pharmacy management team if not
857 resolved in a timely manner.
858 (II) Escalation to the pharmacy management team must be
859 expeditiously granted by the plan if the prescriber can submit
860 appropriate and complete medical documentation to the plan that
861 the preferred treatment required under the step-therapy or fail
862 first protocol:
863 (A) Has been ineffective in the treatment of the enrollee’s
864 disease or medical condition;
865 (B) Is reasonably expected to be ineffective based on the
866 known relevant physical or mental characteristics and medical
867 history of the enrollee and known characteristics of the drug
868 regimen; or
869 (C) Will cause or will likely cause an adverse reaction or
870 other physical harm to the enrollee.
871 (III) The pharmacy management team shall work directly with
872 the medical provider to bring the prior-authorization request to
873 a clinically appropriate, cost-effective, and timely resolution.
874 e. For enrollees Medicaid recipients diagnosed with
875 hemophilia who have been prescribed anti-hemophilic-factor
876 replacement products, the agency shall provide for those
877 products and hemophilia overlay services through the agency’s
878 hemophilia disease management program.
879 3. Prior authorization.—
880 a. Each managed care plan must ensure that the prior
881 authorization process for prescribed drugs is readily accessible
882 to health care providers, including posting appropriate contact
883 information on its website and providing timely responses to
884 providers.
885 b. If a drug, determined to be medically necessary and
886 prescribed for an enrollee by a physician using sound clinical
887 judgment, is subject to prior authorization and approved, the
888 managed care plan must provide for sufficient refills to
889 complete the duration of the prescription. If the medication is
890 still clinically appropriate for ongoing therapy after the
891 initial prior authorization expires, the plan must provide a
892 process of expedited review to evaluate ongoing therapy.
893 c. If a prescribed drug requires prior authorization, the
894 managed care plan shall reimburse the pharmacist for dispensing
895 a 72-hour supply of oral maintenance medications to the enrollee
896 and process the prior authorization request. Dispensing a 72
897 hour supply must be consistent with laws that govern pharmacy
898 practice and controlled substances. The managed care plan shall
899 process all prior authorization requests in as timely a manner
900 as possible.
901 d.3. Managed care plans, and their fiscal agents or
902 intermediaries, must accept prior authorization requests for
903 prescribed drugs any service electronically.
904 Section 9. Subsection (11) is added to section 429.23,
905 Florida Statutes, to read:
906 429.23 Internal risk management and quality assurance
907 program; adverse incidents and reporting requirements.—
908 (11) The agency shall annually submit a report to the
909 Legislature on adverse incident reports by assisted living
910 facilities. The report must include the following information
911 arranged by county:
912 (a) A total number of adverse incidents;
913 (b) A listing, by category, of the type of adverse
914 incidents occurring within each category and the type of staff
915 involved;
916 (c) A listing, by category, of the types of injuries, if
917 any, and the number of injuries occurring within each category;
918 (d) Types of liability claims filed based on an adverse
919 incident report or reportable injury; and
920 (e) Disciplinary action taken against staff, categorized by
921 the type of staff involved.
922 Section 10. Present subsections (9), (10), and (11) of
923 section 429.26, Florida Statutes, are renumbered as subsections
924 (12), (13), and (14), respectively, and new subsections (9),
925 (10), and (11) are added to that section, to read:
926 429.26 Appropriateness of placements; examinations of
927 residents.—
928 (9) If, at any time after admission to a facility, agency
929 personnel question whether a resident needs care beyond that
930 which the facility is licensed to provide, the agency may
931 require the resident to be physically examined by a licensed
932 physician, licensed physician assistant, or certified nurse
933 practitioner. To the extent possible, the examination must be
934 performed by the resident’s preferred physician, physician
935 assistant, or nurse practitioner and paid for by the resident
936 with personal funds, except as provided in s. 429.18(2). This
937 subsection does not preclude the agency from imposing sanctions
938 for violations of subsection (1).
939 (a) Following examination, the examining physician,
940 physician assistant, or nurse practitioner shall complete and
941 sign a medical form provided by the agency. The completed
942 medical form must be submitted to the agency within 30 days
943 after the date the facility owner or administrator was notified
944 by the agency that a physical examination is required.
945 (b) A medical review team designated by the agency shall
946 determine whether the resident is appropriately residing in the
947 facility based on the completed medical form and, if necessary,
948 consultation with the physician, physician assistant, or nurse
949 practitioner who performed the examination. Members of the
950 medical review team making the determination may not include the
951 agency personnel who initially questioned the appropriateness of
952 the resident’s placement. The medical review team shall base its
953 decision on a comprehensive review of the resident’s physical
954 and functional status. A determination that the resident’s
955 placement is not appropriate is final and binding upon the
956 facility and the resident.
957 (c) A resident who is determined by the medical review team
958 to be inappropriately residing in a facility shall be given 30
959 days’ written notice to relocate by the owner or administrator,
960 unless the resident’s continued residence in the facility
961 presents an imminent danger to the health, safety, or welfare of
962 the resident or a substantial probability exists that death or
963 serious physical harm to the resident would result if the
964 resident is allowed to remain in the facility.
965 (10) If a mental health resident appears to have needs in
966 addition to those identified in the community living support
967 plan, the agency may require an evaluation by a mental health
968 professional, as determined by the Department of Children and
969 Family Services.
970 (11) A facility may not be required to retain a resident
971 who requires more services or care than the facility is able to
972 provide in accordance with its policies and criteria for
973 admission and continued residency.
974 Section 11. Effective July 1, 2012, section 456.0635,
975 Florida Statutes, is amended to read:
976 456.0635 Health care Medicaid fraud; disqualification for
977 license, certificate, or registration.—
978 (1) Health care Medicaid fraud in the practice of a health
979 care profession is prohibited.
