Florida Senate - 2012                        COMMITTEE AMENDMENT
       Bill No. SB 1316
       
       
       
       
       
       
                                Barcode 830922                          
       
                              LEGISLATIVE ACTION                        
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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 (6) of section 400.474, Florida
    6  Statutes, is amended, present subsection (7) of that section is
    7  renumbered as subsection (8), and a new subsection (7) is added
    8  to that section, to read:
    9         400.474 Administrative penalties.—
   10         (6) The agency may deny, revoke, or suspend the license of
   11  a home health agency and shall impose a fine of $5,000 against a
   12  home health agency that:
   13         (a) Gives remuneration for staffing services to:
   14         1. Another home health agency with which it has formal or
   15  informal patient-referral transactions or arrangements; or
   16         2. A health services pool with which it has formal or
   17  informal patient-referral transactions or arrangements,
   18  
   19  unless the home health agency has activated its comprehensive
   20  emergency management plan in accordance with s. 400.492. This
   21  paragraph does not apply to a Medicare-certified home health
   22  agency that provides fair market value remuneration for staffing
   23  services to a non-Medicare-certified home health agency that is
   24  part of a continuing care facility licensed under chapter 651
   25  for providing services to its own residents if each resident
   26  receiving home health services pursuant to this arrangement
   27  attests in writing that he or she made a decision without
   28  influence from staff of the facility to select, from a list of
   29  Medicare-certified home health agencies provided by the
   30  facility, that Medicare-certified home health agency to provide
   31  the services.
   32         (b) Provides services to residents in an assisted living
   33  facility for which the home health agency does not receive fair
   34  market value remuneration.
   35         (c) Provides staffing to an assisted living facility for
   36  which the home health agency does not receive fair market value
   37  remuneration.
   38         (d) Fails to provide the agency, upon request, with copies
   39  of all contracts with assisted living facilities which were
   40  executed within 5 years before the request.
   41         (e) Gives remuneration to a case manager, discharge
   42  planner, facility-based staff member, or third-party vendor who
   43  is involved in the discharge planning process of a facility
   44  licensed under chapter 395, chapter 429, or this chapter from
   45  whom the home health agency receives referrals.
   46         (f) Fails to submit to the agency, within 15 days after the
   47  end of each calendar quarter, a written report that includes the
   48  following data based on data as it existed on the last day of
   49  the quarter:
   50         1. The number of insulin-dependent diabetic patients
   51  receiving insulin-injection services from the home health
   52  agency;
   53         2. The number of patients receiving both home health
   54  services from the home health agency and hospice services;
   55         3. The number of patients receiving home health services
   56  from that home health agency; and
   57         4. The names and license numbers of nurses whose primary
   58  job responsibility is to provide home health services to
   59  patients and who received remuneration from the home health
   60  agency in excess of $25,000 during the calendar quarter.
   61         (f)(g) Gives cash, or its equivalent, to a Medicare or
   62  Medicaid beneficiary.
   63         (g)(h) Has more than one medical director contract in
   64  effect at one time or more than one medical director contract
   65  and one contract with a physician-specialist whose services are
   66  mandated for the home health agency in order to qualify to
   67  participate in a federal or state health care program at one
   68  time.
   69         (h)(i) Gives remuneration to a physician without a medical
   70  director contract being in effect. The contract must:
   71         1. Be in writing and signed by both parties;
   72         2. Provide for remuneration that is at fair market value
   73  for an hourly rate, which must be supported by invoices
   74  submitted by the medical director describing the work performed,
   75  the dates on which that work was performed, and the duration of
   76  that work; and
   77         3. Be for a term of at least 1 year.
   78  
   79  The hourly rate specified in the contract may not be increased
   80  during the term of the contract. The home health agency may not
   81  execute a subsequent contract with that physician which has an
   82  increased hourly rate and covers any portion of the term that
   83  was in the original contract.
   84         (i)(j) Gives remuneration to:
   85         1. A physician, and the home health agency is in violation
   86  of paragraph (g) (h) or paragraph (h) (i);
   87         2. A member of the physician’s office staff; or
   88         3. An immediate family member of the physician,
   89  
   90  if the home health agency has received a patient referral in the
   91  preceding 12 months from that physician or physician’s office
   92  staff.
   93         (j)(k) Fails to provide to the agency, upon request, copies
   94  of all contracts with a medical director which were executed
   95  within 5 years before the request.
   96         (k)(l) Demonstrates a pattern of billing the Medicaid
   97  program for services to Medicaid recipients which are medically
   98  unnecessary as determined by a final order. A pattern may be
   99  demonstrated by a showing of at least two such medically
  100  unnecessary services within one Medicaid program integrity audit
  101  period.
  102  
  103  Paragraphs (e) and (i) do not apply to or preclude Nothing in
  104  paragraph (e) or paragraph (j) shall be interpreted as applying
  105  to or precluding any discount, compensation, waiver of payment,
  106  or payment practice permitted by 42 U.S.C. s. 1320a-7(b) or
  107  regulations adopted thereunder, including 42 C.F.R. s. 1001.952
  108  or s. 1395nn or regulations adopted thereunder.
  109         (7) The agency shall impose a fine of $50 per day against a
  110  home health agency that fails to submit to the agency, within 15
  111  days after the end of each calendar quarter, a written report
  112  that includes the following data based on data as it existed on
  113  the last day of the quarter:
  114         (a) The number of patients receiving both home health
  115  services from the home health agency and hospice services;
  116         (b) The number of patients receiving home health services
  117  from the home health agency;
  118         (c) The number of insulin-dependent diabetic patients
  119  receiving insulin-injection services from the home health
  120  agency; and
  121         (d) The names and license numbers of nurses whose primary
  122  job responsibility is to provide home health services to
  123  patients and who received remuneration from the home health
  124  agency in excess of $25,000 during the calendar quarter.
  125         Section 2. Paragraph (l) of subsection (4) of section
  126  400.9905, Florida Statutes, is amended, and paragraph (m) is
  127  added to that subsection, to read:
  128         400.9905 Definitions.—
  129         (4) “Clinic” means an entity at which health care services
  130  are provided to individuals and which tenders charges for
  131  reimbursement for such services, including a mobile clinic and a
  132  portable equipment provider. For purposes of this part, the term
  133  does not include and the licensure requirements of this part do
  134  not apply to:
  135         (l) Orthotic, or prosthetic, pediatric cardiology, or
  136  perinatology clinical facilities or anesthesia clinical
  137  facilities that are not otherwise exempt under paragraph (a) or
  138  paragraph (k) and that are a publicly traded corporation or that
  139  are wholly owned, directly or indirectly, by a publicly traded
  140  corporation. As used in this paragraph, a publicly traded
  141  corporation is a corporation that issues securities traded on an
  142  exchange registered with the United States Securities and
  143  Exchange Commission as a national securities exchange.
  144         (m)Entities that are owned or controlled, directly or
  145  indirectly, by a publicly traded entity that has $100 million or
  146  more, in the aggregate, in total annual revenues derived from
  147  providing health care services by licensed health care
  148  practitioners who are employed or contracted by an entity
  149  described in this paragraph.
  150         Section 3. Paragraph (i) of subsection (4) of section
  151  409.221, Florida Statutes, is amended to read:
  152         409.221 Consumer-directed care program.—
  153         (4) CONSUMER-DIRECTED CARE.—
  154         (i) Background screening requirements.—All persons who
  155  render care under this section must undergo level 2 background
  156  screening pursuant to chapter 435 and s. 408.809. The agency
  157  shall, as allowable, reimburse consumer-employed caregivers for
  158  the cost of conducting such background screening as required by
  159  this section. For purposes of this section, a person who has
  160  undergone screening, who is qualified for employment under this
  161  section and applicable rule, and who has not been unemployed for
  162  more than 90 days following such screening is not required to be
  163  rescreened. Such person must attest under penalty of perjury to
  164  not having been convicted of a disqualifying offense since
  165  completing such screening.
  166         Section 4. Paragraph (c) of subsection (3) of section
  167  409.907, Florida Statutes, is amended, paragraph (k) is added to
  168  that subsection, and subsections (6), (7), and (8) of that
  169  section are amended, to read:
  170         409.907 Medicaid provider agreements.—The agency may make
  171  payments for medical assistance and related services rendered to
  172  Medicaid recipients only to an individual or entity who has a
  173  provider agreement in effect with the agency, who is performing
  174  services or supplying goods in accordance with federal, state,
  175  and local law, and who agrees that no person shall, on the
  176  grounds of handicap, race, color, or national origin, or for any
  177  other reason, be subjected to discrimination under any program
  178  or activity for which the provider receives payment from the
  179  agency.
