Florida Senate - 2012                        COMMITTEE AMENDMENT
       Bill No. SB 1316
       
       
       
       
       
       
                                Barcode 815246                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/09/2012           .                                
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       The Committee on Health Regulation (Gaetz) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (1) of section 395.002, Florida
    6  Statutes, is amended to read:
    7         395.002 Definitions.—As used in this chapter:
    8         (1) “Accrediting organizations” means national
    9  accreditation organizations that are approved by the Centers for
   10  Medicare and Medicaid Services and whose standards incorporate
   11  comparable licensure regulations required by the state the Joint
   12  Commission on Accreditation of Healthcare Organizations, the
   13  American Osteopathic Association, the Commission on
   14  Accreditation of Rehabilitation Facilities, and the
   15  Accreditation Association for Ambulatory Health Care, Inc.
   16         Section 2. Subsection (6) of section 400.474, Florida
   17  Statutes, is amended, present subsection (7) of that section is
   18  renumbered as subsection (8), and a new subsection (7) is added
   19  to that section, to read:
   20         400.474 Administrative penalties.—
   21         (6) The agency may deny, revoke, or suspend the license of
   22  a home health agency and shall impose a fine of $5,000 against a
   23  home health agency that:
   24         (a) Gives remuneration for staffing services to:
   25         1. Another home health agency with which it has formal or
   26  informal patient-referral transactions or arrangements; or
   27         2. A health services pool with which it has formal or
   28  informal patient-referral transactions or arrangements,
   29  
   30  unless the home health agency has activated its comprehensive
   31  emergency management plan in accordance with s. 400.492. This
   32  paragraph does not apply to a Medicare-certified home health
   33  agency that provides fair market value remuneration for staffing
   34  services to a non-Medicare-certified home health agency that is
   35  part of a continuing care facility licensed under chapter 651
   36  for providing services to its own residents if each resident
   37  receiving home health services pursuant to this arrangement
   38  attests in writing that he or she made a decision without
   39  influence from staff of the facility to select, from a list of
   40  Medicare-certified home health agencies provided by the
   41  facility, that Medicare-certified home health agency to provide
   42  the services.
   43         (b) Provides services to residents in an assisted living
   44  facility for which the home health agency does not receive fair
   45  market value remuneration.
   46         (c) Provides staffing to an assisted living facility for
   47  which the home health agency does not receive fair market value
   48  remuneration.
   49         (d) Fails to provide the agency, upon request, with copies
   50  of all contracts with assisted living facilities which were
   51  executed within 5 years before the request.
   52         (e) Gives remuneration to a case manager, discharge
   53  planner, facility-based staff member, or third-party vendor who
   54  is involved in the discharge planning process of a facility
   55  licensed under chapter 395, chapter 429, or this chapter from
   56  whom the home health agency receives referrals.
   57         (f) Fails to submit to the agency, within 15 days after the
   58  end of each calendar quarter, a written report that includes the
   59  following data based on data as it existed on the last day of
   60  the quarter:
   61         1. The number of insulin-dependent diabetic patients
   62  receiving insulin-injection services from the home health
   63  agency;
   64         2. The number of patients receiving both home health
   65  services from the home health agency and hospice services;
   66         3. The number of patients receiving home health services
   67  from that home health agency; and
   68         4. The names and license numbers of nurses whose primary
   69  job responsibility is to provide home health services to
   70  patients and who received remuneration from the home health
   71  agency in excess of $25,000 during the calendar quarter.
   72         (f)(g) Gives cash, or its equivalent, to a Medicare or
   73  Medicaid beneficiary.
   74         (g)(h) Has more than one medical director contract in
   75  effect at one time or more than one medical director contract
   76  and one contract with a physician-specialist whose services are
   77  mandated for the home health agency in order to qualify to
   78  participate in a federal or state health care program at one
   79  time.
   80         (h)(i) Gives remuneration to a physician without a medical
   81  director contract being in effect. The contract must:
   82         1. Be in writing and signed by both parties;
   83         2. Provide for remuneration that is at fair market value
   84  for an hourly rate, which must be supported by invoices
   85  submitted by the medical director describing the work performed,
   86  the dates on which that work was performed, and the duration of
   87  that work; and
   88         3. Be for a term of at least 1 year.
   89  
   90  The hourly rate specified in the contract may not be increased
   91  during the term of the contract. The home health agency may not
   92  execute a subsequent contract with that physician which has an
   93  increased hourly rate and covers any portion of the term that
   94  was in the original contract.
   95         (i)(j) Gives remuneration to:
   96         1. A physician, and the home health agency is in violation
   97  of paragraph (g) (h) or paragraph (h) (i);
   98         2. A member of the physician’s office staff; or
   99         3. An immediate family member of the physician,
  100  
  101  if the home health agency has received a patient referral in the
  102  preceding 12 months from that physician or physician’s office
  103  staff.
  104         (j)(k) Fails to provide to the agency, upon request, copies
  105  of all contracts with a medical director which were executed
  106  within 5 years before the request.
  107         (k)(l) Demonstrates a pattern of billing the Medicaid
  108  program for services to Medicaid recipients which are medically
  109  unnecessary as determined by a final order. A pattern may be
  110  demonstrated by a showing of at least two such medically
  111  unnecessary services within one Medicaid program integrity audit
  112  period.
  113  
  114  Paragraphs (e) and (i) do not apply to or preclude Nothing in
  115  paragraph (e) or paragraph (j) shall be interpreted as applying
  116  to or precluding any discount, compensation, waiver of payment,
  117  or payment practice permitted by 42 U.S.C. s. 1320a-7(b) or
  118  regulations adopted thereunder, including 42 C.F.R. s. 1001.952
  119  or s. 1395nn or regulations adopted thereunder.
  120         (7) The agency shall impose a fine of $50 per day against a
  121  home health agency that fails to submit to the agency, within 15
  122  days after the end of each calendar quarter, a written report
  123  that includes the following data based on data as it existed on
  124  the last day of the quarter:
  125         (a) The number of patients receiving both home health
  126  services from the home health agency and hospice services;
  127         (b) The number of patients receiving home health services
  128  from the home health agency;
  129         (c) The number of insulin-dependent diabetic patients
  130  receiving insulin-injection services from the home health
  131  agency; and
  132         (d) The names and license numbers of nurses whose primary
  133  job responsibility is to provide home health services to
  134  patients and who received remuneration from the home health
  135  agency in excess of $25,000 during the calendar quarter.
  136         Section 3. Paragraph (l) of subsection (4) of section
  137  400.9905, Florida Statutes, is amended, and paragraph (m) is
  138  added to that subsection, to read:
  139         400.9905 Definitions.—
  140         (4) “Clinic” means an entity at which health care services
  141  are provided to individuals and which tenders charges for
  142  reimbursement for such services, including a mobile clinic and a
  143  portable equipment provider. For purposes of this part, the term
  144  does not include and the licensure requirements of this part do
  145  not apply to:
  146         (l) Orthotic, or prosthetic, pediatric cardiology, or
  147  perinatology clinical facilities or anesthesia clinical
  148  facilities that are not otherwise exempt under paragraph (a) or
  149  paragraph (k) and that are a publicly traded corporation or that
  150  are wholly owned, directly or indirectly, by a publicly traded
  151  corporation. As used in this paragraph, a publicly traded
  152  corporation is a corporation that issues securities traded on an
  153  exchange registered with the United States Securities and
  154  Exchange Commission as a national securities exchange.
  155         (m)Entities that are owned or controlled, directly or
  156  indirectly, by a publicly traded entity that has $100 million or
  157  more, in the aggregate, in total annual revenues derived from
  158  providing health care services by licensed health care
  159  practitioners who are employed or contracted by an entity
  160  described in this paragraph.
  161         Section 4. Paragraph (i) of subsection (4) of section
  162  409.221, Florida Statutes, is amended to read:
  163         409.221 Consumer-directed care program.—
  164         (4) CONSUMER-DIRECTED CARE.—
  165         (i) Background screening requirements.—All persons who
  166  render care under this section must undergo level 2 background
  167  screening pursuant to chapter 435 and s. 408.809. The agency
  168  shall, as allowable, reimburse consumer-employed caregivers for
  169  the cost of conducting such background screening as required by
  170  this section. For purposes of this section, a person who has
  171  undergone screening, who is qualified for employment under this
  172  section and applicable rule, and who has not been unemployed for
  173  more than 90 days following such screening is not required to be
  174  rescreened. Such person must attest under penalty of perjury to
  175  not having been convicted of a disqualifying offense since
  176  completing such screening.
  177         Section 5. Paragraph (c) of subsection (3) of section
  178  409.907, Florida Statutes, is amended, paragraph (k) is added to
  179  that subsection, and subsections (6), (7), and (8) of that
  180  section are amended, to read:
  181         409.907 Medicaid provider agreements.—The agency may make
  182  payments for medical assistance and related services rendered to
  183  Medicaid recipients only to an individual or entity who has a
  184  provider agreement in effect with the agency, who is performing
  185  services or supplying goods in accordance with federal, state,
  186  and local law, and who agrees that no person shall, on the
  187  grounds of handicap, race, color, or national origin, or for any
  188  other reason, be subjected to discrimination under any program
  189  or activity for which the provider receives payment from the
  190  agency.
  191         (3) The provider agreement developed by the agency, in
  192  addition to the requirements specified in subsections (1) and
  193  (2), shall require the provider to:
  194         (c) Retain all medical and Medicaid-related records for 6 a
  195  period of 5 years to satisfy all necessary inquiries by the
  196  agency.
  197         (k) Report a change in any principal of the provider,
  198  including any officer, director, agent, managing employee, or
  199  affiliated person, or any partner or shareholder who has an
  200  ownership interest equal to 5 percent or more in the provider,
  201  to the agency in writing no later than 30 days after the change
  202  occurs.
  203         (6) A Medicaid provider agreement may be revoked, at the
  204  option of the agency, due to as the result of a change of
  205  ownership of any facility, association, partnership, or other
  206  entity named as the provider in the provider agreement.
  207         (a) In the event of a change of ownership, the transferor
  208  remains liable for all outstanding overpayments, administrative
  209  fines, and any other moneys owed to the agency before the
  210  effective date of the change of ownership. In addition to the
  211  continuing liability of the transferor, The transferee is also
  212  liable to the agency for all outstanding overpayments identified
  213  by the agency on or before the effective date of the change of
  214  ownership. For purposes of this subsection, the term
  215  “outstanding overpayment” includes any amount identified in a
  216  preliminary audit report issued to the transferor by the agency
  217  on or before the effective date of the change of ownership. In
  218  the event of a change of ownership for a skilled nursing
  219  facility or intermediate care facility, the Medicaid provider
  220  agreement shall be assigned to the transferee if the transferee
  221  meets all other Medicaid provider qualifications. In the event
  222  of a change of ownership involving a skilled nursing facility
  223  licensed under part II of chapter 400, liability for all
  224  outstanding overpayments, administrative fines, and any moneys
  225  owed to the agency before the effective date of the change of
  226  ownership shall be determined in accordance with s. 400.179.
  227         (b) At least 60 days before the anticipated date of the
  228  change of ownership, the transferor must shall notify the agency
  229  of the intended change of ownership and the transferee must
  230  shall submit to the agency a Medicaid provider enrollment
  231  application. If a change of ownership occurs without compliance
  232  with the notice requirements of this subsection, the transferor
  233  and transferee are shall be jointly and severally liable for all
  234  overpayments, administrative fines, and other moneys due to the
  235  agency, regardless of whether the agency identified the
  236  overpayments, administrative fines, or other moneys before or
  237  after the effective date of the change of ownership. The agency
  238  may not approve a transferee’s Medicaid provider enrollment
  239  application if the transferee or transferor has not paid or
  240  agreed in writing to a payment plan for all outstanding
  241  overpayments, administrative fines, and other moneys due to the
  242  agency. This subsection does not preclude the agency from
  243  seeking any other legal or equitable remedies available to the
  244  agency for the recovery of moneys owed to the Medicaid program.