980 (2) Each board under within the jurisdiction of the
981 department, or the department if there is no board, shall refuse
982 to admit a candidate to an any examination and refuse to issue
983 or renew a license, certificate, or registration to an any
984 applicant if the candidate or applicant or any principal,
985 officer, agent, managing employee, or affiliated person of the
986 applicant, has been:
987 (a) Has been convicted of, or entered a plea of guilty or
988 nolo contendere to, regardless of adjudication, a felony under
989 chapter 409, chapter 817, or chapter 893, or a similar felony
990 offense committed in another state or jurisdiction, unless the
991 candidate or applicant has successfully completed a drug court
992 program for that felony and provides proof that the plea has
993 been withdrawn or the charges have been dismissed. Any such
994 conviction or plea shall exclude the applicant or candidate from
995 licensure, examination, certification, or registration 21 U.S.C.
996 ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and
997 any subsequent period of probation for such conviction or plea
998 pleas ended: more than 15 years prior to the date of the
999 application;
1000 1. For felonies of the first or second degree, more than 15
1001 years before the date of application.
1002 2. For felonies of the third degree, more than 10 years
1003 before the date of application, except for felonies of the third
1004 degree under s. 893.13(6)(a).
1005 3. For felonies of the third degree under s. 893.13(6)(a),
1006 more than 5 years before the date of application.
1007 (b) Has been convicted of, or entered a plea of guilty or
1008 nolo contendere to, regardless of adjudication, a felony under
1009 21 U.S.C. ss. 801-970 or 42 U.S.C. ss. 1395-1396, unless the
1010 sentence and any subsequent period of probation for such
1011 conviction or plea ended more than 15 years before the date of
1012 the application.
1013 (c)(b) Has been terminated for cause from the Florida
1014 Medicaid program pursuant to s. 409.913, unless the candidate or
1015 applicant has been in good standing with the Florida Medicaid
1016 program for the most recent 5 years.;
1017 (d)(c) Has been terminated for cause, pursuant to the
1018 appeals procedures established by the state or Federal
1019 Government, from any other state Medicaid program or the federal
1020 Medicare program, unless the candidate or applicant has been in
1021 good standing with that a state Medicaid program or the federal
1022 Medicare program for the most recent 5 years and the termination
1023 occurred at least 20 years before prior to the date of the
1024 application.
1025 (e) Is currently listed on the United States Department of
1026 Health and Human Services Office of Inspector General’s List of
1027 Excluded Individuals and Entities.
1028
1029 This subsection does not apply to candidates or applicants for
1030 initial licensure or certification who were enrolled in an
1031 educational or training program on or before July 1, 2009, which
1032 was recognized by a board or, if there is no board, recognized
1033 by the department, and who applied for licensure after July 1,
1034 2012.
1035 (3) The department shall refuse to renew a license,
1036 certificate, or registration of any applicant if the applicant
1037 or any principal, officer, agent, managing employee, or
1038 affiliated person of the applicant:
1039 (a) Has been convicted of, or entered a plea of guilty or
1040 nolo contendere to, regardless of adjudication, a felony under
1041 chapter 409, chapter 817, or chapter 893, or a similar felony
1042 offense committed in another state or jurisdiction, unless the
1043 applicant is currently enrolled in a drug court program that
1044 allows the withdrawal of the plea for that felony upon
1045 successful completion of that program. Any such conviction or
1046 plea excludes the applicant or candidate from licensure,
1047 examination, certification, or registration unless the sentence
1048 and any subsequent period of probation for such conviction or
1049 plea ended:
1050 1. For felonies of the first or second degree, more than 15
1051 years before the date of application.
1052 2. For felonies of the third degree, more than 10 years
1053 before the date of application, except for felonies of the third
1054 degree under s. 893.13(6)(a).
1055 3. For felonies of the third degree under s. 893.13(6)(a),
1056 more than 5 years before the date of application.
1057 (b) Has been convicted of, or entered a plea of guilty or
1058 nolo contendere to, regardless of adjudication, a felony under
1059 21 U.S.C. ss. 801-970 or 42 U.S.C. ss. 1395-1396 since July 1,
1060 2009, unless the sentence and any subsequent period of probation
1061 for such conviction or plea ended more than 15 years before the
1062 date of the application.
1063 (c) Has been terminated for cause from the Florida Medicaid
1064 program pursuant to s. 409.913, unless the applicant has been in
1065 good standing with the Florida Medicaid program for the most
1066 recent 5 years.
1067 (d) Has been terminated for cause, pursuant to the appeals
1068 procedures established by the state, from any other state
1069 Medicaid program, unless the applicant has been in good standing
1070 with that state Medicaid program for the most recent 5 years and
1071 the termination occurred at least 20 years before the date of
1072 the application.
1073 (e) Is currently listed on the United States Department of
1074 Health and Human Services Office of Inspector General’s List of
1075 Excluded Individuals and Entities.
1076 (4)(3) Licensed health care practitioners shall report
1077 allegations of health care Medicaid fraud to the department,
1078 regardless of the practice setting in which the alleged health
1079 care Medicaid fraud occurred.
1080 (5)(4) The acceptance by a licensing authority of a
1081 licensee’s candidate’s relinquishment of a license which is
1082 offered in response to or anticipation of the filing of
1083 administrative charges alleging health care Medicaid fraud or
1084 similar charges constitutes the permanent revocation of the
1085 license.
1086 Section 12. Effective July 1, 2012, present subsections
1087 (14) and (15) of section 456.036, Florida Statutes, are
1088 renumbered as subsections (15) and (16), respectively, and a new
1089 subsection (14) is added to that section, to read:
1090 456.036 Licenses; active and inactive status; delinquency.—
1091 (14) A person who has been denied license renewal,
1092 certification, or registration under s. 456.0635(3) may regain
1093 licensure, certification, or registration only by meeting the
1094 qualifications and completing the application process for
1095 initial licensure as defined by the board, or the department if
1096 there is no board. However, a person who was denied renewal of
1097 licensure, certification, or registration under s. 24 of chapter
1098 2009-223, Laws of Florida, between July 1, 2009, and June 30,
1099 2012, is not required to retake and pass examinations applicable
1100 for initial licensure, certification, or registration.