  180         (3) The provider agreement developed by the agency, in
  181  addition to the requirements specified in subsections (1) and
  182  (2), shall require the provider to:
  183         (c) Retain all medical and Medicaid-related records for 6 a
  184  period of 5 years to satisfy all necessary inquiries by the
  185  agency.
  186         (k) Report a change in any principal of the provider,
  187  including any officer, director, agent, managing employee, or
  188  affiliated person, or any partner or shareholder who has an
  189  ownership interest equal to 5 percent or more in the provider,
  190  to the agency in writing no later than 30 days after the change
  191  occurs.
  192         (6) A Medicaid provider agreement may be revoked, at the
  193  option of the agency, due to as the result of a change of
  194  ownership of any facility, association, partnership, or other
  195  entity named as the provider in the provider agreement.
  196         (a) In the event of a change of ownership, the transferor
  197  remains liable for all outstanding overpayments, administrative
  198  fines, and any other moneys owed to the agency before the
  199  effective date of the change of ownership. In addition to the
  200  continuing liability of the transferor, The transferee is also
  201  liable to the agency for all outstanding overpayments identified
  202  by the agency on or before the effective date of the change of
  203  ownership. For purposes of this subsection, the term
  204  “outstanding overpayment” includes any amount identified in a
  205  preliminary audit report issued to the transferor by the agency
  206  on or before the effective date of the change of ownership. In
  207  the event of a change of ownership for a skilled nursing
  208  facility or intermediate care facility, the Medicaid provider
  209  agreement shall be assigned to the transferee if the transferee
  210  meets all other Medicaid provider qualifications. In the event
  211  of a change of ownership involving a skilled nursing facility
  212  licensed under part II of chapter 400, liability for all
  213  outstanding overpayments, administrative fines, and any moneys
  214  owed to the agency before the effective date of the change of
  215  ownership shall be determined in accordance with s. 400.179.
  216         (b) At least 60 days before the anticipated date of the
  217  change of ownership, the transferor must shall notify the agency
  218  of the intended change of ownership and the transferee must
  219  shall submit to the agency a Medicaid provider enrollment
  220  application. If a change of ownership occurs without compliance
  221  with the notice requirements of this subsection, the transferor
  222  and transferee are shall be jointly and severally liable for all
  223  overpayments, administrative fines, and other moneys due to the
  224  agency, regardless of whether the agency identified the
  225  overpayments, administrative fines, or other moneys before or
  226  after the effective date of the change of ownership. The agency
  227  may not approve a transferee’s Medicaid provider enrollment
  228  application if the transferee or transferor has not paid or
  229  agreed in writing to a payment plan for all outstanding
  230  overpayments, administrative fines, and other moneys due to the
  231  agency. This subsection does not preclude the agency from
  232  seeking any other legal or equitable remedies available to the
  233  agency for the recovery of moneys owed to the Medicaid program.
  234  In the event of a change of ownership involving a skilled
  235  nursing facility licensed under part II of chapter 400,
  236  liability for all outstanding overpayments, administrative
  237  fines, and any moneys owed to the agency before the effective
  238  date of the change of ownership shall be determined in
  239  accordance with s. 400.179 if the Medicaid provider enrollment
  240  application for change of ownership is submitted before the
  241  change of ownership.
  242         (c) As used in this subsection, the term:
  243         1. “Administrative fines” includes any amount identified in
  244  a notice of a monetary penalty or fine which has been issued by
  245  the agency or other regulatory or licensing agency that governs
  246  the provider.
  247         2. “Outstanding overpayment” includes any amount identified
  248  in a preliminary audit report issued to the transferor by the
  249  agency on or before the effective date of a change of ownership.
  250         (7) The agency may require, As a condition of participating
  251  in the Medicaid program and before entering into the provider
  252  agreement, the agency may require that the provider to submit
  253  information, in an initial and any required renewal
  254  applications, concerning the professional, business, and
  255  personal background of the provider and permit an onsite
  256  inspection of the provider’s service location by agency staff or
  257  other personnel designated by the agency to perform this
  258  function. Before entering into a provider agreement, the agency
  259  may shall perform an a random onsite inspection, within 60 days
  260  after receipt of a fully complete new provider’s application, of
  261  the provider’s service location prior to making its first
  262  payment to the provider for Medicaid services to determine the
  263  applicant’s ability to provide the services in compliance with
  264  the Medicaid program and professional regulations that the
  265  applicant is proposing to provide for Medicaid reimbursement.
  266  The agency is not required to perform an onsite inspection of a
  267  provider or program that is licensed by the agency, that
  268  provides services under waiver programs for home and community
  269  based services, or that is licensed as a medical foster home by
  270  the Department of Children and Family Services. As a continuing
  271  condition of participation in the Medicaid program, a provider
  272  must shall immediately notify the agency of any current or
  273  pending bankruptcy filing. Before entering into the provider
  274  agreement, or as a condition of continuing participation in the
  275  Medicaid program, the agency may also require that Medicaid
  276  providers reimbursed on a fee-for-services basis or fee schedule
  277  basis that which is not cost-based, post a surety bond not to
  278  exceed $50,000 or the total amount billed by the provider to the
  279  program during the current or most recent calendar year,
  280  whichever is greater. For new providers, the amount of the
  281  surety bond shall be determined by the agency based on the
  282  provider’s estimate of its first year’s billing. If the
  283  provider’s billing during the first year exceeds the bond
  284  amount, the agency may require the provider to acquire an
  285  additional bond equal to the actual billing level of the
  286  provider. A provider’s bond need shall not exceed $50,000 if a
  287  physician or group of physicians licensed under chapter 458,
  288  chapter 459, or chapter 460 has a 50 percent or greater
  289  ownership interest in the provider or if the provider is an
  290  assisted living facility licensed under chapter 429. The bonds
  291  permitted by this section are in addition to the bonds
  292  referenced in s. 400.179(2)(d). If the provider is a
  293  corporation, partnership, association, or other entity, the
  294  agency may require the provider to submit information concerning
  295  the background of that entity and of any principal of the
  296  entity, including any partner or shareholder having an ownership
  297  interest in the entity equal to 5 percent or greater, and any
  298  treating provider who participates in or intends to participate
  299  in Medicaid through the entity. The information must include:
  300         (a) Proof of holding a valid license or operating
  301  certificate, as applicable, if required by the state or local
  302  jurisdiction in which the provider is located or if required by
  303  the Federal Government.
  304         (b) Information concerning any prior violation, fine,
  305  suspension, termination, or other administrative action taken
  306  under the Medicaid laws, rules, or regulations of this state or
  307  of any other state or the Federal Government; any prior
  308  violation of the laws, rules, or regulations relating to the
  309  Medicare program; any prior violation of the rules or
  310  regulations of any other public or private insurer; and any
  311  prior violation of the laws, rules, or regulations of any
  312  regulatory body of this or any other state.
  313         (c) Full and accurate disclosure of any financial or
  314  ownership interest that the provider, or any principal, partner,
  315  or major shareholder thereof, may hold in any other Medicaid
  316  provider or health care related entity or any other entity that
  317  is licensed by the state to provide health or residential care
  318  and treatment to persons.
  319         (d) If a group provider, identification of all members of
  320  the group and attestation that all members of the group are
  321  enrolled in or have applied to enroll in the Medicaid program.