  245  In the event of a change of ownership involving a skilled
  246  nursing facility licensed under part II of chapter 400,
  247  liability for all outstanding overpayments, administrative
  248  fines, and any moneys owed to the agency before the effective
  249  date of the change of ownership shall be determined in
  250  accordance with s. 400.179 if the Medicaid provider enrollment
  251  application for change of ownership is submitted before the
  252  change of ownership.
  253         (c) As used in this subsection, the term:
  254         1. “Administrative fines” includes any amount identified in
  255  a notice of a monetary penalty or fine which has been issued by
  256  the agency or other regulatory or licensing agency that governs
  257  the provider.
  258         2. “Outstanding overpayment” includes any amount identified
  259  in a preliminary audit report issued to the transferor by the
  260  agency on or before the effective date of a change of ownership.
  261         (7) The agency may require, As a condition of participating
  262  in the Medicaid program and before entering into the provider
  263  agreement, the agency may require that the provider to submit
  264  information, in an initial and any required renewal
  265  applications, concerning the professional, business, and
  266  personal background of the provider and permit an onsite
  267  inspection of the provider’s service location by agency staff or
  268  other personnel designated by the agency to perform this
  269  function. Before entering into a provider agreement, the agency
  270  may shall perform an a random onsite inspection, within 60 days
  271  after receipt of a fully complete new provider’s application, of
  272  the provider’s service location prior to making its first
  273  payment to the provider for Medicaid services to determine the
  274  applicant’s ability to provide the services in compliance with
  275  the Medicaid program and professional regulations that the
  276  applicant is proposing to provide for Medicaid reimbursement.
  277  The agency is not required to perform an onsite inspection of a
  278  provider or program that is licensed by the agency, that
  279  provides services under waiver programs for home and community
  280  based services, or that is licensed as a medical foster home by
  281  the Department of Children and Family Services. As a continuing
  282  condition of participation in the Medicaid program, a provider
  283  must shall immediately notify the agency of any current or
  284  pending bankruptcy filing. Before entering into the provider
  285  agreement, or as a condition of continuing participation in the
  286  Medicaid program, the agency may also require that Medicaid
  287  providers reimbursed on a fee-for-services basis or fee schedule
  288  basis that which is not cost-based, post a surety bond not to
  289  exceed $50,000 or the total amount billed by the provider to the
  290  program during the current or most recent calendar year,
  291  whichever is greater. For new providers, the amount of the
  292  surety bond shall be determined by the agency based on the
  293  provider’s estimate of its first year’s billing. If the
  294  provider’s billing during the first year exceeds the bond
  295  amount, the agency may require the provider to acquire an
  296  additional bond equal to the actual billing level of the
  297  provider. A provider’s bond need shall not exceed $50,000 if a
  298  physician or group of physicians licensed under chapter 458,
  299  chapter 459, or chapter 460 has a 50 percent or greater
  300  ownership interest in the provider or if the provider is an
  301  assisted living facility licensed under chapter 429. The bonds
  302  permitted by this section are in addition to the bonds
  303  referenced in s. 400.179(2)(d). If the provider is a
  304  corporation, partnership, association, or other entity, the
  305  agency may require the provider to submit information concerning
  306  the background of that entity and of any principal of the
  307  entity, including any partner or shareholder having an ownership
  308  interest in the entity equal to 5 percent or greater, and any
  309  treating provider who participates in or intends to participate
  310  in Medicaid through the entity. The information must include:
  311         (a) Proof of holding a valid license or operating
  312  certificate, as applicable, if required by the state or local
  313  jurisdiction in which the provider is located or if required by
  314  the Federal Government.
  315         (b) Information concerning any prior violation, fine,
  316  suspension, termination, or other administrative action taken
  317  under the Medicaid laws, rules, or regulations of this state or
  318  of any other state or the Federal Government; any prior
  319  violation of the laws, rules, or regulations relating to the
  320  Medicare program; any prior violation of the rules or
  321  regulations of any other public or private insurer; and any
  322  prior violation of the laws, rules, or regulations of any
  323  regulatory body of this or any other state.
  324         (c) Full and accurate disclosure of any financial or
  325  ownership interest that the provider, or any principal, partner,
  326  or major shareholder thereof, may hold in any other Medicaid
  327  provider or health care related entity or any other entity that
  328  is licensed by the state to provide health or residential care
  329  and treatment to persons.
  330         (d) If a group provider, identification of all members of
  331  the group and attestation that all members of the group are
  332  enrolled in or have applied to enroll in the Medicaid program.
  333         (8)(a) Each provider, or each principal of the provider if
  334  the provider is a corporation, partnership, association, or
  335  other entity, seeking to participate in the Medicaid program
  336  must submit a complete set of his or her fingerprints to the
  337  agency for the purpose of conducting a criminal history record
  338  check. Principals of the provider include any officer, director,
  339  billing agent, managing employee, or affiliated person, or any
  340  partner or shareholder who has an ownership interest equal to 5
  341  percent or more in the provider. However, for a hospital
  342  licensed under chapter 395 or a nursing home licensed under
  343  chapter 400, principals of the provider are those who meet the
  344  definition of a controlling interest under s. 408.803. A
  345  director of a not-for-profit corporation or organization is not
  346  a principal for purposes of a background investigation as
  347  required by this section if the director: serves solely in a
  348  voluntary capacity for the corporation or organization, does not
  349  regularly take part in the day-to-day operational decisions of
  350  the corporation or organization, receives no remuneration from
  351  the not-for-profit corporation or organization for his or her
  352  service on the board of directors, has no financial interest in
  353  the not-for-profit corporation or organization, and has no
  354  family members with a financial interest in the not-for-profit
  355  corporation or organization; and if the director submits an
  356  affidavit, under penalty of perjury, to this effect to the
  357  agency and the not-for-profit corporation or organization
  358  submits an affidavit, under penalty of perjury, to this effect
  359  to the agency as part of the corporation’s or organization’s
  360  Medicaid provider agreement application.
  361         (a) Notwithstanding the above, the agency may require a
  362  background check for any person reasonably suspected by the
  363  agency to have been convicted of a crime. This subsection does
  364  not apply to:
  365         1. A hospital licensed under chapter 395;
  366         2. A nursing home licensed under chapter 400;
  367         3. A hospice licensed under chapter 400;
  368         4. An assisted living facility licensed under chapter 429;
  369         1.5. A unit of local government, except that requirements
  370  of this subsection apply to nongovernmental providers and
  371  entities contracting with the local government to provide
  372  Medicaid services. The actual cost of the state and national
  373  criminal history record checks must be borne by the
  374  nongovernmental provider or entity; or
  375         2.6. Any business that derives more than 50 percent of its
  376  revenue from the sale of goods to the final consumer, and the
  377  business or its controlling parent is required to file a form
  378  10-K or other similar statement with the Securities and Exchange
  379  Commission or has a net worth of $50 million or more.
  380         (b) Background screening shall be conducted in accordance
  381  with chapter 435 and s. 408.809. The cost of the state and
  382  national criminal record check shall be borne by the provider.
  383         (c) Proof of compliance with the requirements of level 2
  384  screening under chapter 435 conducted within 12 months before
  385  the date the Medicaid provider application is submitted to the
  386  agency fulfills the requirements of this subsection.
  387         Section 6. Present paragraphs (e) and (f) of subsection (1)
  388  of section 409.913, Florida Statutes, are redesignated as
  389  paragraphs (f) and (g), respectively, a new paragraph (e) is
  390  added to that subsection, and subsections (2), (9), (13), (15),
  391  (16), (21), (22), (25), (28), (29), (30), and (31) of that
  392  section are amended, to read:
  393         409.913 Oversight of the integrity of the Medicaid
  394  program.—The agency shall operate a program to oversee the
  395  activities of Florida Medicaid recipients, and providers and
  396  their representatives, to ensure that fraudulent and abusive
  397  behavior and neglect of recipients occur to the minimum extent
  398  possible, and to recover overpayments and impose sanctions as
  399  appropriate. Beginning January 1, 2003, and each year
  400  thereafter, the agency and the Medicaid Fraud Control Unit of
  401  the Department of Legal Affairs shall submit a joint report to
  402  the Legislature documenting the effectiveness of the state’s
  403  efforts to control Medicaid fraud and abuse and to recover
  404  Medicaid overpayments during the previous fiscal year. The
  405  report must describe the number of cases opened and investigated
  406  each year; the sources of the cases opened; the disposition of
  407  the cases closed each year; the amount of overpayments alleged
  408  in preliminary and final audit letters; the number and amount of
  409  fines or penalties imposed; any reductions in overpayment
  410  amounts negotiated in settlement agreements or by other means;
  411  the amount of final agency determinations of overpayments; the
  412  amount deducted from federal claiming as a result of
  413  overpayments; the amount of overpayments recovered each year;
  414  the amount of cost of investigation recovered each year; the
  415  average length of time to collect from the time the case was
  416  opened until the overpayment is paid in full; the amount
  417  determined as uncollectible and the portion of the uncollectible
  418  amount subsequently reclaimed from the Federal Government; the
  419  number of providers, by type, that are terminated from
  420  participation in the Medicaid program as a result of fraud and
  421  abuse; and all costs associated with discovering and prosecuting
  422  cases of Medicaid overpayments and making recoveries in such
  423  cases. The report must also document actions taken to prevent
  424  overpayments and the number of providers prevented from
  425  enrolling in or reenrolling in the Medicaid program as a result
  426  of documented Medicaid fraud and abuse and must include policy
  427  recommendations necessary to prevent or recover overpayments and
  428  changes necessary to prevent and detect Medicaid fraud. All
  429  policy recommendations in the report must include a detailed
  430  fiscal analysis, including, but not limited to, implementation
  431  costs, estimated savings to the Medicaid program, and the return
  432  on investment. The agency must submit the policy recommendations
  433  and fiscal analyses in the report to the appropriate estimating
  434  conference, pursuant to s. 216.137, by February 15 of each year.
  435  The agency and the Medicaid Fraud Control Unit of the Department
  436  of Legal Affairs each must include detailed unit-specific
  437  performance standards, benchmarks, and metrics in the report,
  438  including projected cost savings to the state Medicaid program
  439  during the following fiscal year.
  440         (1) For the purposes of this section, the term:
  441         (e) “Medicaid provider” or “provider” has the same meaning
  442  as provided in s. 409.901 and, for purposes of oversight of the
  443  integrity of the Medicaid program, also includes a participant
  444  in a Medicaid managed care provider network.
  445         (2) The agency shall conduct, or cause to be conducted by
  446  contract or otherwise, reviews, investigations, analyses,
  447  audits, or any combination thereof, to determine possible fraud,
  448  abuse, overpayment, or recipient neglect in the Medicaid program
  449  and shall report the findings of any overpayments in audit
  450  reports as appropriate. At least 5 percent of all audits must
  451  shall be conducted on a random basis. As part of its ongoing
  452  fraud detection activities, the agency shall identify and
  453  monitor, by contract or otherwise, patterns of overutilization
  454  of Medicaid services based on state averages. The agency shall
  455  track Medicaid provider prescription and billing patterns and
  456  evaluate them against Medicaid medical necessity criteria and
  457  coverage and limitation guidelines adopted by rule. Medical
  458  necessity determination requires that service be consistent with
  459  symptoms or confirmed diagnosis of illness or injury under
  460  treatment and not in excess of the patient’s needs. The agency
  461  shall conduct reviews of provider exceptions to peer group norms
  462  and shall, using statistical methodologies, provider profiling,
  463  and analysis of billing patterns, detect and investigate
  464  abnormal or unusual increases in billing or payment of claims
  465  for Medicaid services and medically unnecessary provision of
  466  services. The agency may review and analyze information from
  467  sources other than enrolled Medicaid providers in conducting its
  468  activities under this subsection.