1101 Section 13. Subsection (1) of section 456.074, Florida
1102 Statutes, is amended to read:
1103 456.074 Certain health care practitioners; immediate
1104 suspension of license.—
1105 (1) The department shall issue an emergency order
1106 suspending the license of any person licensed under chapter 458,
1107 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1108 chapter 464, chapter 465, chapter 466, or chapter 484 who pleads
1109 guilty to, is convicted or found guilty of, or who enters a plea
1110 of nolo contendere to, regardless of adjudication, to:
1111 (a) A felony under chapter 409, chapter 817, or chapter 893
1112 or under 21 U.S.C. ss. 801-970 or under 42 U.S.C. ss. 1395-1396;
1113 or
1114 (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
1115 285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
1116 1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
1117 Medicaid program.
1118 Section 14. Subsections (3), (4), and (5) of section
1119 463.002, Florida Statutes, are amended to read:
1120 463.002 Definitions.—As used in this chapter, the term:
1121 (3)(a) “Licensed practitioner” means a person who is a
1122 primary health care provider licensed to engage in the practice
1123 of optometry under the authority of this chapter.
1124 (b) A licensed practitioner who is not a certified
1125 optometrist shall be required to display at her or his place of
1126 practice a sign which states, “I am a Licensed Practitioner, not
1127 a Certified Optometrist, and I am not able to prescribe topical
1128 ocular pharmaceutical agents.”
1129 (c) All practitioners initially licensed after July 1,
1130 1993, must be certified optometrists.
1131 (4) “Certified optometrist” means a licensed practitioner
1132 authorized by the board to administer and prescribe topical
1133 ocular pharmaceutical agents.
1134 (5) “Optometry” means the diagnosis of conditions of the
1135 human eye and its appendages; the employment of any objective or
1136 subjective means or methods, including the administration of
1137 topical ocular pharmaceutical agents, for the purpose of
1138 determining the refractive powers of the human eyes, or any
1139 visual, muscular, neurological, or anatomic anomalies of the
1140 human eyes and their appendages; and the prescribing and
1141 employment of lenses, prisms, frames, mountings, contact lenses,
1142 orthoptic exercises, light frequencies, and any other means or
1143 methods, including topical ocular pharmaceutical agents, for the
1144 correction, remedy, or relief of any insufficiencies or abnormal
1145 conditions of the human eyes and their appendages.
1146 Section 15. Paragraph (g) of subsection (1) of section
1147 463.005, Florida Statutes, is amended to read:
1148 463.005 Authority of the board.—
1149 (1) The Board of Optometry has authority to adopt rules
1150 pursuant to ss. 120.536(1) and 120.54 to implement the
1151 provisions of this chapter conferring duties upon it. Such rules
1152 shall include, but not be limited to, rules relating to:
1153 (g) Administration and prescription of topical ocular
1154 pharmaceutical agents.
1155 Section 16. Section 463.0055, Florida Statutes, is amended
1156 to read:
1157 463.0055 Administration and prescription of topical ocular
1158 pharmaceutical agents; committee.—
1159 (1)(a) Certified optometrists may administer and prescribe
1160 topical ocular pharmaceutical agents as provided in this section
1161 for the diagnosis and treatment of ocular conditions of the
1162 human eye and its appendages without the use of surgery or other
1163 invasive techniques. However, a licensed practitioner who is not
1164 certified may use topically applied anesthetics solely for the
1165 purpose of glaucoma examinations, but is otherwise prohibited
1166 from administering or prescribing topical ocular pharmaceutical
1167 agents.
1168 (b) Before a certified optometrist may administer or
1169 prescribe oral ocular pharmaceutical agents, the certified
1170 optometrist must complete a course and subsequent examination on
1171 general and ocular pharmacology which have a particular emphasis
1172 on the ingestion of oral pharmaceutical agents and the side
1173 effects of those agents. For certified optometrists licensed
1174 before January 1, 1990, the course shall consist of 50 contact
1175 hours and 25 of those hours shall be Internet-based. For
1176 certified optometrists licensed on or after January 1, 1990, the
1177 course shall consist of 20 contact hours and 10 of those hours
1178 shall be Internet-based. The first course and examination shall
1179 be presented by January 1, 2013, and shall thereafter be
1180 administered at least annually. The Florida Medical Association
1181 and the Florida Optometric Association shall jointly develop and
1182 administer a course and examination for such purpose and jointly
1183 determine the site or sites for the course and examination.
1184 (2)(a) There is hereby created a committee composed of two
1185 certified optometrists licensed pursuant to this chapter,
1186 appointed by the Board of Optometry, two board-certified
1187 ophthalmologists licensed pursuant to chapter 458 or chapter
1188 459, appointed by the Board of Medicine, and one additional
1189 person with a doctorate degree in pharmacology who is not
1190 licensed pursuant to chapter 458, chapter 459, or this chapter,
1191 appointed by the State Surgeon General. The committee shall
1192 review requests for additions to, deletions from, or
1193 modifications of a formulary of topical ocular pharmaceutical
1194 agents for administration and prescription by certified
1195 optometrists and shall provide to the board advisory opinions
1196 and recommendations on such requests. The formulary of topical
1197 ocular pharmaceutical agents shall consist of those topical
1198 ocular pharmaceutical agents that are appropriate to treat and
1199 diagnose ocular diseases and disorders and that which the
1200 certified optometrist is qualified to use in the practice of
1201 optometry. The board shall establish, add to, delete from, or
1202 modify the formulary by rule. Notwithstanding any provision of
1203 chapter 120 to the contrary, the formulary rule shall become
1204 effective 60 days from the date it is filed with the Secretary
1205 of State.
1206 (b) The topical formulary may be added to, deleted from, or
1207 modified according to the procedure described in paragraph (a).
1208 Any person who requests an addition, deletion, or modification
1209 of an authorized topical ocular pharmaceutical agent shall have
1210 the burden of proof to show cause why such addition, deletion,
1211 or modification should be made.
1212 (c) The State Surgeon General shall have standing to
1213 challenge any rule or proposed rule of the board pursuant to s.