  322         (8)(a) Each provider, or each principal of the provider if
  323  the provider is a corporation, partnership, association, or
  324  other entity, seeking to participate in the Medicaid program
  325  must submit a complete set of his or her fingerprints to the
  326  agency for the purpose of conducting a criminal history record
  327  check. Principals of the provider include any officer, director,
  328  billing agent, managing employee, or affiliated person, or any
  329  partner or shareholder who has an ownership interest equal to 5
  330  percent or more in the provider. However, for a hospital
  331  licensed under chapter 395 or a nursing home licensed under
  332  chapter 400, principals of the provider are those who meet the
  333  definition of a controlling interest under s. 408.803. A
  334  director of a not-for-profit corporation or organization is not
  335  a principal for purposes of a background investigation as
  336  required by this section if the director: serves solely in a
  337  voluntary capacity for the corporation or organization, does not
  338  regularly take part in the day-to-day operational decisions of
  339  the corporation or organization, receives no remuneration from
  340  the not-for-profit corporation or organization for his or her
  341  service on the board of directors, has no financial interest in
  342  the not-for-profit corporation or organization, and has no
  343  family members with a financial interest in the not-for-profit
  344  corporation or organization; and if the director submits an
  345  affidavit, under penalty of perjury, to this effect to the
  346  agency and the not-for-profit corporation or organization
  347  submits an affidavit, under penalty of perjury, to this effect
  348  to the agency as part of the corporation’s or organization’s
  349  Medicaid provider agreement application.
  350         (a) Notwithstanding the above, the agency may require a
  351  background check for any person reasonably suspected by the
  352  agency to have been convicted of a crime. This subsection does
  353  not apply to:
  354         1. A hospital licensed under chapter 395;
  355         2. A nursing home licensed under chapter 400;
  356         3. A hospice licensed under chapter 400;
  357         4. An assisted living facility licensed under chapter 429;
  358         1.5. A unit of local government, except that requirements
  359  of this subsection apply to nongovernmental providers and
  360  entities contracting with the local government to provide
  361  Medicaid services. The actual cost of the state and national
  362  criminal history record checks must be borne by the
  363  nongovernmental provider or entity; or
  364         2.6. Any business that derives more than 50 percent of its
  365  revenue from the sale of goods to the final consumer, and the
  366  business or its controlling parent is required to file a form
  367  10-K or other similar statement with the Securities and Exchange
  368  Commission or has a net worth of $50 million or more.
  369         (b) Background screening shall be conducted in accordance
  370  with chapter 435 and s. 408.809. The cost of the state and
  371  national criminal record check shall be borne by the provider.
  372         (c) Proof of compliance with the requirements of level 2
  373  screening under chapter 435 conducted within 12 months before
  374  the date the Medicaid provider application is submitted to the
  375  agency fulfills the requirements of this subsection.
  376         Section 5. Present paragraphs (e) and (f) of subsection (1)
  377  of section 409.913, Florida Statutes, are redesignated as
  378  paragraphs (f) and (g), respectively, a new paragraph (e) is
  379  added to that subsection, and subsections (2), (9), (13), (15),
  380  (16), (21), (22), (25), (28), (29), (30), and (31) of that
  381  section are amended, to read:
  382         409.913 Oversight of the integrity of the Medicaid
  383  program.—The agency shall operate a program to oversee the
  384  activities of Florida Medicaid recipients, and providers and
  385  their representatives, to ensure that fraudulent and abusive
  386  behavior and neglect of recipients occur to the minimum extent
  387  possible, and to recover overpayments and impose sanctions as
  388  appropriate. Beginning January 1, 2003, and each year
  389  thereafter, the agency and the Medicaid Fraud Control Unit of
  390  the Department of Legal Affairs shall submit a joint report to
  391  the Legislature documenting the effectiveness of the state’s
  392  efforts to control Medicaid fraud and abuse and to recover
  393  Medicaid overpayments during the previous fiscal year. The
  394  report must describe the number of cases opened and investigated
  395  each year; the sources of the cases opened; the disposition of
  396  the cases closed each year; the amount of overpayments alleged
  397  in preliminary and final audit letters; the number and amount of
  398  fines or penalties imposed; any reductions in overpayment
  399  amounts negotiated in settlement agreements or by other means;
  400  the amount of final agency determinations of overpayments; the
  401  amount deducted from federal claiming as a result of
  402  overpayments; the amount of overpayments recovered each year;
  403  the amount of cost of investigation recovered each year; the
  404  average length of time to collect from the time the case was
  405  opened until the overpayment is paid in full; the amount
  406  determined as uncollectible and the portion of the uncollectible
  407  amount subsequently reclaimed from the Federal Government; the
  408  number of providers, by type, that are terminated from
  409  participation in the Medicaid program as a result of fraud and
  410  abuse; and all costs associated with discovering and prosecuting
  411  cases of Medicaid overpayments and making recoveries in such
  412  cases. The report must also document actions taken to prevent
  413  overpayments and the number of providers prevented from
  414  enrolling in or reenrolling in the Medicaid program as a result
  415  of documented Medicaid fraud and abuse and must include policy
  416  recommendations necessary to prevent or recover overpayments and
  417  changes necessary to prevent and detect Medicaid fraud. All
  418  policy recommendations in the report must include a detailed
  419  fiscal analysis, including, but not limited to, implementation
  420  costs, estimated savings to the Medicaid program, and the return
  421  on investment. The agency must submit the policy recommendations
  422  and fiscal analyses in the report to the appropriate estimating
  423  conference, pursuant to s. 216.137, by February 15 of each year.
  424  The agency and the Medicaid Fraud Control Unit of the Department
  425  of Legal Affairs each must include detailed unit-specific
  426  performance standards, benchmarks, and metrics in the report,
  427  including projected cost savings to the state Medicaid program
  428  during the following fiscal year.
  429         (1) For the purposes of this section, the term:
  430         (e) “Medicaid provider” or “provider” has the same meaning
  431  as provided in s. 409.901 and, for purposes of oversight of the
  432  integrity of the Medicaid program, also includes a participant
  433  in a Medicaid managed care provider network.
  434         (2) The agency shall conduct, or cause to be conducted by
  435  contract or otherwise, reviews, investigations, analyses,
  436  audits, or any combination thereof, to determine possible fraud,
  437  abuse, overpayment, or recipient neglect in the Medicaid program
  438  and shall report the findings of any overpayments in audit
  439  reports as appropriate. At least 5 percent of all audits must
  440  shall be conducted on a random basis. As part of its ongoing
  441  fraud detection activities, the agency shall identify and
  442  monitor, by contract or otherwise, patterns of overutilization
  443  of Medicaid services based on state averages. The agency shall
  444  track Medicaid provider prescription and billing patterns and
  445  evaluate them against Medicaid medical necessity criteria and
  446  coverage and limitation guidelines adopted by rule. Medical
  447  necessity determination requires that service be consistent with
  448  symptoms or confirmed diagnosis of illness or injury under
  449  treatment and not in excess of the patient’s needs. The agency
  450  shall conduct reviews of provider exceptions to peer group norms
  451  and shall, using statistical methodologies, provider profiling,
  452  and analysis of billing patterns, detect and investigate
  453  abnormal or unusual increases in billing or payment of claims
  454  for Medicaid services and medically unnecessary provision of
  455  services. The agency may review and analyze information from
  456  sources other than enrolled Medicaid providers in conducting its
  457  activities under this subsection.
  458         (9) A Medicaid provider shall retain medical, professional,
  459  financial, and business records pertaining to services and goods
  460  furnished to a Medicaid recipient and billed to Medicaid for 6 a
  461  period of 5 years after the date of furnishing such services or
  462  goods. The agency may investigate, review, or analyze such
  463  records, which must be made available during normal business
  464  hours. However, 24-hour notice must be provided if patient
  465  treatment would be disrupted. The provider is responsible for
  466  furnishing to the agency, and keeping the agency informed of the
  467  location of, the provider’s Medicaid-related records. The
  468  authority of the agency to obtain Medicaid-related records from
  469  a provider is neither curtailed nor limited during a period of
  470  litigation between the agency and the provider.
  471         (13) The agency shall immediately terminate participation
  472  of a Medicaid provider in the Medicaid program and may seek
  473  civil remedies or impose other administrative sanctions against
  474  a Medicaid provider, if the provider or any principal, officer,
  475  director, agent, managing employee, or affiliated person of the
  476  provider, or any partner or shareholder having an ownership
  477  interest in the provider equal to 5 percent or greater, has been
  478  convicted of a criminal offense under federal law or the law of
  479  any state relating to the practice of the provider’s profession,
  480  or an offense listed under s. 409.907(10), s. 408.809(4), or s.
  481  435.04(2) has been:
  482         (a) Convicted of a criminal offense related to the delivery
  483  of any health care goods or services, including the performance
  484  of management or administrative functions relating to the
  485  delivery of health care goods or services;
  486         (b) Convicted of a criminal offense under federal law or
  487  the law of any state relating to the practice of the provider’s
  488  profession; or
  489         (c) Found by a court of competent jurisdiction to have
  490  neglected or physically abused a patient in connection with the
  491  delivery of health care goods or services. If the agency
  492  determines that the a provider did not participate or acquiesce
  493  in the an offense specified in paragraph (a), paragraph (b), or
  494  paragraph (c), termination will not be imposed. If the agency
  495  effects a termination under this subsection, the agency shall
  496  issue an immediate final order pursuant to s. 120.569(2)(n).