  469         (9) A Medicaid provider shall retain medical, professional,
  470  financial, and business records pertaining to services and goods
  471  furnished to a Medicaid recipient and billed to Medicaid for 6 a
  472  period of 5 years after the date of furnishing such services or
  473  goods. The agency may investigate, review, or analyze such
  474  records, which must be made available during normal business
  475  hours. However, 24-hour notice must be provided if patient
  476  treatment would be disrupted. The provider is responsible for
  477  furnishing to the agency, and keeping the agency informed of the
  478  location of, the provider’s Medicaid-related records. The
  479  authority of the agency to obtain Medicaid-related records from
  480  a provider is neither curtailed nor limited during a period of
  481  litigation between the agency and the provider.
  482         (13) The agency shall immediately terminate participation
  483  of a Medicaid provider in the Medicaid program and may seek
  484  civil remedies or impose other administrative sanctions against
  485  a Medicaid provider, if the provider or any principal, officer,
  486  director, agent, managing employee, or affiliated person of the
  487  provider, or any partner or shareholder having an ownership
  488  interest in the provider equal to 5 percent or greater, has been
  489  convicted of a criminal offense under federal law or the law of
  490  any state relating to the practice of the provider’s profession,
  491  or an offense listed under s. 409.907(10), s. 408.809(4), or s.
  492  435.04(2) has been:
  493         (a) Convicted of a criminal offense related to the delivery
  494  of any health care goods or services, including the performance
  495  of management or administrative functions relating to the
  496  delivery of health care goods or services;
  497         (b) Convicted of a criminal offense under federal law or
  498  the law of any state relating to the practice of the provider’s
  499  profession; or
  500         (c) Found by a court of competent jurisdiction to have
  501  neglected or physically abused a patient in connection with the
  502  delivery of health care goods or services. If the agency
  503  determines that the a provider did not participate or acquiesce
  504  in the an offense specified in paragraph (a), paragraph (b), or
  505  paragraph (c), termination will not be imposed. If the agency
  506  effects a termination under this subsection, the agency shall
  507  issue an immediate final order pursuant to s. 120.569(2)(n).
  508         (15) The agency shall seek a remedy provided by law,
  509  including, but not limited to, any remedy provided in
  510  subsections (13) and (16) and s. 812.035, if:
  511         (a) The provider’s license has not been renewed, or has
  512  been revoked, suspended, or terminated, for cause, by the
  513  licensing agency of any state;
  514         (b) The provider has failed to make available or has
  515  refused access to Medicaid-related records to an auditor,
  516  investigator, or other authorized employee or agent of the
  517  agency, the Attorney General, a state attorney, or the Federal
  518  Government;
  519         (c) The provider has not furnished or has failed to make
  520  available such Medicaid-related records as the agency has found
  521  necessary to determine whether Medicaid payments are or were due
  522  and the amounts thereof;
  523         (d) The provider has failed to maintain medical records
  524  made at the time of service, or prior to service if prior
  525  authorization is required, demonstrating the necessity and
  526  appropriateness of the goods or services rendered;
  527         (e) The provider is not in compliance with provisions of
  528  Medicaid provider publications that have been adopted by
  529  reference as rules in the Florida Administrative Code; with
  530  provisions of state or federal laws, rules, or regulations; with
  531  provisions of the provider agreement between the agency and the
  532  provider; or with certifications found on claim forms or on
  533  transmittal forms for electronically submitted claims that are
  534  submitted by the provider or authorized representative, as such
  535  provisions apply to the Medicaid program;
  536         (f) The provider or person who ordered, authorized, or
  537  prescribed the care, services, or supplies has furnished, or
  538  ordered, or authorized the furnishing of, goods or services to a
  539  recipient which are inappropriate, unnecessary, excessive, or
  540  harmful to the recipient or are of inferior quality;
  541         (g) The provider has demonstrated a pattern of failure to
  542  provide goods or services that are medically necessary;
  543         (h) The provider or an authorized representative of the
  544  provider, or a person who ordered, authorized, or prescribed the
  545  goods or services, has submitted or caused to be submitted false
  546  or a pattern of erroneous Medicaid claims;
  547         (i) The provider or an authorized representative of the
  548  provider, or a person who has ordered, authorized, or prescribed
  549  the goods or services, has submitted or caused to be submitted a
  550  Medicaid provider enrollment application, a request for prior
  551  authorization for Medicaid services, a drug exception request,
  552  or a Medicaid cost report that contains materially false or
  553  incorrect information;
  554         (j) The provider or an authorized representative of the
  555  provider has collected from or billed a recipient or a
  556  recipient’s responsible party improperly for amounts that should
  557  not have been so collected or billed by reason of the provider’s
  558  billing the Medicaid program for the same service;
  559         (k) The provider or an authorized representative of the
  560  provider has included in a cost report costs that are not
  561  allowable under a Florida Title XIX reimbursement plan, after
  562  the provider or authorized representative had been advised in an
  563  audit exit conference or audit report that the costs were not
  564  allowable;
  565         (l) The provider is charged by information or indictment
  566  with fraudulent billing practices or any offense referenced in
  567  subsection (13). The sanction applied for this reason is limited
  568  to suspension of the provider’s participation in the Medicaid
  569  program for the duration of the indictment unless the provider
  570  is found guilty pursuant to the information or indictment;
  571         (m) The provider or a person who has ordered, authorized,
  572  or prescribed the goods or services is found liable for
  573  negligent practice resulting in death or injury to the
  574  provider’s patient;
  575         (n) The provider fails to demonstrate that it had available
  576  during a specific audit or review period sufficient quantities
  577  of goods, or sufficient time in the case of services, to support
  578  the provider’s billings to the Medicaid program;
  579         (o) The provider has failed to comply with the notice and
  580  reporting requirements of s. 409.907;
  581         (p) The agency has received reliable information of patient
  582  abuse or neglect or of any act prohibited by s. 409.920; or
  583         (q) The provider has failed to comply with an agreed-upon
  584  repayment schedule.
  585  
  586  A provider is subject to sanctions for violations of this
  587  subsection as the result of actions or inactions of the
  588  provider, or actions or inactions of any principal, officer,
  589  director, agent, managing employee, or affiliated person of the
  590  provider, or any partner or shareholder having an ownership
  591  interest in the provider equal to 5 percent or greater, in which
  592  the provider participated or acquiesced.
  593         (16) The agency shall impose any of the following sanctions
  594  or disincentives on a provider or a person for any of the acts
  595  described in subsection (15):
  596         (a) Suspension for a specific period of time of not more
  597  than 1 year. Suspension precludes shall preclude participation
  598  in the Medicaid program, which includes any action that results
  599  in a claim for payment to the Medicaid program as a result of
  600  furnishing, supervising a person who is furnishing, or causing a
  601  person to furnish goods or services.
  602         (b) Termination for a specific period of time of from more
  603  than 1 year to 20 years. Termination precludes shall preclude
  604  participation in the Medicaid program, which includes any action
  605  that results in a claim for payment to the Medicaid program as a
  606  result of furnishing, supervising a person who is furnishing, or
  607  causing a person to furnish goods or services.
  608         (c) Imposition of a fine of up to $5,000 for each
  609  violation. Each day that an ongoing violation continues, such as
  610  refusing to furnish Medicaid-related records or refusing access
  611  to records, is considered, for the purposes of this section, to
  612  be a separate violation. Each instance of improper billing of a
  613  Medicaid recipient; each instance of including an unallowable
  614  cost on a hospital or nursing home Medicaid cost report after
  615  the provider or authorized representative has been advised in an
  616  audit exit conference or previous audit report of the cost
  617  unallowability; each instance of furnishing a Medicaid recipient
  618  goods or professional services that are inappropriate or of
  619  inferior quality as determined by competent peer judgment; each
  620  instance of knowingly submitting a materially false or erroneous
  621  Medicaid provider enrollment application, request for prior
  622  authorization for Medicaid services, drug exception request, or
  623  cost report; each instance of inappropriate prescribing of drugs
  624  for a Medicaid recipient as determined by competent peer
  625  judgment; and each false or erroneous Medicaid claim leading to
  626  an overpayment to a provider is considered, for the purposes of
  627  this section, to be a separate violation.
  628         (d) Immediate suspension, if the agency has received
  629  information of patient abuse or neglect or of any act prohibited
  630  by s. 409.920. Upon suspension, the agency must issue an
  631  immediate final order under s. 120.569(2)(n).
  632         (e) A fine, not to exceed $10,000, for a violation of
  633  paragraph (15)(i).
  634         (f) Imposition of liens against provider assets, including,
  635  but not limited to, financial assets and real property, not to
  636  exceed the amount of fines or recoveries sought, upon entry of
  637  an order determining that such moneys are due or recoverable.
  638         (g) Prepayment reviews of claims for a specified period of
  639  time.
  640         (h) Comprehensive followup reviews of providers every 6
  641  months to ensure that they are billing Medicaid correctly.
  642         (i) Corrective-action plans that would remain in effect for
  643  providers for up to 3 years and that are would be monitored by
  644  the agency every 6 months while in effect.
  645         (j) Other remedies as permitted by law to effect the
  646  recovery of a fine or overpayment.
  647  
  648  If a provider voluntarily relinquishes its Medicaid provider
  649  number after receiving written notice that the agency is
  650  conducting, or has conducted, an audit or investigation and the
  651  sanction of suspension or termination will be imposed for
  652  noncompliance discovered as a result of the audit or
  653  investigation, the agency shall impose the sanction of
  654  termination for cause against the provider. The Secretary of
  655  Health Care Administration may make a determination that
  656  imposition of a sanction or disincentive is not in the best
  657  interest of the Medicaid program, in which case a sanction or
  658  disincentive may shall not be imposed.
  659         (21) When making a determination that an overpayment has
  660  occurred, the agency shall prepare and issue an audit report to
  661  the provider showing the calculation of overpayments. The
  662  agency’s determination shall be based solely upon information
  663  available to it before issuance of the audit report and, in the
  664  case of documentation obtained to substantiate claims for
  665  Medicaid reimbursement, based solely upon contemporaneous
  666  records.
  667         (22) The audit report, supported by agency work papers,
  668  showing an overpayment to a provider constitutes evidence of the
  669  overpayment. A provider may not present or elicit testimony,
  670  either on direct examination or cross-examination in any court
  671  or administrative proceeding, regarding the purchase or
  672  acquisition by any means of drugs, goods, or supplies; sales or
  673  divestment by any means of drugs, goods, or supplies; or
  674  inventory of drugs, goods, or supplies, unless such acquisition,
  675  sales, divestment, or inventory is documented by written
  676  invoices, written inventory records, or other competent written
  677  documentary evidence maintained in the normal course of the
  678  provider’s business. Testimony or evidence that is not based
  679  upon contemporaneous records or that was not furnished to the
  680  agency within 21 days after the issuance of the audit report is
  681  inadmissible in an administrative hearing on a Medicaid
  682  overpayment or an administrative sanction. Notwithstanding the
  683  applicable rules of discovery, all documentation to that will be
  684  offered as evidence at an administrative hearing on a Medicaid
  685  overpayment or an administrative sanction must be exchanged by
  686  all parties at least 14 days before the administrative hearing
  687  or must be excluded from consideration.
  688         (25)(a) The agency shall withhold Medicaid payments, in
  689  whole or in part, to a provider upon receipt of reliable
  690  evidence that the circumstances giving rise to the need for a
  691  withholding of payments involve fraud, willful
  692  misrepresentation, or abuse under the Medicaid program, or a
  693  crime committed while rendering goods or services to Medicaid
  694  recipients. If it is determined that fraud, willful
  695  misrepresentation, abuse, or a crime did not occur, the payments
  696  withheld must be paid to the provider within 14 days after such
  697  determination with interest at the rate of 10 percent a year.
  698  Any money withheld in accordance with this paragraph shall be
  699  placed in a suspended account, readily accessible to the agency,
  700  so that any payment ultimately due the provider shall be made
  701  within 14 days.