1214 120.56. In addition to challenges for any invalid exercise of
1215 delegated legislative authority, the administrative law judge,
1216 upon such a challenge by the State Surgeon General, may declare
1217 all or part of a rule or proposed rule invalid if it:
1218 1. Does not protect the public from any significant and
1219 discernible harm or damages;
1220 2. Unreasonably restricts competition or the availability
1221 of professional services in the state or in a significant part
1222 of the state; or
1223 3. Unnecessarily increases the cost of professional
1224 services without a corresponding or equivalent public benefit.
1225
1226 However, there shall not be created a presumption of the
1227 existence of any of the conditions cited in this subsection in
1228 the event that the rule or proposed rule is challenged.
1229 (d) Upon adoption of the topical formulary required by this
1230 section, and upon each addition, deletion, or modification to
1231 the topical formulary, the board shall mail a copy of the
1232 amended topical formulary to each certified optometrist and to
1233 each pharmacy licensed by the state.
1234 (3) In addition to the formulary of topical ocular
1235 pharmaceutical agents in subsection (2), there is created a
1236 statutory formulary of oral pharmaceutical agents, which include
1237 the following agents:
1238 (a) The following analgesics, or their generic or
1239 therapeutic equivalents, which may not be administered or
1240 prescribed for more than 72 hours without consultation with a
1241 physician licensed under chapter 458 or chapter 459 who is
1242 skilled in diseases of the eye:
1243 1. Tramadol hydrochloride.
1244 2. Acetaminophen 300 mg with No. 3 codeine phosphate 30 mg.
1245 (b) The following antibiotics, or their generic or
1246 therapeutic equivalents:
1247 1. Amoxicillin.
1248 2. Azithromycin.
1249 3. Ciprofloxacin.
1250 4. Dicloxacillin.
1251 5. Doxycycline.
1252 6. Keflex.
1253 7. Minocycline.
1254 (c) The following antivirals, or their generic or
1255 therapeutic equivalents:
1256 1. Acyclovir.
1257 2. Famciclovir.
1258 3. Valacyclovir.
1259 (d) The following oral anti-glaucoma agents, or their
1260 generic or therapeutic equivalents, which may not be
1261 administered or prescribed for more than 72 hours without
1262 consultation with a physician licensed under chapter 458 or
1263 chapter 459 who is skilled in diseases of the eye:
1264 1. Acetazolamide.
1265 2. Methazolamide.
1266
1267 Any oral pharmaceutical agent listed in the statutory formulary
1268 set forth in this subsection which is subsequently determined by
1269 the United States Food and Drug Administration to be unsafe for
1270 administration or prescription shall be considered to have been
1271 deleted from the formulary of oral pharmaceutical agents. The
1272 oral pharmaceutical agents on the statutory formulary set forth
1273 in this subsection may not otherwise be deleted by the board,
1274 the department, or the State Surgeon General.
1275 (4)(3) A certified optometrist shall be issued a prescriber
1276 number by the board. Any prescription written by a certified
1277 optometrist for a topical ocular pharmaceutical agent pursuant
1278 to this section shall have the prescriber number printed
1279 thereon.
1280 Section 17. Subsection (3) of section 463.0057, Florida
1281 Statutes, is amended to read:
1282 463.0057 Optometric faculty certificate.—
1283 (3) The holder of a faculty certificate may engage in the
1284 practice of optometry as permitted by this section, but may not
1285 administer or prescribe topical ocular pharmaceutical agents
1286 unless the certificateholder has satisfied the requirements of
1287 ss. 463.0055(1)(b) and s. 463.006(1)(b)4. and 5.
1288 Section 18. Subsections (2) and (3) of section 463.006,
1289 Florida Statutes, are amended to read:
1290 463.006 Licensure and certification by examination.—
1291 (2) The examination shall consist of the appropriate
1292 subjects, including applicable state laws and rules and general
1293 and ocular pharmacology with emphasis on the use topical
1294 application and side effects of ocular pharmaceutical agents.
1295 The board may by rule substitute a national examination as part
1296 or all of the examination and may by rule offer a practical
1297 examination in addition to the written examination.
1298 (3) Each applicant who successfully passes the examination
1299 and otherwise meets the requirements of this chapter is entitled
1300 to be licensed as a practitioner and to be certified to
1301 administer and prescribe topical ocular pharmaceutical agents in
1302 the diagnosis and treatment of ocular conditions.
1303 Section 19. Subsections (1) and (2) of section 463.0135,
1304 Florida Statutes, are amended, and subsection (10) is added to
1305 that section, to read:
1306 463.0135 Standards of practice.—
1307 (1) A licensed practitioner shall provide that degree of
1308 care which conforms to that level of care provided by medical
1309 practitioners in the same or similar communities. A certified
1310 optometrist shall administer and prescribe oral ocular
1311 pharmaceutical agents in a manner consistent with applicable
1312 preferred practice patterns of the American Academy of
1313 Ophthalmology. A licensed practitioner shall advise or assist
1314 her or his patient in obtaining further care when the service of
1315 another health care practitioner is required.
1316 (2) A licensed practitioner diagnosing angle closure,
1317 neovascular, infantile, or congenital forms of glaucoma shall
1318 promptly and without unreasonable delay refer the patient to a
1319 physician skilled in diseases of the eye and licensed under
1320 chapter 458 or chapter 459. In addition, a licensed practitioner
1321 shall timely refer any patient who experiences progressive
1322 glaucoma due to failed pharmaceutical intervention to a
1323 physician who is skilled in diseases of the eye and licensed
1324 under chapter 458 or chapter 459.
1325 (10) Comanagement of postoperative care shall be conducted
1326 pursuant to an established protocol that governs the
1327 relationship between the operating surgeon and the optometrist.
1328 The patient shall be informed that either physician will be
1329 available for emergency care throughout the postoperative
1330 period, and the patient shall consent in writing to the
1331 comanagement relationship.
1332 Section 20. Subsections (3) and (4) of section 463.014,
1333 Florida Statutes, are amended to read:
1334 463.014 Certain acts prohibited.—
1335 (3) Prescribing, ordering, dispensing, administering,
1336 supplying, selling, or giving any systemic drugs for the purpose
1337 of treating a systemic disease by a licensed practitioner is
1338 prohibited. However, a certified optometrist is permitted to use
1339 commonly accepted means or methods to immediately address
1340 incidents of anaphylaxis.