  497         (15) The agency shall seek a remedy provided by law,
  498  including, but not limited to, any remedy provided in
  499  subsections (13) and (16) and s. 812.035, if:
  500         (a) The provider’s license has not been renewed, or has
  501  been revoked, suspended, or terminated, for cause, by the
  502  licensing agency of any state;
  503         (b) The provider has failed to make available or has
  504  refused access to Medicaid-related records to an auditor,
  505  investigator, or other authorized employee or agent of the
  506  agency, the Attorney General, a state attorney, or the Federal
  507  Government;
  508         (c) The provider has not furnished or has failed to make
  509  available such Medicaid-related records as the agency has found
  510  necessary to determine whether Medicaid payments are or were due
  511  and the amounts thereof;
  512         (d) The provider has failed to maintain medical records
  513  made at the time of service, or prior to service if prior
  514  authorization is required, demonstrating the necessity and
  515  appropriateness of the goods or services rendered;
  516         (e) The provider is not in compliance with provisions of
  517  Medicaid provider publications that have been adopted by
  518  reference as rules in the Florida Administrative Code; with
  519  provisions of state or federal laws, rules, or regulations; with
  520  provisions of the provider agreement between the agency and the
  521  provider; or with certifications found on claim forms or on
  522  transmittal forms for electronically submitted claims that are
  523  submitted by the provider or authorized representative, as such
  524  provisions apply to the Medicaid program;
  525         (f) The provider or person who ordered, authorized, or
  526  prescribed the care, services, or supplies has furnished, or
  527  ordered, or authorized the furnishing of, goods or services to a
  528  recipient which are inappropriate, unnecessary, excessive, or
  529  harmful to the recipient or are of inferior quality;
  530         (g) The provider has demonstrated a pattern of failure to
  531  provide goods or services that are medically necessary;
  532         (h) The provider or an authorized representative of the
  533  provider, or a person who ordered, authorized, or prescribed the
  534  goods or services, has submitted or caused to be submitted false
  535  or a pattern of erroneous Medicaid claims;
  536         (i) The provider or an authorized representative of the
  537  provider, or a person who has ordered, authorized, or prescribed
  538  the goods or services, has submitted or caused to be submitted a
  539  Medicaid provider enrollment application, a request for prior
  540  authorization for Medicaid services, a drug exception request,
  541  or a Medicaid cost report that contains materially false or
  542  incorrect information;
  543         (j) The provider or an authorized representative of the
  544  provider has collected from or billed a recipient or a
  545  recipient’s responsible party improperly for amounts that should
  546  not have been so collected or billed by reason of the provider’s
  547  billing the Medicaid program for the same service;
  548         (k) The provider or an authorized representative of the
  549  provider has included in a cost report costs that are not
  550  allowable under a Florida Title XIX reimbursement plan, after
  551  the provider or authorized representative had been advised in an
  552  audit exit conference or audit report that the costs were not
  553  allowable;
  554         (l) The provider is charged by information or indictment
  555  with fraudulent billing practices or any offense referenced in
  556  subsection (13). The sanction applied for this reason is limited
  557  to suspension of the provider’s participation in the Medicaid
  558  program for the duration of the indictment unless the provider
  559  is found guilty pursuant to the information or indictment;
  560         (m) The provider or a person who has ordered, authorized,
  561  or prescribed the goods or services is found liable for
  562  negligent practice resulting in death or injury to the
  563  provider’s patient;
  564         (n) The provider fails to demonstrate that it had available
  565  during a specific audit or review period sufficient quantities
  566  of goods, or sufficient time in the case of services, to support
  567  the provider’s billings to the Medicaid program;
  568         (o) The provider has failed to comply with the notice and
  569  reporting requirements of s. 409.907;
  570         (p) The agency has received reliable information of patient
  571  abuse or neglect or of any act prohibited by s. 409.920; or
  572         (q) The provider has failed to comply with an agreed-upon
  573  repayment schedule.
  574  
  575  A provider is subject to sanctions for violations of this
  576  subsection as the result of actions or inactions of the
  577  provider, or actions or inactions of any principal, officer,
  578  director, agent, managing employee, or affiliated person of the
  579  provider, or any partner or shareholder having an ownership
  580  interest in the provider equal to 5 percent or greater, in which
  581  the provider participated or acquiesced.
  582         (16) The agency shall impose any of the following sanctions
  583  or disincentives on a provider or a person for any of the acts
  584  described in subsection (15):
  585         (a) Suspension for a specific period of time of not more
  586  than 1 year. Suspension precludes shall preclude participation
  587  in the Medicaid program, which includes any action that results
  588  in a claim for payment to the Medicaid program as a result of
  589  furnishing, supervising a person who is furnishing, or causing a
  590  person to furnish goods or services.
  591         (b) Termination for a specific period of time of from more
  592  than 1 year to 20 years. Termination precludes shall preclude
  593  participation in the Medicaid program, which includes any action
  594  that results in a claim for payment to the Medicaid program as a
  595  result of furnishing, supervising a person who is furnishing, or
  596  causing a person to furnish goods or services.
  597         (c) Imposition of a fine of up to $5,000 for each
  598  violation. Each day that an ongoing violation continues, such as
  599  refusing to furnish Medicaid-related records or refusing access
  600  to records, is considered, for the purposes of this section, to
  601  be a separate violation. Each instance of improper billing of a
  602  Medicaid recipient; each instance of including an unallowable
  603  cost on a hospital or nursing home Medicaid cost report after
  604  the provider or authorized representative has been advised in an
  605  audit exit conference or previous audit report of the cost
  606  unallowability; each instance of furnishing a Medicaid recipient
  607  goods or professional services that are inappropriate or of
  608  inferior quality as determined by competent peer judgment; each
  609  instance of knowingly submitting a materially false or erroneous
  610  Medicaid provider enrollment application, request for prior
  611  authorization for Medicaid services, drug exception request, or
  612  cost report; each instance of inappropriate prescribing of drugs
  613  for a Medicaid recipient as determined by competent peer
  614  judgment; and each false or erroneous Medicaid claim leading to
  615  an overpayment to a provider is considered, for the purposes of
  616  this section, to be a separate violation.
  617         (d) Immediate suspension, if the agency has received
  618  information of patient abuse or neglect or of any act prohibited
  619  by s. 409.920. Upon suspension, the agency must issue an
  620  immediate final order under s. 120.569(2)(n).
  621         (e) A fine, not to exceed $10,000, for a violation of
  622  paragraph (15)(i).
  623         (f) Imposition of liens against provider assets, including,
  624  but not limited to, financial assets and real property, not to
  625  exceed the amount of fines or recoveries sought, upon entry of
  626  an order determining that such moneys are due or recoverable.
  627         (g) Prepayment reviews of claims for a specified period of
  628  time.
  629         (h) Comprehensive followup reviews of providers every 6
  630  months to ensure that they are billing Medicaid correctly.
  631         (i) Corrective-action plans that would remain in effect for
  632  providers for up to 3 years and that are would be monitored by
  633  the agency every 6 months while in effect.
  634         (j) Other remedies as permitted by law to effect the
  635  recovery of a fine or overpayment.
  636  
  637  If a provider voluntarily relinquishes its Medicaid provider
  638  number after receiving written notice that the agency is
  639  conducting, or has conducted, an audit or investigation and the
  640  sanction of suspension or termination will be imposed for
  641  noncompliance discovered as a result of the audit or
  642  investigation, the agency shall impose the sanction of
  643  termination for cause against the provider. The Secretary of
  644  Health Care Administration may make a determination that
  645  imposition of a sanction or disincentive is not in the best
  646  interest of the Medicaid program, in which case a sanction or
  647  disincentive may shall not be imposed.
  648         (21) When making a determination that an overpayment has
  649  occurred, the agency shall prepare and issue an audit report to
  650  the provider showing the calculation of overpayments. The
  651  agency’s determination shall be based solely upon information
  652  available to it before issuance of the audit report and, in the
  653  case of documentation obtained to substantiate claims for
  654  Medicaid reimbursement, based solely upon contemporaneous
  655  records.