  702         (b) The agency shall deny payment, or require repayment, if
  703  the goods or services were furnished, supervised, or caused to
  704  be furnished by a person who has been suspended or terminated
  705  from the Medicaid program or Medicare program by the Federal
  706  Government or any state.
  707         (c) Overpayments owed to the agency bear interest at the
  708  rate of 10 percent per year from the date of determination of
  709  the overpayment by the agency, and payment arrangements
  710  regarding overpayments and fines must be made within 30 days
  711  after the date of the final order and are not subject to further
  712  appeal at the conclusion of legal proceedings. A provider who
  713  does not enter into or adhere to an agreed-upon repayment
  714  schedule may be terminated by the agency for nonpayment or
  715  partial payment.
  716         (d) The agency, upon entry of a final agency order, a
  717  judgment or order of a court of competent jurisdiction, or a
  718  stipulation or settlement, may collect the moneys owed by all
  719  means allowable by law, including, but not limited to, notifying
  720  any fiscal intermediary of Medicare benefits that the state has
  721  a superior right of payment. Upon receipt of such written
  722  notification, the Medicare fiscal intermediary shall remit to
  723  the state the sum claimed.
  724         (e) The agency may institute amnesty programs to allow
  725  Medicaid providers the opportunity to voluntarily repay
  726  overpayments. The agency may adopt rules to administer such
  727  programs.
  728         (28) Venue for all Medicaid program integrity overpayment
  729  cases lies shall lie in Leon County, at the discretion of the
  730  agency.
  731         (29) Notwithstanding other provisions of law, the agency
  732  and the Medicaid Fraud Control Unit of the Department of Legal
  733  Affairs may review a person’s or provider’s Medicaid-related and
  734  non-Medicaid-related records in order to determine the total
  735  output of a provider’s practice to reconcile quantities of goods
  736  or services billed to Medicaid with quantities of goods or
  737  services used in the provider’s total practice.
  738         (30) The agency shall terminate a provider’s participation
  739  in the Medicaid program if the provider fails to reimburse an
  740  overpayment or pay a fine that has been determined by final
  741  order, not subject to further appeal, within 30 35 days after
  742  the date of the final order, unless the provider and the agency
  743  have entered into a repayment agreement.
  744         (31) If a provider requests an administrative hearing
  745  pursuant to chapter 120, such hearing must be conducted within
  746  90 days following assignment of an administrative law judge,
  747  absent exceptionally good cause shown as determined by the
  748  administrative law judge or hearing officer. Upon issuance of a
  749  final order, the outstanding balance of the amount determined to
  750  constitute the overpayment and fines is shall become due. If a
  751  provider fails to make payments in full, fails to enter into a
  752  satisfactory repayment plan, or fails to comply with the terms
  753  of a repayment plan or settlement agreement, the agency shall
  754  withhold medical assistance reimbursement payments for Medicaid
  755  services until the amount due is paid in full.
  756         Section 7. Subsection (8) of section 409.920, Florida
  757  Statutes, is amended to read:
  758         409.920 Medicaid provider fraud.—
  759         (8) A person who provides the state, any state agency, any
  760  of the state’s political subdivisions, or any agency of the
  761  state’s political subdivisions with information about fraud or
  762  suspected fraudulent acts fraud by a Medicaid provider,
  763  including a managed care organization, is immune from civil
  764  liability for libel, slander, or any other relevant tort for
  765  providing any the information about fraud or suspected
  766  fraudulent acts, unless the person acted with knowledge that the
  767  information was false or with reckless disregard for the truth
  768  or falsity of the information. For purposes of this subsection,
  769  the term “fraudulent acts” includes actual or suspected fraud,
  770  abuse, or overpayment, including any fraud-related matters that
  771  a provider or health plan is required to report to the agency or
  772  a law enforcement agency. The immunity from civil liability
  773  extends to reports of fraudulent acts conveyed to the agency in
  774  any manner, including any forum and with any audience as
  775  directed by the agency, and includes all discussions subsequent
  776  to the report and subsequent inquiries from the agency, unless
  777  the person acted with knowledge that the information was false
  778  or with reckless disregard for the truth or falsity of the
  779  information.
  780         Section 8. Paragraph (c) of subsection (2) of section
  781  409.967, Florida Statutes, is amended to read:
  782         409.967 Managed care plan accountability.—
  783         (2) The agency shall establish such contract requirements
  784  as are necessary for the operation of the statewide managed care
  785  program. In addition to any other provisions the agency may deem
  786  necessary, the contract must require:
  787         (c) Access.—
  788         1. Providers.—The agency shall establish specific standards
  789  for the number, type, and regional distribution of providers in
  790  managed care plan networks to ensure access to care for both
  791  adults and children. Each plan must maintain a regionwide
  792  network of providers in sufficient numbers to meet the access
  793  standards for specific medical services for all recipients
  794  enrolled in the plan. The exclusive use of mail-order pharmacies
  795  is may not be sufficient to meet network access standards.
  796  Consistent with the standards established by the agency,
  797  provider networks may include providers located outside the
  798  region. A plan may contract with a new hospital facility before
  799  the date the hospital becomes operational if the hospital has
  800  commenced construction, will be licensed and operational by
  801  January 1, 2013, and a final order has issued in any civil or
  802  administrative challenge. Each plan shall establish and maintain
  803  an accurate and complete electronic database of contracted
  804  providers, including information about licensure or
  805  registration, locations and hours of operation, specialty
  806  credentials and other certifications, specific performance
  807  indicators, and such other information as the agency deems
  808  necessary. The database must be available online to both the
  809  agency and the public and have the capability to compare the
  810  availability of providers to network adequacy standards and to
  811  accept and display feedback from each provider’s patients. Each
  812  plan shall submit quarterly reports to the agency identifying
  813  the number of enrollees assigned to each primary care provider.
  814         2. Prescribed drugs.—
  815         a. If establishing a prescribed drug formulary or preferred
  816  drug list, a managed care plan must:
  817         (I)Provide a broad range of therapeutic options for the
  818  treatment of disease states consistent with the general needs of
  819  an outpatient population. Whenever feasible, the formulary or
  820  preferred drug list should include at least two products in a
  821  therapeutic class;
  822         (II)Include coverage via prior authorization for each drug
  823  newly approved by the federal Food and Drug Administration until
  824  the plan’s Pharmaceutical and Therapeutics Committee reviews
  825  such drug for inclusion on the formulary. The timing of the
  826  formulary review must comply with s. 409.91195; and
  827         (III)Provide a response within 24 hours after receipt of
  828  all necessary information from the medical provider for a
  829  request for prior authorization and provide a procedure for
  830  escalating a delayed prior authorization request to the pharmacy
  831  management team for resolution or to override other medical
  832  management tools.
  833         b. Each managed care plan shall must publish any prescribed
  834  drug formulary or preferred drug list on the plan’s website in a
  835  manner that is accessible to and searchable by enrollees and
  836  providers. The plan must update the list within 24 hours after
  837  making a change. Each plan must ensure that the prior
  838  authorization process for prescribed drugs is readily accessible
  839  to health care providers, including posting appropriate contact
  840  information on its website and providing timely responses to
  841  providers.
  842         c.The managed care plan must continue to permit an
  843  enrollee who was receiving a prescription drug that was on the
  844  plan’s formulary and subsequently removed or changed to continue
  845  to receive that drug if the provider submits a written request
  846  that demonstrates that the drug is medically necessary, and the
  847  enrollee meets clinical criteria to receive the drug.
  848         d.A managed care plan that imposes a step-therapy or a
  849  fail-first protocol must do so in accordance with the following:
  850         (I)If prescribed drugs for the treatment of a medical
  851  condition are restricted for use by the plan through a step
  852  therapy or fail-first protocol, the plan must provide the
  853  prescriber with access to a clear and convenient process to
  854  expeditiously request a prior authorization that includes a
  855  procedure for escalation to the pharmacy management team if not
  856  resolved in a timely manner.
  857         (II)Escalation to the pharmacy management team must be
  858  expeditiously granted by the plan if the prescriber can submit
  859  appropriate and complete medical documentation to the plan that
  860  the preferred treatment required under the step-therapy or fail
  861  first protocol:
  862         (A) Has been ineffective in the treatment of the enrollee’s
  863  disease or medical condition;
  864         (B) Is reasonably expected to be ineffective based on the
  865  known relevant physical or mental characteristics and medical
  866  history of the enrollee and known characteristics of the drug
  867  regimen; or
  868         (C) Will cause or will likely cause an adverse reaction or
  869  other physical harm to the enrollee.
  870         (III)The pharmacy management team shall work directly with
  871  the medical provider to bring the prior-authorization request to
  872  a clinically appropriate, cost-effective, and timely resolution.
  873         e. For enrollees Medicaid recipients diagnosed with
  874  hemophilia who have been prescribed anti-hemophilic-factor
  875  replacement products, the agency shall provide for those
  876  products and hemophilia overlay services through the agency’s
  877  hemophilia disease management program.
  878         3.Prior authorization.—
  879         a. Each managed care plan must ensure that the prior
  880  authorization process for prescribed drugs is readily accessible
  881  to health care providers, including posting appropriate contact
  882  information on its website and providing timely responses to
  883  providers.
  884         b. If a drug, determined to be medically necessary and
  885  prescribed for an enrollee by a physician using sound clinical
  886  judgment, is subject to prior authorization and approved, the
  887  managed care plan must provide for sufficient refills to
  888  complete the duration of the prescription. If the medication is
  889  still clinically appropriate for ongoing therapy after the
  890  initial prior authorization expires, the plan must provide a
  891  process of expedited review to evaluate ongoing therapy.
  892         c.If a prescribed drug requires prior authorization, the
  893  managed care plan shall reimburse the pharmacist for dispensing
  894  a 72-hour supply of oral maintenance medications to the enrollee
  895  and process the prior authorization request. Dispensing a 72
  896  hour supply must be consistent with laws that govern pharmacy
  897  practice and controlled substances. The managed care plan shall
  898  process all prior authorization requests in as timely a manner
  899  as possible.
  900         d.3. Managed care plans, and their fiscal agents or
  901  intermediaries, must accept prior authorization requests for
  902  prescribed drugs any service electronically.
  903         Section 9. Subsection (11) is added to section 429.23,
  904  Florida Statutes, to read:
  905         429.23 Internal risk management and quality assurance
  906  program; adverse incidents and reporting requirements.—
  907         (11) The agency shall annually submit a report to the
  908  Legislature on adverse incident reports by assisted living
  909  facilities. The report must include the following information
  910  arranged by county:
  911         (a) A total number of adverse incidents;
  912         (b) A listing, by category, of the type of adverse
  913  incidents occurring within each category and the type of staff
  914  involved;
  915         (c) A listing, by category, of the types of injuries, if
  916  any, and the number of injuries occurring within each category;
  917         (d) Types of liability claims filed based on an adverse
  918  incident report or reportable injury; and
  919         (e) Disciplinary action taken against staff, categorized by
  920  the type of staff involved.
  921         Section 10. Present subsections (9), (10), and (11) of
  922  section 429.26, Florida Statutes, are renumbered as subsections
  923  (12), (13), and (14), respectively, and new subsections (9),
  924  (10), and (11) are added to that section, to read:
  925         429.26 Appropriateness of placements; examinations of
  926  residents.—
  927         (9) If, at any time after admission to a facility, agency
  928  personnel question whether a resident needs care beyond that
  929  which the facility is licensed to provide, the agency may
  930  require the resident to be physically examined by a licensed
  931  physician, licensed physician assistant, or certified nurse
  932  practitioner. To the extent possible, the examination must be
  933  performed by the resident’s preferred physician, physician
  934  assistant, or nurse practitioner and paid for by the resident
  935  with personal funds, except as provided in s. 429.18(2). This
  936  subsection does not preclude the agency from imposing sanctions
  937  for violations of subsection (1).