1341 (4) Surgery of any kind, including the use of lasers, is
1342 expressly prohibited. For purposes of this subsection, the term
1343 “surgery” means a procedure using an instrument, including
1344 lasers, scalpels, or needles, in which human tissue is cut,
1345 burned, or vaporized by incision, injection, ultrasound, laser,
1346 or radiation. The term includes procedures using instruments
1347 that require closing by suturing, clamping, or another such
1348 device. Certified optometrists may remove superficial foreign
1349 bodies. For the purposes of this subsection, the term
1350 “superficial foreign bodies” means any foreign matter that is
1351 embedded in the conjunctiva or cornea but which has not
1352 penetrated the globe.
1353 Section 21. Section 463.0141, Florida Statutes, is created
1354 to read:
1355 463.0141 Reports of adverse incidents in the practice of
1356 optometry.—
1357 (1) Any adverse incident that occurs on or after January 1,
1358 2013, in the practice of optometry must be reported to the
1359 department in the accordance with this section.
1360 (2) The required notification to the department must be
1361 submitted in writing by certified mail and postmarked within 15
1362 days after the occurrence of the adverse incident.
1363 (3) For purposes of notification to the department, the
1364 term “adverse incident,” as used in this section, means an event
1365 that is associated in whole or in part with the prescribing of
1366 an oral ocular pharmaceutical agent and that results in one of
1367 the following:
1368 (a) Any condition that requires the transfer of a patient
1369 to a hospital licensed under chapter 395;
1370 (b) Any condition that requires the patient to obtain care
1371 from a physician licensed under chapter 458 or chapter 459,
1372 other than a referral or a consultation required under this
1373 chapter;
1374 (c) Permanent physical injury to the patient;
1375 (d) Partial or complete permanent loss of sight by the
1376 patient; or
1377 (e) Death of the patient.
1378 (4) The department shall review each incident and determine
1379 whether it potentially involved conduct by the licensed
1380 practitioner which may be subject to disciplinary action, in
1381 which case s. 456.073 applies. Disciplinary action, if any,
1382 shall be taken by the board.
1383 Section 22. Subsection (1) of section 483.035, Florida
1384 Statutes, is amended to read:
1385 483.035 Clinical laboratories operated by practitioners for
1386 exclusive use; licensure and regulation.—
1387 (1) A clinical laboratory operated by one or more
1388 practitioners licensed under chapter 458, chapter 459, chapter
1389 460, chapter 461, chapter 462, chapter 463, or chapter 466,
1390 exclusively in connection with the diagnosis and treatment of
1391 their own patients, must be licensed under this part and must
1392 comply with the provisions of this part, except that the agency
1393 shall adopt rules for staffing, for personnel, including
1394 education and training of personnel, for proficiency testing,
1395 and for construction standards relating to the licensure and
1396 operation of the laboratory based upon and not exceeding the
1397 same standards contained in the federal Clinical Laboratory
1398 Improvement Amendments of 1988 and the federal regulations
1399 adopted thereunder.
1400 Section 23. Subsection (7) of section 483.041, Florida
1401 Statutes, is amended to read:
1402 483.041 Definitions.—As used in this part, the term:
1403 (7) “Licensed practitioner” means a physician licensed
1404 under chapter 458, chapter 459, chapter 460, or chapter 461, or
1405 chapter 463; a dentist licensed under chapter 466; a person
1406 licensed under chapter 462; or an advanced registered nurse
1407 practitioner licensed under part I of chapter 464; or a duly
1408 licensed practitioner from another state licensed under similar
1409 statutes who orders examinations on materials or specimens for
1410 nonresidents of the State of Florida, but who reside in the same
1411 state as the requesting licensed practitioner.
1412 Section 24. Subsection (5) of section 483.181, Florida
1413 Statutes, is amended to read:
1414 483.181 Acceptance, collection, identification, and
1415 examination of specimens.—
1416 (5) A clinical laboratory licensed under this part must
1417 accept a human specimen submitted for examination by a
1418 practitioner licensed under chapter 458, chapter 459, chapter
1419 460, chapter 461, chapter 462, chapter 463, s. 464.012, or
1420 chapter 466, if the specimen and test are the type performed by
1421 the clinical laboratory. A clinical laboratory may only refuse a
1422 specimen based upon a history of nonpayment for services by the
1423 practitioner. A clinical laboratory shall not charge different
1424 prices for tests based upon the chapter under which a
1425 practitioner submitting a specimen for testing is licensed.
1426 Section 25. Paragraph (a) of subsection (54) of section
1427 499.003, Florida Statutes, is amended to read:
1428 499.003 Definitions of terms used in this part.—As used in
1429 this part, the term:
1430 (54) “Wholesale distribution” means distribution of
1431 prescription drugs to persons other than a consumer or patient,
1432 but does not include:
1433 (a) Any of the following activities, which is not a
1434 violation of s. 499.005(21) if such activity is conducted in
1435 accordance with s. 499.01(2)(g):
1436 1. The purchase or other acquisition by a hospital or other
1437 health care entity that is a member of a group purchasing
1438 organization of a prescription drug for its own use from the
1439 group purchasing organization or from other hospitals or health
1440 care entities that are members of that organization.
1441 2. The sale, purchase, or trade of a prescription drug or
1442 an offer to sell, purchase, or trade a prescription drug by a
1443 charitable organization described in s. 501(c)(3) of the
1444 Internal Revenue Code of 1986, as amended and revised, to a
1445 nonprofit affiliate of the organization to the extent otherwise
1446 permitted by law.
1447 3. The sale, purchase, or trade of a prescription drug or
1448 an offer to sell, purchase, or trade a prescription drug among
1449 hospitals or other health care entities that are under common
1450 control. For purposes of this subparagraph, “common control”
1451 means the power to direct or cause the direction of the
1452 management and policies of a person or an organization, whether
1453 by ownership of stock, by voting rights, by contract, or
1454 otherwise.