  656         (22) The audit report, supported by agency work papers,
  657  showing an overpayment to a provider constitutes evidence of the
  658  overpayment. A provider may not present or elicit testimony,
  659  either on direct examination or cross-examination in any court
  660  or administrative proceeding, regarding the purchase or
  661  acquisition by any means of drugs, goods, or supplies; sales or
  662  divestment by any means of drugs, goods, or supplies; or
  663  inventory of drugs, goods, or supplies, unless such acquisition,
  664  sales, divestment, or inventory is documented by written
  665  invoices, written inventory records, or other competent written
  666  documentary evidence maintained in the normal course of the
  667  provider’s business. Testimony or evidence that is not based
  668  upon contemporaneous records or that was not furnished to the
  669  agency within 21 days after the issuance of the audit report is
  670  inadmissible in an administrative hearing on a Medicaid
  671  overpayment or an administrative sanction. Notwithstanding the
  672  applicable rules of discovery, all documentation to that will be
  673  offered as evidence at an administrative hearing on a Medicaid
  674  overpayment or an administrative sanction must be exchanged by
  675  all parties at least 14 days before the administrative hearing
  676  or must be excluded from consideration.
  677         (25)(a) The agency shall withhold Medicaid payments, in
  678  whole or in part, to a provider upon receipt of reliable
  679  evidence that the circumstances giving rise to the need for a
  680  withholding of payments involve fraud, willful
  681  misrepresentation, or abuse under the Medicaid program, or a
  682  crime committed while rendering goods or services to Medicaid
  683  recipients. If it is determined that fraud, willful
  684  misrepresentation, abuse, or a crime did not occur, the payments
  685  withheld must be paid to the provider within 14 days after such
  686  determination with interest at the rate of 10 percent a year.
  687  Any money withheld in accordance with this paragraph shall be
  688  placed in a suspended account, readily accessible to the agency,
  689  so that any payment ultimately due the provider shall be made
  690  within 14 days.
  691         (b) The agency shall deny payment, or require repayment, if
  692  the goods or services were furnished, supervised, or caused to
  693  be furnished by a person who has been suspended or terminated
  694  from the Medicaid program or Medicare program by the Federal
  695  Government or any state.
  696         (c) Overpayments owed to the agency bear interest at the
  697  rate of 10 percent per year from the date of determination of
  698  the overpayment by the agency, and payment arrangements
  699  regarding overpayments and fines must be made within 30 days
  700  after the date of the final order and are not subject to further
  701  appeal at the conclusion of legal proceedings. A provider who
  702  does not enter into or adhere to an agreed-upon repayment
  703  schedule may be terminated by the agency for nonpayment or
  704  partial payment.
  705         (d) The agency, upon entry of a final agency order, a
  706  judgment or order of a court of competent jurisdiction, or a
  707  stipulation or settlement, may collect the moneys owed by all
  708  means allowable by law, including, but not limited to, notifying
  709  any fiscal intermediary of Medicare benefits that the state has
  710  a superior right of payment. Upon receipt of such written
  711  notification, the Medicare fiscal intermediary shall remit to
  712  the state the sum claimed.
  713         (e) The agency may institute amnesty programs to allow
  714  Medicaid providers the opportunity to voluntarily repay
  715  overpayments. The agency may adopt rules to administer such
  716  programs.
  717         (28) Venue for all Medicaid program integrity overpayment
  718  cases lies shall lie in Leon County, at the discretion of the
  719  agency.
  720         (29) Notwithstanding other provisions of law, the agency
  721  and the Medicaid Fraud Control Unit of the Department of Legal
  722  Affairs may review a person’s or provider’s Medicaid-related and
  723  non-Medicaid-related records in order to determine the total
  724  output of a provider’s practice to reconcile quantities of goods
  725  or services billed to Medicaid with quantities of goods or
  726  services used in the provider’s total practice.
  727         (30) The agency shall terminate a provider’s participation
  728  in the Medicaid program if the provider fails to reimburse an
  729  overpayment or pay a fine that has been determined by final
  730  order, not subject to further appeal, within 30 35 days after
  731  the date of the final order, unless the provider and the agency
  732  have entered into a repayment agreement.
  733         (31) If a provider requests an administrative hearing
  734  pursuant to chapter 120, such hearing must be conducted within
  735  90 days following assignment of an administrative law judge,
  736  absent exceptionally good cause shown as determined by the
  737  administrative law judge or hearing officer. Upon issuance of a
  738  final order, the outstanding balance of the amount determined to
  739  constitute the overpayment and fines is shall become due. If a
  740  provider fails to make payments in full, fails to enter into a
  741  satisfactory repayment plan, or fails to comply with the terms
  742  of a repayment plan or settlement agreement, the agency shall
  743  withhold medical assistance reimbursement payments for Medicaid
  744  services until the amount due is paid in full.
  745         Section 6. Subsection (8) of section 409.920, Florida
  746  Statutes, is amended to read:
  747         409.920 Medicaid provider fraud.—
  748         (8) A person who provides the state, any state agency, any
  749  of the state’s political subdivisions, or any agency of the
  750  state’s political subdivisions with information about fraud or
  751  suspected fraudulent acts fraud by a Medicaid provider,
  752  including a managed care organization, is immune from civil
  753  liability for libel, slander, or any other relevant tort for
  754  providing any the information about fraud or suspected
  755  fraudulent acts, unless the person acted with knowledge that the
  756  information was false or with reckless disregard for the truth
  757  or falsity of the information. For purposes of this subsection,
  758  the term “fraudulent acts” includes actual or suspected fraud,
  759  abuse, or overpayment, including any fraud-related matters that
  760  a provider or health plan is required to report to the agency or
  761  a law enforcement agency. The immunity from civil liability
  762  extends to reports of fraudulent acts conveyed to the agency in
  763  any manner, including any forum and with any audience as
  764  directed by the agency, and includes all discussions subsequent
  765  to the report and subsequent inquiries from the agency, unless
  766  the person acted with knowledge that the information was false
  767  or with reckless disregard for the truth or falsity of the
  768  information.
  769         Section 7. Paragraph (c) of subsection (2) of section
  770  409.967, Florida Statutes, is amended to read:
  771         409.967 Managed care plan accountability.—
  772         (2) The agency shall establish such contract requirements
  773  as are necessary for the operation of the statewide managed care
  774  program. In addition to any other provisions the agency may deem
  775  necessary, the contract must require:
  776         (c) Access.—
  777         1. Providers.—The agency shall establish specific standards
  778  for the number, type, and regional distribution of providers in
  779  managed care plan networks to ensure access to care for both
  780  adults and children. Each plan must maintain a regionwide
  781  network of providers in sufficient numbers to meet the access
  782  standards for specific medical services for all recipients
  783  enrolled in the plan. The exclusive use of mail-order pharmacies
  784  is may not be sufficient to meet network access standards.
  785  Consistent with the standards established by the agency,
  786  provider networks may include providers located outside the
  787  region. A plan may contract with a new hospital facility before
  788  the date the hospital becomes operational if the hospital has
  789  commenced construction, will be licensed and operational by
  790  January 1, 2013, and a final order has issued in any civil or
  791  administrative challenge. Each plan shall establish and maintain
  792  an accurate and complete electronic database of contracted
  793  providers, including information about licensure or
  794  registration, locations and hours of operation, specialty
  795  credentials and other certifications, specific performance
  796  indicators, and such other information as the agency deems
  797  necessary. The database must be available online to both the
  798  agency and the public and have the capability to compare the
  799  availability of providers to network adequacy standards and to
  800  accept and display feedback from each provider’s patients. Each
  801  plan shall submit quarterly reports to the agency identifying
  802  the number of enrollees assigned to each primary care provider.
  803         2. Prescribed drugs.—
  804         a. If establishing a prescribed drug formulary or preferred
  805  drug list, a managed care plan must:
  806         (I)Provide coverage for drugs in categories and classes
  807  for all disease states and provide a broad range of therapeutic
  808  options for all therapeutic categories;
  809         (II)Include coverage for each drug newly approved by the
  810  federal Food and Drug Administration until the plan’s
  811  Pharmaceutical and Therapeutics Committee reviews such drug for
  812  inclusion on the formulary;
  813         (III)Provide a response within 24 hours after receipt of
  814  all necessary information for a request for prior authorization
  815  or override of other medical management tools; and
  816         (IV)Report all denials to the agency on a quarterly basis.