  938         (a) Following examination, the examining physician,
  939  physician assistant, or nurse practitioner shall complete and
  940  sign a medical form provided by the agency. The completed
  941  medical form must be submitted to the agency within 30 days
  942  after the date the facility owner or administrator was notified
  943  by the agency that a physical examination is required.
  944         (b) A medical review team designated by the agency shall
  945  determine whether the resident is appropriately residing in the
  946  facility based on the completed medical form and, if necessary,
  947  consultation with the physician, physician assistant, or nurse
  948  practitioner who performed the examination. Members of the
  949  medical review team making the determination may not include the
  950  agency personnel who initially questioned the appropriateness of
  951  the resident’s placement. The medical review team shall base its
  952  decision on a comprehensive review of the resident’s physical
  953  and functional status. A determination that the resident’s
  954  placement is not appropriate is final and binding upon the
  955  facility and the resident.
  956         (c) A resident who is determined by the medical review team
  957  to be inappropriately residing in a facility shall be given 30
  958  days’ written notice to relocate by the owner or administrator,
  959  unless the resident’s continued residence in the facility
  960  presents an imminent danger to the health, safety, or welfare of
  961  the resident or a substantial probability exists that death or
  962  serious physical harm to the resident would result if the
  963  resident is allowed to remain in the facility.
  964         (10) If a mental health resident appears to have needs in
  965  addition to those identified in the community living support
  966  plan, the agency may require an evaluation by a mental health
  967  professional, as determined by the Department of Children and
  968  Family Services.
  969         (11) A facility may not be required to retain a resident
  970  who requires more services or care than the facility is able to
  971  provide in accordance with its policies and criteria for
  972  admission and continued residency.
  973         Section 11. Effective July 1, 2012, section 456.0635,
  974  Florida Statutes, is amended to read:
  975         456.0635 Health care Medicaid fraud; disqualification for
  976  license, certificate, or registration.—
  977         (1) Health care Medicaid fraud in the practice of a health
  978  care profession is prohibited.
  979         (2) Each board under within the jurisdiction of the
  980  department, or the department if there is no board, shall refuse
  981  to admit a candidate to an any examination and refuse to issue
  982  or renew a license, certificate, or registration to an any
  983  applicant if the candidate or applicant or any principal,
  984  officer, agent, managing employee, or affiliated person of the
  985  applicant, has been:
  986         (a) Has been convicted of, or entered a plea of guilty or
  987  nolo contendere to, regardless of adjudication, a felony under
  988  chapter 409, chapter 817, or chapter 893, or a similar felony
  989  offense committed in another state or jurisdiction, unless the
  990  candidate or applicant has successfully completed a drug court
  991  program for that felony and provides proof that the plea has
  992  been withdrawn or the charges have been dismissed. Any such
  993  conviction or plea shall exclude the applicant or candidate from
  994  licensure, examination, certification, or registration 21 U.S.C.
  995  ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and
  996  any subsequent period of probation for such conviction or plea
  997  pleas ended: more than 15 years prior to the date of the
  998  application;
  999         1. For felonies of the first or second degree, more than 15
 1000  years before the date of application.
 1001         2. For felonies of the third degree, more than 10 years
 1002  before the date of application, except for felonies of the third
 1003  degree under s. 893.13(6)(a).
 1004         3. For felonies of the third degree under s. 893.13(6)(a),
 1005  more than 5 years before the date of application.
 1006         (b) Has been convicted of, or entered a plea of guilty or
 1007  nolo contendere to, regardless of adjudication, a felony under
 1008  21 U.S.C. ss. 801-970 or 42 U.S.C. ss. 1395-1396, unless the
 1009  sentence and any subsequent period of probation for such
 1010  conviction or plea ended more than 15 years before the date of
 1011  the application.
 1012         (c)(b)Has been terminated for cause from the Florida
 1013  Medicaid program pursuant to s. 409.913, unless the candidate or
 1014  applicant has been in good standing with the Florida Medicaid
 1015  program for the most recent 5 years.;
 1016         (d)(c)Has been terminated for cause, pursuant to the
 1017  appeals procedures established by the state or Federal
 1018  Government, from any other state Medicaid program or the federal
 1019  Medicare program, unless the candidate or applicant has been in
 1020  good standing with that a state Medicaid program or the federal
 1021  Medicare program for the most recent 5 years and the termination
 1022  occurred at least 20 years before prior to the date of the
 1023  application.
 1024         (e) Is currently listed on the United States Department of
 1025  Health and Human Services Office of Inspector General’s List of
 1026  Excluded Individuals and Entities.
 1027  
 1028  This subsection does not apply to candidates or applicants for
 1029  initial licensure or certification who were enrolled in an
 1030  educational or training program on or before July 1, 2009, which
 1031  was recognized by a board or, if there is no board, recognized
 1032  by the department, and who applied for licensure after July 1,
 1033  2012.
 1034         (3) The department shall refuse to renew a license,
 1035  certificate, or registration of any applicant if the applicant
 1036  or any principal, officer, agent, managing employee, or
 1037  affiliated person of the applicant:
 1038         (a) Has been convicted of, or entered a plea of guilty or
 1039  nolo contendere to, regardless of adjudication, a felony under
 1040  chapter 409, chapter 817, or chapter 893, or a similar felony
 1041  offense committed in another state or jurisdiction, unless the
 1042  applicant is currently enrolled in a drug court program that
 1043  allows the withdrawal of the plea for that felony upon
 1044  successful completion of that program. Any such conviction or
 1045  plea excludes the applicant or candidate from licensure,
 1046  examination, certification, or registration unless the sentence
 1047  and any subsequent period of probation for such conviction or
 1048  plea ended:
 1049         1. For felonies of the first or second degree, more than 15
 1050  years before the date of application.
 1051         2. For felonies of the third degree, more than 10 years
 1052  before the date of application, except for felonies of the third
 1053  degree under s. 893.13(6)(a).
 1054         3. For felonies of the third degree under s. 893.13(6)(a),
 1055  more than 5 years before the date of application.
 1056         (b) Has been convicted of, or entered a plea of guilty or
 1057  nolo contendere to, regardless of adjudication, a felony under
 1058  21 U.S.C. ss. 801-970 or 42 U.S.C. ss. 1395-1396 since July 1,
 1059  2009, unless the sentence and any subsequent period of probation
 1060  for such conviction or plea ended more than 15 years before the
 1061  date of the application.
 1062         (c) Has been terminated for cause from the Florida Medicaid
 1063  program pursuant to s. 409.913, unless the applicant has been in
 1064  good standing with the Florida Medicaid program for the most
 1065  recent 5 years.
 1066         (d) Has been terminated for cause, pursuant to the appeals
 1067  procedures established by the state, from any other state
 1068  Medicaid program, unless the applicant has been in good standing
 1069  with that state Medicaid program for the most recent 5 years and
 1070  the termination occurred at least 20 years before the date of
 1071  the application.
 1072         (e) Is currently listed on the United States Department of
 1073  Health and Human Services Office of Inspector General’s List of
 1074  Excluded Individuals and Entities.
 1075         (4)(3) Licensed health care practitioners shall report
 1076  allegations of health care Medicaid fraud to the department,
 1077  regardless of the practice setting in which the alleged health
 1078  care Medicaid fraud occurred.
 1079         (5)(4) The acceptance by a licensing authority of a
 1080  licensee’s candidate’s relinquishment of a license which is
 1081  offered in response to or anticipation of the filing of
 1082  administrative charges alleging health care Medicaid fraud or
 1083  similar charges constitutes the permanent revocation of the
 1084  license.
 1085         Section 12. Effective July 1, 2012, present subsections
 1086  (14) and (15) of section 456.036, Florida Statutes, are
 1087  renumbered as subsections (15) and (16), respectively, and a new
 1088  subsection (14) is added to that section, to read:
 1089         456.036 Licenses; active and inactive status; delinquency.—
 1090         (14) A person who has been denied license renewal,
 1091  certification, or registration under s. 456.0635(3) may regain
 1092  licensure, certification, or registration only by meeting the
 1093  qualifications and completing the application process for
 1094  initial licensure as defined by the board, or the department if
 1095  there is no board. However, a person who was denied renewal of
 1096  licensure, certification, or registration under s. 24 of chapter
 1097  2009-223, Laws of Florida, between July 1, 2009, and June 30,
 1098  2012, is not required to retake and pass examinations applicable
 1099  for initial licensure, certification, or registration.
 1100         Section 13. Subsection (1) of section 456.074, Florida
 1101  Statutes, is amended to read:
 1102         456.074 Certain health care practitioners; immediate
 1103  suspension of license.—
 1104         (1) The department shall issue an emergency order
 1105  suspending the license of any person licensed under chapter 458,
 1106  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
 1107  chapter 464, chapter 465, chapter 466, or chapter 484 who pleads
 1108  guilty to, is convicted or found guilty of, or who enters a plea
 1109  of nolo contendere to, regardless of adjudication, to:
 1110         (a) A felony under chapter 409, chapter 817, or chapter 893
 1111  or under 21 U.S.C. ss. 801-970 or under 42 U.S.C. ss. 1395-1396;
 1112  or
 1113         (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
 1114  285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
 1115  1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
 1116  Medicaid program.
 1117         Section 14. Subsections (3), (4), and (5) of section
 1118  463.002, Florida Statutes, are amended to read:
 1119         463.002 Definitions.—As used in this chapter, the term:
 1120         (3)(a) “Licensed practitioner” means a person who is a
 1121  primary health care provider licensed to engage in the practice
 1122  of optometry under the authority of this chapter.
 1123         (b) A licensed practitioner who is not a certified
 1124  optometrist shall be required to display at her or his place of
 1125  practice a sign which states, “I am a Licensed Practitioner, not
 1126  a Certified Optometrist, and I am not able to prescribe topical
 1127  ocular pharmaceutical agents.”
 1128         (c) All practitioners initially licensed after July 1,
 1129  1993, must be certified optometrists.
 1130         (4) “Certified optometrist” means a licensed practitioner
 1131  authorized by the board to administer and prescribe topical
 1132  ocular pharmaceutical agents.
 1133         (5) “Optometry” means the diagnosis of conditions of the
 1134  human eye and its appendages; the employment of any objective or
 1135  subjective means or methods, including the administration of
 1136  topical ocular pharmaceutical agents, for the purpose of
 1137  determining the refractive powers of the human eyes, or any
 1138  visual, muscular, neurological, or anatomic anomalies of the
 1139  human eyes and their appendages; and the prescribing and
 1140  employment of lenses, prisms, frames, mountings, contact lenses,
 1141  orthoptic exercises, light frequencies, and any other means or
 1142  methods, including topical ocular pharmaceutical agents, for the
 1143  correction, remedy, or relief of any insufficiencies or abnormal
 1144  conditions of the human eyes and their appendages.
 1145         Section 15. Paragraph (g) of subsection (1) of section
 1146  463.005, Florida Statutes, is amended to read:
 1147         463.005 Authority of the board.—
 1148         (1) The Board of Optometry has authority to adopt rules
 1149  pursuant to ss. 120.536(1) and 120.54 to implement the
 1150  provisions of this chapter conferring duties upon it. Such rules
 1151  shall include, but not be limited to, rules relating to:
 1152         (g) Administration and prescription of topical ocular
 1153  pharmaceutical agents.
 1154         Section 16. Section 463.0055, Florida Statutes, is amended
 1155  to read:
 1156         463.0055 Administration and prescription of topical ocular
 1157  pharmaceutical agents; committee.—
 1158         (1)(a) Certified optometrists may administer and prescribe
 1159  topical ocular pharmaceutical agents as provided in this section
 1160  for the diagnosis and treatment of ocular conditions of the
 1161  human eye and its appendages without the use of surgery or other
 1162  invasive techniques. However, a licensed practitioner who is not
 1163  certified may use topically applied anesthetics solely for the
 1164  purpose of glaucoma examinations, but is otherwise prohibited
 1165  from administering or prescribing topical ocular pharmaceutical
 1166  agents.