1455 4. The sale, purchase, trade, or other transfer of a
1456 prescription drug from or for any federal, state, or local
1457 government agency or any entity eligible to purchase
1458 prescription drugs at public health services prices pursuant to
1459 Pub. L. No. 102-585, s. 602 to a contract provider or its
1460 subcontractor for eligible patients of the agency or entity
1461 under the following conditions:
1462 a. The agency or entity must obtain written authorization
1463 for the sale, purchase, trade, or other transfer of a
1464 prescription drug under this subparagraph from the State Surgeon
1465 General or his or her designee.
1466 b. The contract provider or subcontractor must be
1467 authorized by law to administer or dispense prescription drugs.
1468 c. In the case of a subcontractor, the agency or entity
1469 must be a party to and execute the subcontract.
1470 d. A contract provider or subcontractor must maintain
1471 separate and apart from other prescription drug inventory any
1472 prescription drugs of the agency or entity in its possession.
1473 d.e. The contract provider and subcontractor must maintain
1474 and produce immediately for inspection all records of movement
1475 or transfer of all the prescription drugs belonging to the
1476 agency or entity, including, but not limited to, the records of
1477 receipt and disposition of prescription drugs. Each contractor
1478 and subcontractor dispensing or administering these drugs must
1479 maintain and produce records documenting the dispensing or
1480 administration. Records that are required to be maintained
1481 include, but are not limited to, a perpetual inventory itemizing
1482 drugs received and drugs dispensed by prescription number or
1483 administered by patient identifier, which must be submitted to
1484 the agency or entity quarterly.
1485 e.f. The contract provider or subcontractor may administer
1486 or dispense the prescription drugs only to the eligible patients
1487 of the agency or entity or must return the prescription drugs
1488 for or to the agency or entity. The contract provider or
1489 subcontractor must require proof from each person seeking to
1490 fill a prescription or obtain treatment that the person is an
1491 eligible patient of the agency or entity and must, at a minimum,
1492 maintain a copy of this proof as part of the records of the
1493 contractor or subcontractor required under sub-subparagraph e.
1494 f.g. In addition to the departmental inspection authority
1495 set forth in s. 499.051, the establishment of the contract
1496 provider and subcontractor and all records pertaining to
1497 prescription drugs subject to this subparagraph shall be subject
1498 to inspection by the agency or entity. All records relating to
1499 prescription drugs of a manufacturer under this subparagraph
1500 shall be subject to audit by the manufacturer of those drugs,
1501 without identifying individual patient information.
1502 Section 26. Paragraph (b) of subsection (6) of section
1503 766.106, Florida Statutes, is amended to read:
1504 766.106 Notice before filing action for medical negligence;
1505 presuit screening period; offers for admission of liability and
1506 for arbitration; informal discovery; review.—
1507 (6) INFORMAL DISCOVERY.—
1508 (b) Informal discovery may be used by a party to obtain
1509 unsworn statements, the production of documents or things, and
1510 physical and mental examinations, and ex parte interviews, as
1511 follows:
1512 1. Unsworn statements.—Any party may require other parties
1513 to appear for the taking of an unsworn statement. Such
1514 statements may be used only for the purpose of presuit screening
1515 and are not discoverable or admissible in any civil action for
1516 any purpose by any party. A party desiring to take the unsworn
1517 statement of any party must give reasonable notice in writing to
1518 all parties. The notice must state the time and place for taking
1519 the statement and the name and address of the party to be
1520 examined. Unless otherwise impractical, the examination of any
1521 party must be done at the same time by all other parties. Any
1522 party may be represented by counsel at the taking of an unsworn
1523 statement. An unsworn statement may be recorded electronically,
1524 stenographically, or on videotape. The taking of unsworn
1525 statements is subject to the provisions of the Florida Rules of
1526 Civil Procedure and may be terminated for abuses.
1527 2. Documents or things.—Any party may request discovery of
1528 documents or things. The documents or things must be produced,
1529 at the expense of the requesting party, within 20 days after the
1530 date of receipt of the request. A party is required to produce
1531 discoverable documents or things within that party’s possession
1532 or control. Medical records shall be produced as provided in s.
1533 766.204.
1534 3. Physical and mental examinations.—A prospective
1535 defendant may require an injured claimant to appear for
1536 examination by an appropriate health care provider. The
1537 prospective defendant shall give reasonable notice in writing to
1538 all parties as to the time and place for examination. Unless
1539 otherwise impractical, a claimant is required to submit to only
1540 one examination on behalf of all potential defendants. The
1541 practicality of a single examination must be determined by the
1542 nature of the claimant’s condition, as it relates to the
1543 liability of each prospective defendant. Such examination report
1544 is available to the parties and their attorneys upon payment of
1545 the reasonable cost of reproduction and may be used only for the
1546 purpose of presuit screening. Otherwise, such examination report
1547 is confidential and exempt from the provisions of s. 119.07(1)
1548 and s. 24(a), Art. I of the State Constitution.
1549 4. Written questions.—Any party may request answers to
1550 written questions, the number of which may not exceed 30,
1551 including subparts. A response must be made within 20 days after
1552 receipt of the questions.
1553 5. Unsworn statements of treating health care providers.—A
1554 prospective defendant or his or her legal representative may
1555 also take unsworn statements of the claimant’s treating health
1556 care providers. The statements must be limited to those areas
1557 that are potentially relevant to the claim of personal injury or
1558 wrongful death. Subject to the procedural requirements of
1559 subparagraph 1., a prospective defendant may take unsworn
1560 statements from a claimant’s treating physicians. Reasonable
1561 notice and opportunity to be heard must be given to the claimant
1562 or the claimant’s legal representative before taking unsworn
1563 statements. The claimant or claimant’s legal representative has
1564 the right to attend the taking of such unsworn statements.
1565 6. Ex parte interviews of treating health care providers.—A
1566 prospective defendant or his or her legal representative may
1567 interview the claimant’s treating health care providers without
1568 the presence of the claimant or the claimant’s legal
1569 representative. If a prospective defendant or his or her legal
1570 representative intends to interview a claimant’s health care
1571 providers, the prospective defendant must provide the claimant
1572 with notice of such interview at least 10 days before the date
1573 of the interview.