  817  For each nonformulary drug, the plan must report the total
  818  number of requests and the total number of denials.
  819         b. Each managed care plan shall must publish any prescribed
  820  drug formulary or preferred drug list on the plan’s website in a
  821  manner that is accessible to and searchable by enrollees and
  822  providers. The plan must update the list within 24 hours after
  823  making a change. Each plan must ensure that the prior
  824  authorization process for prescribed drugs is readily accessible
  825  to health care providers, including posting appropriate contact
  826  information on its website and providing timely responses to
  827  providers.
  828         c.The managed care plan must continue to permit an
  829  enrollee who was receiving a prescription drug that was on the
  830  plan’s formulary and subsequently removed or changed to continue
  831  to receive that drug if requested by the enrollee and prescriber
  832  for as long as the enrollee is a member of the plan.
  833         d.A managed care plan that imposes a step-therapy or a
  834  fail-first protocol must do so in accordance with the following:
  835         (I)If prescribed drugs for the treatment of a medical
  836  condition are restricted for use by the plan through a step
  837  therapy or fail-first protocol, the plan must provide the
  838  prescriber with access to a clear and convenient process to
  839  expeditiously request an override of such restriction from the
  840  plan.
  841         (II)An override of the restriction must be expeditiously
  842  granted by the plan if the prescriber can demonstrate to the
  843  plan that the preferred treatment required under the step
  844  therapy or fail-first protocol:
  845         (A) Has been ineffective in the treatment of the enrollee’s
  846  disease or medical condition;
  847         (B) Is reasonably expected to be ineffective based on the
  848  known relevant physical or mental characteristics and medical
  849  history of the enrollee and known characteristics of the drug
  850  regimen; or
  851         (C) Will cause or will likely cause an adverse reaction or
  852  other physical harm to the enrollee.
  853         (III)The maximum duration of a step-therapy or fail-first
  854  protocol requirement may not be longer than the customary period
  855  for the prescribed drug if such treatment is demonstrated by the
  856  prescriber to be clinically ineffective. If the plan can
  857  demonstrate, through sound clinical evidence, that the
  858  originally prescribed drug is likely to require more than the
  859  customary period for such drug to provide any relief or
  860  amelioration to the enrollee, the step-therapy or fail-first
  861  protocol may be extended, but no longer than the original
  862  customary period for the drug, after which time the prescriber
  863  may deem such treatment as clinically ineffective for the
  864  enrollee. Once the prescriber deems the treatment to be
  865  clinically ineffective, the plan must dispense and cover the
  866  originally prescribed drug recommended by the prescriber.
  867         e. For enrollees Medicaid recipients diagnosed with
  868  hemophilia who have been prescribed anti-hemophilic-factor
  869  replacement products, the agency shall provide for those
  870  products and hemophilia overlay services through the agency’s
  871  hemophilia disease management program.
  872         3.Prior authorization.—
  873         a. Each managed care plan must ensure that the prior
  874  authorization process for prescribed drugs is readily accessible
  875  to health care providers, including posting appropriate contact
  876  information on its website and providing timely responses to
  877  providers.
  878         b. If a drug, determined to be medically necessary and
  879  prescribed for an enrollee by a physician using sound clinical
  880  judgment, is subject to prior authorization, the managed care
  881  plan must provide payment to the pharmacist for dispensing such
  882  drug without seeking prior authorization if the pharmacist
  883  confirms that:
  884         (I)The prescription is a refill or renewal of the same
  885  drug for the same enrollee written by the same prescriber; or
  886         (II)If the drug is generally prescribed for an indication
  887  that is treated on an ongoing basis by continuous medication or
  888  as-needed, the enrollee for whom the drug is prescribed has
  889  filled a prescription for the same drug within the preceding 30
  890  to 90 days.
  891         c.If a prescribed drug requires prior authorization, the
  892  managed care plan shall reimburse the pharmacist for dispensing
  893  a 72-hour supply to the enrollee and process the prior
  894  authorization request and send a response to the requesting
  895  pharmacist within 24 hours after receiving the pharmacist’s
  896  request for prior authorization.
  897         d.3. Managed care plans, and their fiscal agents or
  898  intermediaries, must accept prior authorization requests for any
  899  service electronically.
  900         Section 8. Subsection (11) is added to section 429.23,
  901  Florida Statutes, to read:
  902         429.23 Internal risk management and quality assurance
  903  program; adverse incidents and reporting requirements.—
  904         (11) The agency shall annually submit a report to the
  905  Legislature on adverse incident reports by assisted living
  906  facilities. The report must include the following information
  907  arranged by county:
  908         (a) A total number of adverse incidents;
  909         (b) A listing, by category, of the type of adverse
  910  incidents occurring within each category and the type of staff
  911  involved;
  912         (c) A listing, by category, of the types of injuries, if
  913  any, and the number of injuries occurring within each category;
  914         (d) Types of liability claims filed based on an adverse
  915  incident report or reportable injury; and
  916         (e) Disciplinary action taken against staff, categorized by
  917  the type of staff involved.
  918         Section 9. Present subsections (9), (10), and (11) of
  919  section 429.26, Florida Statutes, are renumbered as subsections
  920  (12), (13), and (14), respectively, and new subsections (9),
  921  (10), and (11) are added to that section, to read:
  922         429.26 Appropriateness of placements; examinations of
  923  residents.—
  924         (9) If, at any time after admission to a facility, agency
  925  personnel question whether a resident needs care beyond that
  926  which the facility is licensed to provide, the agency may
  927  require the resident to be physically examined by a licensed
  928  physician, licensed physician assistant, or certified nurse
  929  practitioner. To the extent possible, the examination must be
  930  performed by the resident’s preferred physician, physician
  931  assistant, or nurse practitioner and paid for by the resident
  932  with personal funds, except as provided in s. 429.18(2). This
  933  subsection does not preclude the agency from imposing sanctions
  934  for violations of subsection (1).
  935         (a) Following examination, the examining physician,
  936  physician assistant, or nurse practitioner shall complete and
  937  sign a medical form provided by the agency. The completed
  938  medical form must be submitted to the agency within 30 days
  939  after the date the facility owner or administrator was notified
  940  by the agency that a physical examination is required.
  941         (b) A medical review team designated by the agency shall
  942  determine whether the resident is appropriately residing in the
  943  facility based on the completed medical form and, if necessary,
  944  consultation with the physician, physician assistant, or nurse
  945  practitioner who performed the examination. Members of the
  946  medical review team making the determination may not include the
  947  agency personnel who initially questioned the appropriateness of
  948  the resident’s placement. The medical review team shall base its
  949  decision on a comprehensive review of the resident’s physical
  950  and functional status. A determination that the resident’s
  951  placement is not appropriate is final and binding upon the
  952  facility and the resident.
  953         (c) A resident who is determined by the medical review team
  954  to be inappropriately residing in a facility shall be given 30
  955  days’ written notice to relocate by the owner or administrator,
  956  unless the resident’s continued residence in the facility
  957  presents an imminent danger to the health, safety, or welfare of
  958  the resident or a substantial probability exists that death or
  959  serious physical harm to the resident would result if the
  960  resident is allowed to remain in the facility.
  961         (10) If a mental health resident appears to have needs in
  962  addition to those identified in the community living support
  963  plan, the agency may require an evaluation by a mental health
  964  professional, as determined by the Department of Children and
  965  Family Services.
  966         (11) A facility may not be required to retain a resident
  967  who requires more services or care than the facility is able to
  968  provide in accordance with its policies and criteria for
  969  admission and continued residency.
  970         Section 10. Effective July 1, 2012, section 456.0635,
  971  Florida Statutes, is amended to read:
  972         456.0635 Health care Medicaid fraud; disqualification for
  973  license, certificate, or registration.—
  974         (1) Health care Medicaid fraud in the practice of a health
  975  care profession is prohibited.