 1167         (b) Before a certified optometrist may administer or
 1168  prescribe oral ocular pharmaceutical agents, the certified
 1169  optometrist must complete a course and subsequent examination on
 1170  general and ocular pharmacology which have a particular emphasis
 1171  on the ingestion of oral pharmaceutical agents and the side
 1172  effects of those agents. For certified optometrists licensed
 1173  before January 1, 1990, the course shall consist of 50 contact
 1174  hours and 25 of those hours shall be Internet-based. For
 1175  certified optometrists licensed on or after January 1, 1990, the
 1176  course shall consist of 20 contact hours and 10 of those hours
 1177  shall be Internet-based. The first course and examination shall
 1178  be presented by January 1, 2013, and shall thereafter be
 1179  administered at least annually. The Florida Medical Association
 1180  and the Florida Optometric Association shall jointly develop and
 1181  administer a course and examination for such purpose and jointly
 1182  determine the site or sites for the course and examination.
 1183         (2)(a) There is hereby created a committee composed of two
 1184  certified optometrists licensed pursuant to this chapter,
 1185  appointed by the Board of Optometry, two board-certified
 1186  ophthalmologists licensed pursuant to chapter 458 or chapter
 1187  459, appointed by the Board of Medicine, and one additional
 1188  person with a doctorate degree in pharmacology who is not
 1189  licensed pursuant to chapter 458, chapter 459, or this chapter,
 1190  appointed by the State Surgeon General. The committee shall
 1191  review requests for additions to, deletions from, or
 1192  modifications of a formulary of topical ocular pharmaceutical
 1193  agents for administration and prescription by certified
 1194  optometrists and shall provide to the board advisory opinions
 1195  and recommendations on such requests. The formulary of topical
 1196  ocular pharmaceutical agents shall consist of those topical
 1197  ocular pharmaceutical agents that are appropriate to treat and
 1198  diagnose ocular diseases and disorders and that which the
 1199  certified optometrist is qualified to use in the practice of
 1200  optometry. The board shall establish, add to, delete from, or
 1201  modify the formulary by rule. Notwithstanding any provision of
 1202  chapter 120 to the contrary, the formulary rule shall become
 1203  effective 60 days from the date it is filed with the Secretary
 1204  of State.
 1205         (b) The topical formulary may be added to, deleted from, or
 1206  modified according to the procedure described in paragraph (a).
 1207  Any person who requests an addition, deletion, or modification
 1208  of an authorized topical ocular pharmaceutical agent shall have
 1209  the burden of proof to show cause why such addition, deletion,
 1210  or modification should be made.
 1211         (c) The State Surgeon General shall have standing to
 1212  challenge any rule or proposed rule of the board pursuant to s.
 1213  120.56. In addition to challenges for any invalid exercise of
 1214  delegated legislative authority, the administrative law judge,
 1215  upon such a challenge by the State Surgeon General, may declare
 1216  all or part of a rule or proposed rule invalid if it:
 1217         1. Does not protect the public from any significant and
 1218  discernible harm or damages;
 1219         2. Unreasonably restricts competition or the availability
 1220  of professional services in the state or in a significant part
 1221  of the state; or
 1222         3. Unnecessarily increases the cost of professional
 1223  services without a corresponding or equivalent public benefit.
 1224  
 1225  However, there shall not be created a presumption of the
 1226  existence of any of the conditions cited in this subsection in
 1227  the event that the rule or proposed rule is challenged.
 1228         (d) Upon adoption of the topical formulary required by this
 1229  section, and upon each addition, deletion, or modification to
 1230  the topical formulary, the board shall mail a copy of the
 1231  amended topical formulary to each certified optometrist and to
 1232  each pharmacy licensed by the state.
 1233         (3) In addition to the formulary of topical ocular
 1234  pharmaceutical agents in subsection (2), there is created a
 1235  statutory formulary of oral pharmaceutical agents, which include
 1236  the following agents:
 1237         (a) The following analgesics, or their generic or
 1238  therapeutic equivalents, which may not be administered or
 1239  prescribed for more than 72 hours without consultation with a
 1240  physician licensed under chapter 458 or chapter 459 who is
 1241  skilled in diseases of the eye:
 1242         1. Tramadol hydrochloride.
 1243         2. Acetaminophen 300 mg with No. 3 codeine phosphate 30 mg.
 1244         (b) The following antibiotics, or their generic or
 1245  therapeutic equivalents:
 1246         1. Amoxicillin.
 1247         2. Azithromycin.
 1248         3. Ciprofloxacin.
 1249         4. Dicloxacillin.
 1250         5. Doxycycline.
 1251         6. Keflex.
 1252         7. Minocycline.
 1253         (c) The following antivirals, or their generic or
 1254  therapeutic equivalents:
 1255         1. Acyclovir.
 1256         2. Famciclovir.
 1257         3. Valacyclovir.
 1258         (d) The following oral anti-glaucoma agents, or their
 1259  generic or therapeutic equivalents, which may not be
 1260  administered or prescribed for more than 72 hours without
 1261  consultation with a physician licensed under chapter 458 or
 1262  chapter 459 who is skilled in diseases of the eye:
 1263         1. Acetazolamide.
 1264         2. Methazolamide.
 1265  
 1266  Any oral pharmaceutical agent listed in the statutory formulary
 1267  set forth in this subsection which is subsequently determined by
 1268  the United States Food and Drug Administration to be unsafe for
 1269  administration or prescription shall be considered to have been
 1270  deleted from the formulary of oral pharmaceutical agents. The
 1271  oral pharmaceutical agents on the statutory formulary set forth
 1272  in this subsection may not otherwise be deleted by the board,
 1273  the department, or the State Surgeon General.
 1274         (4)(3) A certified optometrist shall be issued a prescriber
 1275  number by the board. Any prescription written by a certified
 1276  optometrist for a topical ocular pharmaceutical agent pursuant
 1277  to this section shall have the prescriber number printed
 1278  thereon.
 1279         Section 17. Subsection (3) of section 463.0057, Florida
 1280  Statutes, is amended to read:
 1281         463.0057 Optometric faculty certificate.—
 1282         (3) The holder of a faculty certificate may engage in the
 1283  practice of optometry as permitted by this section, but may not
 1284  administer or prescribe topical ocular pharmaceutical agents
 1285  unless the certificateholder has satisfied the requirements of
 1286  ss. 463.0055(1)(b) and s. 463.006(1)(b)4. and 5.
 1287         Section 18. Subsections (2) and (3) of section 463.006,
 1288  Florida Statutes, are amended to read:
 1289         463.006 Licensure and certification by examination.—
 1290         (2) The examination shall consist of the appropriate
 1291  subjects, including applicable state laws and rules and general
 1292  and ocular pharmacology with emphasis on the use topical
 1293  application and side effects of ocular pharmaceutical agents.
 1294  The board may by rule substitute a national examination as part
 1295  or all of the examination and may by rule offer a practical
 1296  examination in addition to the written examination.
 1297         (3) Each applicant who successfully passes the examination
 1298  and otherwise meets the requirements of this chapter is entitled
 1299  to be licensed as a practitioner and to be certified to
 1300  administer and prescribe topical ocular pharmaceutical agents in
 1301  the diagnosis and treatment of ocular conditions.
 1302         Section 19. Subsections (1) and (2) of section 463.0135,
 1303  Florida Statutes, are amended, and subsection (10) is added to
 1304  that section, to read:
 1305         463.0135 Standards of practice.—
 1306         (1) A licensed practitioner shall provide that degree of
 1307  care which conforms to that level of care provided by medical
 1308  practitioners in the same or similar communities. A certified
 1309  optometrist shall administer and prescribe oral ocular
 1310  pharmaceutical agents in a manner consistent with applicable
 1311  preferred practice patterns of the American Academy of
 1312  Ophthalmology. A licensed practitioner shall advise or assist
 1313  her or his patient in obtaining further care when the service of
 1314  another health care practitioner is required.
 1315         (2) A licensed practitioner diagnosing angle closure,
 1316  neovascular, infantile, or congenital forms of glaucoma shall
 1317  promptly and without unreasonable delay refer the patient to a
 1318  physician skilled in diseases of the eye and licensed under
 1319  chapter 458 or chapter 459. In addition, a licensed practitioner
 1320  shall timely refer any patient who experiences progressive
 1321  glaucoma due to failed pharmaceutical intervention to a
 1322  physician who is skilled in diseases of the eye and licensed
 1323  under chapter 458 or chapter 459.
 1324         (10) Comanagement of postoperative care shall be conducted
 1325  pursuant to an established protocol that governs the
 1326  relationship between the operating surgeon and the optometrist.
 1327  The patient shall be informed that either physician will be
 1328  available for emergency care throughout the postoperative
 1329  period, and the patient shall consent in writing to the
 1330  comanagement relationship.
 1331         Section 20. Subsections (3) and (4) of section 463.014,
 1332  Florida Statutes, are amended to read:
 1333         463.014 Certain acts prohibited.—
 1334         (3) Prescribing, ordering, dispensing, administering,
 1335  supplying, selling, or giving any systemic drugs for the purpose
 1336  of treating a systemic disease by a licensed practitioner is
 1337  prohibited. However, a certified optometrist is permitted to use
 1338  commonly accepted means or methods to immediately address
 1339  incidents of anaphylaxis.
 1340         (4) Surgery of any kind, including the use of lasers, is
 1341  expressly prohibited. For purposes of this subsection, the term
 1342  “surgery” means a procedure using an instrument, including
 1343  lasers, scalpels, or needles, in which human tissue is cut,
 1344  burned, or vaporized by incision, injection, ultrasound, laser,
 1345  or radiation. The term includes procedures using instruments
 1346  that require closing by suturing, clamping, or another such
 1347  device. Certified optometrists may remove superficial foreign
 1348  bodies. For the purposes of this subsection, the term
 1349  “superficial foreign bodies” means any foreign matter that is
 1350  embedded in the conjunctiva or cornea but which has not
 1351  penetrated the globe.
 1352         Section 21. Section 463.0141, Florida Statutes, is created
 1353  to read:
 1354         463.0141Reports of adverse incidents in the practice of
 1355  optometry.—
 1356         (1) Any adverse incident that occurs on or after January 1,
 1357  2013, in the practice of optometry must be reported to the
 1358  department in the accordance with this section.
 1359         (2) The required notification to the department must be
 1360  submitted in writing by certified mail and postmarked within 15
 1361  days after the occurrence of the adverse incident.
 1362         (3) For purposes of notification to the department, the
 1363  term “adverse incident,” as used in this section, means an event
 1364  that is associated in whole or in part with the prescribing of
 1365  an oral ocular pharmaceutical agent and that results in one of
 1366  the following:
 1367         (a) Any condition that requires the transfer of a patient
 1368  to a hospital licensed under chapter 395;
 1369         (b) Any condition that requires the patient to obtain care
 1370  from a physician licensed under chapter 458 or chapter 459,
 1371  other than a referral or a consultation required under this
 1372  chapter;
 1373         (c) Permanent physical injury to the patient;
 1374         (d) Partial or complete permanent loss of sight by the
 1375  patient; or
 1376         (e) Death of the patient.
 1377         (4) The department shall review each incident and determine
 1378  whether it potentially involved conduct by the licensed
 1379  practitioner which may be subject to disciplinary action, in
 1380  which case s. 456.073 applies. Disciplinary action, if any,
 1381  shall be taken by the board.
 1382         Section 22. Subsection (1) of section 483.035, Florida
 1383  Statutes, is amended to read:
 1384         483.035 Clinical laboratories operated by practitioners for
 1385  exclusive use; licensure and regulation.—
 1386         (1) A clinical laboratory operated by one or more
 1387  practitioners licensed under chapter 458, chapter 459, chapter
 1388  460, chapter 461, chapter 462, chapter 463, or chapter 466,
 1389  exclusively in connection with the diagnosis and treatment of
 1390  their own patients, must be licensed under this part and must
 1391  comply with the provisions of this part, except that the agency
 1392  shall adopt rules for staffing, for personnel, including
 1393  education and training of personnel, for proficiency testing,
 1394  and for construction standards relating to the licensure and
 1395  operation of the laboratory based upon and not exceeding the
 1396  same standards contained in the federal Clinical Laboratory
 1397  Improvement Amendments of 1988 and the federal regulations
 1398  adopted thereunder.