1574 Section 27. Section 766.1091, Florida Statutes, is created
1575 to read:
1576 766.1091 Voluntary binding arbitration; damages.—
1577 (1) A health care provider licensed under chapter 458,
1578 chapter 459, chapter 463, or chapter 466; any entity owned in
1579 whole or in part by a health care provider licensed under
1580 chapter 458, chapter 459, chapter 463, or chapter 466; or any
1581 health care clinic licensed under part X of chapter 400, and a
1582 patient or prospective patient, may agree in writing to submit
1583 to arbitration any claim for medical negligence which may
1584 currently exist or may accrue in the future and would otherwise
1585 be brought pursuant to this chapter. Any arbitration agreement
1586 entered into pursuant to this section shall be governed by
1587 chapter 682.
1588 (2) Any arbitration agreement entered into pursuant to
1589 subsection (1) may contain a provision that limits the available
1590 damages in an arbitration award.
1591 Section 28. Subsection (21) of section 893.02, Florida
1592 Statutes, is amended to read:
1593 893.02 Definitions.—The following words and phrases as used
1594 in this chapter shall have the following meanings, unless the
1595 context otherwise requires:
1596 (21) “Practitioner” means a physician licensed pursuant to
1597 chapter 458, a dentist licensed pursuant to chapter 466, a
1598 veterinarian licensed pursuant to chapter 474, an osteopathic
1599 physician licensed pursuant to chapter 459, a naturopath
1600 licensed pursuant to chapter 462, a certified optometrist
1601 licensed under chapter 463, or a podiatric physician licensed
1602 pursuant to chapter 461, provided such practitioner holds a
1603 valid federal controlled substance registry number.
1604 Section 29. Subsection (1) of section 893.05, Florida
1605 Statutes, is amended to read:
1606 893.05 Practitioners and persons administering controlled
1607 substances in their absence.—
1608 (1) A practitioner, in good faith and in the course of his
1609 or her professional practice only, may prescribe, administer,
1610 dispense, mix, or otherwise prepare a controlled substance, or
1611 the practitioner may cause the same to be administered by a
1612 licensed nurse or an intern practitioner under his or her
1613 direction and supervision only. A veterinarian may so prescribe,
1614 administer, dispense, mix, or prepare a controlled substance for
1615 use on animals only, and may cause it to be administered by an
1616 assistant or orderly under the veterinarian’s direction and
1617 supervision only. A certified optometrist licensed under chapter
1618 463 may not administer or prescribe pharmaceutical agents in
1619 Schedule I or Schedule II of the Florida Comprehensive Drug
1620 Abuse Prevention and Control Act.
1621 Section 30. The Agency for Health Care Administration shall
1622 prepare a report within 18 months after the implementation of an
1623 expansion of managed care to new populations or the provision of
1624 new items and services. The agency shall post a draft of the
1625 report on its website and provide an opportunity for public
1626 comment. The final report shall be submitted to the Legislature,
1627 along with a description of the process for public input. The
1628 report must include an assessment of:
1629 (1) The impact of managed care on patient access to care,
1630 including an evaluation of any new barriers to the use of
1631 services and prescription drugs, created by the use of medical
1632 management or cost-containment tools.
1633 (2) The impact of the increased managed care expansion on
1634 the utilization of services, quality of care, and patient
1635 outcomes.
1636 (3) The use of prior authorization and other utilization
1637 management tools, including an assessment of whether these tools
1638 pose an undue administrative burden for health care providers or
1639 create barriers to needed care.
1640 Section 31. Except as otherwise expressly provided in this
1641 act, this act shall take effect upon becoming a law.
1642
1643
1644 ================= T I T L E A M E N D M E N T ================
1645 And the title is amended as follows:
1646 Delete everything before the enacting clause
1647 and insert:
1648 A bill to be entitled
1649 An act relating to health care; amending s. 395.002,
1650 F.S.; redefining the term “accrediting organizations”
1651 as it applies to the regulation of hospitals and other
1652 licensed facilities; amending s. 400.474, F.S.;
1653 revising the fine that may be imposed against a home
1654 health agency for failing to timely submit certain
1655 information to the Agency for Health Care
1656 Administration; amending s. 400.9905, F.S.; revising
1657 the definition of the term “clinic” as it relates to
1658 the Health Care Clinic Act; amending s. 409.221, F.S.;
1659 revising the background screening requirements for
1660 persons rendering care in the consumer-directed care
1661 program administered by the Agency for Health Care
1662 Administration; amending s. 409.907, F.S.; extending
1663 the records-retention period for certain Medicaid
1664 provider records; revising the provider agreement to
1665 require Medicaid providers to report changes in any
1666 principal of the provider to the agency; defining the
1667 term “administrative fines” for purposes of revoking a
1668 Medicaid provider agreement due to changes of
1669 ownership; authorizing, rather than requiring, an
1670 onsite inspection of a Medicaid provider’s service
1671 location before entering into a provider agreement;
1672 specifying the principals of a hospital or nursing
1673 home provider for the purposes of submitting
1674 fingerprints for background screening; removing
1675 certain providers from being subject to agency
1676 background checks; amending s. 409.913, F.S.; defining
1677 the term “Medicaid provider” or “provider” for
1678 purposes of oversight of the integrity of the Medicaid
1679 program; authorizing the agency to review and analyze
1680 information from sources other than Medicaid-enrolled
1681 providers for purposes of determining fraud, abuse,
1682 overpayment, or neglect; extending the records
1683 retention period for certain Medicaid provider
1684 records; revising the grounds for terminating a
1685 provider from the Medicaid program; requiring the
1686 agency to base its overpayment audit reports on
1687 certain information; deleting a requirement that the
1688 agency pay interest on certain withheld Medicaid
1689 payments; requiring payment arrangements for
1690 overpayments and fines to be made within a certain
1691 time; specifying that the venue for all Medicaid
1692 program integrity cases lies in Leon County;
1693 authorizing the agency and the Medicaid Fraud Control
1694 Unit to review certain records; amending s. 409.920,
1695 F.S.; clarifying the applicability of immunity from
1696 civil liability extended to persons who provide
1697 information about fraud or suspected fraudulent acts
1698 by a Medicaid provider; amending s. 409.967, F.S.;
1699 specifying required components of a Medicaid managed
1700 care plan relating to the provisions of medications;
1701 amending s. 429.23, F.S.; requiring the agency to
1702 submit a report to the Legislature on adverse incident
1703 reports from assisted living facilities; amending s.