  976         (2) Each board under within the jurisdiction of the
  977  department, or the department if there is no board, shall refuse
  978  to admit a candidate to an any examination and refuse to issue
  979  or renew a license, certificate, or registration to an any
  980  applicant if the candidate or applicant or any principal,
  981  officer, agent, managing employee, or affiliated person of the
  982  applicant, has been:
  983         (a) Has been convicted of, or entered a plea of guilty or
  984  nolo contendere to, regardless of adjudication, a felony under
  985  chapter 409, chapter 817, or chapter 893, or a similar felony
  986  offense committed in another state or jurisdiction, unless the
  987  candidate or applicant has successfully completed a drug court
  988  program for that felony and provides proof that the plea has
  989  been withdrawn or the charges have been dismissed. Any such
  990  conviction or plea shall exclude the applicant or candidate from
  991  licensure, examination, certification, or registration 21 U.S.C.
  992  ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and
  993  any subsequent period of probation for such conviction or plea
  994  pleas ended: more than 15 years prior to the date of the
  995  application;
  996         1. For felonies of the first or second degree, more than 15
  997  years before the date of application.
  998         2. For felonies of the third degree, more than 10 years
  999  before the date of application, except for felonies of the third
 1000  degree under s. 893.13(6)(a).
 1001         3. For felonies of the third degree under s. 893.13(6)(a),
 1002  more than 5 years before the date of application.
 1003         (b) Has been convicted of, or entered a plea of guilty or
 1004  nolo contendere to, regardless of adjudication, a felony under
 1005  21 U.S.C. ss. 801-970 or 42 U.S.C. ss. 1395-1396, unless the
 1006  sentence and any subsequent period of probation for such
 1007  conviction or plea ended more than 15 years before the date of
 1008  the application.
 1009         (c)(b)Has been terminated for cause from the Florida
 1010  Medicaid program pursuant to s. 409.913, unless the candidate or
 1011  applicant has been in good standing with the Florida Medicaid
 1012  program for the most recent 5 years.;
 1013         (d)(c)Has been terminated for cause, pursuant to the
 1014  appeals procedures established by the state or Federal
 1015  Government, from any other state Medicaid program or the federal
 1016  Medicare program, unless the candidate or applicant has been in
 1017  good standing with that a state Medicaid program or the federal
 1018  Medicare program for the most recent 5 years and the termination
 1019  occurred at least 20 years before prior to the date of the
 1020  application.
 1021         (e) Is currently listed on the United States Department of
 1022  Health and Human Services Office of Inspector General’s List of
 1023  Excluded Individuals and Entities.
 1024  
 1025  This subsection does not apply to candidates or applicants for
 1026  initial licensure or certification who were enrolled in an
 1027  educational or training program on or before July 1, 2009, which
 1028  was recognized by a board or, if there is no board, recognized
 1029  by the department, and who applied for licensure after July 1,
 1030  2012.
 1031         (3) The department shall refuse to renew a license,
 1032  certificate, or registration of any applicant if the applicant
 1033  or any principal, officer, agent, managing employee, or
 1034  affiliated person of the applicant:
 1035         (a) Has been convicted of, or entered a plea of guilty or
 1036  nolo contendere to, regardless of adjudication, a felony under
 1037  chapter 409, chapter 817, or chapter 893, or a similar felony
 1038  offense committed in another state or jurisdiction, unless the
 1039  applicant is currently enrolled in a drug court program that
 1040  allows the withdrawal of the plea for that felony upon
 1041  successful completion of that program. Any such conviction or
 1042  plea excludes the applicant or candidate from licensure,
 1043  examination, certification, or registration unless the sentence
 1044  and any subsequent period of probation for such conviction or
 1045  plea ended:
 1046         1. For felonies of the first or second degree, more than 15
 1047  years before the date of application.
 1048         2. For felonies of the third degree, more than 10 years
 1049  before the date of application, except for felonies of the third
 1050  degree under s. 893.13(6)(a).
 1051         3. For felonies of the third degree under s. 893.13(6)(a),
 1052  more than 5 years before the date of application.
 1053         (b) Has been convicted of, or entered a plea of guilty or
 1054  nolo contendere to, regardless of adjudication, a felony under
 1055  21 U.S.C. ss. 801-970 or 42 U.S.C. ss. 1395-1396 since July 1,
 1056  2009, unless the sentence and any subsequent period of probation
 1057  for such conviction or plea ended more than 15 years before the
 1058  date of the application.
 1059         (c) Has been terminated for cause from the Florida Medicaid
 1060  program pursuant to s. 409.913, unless the applicant has been in
 1061  good standing with the Florida Medicaid program for the most
 1062  recent 5 years.
 1063         (d) Has been terminated for cause, pursuant to the appeals
 1064  procedures established by the state, from any other state
 1065  Medicaid program, unless the applicant has been in good standing
 1066  with that state Medicaid program for the most recent 5 years and
 1067  the termination occurred at least 20 years before the date of
 1068  the application.
 1069         (e) Is currently listed on the United States Department of
 1070  Health and Human Services Office of Inspector General’s List of
 1071  Excluded Individuals and Entities.
 1072         (4)(3) Licensed health care practitioners shall report
 1073  allegations of health care Medicaid fraud to the department,
 1074  regardless of the practice setting in which the alleged health
 1075  care Medicaid fraud occurred.
 1076         (5)(4) The acceptance by a licensing authority of a
 1077  licensee’s candidate’s relinquishment of a license which is
 1078  offered in response to or anticipation of the filing of
 1079  administrative charges alleging health care Medicaid fraud or
 1080  similar charges constitutes the permanent revocation of the
 1081  license.
 1082         Section 11. Effective July 1, 2012, present subsections
 1083  (14) and (15) of section 456.036, Florida Statutes, are
 1084  renumbered as subsections (15) and (16), respectively, and a new
 1085  subsection (14) is added to that section, to read:
 1086         456.036 Licenses; active and inactive status; delinquency.—
 1087         (14) A person who has been denied license renewal,
 1088  certification, or registration under s. 456.0635(3) may regain
 1089  licensure, certification, or registration only by meeting the
 1090  qualifications and completing the application process for
 1091  initial licensure as defined by the board, or the department if
 1092  there is no board. However, a person who was denied renewal of
 1093  licensure, certification, or registration under s. 24 of chapter
 1094  2009-223, Laws of Florida, between July 1, 2009, and June 30,
 1095  2012, is not required to retake and pass examinations applicable
 1096  for initial licensure, certification, or registration.
 1097         Section 12. Subsection (1) of section 456.074, Florida
 1098  Statutes, is amended to read:
 1099         456.074 Certain health care practitioners; immediate
 1100  suspension of license.—
 1101         (1) The department shall issue an emergency order
 1102  suspending the license of any person licensed under chapter 458,
 1103  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
 1104  chapter 464, chapter 465, chapter 466, or chapter 484 who pleads
 1105  guilty to, is convicted or found guilty of, or who enters a plea
 1106  of nolo contendere to, regardless of adjudication, to:
 1107         (a) A felony under chapter 409, chapter 817, or chapter 893
 1108  or under 21 U.S.C. ss. 801-970 or under 42 U.S.C. ss. 1395-1396;
 1109  or
 1110         (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
 1111  285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
 1112  1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
 1113  Medicaid program.
 1114         Section 13. Paragraph (a) of subsection (54) of section
 1115  499.003, Florida Statutes, is amended to read:
 1116         499.003 Definitions of terms used in this part.—As used in
 1117  this part, the term:
 1118         (54) “Wholesale distribution” means distribution of
 1119  prescription drugs to persons other than a consumer or patient,
 1120  but does not include:
 1121         (a) Any of the following activities, which is not a
 1122  violation of s. 499.005(21) if such activity is conducted in
 1123  accordance with s. 499.01(2)(g):
 1124         1. The purchase or other acquisition by a hospital or other
 1125  health care entity that is a member of a group purchasing
 1126  organization of a prescription drug for its own use from the
 1127  group purchasing organization or from other hospitals or health
 1128  care entities that are members of that organization.
 1129         2. The sale, purchase, or trade of a prescription drug or
 1130  an offer to sell, purchase, or trade a prescription drug by a
 1131  charitable organization described in s. 501(c)(3) of the
 1132  Internal Revenue Code of 1986, as amended and revised, to a
 1133  nonprofit affiliate of the organization to the extent otherwise
 1134  permitted by law.
 1135         3. The sale, purchase, or trade of a prescription drug or
 1136  an offer to sell, purchase, or trade a prescription drug among
 1137  hospitals or other health care entities that are under common
 1138  control. For purposes of this subparagraph, “common control”
 1139  means the power to direct or cause the direction of the
 1140  management and policies of a person or an organization, whether
 1141  by ownership of stock, by voting rights, by contract, or
 1142  otherwise.