 1399         Section 23. Subsection (7) of section 483.041, Florida
 1400  Statutes, is amended to read:
 1401         483.041 Definitions.—As used in this part, the term:
 1402         (7) “Licensed practitioner” means a physician licensed
 1403  under chapter 458, chapter 459, chapter 460, or chapter 461, or
 1404  chapter 463; a dentist licensed under chapter 466; a person
 1405  licensed under chapter 462; or an advanced registered nurse
 1406  practitioner licensed under part I of chapter 464; or a duly
 1407  licensed practitioner from another state licensed under similar
 1408  statutes who orders examinations on materials or specimens for
 1409  nonresidents of the State of Florida, but who reside in the same
 1410  state as the requesting licensed practitioner.
 1411         Section 24. Subsection (5) of section 483.181, Florida
 1412  Statutes, is amended to read:
 1413         483.181 Acceptance, collection, identification, and
 1414  examination of specimens.—
 1415         (5) A clinical laboratory licensed under this part must
 1416  accept a human specimen submitted for examination by a
 1417  practitioner licensed under chapter 458, chapter 459, chapter
 1418  460, chapter 461, chapter 462, chapter 463, s. 464.012, or
 1419  chapter 466, if the specimen and test are the type performed by
 1420  the clinical laboratory. A clinical laboratory may only refuse a
 1421  specimen based upon a history of nonpayment for services by the
 1422  practitioner. A clinical laboratory shall not charge different
 1423  prices for tests based upon the chapter under which a
 1424  practitioner submitting a specimen for testing is licensed.
 1425         Section 25. Paragraph (a) of subsection (54) of section
 1426  499.003, Florida Statutes, is amended to read:
 1427         499.003 Definitions of terms used in this part.—As used in
 1428  this part, the term:
 1429         (54) “Wholesale distribution” means distribution of
 1430  prescription drugs to persons other than a consumer or patient,
 1431  but does not include:
 1432         (a) Any of the following activities, which is not a
 1433  violation of s. 499.005(21) if such activity is conducted in
 1434  accordance with s. 499.01(2)(g):
 1435         1. The purchase or other acquisition by a hospital or other
 1436  health care entity that is a member of a group purchasing
 1437  organization of a prescription drug for its own use from the
 1438  group purchasing organization or from other hospitals or health
 1439  care entities that are members of that organization.
 1440         2. The sale, purchase, or trade of a prescription drug or
 1441  an offer to sell, purchase, or trade a prescription drug by a
 1442  charitable organization described in s. 501(c)(3) of the
 1443  Internal Revenue Code of 1986, as amended and revised, to a
 1444  nonprofit affiliate of the organization to the extent otherwise
 1445  permitted by law.
 1446         3. The sale, purchase, or trade of a prescription drug or
 1447  an offer to sell, purchase, or trade a prescription drug among
 1448  hospitals or other health care entities that are under common
 1449  control. For purposes of this subparagraph, “common control”
 1450  means the power to direct or cause the direction of the
 1451  management and policies of a person or an organization, whether
 1452  by ownership of stock, by voting rights, by contract, or
 1453  otherwise.
 1454         4. The sale, purchase, trade, or other transfer of a
 1455  prescription drug from or for any federal, state, or local
 1456  government agency or any entity eligible to purchase
 1457  prescription drugs at public health services prices pursuant to
 1458  Pub. L. No. 102-585, s. 602 to a contract provider or its
 1459  subcontractor for eligible patients of the agency or entity
 1460  under the following conditions:
 1461         a. The agency or entity must obtain written authorization
 1462  for the sale, purchase, trade, or other transfer of a
 1463  prescription drug under this subparagraph from the State Surgeon
 1464  General or his or her designee.
 1465         b. The contract provider or subcontractor must be
 1466  authorized by law to administer or dispense prescription drugs.
 1467         c. In the case of a subcontractor, the agency or entity
 1468  must be a party to and execute the subcontract.
 1469         d. A contract provider or subcontractor must maintain
 1470  separate and apart from other prescription drug inventory any
 1471  prescription drugs of the agency or entity in its possession.
 1472         d.e. The contract provider and subcontractor must maintain
 1473  and produce immediately for inspection all records of movement
 1474  or transfer of all the prescription drugs belonging to the
 1475  agency or entity, including, but not limited to, the records of
 1476  receipt and disposition of prescription drugs. Each contractor
 1477  and subcontractor dispensing or administering these drugs must
 1478  maintain and produce records documenting the dispensing or
 1479  administration. Records that are required to be maintained
 1480  include, but are not limited to, a perpetual inventory itemizing
 1481  drugs received and drugs dispensed by prescription number or
 1482  administered by patient identifier, which must be submitted to
 1483  the agency or entity quarterly.
 1484         e.f. The contract provider or subcontractor may administer
 1485  or dispense the prescription drugs only to the eligible patients
 1486  of the agency or entity or must return the prescription drugs
 1487  for or to the agency or entity. The contract provider or
 1488  subcontractor must require proof from each person seeking to
 1489  fill a prescription or obtain treatment that the person is an
 1490  eligible patient of the agency or entity and must, at a minimum,
 1491  maintain a copy of this proof as part of the records of the
 1492  contractor or subcontractor required under sub-subparagraph e.
 1493         f.g. In addition to the departmental inspection authority
 1494  set forth in s. 499.051, the establishment of the contract
 1495  provider and subcontractor and all records pertaining to
 1496  prescription drugs subject to this subparagraph shall be subject
 1497  to inspection by the agency or entity. All records relating to
 1498  prescription drugs of a manufacturer under this subparagraph
 1499  shall be subject to audit by the manufacturer of those drugs,
 1500  without identifying individual patient information.
 1501         Section 26. Subsection (4) of section 766.102, Florida
 1502  Statutes, is amended to read:
 1503         766.102 Medical negligence; standards of recovery; expert
 1504  witness.—
 1505         (4)(a) The Legislature is cognizant of the changing trends
 1506  and techniques for the delivery of health care in this state and
 1507  the discretion that is inherent in the diagnosis, care, and
 1508  treatment of patients by different health care providers. The
 1509  failure of a health care provider to order, perform, or
 1510  administer supplemental diagnostic tests is shall not be
 1511  actionable if the health care provider acted in good faith and
 1512  with due regard for the prevailing professional standard of
 1513  care.
 1514         (b) The claimant has the burden of proving by clear and
 1515  convincing evidence that the alleged actions of the health care
 1516  provider represent a breach of the prevailing professional
 1517  standard of care in an action for damages based on death or
 1518  personal injury which alleges that the death or injury resulted
 1519  from the failure of a health care provider to order, perform, or
 1520  administer supplemental diagnostic tests.
 1521         Section 27. Paragraph (b) of subsection (6) of section
 1522  766.106, Florida Statutes, is amended to read:
 1523         766.106 Notice before filing action for medical negligence;
 1524  presuit screening period; offers for admission of liability and
 1525  for arbitration; informal discovery; review.—
 1526         (6) INFORMAL DISCOVERY.—
 1527         (b) Informal discovery may be used by a party to obtain
 1528  unsworn statements, the production of documents or things, and
 1529  physical and mental examinations, and ex parte interviews, as
 1530  follows:
 1531         1. Unsworn statements.—Any party may require other parties
 1532  to appear for the taking of an unsworn statement. Such
 1533  statements may be used only for the purpose of presuit screening
 1534  and are not discoverable or admissible in any civil action for
 1535  any purpose by any party. A party desiring to take the unsworn
 1536  statement of any party must give reasonable notice in writing to
 1537  all parties. The notice must state the time and place for taking
 1538  the statement and the name and address of the party to be
 1539  examined. Unless otherwise impractical, the examination of any
 1540  party must be done at the same time by all other parties. Any
 1541  party may be represented by counsel at the taking of an unsworn
 1542  statement. An unsworn statement may be recorded electronically,
 1543  stenographically, or on videotape. The taking of unsworn
 1544  statements is subject to the provisions of the Florida Rules of
 1545  Civil Procedure and may be terminated for abuses.
 1546         2. Documents or things.—Any party may request discovery of
 1547  documents or things. The documents or things must be produced,
 1548  at the expense of the requesting party, within 20 days after the
 1549  date of receipt of the request. A party is required to produce
 1550  discoverable documents or things within that party’s possession
 1551  or control. Medical records shall be produced as provided in s.
 1552  766.204.
 1553         3. Physical and mental examinations.—A prospective
 1554  defendant may require an injured claimant to appear for
 1555  examination by an appropriate health care provider. The
 1556  prospective defendant shall give reasonable notice in writing to
 1557  all parties as to the time and place for examination. Unless
 1558  otherwise impractical, a claimant is required to submit to only
 1559  one examination on behalf of all potential defendants. The
 1560  practicality of a single examination must be determined by the
 1561  nature of the claimant’s condition, as it relates to the
 1562  liability of each prospective defendant. Such examination report
 1563  is available to the parties and their attorneys upon payment of
 1564  the reasonable cost of reproduction and may be used only for the
 1565  purpose of presuit screening. Otherwise, such examination report
 1566  is confidential and exempt from the provisions of s. 119.07(1)
 1567  and s. 24(a), Art. I of the State Constitution.
 1568         4. Written questions.—Any party may request answers to
 1569  written questions, the number of which may not exceed 30,
 1570  including subparts. A response must be made within 20 days after
 1571  receipt of the questions.
 1572         5. Unsworn statements of treating health care providers.—A
 1573  prospective defendant or his or her legal representative may
 1574  also take unsworn statements of the claimant’s treating health
 1575  care providers. The statements must be limited to those areas
 1576  that are potentially relevant to the claim of personal injury or
 1577  wrongful death. Subject to the procedural requirements of
 1578  subparagraph 1., a prospective defendant may take unsworn
 1579  statements from a claimant’s treating physicians. Reasonable
 1580  notice and opportunity to be heard must be given to the claimant
 1581  or the claimant’s legal representative before taking unsworn
 1582  statements. The claimant or claimant’s legal representative has
 1583  the right to attend the taking of such unsworn statements.
 1584         6. Ex parte interviews of treating health care providers.—A
 1585  prospective defendant or his or her legal representative may
 1586  interview the claimant’s treating health care providers without
 1587  the presence of the claimant or the claimant’s legal
 1588  representative. If a prospective defendant or his or her legal
 1589  representative intends to interview a claimant’s health care
 1590  providers, the prospective defendant must provide the claimant
 1591  with notice of such interview at least 10 days before the date
 1592  of the interview.
 1593         Section 28. Section 766.1091, Florida Statutes, is created
 1594  to read:
 1595         766.1091 Voluntary binding arbitration; damages.—
 1596         (1)A health care provider licensed under chapter 458,
 1597  chapter 459, chapter 463, or chapter 466; any entity owned in
 1598  whole or in part by a health care provider licensed under
 1599  chapter 458, chapter 459, chapter 463, or chapter 466; or any
 1600  health care clinic licensed under part X of chapter 400, and a
 1601  patient or prospective patient, may agree in writing to submit
 1602  to arbitration any claim for medical negligence which may
 1603  currently exist or may accrue in the future and would otherwise
 1604  be brought pursuant to this chapter. Any arbitration agreement
 1605  entered into pursuant to this section shall be governed by
 1606  chapter 682.
 1607         (2)Any arbitration agreement entered into pursuant to
 1608  subsection (1) may contain a provision that limits the available
 1609  damages in an arbitration award.