1704 429.26, F.S.; authorizing the agency to require a
1705 resident of an assisted living facility to undergo a
1706 physical examination if the agency questions the
1707 appropriateness of the resident’s placement in that
1708 facility; authorizing release of the results of the
1709 examination to a medical review team to be used along
1710 with additional information to determine whether the
1711 resident’s placement in the assisted living facility
1712 is appropriate; providing for resident notification
1713 and relocation if the resident’s continued placement
1714 in the facility is not appropriate; authorizing the
1715 agency to require the evaluation of a mental health
1716 resident by a mental health professional; authorizing
1717 an assisted living facility to discharge a resident
1718 who requires more services or care than the facility
1719 is able to provide; amending s. 456.0635, F.S.;
1720 revising the grounds under which the Department of
1721 Health or corresponding board is required to refuse to
1722 admit a candidate to an examination and refuse to
1723 issue or renew a license, certificate, or registration
1724 of a health care practitioner; providing an exception;
1725 amending s. 456.036, F.S.; providing that all persons
1726 who were denied renewal of licensure, certification,
1727 or registration under s. 456.0635(3), F.S., may regain
1728 licensure, certification, or registration only by
1729 completing the application process for initial
1730 licensure; providing an exception; amending s.
1731 456.074, F.S.; revising the federal offenses for which
1732 the Department of Health must issue an emergency order
1733 suspending the license of certain health care
1734 professionals; amending s. 463.002, F.S.; conforming
1735 provisions to changes made by the act; amending s.
1736 463.005, F.S.; authorizing the Board of Optometry to
1737 adopt rules for the administration and prescription of
1738 ocular pharmaceutical agents; amending s. 463.0055,
1739 F.S.; authorizing certified optometrists to administer
1740 and prescribe pharmaceutical agents under certain
1741 circumstances; requiring that a certified optometrist
1742 complete a course and subsequent examination on
1743 general and ocular pharmacology; providing
1744 requirements for the course; requiring that the
1745 Florida Medical Association and the Florida Optometric
1746 Association jointly develop and administer the course
1747 and examination; revising qualifications of certain
1748 members of the formulary committee; providing for a
1749 formulary of topical ocular pharmaceutical agents
1750 which the committee may modify; specifying the agents
1751 that make up the statutory formulary of oral
1752 pharmaceutical agents; authorizing the deletion of an
1753 oral pharmaceutical agent listed in the statutory
1754 formulary under certain circumstances; prohibiting the
1755 board, the Department of Health, or the State Surgeon
1756 General from deleting an oral pharmaceutical agent
1757 listed in the statutory formulary; amending ss.
1758 463.0057 and 463.006, F.S.; conforming provisions to
1759 changes made by the act; amending s. 463.0135, F.S.;
1760 requiring that a certified optometrist administer and
1761 prescribe oral ocular pharmaceutical agents in a
1762 certain manner; requiring that a licensed practitioner
1763 who diagnoses a patient who has a neovascular form of
1764 glaucoma or progressive glaucoma immediately refer the
1765 patient to a physician who is skilled in the diseases
1766 of the eye; requiring that comanagement of
1767 postoperative care be conducted pursuant to an
1768 established protocol; requiring that the patient be
1769 informed that a physician will be available for
1770 emergency care throughout the postoperative period;
1771 requiring that the patient consent in writing to the
1772 comanagement relationship; amending s. 463.014, F.S.;
1773 revising certain prohibited acts regarding an
1774 optometrist conducting surgery and dispensing,
1775 administering, ordering, supplying, or selling certain
1776 drugs; creating s. 463.0141, F.S.; requiring that
1777 adverse incidents in the practice of optometry be
1778 reported to the Department of Health; providing
1779 requirements for notifying the department of an
1780 adverse incident; providing a definition; requiring
1781 that the department review each incident and determine
1782 whether it involved conduct that is subject to
1783 disciplinary action; requiring that the Board of
1784 Optometry take disciplinary action if necessary;
1785 amending s. 483.035, F.S., relating to licensure and
1786 regulation of clinical laboratories operated by
1787 practitioners for exclusive use; providing
1788 applicability to clinical laboratories operated by
1789 practitioners licensed to practice optometry; amending
1790 s. 483.041, F.S.; revising the definition of the term
1791 “licensed practitioner” to include a practitioner
1792 licensed under ch. 463, F.S.; amending s. 483.181,
1793 F.S.; requiring clinical laboratories to accept human
1794 specimens submitted by practitioners licensed to
1795 practice under ch. 463, F.S.; amending s. 499.003,
1796 F.S.; removing a requirement that a contract provider
1797 or subcontractor maintain prescription drugs of the
1798 agency or entity in its possession separate and apart
1799 from other prescription drugs; amending s. 766.106,
1800 F.S.; authorizing a prospective defendant to obtain
1801 informal discovery by conducting ex parte interviews
1802 of treating health care providers; requiring advance
1803 notice to the claimant of an ex parte interview;
1804 creating s. 766.1091, F.S.; authorizing a health care
1805 provider or health care clinic and a patient to agree
1806 to submit a claim of medical negligence to
1807 arbitration; requiring that the arbitration agreement
1808 be governed by ch. 682, F.S.; authorizing the
1809 arbitration agreement to contain a provision that
1810 limits an award of damages; amending s. 893.02, F.S.;
1811 revising the definition of the term “practitioner” to
1812 include certified optometrists for purposes of the
1813 Florida Comprehensive Drug Abuse Prevention and
1814 Control Act; amending s. 893.05, F.S.; prohibiting
1815 certified optometrists from administering and
1816 prescribing certain controlled substances; requiring
1817 the Agency for Health Care Administration to prepare a
1818 report for public comment and submission to the
1819 Legislature following the expansion of services to new
1820 populations or of new services; providing an effective
1821 date.