 1143         4. The sale, purchase, trade, or other transfer of a
 1144  prescription drug from or for any federal, state, or local
 1145  government agency or any entity eligible to purchase
 1146  prescription drugs at public health services prices pursuant to
 1147  Pub. L. No. 102-585, s. 602 to a contract provider or its
 1148  subcontractor for eligible patients of the agency or entity
 1149  under the following conditions:
 1150         a. The agency or entity must obtain written authorization
 1151  for the sale, purchase, trade, or other transfer of a
 1152  prescription drug under this subparagraph from the State Surgeon
 1153  General or his or her designee.
 1154         b. The contract provider or subcontractor must be
 1155  authorized by law to administer or dispense prescription drugs.
 1156         c. In the case of a subcontractor, the agency or entity
 1157  must be a party to and execute the subcontract.
 1158         d. A contract provider or subcontractor must maintain
 1159  separate and apart from other prescription drug inventory any
 1160  prescription drugs of the agency or entity in its possession.
 1161         d.e. The contract provider and subcontractor must maintain
 1162  and produce immediately for inspection all records of movement
 1163  or transfer of all the prescription drugs belonging to the
 1164  agency or entity, including, but not limited to, the records of
 1165  receipt and disposition of prescription drugs. Each contractor
 1166  and subcontractor dispensing or administering these drugs must
 1167  maintain and produce records documenting the dispensing or
 1168  administration. Records that are required to be maintained
 1169  include, but are not limited to, a perpetual inventory itemizing
 1170  drugs received and drugs dispensed by prescription number or
 1171  administered by patient identifier, which must be submitted to
 1172  the agency or entity quarterly.
 1173         e.f. The contract provider or subcontractor may administer
 1174  or dispense the prescription drugs only to the eligible patients
 1175  of the agency or entity or must return the prescription drugs
 1176  for or to the agency or entity. The contract provider or
 1177  subcontractor must require proof from each person seeking to
 1178  fill a prescription or obtain treatment that the person is an
 1179  eligible patient of the agency or entity and must, at a minimum,
 1180  maintain a copy of this proof as part of the records of the
 1181  contractor or subcontractor required under sub-subparagraph e.
 1182         f.g. In addition to the departmental inspection authority
 1183  set forth in s. 499.051, the establishment of the contract
 1184  provider and subcontractor and all records pertaining to
 1185  prescription drugs subject to this subparagraph shall be subject
 1186  to inspection by the agency or entity. All records relating to
 1187  prescription drugs of a manufacturer under this subparagraph
 1188  shall be subject to audit by the manufacturer of those drugs,
 1189  without identifying individual patient information.
 1190         Section 14. The Agency for Health Care Administration shall
 1191  prepare a report within 18 months after the implementation of an
 1192  expansion of managed care to new populations or the provision of
 1193  new items and services. The agency shall post a draft of the
 1194  report on its website and provide an opportunity for public
 1195  comment. The final report shall be submitted to the Legislature,
 1196  along with a description of the process for public input. The
 1197  report must include an assessment of:
 1198         (1) The impact of managed care on patient access to care,
 1199  including an evaluation of any new barriers to the use of
 1200  services and prescription drugs, created by the use of medical
 1201  management or cost-containment tools.
 1202         (2) The impact of the increased managed care expansion on
 1203  the utilization of services, quality of care, and patient
 1204  outcomes.
 1205         (3) The use of prior authorization and other utilization
 1206  management tools, including an assessment of whether these tools
 1207  pose an undue administrative burden for health care providers or
 1208  create barriers to needed care.
 1209         Section 15. Except as otherwise expressly provided in this
 1210  act, this act shall take effect upon becoming a law.
 1211  
 1212  ================= T I T L E  A M E N D M E N T ================
 1213         And the title is amended as follows:
 1214         Delete everything before the enacting clause
 1215  and insert:
 1216                        A bill to be entitled                      
 1217         An act relating to health care; amending s. 400.474,
 1218         F.S.; revising the fine that may be imposed against a
 1219         home health agency for failing to timely submit
 1220         certain information to the Agency for Health Care
 1221         Administration; amending s. 400.9905, F.S.; revising
 1222         the definition of the term “clinic” as it relates to
 1223         the Health Care Clinic Act; amending s. 409.221, F.S.;
 1224         revising the background screening requirements for
 1225         persons rendering care in the consumer-directed care
 1226         program administered by the Agency for Health Care
 1227         Administration; amending s. 409.907, F.S.; extending
 1228         the records-retention period for certain Medicaid
 1229         provider records; revising the provider agreement to
 1230         require Medicaid providers to report changes in any
 1231         principal of the provider to the agency; defining the
 1232         term “administrative fines” for purposes of revoking a
 1233         Medicaid provider agreement due to changes of
 1234         ownership; authorizing, rather than requiring, an
 1235         onsite inspection of a Medicaid provider’s service
 1236         location before entering into a provider agreement;
 1237         specifying the principals of a hospital or nursing
 1238         home provider for the purposes of submitting
 1239         fingerprints for background screening; removing
 1240         certain providers from being subject to agency
 1241         background checks; amending s. 409.913, F.S.; defining
 1242         the term “Medicaid provider” or “provider” for
 1243         purposes of oversight of the integrity of the Medicaid
 1244         program; authorizing the agency to review and analyze
 1245         information from sources other than Medicaid-enrolled
 1246         providers for purposes of determining fraud, abuse,
 1247         overpayment, or neglect; extending the records
 1248         retention period for certain Medicaid provider
 1249         records; revising the grounds for terminating a
 1250         provider from the Medicaid program; requiring the
 1251         agency to base its overpayment audit reports on
 1252         certain information; deleting a requirement that the
 1253         agency pay interest on certain withheld Medicaid
 1254         payments; requiring payment arrangements for
 1255         overpayments and fines to be made within a certain
 1256         time; specifying that the venue for all Medicaid
 1257         program integrity cases lies in Leon County;
 1258         authorizing the agency and the Medicaid Fraud Control
 1259         Unit to review certain records; amending s. 409.920,
 1260         F.S.; clarifying the applicability of immunity from
 1261         civil liability extended to persons who provide
 1262         information about fraud or suspected fraudulent acts
 1263         by a Medicaid provider; amending s. 409.967, F.S.;
 1264         specifying required components of a Medicaid managed
 1265         care plan relating to the provisions of medications;
 1266         amending s. 429.23, F.S.; requiring the agency to
 1267         submit a report to the Legislature on adverse incident
 1268         reports from assisted living facilities; amending s.
 1269         429.26, F.S.; authorizing the agency to require a
 1270         resident of an assisted living facility to undergo a
 1271         physical examination if the agency questions the
 1272         appropriateness of the resident’s placement in that
 1273         facility; authorizing release of the results of the
 1274         examination to a medical review team to be used along
 1275         with additional information to determine whether the
 1276         resident’s placement in the assisted living facility
 1277         is appropriate; providing for resident notification
 1278         and relocation if the resident’s continued placement
 1279         in the facility is not appropriate; authorizing the
 1280         agency to require the evaluation of a mental health
 1281         resident by a mental health professional; authorizing
 1282         an assisted living facility to discharge a resident
 1283         who requires more services or care than the facility
 1284         is able to provide; amending s. 456.0635, F.S.;
 1285         revising the grounds under which the Department of
 1286         Health or corresponding board is required to refuse to
 1287         admit a candidate to an examination and refuse to
 1288         issue or renew a license, certificate, or registration
 1289         of a health care practitioner; providing an exception;
 1290         amending s. 456.036, F.S.; providing that all persons
 1291         who were denied renewal of licensure, certification,
 1292         or registration under s. 456.0635(3), F.S., may regain
 1293         licensure, certification, or registration only by
 1294         completing the application process for initial
 1295         licensure; providing an exception; amending s.
 1296         456.074, F.S.; revising the federal offenses for which
 1297         the Department of Health must issue an emergency order
 1298         suspending the license of certain health care
 1299         professionals; amending s. 499.003, F.S.; removing a
 1300         requirement that a contract provider or subcontractor
 1301         maintain prescription drugs of the agency or entity in
 1302         its possession separate and apart from other
 1303         prescription drugs; requiring the Agency for Health
 1304         Care Administration to prepare a report for public
 1305         comment and submission to the Legislature following
 1306         the expansion of services to new populations or of new
 1307         services; providing effective dates.