 1610         Section 29. Subsection (21) of section 893.02, Florida
 1611  Statutes, is amended to read:
 1612         893.02 Definitions.—The following words and phrases as used
 1613  in this chapter shall have the following meanings, unless the
 1614  context otherwise requires:
 1615         (21) “Practitioner” means a physician licensed pursuant to
 1616  chapter 458, a dentist licensed pursuant to chapter 466, a
 1617  veterinarian licensed pursuant to chapter 474, an osteopathic
 1618  physician licensed pursuant to chapter 459, a naturopath
 1619  licensed pursuant to chapter 462, a certified optometrist
 1620  licensed under chapter 463, or a podiatric physician licensed
 1621  pursuant to chapter 461, provided such practitioner holds a
 1622  valid federal controlled substance registry number.
 1623         Section 30. Subsection (1) of section 893.05, Florida
 1624  Statutes, is amended to read:
 1625         893.05 Practitioners and persons administering controlled
 1626  substances in their absence.—
 1627         (1) A practitioner, in good faith and in the course of his
 1628  or her professional practice only, may prescribe, administer,
 1629  dispense, mix, or otherwise prepare a controlled substance, or
 1630  the practitioner may cause the same to be administered by a
 1631  licensed nurse or an intern practitioner under his or her
 1632  direction and supervision only. A veterinarian may so prescribe,
 1633  administer, dispense, mix, or prepare a controlled substance for
 1634  use on animals only, and may cause it to be administered by an
 1635  assistant or orderly under the veterinarian’s direction and
 1636  supervision only. A certified optometrist licensed under chapter
 1637  463 may not administer or prescribe pharmaceutical agents in
 1638  Schedule I or Schedule II of the Florida Comprehensive Drug
 1639  Abuse Prevention and Control Act.
 1640         Section 31. The Agency for Health Care Administration shall
 1641  prepare a report within 18 months after the implementation of an
 1642  expansion of managed care to new populations or the provision of
 1643  new items and services. The agency shall post a draft of the
 1644  report on its website and provide an opportunity for public
 1645  comment. The final report shall be submitted to the Legislature,
 1646  along with a description of the process for public input. The
 1647  report must include an assessment of:
 1648         (1) The impact of managed care on patient access to care,
 1649  including an evaluation of any new barriers to the use of
 1650  services and prescription drugs, created by the use of medical
 1651  management or cost-containment tools.
 1652         (2) The impact of the increased managed care expansion on
 1653  the utilization of services, quality of care, and patient
 1654  outcomes.
 1655         (3) The use of prior authorization and other utilization
 1656  management tools, including an assessment of whether these tools
 1657  pose an undue administrative burden for health care providers or
 1658  create barriers to needed care.
 1659         Section 32. Except as otherwise expressly provided in this
 1660  act, this act shall take effect upon becoming a law.
 1661  
 1662  ================= T I T L E  A M E N D M E N T ================
 1663         And the title is amended as follows:
 1664         Delete everything before the enacting clause
 1665  and insert:
 1666                        A bill to be entitled                      
 1667         An act relating to health care; amending s. 395.002,
 1668         F.S.; redefining the term “accrediting organizations”
 1669         as it applies to the regulation of hospitals and other
 1670         licensed facilities; amending s. 400.474, F.S.;
 1671         revising the fine that may be imposed against a home
 1672         health agency for failing to timely submit certain
 1673         information to the Agency for Health Care
 1674         Administration; amending s. 400.9905, F.S.; revising
 1675         the definition of the term “clinic” as it relates to
 1676         the Health Care Clinic Act; amending s. 409.221, F.S.;
 1677         revising the background screening requirements for
 1678         persons rendering care in the consumer-directed care
 1679         program administered by the Agency for Health Care
 1680         Administration; amending s. 409.907, F.S.; extending
 1681         the records-retention period for certain Medicaid
 1682         provider records; revising the provider agreement to
 1683         require Medicaid providers to report changes in any
 1684         principal of the provider to the agency; defining the
 1685         term “administrative fines” for purposes of revoking a
 1686         Medicaid provider agreement due to changes of
 1687         ownership; authorizing, rather than requiring, an
 1688         onsite inspection of a Medicaid provider’s service
 1689         location before entering into a provider agreement;
 1690         specifying the principals of a hospital or nursing
 1691         home provider for the purposes of submitting
 1692         fingerprints for background screening; removing
 1693         certain providers from being subject to agency
 1694         background checks; amending s. 409.913, F.S.; defining
 1695         the term “Medicaid provider” or “provider” for
 1696         purposes of oversight of the integrity of the Medicaid
 1697         program; authorizing the agency to review and analyze
 1698         information from sources other than Medicaid-enrolled
 1699         providers for purposes of determining fraud, abuse,
 1700         overpayment, or neglect; extending the records
 1701         retention period for certain Medicaid provider
 1702         records; revising the grounds for terminating a
 1703         provider from the Medicaid program; requiring the
 1704         agency to base its overpayment audit reports on
 1705         certain information; deleting a requirement that the
 1706         agency pay interest on certain withheld Medicaid
 1707         payments; requiring payment arrangements for
 1708         overpayments and fines to be made within a certain
 1709         time; specifying that the venue for all Medicaid
 1710         program integrity cases lies in Leon County;
 1711         authorizing the agency and the Medicaid Fraud Control
 1712         Unit to review certain records; amending s. 409.920,
 1713         F.S.; clarifying the applicability of immunity from
 1714         civil liability extended to persons who provide
 1715         information about fraud or suspected fraudulent acts
 1716         by a Medicaid provider; amending s. 409.967, F.S.;
 1717         specifying required components of a Medicaid managed
 1718         care plan relating to the provisions of medications;
 1719         amending s. 429.23, F.S.; requiring the agency to
 1720         submit a report to the Legislature on adverse incident
 1721         reports from assisted living facilities; amending s.
 1722         429.26, F.S.; authorizing the agency to require a
 1723         resident of an assisted living facility to undergo a
 1724         physical examination if the agency questions the
 1725         appropriateness of the resident’s placement in that
 1726         facility; authorizing release of the results of the
 1727         examination to a medical review team to be used along
 1728         with additional information to determine whether the
 1729         resident’s placement in the assisted living facility
 1730         is appropriate; providing for resident notification
 1731         and relocation if the resident’s continued placement
 1732         in the facility is not appropriate; authorizing the
 1733         agency to require the evaluation of a mental health
 1734         resident by a mental health professional; authorizing
 1735         an assisted living facility to discharge a resident
 1736         who requires more services or care than the facility
 1737         is able to provide; amending s. 456.0635, F.S.;
 1738         revising the grounds under which the Department of
 1739         Health or corresponding board is required to refuse to
 1740         admit a candidate to an examination and refuse to
 1741         issue or renew a license, certificate, or registration
 1742         of a health care practitioner; providing an exception;
 1743         amending s. 456.036, F.S.; providing that all persons
 1744         who were denied renewal of licensure, certification,
 1745         or registration under s. 456.0635(3), F.S., may regain
 1746         licensure, certification, or registration only by
 1747         completing the application process for initial
 1748         licensure; providing an exception; amending s.
 1749         456.074, F.S.; revising the federal offenses for which
 1750         the Department of Health must issue an emergency order
 1751         suspending the license of certain health care
 1752         professionals; amending s. 463.002, F.S.; conforming
 1753         provisions to changes made by the act; amending s.
 1754         463.005, F.S.; authorizing the Board of Optometry to
 1755         adopt rules for the administration and prescription of
 1756         ocular pharmaceutical agents; amending s. 463.0055,
 1757         F.S.; authorizing certified optometrists to administer
 1758         and prescribe pharmaceutical agents under certain
 1759         circumstances; requiring that a certified optometrist
 1760         complete a course and subsequent examination on
 1761         general and ocular pharmacology; providing
 1762         requirements for the course; requiring that the
 1763         Florida Medical Association and the Florida Optometric
 1764         Association jointly develop and administer the course
 1765         and examination; revising qualifications of certain
 1766         members of the formulary committee; providing for a
 1767         formulary of topical ocular pharmaceutical agents
 1768         which the committee may modify; specifying the agents
 1769         that make up the statutory formulary of oral
 1770         pharmaceutical agents; authorizing the deletion of an
 1771         oral pharmaceutical agent listed in the statutory
 1772         formulary under certain circumstances; prohibiting the
 1773         board, the Department of Health, or the State Surgeon
 1774         General from deleting an oral pharmaceutical agent
 1775         listed in the statutory formulary; amending ss.
 1776         463.0057 and 463.006, F.S.; conforming provisions to
 1777         changes made by the act; amending s. 463.0135, F.S.;
 1778         requiring that a certified optometrist administer and
 1779         prescribe oral ocular pharmaceutical agents in a
 1780         certain manner; requiring that a licensed practitioner
 1781         who diagnoses a patient who has a neovascular form of
 1782         glaucoma or progressive glaucoma immediately refer the
 1783         patient to a physician who is skilled in the diseases
 1784         of the eye; requiring that comanagement of
 1785         postoperative care be conducted pursuant to an
 1786         established protocol; requiring that the patient be
 1787         informed that a physician will be available for
 1788         emergency care throughout the postoperative period;
 1789         requiring that the patient consent in writing to the
 1790         comanagement relationship; amending s. 463.014, F.S.;
 1791         revising certain prohibited acts regarding an
 1792         optometrist conducting surgery and dispensing,
 1793         administering, ordering, supplying, or selling certain
 1794         drugs; creating s. 463.0141, F.S.; requiring that
 1795         adverse incidents in the practice of optometry be
 1796         reported to the Department of Health; providing
 1797         requirements for notifying the department of an
 1798         adverse incident; providing a definition; requiring
 1799         that the department review each incident and determine
 1800         whether it involved conduct that is subject to
 1801         disciplinary action; requiring that the Board of
 1802         Optometry take disciplinary action if necessary;
 1803         amending s. 483.035, F.S., relating to licensure and
 1804         regulation of clinical laboratories operated by
 1805         practitioners for exclusive use; providing
 1806         applicability to clinical laboratories operated by
 1807         practitioners licensed to practice optometry; amending
 1808         s. 483.041, F.S.; revising the definition of the term
 1809         “licensed practitioner” to include a practitioner
 1810         licensed under ch. 463, F.S.; amending s. 483.181,
 1811         F.S.; requiring clinical laboratories to accept human
 1812         specimens submitted by practitioners licensed to
 1813         practice under ch. 463, F.S.; amending s. 499.003,
 1814         F.S.; removing a requirement that a contract provider
 1815         or subcontractor maintain prescription drugs of the
 1816         agency or entity in its possession separate and apart
 1817         from other prescription drugs; amending s. 766.102,
 1818         F.S.; providing that the claimant has the burden of
 1819         proving by clear and convincing evidence that the
 1820         actions of a health care provider represented a breach
 1821         of the prevailing professional standard of care in an
 1822         action for damages based on death or personal injury
 1823         which alleges that the death or injury resulted from
 1824         the failure of a health care provider to order,
 1825         perform, or administer supplemental diagnostic tests;
 1826         amending s. 766.106, F.S.; authorizing a prospective
 1827         defendant to obtain informal discovery by conducting
 1828         ex parte interviews of treating health care providers;
 1829         requiring advance notice to the claimant of an ex
 1830         parte interview; creating s. 766.1091, F.S.;
 1831         authorizing a health care provider or health care
 1832         clinic and a patient to agree to submit a claim of
 1833         medical negligence to arbitration; requiring that the
 1834         arbitration agreement be governed by ch. 682, F.S.;
 1835         authorizing the arbitration agreement to contain a
 1836         provision that limits an award of damages; amending s.
 1837         893.02, F.S.; revising the definition of the term
 1838         “practitioner” to include certified optometrists for
 1839         purposes of the Florida Comprehensive Drug Abuse
 1840         Prevention and Control Act; amending s. 893.05, F.S.;
 1841         prohibiting certified optometrists from administering
 1842         and prescribing certain controlled substances;
 1843         requiring the Agency for Health Care Administration to
 1844         prepare a report for public comment and submission to
 1845         the Legislature following the expansion of services to
 1846         new populations or of new services; providing
 1847         effective dates.